Simba was diagnosed with DKA. Vet thinks we're out of options. Help :(

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382 AMPS. We only have 3 strips left & delivery for the new ones was delayed until tomorrow afternoon.
I'm planning on getting a reading around +5 or +6 to see where he's at. That would leave us with enough strips for his next two pre-shot tests before the strips arrive.
Hoping 5u wasn't too much this time.
 
Eric and Simba said:
382 AMPS. We only have 3 strips left & delivery for the new ones was delayed until tomorrow afternoon.
I'm planning on getting a reading around +5 or +6 to see where he's at. That would leave us with enough strips for his next two pre-shot tests before the strips arrive.
Hoping 5u wasn't too much this time.
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I've been there. I had to get strips from my vet at $15 more than I normally pay because I ran out. Now I always have at least one backup bottle of strips. Right now I have about 10 boxes of 50 and 3 more on the way. Maybe more than I need. Lol I would be VERY surprised if Simba went low. I'd love to see some yellow numbers though! Crossing fingers for you.
 
+6 came up at 582. I think we're going to hold him at 5u for a bit until we can get a better curve done to see how low he's actually going - especially because we don't have enough strips to test frequently after changes. Probably will change his dose either Tuesday or Wednesday.

He's been visually improving across the board & his ketone test this morning showed trace amounts. He's been eating more and more on his own as well, though he still gets most of his food through the syringe.
 
His AM test came up "HI" on the AT2. Found a web page that says that means over 750??? We don't have any strips left to confirm an accurate reading. That would be a massive jump from his historical highs.
 
I was worried you might go up today with those blacks yesterday. There is a 20% variance so even a 600 could actually be 480-720 (600 plus or minus 20%), so it actually isn't terribly surprising to me.

If it were me, I would go to 6u since your strips are coming today, but you have to be comfortable with that. I can all but promise that there is almost zero chance of him getting below 50 today. I have never seen A jump like that, unless I suppose you gave ten times more than you intended (a 10x dose has happened with newbies here before who didn't understand the syringe readings).
 
Eric and Simba said:
His AM test came up "HI" on the AT2. Found a web page that says that means over 750??? We don't have any strips left to confirm an accurate reading. That would be a massive jump from his historical highs.
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I suggest you buy a human meter from a pharmacy. Get one that needs only a tiny blood drop to give a reading and has fairly cheap test strips. The AT meter is great but it's far too expensive to use long term and you need to be able to get a strips supply on short notice.

Too high is too high. Try not to figure out patterns right now. Your goal is to get his BG range down into yellows and blues. That's when you think about dosing strategically.
 
I already gave him 5u an hour ago. Too late to add another 1u, right?

Kris & Teasel said:
I suggest you buy a human meter from a pharmacy.
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I've been thinking about this lately, but decided it may be unwise to change meters immediately when we're making big 1u changes. Adding another variable and all that. Do you have any recommendations for a decent human meter?
 
Eric and Simba said:
I already gave him 5u an hour ago. Too late to add another 1u, right?


I've been thinking about this lately, but decided it may be unwise to change meters immediately when we're making big 1u changes. Adding another variable and all that. Do you have any recommendations for a decent human meter?
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Correct. Leave that 5 u dose as is. I'm in Canada so all BG testing supplies are pricey. US members bought the Walmart ReliOn store brand up until recently. It seems those are no longer available. I suggest you post asking specifically about that.
 
Sorry, I thought we were catching you at preshot this morning, and I had to run into a doctor appointment.

Right, never give a second dose. But I strongly suggest increasing tonight rather than waiting for tomorrow or Wednesday.
 
Sandi & Whisper said:
Sorry, I thought we were catching you at preshot this morning, and I had to run into a doctor appointment.

Right, never give a second dose. But I strongly suggest increasing tonight rather than waiting for tomorrow or Wednesday.
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Will do.

He's been drinking a TON of water today/yesterday. I know that's a side effect of hyperglycemia - is there any reason to not let him drink as much as he wants?
 
We're thinking about giving him another day or two to adjust to the new dose. It seems every time we've upped the dose he's had one good cycle of mostly pinks followed by record highs. Prior to this week we had never even seen anything above mid-500s, and now we're seeing 600s and 750+s. The lows aren't really getting lower either. He seems overall pretty healthy right now and I don't think he's immediately at risk for DKA (the past handful of ketone tests only showed trace levels as well).

Thoughts?
 
Eric and Simba said:
We're thinking about giving him another day or two to adjust to the new dose. It seems every time we've upped the dose he's had one good cycle of mostly pinks followed by record highs. Prior to this week we had never even seen anything above mid-500s, and now we're seeing 600s and 750+s. The lows aren't really getting lower either. He seems overall pretty healthy right now and I don't think he's immediately at risk for DKA (the past handful of ketone tests only showed trace levels as well).

Thoughts?
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I'd do 6. Your have to get him out of the black. It is absolutely putting him at a higher risk for developing ketones.
 
My point is that he may just need more time to adjust. The recent blacks seem to be a rebound from going below 350~. We have seen more consistent blacks since upping his dose to 5u than we ever did prior. May not be related, but increasing the dose this quickly/often seems that it could be making things worse.
 
I see what you are saying, but you also need to understand that the longer you stay in high numbers, the higher the risk for DKA as well as developing glucose toxicity.

Personally I agree on 6u as well, but you hold the syringe and have to be comfortable with it. There are very few guarantees with insulin, but as Kris echoed, you are way way off from being in hypo territory and you need to get rid of these blacks -- that is the only way I felt comfortable giving a recommendation, with no test strips in reserve, of increasing the other day. That is something we almost NEVER recommend. If you want to do this as an experiment and want to stay where you are for now, then you must be super diligent on ketone tests and food/water intake and jump up on the very next shot if anything degrades.

So let's get a check in on everything else. When was the last ketone test and what was it, how much food is he getting per day (on his own, and syringed), and is his course of clavamox complete now? I'm sorry that I don't remember the original purpose of the clavamox but based on what kind of infection it was for, can you tell if the symptoms have resolved?

I am just trying to assess the other components that help contribute to DKA. DKA is ugly ugly stuff to be avoided at all costs and we would hate for you to be facing that again. Ketone tests are critical, food is critical, water is critical (and of course enough insulin is critical). I personally don't think of DKA as something you tiptoe into. I think of it as a cliff you fall off of, where getting back up is way harder than it was to go down (just my own analogy, btw).

I don't want to frighten you and I absolutely don't want you to feel bullied. You all are doing SO well that I want you to realize how lucky* you are to get to the point that you are at now, but also to know you aren't out of the woods yet. We are all pulling so hard for you. I said I thought about Simba all day, and I am not exaggerating even one bit.

* Clearly "luck" had nothing to do with it, you all have worked your butts off on caring for and loving this little guy, and all we can do is give our recommendations and experiences.
 
Sandi & Whisper said:
When was the last ketone test and what was it?
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We've been checking him every time we catch him at the litterbox, which is pretty frequent since he's always in our bedroom. The past 6 or 7 readings have all been trace (~5mg/dL).
Sandi & Whisper said:
How much food is he getting per day (on his own, and syringed)?
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He's getting his normal amount of food, which is around 360 kcal or 4 cans of FF classics (12oz total). Until now, probably 90% was syringe fed. Today, he's started eating again, and has already ate almost all of his dinner on his own.
Sandi & Whisper said:
Is his course of clavamox complete now? I'm sorry that I don't remember the original purpose of the clavamox but based on what kind of infection it was for, can you tell if the symptoms have resolved?
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This morning was the final dose. It was to treat an upper respiratory infection. His inner eyelids aren't showing anymore, and he doesn't seem to have trouble breathing either - it appears that he's recovered. We've also stopped giving him the cerenia & ondansetron as of today. Going to see how he does going forward without them.

We gave him 5 units tonight. I understand that we don't want him in the blacks, but so far increasing the dose has correlated with more blacks at higher numbers. We have never seen numbers anywhere near this high, and I don't think it's crazy to assume it's related to the higher dose. Again, this could be a coincidence, but I think it may be a good idea to let him recover from this bounce & get more tests in before adding more insulin. He may have reached yellows yesterday morning before jumping back up to the black at +6. If his numbers are relatively low for tomorrow's AMPS, we're going to do a full hourly curve throughout the day to see what's going on. If it doesn't look like he's going down much, we'll up the dose.
 
Trace is great, eating is great, and no more clavamox is excellent!

That sounds like a plan then. We will keep an eye on his spreadsheet, but just continue to keep us updated here on everything else, and we'll jump in if we see or hear something that concerns us. :bighug:
 
Pre-shot was 441. He ate most of his breakfast pretty eagerly. Gave 5u. We'll do our best to get a measurement every hour starting from +2
 
Looks like he's going to have a pretty active cycle today. Down to 354 at +3.

Kris & Teasel said:
Every two hours would give plenty of data while sparing his ears and your supply of $$$ test strips. :)
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I wanted to do tests every hour to get a better idea of what his lowest point is when he rebounds (the 326 measurement could've been missed on 12/8). Ended up skipping that yesterday since he didn't actually go down :(
 
Sandi & Whisper said:
How are things going this morning, I didn't see your reading. And how is eating and ketones?
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We tested about an hour and a half before the shot & it came up @ 509. Higher than we were hoping to see, but at least it's not 700. That's the only test we got so far today. Probably going to increase dose by .25 starting tomorrow.
He is eating very well now. Last few ketone readings have been good, but haven't been able to get one in a while.
 
Eric and Simba said:
We tested about an hour and a half before the shot & it came up @ 509. Higher than we were hoping to see, but at least it's not 700. That's the only test we got so far today. Probably going to increase dose by .25 starting tomorrow.
He is eating very well now. Last few ketone readings have been good, but haven't been able to get one in a while.
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I'd definitly do the 5.5. I know you hit yellow but there's still a ways to drop.
 
PMPS came up 157. Retested and got 160. No idea what to do now. Aside from the AM, these were the only BGs we got today. Definitely cannot give him 5+ units. Should we skip the shot entirely? Give a small amount like a half unit?
 
No, I wouldn't give him 5 u on that PS. It looks like you're reaching his "breakthrough" dose range where you're getting through the glucose toxicity caused by time in very high numbers. You could try stalling without feeding for a half hour and retest to see if he's going up. If so, maybe try a 50% dose. It's always guesswork in these situations. If he's not rising but staying level, maybe try 1 u.
 
Kris & Teasel said:
No, I wouldn't give him 5 u on that PS. It looks like you're reaching his "breakthrough" dose range where you're getting through the glucose toxicity caused by time in very high numbers. You could try stalling without feeding for a half hour and retest to see if he's going up. If so, maybe try a 50% dose. It's always guesswork in these situations. If he's not rising but staying level, maybe try 1 u.
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I already gave him his food & he wolfed down 70% of it. Also created a new thread since this isn't really on topic anymore.
 
With his latest bounce, things have taken a turn for the worse. His ketones have been going up and up and we aren't able to feed him now. He got 1 can of ff earlier and threw part of it up later. He is hardly responsive, won't chew the food from the syringe. Only picks his head up slightly every once in a while. He can't walk. My girlfriend panicked and gave him more insulin around 3 pm EST today after getting another HI reading. All bg readings have been HIGH today. We picked up another bag of fluids for subq and gave him a bunch of that.

I'm lying with him in bed right now with a heated blanket trying to keep him warm and let him know he hasn't been abandoned. We cannot afford another hospital stay. If we don't see any improvement by tonight, I don't think we can keep putting him through this. I don't even know that he'll make it that far.

Thank you everyone for your support.
 
Eric and Simba said:
With his latest bounce, things have taken a turn for the worse. His ketones have been going up and up and we aren't able to feed him now. He got 1 can of ff earlier and threw part of it up later. He is hardly responsive, won't chew the food from the syringe. Only picks his head up slightly every once in a while. He can't walk. My girlfriend panicked and gave him more insulin around 3 pm EST today after getting another HI reading. All bg readings have been HIGH today. We picked up another bag of fluids for subq and gave him a bunch of that.

I'm lying with him in bed right now with a heated blanket trying to keep him warm and let him know he hasn't been abandoned. We cannot afford another hospital stay. If we don't see any improvement by tonight, I don't think we can keep putting him through this. I don't even know that he'll make it that far.

Thank you everyone for your support.
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Are you sure the infection cleared? Maybe he needs another round of antibiotics. So sorry he's struggling so much. :( I'm glad you raised to 6.
 
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Oh, Eric I'm so sorry. Poor little guy....

I don't know what to say about 8 hour dosing. Never done it myself, but obviously it is the same principles, just slightly more complicated.

He kind of got a triple whammy: a bounce from that blue on 12/20, the 0.75u reduced dose on 12/20 PM, and a reduction from 5.25u to 5.0u on 12/21 AM. So I'd like to think that, assuming you can get food into him, that we can right the ship with this increase to 6, but ketones and not eating surely complicates everything.

How much insulin did he get at 3pm (so that would have been at about AM +5.5 ?) and have you gotten a reading since then? That might help us see if 8 hour dosing would help.
 
He couldn't eat, he couldn't stand, he couldn't even hold his head or arms off the ground for more than a couple seconds without convulsing. He only got worse as the hours went on. We could not afford another $3000 hospital stay with the chance that he could relapse as soon as he came home. He was unhappy and suffering. In the end, we had to let him go.

I'm sorry to everybody that got invested in our story just to see it end like this. I'm especially sorry to Simba. He deserved to see many years to come. If I had been more diligent and less stubborn, this could have been avoided. I only hope that his year with us was as wonderful as ours was with him.

Thank you, everybody that shared opinions and anecdotes. It means the world to me that there were so many people willing to help a complete stranger. Simba would have appreciated it as well.


Rest in peace Simba, the best friend I ever could have asked for
Oct. 3, 2004 - Dec. 22, 2018
 
There are no apologies needed, and no blame is to be had. You did an amazing thing with your boy. We feel honored to have been here for you, and are heartbroken with you, but will be here again whenever someone needs help.

Be kind to yourselves, you were Simba's Angels, and now he is yours.

:bighug:

Sandi & Whisper.
 
Eric and Simba said:
He couldn't eat, he couldn't stand, he couldn't even hold his head or arms off the ground for more than a couple seconds without convulsing. He only got worse as the hours went on. We could not afford another $3000 hospital stay with the chance that he could relapse as soon as he came home. He was unhappy and suffering. In the end, we had to let him go.

I'm sorry to everybody that got invested in our story just to see it end like this. I'm especially sorry to Simba. He deserved to see many years to come. If I had been more diligent and less stubborn, this could have been avoided. I only hope that his year with us was as wonderful as ours was with him.

Thank you, everybody that shared opinions and anecdotes. It means the world to me that there were so many people willing to help a complete stranger. Simba would have appreciated it as well.


Rest in peace Simba, the best friend I ever could have asked for
Oct. 3, 2004 - Dec. 22, 2018
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I am sorry for your lost :(:bighug:. Fly free little angel cat_wings>o:rb_icon:.
 
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