For the past week, Sibylle and I have kept a much closer watch on Nekko, her insulin injections, her food intake, litter box usage, and general overall demeanor. For the most part Nekko has seemed to be fine. She still displayed some aggressiveness around our food, but willingly ate her own food. We reduced her insulin dosage to 3 units every twelve hours; a 25% reduction from the 4 units she has been getting twice daily since March 2007.
This morning at about 4:00 am, or about seven hours into her insulin cycle, Nekko let out a very loud, unhappy sounding meow. Sibylle got up immediately to see what was going on. Nekko seemed fine. When offered a plate with syrup on it, she sniffed but didn’t partake. After a few minutes Sibylle came back to bed only to have Nekko meow loudly again. This time I got up and sat in the room with her for a while. Again, she seemed normal.
Around 7:00 am, while I was eating my breakfast, Nekko start meowing loudly and continuously. Sibylle immediately recognized that this was the same meowing Nekko had displayed last week prior to going into insulin shock. She showed Nekko the plate of syrup, which was lapped up immediately. We moved on to a small can of wet cat food, which was also consumed rapidly. After eating and consuming some more syrup Nekko again seemed fine. Within minutes however, she threw up. Obviously her system wasn’t prepared for large amounts of food. Worried that she might not have absorbed or retained enough glucose from the syrup, we decided that we needed a home test kit.
I was able to get an Accu-Check blood glucose monitoring kit and some test strips at the local Wal-Mart. Nekko was surprisingly obliging as we fumbled around with the lancet trying to find a setting that would sufficiently prick her ear. When we finally got enough blood for a reading it was 84.
Felines are a bit different than people, in how they express diabetes. The “normal” range for a cat is something like 70-160. However, for a diabetic cat the danger is getting too much insulin and dropping the BG below 70. The optimal range for Nekko is more like 100 - 200, with 100 being the absolute lowest reading we’d like to see. The safe human range extends to nearly 350, so a high reading isn’t going to bother us at this stage of her disease.
Two hours, and a little bit of food later, Nekko’s reading was 90. Two more hours later it was 204. Throughout the day she has had some diarrhea and has thrown up again. Sibylle mixed some rice (bland) with canned cat food, and Nekko has thus far kept that down. At that time her BG was 202. Once she manages an hour without incident we’ll give her another portion.
We are going to test her glucose level every couple, three hours for the next day or two. Hopefully that will give us a baseline of where she is now. We are going to discontinue insulin for the time being. As the doctor said, too high is better right now than too low.
As for the cause of her sudden hypoglycemia, the Diabetes Mellitus in Cats site, offers this information:
The first signs of spontaneous remission is hypoglycemia. At the peak time (determined by the glucose curve), the cat is very unresponsive; however, a few minutes to a few hours later he appears normal. The cat has the ability to respond to hypoglycemia by converting glycogen (stored in the liver) to glucose. However, after a few days of this response, glycogen stores are depleted and the cat becomes seriously hypoglycemic. He may die without immediate intravenous glucose. The episode last week certainly sounds like it could be the onset of remission. That she has continued on for another week, with insulin injections, seems to fit with the use of stored glycogen. It is based on this information that we are taking the steps to monitor her BG and suspend insulin injections for the time being.