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Preventing And Handling Diabetic Emergencies

Caring for a pet with diabetes can be daunting. Fortunately, the key to successful diabetes management is simple: a consistent, established daily routine. A healthy diet is essential, and feeding your pet the same amount of food at the same time every day will help make blood sugar easiest to control. Your pet will usually also need twice-daily insulin injections, which should be given at the same time every day. (The easiest way to do this is to coordinate shots with mealtimes.) Routine daily exercise and regular at-home monitoring of urine and/or blood sugar round out a plan for good diabetic regulation. Even if you are following a consistent routine, a diabetic pet may occasionally experience an emergency. A number of different things can cause an emergency, but the most common is hypoglycemia, or low blood sugar. In this case, it is important that you be prepared in order to avoid a life-threatening situation. Hypoglycemia: Why It Happens Hypoglycemia most often results from accidental overdosage of insulin, but it can also occur if a pet is not eating well, misses a meal or vomits after eating, or if the type and amount of food he is being fed changes. Hypoglycemia may become Continue reading >>

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  1. the_food_lady

    Hello All,
    I posted this on the Feline Diabetes Forums but I'm not sure if I'll get many responses because hypoglycemia (low blood sugar) in a diabetic cat is a whole other story. Posting it here, too because i would sure appreciate some input.
    My old girl Cleo (she's never been diabetic) seems to be running low blood sugars. She has early stages of Chronic Renal Failure (CRF).
    She had a full senior panel done in Feb 2011 which showed her BUN and Creat were just over the high end of the normal range (I have all of her results here at home). The year prior they were only getting close to the high end of the range.
    A cat I believe to be her sister (I rescued them both a year apart from around the same area back in 1996 (Cleo) and 1997 (Fuzzy) and they have identical markings (both tabbies), except Fuzzy was long-haired and Cleo is short. They've never been exceptionally close or anything but being the older girls, they've probably spent more time over the past few years lounging in the sun in the same spots. Sadly, I had to let Fuzzy go to the Bridge last Saturday due to her CRF getting so bad despite every treatment possible (daily subQ fluids, meds for BP, potassium supplementation, phosphorus binders; even had been syringe feeding her twice daily for weeks as she wouldn't eat on her own).
    I can say I've noticed Cleo not maybe eating as much over the past 3 weeks but I was so focused on Fuzzy that I simply could only deal with one cat at a time.
    One might think her lack of appetite is related to her grieving the loss of Fuzzy but her appetite has been poor-ish the past few weeks.
    The last couple of days it's been very tough to get her to eat; I open up a million cans and she'll only nibble a bit. Same with dry food. Now she's always been a nibbler and not one to sit and eat a whole meal in one sitting, but she's nibbling very little. She's not dehydrated but I have given her some SubQ fluids because sooner or later she'll end up dehydrated if she's not eating much canned. Her BUN and Creat aren't horrible at all.....still very early stages of CRF though BUN a little higher than in Feb 2011.
    It's her GLUCOSE I'm worried about.....and I don't know if I should be? (My primary Vet isn't but nothing ever worries him, I'm in the process of trying to find a new vet, I think)
    February 2010 (done a week prior to dental cleaning) -- glucose (not fasting) was 5.16 (range 3.94 to 8.83)
    Feb 2011 -- glucose 4.2 (range 4.0 - 8.0)
    Aug 25 2011 -- glucose 3.7 (!!!). How i had intentionally not fed her prior to taking her for bloodwork that evening because I know that protein in the food can impact the BUN level....but it IS possible she would have eaten during the day when I was at work (though also possible she didn't?). The Vet at the Lab who reviewed her results left the comment about this low glucose level:
    "Hypoglycemia - rule out artifact of transport (was blood centrifuged within an hour?), sepsis, neoplasia, seizures, insulinoma, other."
    Now when my own vet reviewed these results with me, he didn't even worry about this. To note: her blood was drawn the early evening of Aug 25 and was transported the next day to the vet lab and sample wasn't process until 9:30pm on Aug 26. I just assumed that maybe this low # had something to do with what the vet lab doc said, that it wasn't centrifuged within an hour of collection.
    Well last night I took her to the Emerg Clinic because her urinalysis of Aug 25 showed "large blood" in it that both the Vet lab doc and my Vet just brushed off as being due to the cystocentesis.........(neg for bacteria, crystals, specific gravity 1.032, no ketones, no glucose, no bili, trace protein).....but my fear, due to the it being such a large amount of blood (++++ or 10/20/HPF), what if there was another cause? So I managed to catch a sample from her last evening (never thought I'd be able to) so wanted it checked because if the previous blood was just due to the cysto, then you'd expect this free catch sample to have none. I remembered that i had a bottle of brand new Chemstrips (like Multistix) and I poured off a little from the sample and tested it with a stick and it was clearly NEGATIVE for blood (I've used these in the past w/ Taco as well as an old CRF kitty I had years ago who was the queen of UTIs and they were accurate, plus I know vet clinics use them too for preliminary testing).
    I still took her to the Emerg Clinic because I wanted her blood pressure checked again and I wanted her BUN and Creat run again (apparently the sample taken on Aug 25 was "hemolyzed ++" and I was afraid that would have impacted some of her results; her BUN on Aug 25 was higher than in Feb, but strangely her Creat had improved considerably such that though it was a tough high in Feb 2010 and just over the high end of normal in Feb 2011, but way way normal recently; that didn't make "sense" to me that Creat would suddenly be so normal (we're talking 238 in Feb but now 172) so I was worried about the accuracy of this.
    Her BP was fine, Vet was confident that no urinalysis was required citing the chemstrip indicating no blood was accurate.
    Bloodwork was run; BUN consistent with Aug 25, Creat no longer "normal" but 247 (which made more sense to me given what it was in Feb).....but glucose was only 4.2 (their range 3.9 - 7.2) The vet who called me with these results (not the one we'd seen) said that was low considering it's usually higher in a cat due to stress.
    Now for the record.............Cleo is the most non-stressed cat you can imagine. Even last night when they were in the room with me checking her BP (they use a digital machine), she couldn't care less. Purring, giving everyone head butts, not a care in the world. They even drew her blood on the exam table in the room with me. Took it from a front leg vein with her standing on the table if you can believe it. She didn't care at all. they kept commenting on how great she was. So perhaps she's an unusual cat who just doesn't get stressed at the vet such that BG is elevated? Vets have always commented on how sweet she is, how easy to draw blood or urine.....(which she'd be that easy when I'm giving her subQ fluids LOL).
    I tested her BG at home today twice. 66 and 77. Now the One Touch Strips I'm using expired in March but they're all I had. I'll be buying new ones today.
    I've read that a malignant tumor of the pancreas, called an "insulinoma" is very very rare in cats but it's a tumor that causes elevated levels of insulin. From what I've read, giving large carb meals doesn't necessarily help because if you give large glucose containing meals, more insulin is released to combat it so it doesn't really help. Surgery for this is the best option but given her age (at least 16 yrs old) and impaired kidney function, I wouldn't even consider surgery (that's IF the tumor was in a place where it could be removed).
    The only thing she wants to eat today is Whiskas Temptation treats. Even refused the baked chicken she liked yesterday. I finally had to resort to syringe feeding her about 60 cc of canned food with a little syrup mixed in (some glucose for energy)...........she really fought the feeding and she's the type of cat that if you repeatedly do things she doesn't like, she'll start hiding under beds and i don't want her to do that nor do I want to lock her up in a room by herself as that would really stress her.
    I'll recheck her BG about an hour after I've fed her to see what it's at.
    She doesn't seem nauseated at all. I pretty much rarely see her drink water (whereas other CRF cats I've had, even when Fuzzy was at this stage of CRF, she would drink frequently, small amounts.....would never walk by the water bowl without having a sip).
    Her liver enzymes are fine. She's not anemic at all. Her potassium level is in the middle of the range. Her WBC count is totally normal. Her phosphorus level is about 4 (so good).
    Should I be concerned that there's something else going on here with respect to her glucose level..................or should I just periodically test it and log it.......and attribute her lowish blood glucose levels at the vet to merely a cat who is not stressed at the vet and therefore her BG doesn't reflect it?
    Many thanks,
    Lisa
    PS - PS - in the event that anyone reading would like to see her actual BUN / Creat numbers, here they are:
    Feb 2010
    BUN - 11.0 (range 5.7-12.9)
    Creat 210 (range 71-212)
    Feb 2011
    BUN - 12.3 (range 5.0-12.0)
    Creat 238 (range 71-203)
    Aug 25, 2011
    BUN - 18.9 (range 5.0-12.0) -- so increased from Feb
    Creat - 172 (range 71-203) --much improved, which made no sense to me
    Aug 27, 2011
    BUN - 20.7 (range 5.4-11.7) - run in-house so different ranges
    Creat 247 (range: 71-159) (strange their range has a much lower end value than Idexx and Antech who did previous bloodwork)

  2. the_food_lady

    So 3 hours after I syringe fed her 60cc of canned food with a bit of syrup (I'd say 1 to 1.5 tsp of syrup mixed into a bowl that contained TWO 85g [size of fancy feast can each] sized cans of canned food) in it for glucose/energy, BG was 94 mg/dl (or 5.2 mmol/L). She'd also had about 7 Whiskas Temptations treats about that time (I believe they're fairly high in carbs as they would make my previous diabetic kitty's BG go up a fair bit so I only rarely gave 1-2 as a treat). I probably should have checked her BG a little sooner; maybe at the 1 and 2 hour post feeding mark?

  3. catsallaround

    IMO NO shes not. I have a diabetic cat and when I was getting used to him I tested some of my others and all came up under 75. He is now food controlled(as long as he eats low carb wet friskies non chunks, he comes up 50-80.
    A cat at home may test lower due to less stress. I use4 the walmart relion confirm meter but same thing happened with the alpha trak(cat/dog meter)

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