HELP with bottoming out

I have a new diabetic kitty. Only a week diagnosed. We has a stupid Dr. Give her too high a dose of insulin. 4 units twice a day (40UI). She bottomed out and we took her to the emergency vet comatose. That was the Sunday before last. Now we got a new vet and we are on one unit (40 UI) and still had an episode where she got to 44 on her glucose scan yesterday around 2. We have her Karo and got it back up. After research we decided to only give her .5 unit A last night.

I just started testing before she eats.... she was just at 286. I am scared as I have to work all day today. Would you all reccomend me give her half a unit or none at all?
More background, she was testing 550 when we took her in the Sunday before yesterday. She is about 8lbs. Eats about 1/4 of a can of Dietic Managment twice a day about 10 min. Before we give her insulin.
Thanks

 

The 0.5 u last night gave you a 286 this AM. That's not bad! Good call on dropping her dose to half a unit.

• You probably could give 0.5 u this AM safely. If you can leave food out for her do so.
• If you aren't comfortable with that, try eyeballing 0.25 u if you're using U40 syringes. If using a vet pen that's not possible because they only give full or half unit doses, right?
• If you're very worried skip this AM's dose.

It's very early days so predicting your kitty's response to insulin is almost impossible. However, you're doing a lot of things right - testing BG at home, dropping the dose because it's too high, coming here for help.

I'll post this and do another one with more info. Welcome, by the way!

 

Here's my "guide for new members". Lots of info here so read it over a few times and ask a lot of questions.

It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

Thank you so much. I will update my profile tonight.I appreciate it.

 

Another night and another low. This time we gave 1 unit with beginning bg of 350. Bounced to 88 after 3 hours.. 30 minutes later to 44. Now back to Karo and more food. So scared.

 

Kris is a diabetic expert (and I am as well). The protocol for hypos is pretty simple.
- try to get food into the kitteh
- keep the BG above 50
- monitor every 15 minutes until you see BG going up
- once you get 2 hours of rising BG after the last food, your kitteh is safe

Leo had a hypo last week. You can do it. Keep the BG above 50.

 

I'll stay on and monitor until 1am CST if you need it. I'm just watching netflix, so no big deal.

 

I'm going to bed. Please update us on your kitteh. I hope she is doing okay.

I would recommend even a smaller dose tomorrow. My general target nadirs for Leo are in the 120-150 range.

 

We are at 356 this morning pre food. Now eating. This roller coaster sucks. Thanks for the help.

 

Thanks, Jeff! Not an expert, just FD school of hard knocks ...

 

I think you're using Vetsulin right? These numbers tell you that a 1 unit dose is too high. I'd stick to 0.5 u for now both AM and PM and start testing as per the routine in post #3 above and logging in a spreadsheet. At this point I have to visualize your curve in my mind. Seeing it on a spreadsheet would be a lot easier. When dosing insulin, especially one like Vetsulin, you:

• look at pre shot BG number to judge if it's safe to give a dose (it looked safe last night with a 350)
• MOST IMPORTANT! get BG tests between +4 and +6 on the dose to see how low it dropped BG. This shows you what the dose is capable of
• always give more weight to the low numbers after a dose to judge the dose, NOT on the high numbers at pre shot test time
• avoid too many dose changes too close together and by too large an increment (0.25 u max right now) - unless nadir is too low.

Vetsulin is fairly fast in onset, can drop BG quite low and can wear off before the 12 hour mark in some cats. Because of these characteristics you need to aim for nadir numbers that leave you with a margin of safety - 90 to 110 range at the lowest. If a dose is dropping your kitty lower than that it's too high, regardless of the BG at the pre shot test time. Think of the BG curve as having a smile shape or bowl shape that you want to get a little shallower. Too high a dose makes it too deep.

What would an ideal Vetsulin curve look like? You'd have pre shot BGs in the low to mid 200s and a nadir in the high doubles digits to low 100s. It can take a long time to achieve this degree of control and some kitties will always be dramatic in their responses. In those cases especially it's the nadir numbers that govern the dosing decisions.

Yes, this FD roller coaster is stressful and worrying. I guarantee you'll feel a lot better once you set up you testing routine and spreadsheet and post here for advice often.

 

Glad to hear your kitteh is doing well. You are getting some excellent advice from Kris. It will really help when you create and maintain a spreadsheet. What is your kitteh's name?

The Dietetic food is good. Many diabetic owners including myself feel Fancy Feast Classics. They are low carb, canned, and there are 10 or so flavors.