blood sugar, infections, and stress

Does anyone here know how much a bacterial infection and stress could possibly raise blood sugar? Also, once the infection is treated, how long before the sugar starts dropping, and how long before it hits a stable number?

The situation: my girl, Ivanna, had a severe ear infection that showed no symptoms until it became very bad. We don't know how long it was there. Tuesday the vet put her under to remove a very stubborn polyp and infection that she said was like cottage cheese from her middle ear. (they got 99% of it out) When running her blood panel on Monday before the surgery, her sugar came back as 323, with no keto. They ran it again Tuesday and it was 325 with no countable keto, but was supposedly turning the test strip a color that indicated that there might be a very low number there.

 I know infection and stress can both raise sugar in cats, but can't find by how much or how long it would take for things to go back down to a true number once the infection is gone. The vet won't answer me. I don't know if she just doesn't know herself. For now, they put her on 1 unit of insulin twice a day. They will be checking her again today and tomorrow to see where it is. The vet is adamant about the fact that she is definitely diabetic. But I did get her to agree to the possibility that maybe it can be managed without medicine in the not too distant future.

 Another thing that could have factored into the sugar is that, once the infection started to affect her, I started giving her more dry food and treats to keep her eating.

 She has shown no symptoms common with diabetes. No frequent drinking, no frequent urination, no weight loss. She is not overweight. The vet is actually surprised about all of this.

 Other information: she already is on what is considered a low carb diet. The food she eats runs 8-11 carbs per 100 calories, which I am told is low. I know there are some lower ones, but I am hesitant to change while everything is in flux at the moment. The vet said I could change if I wanted to, since so much was changing now...but I've heard elsewhere not to change diet when first starting insulin? 

Any ideas, information, or help?

I don't think I would mess around with this issue and would go ahead and give her the prescribed insulin and keep checking her blood sugar until it gets within normal range again.  I have no idea whether it will ever get back to normal or not..only time will tell.  Did you straight up ask your Vet WHY she won't answer your question..whether she just doesn't know or what?  I would. 

If your Vet says it's ok to change her food now, I would imagine there is no issue with doing that.  Do you think Ivanna will take to a food change easily?  I go by% of carbs a a dry matter basis rather than the number per calories, and try to keep it under 10 %.  What did your Vet advise in this instance?  (however, I don't have any diabetic cats).

I am giving her the medication as prescribed, I'm just concerned about what happens if her sugar starts dropping as the infection moves out, and it's not being monitored properly. 

 Ivanna will eat anything that has a picture of a cat on it, so yes, she would probably take the food change well! The vet was fine with the carb content of her current food, but my view is that if it gets cut down more it should help the sugar get back where it should be. But then, this is my first diabetic cat, so I don't know if that is actually true. Maybe anything under a certain number is fine and going lower won't make a big difference. 

 I just find it odd that she would be diabetic with no symptoms...

Yes, it IS odd, and perhaps it is Secondary Diabetes due to her other issues...impossible to know.

You are going to monitor her blood glucose and ketones, right?  Say before you give her the insulin, test her blood to make sure she needs it?  That's what normally happens, I think.  Otherwise, be sure you know the symptoms of low blood sugar so you know what to look for. 

The signs of hypoglycemia may occur suddenly and include:

• Lethargy or dullness
• Restlessness, anxiety or other behavioral changes
• Weakness, difficulty standing or a staggering gait
• Muscle twitching
• Seizures
• Coma
• Death

ff you think she's having a hypoglycemia attack, get some food into her, and some honey or corn syrup if possible.

Well, I just gOt back from a 24 hour follow up appointment. It was supposed to be a couple if days, but the vet fit me in because of my concerns to test her again. Less than 24 hours of being on insulin, and they have already cut the dosage in half. So, now it is only one unit in the morning, and nothing in the evening.

Tomorrow there is another follow up. I don't know what numbers she wants to see, but I am hoping to get Ivanna off of the meds as soon as possible.

To answer your question: no, her sugar isn't being measured at home. That's what is making me so hesitant about the entire thing. I was told to give her a shot twice a day going off of the assumption it would be high. If she had been given the evening shot today, blindly as ordered, I do wonder if her sugar would have crashed.

I was told to watch for the symptoms of low blood sugar and told to buy Karo syrup just in case. I know humans do a finger prick test before dosage but I don't know if there is a method to test a cat before every dose.

Well, there IS a way to test cats...same as humans on they you prick their ear to get the drop of blood instead of pricking their finger.  I think you use the same test strips, etc. but on that I am not completely sure.  I'm surprised your Vet didn't go over that with you.  I suspect she really didn't think Ivanna would be on the insulin for long. 

Hopefully her glucose will be back to normal very soon and you can put this behind you.  It is worrisome, I know

Thanks, that is my hope too!

For more info and help on testing a cat's blood glucose levels at home, visit FelineDiabetes.com There's a great message board there too for additional help with experienced members.

Some diabetic cats will have no signs of hypo until the blood glucose level is very very low and sometimes not at all I had a diabetic cat before and he had quite a few hypo episodes. One time I felt something was off so I tested his blood glucose level and it was 38 mg/dl This was just 3 hours after I had tested his blood glucose level and got a reading over 300 so I had given him the usual amount of insulin. My cat was perfectly fine and had no hypo symptoms despite the very low blood glucose level.

mrsgreenjeens said:

 
Well, there IS a way to test cats...same as humans on they you prick their ear to get the drop of blood instead of pricking their finger.  I think you use the same test strips, etc. but on that I am not completely sure.  I'm surprised your Vet didn't go over that with you.

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Test strips and the meter can't tell the difference between a Human and a cat The test strip just take the blood sample and the meter gives a reading within a second or two.

There are pet specific blood glucose meters you can buy but they are no more accurate than a Human blood glucose meter IMO. Plus the pet meter test strips are not sold in any store so if you run out of test strips, you're stuck until you can buy more online or from the vet. Some people like to keep a Human meter and test strips on hand as a back up. You do need to remember to check the test strips regularily and use them up before they expire.

Blindly giving insulin is dangerous. It has been compared to as driving a car with a paper bag over your head. Sometimes diabetic cats will be a perfectly healthy normal blood glucose level at insulin time. If you just give insulin, you risk your cat being hypoglycemic within a few hours when you may not be at home. So it's safer to test the blood glucose level to see where your cat is and then determine if insulin can be safely given or not. The usual cut off number for no insulin is around 200 mg/dl. Ask your vet what the cut off number he / she recommends.

Infection and stress can cause elevated blood glucose levels. My diabetic would have much better blood glucose levels after having a dental. One time I tested his level before a trip to the vet and he was at a good level, just under 100 I think. A few hours later when we returned from the vet I tested him again and he had shot up to over 300 from all the stress. A few hours after that I retested him and got lower blood glucose level.

Just my two cents based on my experience with a diabetic cat  

Thank you for the reply! I really do feel the blind dose is dangerous.
When they tested her Wednesday, she was only at 175, and I assume if we had done the evening dose without checking, she probably would have crashed.

Yesterday when they tested her again, she was at 345, and the vet said go back to 2 injections. But knowing that stress can cause a jump to 300, I can't help but to wonder if it were truly a lack of insulin. And I'd say she was pretty stressed yesterday. The screaming cat in the other room while we we were in the waiting area was sending her into a bit of a panic.

I'm going to call her doctor later today and tell her I am getting a monitor, and find out what level should actually warrant an injection. In the mean time, we've skipped the morning dose as a precaution.

When do you check your cat's sugar? An hour after eating? Half hour?


And thanks for that link! I will look at it later today!

jikin said:

I'm going to call her doctor later today and tell her I am getting a monitor, and find out what level should actually warrant an injection. In the mean time, we've skipped the morning dose as a precaution.

When do you check your cat's sugar? An hour after eating? Half hour?
 

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Some vets don't encourage home testing but you do not need the vet's permission to do it. There are many published studies in scientific veterinary journals that support home testing of blood glucose levels in cats. Here's one recent pubslished guideline on managing diabetic cats that has a section on home testing: http://jfm.sagepub.com/content/17/3/235.full.pdf+html

What insulin are you giivng and how much insulin twice a day? I'm only familar with Lantus and Levemir insulins. For all insulins, you test before giving each insulin shot a the very minimum, so twice a day every single day. The "spot checks" can be done whenever you have a free minute. I used to test my diabetic cat a few times in the evening because I worked during the day. One or two spot checks is good. Insulin needs a bit of time to start working so the first check should be done around 2 hours post insulin. A check around the nadir, or when the insulin reaches its peak effectiveness, is helpful to see how low your cat is getting on the current dose of insulin. Nadir can be around 6 hours post insulin but in some cats it may be a bit later. If you're using either Lantus or Levemir, there's a great explanation on what happens every hour to a cat's blood glucose level in one of the stickies at the top of the FDMB Lantus and Levemir board. I'm not sure if any of the other insulin specific boards have similar info but users of those insulin can definitely  tell you.

With a hypo cat,  you test about every 15 minutes or so until the cat reaches a more normal blood glucose level and stays there. Make sure to always have plenty of unexpired test strips on hand. If the cat keeps crashing despite home treatment of high carb food and honey or other sugar for more than a few hours or starts to show more serious signs of hypo, then a trip to the vet ER is needed for more aggressive treatment.

If you do a curve at home, you test approximately every 2 hours from right before giving the morning insulin shot to right before the evening insulin shot. Don't go nuts trying to do it exactly every 2 hours. Sometimes cats don't cooperate

The FDMB board is great and the members there can help you with your cat even if she's just a temporary diabetic possibly caused by the ear infection.

Thanks for the information!

She is on Prozinc. 1 unit twice a day after eating, if she eats at least 50% of her normal amount of food.

I've left a message with the vet and let her know that I am picking up the monitor and having her call me back at what level she wants her getting an injection at. I have another appointment on Tuesday before Ivanna's dinner time, and will keep a log of her sugar levels until then. 

At lease Ivanna doesn't have to see the vet for a few dayst. 3 days in a row...she doesn't trust me at the moment when she thinks I'm leaving the house. She thinks I'm about to stuff her in the carrier again!

A log of blood glucose levels is really helpful, especially when you share it with the vet The FDMB has a Google based spreadsheet you can use to track blood glucose level. People on that board can help you get one set up. You just email the vet with the link to the spreadsheet and discuss from there your cat's progress. Paper and pencil is also a simple way to track numbers.