6/28 Lovie - very recent history of DKA- pmsp is 63; pmps +30 min is 85

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Hi there :cool:

Are there currently ketones present?

The way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.

So there is a delicate balance to figure out and maintain. It’s recommended that a kitty recovering from DKA consume at least 1.5 times the calories required for maintaining ideal body weight. To get those calories metabolized and get the energy to the cells of the body requires insulin. So for now you want to get plenty of both calories and insulin into your kitty.

Was/is there an active infection of some kind?

How is her appetite? What is the carb content of the food she is currently eating?

What time zone are you in and what time do you shoot?




 
This is Michelle's sister, Jan, typing for her... Thanks for being out there to help. I'm trying to get answers to your questions.

Michelle and her kitty are in Eastern time - Florida- shot time is in half an hour or so
 
It's almost shot time - This is still Michelle's sister Jan typing for her and trying to find someone who can help us figure out what to do about Lovie's shot this morning
 
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Sandy and Black Kitty said:
Hi there :cool:

Are there currently ketones present?

The way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.

So there is a delicate balance to figure out and maintain. It’s recommended that a kitty recovering from DKA consume at least 1.5 times the calories required for maintaining ideal body weight. To get those calories metabolized and get the energy to the cells of the body requires insulin. So for now you want to get plenty of both calories and insulin into your kitty.

Was/is there an active infection of some kind?

How is her appetite? What is the carb content of the food she is currently eating?

What time zone are you in and what time do you shoot?
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The test this morning was in just a few drops of pee but it shows no ketones
The vet was not sure last week if there was an infection or not. She was given antibiotics just in case last week. Lovie is not on antibiotics right now.
Her appetite is good. She is currently eating Purina DM from the vet's office. The food list says this is 6% She is also eating some friskies that my sister made me go buy yesterday. It has 13 to 14 % carbs. Lovie is really liking that food.
It is past shot time right now. My sister and I decided to give her a little of the DM which she really loves. We are also giving her some of the 14% carbs food since her number this morning is relatively lowish. It seems that a dose of 1.5 units is a good idea. I can be home for a few hours to monitor before I have to go to work. I hope this is the right thing to do....:nailbiting:
 
Sorry no one was around to answer you at shot time this morning. Good news on no ketones and good appetite! More than half the battle, there.

I think you made some good calls this morning. Lovie's got a good bit of insulin, and a bit higher carbs for it to work on, so that's basically what needs to be happening now so soon after DKA.

If anyone is able to get any tests during the day today, that would be good. If testing isn't possible but someone will be home, I might add some insurance by giving her some more of the 13-14% Friskies today. She dropped pretty late in the cycle yesterday and she's already in the green numbers early today. Often, with Lantus, we say "shoot low to stay low"-- they just stay flat when they start in the low numbers-- but a little insurance wouldn't hurt.

@Sandy and Black Kitty has a ton of DKA recovery experience, you are in good hands with her advice and knowledge. Hopefully some of the other experts will be able to stop by and weigh in, too, maybe before your evening shot tonight.
 
Nan & Amber said:
Sorry no one was around to answer you at shot time this morning. Good news on no ketones and good appetite! More than half the battle, there.

I think you made some good calls this morning. Lovie's got a good bit of insulin, and a bit higher carbs for it to work on, so that's basically what needs to be happening now so soon after DKA.

If anyone is able to get any tests during the day today, that would be good. If testing isn't possible but someone will be home, I might add some insurance by giving her some more of the 13-14% Friskies today. She dropped pretty late in the cycle yesterday and she's already in the green numbers early today. Often, with Lantus, we say "shoot low to stay low"-- they just stay flat when they start in the low numbers-- but a little insurance wouldn't hurt.

@Sandy and Black Kitty has a ton of DKA recovery experience, you are in good hands with her advice and knowledge. Hopefully some of the other experts will be able to stop by and weigh in, too, maybe before your evening shot tonight.
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Thank you thank you thank you for your reassurance, Nan. This is still Michelle's sister, Jan. I'm using her account to keep all the information about Lovie separate from my sweet boy Radar. It just seems less confusing in general for everyone.

My crash course in ketones and DKA recovery is in its early days and I just don't feel I always have enough solid knowledge to keep Lovie safe. I know the FD basics and am familiar with Lantus but I feel nervous about making decisions at shot time with DKA recovery in the picture. Wise and experienced eyes are therefore really appreciated. :bighug::bighug::bighug:

Unfortunately, no one will be home today with Lovie in the afternoon. Michelle left lots of the 13-14% food available for Lovie. I would love the chance to talk with @Sandy and Black Kitty some more about what we need to be doing moving forward. We have a family reunion that we've been planning for months that is quickly approaching in just 10 days. Lovie's diabetes dx and DKA came at a bad moment. Michelle is very concerned about leaving Lovie especially in view of the scare we had yesterday with low numbers. We will need to figure out a "safety dose" for the week when Michelle is out of town and I have no idea how to do that safely. :nailbiting:

Shot time tonight is about 830 pm eastern time. Michelle won't get home from work before then so we won't have any further information until then.
 
Lovie's Mom said:
This is still Michelle's sister, Jan. I'm using her account to keep all the information about Lovie separate from my sweet boy Radar.
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Oh! I just finally figured that out, @Jan Radar !!!

Wish I could be more help on dosing, but I don't feel confident in this kind of situation. :( I do remember that @Meya14, who also has tons of knowledge about DKA, recommends a somewhat higher "target" for BG than Lovie is currently hitting-- more like low blues than high greens. But that might just be for the intense, immediately-post-DKA period with a cat that isn't eating well on its own. It sounds like Lovie is doing pretty well on the appetite front, though, which helps the balancing act and gives you much more of a safety buffer.
 
Lovies pmps is 63. Anyone have any opinions about her current dose of 1.5??? Is that too much insulin with recent DKA?
 
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Can you edit the post title with the PMPS and add a "?" using the drop-down menu? Might help get some more eyes on this.

I don't know how comfortable I'd be shooting 1.5, even with the DKA. Especially if she was munching on 14% carb food all day-- that's a low pre-shot for a new diabetic.

Step 1: have her stall for a half hour (no dinner yet) if possible, let's see if that 63 is on the way up or holding steady...

Really hope someone who can suggest a dose jumps in here :nailbiting: !
 
Jan Radar said:
Levies pmps is 63. Anyone have any opinions about her current dose of 1.5??? Is that too much insulin with recent DKA?
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Update title with PMPS and put "?" With "dosing help"

I think it is too much but you need to pick a dose and shoot that dose consistently.
 
Michelle has some 25% carb friskies. Should she be feeding this or the 14% she gave her earlier in the day. ???

she is testing Lovie now
 
the +30 minute test is 85- this is mostly the gravy she lapped up

so does anyone have any thoughts about the dose?? could we do 1 unit??
 
Hmm, so, up a little bit, but probably holding flat accounting for the food bump.

I was actually thinking an even lower token dose-- 0.5U, just enough so that she had insulin "on board"-- but 1.0U is another good possibility. In either case you'd have to monitor for a while tonight.
 
Lovie's Mom said:
the +30 minute test is 85- this is mostly the gravy she lapped up

so does anyone have any thoughts about the dose?? could we do 1 unit??
Click to expand...

will you be able to stay late and keep testing? If you shoot even 1U tonight you might have some action later on.

vrery tough call. When my cat was recovering after DKA I heard mostly that I need to give her something at least. ETA : I mean some insulin.
 
Yes. We can stay up and test. My sister will help me with my first pajama party. We are giving Lovie 0.5 a unit of Lantus along with 25% carb Friskies to cushion her drop.
 
I agree with Tanya-- I'd hold off on the 25% at first until you get a sense of where the night is going. She may very well zoom to the moon tonight and not need the extra carbs.
 
Hey there! Just peeked at the spreadsheet and saw you shot 0.5U again this morning. As long as she's still acting perky (eating well, etc.) that should be fine, especially if you're going to have to be at work all day again today. That said, I do think you'll want to consider pushing it back up to at least 1.0U tonight-- adding extra carbs if necessary.

It's a really tricky case because we don't have a lot of data on Lovie yet, and what data we have strongly suggests that she "wants" (absent DKA considerations) a smaller amount of insulin than what she's been getting, but with the DKA we can't just consider that. It's especially hard because it's not clear how much the (assumed) low yesterday was due to depot effects-- she was on 2.0U for a while, after all. Two successive 0.5U shots (after 1.0 and 1.5) should drain the Lantus depot sufficiently that you can go back up to 1.0U, maybe even 1.5U, and get a better sense of what that dose does for her.

Hopefully, someone who is more comfortable with dose advice in this kind of situation will also weigh in before you have to make the dose decision tonight. These are just my thoughts, so that you have something to work with.
 
Oh, and forum housekeeping: if you post again today/tonight, start a new thread with a link back to this one. We try to keep to one thread (we call them "condos") per day per cat, otherwise it gets a bit difficult to follow events in this rather busy forum!
 
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