So we had an epic crisis - Makari

Apologies for the length! I can't believe what happened I'm still in shock a week later trying to process. We had gone out of town for Thanksgiving. We were going to cancel but Mak was doing so well that we decided it would be fine. One pet sitter is a vet tech and the other is my mom who was well trained in how to care for Makari. Hindsight, I should have never left, but I had no reason not to.

Thanksgiving night my mom and Aunt (yes two caretakers) came in for the evening shift and found Makari unresponsive under a bed. His BG was 32. They knew exactly what to do and acted quickly. They got him up to 50 in a few minutes. Then he started having a seizure. In our area - which is a major city - we still have limited emergency veterinary services but they found one that was open and took him. Thank God it was only 20 minutes away.

When he arrived, Mak was actively having a Grand Mal seizure, was unresponsive, a BG of 208, temp of 94, and bradycardic (low heartbeat) and low respiratory rate. He was dang near dead in every sense. He remained comatose for 5 hours.

When I got the phone call they had found him, I of course, got in the car and made the over six hour ride home straight to the ER vet. It was the longest ride of my life. I didn't know exactly what shape he was in until I got there. The vet had told my mom he not likely to survive and if he did he would likely have significate neurological damage. 45 minutes before I got to the ER, at 3:30am, Makari had become minimally aware and we were able to see him. He continued to improve through the morning.

I have NO IDEA how but he came home Friday night. It is an absolute miracle he is here and he is pretty dang good for what he's been through. He continues to do well. He has a slight twitch which could be muscle spasm, soft tissue damage from the massive and prolonged seizure, or some neurological damage. At this point we are managing him with some pain control and watching him like crazy. We are letting him rest and continue to stabilize at home. We will start to do follow up testing in two weeks. Unfortunately he's so fragile right now he's just untouchable.

We also have NO IDEA how this happened. The three doctors at the ER plus his own think he honestly went into remission - possibly - in 22 days. Which is absolutely insane. But his BG has been okay at the ER and the few times tested at home. From diagnosed with diabetes to remission in less than a month? And this kind of a crisis out of the blue - I just can't wrap my head around it all. I know you all don't know me but I'm so diligent. Nothing was missed - nothing was done wrong. This is all just so insane.

 

Hi Lisa. I am so sorry this has happened to Makari. It must have been very frightening. . Well done to your mother and aunt for acting so quickly.
Yes it is possible for a cat to go into remission in a short time if they are put on low carb food and insulin. Some cats can go into remission with just the change to a low carb diet. This is why it is so important to test before each dose and again during the cycles to see how well the dose is working for each individual cat. I read back through your posts and saw your vet said it wasn’t necessary to test again for 3 months. I hope this has been a big learning curve for your vet.
Are you testing at home still to check the BG at all?
Is he walking ok?
And eating ok?

 

Honestly he seems to be fine - which in itself is completely unnerving to be honest. Just the twitch which is also improving. Who knows if that is due to time and healing or the medication. Time will tell I suppose. He is eating well - he's really himself in nearly every possible way.

What's frustrating to NO END and even making me angry to be honest is four vets in two practices stand by the fact that the advice given by the first vet to not do a repeat BG curve for 90 days and NOT do daily testing for his BG was the same advice they would have all given. So in one respect are they all just stupid - no, I guess not. Are protocols just that lax and should they be changed - probably. But the times that I did test him - he was well within a perfectly normal mid 100 range. No I didn't test him often - I didn't test him daily even, but I did test him a few times, even that was more than they suggested and he was always perfect.

The issue now is the possible remission or not is so secondary to what we are dealing with now. And I'm not testing him because any amount of stress could be detrimental. He's not getting any insulin and even if his BG was high, I can't give him anything to correct it. He's eating his DM when he will, and the Tiki Cat he prefers (which is fine) because it's just so important that he eats. Part of me wants to blame myself or the vets bad advice for this having happened at all. Part of me thinks this is just something awful that no matter what I was doing I could not have seen coming or avoided. Two doctors (different practices) said it just does. Their BG is FINE and then the bottom falls out unexpected like this with no warning.

I'm so grateful he seems to be okay though we are so far from out of the woods on this. Literally yesterday his primary vet said he really could pass away still without much warning at this point. And I'm struggling not to be so very angry that this happened. I feel so mad and stupid at myself. I feel so mad at his vet that diagnosed him and began his treatment - who is in the practice we've been going to for about 18 year but is NOT his usual doctor. I had to see someone new to the practice when I had to take him for his first presentation of symptoms because his normal doctor couldn't see him for more than a week and maybe that was my very first mistake.

 

See this is why I am pissed off at one of my vets, who said that he doesn't encourage home testing because "all it does is makes people anxious." Cadmium is very sensitive to insulin and food, and he can have drastic changes within only hours with ease, and have been needing to fine tune what works for him. I'm so sorry you went through this, and I hope Makari is able to recover well.

 

All I can say is those vets have not looked after a diabetic cat of their own on a daily basis. If they had, they would not have said it I was fine to leave it for 90 days to do a curve. They just have each other’s back. Absolutely the vets protocols on this are very lax and should change.
When you are testing you will see the BG can be fine and then it can drop. Have a look at some of the spreadsheets that everyone has. You will see that the BG does not stay the same all day or all week or each month. If Mak was my cat I would definitely be testing him before every dose and again during the cycles. My Sheba used to run to me when she heard me at the testing strips because she knew she would get a treat.

I am really glad to hear that Mak is doing so well and seems to be recovering. However I really think you need to be testing the BG to see what is happening. If he is indeed in remission that is great but you won’t know unless you test the BG over a period of 2 weeks.
If he is high again and not getting insulin, you are running the risk of him developing ketones in the urine which can be dangerous, I would recommend you buy a bottle of Ketostix from Walmart or a pharmacy and test the urine every couple of days for ketones. If there are more than a trace, he needs to go back on insulin.
If you give him something to eat as you test he should not get anxious and I have to say even getting anxious is better than getting ketones or not knowing if your kitty needs insulin or not.
Cats that have suffered a symptomatic hypo can be very sensitive to insulin for a time afterwards. That is another reason to test.
I don’t mean to harp on about this but I do get really angry with vets that don’t advocate hometesting and then when something goes wrong its not because of not hometesting. If you are home testing you can prevent the hypo from happening by intervening with food and if necessary reducing the dose. That is what we do here all the time.

Why does the vet think this? Does he have a heart condition or some other health problem. In my experience here, cats that recover from a symptomatic hypo usually do well if they recover from the initial hypo.

Mak is your kitty and it is up to you what you decide to do.
We can only give you help and advice from all our experiences here. From my years here I have rarely seen a kitty have a symptomatic hypo when the caregiver was hometesting but I have seen many arrive here having had a symptomatic hypo after starting insulin and they have not been hometesting the BGs.
I hope you stay around so we can help you. We care a lot for all the kitties and caregivers that arrive here.
Bron

 

Hi, I am happy it all worked out for you so far, that is great news... prayers to both of you. I do have a question, I am so very new to this... I just started giving shots, Trixie won't seem to eat at the 12 hour mark no matter what I give her, she will eat a little, so I gave her shot (1 u of Lantus) she was at 30.1, is this the right thing to do?? I cannot for the life of me find when to give insulin, do I give it at 30.1?? My vet(s) are all over the place and do not get back to me until 5 hours later at times...(She was at 14.0 earlier in the day) no shots for 2 days prior because she wouldn't eat!! I also do not know all the short forms you all use, so I am even at more of a loss trying to figure this out... can someone post a list of all the short forms? so dolts like me can decipher what you are all saying? lol... OH YES, SHE VOMITED A LITTLE CLEAR LIQUID 5 MINS AFTER THE SHOT! She seems fine now, but... was I correct in giving her a 1 u dose at 30.1?/ Thank you or anyone that sees this!

 

New members need to post on the main health board to start with and to get set up, not the Lantus based.

Have you started a a thread for yourself? @Marccp24
I can answer to you fully there.this thread is for sassy cat and if we answer other people with their issues it all gets muddled .
But just to let you know, Don’t let a cat go longer than 24 hours without eating…it can cause other problems. Also it is not advisable to not give the dose of insulin….your kitty may need an antinausea medication to eat. I will watch out for your thread on the main health forum….this forum.

 

At this point the hypoglycemic shock really isn't what the danger is. It's that he had a Grand Mal seizure that lasted more than 30 minutes and he was completely unresponsive at the ER for about 5 hours. When talking to my primary vet yesterday she is still very very concerned about him even though he seems to recovering well. His tremor, tick, whatever you want to call it seems to be resolving but we don't know if it's from the Gabapentin she started him on or just from time itself. At this point it's too soon to tell if he'll have any form of lasting neurological damage - though I'm at least suspecting given how he's acting anything would be minor. Her words were very few survive what he did. And she's seen them pass away suddenly even a week or so afterwards. So I think tread very lightly for now is the thought process. Honestly her focus is get him through this and the diabetes is something we circle back to when he hits two weeks of being home and seems stable. Then we will take him in to start running tests.

He never had any ketones which is good, which is why I wasn't urine testing at home. Doesn't mean he can't - I understand that. I don't mind you "harping" it's fine. I don't think at this point there is much risk of him being hypo since we are not doing insulin. I don't know what we'll end up doing if we figure out that his BG is actually still high in a few weeks and not being diet controlled. I really don't know what information to trust.

 

While he is not getting any insulin, he can’t go hypo so that is not a worry.
If you are not going to test in the next two weeks I would strongly suggest you do test for ketones in the urine as diabetic cats that are not getting insulin can get ketones. As we don’t know if he is going to need insulin again, it would be a good insurance policy. You don’t want to have to deal with DKA which can happen if ketones are not addressed.
I would also make sure he is eating well.
I wish Mak all the best for a full recovery.