Switching right after DKA?

Gage's Mommy

Gage's Mommy

Member Since 2019
Gage has been everywhere number wise on Vetsulin. Maybe it has not had enough time to work or maybe its just not for him but I'm heading to Lantus. I have read every sticky note here about the switchover but Gage just came home today after being hospitalized all week with DKA. He was so severe Monday they did not expect him to make it but I have a fighter on my hands and I didn't lose hope and neither did he. Basically, I'm just wondering with his numbers like they are in the spreadsheet and with him DKAing I'm needing advice on the switchover. Would you wait a few weeks since he's acting like himself now but his dinner number was high or would you just go through with the switch over asap and hope for not a slip back? Really I can't afford a slip back into the vet so I'm needing happy healthy numbers.
 
Hi Gage's Mommy! What a scare for you and your boy! He is so young to be diabetic! Just curious, did he ever get steroids for something? That can throw a kitty into diabetes. I'm not an expert , but can offer some advice.

A few question: Do they know what caused the DKA? Was there an infection? Pancreatitis?

If it were my kitty, I would start him on Lantus ASAP. Do you have any test results for his BG's while he was in the hospital? It looks like he was getting 3 units in the hospital. It would be nice to see some numbers to get an idea of what the starting dose for Lantus should be.

Since you were using Vetsulin, and wanting to switch, just to reiterate, you will need U100 syringes for Lantus unlike what you are using now with Vetsulin.

How's he doing since he came home? Eating okay?

Since you have all ready read up all the sticky notes, it would be very prudent for you to follow Tight Regulation ( TR) with the recent DKA. It is a more aggressive dosing protocol and you want to get a much insulin into Gage as safely possible.
 
My concern here is there aren’t enough tests to determine what a good dose for Gage is. It’s likely that because he got DKA, he’s not been getting into good numbers since DKA usually occurs from lack of enough insulin + not enough food/water + infection. Did they find the source of his infection? Are you testing for ketones?

I’m going to offer a bit of a different “potential” option. Lantus takes some time to build a depot. Even if we started him at 3u bid of Lantus, it could take several days for the depot to build. One school of thought is to continue shooting the Vetsulin because you can vary the dose as needed and get insulin in him. It’s not my favorite choice for insulin but it could help to more quickly get to a good dose and make sure he’s stable and any infection addressed before we switch to Lantus.

But you would need to be able to test more so we can see what he’s doing. Possible? And, as I said, that’s just a potential option.
 
Marje and Gracie said:
I’m going to offer a bit of a different “potential” option. Lantus takes some time to build a depot. Even if we started him at 3u bid of Lantus, it could take several days for the depot to build. One school of thought is to continue shooting the Vetsulin because you can vary the dose as needed and get insulin in him. It’s not my favorite choice for insulin but it could help to more quickly get to a good dose and make sure he’s stable and any infection addressed before we switch to Lantus.
Click to expand...
The vetsulin dose can be varied and shot more frequently if necessary. This is especially helpful if Gage is still throwing ketones. If he's still throwing ketones, we don't have the luxury of waiting for the 'depot' to build. If he's not and everything else is good (appetite, infection/health issues), it will make for a smooth transition to Lantus. That's the reason for all the questions. :)

When coming off of a recent DKA, you'll want to test blood glucose often. Also, testing urine or blood for ketones at least once, if not twice a day is very helpful.

The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses. That's why it's important to address any underlying infection or condition, make sure Gage is eating well, and administer an adequate supply of insulin.

Marje as well as several others here in the group can help guide you.
 
Jill & Alex (GA) said:
Marje as well as several others here in the group can help guide you.
Click to expand...
I can and would normally be happy to but I’m out of town through May 20 and not able to post reliably every day. :confused: However @Wendy&Neko is also very familiar with Vetsulin and might be around more; she leaves the 21st but since I’ll be back, I can pick up where she leaves off.
 
Bobbie And Bubba said:
Hi Gage's Mommy! What a scare for you and your boy! He is so young to be diabetic! Just curious, did he ever get steroids for something? That can throw a kitty into diabetes. I'm not an expert , but can offer some advice.

A few question: Do they know what caused the DKA? Was there an infection? Pancreatitis?

If it were my kitty, I would start him on Lantus ASAP. Do you have any test results for his BG's while he was in the hospital? It looks like he was getting 3 units in the hospital. It would be nice to see some numbers to get an idea of what the starting dose for Lantus should be.

Since you were using Vetsulin, and wanting to switch, just to reiterate, you will need U100 syringes for Lantus unlike what you are using now with Vetsulin.

How's he doing since he came home? Eating okay?

Since you have already read up all the sticky notes, it would be very prudent for you to follow Tight Regulation ( TR) with the recent DKA. It is a more aggressive dosing protocol and you want to get a much insulin into Gage as safely possible.
Click to expand...

They did not say a cause for DKA but he did have a bladder infection so maybe that could have added to it/ Gage was always a super healthy boy other than diarrhea that had no explanation for about his entire life (although my other vet was terrible so maybe his sugar was causing it, I switched vets).

I do not have his test results for the BG's while he was there but I can call and get them Monday since they are closed for the weekend. They handed me paperwork but it just included his full blood panel and not BG's.

He is eating great since he has been here and I have him 1 water sitting out with sugar-free Gatorade mixed in it and then one plain water to hopefully entice him to stay as hydrated as possible since he is no longer on IV's. In fact, he is in the best mood he has been in since before he was diagnosed and following me around every second of the day not leaving my side.

Oh and I forgot to say that he was never on any medicine prior to this it just all the sudden happened.
 
Jill & Alex (GA) said:
Hi there! A couple more questions...
  • Is Gage still throwing ketones?
  • Do you have the availability to monitor more often than you have been?
Click to expand...

They did not say if he is still throwing ketones they did tell me he is a DKA kitty. I have some ketosis strips I'm going to try and get him tested the next time he goes to the litter box and find out.

I just ordered more test strips so I can test him more. They should be here Monday, unfortunately, I'm not that close to a Walmart to go grab some but 2-day shipping should get them here quickly. I have about 10 left I could split them up until then.
 
Marje and Gracie said:
My concern here is there aren’t enough tests to determine what a good dose for Gage is. It’s likely that because he got DKA, he’s not been getting into good numbers since DKA usually occurs from lack of enough insulin + not enough food/water + infection. Did they find the source of his infection? Are you testing for ketones?

I’m going to offer a bit of a different “potential” option. Lantus takes some time to build a depot. Even if we started him at 3u bid of Lantus, it could take several days for the depot to build. One school of thought is to continue shooting the Vetsulin because you can vary the dose as needed and get insulin in him. It’s not my favorite choice for insulin but it could help to more quickly get to a good dose and make sure he’s stable and any infection addressed before we switch to Lantus.

But you would need to be able to test more so we can see what he’s doing. Possible? And, as I said, that’s just a potential option.
Click to expand...

They found that he had a bladder infection while he was there. I had no idea what so ever. but he did slowly loose his appetite last week until he had none on the weekend.

I was kinda thinking your potential option to Im so scared he is going to fall back I thought maybe a couple of weeks to vetsulin to keep everything regulate might not hurt
 
Gage's Mommy said:
I have some ketosis strips I'm going to try and get him tested the next time he goes to the litter box and find out.
Click to expand...
Wonderful! Please post the result when you get it.

PMPS was 387 and spreadsheet shows a 3u dose was given. Vetsulin, I presume?

If you have enough test strips you might want to get a mid-cycle test test tonight to see if his BG numbers come down at all.
 
Jill & Alex (GA) said:
The vetsulin dose can be varied and shot more frequently if necessary. This is especially helpful if Gage is still throwing ketones. If he's still throwing ketones, we don't have the luxury of waiting for the 'depot' to build. If he's not and everything else is good (appetite, infection/health issues), it will make for a smooth transition to Lantus. That's the reason for all the questions. :)

When coming off of a recent DKA, you'll want to test blood glucose often. Also, testing urine or blood for ketones at least once, if not twice a day is very helpful.

The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses. That's why it's important to address any underlying infection or condition, make sure Gage is eating well, and administer an adequate supply of insulin.

Marje as well as several others here in the group can help guide you.
Click to expand...

As soon as he goes to the litter again Im going to get a Ketone strip on him. He is such my shadow I think he feels insecure after the huge DKA scare and don't want to leave.

I just ordered some more test strips but I kinda think 10 isnt going to last till monday so Im going to drive out to get more. Im quite aways from Walmart but to help him I'm up for it. He is eatting well but he did have a bladder infection that they treated in the hospital but didnt send him home with anything I don't know if that is normal?
 
I'm not sure when Marje will be back since she's out-of-town. I'm sure she'll want to comment.

Generally speaking, we'd like to see a DKA kitty switched to Lantus as soon as possible. If he's not throwing ketones, that should happen sooner than later. Let's see a few ketone test results over the next day or two so we can offer you informed advice.
 
Jill & Alex (GA) said:
Wonderful! Please post the result when you get it.

PMPS was 387 and spreadsheet shows a 3u dose was given. Vetsulin, I presume?

If you have enough test strips you might want to get a mid-cycle test test tonight to see if his BG numbers come down at all.
Click to expand...

Vetsulin was given I at 3 units. I will get him a mid-cycle test just to see where we stand in a couple more hours :) I'm thinking I should just make the drive and buy more test strips from Walmart it might be a distance but it might keep him from DKAing again.
 
Gage's Mommy said:
As soon as he goes to the litter again Im going to get a Ketone strip on him. He is such my shadow I think he feels insecure after the huge DKA scare and don't want to leave.

I just ordered some more test strips but I kinda think 10 isnt going to last till monday so Im going to drive out to get more. Im quite aways from Walmart but to help him I'm up for it. He is eatting well but he did have a bladder infection that they treated in the hospital but didnt send him home with anything I don't know if that is normal?
Click to expand...
Did they give him a convenia injection? If they didn’t send you home with antibiotics for the UTIs, they might have given convenia which is extended release antibiotic. You can check your discharge papers.
 
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Jill & Alex (GA) said:
I'm not sure when Marje will be back since she's out-of-town. I'm sure she'll want to comment.

Generally speaking, we'd like to see a DKA kitty switched to Lantus as soon as possible. If he's not throwing ketones, that should happen sooner than later. Let's see a few ketone test results over the next day or two so we can offer you informed advice.
Click to expand...

I have the ketone test strips here waiting. I will get them done asap :)
 
Gage's Mommy said:
As soon as he goes to the litter again Im going to get a Ketone strip on him. He is such my shadow I think he feels insecure after the huge DKA scare and don't want to leave.
Click to expand...
Oh, does that sound familiar! When Alex came home after being hospitalized with DKA, she stuck to me like glue.
Gage's Mommy said:
I'm thinking I should just make the drive and buy more test strips from Walmart it might be a distance but it might keep him from DKAing again.
Click to expand...
That's up to you. If you have some strips, you could wait til tomorrow to get more. Thinking of you... you must be tired... physically and emotionally. Why not try to get some rest?
 
Jill & Alex (GA) said:
Oh, does that sound familiar! When Alex came home after being hospitalized after DKA, she stuck to me like glue.

That's up to you. If you have some strips, you could wait til tomorrow to get more. Thinking of you... you must be tired... physically and emotionally. Why not try to get some rest?
Click to expand...

I do have enough to last till tomorrow. I think waiting till then is the way to go me and him are just kicked back typing with him on my chest like hes part of my clothes lol
 
Going forward...
Like I mentioned earlier, several of our members have the experience necessary to guide you thru Gage's recovery and switch to Lantus. Please stay in touch by posting test results and any changes or concerns. The more information you give us, the better able we are to help.
 
Marje and Gracie said:
However @Wendy&Neko is also very familiar with Vetsulin and might be around more; she leaves the 21st but since I’ll be back, I can pick up where she leaves off.
Click to expand...
I would not call myself very familiar with Vetsulin by any stretch. Neko was on Caninsulin for 2 months (same as Vetsulin), but unfortunately it was before I started home testing.:oops: Plus Neko was a high dose kitty and we didn’t get to a good Caninsulin dose.

However, more than willing to help with the Lantus piece, once that gets started. Maybe another option for strips is something you can buy close by and use as a backup meter/strips.
 
I’ve got to sign off here but in summary, I believe @Jill & Alex (GA) and @Wendy&Neko will agree, and might have something to add, that the next steps are:

  • Always get a preshot test before you give insulin;
  • Continue with 3u Vetsulin twice a day until we have a bit of data unless he drops below 50 on your meter; we will then need to lower the dose; at some point, if his numbers aren’t coming down, we might suggest adding another shot in at a specific time;
  • Try to get 2-3 tests at different times in the a.m. cycle and at least a before bed test in the p.m. cycle;
  • Post for help anytime you get a 200 or below at preshot (please don’t feed until you get some guidance);
  • Try to test urine ketones at least once, but twice if possible, a day;
  • Let us know right away if he vomits, won’t eat, is lethargic;
  • Post every day so we know how he’s doing and can make dose recommendations
  • After a couple days that he’s stable with no ketones and he’s eating /drinking and we have a bit of data, make the switch to Lantus.
A couple important things to remember are:
  • Your goal is to get as many calories in him as you can and it doesn’t really matter what you feed him as long as he’s eating. If he prefers a high carb food, that’s fine but please let us know so we can figure that in when looking at the dose.
  • We want to try and avoid skipping shots so if he’s lower at shot time, it’s important that the person helping you at that time understands he has just had a bout of DKA; we need to safely get “some” insulin in him. An experienced member will know how to help you do this.
  • Vetsulin can drop numbers quickly so it’s important to pay close attention to the preshot.
Thoughts or questions?
 
Hi there,
I see you have gotten some great advice regarding a switch to Lantus, I have nothing to add on that front.

I've never had a problem getting a urine ketone test with BFG he's not in the least bit shy, but if you struggle with that just wanted to let you know that there are blood ketone monitors available as well, if you find that it becomes problematic grabbing Gage when he's on the LB.
 
Great plan as noted above.

One question, though... Why are you giving your kitty Gatorade? Hopefully, your cat's electrolytes were where they should be after the DKA was treated. Did your vet recommend this? Honestly, I've not heard of anyone giving their cat Gatorade.
 
Marje and Gracie said:
I’ve got to sign off here but in summary, I believe @Jill & Alex (GA) and @Wendy&Neko will agree, and might have something to add, that the next steps are:

  • Always get a preshot test before you give insulin;
  • Continue with 3u Vetsulin twice a day until we have a bit of data unless he drops below 50 on your meter; we will then need to lower the dose; at some point, if his numbers aren’t coming down, we might suggest adding another shot in at a specific time;
  • Try to get 2-3 tests at different times in the a.m. cycle and at least a before bed test in the p.m. cycle;
  • Post for help anytime you get a 200 or below at preshot (please don’t feed until you get some guidance);
  • Try to test urine ketones at least once, but twice if possible, a day;
  • Let us know right away if he vomits, won’t eat, is lethargic;
  • Post every day so we know how he’s doing and can make dose recommendations
  • After a couple days that he’s stable with no ketones and he’s eating /drinking and we have a bit of data, make the switch to Lantus.
A couple important things to remember are:
  • Your goal is to get as many calories in him as you can and it doesn’t really matter what you feed him as long as he’s eating. If he prefers a high carb food, that’s fine but please let us know so we can figure that in when looking at the dose.
  • We want to try and avoid skipping shots so if he’s lower at shot time, it’s important that the person helping you at that time understands he has just had a bout of DKA; we need to safely get “some” insulin in him. An experienced member will know how to help you do this.
  • Vetsulin can drop numbers quickly so it’s important to pay close attention to the preshot.
Thoughts or questions?
Click to expand...

Sounds like a good plan to me. I got a 4 hour post shot BG on him last night and plan on getting a few today. I missed his morning pee and I really have no idea how he was at my feet looking at me at one second and then a minute later he was coming back. But Im super stalking him now so we can get a ketones on him.
He ate like a champ just now and so far has held everything down. I have him on friskies pate and he loves it. Last night I thought it was going to come back up but maybe he had the hiccups. His mood is great but his number this morning was off the charts Hi.
 
Sienne and Gabby (GA) said:
Great plan as noted above.

One question, though... Why are you giving your kitty Gatorade? Hopefully, your cat's electrolytes were where they should be after the DKA was treated. Did your vet recommend this? Honestly, I've not heard of anyone giving their cat Gatorade.
Click to expand...

The vet said nothing about Gatorade, I just thought 2 bowls of water might make it more tasteful and kinda did it myself to hopefully keep him hydrated. That's why I noted it because I have no idea if its a good or bad thing. But last night he took a few licks of both bowls like he was taste testing them when he went to drink.
 
I was wondering about the Gatorade too and was thinking that the sugar in it can't be a good thing for a diabetic cat. I would just put water in his food, a few tablespoons at a time to help keep him hydrated. The more water you can get into him, the better as it helps to flush the ketones.

I could never get Bubba in the litterbox to use the ketone stix. I invested in a ketone meter. The one I got was the Abbot Precison Xtra. I got in off of Amazon. It wasn't very expensive, maybe 30 bucks or so. But, the test strips for all the ketone meters are very pricey. The best price I found for them was using a Canadian online pharmacy called Universal.
 
Wishing you tons of luck getting a pee sample today! I've heard of others crumpling up little balls of saran wrap and putting them in the litter box. It might help catch a couple of drops.
:bighug::bighug::bighug:
 
I also saw that but was so focused on the other stuff to tell you that I would strongly recommend against anything to orally hydrate him but water. Kitties aren’t little furry people so they can’t eat or drink all that we do :) Glad he’s eating well.
 
If you are able to post every day, we can offer you more help. Also, if possible, a test around +4/+5 during the day cycle would be very informative.

It looks to me like Gage needs a bit more insulin. If you get another red or black number at PS, I’d suggest giving him 3.25u if you can monitor him. Also, pls let us know how he’s eating, etc, and how his ketones are doing. We need to get him switched to Lantus when we know he’s stable for a few days with no ketones.
 
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