Diabetic Cat having funny episodes

Re: Diabetic Cat having funny episodes

Claire Edgington — Sat, 22 Oct 2011 10:19:49 GMT

Thanks. No other clues I'm afraid. He's otherwise very healthy. The only neuro signs were hyperaesthesia when he was having an episode and the manic pacing. Chest ausc was unremarkable.

Re: Diabetic Cat having funny episodes

Christopher Saul — Sat, 22 Oct 2011 00:10:59 GMT

[quote user="Claire Edgington"] I wasn't thinking about an overswing at that time of night.[/quote]

Just be careful. Some of counter-regulatory hormones responsible for an overswing may persist for quite some time, even into the following day or days,so overswings may not occur at the same time each day, or may not occur every day.

I would in general echo Martin's suggestion of reducing the dose by 25% ( let's face it, 3iu bid would still be a reasonably good dose), then waiting a week or so, then getting a 12 hour glucose curve

Also, any other clues? any abnormalities on neuro exam? any reason to suspect cardiac disease?

Hope this helps

Chris

Re: Diabetic Cat having funny episodes

Martin Atkinson — Fri, 21 Oct 2011 08:57:42 GMT

The disparity in readings within 20 minutes even given that the glucometer readings are often a couple of units low suggests one of them has to be wrong and it is most likely the glucometer which would reduce the likelihood of an overswing. However we need timings between insulin doses and readings other wise its too vague. Your fructosamine level is in the area where I would be concerned hypoglycaemic episodes are likely. In an overswing situation the glucose can continue to rise even after the next insulin injection, don't forget if your'e using lente which I assume you are then there is little or no action of the insulin for 2 hrs and peak action isn't reached until 4-6 hrs post dose. A 12 hr glucose curve has to be the way forward, if you can trust the client and they are competent this may be best performed at home to remove stress factors. Whatever, I would want a curve every 7 - 10 days until my patient was stable and then at least every 3 months, preferably 6 weeks. Don't forget the dose may need to be lower at night than in the morning to account for different feeding and excercise habits.

Re: Diabetic Cat having funny episodes

Claire Edgington — Thu, 20 Oct 2011 20:24:04 GMT

The glucometer was taken about 20 mins before the vettest reading (my nurses did it while I was in with the previous client). He hadn't had his insulin that evening so I wasn't thinking about an overswing at that time of night. When he had another episode on Sunday, the owner noticed he improved after he was given his insulin at night - I can't work out how this would fit in......

I will maybe speak to the owners about having him in for a glucose curve a some point.

Re: Diabetic Cat having funny episodes

Martin Atkinson — Thu, 20 Oct 2011 17:54:01 GMT

Were the samples for the glucometer and the Vettest taken at the same time? Glucometers except the Alphatrac tend to read low but that is a big difference. 3.3 however suggests he may have gone hypo and if the Vettest sample was take shortly after it sounds like a Somogyi over swing and the level before the glucometer test may have been even lower than the 3.3. Fructosamine is unreliable on its own and you really need a glucose curve. If this is not possible immediately I would suggest lowering the dose of insulin by 25% as a precaution then doing a curve in a few days. Diabetic neuropathies do occur but usually at much higher levels of hyperglycaemia. If it is truly unstable with these peaks and troughs then you may like to consider insulin glargine. I had a diabetic pet cat which had similar neurological symptoms but when I took his glucose it was always normal. I have since learned that spot tests are useless as he probably had been hypo and was now over swinging before the symptoms subsided.