New Member, very nervous!

Hello everyone! My 13 year old cat Dwight was diagnosed with diabetes yesterday.

He hasn't been eating or drinking regularly, which led him to develop ketones, but the vet was thinking we could bring him back from the brink without an overnight treatment of DKA. I don't believe he had it officially.

He is on 2 units of Lantus daily for now, but because he is a very picky eater and hasn't been feeling well, he already had his first hypoglycemic episode about an hour ago. I'm absolutely terrified. I'm not sure what to do or what to expect, and I'm facing the prospect of losing my boy because of this. I'm terrified to leave him alone to go to work, or sleep, or do anything. I feel like I have to watch him 24/7.

He was given honey on his gums and ate half a can of Science Diet a/d, but I'm out of that now and he hasn't left the spot he was laying on when he went hypo.

This is all very new and exhausting and emotionally raw for me. I've been crying a lot. Do you guys have any tips or tricks I could use to give him the best chance possible? Thank you so, so much.

 

Hello and welcome. Are you home testing Dwight's blood sugars? Do you have more honey or corn syrup/karo on hand?

What other type of food do you have around besides the a/d? I'm looking for something higher carbs in value.

It sounds like 2 units is two high a dose.

 

I have a glucometer coming on Sunday. I wasn't able to get one yesterday when he was diagnosed. I have a fancy feast wet kitten food (I bought it before I knew why he was so thin), and off brand wet food from Trader Joe's and Aldi (also because I didn't know why he wasn't eating. I know those aren't great for him.) I'm nervous about changing his dose but I think you might be right. He is due for his second dose now, actually. It was suggested to me not to change it until the vet said so, though.

 

Where do you live? If in the US and have a Walmart near you, you should be able to pick up one of their Relion meters, like the Prime quite cheaply. You don't need to have a pet meter.

Both the Fancy Feast Kitten foods are low carb and perfectly safe to give diabetics. If you take a look in this food chart, you are looking for foods under 10% carbs. A/D is 12% so what we call medium carb. At this point, you absolutely do not want to give him lower carb food until you are home testing. Which Trader Joes were you giving? None of them are higher carb than the a/d.

If he just had a hypo an hour or two ago, it is not safe to give him 2 units right now. How many days has he been on the 2 units twice a day?

Any chance you've got someone at home who can go to the store and pick up some Fancy Feast Gravy Lovers food and hopefully a blood glucose meter and strips? Add some lancets to the list and a container of Ketostix (or equivalent). With him being close to DKA you need to test for ketones daily. And he does need some insulin as well.

 

Sorry, I think I mis-typed. I give him one unit twice a day. He has had three doses total because he was diagnosed yesterday, and received one last night and 2 today. I made the second dose a half dose because I was scared to give him the full one and have him have another episode overnight. There isn't anyone who can go out, and the stores are closed for tonight so I just have to wait until tomorrow. I'm glad the fancy feast is at least a decent option, but he won't eat now. He ate a full slice of turkey and that's it. I'm going to try and bribe him with the kitten food.

I thought the human glucose meters were inaccurate for animals? I didn't realize that they were the same.

 

The human meters are accurate for testing cats blood glucose. They just test a bit lower than the pet meters. Most of us here use human meters.
How is Dwight acting now?
Is he up and about or lying down?

I’m a bit confused about the insulin dose.
Have you given another dose since the hypo episode?

 

The numbers for the human meters are slightly different, but it wasn't that long ago that people only used the human BG meters. All of our dosing methods were written a while ago and were developed for human meter numbers. Plus the test strips are way cheaper!

I'm linking a couple posts for you. You need to see what you can do to get him to eat. The vet should have given you some anti nausea medication to help his appetite.

• Suggestions on How to Stimulate Kitty's Appetite
• Syringe/Assisted Feeding (Video and Tips)
  
  

 

So you gave 1 unit last night, 0.5 units this morning and did you give 0.5 units tonight?

Could you tell me what brand of syringe you are using?

 

It would be good if you could confirm the syringes, and possibly take a picture of what you considered to be 1u? Please post when you can, sorry we have a lot of questions, but we are here to help.

 

I'm so sorry, I keep messing up. He received one unit last night, one unit this morning, and half a unit this evening. I was told to keep up with his insulin, so I gave him that half unit about an hour after the episode. I now realize that was not a good idea, and gave him some honey as I don't have karo syrup yet.

He is lying down at the moment. He was drinking water about 15 minutes ago, but has not been interested in any food I've given him besides the turkey. I was able to hand feed him about a half teaspoon of the fancy feast kitten, but he wouldn't take it in the bowl.

My brand of syringe is BD??? Insulin Syringes. I'm sorry, I don't know exactly. They have increments of 10 on them. I was told that one unit goes to the line labeled 10 and that's what I've given him. The most recent dose was half that. I was shown how to do it yesterday, and that's the line they drew it to, so I'm hoping I haven't messed it up.

If I have already been making his dose too large I'm going to be devastated.

 

Any chance you could post a picture of the syringes? I used BD syringes, but there were 30 units total in the syringe. They looked like what was on the left and the line to the 10 was 10 units.

 

Depending on the BD syringes, one unit would be the first line just past zero. If you are drawing up to 10, that's 10u.

 

Oh my god. Oh my GOD. If that's the case I've been giving him WAY TOO MUCH.

I've been trying to upload a photo and it hasn't been working but that's what my syringes look like. When I practiced giving my injection with saline at the clinic they told me to pull it all the way to the 10 and that was a unit.

I can't sleep now. I've given him a major overdose, what do I do to fix this

*ETA my syringes aren't in increments of 5 but I think this still applies. How could I have been so stupid??

 

@Pyrotemis - no advice from me, just letting you know that we od'd our cat the other day and I feel your fear and guilt. The folks here are amazing and really helped. Sending you calming breaths.

ETA Also, you're doing the best you can. It's a scary thing. The fear is natural. The guilt is as well, but you're likely harder on yourself than anyone else would be on you. Try to give yourself the same grace you would others.

 

Do you have an ER vet or 24 hours vet open near you? I'd pack him up and take him there. They can put him on a glucose drip and save him.

Not your fault on the dosing. I heard a story of someone being shown 20 units instead of 2 units. The vet fired the tech who did that.

 

Ok hon, stay calm, I know this is overwhelming. Can you see the post from Wendy about the lines on syringes? There are two, one with half unit markings. Can you see where the 0.5u and 1u markings are there?

You may need to seek emergency help, that is a lot of insulin, and already symptomatic hypo.

 

I agree with Wendy. I would pack him up now along with the jar of honey and go to the ER. I would rub some honey on his gums now before you go.

Stay calm. You are on to this. Drive carefully

 

There are no emergency vets close enough to me. The regular vets are all closed. And I spent all my money yesterday getting him this medicine!

Just rubbed more honey on his gums. He seems to be perked up enough to fight me but I'm still scared.

My mum is a vet tech. I'm going to give her a call.

 

Does your mom have access to a glucose meter?

 

She might. I'm not sure if they have one in the house

 

Could she get one from the surgery?
Would her vet open up for you and treat your kitty?

 

Also see if she can get a syringe so you can give honey via your kitties bottom

 

Any update? How is Dwight doing? How long since you shot the last dose of insulin? You have a couple hours after the shot then that dose will kick in too.

 

Since you can't get to a vet, it will be important to continue to watch Dwight, and offer food and honey/syrup and without having a glucometer, you are flying in the dark. Do you have any dry cat food? Temptations treats? I'd also try and keep adding a couple of drops of honey with the food you have, syrup alone can give them an upset tummy, so getting something in his belly would be ideal.

I hope everything is okay, we worry when there are no updates.

ETA: cats who have had symptomatic hypo will be more sensitive to insulin, so I'd be cautious with the next dose, and discuss with your vet tomorrow, since Dwight also has had history of ketones. Regardless I'd have some strong words for whomever showed you incorrectly what 1u is.

 

How are you doing?

Sending prayers,

 

Prayers on their way from here too.

(((Dwight)))




Mogs
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Hey everyone, I have lukewarm news.

Dwight made it through the night, but not well. I can't get him to eat, so he was extremely weak and disoriented and twitchy this morning. He couldn't walk, he was dazed, and he soiled himself.

He is at the vet. My mum was the tech who told me about the wrong measurement. She has beat herself up enough about it, and is taking on the brunt of his treatment right now to get him back to where he needs to be.

However. If he is still unwilling to eat after he is stabilized, then it will be time to say goodbye. I don't have the money to give him emergency care every time this happens, and as much as it breaks my heart, I don't know how much he is willing to fight.

ETA: I was up all night giving him honey on his gums and trying to entice him with kitten food. He never took more than a couple nibbles. This morning, he licked some turkey off my hand, but was too dazed to chew his favorite treats even though he was interested in the smell. It was very, very scary and we aren't sure if he will want to eat. He hasn't wanted to for a long time now.

 

I'm so sorry you have had such a rough night.
All our prayers are with you.
They are strong little creatures I have found myself on the verge of making that decision at times to find that they turn it around.

It is possible to assist feed for a while if you feel you want to give him a little more time to see if he will recover.
https://www.felinediabetes.com/FDMB/threads/syringe-assisted-feeding-videos-and-tips.144367/
I was very worried when I first had to do it with one of my cats (heart/kidney probs form a GSW, I wasn't sure he would pull through),
If you go down this route it is best not to do this with their regular foods, as they can develop food aversions.

Whatever you decide, my thoughts are with you.

 

Is Dwight amendable to syringe feeding? I have been syringe feeding my civi Moxie most of her calories for for over 5 years. Year ago when I worked at a shelter I took home Joey who was not eating. I syringe-fed him for 2 months before he would eat by himself.
Some caretakers have has success with an appetite stimulant. I wouod discuss that with your vet if Dwight is not amenable to syringe feeding.

 

[Emphasis mine]

You did an incredible job to get Dwight through the night - and working 'blind' too.

Just throwing out an idea here:

Interest in the smell of food but reluctance to eat is a classic sign of nausea in cats. Dwight's system has been through a fair bit of upheaval. After last night's low and all the life-saving honey you administered it's possible his body might respond by going into high BG numbers temporarily. According to diabetes.co.uk, hypoglycaemia and hyperglycaemia can cause nausea in humans. It might be worth considering whether Dwight doesn't want to eat much because he's nauseated and asking your vet about treating for it?

Cerenia and ondansetron can both help cats with nausea to start eating again. Cerenia injections can help a little bit relatively quickly. Ondansetron may only help a little bit initially but over a period of 24-48 hours the anti-nausea effect tends to build to a more effective level. Maybe ask your vet if it's worth a try? Also, if Dwight were nauseated, then the supportive meds could help him to get on better with assisted syringe feeding. If you can keep getting frequent small amounts of food into him it might help settle his digestive system and his appetite may gradually get stronger as he goes along. For safety it might be worth considering feeding a food with high enough carbs to support safe administration of insulin while you're waiting for his food intake to increase to the normal amount. Also, the more calorie-dense the food, the better.

If you can get him eating some bit with the anti-nausea meds then subsequent addition of an appetite stimulant may help on the way to restoring his appetite to normal. (Note: Appetite stimulants don't tend to help much if any nausea present isn't treated first.)

Prayers continue for your little fella. As Gill mentions above, cats can be extraordinarily resilient.

(((Dwight)))




Mogs
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I'm so sorry that your introduction to caring for a diabetic kitty has been so traumatic, but what happened last night isn't how things are normally. God willing, Dwight will pull through and we can help you learn all you need to know to keep him safe going forward. Life with a sugar cat is NOT an endless series of trips to an emergency vet, I promise you.




Mogs
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Currently, Dwight is stable and eating his a/d food ravenously. He started growling at the techs in the hospital which means he's getting his spirit back. He is out of the woods for now!

I might be able to try syringe feeding him if he needs it, but I'm not sure yet. They're keeping him for the day and he will be brought home tonight when they close. His sugar was unreadable when I brought him in because it was so low, but now is in the mid/high 200s. They're deciding now if they want to keep him on glucose drip or take him off and give him insulin again.

I'm just glad he is eating. I'm going to buy some more science diet canned food for him since he seems to like it (even though I know a/d is prescription, and I'm getting about 10 cans of that when he comes home) and some of his favorite dry food. If he keeps eating the way he is right now, I think we stand a chance.

Thank you to everyone here. It has been an exhausting, emotionally raw several days. You're all so kind and amazing.

 

I'm beyond delighted to hear this news! Attaboy, Dwight!!

Lantus is a depot insulin. Each dose administered contributes to the filling of a little 'tank' of insulin under the skin. It is this characteristic that gives Lantus such good duration in cats.

What is the insulin depot? (Click on this blue text for more info.)

With a depot insulin, successive doses build on previous ones. Given that Dwight has had several very large doses, the insulin depot will still be in play, it is likely to be significant and it will continue to affect blood glucose levels until it has had time to drain. (The size of the depot at any given point may affect BG levels for up to 3 days from that point.) Also, after the hypo there is a possibility that Dwight will be much more sensitive to the effects of insulin. I would suggest an ultra-conservative and cautious approach to insulin treatment. If it were my cat I'd want to see what happened to blood glucose levels for a reasonable period of time - especially if it were to be taken off the dextrose drip - before administering the next dose.

While you're continuing to stabilise Dwight's appetite and determining his safety insulin-wise, I'd also recommend you start daily monitoring for ketones as a safety precaution. You can do this either with urine test strips (cheaper) or using a blood beta ketone meter (strips are pricey but you can test on demand in the same way as you would test blood glucose (with a sample from the ear) and it's a more reliable measure). As long as ketones are negative, you should only need to test once a day. More helpful links:

FDMB primer on ketones and ketone meters

Tips for collecting and testing urine samples

With regard to blood glucose monitoring, many members here use Relion Prime or Relion Premier meters from Walmart. The meters are fairly inexpensive (c.$9) and the test strips are reasonably priced. When monitoring a cat's blood glucose at home using a human glucometer a different reference range is used to the one used with pet meters. Both meter types are safe and effective to use, but the pet meter strips cost an arm and a leg (c.$2c.$1/strip for an Alphatrak meter compared to c.$0.18/strip for the Relion meter). When you're ready, here are some good resources to help you learn about home testing:

Home testing links and tips

Testing and injection tips

Again, I am so pleased to hear that Dwight is eating. Long may that continue. (((Dwight)))

Tip: You may get suggestions here from members replying to your posts recommending a low carb diet. In the long term that would be a good suggestion, but right now for safety I'd suggest not making any changes to Dwight's diet until this incident is well behind him, you've learned how to home test his BG levels and his insulin needs are more clearly understood. For the time being, the food he's willing to eat readily is the right food.

BTW, you've been through a really rough trip over the last few days so get yourself a little treat of something nice. That's an order!


Mogs
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The fact that it's a long-acting insulin that stays for a while has me a bit worried. I think it's still affecting him; his BG fell to 31 after being taken off dextrose. He's back on it, but now I'm afraid he will have to stay there for an unknown amount of time before it wears off.

 

That's what I was afraid might happen. What is the vet advising you?


Mogs
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Can you tell us the brand and variety of his favourite dry food so we can check the carb content for you? (Right now, it's good if it's carby.)


Mogs
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He has to come home with my mum today, he can't stay overnight. Neither of us can afford care longer than this. I didn't think his blood sugar would drop again.
I'm looking into what the vet says, but we are super limited by money. I didn't even have an appointment today, they just squeezed me in because my mum works there. I'm not sure what they will be able to do.

His favorite is Science Diet Sensitive Stomach & Skin, which he typically devours. He used to vomit a lot, but hasn't been at all since this food. I'm going to be supplementing that with wet food a lot until he is back to normal.

 

I would not give him any insulin tonight. Sometimes severe hypoglycemia can shock the pancreas into working. It’s important, also, that you have urine ketone strips and check is ketones. We’re you able to get them? Any pharmacy has them as well as glucometers and strips.

Did you get a human glucometer today so you can check his BG.

I’m going to send you a private message so I can get a spreadsheet started for Dwight and you can post whatever numbers you have for him. If you can get them all from the vet, that will help. Check your inbox in the upper right corner and you’ll see a number there when my message pops up for you. Just click on it.

 

Thanks for this. Will check the carb content for you once I've finished this post. While I'm doing so, have a look at the following link. It has recommendations for some foods with higher carbs that can help raise BG numbers:

Hypo Toolkit

As Marje says above, one of the best things you can do is get a human glucometer. That way you'd be able to monitor Dwight, it would give you some much needed peace of mind, and members here will be better able to help you monitor and steer his BG levels in real time when you get him home.

BRB...


Mogs
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Hill's Science Diet Feline - Sensitive Stomach and Skin Chicken Variety Dry Food - Hill's US website gives dry matter carbs as 36.3%* - high carb, just what you want right now.

Is Dwight just eating the a/d wet food at the moment, or has he shown any interest in the 'Sensitive' kibble?


Mogs


(* For general info, Hill's UK website typical analysis gives 30.9% kcals from carbs/37.9% dry matter carbs for the UK formulation which, I assume, is pretty much the same as the US product.)
.

 

I agree that he should not be given any insulin tonight.
Also, I would leave some of that higher carb dry food out for him, in case you fall asleep. You must be exhausted. I used to set my alarms away from me, so that I had to physically get up and walk to turn it off, otherwise sometimes if I was super tired I would find my phone under my pillow in the morning

Can you ask the vet to give you a few feeding syringes to take home with you, in case you need to get his BGs up with wet food?

Go and get the glucometer and test strips, and ketone test strips today, if you haven't already, so that you have them when he comes home.

I've been following and keeping positive thoughts for your kitty.

 

You and Dwight have been through a lot in the last day. You must both be exhausted. I agree with the others, no insulin tonight, but do try to test for urinary ketones, just in case.

Love to hear that he was eating his a/d ravenously.. It's great news that there is something he will eat. If you are out shopping for meter, test trips, lancets, and ketone test sticks, add a couple jars of all meat baby food to the shopping cart. Gerbers or Beechnut, make sure there is nothing but meat and broth (no onions or garlic). It's often something cats will eat when nothing else will do. Not a great long term solution, but it is food.

 

I have heard this multiple times now, I will definitely have to get some!!

Unfortunately I'm at work for a few more hours. I've explained the situation to them and they're comfortable with me leaving early, plus there's another storm on the way so that's another reason to pack up. Updates will be hard until I get home.

His sugar has been bouncing around all day because he has been on dextrose twice. I'm hoping that it will stabilize to the point where I can take him home without fear... but I'm worried about getting him to eat as always. He might get home and decide he's done for the day and not touch anything.

If I can get out early enough I'll cancel my amazon order of the alphatrak and get a human meter. I'm worried about the numbers being messed up, but I need one now, not Sunday.

 

It will be cheaper and easier to get the test strips. Don't worry about the numbers being messed up. We are all very used to seeing BG with a human meter.
Stay safe in the storm.

 

There's a list of cat-friendly baby foods at the following link:

Persuading your cat to eat - baby foods and broths


Mogs
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Maybe ask the vet for anti-nausea med and an appetite stimulant to take home?


Mogs
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I asked about it; they said it was brought up earlier today so I'm reeeeally hoping that they grabbed some. They'd be on their way home now so idk if I will hear anything until he is back at the house.

 

... I can get test strips that work without a meter? Sorry if that sounds uneducated, I just thought that they needed the meter to work.

 

Don't worry about any questions you have. We all had to learn about this stuff when we were new.

You do need a meter and the correct test strips that work with that particular meter. Gill was referring to the fact that if you're using a Relion meter it would be really easy to pop along to Walmart to get more test strips when you need them. In comparison, test strips for an Alphatrak meter aren't available locally and there's a delay while you're waiting for an order to be delivered, thus there's a greater risk of running out of supplies.


Mogs
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Ahh, okay.

We are both home for the evening. He is going back to the vet tomorrow because he isn't quite there, and I'm supposed to offer him canned a/d every hour for the rest of the night. He is still eating pretty well, he dove into his dry food just now.

I'm going to do what the vet said and just keep an eye on him until tomorrow morning, offering wet food hourly to keep his sugar up. I'm fried, I'm probably not going to update until tomorrow unless something happens. I just need to step away from the forum for a hot second.

Thank you all for everything! I'll come back here with updates.

 

Have a quiet peaceful night.

 

My heart just hurts for you. Well wishes and and skritches for kitty!

 

Typed out the following several hours ago but clicked the link for the board index instead of the Post Reply button.

The content is a wee bit stale now but there are some general tips in it so I'm going to post it to you now.

Good that he's eating some of the higher carb dry - it would help keep his numbers up a bit better. Also, you can try mixing some honey or karo into the a/d food to up the carbs a bit. Remember that the sugars can kick in a little bit faster than food but they also wear off quickly. If you do suspect a hypo, give honey/karo moIn case you've not already found this:

How to treat hypos

If in any doubt about anything overnight, post for help. If you don't get a quick answer here, try posting a new thread saying that your cat is low/hypo and you need help on the Lantus & Levemir support board (usually has more footfall). If you think Dwight might be having a hypo, switch on the 911 emergency prefix next to the title when you're creating the thread. (It would also help if you could copy/paste the URL for this thread into the new one so that members can check back on what has happened thus far.)

Sending prayers that Dwight will continue to eat well and that the night will pass safely for both of you.




Mogs
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Hi,

Just checking in to ask how yourself and Dwight are doing today.


Mogs
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Hey guys,

Dwight is okay. We are back to baseline, fixed the insulin dosage. Made sure of it. He isn't eating much today, but he is exhausted. He's acting like his normal self.

We've been through a lot the past couple of days. The next few days of seeing if he will eat on his own are critical to see what we do next. Thank you for all your help and suggestions. I'm very overwhelmed right now so I apologize for not replying. Being on the forum and discussing what was happening was really taking a toll on me.

 

You've been through a lot, trial by fire is unfortunately way too common here. Proceed in baby steps and come back when you are up to it. I'll keep finger, toes, and paws crossed here for Dwight.