DKA Kitty Back in Hospital - Please Help!

[Bobbie And Bubba]

Hi there. It's hard to know what's happening with the numbers without seeing the tests numbers in a spread sheet(SS). If you could get that set up and put in all the text you have, that would be helpful. If you need help setting it up just yell and someone can you. (sadly , it won't be me as I'm a tech mo mo)

Just wondering if you changed the insulin schedule even an hour sooner than the hospital's insulin schedule, it could have acted as an increase for Millie and she is bouncing from the lows. Did you shot 2 units on 3/14 when you got the 79? And did you get any other test in prior to the PM test.

 

[Wendy&Neko]

Is it normal for a cat to have these types of fluctuations in BG?


3/14 8:00am 79
7:30pm 479
3/15 7:35am 408
7:15pm 70
3/16 7:30am 535

We have not been given instructions regarding increasing her insulin.

On these days, what time did you give insulin? Were these the blood sugar values before you gave the shot? It is very important to get some tests in part way through the cycle ( time between shots). Lantus generally produces numbers that go down starting a couple hours after the shot, to the lowest point, or nadir, somewhere in the middle, then back up again towards the next shot time. If kitty is 70 at shot time, it begs the question, how low was she a few hours before that and a few hours after. We try to figure out the Lantus dose based on how low it takes kitty, so getting some tests 4 to 7 hours after the shot are very informative. That includes night time, as our furred ones like going lower at night.

What food is Millie eating now?

 

[Sylvia & Millie]

On these days, what time did you give insulin? Were these the blood sugar values before you gave the shot? It is very important to get some tests in part way through the cycle ( time between shots). Lantus generally produces numbers that go down starting a couple hours after the shot, to the lowest point, or nadir, somewhere in the middle, then back up again towards the next shot time. If kitty is 70 at shot time, it begs the question, how low was she a few hours before that and a few hours after. We try to figure out the Lantus dose based on how low it takes kitty, so getting some tests 4 to 7 hours after the shot are very informative. That includes night time, as our furred ones like going lower at night.

What food is Millie eating now?

We take her bg reading about an hour before her shot. Problem is we need to both be here to test her, she does not look having her ear pricked, but it's only the weekend that we're both here & can test.

Millie is eating Fancy Feast Classic.

 

[Sienne and Gabby (GA)]

I'd strongly encourage you to use treats as bribes when it comes to testing. The more you associate testing with a treat, the easier it will become to get tests.

Some cats who are recently recovering from DKA can easily have another episode. Because insulin is part of the treatment, you need to know how your cat is responding. The basic "formula" for developing DKA is infection/inflammation + not eating + not enough insulin. It's important to get calories into Millie as well as insulin -- as much of both as is safely possible.

 

[Sylvia & Millie]

I'd strongly encourage you to use treats as bribes when it comes to testing. The more you associate testing with a treat, the easier it will become to get tests.

Some cats who are recently recovering from DKA can easily have another episode. Because insulin is part of the treatment, you need to know how your cat is responding. The basic "formula" for developing DKA is infection/inflammation + not eating + not enough insulin. It's important to get calories into Millie as well as insulin -- as much of both as is safely possible.

Yes, we are giving her treats. There for a number of days it was extremely hard to draw blood, requiring numerous pricks. Now she is a bit resistant.

She is on antibiotics and has a really good appetite, eating up to three 3 oz cans of food.

I'm confused because the other posts said she may be getting too much insulin. Am I reading something incorrectly?

 

[Kris & Teasel]

Yes, we are giving her treats. There for a number of days it was extremely hard to draw blood, requiring numerous pricks. Now she is a bit resistant.

She is on antibiotics and has a really good appetite, eating up to three 3 oz cans of food.

I'm confused because the other posts said she may be getting too much insulin. Am I reading something incorrectly?

I said that the low numbers might be due to a dose that's too high. That's one possibility. I tagged the people who responded and they're giving you their input. They've touched on key points:

• The need to log data in a spreadsheet
• The need to do some testing mid way through the time between doses
• Getting a testing routine that involves treats
• Millie getting enough calories post DKA
• The difficulty in knowing what's going on with her BG without quite a bit of BG data gathering.

The dose might still be a little high. However, your immediate task is to get more test data.

 

[Sylvia & Millie]

I said that the low numbers might be due to a dose that's too high. That's one possibility. I tagged the people who responded and they're giving you their input. They've touched on key points:

• The need to log data in a spreadsheet
• The need to do some testing mid way through the time between doses
• Getting a testing routine that involves treats
• Millie getting enough calories post DKA
• The difficulty in knowing what's going on with her BG without quite a bit of BG data gathering.

The dose might still be a little high. However, your immediate task is to get more test data.

I went to the instructions & tried doing spread sheet but I have some medical issues myself and it's affecting my reading & processing today so I wasn't able to complete. I did give her some higher calorie food and will test her as soon as my husband gets homes (two hours earlier than usual). We will try to proceed once we have that bg reading. Moving forward I am going to try to ask a neighbor to help with Millie's mid-day reading.

 

[Wendy&Neko]

Are you both there in the evenings? Getting a test before bed is usually very informative. As Kris said, we don't have enough data to know if the dose is too much. We determine how to dose Lantus by how low it takes kitty. We don't want her going below 68. If you see her below that, you need to give her high carb food and reduce the dose.

 

[Sylvia & Millie]

Are you both there in the evenings? Getting a test before bed is usually very informative. As Kris said, we don't have enough data to know if the dose is too much. We determine how to dose Lantus by how low it takes kitty. We don't want her going below 68. If you see her below that, you need to give her high carb food and reduce the dose.

We usually test around 7/7:30 in am & 7/7:30 in pm, insulin is then given around 8/8:15. The 70 and 79 were the first times her numbers were that low. I will be giving her a higher calorie food 'til this is straightened out. I sent an email to the ER hospital she was in and her (resident) vet just wrote back. She said to bring her in Friday or Saturday for a Fructosamine test. I have no idea what that is.

 

[Kris & Teasel]

We usually test around 7/7:30 in am & 7/7:30 in pm, insulin is then given around 8/8:15. The 70 and 79 were the first times her numbers were that low. I will be giving her a higher calorie food 'til this is straightened out. I sent an email to the ER hospital she was in and her (resident) vet just wrote back. She said to bring her in Friday or Saturday for a Fructosamine test. I have no idea what that is.

It's a blood test that gives an idea of what the average BG has been in the preceding couple of weeks. Based on that average the degree of BG control is specified all the way from poor control up to well controlled. Problem is it says nothing about how high or low BG has gone.

 

[Sylvia & Millie]

Millie ate a little around 4:00 (she's a grazer). We just took her bg and it was 61. I gave her some honey. Not sure when we should re-test (in an hour, two hours)? I am going to call her regular vet, who hasn't seen her since before the DKA.

 

[Sienne and Gabby (GA)]

Most of us test, feed, and shoot all within about a 5 - 10 minute time span. With Lantus, insulin onset doesn't occur for about 2 hours in most cats so there is no reason to test, feed, then wait for digestion to start and then shoot. If you were using a shorter acting insulin where onset is much earlier, you would want to make sure you kitty has eaten before giving insulin.

You noted that Millie eats "all flavors" of Fancy Feast. Are these the Classic pate (i.e., low carb) only? If not, it's likely that you will see some wide swings in Millie's numbers due to what the carb percentage is in what you're feeding. Most of the varieties of Fancy Feast, other than the pate style, are fairly to very high in carbs.

 

[Sylvia & Millie]

Most of us test, feed, and shoot all within about a 5 - 10 minute time span. With Lantus, insulin onset doesn't occur for about 2 hours in most cats so there is no reason to test, feed, then wait for digestion to start and then shoot. If you were using a shorter acting insulin where onset is much earlier, you would want to make sure you kitty had eaten before giving insulin.

I was actually just giving her more food because she seemed hungry. Her shot is due at 8:00pm. Should we be concerned that she ate and her bg is still only 61? I called her vet but she isn't in today. We don't know the vet who is filling in but she is supposed to call back. I'm not sure what we should do, re-test at 8pm then decide how much insulin to give? Or give it regardless but also give her honey? Quite confused.

 

[Bobbie And Bubba]

7/7:30 in am & 7/7:30 in pm, insulin is then given around 8/8:15.

You need to test, feed and shoot all within 5_10 mins apart to get an more accurate reading as to whether to shoot

Without more data , it is going to be hard to know if Millie is on the correct dose. Do your best to test more when your home so we can help you help Millie.

 

[Sienne and Gabby (GA)]

First, 61 is not a terribly low number. It's safe. You just don't want number to drop below 50. If numbers drop, that's when you need to intervene with either high carb food or add a bit of honey (a few drops) to low carb food. There are instructions in this link on how to manage low numbers.

I don't know what time zone you're in to know how far from shot time you are. We count in +time -- your test at shot time is your AM or PM Pre-shot (AMPS OR PMPS) time and every hour after that for the next 12-hours is counted off. In other words, 5 hours after AMPS is +5.

It sounds like you still have several hours until your PM shot. I would re-test in 30 to 60 min so you know what's going on. You can give Millie some low carb food just don't continue to feed past 2 hours prior to shot time (unless her numbers drop below 50).

I would suggest you keep the people here on Health informed of where Millie's numbers are heading. There's a good chance that since it's toward the end of the cycle that numbers will start to rise and all will be good by shot time. If you don't know what to do at shot time, change the subject line in your first post in this thread and ask for help.

 

[Sylvia & Millie]

Sorry, someone recommended a higher calorie Fancy Feast when the kitties are hypo but I can't find the post. Not sure if it was FF Grilled? Millie really like the FF and it was hard finding a good for her so I'd like to stay with that brand.

 

[Wendy&Neko]

The FF Gravy Lovers are good ones for when they are low. The carbs are in the gravy and you can just squeeze it out. The Grilled FF are mostly what we would call medium carb food. The gravy lovers is higher carbs.

Since you are using at AT, that 61 is lower than we want and earned Millie a reduction in dose. Do you think you could eyeball a 1.75 unit dose?

When kitty is below 68, it's a good idea to give a little honey like you did, or a couple tsp of the higher carb foods. It's been a while since you tested the 61. I would test again now. You want to make sure that the honey or gravy has prevented her from going any lower.

 

[Sylvia & Millie]

Thanks for getting back to me about the food.

Millie's bg was 61 at 5:40 and 62 at 7:40. I gave her more honey and some dry food that she likes. Her vet got back to us and said not to give insulin tonight. I am taking her in tomorrow to have the frutosamine tested.

 

[Wendy&Neko]

If you haven't seen it yet, this chart on catinfo.org lists a number of the commonly available cat foods and their carb contents. There are several pages with Fancy Feast. Generally you want over 15+% for high carb food and under 10% for her regular low carb food. If all you have in the house is the grilled FF, I'd give a bit now. You don't want her spending much time below 68. How is she acting now?

 

[Sylvia & Millie]

Should I keep posting in this thread?

We tested Millie this morning and at 7:30 am her BG was 540. She gets her Lantus at 8 and I was considering giving her a smaller dose (1 or 1.5 units as opposed to her 2 units). Any opinions? We have an appointment with her vet at 12:00. I thought we could retest at the vet office.

I just read the TR protocol for Lantus and feel very guilty that we didn't con tin testing her last night. This is not a complaint but it's been a lot to take in in a short time, first the diagnosis and trying to get her on her correct dose, the DKA, two hospitalizations and now the low numbers. Not having an opportunity to really catch up and grasp everything we need to know. After reading the TR protocol I do want to try to set that up with her. Was wondering if I should shift the time to make sure it's a better schedule for us to adhere to (so we don't run late if we're out, etc).

 

[StephG]

Should I keep posting in this thread?

We tested Millie this morning and at 7:30 am her BG was 540. She gets her Lantus at 8 and I was considering giving her a smaller dose (1 or 1.5 units as opposed to her 2 units). Any opinions? We have an appointment with her vet at 12:00. I thought we could retest at the vet office.

I just read the TR protocol for Lantus and feel very guilty that we didn't con tin testing her last night. This is not a complaint but it's been a lot to take in in a short time, first the diagnosis and trying to get her on her correct dose, the DKA, two hospitalizations and now the low numbers. Not having an opportunity to really catch up and grasp everything we need to know. After reading the TR protocol I do want to try to set that up with her. Was wondering if I should shift the time to make sure it's a better schedule for us to adhere to (so we don't run late if we're out, etc).

If you don't get an answer in time here you can try the lantus group.

 

[Kris & Teasel]

Should I keep posting in this thread?

We tested Millie this morning and at 7:30 am her BG was 540. She gets her Lantus at 8 and I was considering giving her a smaller dose (1 or 1.5 units as opposed to her 2 units). Any opinions? We have an appointment with her vet at 12:00. I thought we could retest at the vet office.

I just read the TR protocol for Lantus and feel very guilty that we didn't con tin testing her last night. This is not a complaint but it's been a lot to take in in a short time, first the diagnosis and trying to get her on her correct dose, the DKA, two hospitalizations and now the low numbers. Not having an opportunity to really catch up and grasp everything we need to know. After reading the TR protocol I do want to try to set that up with her. Was wondering if I should shift the time to make sure it's a better schedule for us to adhere to (so we don't run late if we're out, etc).

I sympathize totally with you feeling overwhelmed on your steep learning curve. There's a ton of info you have to absorb and you've had many complicating issues on top of that. Try to take it one little chunk at a time. I suggested yesterday that these big swings in BG might be due to the dose being a bit too high but, as others, have said, we need to see more data to know for sure. I don't know if this will help but a "to do" list for you might look like:

1. decide on two dosing times 12 hours apart the you can fit into your schedule consistently
2. set up a BG testing schedule like the one I described in my post #48 above
3. set up the spreadsheet we use here ASAP
4. post all BG numbers in a clear list in a post here until the SS is set up
5. go read the Lantus protocol you want to follow (TR) a few times untli it makes sense to you
6. post on the Lantus forum where the pros can see your questions.

Does this help?

 

[Sylvia & Millie]

I sympathize totally with you feeling overwhelmed on your steep learning curve. There's a ton of info you have to absorb and you've had many complicating issues on top of that. Try to take it one little chunk at a time. I suggested yesterday that these big swings in BG might be due to the dose being a bit too high but, as others, have said, we need to see more data to know for sure. I don't know if this will help but a "to do" list for you might look like:

1. decide on two dosing times 12 hours apart the you can fit into your schedule consistently
2. set up a BG testing schedule like the one I described in my post #48 above
3. set up the spreadsheet we use here ASAP
4. post all BG numbers in a clear list in a post here until the SS is set up
5. go read the Lantus protocol you want to follow (TR) a few times untli it makes sense to you
6. post on the Lantus forum where the pros can see your questions.

Does this help?

Yes, it does. I was just writing on the Lantus thread. Thank you!