Recently diagnosed diabetic cat - seeking general advice

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Glad the nurse stopped the doctor. Also, 4U might have worked for them while Oliver was there but not when he came home. Most likely his BG's are higher at the vet because they're stressed. As far as how high is too high, I don't think there's a set answer but more of how long they stay in higher numbers, which can result in the DKA. Hopefully one of the more knowledgeable members will chime in :).
 
Wow. So glad that the nurse was on the ball and was able to stop things in their tracks! Yikes.

I think there's value in having him monitored at the vet overnight-- you won't have to worry about his safety all night and it gives you a break from the stress (it ended up being a pretty stressful day!) so you can regroup for tomorrow.

Couple of things: first, it's not surprising that he might have needed less insulin at home than at the vet's. Stress in cats can raise BG numbers, in some cases by hundreds of points. This is one of the things that makes it hard to determine insulin dosage in a vet's office, and one of the reasons why we are such big advocates of home testing-- until you see how a cat reacts to a particular dose in the home environment, it's hard to tell what the right dose even is.

Second: yeah, unfortunately that 487 isn't all that surprising. A lot of that is probably due to what we call a "bounce"-- when a cat's numbers go low (lower than they are used to, or even just dropping at a fast rate), their body reacts with hormones to release stored glucose into the bloodstream to counteract it. Result: numbers that go sky high after a low.

Get some rest tonight, you deserve it-- that was quite a rough intro today, going from "not testing yet" to "OK, really need to test now" in a few short hours! Check in tomorrow, we'll be looking out for you.
 
Glad everything turned out for he best - I also agree that it's just as well Oliver spends the night at the vet's. Keep us posted on his progress, and always feel free to ask questions or ask for help! :):cat::)
 
Hi everyone. I picked Oliver up about an hour ago. We're both home now. He was given his food and some insulin right before I picked him up at the vet. He looks really good. He was very curious and checking every room of the house out as if he had never been here. And, of course, he's still hungry and wanting to eat more. But I'm glad he is feeling better and is doing well. He seems to be responding better to the 3U but we'll just have to see how he does at home. His BGs were monitored throughout the night and he never got low at all. So all is well for now. I think we are both going to rest now. I didn't sleep well but I generally have issues sleeping. Will update when I get some more information and observations on how he is behaving.
 
So glad to hear he's feeling so much better! Hope you are able to catch a nap or something now that he's home.

It'd be good to get a BG reading when you can, too-- I know he didn't go low at the vet's but, again, vet stress can have a big impact on numbers, so he may drop again now that he's home, even on the reduced dose, so you'll want to keep an eye on him.

Welcome home, Oliver!
 
I'm glad to hear that Oliver is back home and doing so well! Nan is right, you may see his bg still drop some more, so it's a good idea to monitor. Hope yu can get some rest now, knowing Oliver is okay!:cat:
 
Thanks guys. I agree that a test is necessary. I tried to test him a little while ago and was unsuccessful. Unfortunately I just couldn't get a blood sample after pricking. I think I need to find a way to better warm his ear. I tried a warm washcloth in a plastic bag but he just wouldn't let it anywhere near his ears for more than a second. I'm going to let him relax for a bit and try again in a little while. The good thing is he is much more interactive. He isn't hiding under beds and even when he is napping he is within view. This is much more typical of his normal behavior.

Edit: Earlier today.

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ML31 said:
Thanks guys. I agree that a test is necessary. I tried to test him a little while ago and was unsuccessful. Unfortunately I just couldn't get a blood sample after pricking. I think I need to find a way to better warm his ear. I tried a warm washcloth in a plastic bag but he just wouldn't let it anywhere near his ears for more than a second. I'm going to let him relax for a bit and try again in a little while. The good thing is he is much more interactive. He isn't hiding under beds and even when he is napping he is within view. This is much more typical of his normal behavior.
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Many of us (myself included) use an old, clean sock with about 1/2 cup dry rice in the toe, tied off and warmed in the microwave until very warm but touchable. Others use any small bottle with a lid that screws on tightly and fill it with very warm tap water.
 
Aww, cute pic. He looks very relaxed and content.

To warm his ear you can try a bit of rice in a sock, that you can warm in the microwave (just don't let it get too hot) or some warm water in a small pill bottle. Sometimes you can just rub their ears for a few minutes to warm them up.
 
That's a safe number, but it makes me wonder about that 3U, given that it's been 7.5 hrs since the shot on a short-acting insulin. Hmmm.

For reference: 50-120 is the rough range of "normal" BGs for a cat when using a human meter. Please do post a pre-shot reading tonight before shooting 3U tonight-- if he's anywhere below 250 or so I would be very wary of shooting the full dose.

You are going to go see your regular vet tomorrow, correct? I don't think we've talked a lot about insulin choices. Good insulins for cats are the depot insulins Lantus and Levemir, and the long-duration non-depot insulin ProZinc. I've only used Lantus, and would recommend it (among other things, the L+L community on this site is enormous and enormously knowledgable), but they all have their strengths, and it may depend on what your vet is comfortable with. Vetsulin/Caninsulin is another in-and-out insulin, it's less dramatic in action than the NPH you are using, but similarly tricky to dose in cats-- some cats do very well on it, but I wouldn't recommend it as the first choice if you are given a choice.
 
Will test him again before food/insulin. Due at around 2.5 hours. I absolutely agree. I am going to mention insulin and see if there are other choices available. I still find the 3U to be high. I noticed when he came home from the vet shortly after he was very alert and friendly. As it neared toward peak time, he became withdrawn and was hiding again. I think we are making progress but there is still a long way to go. I will update when I have more information later. He's comfortable now, was out and socializing after a little snack for a bit but is now back to lurking from underneath the pull-out sofa in the hallway, kind of just observing.
 
He is at 175 right now. It is time for him to eat. His insulin is due in about 25-30 minutes. Do you have any dosage recommendations? Should I still give him insulin? I'm really worried that it's been almost 12 hours and he's 175 so I don't know how 3U would affect him. I'll be back in a few minutes.
 
Nan & Amber said:
We generally try to "stall" without eating in this situation, retesting in 15-30mins to see if the numbers are climbing. But that is pretty low for a pre-shot.

@Jill & Alex (GA) , I don't suppose you are around to help? @Bobbie And Bubba , @Chris & China , @Kris & Teasel
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I'm here. What insulin again? Vetsulin? This is a post DKA cat so no insulin isn't the best idea but 3 u is likely too much. I think a stall up to 60 minutes in 20 minute increments is possible. There's more dose timing flexibility than with the L insulins.

ETA: Found it - it's NPH. Stalling would work with this too.
 
Kris, it's NPH, which is I think like an even more dramatic Vetsulin. I don't think I'd give more than 2.0U in this situation, I'm even wondering about 1.0U.

Is he eating well today? I know he's been doing a bit of hiding, but that may have been just him reacting to the yo-yo-ing BG numbers. We don't want to skimp on the insulin with a post-DKA cat, but I'm not sure that's the biggest risk in the very near future.

Can you monitor for a while tonight if you had to?
 
Nan & Amber said:
Kris, it's NPH, which is I think like an even more dramatic Vetsulin. I don't think I'd give more than 2.0U in this situation, I'm even wondering about 1.0U.

Is he eating well today? I know he's been doing a bit of hiding, but that may have been just him reacting to the yo-yo-ing BG numbers. We don't want to skimp on the insulin with a post-DKA cat, but I'm not sure that's the biggest risk in the very near future.

Can you monitor for a while tonight if you had to?
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I agree that 1 u is the way to go as well. Evening testing is important.
 
I agree that stalling for 20 mins and a retest to see if Oliver comes up is a good idea. I am scanning through the post since yesterday to get a feel for everything. Oliver has only been on insulin for about a week is what I am gathering? If that is correct, shooting under 200 without any data is tricky but a cat recently with a DKA history needs to have insulin.

How is Oliver eating?
 
Matt, you don't happen to know what his BG numbers were this morning at the vet before the shot, do you?

Brief history: on insulin (NPH) for about a week, most of which time was in the hospital from DKA. Just started monitoring yesterday.

At the moment, we have him at 84 at +7.5 after 3U NPH this morning, and 175 at +11.5, so maybe 20-25 pts per hour. Yesterday (first home bg tests) he was in the 40's at +8 and (after loading up with carbs) in the 400's a couple hours later. At the vet that evening, he got 3U NPH and "didn't go low" all night, but we don't have numbers that I know of.

So, we know that he responds to carbs. We'll see what Matt says about possible food changes today. I think another option (considering the DKA) would be to give more insulin but also carb him up, but this kind of thing is pretty far out of my league.
 
Nan & Amber said:
Matt, you don't happen to know what his BG numbers were this morning at the vet before the shot, do you?

Brief history: on insulin (NPH) for about a week, most of which time was in the hospital from DKA. Just started monitoring yesterday.

At the moment, we have him at 84 at +7.5 after 3U NPH this morning, and 175 at +11.5, so maybe 20-25 pts per hour. Yesterday (first home bg tests) he was in the 40's at +8 and (after loading up with carbs) in the 400's a couple hours later. At the vet that evening, he got 3U NPH and "didn't go low" all night, but we don't have numbers that I know of.

So, we know that he responds to carbs. We'll see what Matt says about possible food changes today. I think another option (considering the DKA) would be to give more insulin but also carb him up, but this kind of thing is pretty far out of my league.
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I'm not that confident advising about carbing and dosing a post DKA kitty.
 
Didn't get to read in time. I felt so bad after unsuccessfully testing him several times I had to feed him. He ate but I'm just not sure about the insulin. Since he came home he has maintained an almost unquenchable hunger so he's been eating very well.
 
I am sorry but I'm in TX....my brother in law passed away and the funeral was today. I just had so many notifications that I checked in quickly.

I haven't kept up on what is going on with this kitty and I can't stay online so I'm a little nervous about trying to offer advice under the circumstance. I don't know how he's been eating and drinking or how long since he's had ketones.

I'm very sorry I am not able to help tonight but I don't have the time to educate myself on this kitty to be sure the advice I give is safe.
 
Nan & Amber said:
At the moment, we have him at 84 at +7.5 after 3U NPH this morning, and 175 at +11.5
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Are there any test in between the +7.75 and the 11.5? If he didn't go any lower, that was a nice nadir today. Can you monitor tonight carefully if you should give him 3 units? Plenty of test strips
Marje and Gracie said:
I am sorry but I'm in TX....my brother in law passed away and the funeral was today. I just had so many notifications that I checked in quickly.

I haven't kept up on what is going on with this kitty and I can't stay online so I'm a little nervous about trying to offer advice under the circumstance. I don't know how he's been eating and drinking or how long since he's had ketones.

I'm very sorry I am not able to help tonight but I don't have the time to educate myself on this kitty to be sure the advice I give is safe.
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Understandable Marje. Sending hugs and we will do the best we can tonight. Hugs. :bighug:
 
I think part of the concern is that, though none of us here presently have worked with NPH, our impression is that it's a pretty fast-acting short-duration insulin in general. So, that 84 at +7.5 might not have been the nadir-- Matt reports that Oliver was hiding and withdrawn "at peak time" (not sure when exactly that was), which is the kind of thing he was doing this weekend when 4U bid was being shot blind, before we got the 43 shocker at +8 yesterday.
 
I'm just so upset. I just pricked him two separate times and I was unable to draw blood. I feel so bad for him. I want to help him but I don't know how many more times I can do this.
 
Nan & Amber said:
I think part of the concern is that, though none of us here presently have worked with NPH, our impression is that it's a pretty fast-acting short-duration insulin in general. So, that 84 at +7.5 might not have been the nadir-- Matt reports that Oliver was hiding and withdrawn "at peak time" (not sure when exactly that was), which is the kind of thing he was doing this weekend when 4U bid was being shot blind, before we got the 43 shocker at +8 yesterday.
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I think 3 u is obviously too much based on PS of 175. This is a short duration insulin so if it's still hanging around at +11.5, the dose is too high. A dose of 1 u would be a minimum and maybe 2 u a maximum. This is all guessing of course.
 
ML31 said:
I'm just so upset. I just pricked him two separate times and I was unable to draw blood. I feel so bad for him. I want to help him but I don't know how many more times I can do this.
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You're doing great. This is really hard--- normally you wouldn't be doing this so much when you first started testing, you'd build up slowly to get a routine going, etc. Give him some treats and pets, and remember-- it's unlikely that you're actually hurting him (very few nerve endings in the ears compared to, say, a human finger) you're just kind of annoying him right now. It'll be OK. :bighug::bighug::bighug:
 
ML31 said:
I'm just so upset. I just pricked him two separate times and I was unable to draw blood. I feel so bad for him. I want to help him but I don't know how many more times I can do this.
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Deep breath, I have been there too with not able to draw blood. Are you using a warm rice filed sock microwaved for a few seconds?
 
Matt, try and get another test. You can poke two pokes close together if the first one does not yield any blood. I had to do that tonight with my cat and I have been testing for almost 2 years. I am uncomfortable to advice you with shooting until you get another test number.
 
@Wendy&Neko can you advise? This is recent DKA kitty n 4 Units and presently taking to 3 Units today and a lower than normal PMPS. I need to sign off and get my mom ready for bed. Waiting for a second test 30 + minutes after a 175 test.
 
And, Matt, to confirm-- he's still eating the W/D canned, which Jill+Alex said was about 25% carb?

He's definitely not making it easy!
 
He still eats it but since I gave him the Friskies canned food with gravy he's been a bit more fussy. I've been trying to give him some of this as well but he mainly eats the Hills W/D.
 
Nan & Amber said:
And, Matt, to confirm-- he's still eating the W/D canned, which Jill+Alex said was about 25% carb?

He's definitely not making it easy!
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What are we at now, +13? I don't think stalling is going to work. Why not feed a full meal to get food on board and give something between 1 u and 2 u of NPH with a plan to monitor for the next 3+ hours?
 
If you can afford to be off schedule, I think what I would do is feed Oliver and retest in 2 hours. If his number is above 200, I would go ahead a shoot but I don't know if I would shoot 3 units. Do you have 1/2 marks on your syringe? Perhaps 2.5 units? And test tonight to keep him safe.

ETA: Or go with Kris's plan to feed an shot a reduced shot now.
 
Kris & Teasel said:
What are we at now, +13? I don't think stalling is going to work. Why not feed a full meal to get food on board and give something between 1 u and 2 u of NPH with a plan to monitor for the next 3+ hours?
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We are on the same page Kris. I don't have experience with DKA or NPH but I do know that not giving insulin to a kittie who is recently DKA is not a good thing. We need to hit a happy medium.
 
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