Diabetic cat - in and out of hypo/hyper glycemia / no appetite

11 year old female Ragdoll was found unresponsive but conscious on Monday morning (Jan 16). We took her to the animal hospital where her BG was 1.3mmol/L. During her stay she was administered dextrose, catheter placed and IV infusion. She was then discharged in the evening with a BG of 14.5mmol/L.  -- At discharge she continued to exhibit symptoms of not responding to her name, walking around aimlessly, and confused. Monday evening we could not give her insulin because of the state she was in, and not eating. Tuesday morning (Jan 17), she stopped drinking, and ate very small amount of dry food. Was fatigued, tired, sleeping. We could not administer the insulin because she was not eating. Wednesday morning (Jan 18), we took her back to the hospital due to no improvement in condition and no appetite. We were advised her BG was at 35.8mmol/L and was hyperglycemic. Given continuous low-dose IV infusion of 25Y of Regular insult to 500ml of 0.9% NaCl solution. 1+ ketones discovered in urine, and changed protocol to IM insulin injections: 0.25U/kg, then 0.14U/kg one hour after. Following this, BG rises to 40.6mmol/L. We were advised at discharge that we required to transfer her overnight to the ER, as her BG only went down to 38.5mmol/L. Unfortunately, we were not able to afford the overnight stay, and our only option was to take her home for monitoring. We gave her 3U of lantus that night, and then 2U Thursday morning (we were instructed to do so). Thursday morning (Jan 19) - no improvement in condition, not eating, but did drink a little bit. We were told to bring her into the hospital again. Her BG was 4.8mmol/L. She was syringe fed, and fluids. BG dropped to 4.1mmol/L. fluid rate was decreased and BG continued dropping to 3.2mmol/L.  In the afternoon she was given 0.37mL of Cerenia IV over 5 min and placed 0.2mL of corn syrup on gums. BG further dropped to 2.5mmol/L, and began starting 5% Dextrose in PLA at maintenance rate. VJ, RVT. She was later assist fed 12mL of DM with warm water via syringe.  This followed by taking out 100mL of PLA and replaced with 100mL of Dextrose 50% to make a 5% solution. BG rised to 3.3mmol/L. then later again to 5.7mmol/L. We were told that she would need continued care for multiple days, however due to our financial restraints we were advised to book an appointment to euthanize her. When we came to the hospital in the evening, her BG was at 8.4, but was walking around aimlessly (same symptoms/state), and wasn't meowing etc. We were then told by the vet who was going to inject her that if we are uncertain, and given her being within normal BG range, we should try to see if she will improve, and provided us with syringes to feed her, as well as Buprenorphine and Mirtazapine. Since last night and today (Jan 20), she still is not eating by herself, but accepting the food from syringe. She is drinking. Mentally she isn't meowing, looks still lethargic and rests. She has jumped on our couch/bed a couple of times. We decided to give her the weekend, to see if a) she starts eating on her own, and b) improve mentally. We will take her back to the hospital Monday if unfortunately she does not improve to say our goodbyes. Given these events, and treatment provided, I feel that her Hyperglycemia  on Wednesday and Hypoglycemia on Friday could have easily been avoided if we were provided with syringes that Monday to feed her so we can give her insulin. No one was able to tell us why she did not have an appetite since Monday evening either. We have come to terms with what we need to do if she does not improve in the next two days. But I want to ask and have your opinion on whether the way the animal hospital treated her was proper, and/or what should have been done instead/concurrently? Additionally, if there are any recommendations or advice to perhaps try and get her eating this weekend on her own, or if there is anything else we could possibly do to get her to turn this around?

Hello and thankyou for this well explained history.  I empathise a lot with your cat because I am diabetic too and let me tell ypu that diabetes and insulin control is not an exact science;  in geberal, insulin lowers blood glucose and sugar increases it, but illness knocks sugar control out of the ballpark.  I once had a Covid vacc and couldn't get my sugar under 10 for five days.

Now then, your cat is ill and showing neurological signs.  Could she be made better?  Well it depends on the underlying cause of those signs.  Meanwhile, it seems to be proving extremely difficult to get her diabetes stable - every time the vet seems to be making progress, they have to take her off the drugs she is on and pack her off home.  On the first day she seemed to be making progress but then wasn't seen again until the Wednesday and they were back to square one with her sugar control - now she keeps going home overnight and the sugar levels are struggling each time.  Damage may be happen to a cats system when ketones are about, but more concerningly, because vets are having to address the difficult business of keeping a cats' sugar levels right (which sounds to be taking up a lot of financial resources), finding the underlying cause may not be getting the resources that it needs. Is it just that the blood sugar's gone out of kilter?  Is there a tumour in her liver or pancreas?

What is causing the brain signs?  These are important questions if the answer is going to be crucial to recovery. I know that financial and practical resources would ideally not come into decisions regarding the care of an obviously very loved cat, but sadly they do;  they come into human NHS care too, and every doctor, vet and patient wishes they didn't.  It sounds as though resources - either financial or practical - havent been available for the round the clock drugs, nursing and fluids required to keep this patient stable.  It sounds as though the full extent of her issues (pancreatitis for example?)  may not yet be known.  It sounds as though she is not responding well to the considerable treatment and effort she is already receiving from yourselves and her team as it stands, and as the illness progresses this may need to be stepped up - perhaps to hospitalisation with a 24/7 provision - rather than down .  Further, she is a 12 year old diabetic cat with the known possibility of underlying issues, so her life expectancy may not be long.

I think that two good questions for your clinician are, 'what would you be doing in my shoes?' - I dont know one vet who wouldn't take that question seriously and answer it honestly.  Also, if you want to know, 'Do you think we could have done anything differently?' and 'Would it have changed the outcome?'   Greif - regarding a dying animal or simply an ill one - can be enormous and it is human nature to blame ourselves, or the vet, or the system, or the animal.   In general however, I would argue that most people try to do the best they can with what they have and what they know.

Finally, wishing you all the best going forward.