Hypo Help!! Newly diagnosed

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Whitney&Mimi

Member Since 2021
Mimi was just diagnosed on Monday and I’m still learning and researching.
Vet did glucose curve yesterday and ranged from 200-500.
Now here is where I screwed up, vet said just to give her 4 units and testing BG was optional.
I gave her 4 units this morning at 6:30am after eating and tested her 2 hours later just to practice and it was 38!! I rushed her to vet who gave sugar and got her up to 136 around noon. Tested her again at 2pm and she was at 44! Gave sugar, treats, food. 3pm up to 66. Tested again at 5pm and 61. Gave more sugar and treats and her old high carb foods, will test again tonight.

I can’t seem to keep her BG up in normal range where yesterday it was over 400! Vet has said to stop insulin completely until I get more tests done over the long weekend to monitor what is going on. He said it might be tumor in pancreas but he isn’t sure.
 
Wow, how scary! So glad you caught that low!

As long as there are no ketones in the mix, it's not a problem to skip a shot. Oftentimes, cats are more sensitive to insulin after a hypo, so extra caution is fine. In addition, 4U is a very large starting dose-- it may have just been too much for her. It's 100% fine to do a re-set and start over, and I wouldn't start thinking about things like a tumor on the pancreas just yet.

We usually don't recommend shooting if the BG is less than 200 when you first start out. What kind of insulin are you using?

Welcome, and, again, good catch on those lows, so glad you were testing!
 
Ok yes first step is no more insulin. More than likely that dose was just waaaaayyyy too high

I'll be back with more info in a few minutes...
 
@Nan & Amber (GA) – it looks like Whitney is using an AlphaTrak
Relevant information from previous thread https://www.felinediabetes.com/FDMB/threads/05-24-2021-newly-diagnosed-cat-mimi.247867/

I've ordered Alpha Trak 2 for in home testing arrives 5/27.

Previous diet: Nutro Indoor Cat Chicken and Brown Rice (unknown carbs, assuming at least 40-50%), Fancy Feast Medleys White Meat Chicken Tuscany With Long Grain Rice & Garden Greens In A Savory Sauce (20-23% carbs)
New diet: Wellness Minced Chicken in Gravy (10% carbs) (so impressed with my picky kitty for switching so fast)​
 
Whitney&Mimi said:
She is on ProZinc insulin. Thanks for the replies!
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OK, great. @FrostD, I don't have a lot of experience with Prozinc, so I'll pass this back to you for detailed advice. Whichever insulin it is, though, clearly 4U is waaaaay too much insulin! Thanks, Kel, I'd missed the previous thread:

Red & Rover (GA) said:
it looks like Whitney is using an AlphaTrak
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That makes those numbers even more scary-- 38 on an AT2, my goodness!

Whitney, you may have saved your kitty's life today by testing and knowing what to do when you got the low number. Pat yourself on the back!
 
Ok let's do this - no more insulin for now.

Let's do a curve one day over the weekend like we would with insulin - at what would be your AM shot time (withhold food 2 hrs prior), then every other hour, and then again at the PM shot time. Don't worry about testing overnight. Please see our instructions on setting up your signature and a spreadsheet.

Please use the Remarks column in the spreadsheet to note any diet changes, vet appointments, instructions, etc.

If you need any help let us know. And if you start a new thread be sure to tag me so I see it.

Once that's all set up I'll take a look and see what the best plan of attack is. More than likely we'll restart at 1U, but we'll see.


Couple questions:
- You are using U40 syringes, correct? It should say somewhere on the side of the barrel.
- Did you start the diet change while Mimi was on insulin, or before starting insulin?
- Does she have any other health issues?
- Do you have a hypo kit (as outlined in the past I linked above)?

Also, take a minute to breathe! No insulin means she'll be ok for a few days, and it'll give you space to breathe and read through things without having to worry about her.
 
Couple questions:
- You are using U40 syringes, correct? It should say somewhere on the side of the barrel.

Yes, U40.

- Did you start the diet change while Mimi was on insulin, or before starting insulin?

Just before starting insulin. Diet changed Wednesday, vet gave insulin Thursday for 1st time, I gave insulin Friday for 2nd time

- Does she have any other health issues?

Just a bit overweight.

- Do you have a hypo kit (as outlined in the past I linked above)?

Yes, I had just printed out the hypo instructions from this forum this morning before everything went sideways. I picked up Karo syrup from store after vet visit and her old food I still have is carb loaded and got contact for emergency vet.
 
Ok perfect!

Realistically the vet should have given more time for the diet change to take effect, as in a few days, before starting insulin. A curve should have been done after the diet change, and the starting dose decided based on that. You may want to consider looking for a new vet with more experience with diabetes...this could have very well killed your cat, so unbelievably fortunate you decided to test!

Let me know once you've got everything together, or if you need help!
 
Thanks, @FrostD!

Just to add one thing, @Whitney&Mimi, we'll be particularly interested in comparing the tests before food, and then an hour or two after food. That will give us some hints as to whether the pancreas may be perking up a little after the food change :).

Once you're sure she's above 68 (the cutoff for an AT) tonight (have you tested since that 61?), I think you can relax some. I don't have personal experience with Prozinc, but I do know that it is an "in and out" insulin, so 12+ hours along (as I assume we are at this point), the effects of the shot itself should be pretty limited.

Don't be surprised if, once she does start rising, she suddenly shoots to the moon. It's a normal reaction to a low BG (we call this "bouncing").
 
Yes, I’ve been unhappy with this vet from the start of this journey, they are my secondary vet as my primary one couldn’t get her in sooner. I got appointment with primary vet for June 19th but will keep secondary vet for now to try and get her stable in meantime.
 
Whitney&Mimi said:
Yes, I’ve been unhappy with this vet from the start of this journey, they are my secondary vet as my primary one couldn’t get her in sooner. I got appointment with primary vet for June 19th but will keep secondary vet for now to try and get her stable in meantime.
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Well, at least this vet prescribed a decent insulin for cats-- the Prozinc should be good for her, once you can figure out a more appropriate dose, that is!
 
Starting off with 4 units is way too high a dose.
If you are going to stop giving insulin over the weekend,you need to be testing for ketones in the urine. To do that you will need a bottle of Ketostix from Walmart or a pharmacy. It’s a simple test.
The higher numbers you are seeing are from bouncing which can happen if the BG drops too low, too fast or lower than kitty is used to.
It will probably happen again after the low numbers today.Don’t be surprised or worried if that happens.
I’m going to tag @Deb & Wink and @JanetNJ to help you with the Prozinc dosing.
 
FrostD said:
@JanetNJ would you not start with less given a recent hypo? Since many times they're more sensitive to insulin afterwards
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She could do less for a day or so and see... Bit I think 1 unit is a decent starting place if the preshot is high enough. (Over 250ish). Could always start lower if she wants to though.
 
FrostD said:
Ok let's do this - no more insulin for now.

Let's do a curve one day over the weekend like we would with insulin - at what would be your AM shot time (withhold food 2 hrs prior), then every other hour, and then again at the PM shot time. Don't worry about testing overnight. Please see our instructions on setting up your signature and a spreadsheet.

Please use the Remarks column in the spreadsheet to note any diet changes, vet appointments, instructions, etc.

If you need any help let us know. And if you start a new thread be sure to tag me so I see it.

Once that's all set up I'll take a look and see what the best plan of attack is. More than likely we'll restart at 1U, but we'll see.


Couple questions:
- You are using U40 syringes, correct? It should say somewhere on the side of the barrel.
- Did you start the diet change while Mimi was on insulin, or before starting insulin?
- Does she have any other health issues?
- Do you have a hypo kit (as outlined in the past I linked above)?

Also, take a minute to breathe! No insulin means she'll be ok for a few days, and it'll give you space to breathe and read through things without having to worry about her.
Click to expand...

Thank you! I monitored her BG through out the day as much as possible and it stayed around 300 on average all day.
 
Whitney&Mimi said:
Thank you! I monitored her BG through out the day as much as possible and it stayed around 300 on average all day.
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Okie dokie. Let's do it again today if you can, she may be bouncing from those low numbers.

0.5U is likely safe right now, you can try that if you can stay around to monitor. Typical starting dose is 1U, I just prefer to be cautious given the hypo and diet change.
 
Have you been testing for ketones since you stopped giving the insulin? I see you have noted that Mimi didn’t eat much food yesterday in the SS.
Does she seem unwell or lethargic? With no insulin and not much food, you need to be on the lookout for ketones.
I would definitely restart the insulin today if the BG is high enough and as long as you can monitor.
Is there a reason you are not giving the insulin twice a day?
 
Bron and Sheba (GA) said:
Is there a reason you are not giving the insulin twice a day?
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I see in the spreadsheet notes that the vet advised one shot a day, sigh.

Whitney, cat metabolisms are too fast for once-a-day dosing. There's no insulin that is expected to last more than 12-14hrs in cats (and most of them are quite a bit shorter-lasting), so you have to do twice a day dosing. Aim for exactly 12hrs between shots to try to get consistent patterns to interpret (although my understanding is that prozinc allows a little more wiggle room than the depot insulins like lantus that I am more familiar with).

And I agree, Mimi might still be bouncing a little bit right now, but it makes sense to re-start the insulin now, at a safer dose.
 
Whitney, I can see on the SS you have not started the insulin again. This is very concerning as Mimi definitely needs some insulin.
Are you testing for ketones in the urine?
A diabetic cat who is taken off insulin is in danger of getting ketones which can lead on to DKA which can be life threatening.
Is her appetite any better today?
Please let us know what is happening.
 
Bron and Sheba (GA) said:
Whitney, I can see on the SS you have not started the insulin again. This is very concerning as Mimi definitely needs some insulin.
Are you testing for ketones in the urine?
A diabetic cat who is taken off insulin is in danger of getting ketones which can lead on to DKA which can be life threatening.
Is her appetite any better today?
Please let us know what is happening.
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Not sure I would be able to test for ketones, she runs away if you approach in litter box. I don't think you can test once it is in the litter box? Edit. looks like they have blood ketone monitors! I ordered one, should arrive today.
Much better appetite today.
I'm concerned about the BG drops I'm seeing after eating. She went from 283-177 (2+) today after eating with no insulin. I would expect that to go up after eating... can cats get reactive hypoglycemia? I worry giving insulin would make her crash again on top of these after eating dips.
 
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Ah, good, the blood ketone meters are a nice tool to have (takes some of the stress out of it).

For catching pee in the litterbox, one trick is to crumple up some plastic wrap in the spot where she likes to pee-- you only need to catch a drop or two for the test.

The dropping after eating is a very good sign that her pancreas is doing a little work :), but it still might need a little insulin support to get into a strong remission.

The blue numbers you're seeing today are in the sixth cycle after those extreme lows-- it's possible that she has been in high numbers the past couple days in reaction to the lows, and that this "bounce" is now breaking. What she does the rest of today is going to help guide the next stage of her treatment-- she's doing great so far :cat:!
 
Also, I realized I didn't say this explicitly, but no, she's not at risk for going hypoglycemic today, not without insulin for the past few days. She's looking good :)!
 
I agree. Mimi had a great day yesterday, but rising again at night makes it clear that her pancreas still needs some insulin support.

Those lows were really scary, but if you start back up at one of the lower doses suggested (1.0U or 0.5U), and are able to monitor, you'll be able to keep her safe. Starting at 4.0U was pretty extreme, her response to insulin is likely to look very very different at a lower dose. And as Bron says, withholding insulin is not risk-free-- ketones are an extremely serious possible complication, and best avoided entirely.

We're here to help in any way we can!
 
Hi. While I never used Prozinc I do see that your cat needs insulin. That starting dose was crazy high. You don’t want to risk ketones or worse DKA. Your cat will be safe starting back on 1.0 with testing and posting here for help. Going from a high dose to nothing is never successful. While going low was scary, DKA can have dire consequences. I hope you come back and start insulin today.
 
She has only had insulin twice in her life, is ketones still a big concern?

I wanted to start insulin today but her AMPS was 118. My u40 only have marks 1-10, do I need different syringe to do 0.5U/0.25U?

I also gave her appetite stimulant the vet gave last week and she ate over half the can (5.5oz).

I called vet again (called Sat and no call back) but they were busy in surgery so left message with reception. Sigh..
 
This is a little odd. Was she on kibble before?

Edit: yes, you will want to pick up syringes with 1/2 unit markings. It looks like she may be a low dose kitty, possibly remission on diet change alone or close to it
 
FrostD said:
This is a little odd. Was she on kibble before?

Edit: yes, you will want to pick up syringes with 1/2 unit markings. It looks like she may be a low dose kitty, possibly remission on diet change alone or close to it
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Yes she was on kibble before and ate about 1/4 can (3oz) of 23% carb wet food in morning. Now on 10% carb wet food only. Will be trying to go lower carb on wet food in future.
 
I'm glad you didn't shoot the 118 this morning-- that's too low on an AT to shoot even a small dose without some data about how she responds to that dose. If the number were closer to 200, you could try a stall (don't feed, test again in 30mins to see if she's moving up and it's safe to shoot), but I don't think that would have helped in this case.

Interesting about the food changes. If she's eating a mixture of different carb %s right now, that's good information to put into your spreadsheet notes. Over time, it might help to explain some of her patterns (some kitties are very carb-sensitive).

Let's see where she is tonight!
 
Whitney&Mimi said:
She has only had insulin twice in her life, is ketones still a big concern?
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Good question... Basically, it's the combination of the poor appetite and no insulin that has us concerned. The "recipe" for ketone development/DKA is: not enough food, not enough insulin, and some kind of infection/inflammation/other stress as a trigger. And it's not really dependent upon past history with insulin or diabetes-- there are some cats for whom a DKA hospitalization was the first symptom of diabetes seen by the caregiver!

Not all diabetic cats are that ketone-prone, of course, many never develop ketones ever despite often going through periods of low appetite (my own kitty, who suffered from chronic pancreatitis, was one of those). The reason we're so diligent about the warnings and ketone testing around here basically comes down to a kind of cost/benefit or risk/reward calculation: DKA is really really really bad. Sometimes fatally so. Because of this, and because it's something that is much easier to treat if caught early, we're very proactive about encouraging people to test for ketones, especially if there are any known risk factors such as poor appetite.
 
Hi Whitney,
How are you doing?
Did you shoot this morning? I saw in your remarks that vet advised 1u if above 200. Since she was on 257, was wondering if you shot?

On the face of it it does seem as though she still needs insulin with those pink numbers coming through.
Do you think that you could keep a record of what you are feeding and when. (It will be helpful particularly to know what carb % you are using when and to see if that is relating to some of the higher numbers you are seeing,nideally you want to be feeding under 10%,=but if you are struggling and she will only eat the 23% because her appt is off, it's more important that she get some food into her system than the carbs they contain. Stick to wet if you can, the kibble can remain in her system for a number of days and that will cloud the insulin requirement picture further,. I've seen cats where it takes about 5 days to see the effect of removing kibble, others just 24 hours or so. It's a case of ECID (Every Cat is Different). With the wet you fonts have that problem.



How is her appetite today?

Did you get that blood ketone meter? Managed to use it? As others have already said ketones/DKA are a real concern, especially in a kitty that is not eating, and where there isn't enough insulin, it can develop into a life threatening emergency in a matter of hours, so it's important to keep on top of that.

Is Mimi the only kitty in the house?

If you shot this morning do get a test, I would suggest no later than +2, even though you may have reduced the dose by 75%, we still have no idea if that is too much or not enough.

I
 
Gill & George said:
Hi Whitney,
How are you doing?
Did you shoot this morning? I saw in your remarks that vet advised 1u if above 200. Since she was on 257, was wondering if you shot?

On the face of it it does seem as though she still needs insulin with those pink numbers coming through.
Do you think that you could keep a record of what you are feeding and when. (It will be helpful particularly to know what carb % you are using when and to see if that is relating to some of the higher numbers you are seeing,nideally you want to be feeding under 10%,=but if you are struggling and she will only eat the 23% because her appt is off, it's more important that she get some food into her system than the carbs they contain. Stick to wet if you can, the kibble can remain in her system for a number of days and that will cloud the insulin requirement picture further,. I've seen cats where it takes about 5 days to see the effect of removing kibble, others just 24 hours or so. It's a case of ECID (Every Cat is Different). With the wet you fonts have that problem.



How is her appetite today?

Did you get that blood ketone meter? Managed to use it? As others have already said ketones/DKA are a real concern, especially in a kitty that is not eating, and where there isn't enough insulin, it can develop into a life threatening emergency in a matter of hours, so it's important to keep on top of that.

Is Mimi the only kitty in the house?

If you shot this morning do get a test, I would suggest no later than +2, even though you may have reduced the dose by 75%, we still have no idea if that is too much or not enough.

I
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Good, she went right for the food this morning. I shot 1U. Will test at +2.

I got the ketone meter, haven't tried it yet.

I'm fostering a little one in a spare bedroom right now, they don't interact at all.
 
Whitney&Mimi said:
Good, she went right for the food this morning. I shot 1U. Will test at +2.
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Excellent, what carb?

Whitney&Mimi said:
I'm fostering a little one in a spare bedroom right now, they don't interact at all.
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That's so sweet of you to be helping out a kitty in need. I was asking, because I know that George is a stinker for getting into my other kitties food, I swear he's part shark, if there's kibble in the household for the other cats, he gets to it and it plays havoc with his BG, we don't, as a rule, give kibble to our other cats, but we do have to use it when they go into the cattery, when we go into vacation. Usually they're all on a LC diet, but we have had some 'accidents' when we are transitioning the others onto the dry, and his BG really does not look pretty when that happens.
 
I suspected 1U might be a little too high. Because she hit 76 (under 90) you'll reduce to 0.75U tonight. For now I'm assuming the SLGS dosing method since that's a bit safer until you can test more and decide which dosing method you'd like to use.
 
FrostD said:
I suspected 1U might be a little too high. Because she hit 76 (under 90) you'll reduce to 0.75U tonight. For now I'm assuming the SLGS dosing method since that's a bit safer until you can test more and decide which dosing method you'd like to use.
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The smallest number on my syringe is 1 which I used this morning. Looking at ones online and no idea which ones to get. I called and left message at vet, will see when he calls back. I’m using U40 and it marked from 1-12.
 
Do you feel comfortable "eyeballing" 0.75U? With the syringes I had, it was basically the back end of the plunger (where the plastic stick is attached) was at the 1U line.

Something like this is what you want (U40, 1/3 cc, with half unit markings...I prefer the shorter 5/16" needle but many come with 1/2" needle, 29 or 31 gauge is fine). You can buy from amazon, countryside pet supply, adw diabetes without needing a prescription

https://www.chewy.com/pettest-u-40-syringes-31-gauge-x-516/dp/284667
 
Whitney&Mimi said:
And down the 67 we go! Gave her some 23% carb wet food to try and boost.
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Did you feed anything at +5/+6? Carb %?

It's probably nadir about now, so I'd stick with LC if you haven't already fed and test again in 20 minutes. You probably already fed HC, no harm, just a little bit counterproductive.
 
FrostD said:
Did you feed anything at +5/+6? Carb %?

It's probably nadir about now, so I'd stick with LC if you haven't already fed and test again in 20 minutes. You probably already fed HC, no harm, just a little bit counterproductive.
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Yes she ate a little 10% at 5+ and 6+.
I’d rather not see her levels dip lower again like on Friday. and yes I feel like I’m playing a game of yo-yo with her BG *cry*
 
Well, with the 67 on the AT, she dipped below the "take action number" of 68, so that justifies the HC! She did have a pretty extended hypo the other day, too.
 
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