New Member: Margo | Insulin Issues

[Kay12]

Hello,

Apologies in advance for the long message.

My cat Margo (13) was diagnosed with diabetes in November 2023. She has been on a dose of 2.5 units of Lantus twice a day since December and had been doing really well on it. A few weeks ago she had a hypoglycemic episode that caused a seizure. I rushed her to the ER and she had another seizure before they got her blood sugar back up. Since then we've been in and out of the animal hospital (and back to the ER once) trying to figure out what dose she should be on.

She had a second seizure like incident when they sent her home on 0.5 units twice a day, and she responded well to dextrose. They recommended keeping her in the hospital, and then trying lowering her to 0.5 in the hospital - this still lowered her down to hypo levels, though she didn't have a symptoms.

So, she came home on 6/6 on no insulin, with an appointment for the following week. She also came home with an appetite stimulant and a anti nausea (Cerenia). When we went back in, her blood sugar was high so they recommended we try her on 0.25 units twice a day.

She came home from the hospital on Friday the 14th on 0.5 units twice a day. Still on the appetite stimulant and the Cerenia, but with instructions to try weaning her off the cerenia and anti nausea. She seemed to respond well, so I didn't give her any cerenia on Saturday. Then, on Sunday night she showed signs of hypoglycemia and I ended up rubbing Karo syrup on her gums which prevented her from going too low and she seemed to be doing well.

I held off on the insulin until we were able to see the specialist again on the 20th. When they tested, her blood sugar was high and there were ketones present. They theorized that perhaps taking her off the Cerenia was what caused the issue, since her appetite has still been down. They sent her back home with instructions to keep her on the cerenia and the appetite stimulant and keep her at the 0.5 units, and then to bring her in for a glucose curve on the 28th.

Right now, her appetite seems to be coming back though she is very picky about what she eats at the moment and really just wants treats - which she did not get a lot of prior to this since she's been on her diabetic diet. Tonight she started showing some signs of discomfort and I'm not really sure what to do. She has been losing her vision and when she had the seizures, it seemed to accelerate the process so it is hard to tell if the disorientation is from hypoglycemia or from the vision loss.

I've asked the vet about home testing, but have been told that she has very difficult ears and paw pads for testing and that I will likely have too much trouble with it. Would love advice on if I should proceed with learning via youtube videos against that advice? I've been reading through this forum and it seems like home testing is a necessary part of the process.

Any advice is appreciated! For further context, she also has some issues with her kidneys that we are trying to manage.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum. I am so glad you have found us as we can help you. And I’m so sorry you have both gone through this as it was not necessary if you have been hometesting.
I would definitely recommend you start to home test. It is not hard and Margo will not hate you. You will then be in control and you should not get any hypos as you will see when the blood glucose is dropping and you can feed her or give her some honey.
I will give you a link to HOMETESTING. Let us know if you are having any issues at all with it and we will help you.
If you live in the US you can buy a ReliOn Premier glucose meter from Walmart. You will also need some test trips that go with the meter and some lancets…get size 26 or 28. And get some cotton balls to hold behind the ear when testing. Expect to fail a few times as both you and Margo get used to the new routine. That’s normal. And always give her a treat, even if you fail, and don’t forget to give your self a treat too! But you will get there!

When they tested, her blood sugar was high and there were ketones present. They theorized that perhaps taking her off the Cerenia was what caused the issue, since her appetite has still been down

The reason she developed ketones was because she was not getting any insulin and she may not have been eating enough. The vets should have been getting you to test for ketones while not on insulin.
I would recommend while you are out getting the ReliOn meter from Walmart you also get a bottle of Ketostix so you can test for ketones each day.
I would not stop the cerenia or the appetite stimulant at the moment and try and make sure she is eating up to 1 and a half times as many calories as she normally does. This is to keep the ketones at bay. If you are testing for ketones daily we will be able to see if she is getting enough food and enough insulin. If there is, there should be no ketones. If she is not eating her normal food, let her eat whatever she will eat as eating trumps everything when it comes to ketones. Uncontrolled ketones can lead to diabetic ketoacidosis which is very serious for the cat and costly.
Link to STIMULATING KITTYS APPETITE

You mention she is losing her vision. Did she have that issue before the seizures? It is not uncommon for cats who have diabetic seizures to lose their vision for a few days…some do not get it back.. Has she been tested for high blood pressure?.
What are the issues with her kidneys?

Just to add….with testing….you test before every dose is given and then try and get a few tests in during the cycles so we can see how she is reacting to the dose.
Here is a link for information for new members. In it you will find a link to the spreadsheet, the signature and a hypo box. Make sure you have a hypo box set up asap, and if you have any trouble with the spreadsheet set up let me know and I can get someone to help you.
HELP US HELP YOU
I hope you find this useful. Please keep posting and asking lots of questions.
Bron

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

One consideration is that many cats are very sensitive to insulin after a hypoglycemic episode. I suspect that explains some of the variability in Margo's response to insulin.

I also agree wholeheartedly with Bron. Please start home testing. It is the best, if not the only way, to ensure that your cat is in safe numbers. Most cats are harder to test when you first start out. It takes a few weeks for the capillary bed in the ear to develop. Once it does, testing is easier. Also, start out with a wider gauge lancet. Using a thicker lancet will help to draw blood. You want a 28 gauge or lower number lancet. (Lower would be better.) Once it's easier to test, you can switch over to a thinner lancet. Also, a key to testing is treats! Please get some low carb treats if you do not have them already on hand. Freeze dried protein (e.g., chicken or other protein) are a great treat for a diabetic or you can use cooked chicken, cheese, etc. -- whatever Margo likes. Rewarding Margo, regardless of whether your test is successful or not, helps to reinforce your testing her. And as an FYI, there are several veterinary professional organizations and journal publications that support home testing.

 

[Kay12]

Thank you both!

I can't really understand why they've been so reluctant to have me home test, so I appreciate the encouragement. When she was first diagnosed, she went on a glucose monitor which I found very helpful, but where we've been going this time around they've said they find the newer models don't really give accurate testing, so I've been pushing to learn but was getting gently rebuffed. I'm going to go out this afternoon and get all of the materials.

For clarification on the Cerenia, they thought that it might have had something to do with her blood sugar dropping - not it raising when she was off the insulin. I've been trying to research and see if this is backed up anywhere, but I cannot really find an answer other than if it led to less of an appetite she might not have needed that round of insulin. (That's actually how I came across this forum!)

Eyesight - She's been losing her vision due to cataracts for awhile though it seemed to not impact her much at all. Post seizures her vision has been much worse. It has been a few weeks since her last seizure, so the vet doesn't think it will return at this point, unfortunately, but she seems to see enough to navigate around just fine.

Blood Pressure - She was tested when we were there on Thursday and she was fine.

Kidneys - She's had elevated levels and they suspect some form of chronic kidney disease, but are focused on figuring out the diabetes control at the moment.