Looking for advice about insulin and vomiting

[Erin720]

Hi, my cat was put in the hospital on 6/30 to 7/3 for Diabetic ketoacidosis (also had a UTI). Anyway, he was released last Monday and they've instructed me to give him Lantus twice daily, 1 mg. They told me not to give him the shot if he was under 200 or not feeling well. Anyway, there's only been a couple days since he's been out he's gotten both shots. He's vomited four times today, the most recent two just 1/2 hour ago. I'm going to call the vet in the morning, but any thoughts of what this might be? Is this common for kitties newly on insulin? His numbers were around 80 both times I took it today with the Relion. I don't really trust the Relion since I tested it against the Alpha Trak at the hospital last week and it was 100 points lower. Anyway, I'm super stressed about what's wrong with him, and also worried about having another $3000 vet/hospital bill like last week. HELP!

 

[Kris & Teasel]

give him Lantus twice daily, 1 mg.

I think you mean 1 unit of Lantus twice a day, right?

Anyway, there's only been a couple days since he's been out he's gotten both shots

It's not a good idea to withhold insulin in a post-DKA kitty. They can readily start producing ketones again. The keys to preventing that are keeping him well-hydrated, making sure he eats enough food and feeding higher carb food to allow larger doses of insulin to be given. Have you been testing his BG regularly? Did you withhold insulin because of low BGs under 200 or because he wasn't feeling well?

I'm going to call the vet in the morning, but any thoughts of what this might be?

I think this is very wise. It can take a post-DKA kitty a long time to recover and he's very vulnerable to relapse in the first days/weeks after the episode. I'm concerned that this could happen.

His numbers were around 80 both times I took it today with the Relion.

The AlphaTrak would give a higher result, maybe around 100 or so. These are good BG numbers. Have you tested AM and PM before feeding and giving insulin?

He might need some antinausea and appetite stimulant meds to get him over this bump in the road. Vet attention is in order forsure.

 

[Erin720]

@Kris & Teasel I've withhold this week due to his numbers and vomiting. I'm kind of not trusting the numbers on the Relion anyway, since it was giving me readings in the 200s and he was in Diabetic Ketoacidosis and it was 100 off from the Alpha Trak. Besides today and through the night, he vomited twice in the past week. Today I tested 3 times, first thing post breakfast, dinner time (both 80s) and just now (150).

 

[Kris & Teasel]

@Kris & Teasel I've withhold this week due to his numbers and vomiting. I'm kind of not trusting the numbers on the Relion anyway, since it was giving me readings in the 200s and he was in Diabetic Ketoacidosis and it was 100 off from the Alpha Trak. Besides today and through the night, he vomited twice in the past week. Today I tested 3 times, first thing post breakfast, dinner time (both 80s) and just now (150).

Some kitties can be in DKA at low BGs. It's very strange that your ReliOn was reading higher than the AT meter. It's usually the other way around. You might check the battery in the ReliOn. Getting BGs is important right now so you'll have to use the $$$ AT strips.

Please do call your vet ASAP this AM. I think your kitty needs attention to avoid a DKA relapse. Fingers crossed for you. I went through a bout with my guy last year - very serious.

 

[Erin720]

Thanks @Kris & Teasel. No, the Relion read 100 points less than the Alpha Trak at the hospital. Good news! He was monitored all day at the vet Friday. He hasn't vomited since Thursday. They did not give him the insulin and his numbers were around 80-120. He has been off insulin since then b/c they don't trust my meter until I get my Alpha Trak and his numbers at the vet's office didn't warrant it. It wasn't DK, no ketones found. They think it was the antibiotics upsetting his stomach, so they have me giving him Pepsid and then the second cycle of Clavamox for his (I think gone) UTI. The Alpha Trak should be here on Tuesday. I did test on the Relion last night (even though they told me not to) and his number was around 70 some, so I think he's ok, even if it is 80 points or so higher in actuality.

 

[Yong & Maury GA]

70 something on a Relion should not have a difference of 80 points or more on the AT2. While there is no direct conversion for the two meters, the variance is greater at higher numbers and lesser at lower numbers . So it's not unusual that your ReliOn read about 100 points less at the higher reading, but a 70 on ReliOn might only be like 40 points difference. Make sense? Like I said, no direct conversion but the difference should be less extreme at more normal numbers

 

[Erin720]

Oh ok, thanks @Yong ! I am still going to spot check until Tuesday to make sure he doesn't spike or go down super low, like the 29 I saw on Wednesday.

 

[Yong & Maury GA]

Just keep in mind that 50 is the "take action" number on the ReliOn and when you get the AlphaTrak 2, the "take action" number is 68. If you get this number or lower, hopefully not a 29 again , give 1 full tablespoon of LC food and retest in 20 minutes. If the next test has similar reading to the first, give 1T of MC or HC food, retest in 20 minutes. The idea is to feed small amounts to help the BG rise and then 2-3 tests of non food influenced rising numbers. You can always post a 911 thread if you need help doing this .

 

[Erin720]

Thanks @Yong So tonight he was 64 on the Alpha Trak - he's been in the 70s since Monday morning. He ate dinner, I tested him, and then I gave him more food at bedtime that he ate. I'm just confused because two weeks ago before his DK episode, he was in the 200s and 300's (on the Relion). Due to his numbers I haven't been giving him the Lantus. So I'm assuming LC food is low carb, and HC is high carb, but what is MC? What are suggestions of high carb food you use?

 

[Chris & China (GA)]

what is MC?

Medium carb....something in the 12-16% range

What are suggestions of high carb food you use?

Most of us use Fancy Feast Gravy Lovers....there's lots of carbs in the "gravy" part. What I do is pop the top, put it back and "squeeze" the gravy into another bowl (it's messy but it works)....usually a teaspoon or two of the gravy is enough to bring them up

 

[Yong & Maury GA]

You may have a diet controlled diabetic if he's not had insulin since Monday and is holding those 70's on his own

 

[Erin720]

Yep, he is still in the 70s and hasn't had insulin in over a week. I think the 70's (Alpha Trak) is like borderline low, right? I guess I'll take him in next week for a BG curve like they recommended because they wanted to figure out the right amount of insulin, but can't imagine they will want me to give it to him with those numbers @Yong

 

[Erin720]

@Chris & China i bought him the Friskies Cheese and Chicken with Gravy to get his numbers up a bit and he was obsessed with it. Lol. Ate most of the can. I let him though bc he was in the 60s on the AT. The Friskies classic pate he'll eat some, but doesn't seem to like it much.

 

[Yong & Maury GA]

Yep, he is still in the 70s and hasn't had insulin in over a week. I think the 70's (Alpha Trak) is like borderline low, right? I guess I'll take him in next week for a BG curve like they recommended because they wanted to figure out the right amount of insulin, but can't imagine they will want me to give it to him with those numbers @Yong

That's fantastic!
He may just be a kitty that naturally runs in the lower range of normal, without insulin he shouldn't have any risk of hypo with his own body . Please do not let them try to give him insulin with NORMAL numbers, if they do still want to give it, fire your Vet . If he's not big on pate (my boy is not either), Fancy Feast makes some low carb non pate food: Roasted, Chunky, and Flaked varieties .

He'll have to stay on the low carb diet for life and even after 14 days you'll still want to spot check to see if his numbers are going back up. No need to carb him up since he's not getting insulin

 

[Chris & China (GA)]

he was obsessed with it

That's good!! Obsessed is great when you need them to eat!!

But if you're just trying to get the number up a little, just feed a teaspoon or two and then test again in about 30 minutes...we want to get them up a little, not send them to the moon....LOL

 

[Erin720]

@Yong and @Chris & China Well, prior to the DK episode two weeks ago, we were managing the diabetes with diet and losing some weight. His numbers on the Relion were mainly in the 200s, but the vet didn't recommend insulin at that point. Then he got the UTI and the vet said that probably threw his body off and sent him into the DK episode. He was only on insulin for a week or so post hospital release until his numbers at dosage time were lower. I stopped giving it after the vet checked his BG and found they were 80-120. So it's weird to me that post DK, he's only in the 70s with the Alpha Trak and no insulin again because before DK episdoe they were in the 200's. Like what's different now vs before? I don't understand it, but I'm being very vigilant bc I do not want him to go into DK again b/c that was the worst. I know I don't want to overdo it with the cheesy Friskies food, but I want him to eat, as he's lost 4 pounds in 2-3 months and he feels so skinny.

 

[Yong & Maury GA]

You can feed him extra foods as long as it's lower carbs .

 

[Erin720]

They did a curve today at the vet and his BG was 138 and 131. Hasn't had insulin for two weeks. My Alpha trak came back 111 and 112 against theirs, so about 20 points off. Not sure why they only stuck him twice, but guess it was because his numbers were stable. Vet thinks he's in remission for now and suggests I only do spot checks on his BG.