Poncho diagnosed diabetic 1/15

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For all helping Chris, I've done a tid dosing SS for him and have linked it so it is the first one you see. The bid dosing SS is the second tab if you need to look back at that one.
 
Chris - BREATHE! And another big slooow breath. Compared to what you've already gone through, a 'hypo number' isn't a big deal, it's just a low glucose number. There's no need to go into panic mode, it can be handled easily. All you need to do is get some 'sweet' into him just like a human diabetic eating a piece of candy when they feel weak and shaky. The panic part is when you don't anticipate it and suddenly have a dangerous situation on your hands. You're already prepared 'just in case' - you'll just be doing something different than what you've been doing. Rubbing honey on his gums is a LOT easier than giving those fluids!

BREATHE! HUGS too! You're doing AMAZING!
 
Squeaky and KT said:
Chris - BREATHE! And another big slooow breath. Compared to what you've already gone through, a 'hypo number' isn't a big deal, it's just a low glucose number. There's no need to go into panic mode, it can be handled easily. All you need to do is get some 'sweet' into him just like a human diabetic eating a piece of candy when they feel weak and shaky. The panic part is when you don't anticipate it and suddenly have a dangerous situation on your hands. You're already prepared 'just in case' - you'll just be doing something different than what you've been doing. Rubbing honey on his gums is a LOT easier than giving those fluids!

BREATHE! HUGS too! You're doing AMAZING!
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Thank you! I'm sure I can handle it fine.....I agree about the giving fluids....I hate sticking that big needle in. It got easier tho after I trimmed down his fur so I could see what I was doing. But he can feel it I think.
 
It seems okay to me but I would keep feeding him as you are doing. Am sure others will be able to advise on the drop. We want him in these lower numbers.
 
Syringing him some LC right now is fine. You might want to check him at +4 as long as the food has had at least 30 minutes in his system just to see the exact rate of the drop.
 
christoph,

If there is any way on monday that your Vet (the one in St. Louis) could call in a potassium supplement and an anti-nausea med to a pharmacy, and give you dosing instructions this would help. His potassium is probably low at this point (due to insulin + diuresis + fluids) and usually supplementation is necessary for a day or two.

If he starts eating normally, you can forgo the suppliment. The anti-nausea will really be the magic bullet to allow you to get more sleep and allow him to want to eat on his own. If he's a dry food junkie, now is the time to leave a bowl out and see if he'll eat during the day.

You'll want to get some labs done pretty soon to see if there are any other issues going on and prevent a recurrence.

Also, when he is back to eating and feeling better, you might want to ask a vet about changing your insulin to lantus or levemir. These provide better protection from DKA in a cat such as yours, and won't send his blood sugar down so hard. These would be twice a day dosing.
 
phlika29 said:
It seems okay to me but I would keep feeding him as you are doing. Am sure others will be able to advise on the drop. We want him in these lower numbers.
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Sarah, his last dose before the 1 unit was 0.5 unit right? I must have put 1 unit on my SS in error.....sleep deprived I guess. I'll go back through the
Marje and Gracie said:
Syringing him some LC right now is fine. You might want to check him at +4 as long as the food has had at least 30 minutes in his system just to see the exact rate of the drop.
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By LC do you mean low carb?
 
Meya14 said:
christoph,

If there is any way on monday that your Vet (the one in St. Louis) could call in a potassium supplement and an anti-nausea med to a pharmacy, and give you dosing instructions this would help. His potassium is probably low at this point (due to insulin + diuresis + fluids) and usually supplementation is necessary for a day or two.

If he starts eating normally, you can forgo the suppliment. The anti-nausea will really be the magic bullet to allow you to get more sleep and allow him to want to eat on his own. If he's a dry food junkie, now is the time to leave a bowl out and see if he'll eat during the day.

You'll want to get some labs done pretty soon to see if there are any other issues going on and prevent a recurrence.

Also, when he is back to eating and feeling better, you might want to ask a vet about changing your insulin to lantus or levemir. These provide better protection from DKA in a cat such as yours, and won't send his blood sugar down so hard. These would be twice a day dosing.
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I think he'd be ok with that....or a mobile vet I use but he's hard to get ahold of. Thanks for the useful info. I'll put out a bowl of dry to see if it will help his appetite.
 
Christoph, what is the fluids you're giving him? I glanced thru the posts and just see 'subq fluids' but likely missed it. If it's 'lactated ringers solution', that will have potassium in it...

DANCE!!! WOOT WOOT!
 
Squeaky and KT said:
Christoph, what is the fluids you're giving him? I glanced thru the posts and just see 'subq fluids' but likely missed it. If it's 'lactated ringers solution', that will have potassium in it...

DANCE!!! WOOT WOOT!
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Yes...lactated ringers. The right stuff?
 
BJM said:
That 182 is really nice. And the lowering of the ketones is really, really good.
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That's encouraging.....thanks BJM. He sure doesn't feel better it seems. Guess I'm impatient to get him back. Should I test every hour until 8pm (?dosing time?)?
 
I'd go for every 2 hours and just watch him. If you see something concerning - ex dilated eyes, vacant stare - then test.
He dropped only 21 mg/dL between +3 and +4.

So the next test is a +6.
 
Yes, supplementation beyond the lactated ringers is usually needed at least until the oral intake improves. It's hard to say how much to supplement, however, because really this is something you'd track through labs. Too high is just as bad as too low, but right now, a little bit extra is going to support all the potassium his body is wasting.
 
That's great. It looks like the 1 unit is working well. I don't think you need to add dry food just keep going with the low carb wet and as BJM said retest in another 2 hours at +5 unless you see something that might indicate he is going low.

I don't think he will go low but just be aware of these symptoms. If you do get concerned don't forget you can always edit the title of the original post by going back to the first post and editing it. Again I don't thankyou will need to but just in case change it to today's date and put low blood glucose help needed.

SYMPTOMS
Some cats may have NO symptoms whatsoever, but here are the most common ones:

MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

You are doing great. It will be a while before Poncho begins to perk up so don't get disheartened. Just keep going with the fluids and the food.

I will leave you now as it time for my bed. Please look after yourself and get some sleep when you can. I am sure others will be about to keep an eye of you. I will see you in seven hours.
 
Just my opinion but I wouldn't suggest starting potassium supplementation until blood work can be done to find out that level. Too much can adversely affect the heart, too low will cause muscle weakness. I just wasn't sure how much K was in LRS.
 
Per Renal K (a dog cat/supplement) the dosage is 2mEq/10lbs given twice daily. Since the lactated ringers has potassium in it, less then this would probably be ok until he starts eating. It's hard to say without seeing labs, but listlessness is a sign of low K+ (and everything else going on).

There is a "naturemade potassium gluconate" over the counter supplement from walgreens (550mg - 90mg k elemental) that is about 2.3mEq per tablet. You could crush 1 tab a day and add to food.

The potassium in lactated ringers is lower than the potassium that is normally in the blood therefore, overtime of giving LRS, this will still lower the k+. In addition, diuresis and insulin lower k+. I feel it's safe to add a small amount of supplement for a couple days until he can get labs drawn. The likelihood and risks of low are outweighing high at this point, until he starts eating.
 
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But how does that compare to mEQ - milliequivalents? That is a vet question as too much or too little potassium can affect the heart and interfere with its function ... fatally.
 
I've been looking in on this thread now and then, though I don't have anything I can add on dosing/food etc. But I would second BJM and Squeaky & KT on how tricky potassium dosing can be. Our CKD kitty is on potassium every day plus lactated ringers twice a week. The potassium pills come with very strict dosing instructions - including timing of doses to make sure she's not in overdose even for an hour because of how dangerous it would be. We use Tumil-K on prescription from the vet. Although we buy the pills in bulk and therefore they look quite expensive per batch, I don't think the price per pill is all that high overall. I'd be inclined to ask your vet for bloodwork and a prescription rather than take any risk of giving too much.
 
Each tab of the OTC mentioned above is 2.3mEq. I agree with the comments regarding safety, but that's why I'm bringing it up. Everything we are telling him to do is going to drive him low. Labs do need to be done. 1-2 days of k+ supplement is not going to raise him that much, until he can get labs drawn.
 
yeah no more than 1 per day. I wouldn't do it more than a couple days (blindly) without seeing a lab. However, he may be verging on heart-attack territory from being low, and this needs to be addressed.

Chris, can the mobile vet draw labs?

With the BS and ketones decreasing, he really should start to perk up and not be as listless. I suspect if he remains listless it's an electrolyte imbalance (and probably not sodium as cat food has plenty).
 
Meya14 said:
yeah no more than 1 per day. I wouldn't do it more than a couple days (blindly) without seeing a lab. However, he may be verging on heart-attack territory from being low, and this needs to be addressed.

Chris, can the mobile vet draw labs?

With the BS and ketones decreasing, he really should start to perk up and not be as listless. I suspect if he remains listless it's an electrolyte imbalance (and probably not sodium as cat food has plenty).
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Aren't electrolytes in sub q fluids? He is still getting over an upper respiratory illness and has 5 days to go on the antibiotics Clavamox and Doxycycline. That illness was full blown when they tried the curves unsuccessfully. I'm sure the mobile vet can draw labs....it might take a couple days to have him call me back.
 
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Come up, probably; bounce, maybe. Keep in mind you are feeding a medium carb food which will push the numbers up a bit faster. It also lets us give enough insulin to help prevent the ketones.
 
Wow,
I can't hope to catch up with almost 300 posts.
But I will say this, because my cat was DKA, and he got potassium supplements for weeks due to low K levels in his blood work.

Excessive potassium can kill a cat.
NOBODY HERE is a licensed vet.
NOBODY HERE is qualified to advise that you give your cat potassium.
You should not give potassium until your vet tells you to, and it has been verified BY YOUR VET that potassium is indicated.
After that, you will need to bring the cat back in for blood work so that his potassium can be monitored to keep it within the normal range. Too high is just as bad, or worse, than too low.

Telling a caregiver that "I feel it's safe", or " X amount should be okay" doesn't cut it. Not unless you are ready to take personal responsibility for the life of their cat, or plan on covering the vet costs for "bad" advice.
 
Meya14 said:
.... he may be verging on heart-attack territory from being low, .....
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Full body extreme weakness will occur before that point is reached...he's not near that point so let's not scare Christoph. Unfortunately I know way more about the effects of potassium in the body than I EVER desired to know...hubby has 'hypokalemic periodic paralysis'. Our lives revolve around potassium...
 
christoph said:
Aren't electrolytes in sub q fluids? He is still getting over an upper respiratory illness and has 5 days to go on the antibiotics Clavamox and Doxycycline. That illness was full blown when they tried the curves unsuccessfully. I'm sure the mobile vet can draw labs....it might take a couple days to have him call me back.
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Yes electrolytes are in Lactated Ringers fluids. Potassium levels are included in about every blood test.
 
Sorry, I guess I'm jumping the gun on all this/thinking aloud too much in my previous posts. I guess my point is - the potassium is likely pretty low with everything going on, this could be very serious, get labs ASAP.
 
Chris, I just want to add a little moral support. You sound tired and you're getting a lot of advice right now. I would find it overwhelming.

Please continue to work closely with your vet - whichever one will work with you, to help pull Poncho through this. I would continue testing a couple of times a day for ketones as well.
 
Squeaky and KT said:
Full body extreme weakness will occur before that point is reached...he's not near that point so let's not scare Christoph. Unfortunately I know way more about the effects of potassium in the body than I EVER desired to know...hubby has 'hypokalemic periodic paralysis'. Our lives revolve around potassium...
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Lyresa,
Bob suffered from full body muscle weakness due to hypokalemia. Can't hyperkalemia also lead to a heart attack at some point?
 
@Carl & Polly Hypokalemia is low potassium. It begins with general muscle weakness and moves to full body muscle weakness involving all the skeletal muscles. Altho' the heart is a muscle, it is not affected nearly as quickly as the skeletal muscles. The muscles supporting breathing are also not affected as quickly altho' it can cause shallow breaths due to weak diaphragm muscles. The body is basically flacid and skeletal muscles unable to contract before the heart muscles begin weakening. The heart won't beat as fast but there are many signs that something is very seriously wrong before the heart muscle becomes weak enough to quit.

Hyperkalemia, high potassium, does quickly affect the heart by causing the heart to race and blood pressure to be extreme fairly quickly. The more potassium given when high, the harder the heart beats until it can't stand the force and stops.

Potassium is the main ingredient in lethal injections used for the death penalty.
 
Libby and Lucy said:
guys, let's be careful about crossing the line between helping a caregiver of a diabetic cat and giving medical advice. We are not veterinarians and can only responsibly do so much.
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Boy I couldn't agree more with this statement. It's one thing to give fluids with potassium under a vet's orders; there's not enough potassium to generally do harm in the fluids. Supplementation with potassium absolutely must be done under a vet's supervision with close monitoring.
 
I need to do Ponchos +8 BG test. I will post and want some input as to insulin dose. Still using the scale and is it based on 8 hour doses? Thanks.
 
Still using the scale; for now, it can be used with any time frame. We're still learning what works for Poncho.
 
BG @ +8 1/2 is 370......fed at 7pm which was very stressful as usual .....it really jumped. Do I give 1 unit?
 
Yes. It looks like it could be safe. Checking about +4 should let you grab a nap of 3 hours.
 
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