At the ER

[Sienne and Gabby (GA)]

It is generally recommended that Lantus/Lev not be used to treat DKA. In most cases with a hospitalized cat, the vets are using Humulin R/Novolin R. It is very short acting and can lower numbers rapidly. In the ER/ICU this gives the vet a great deal of flexibility due to constant monitoring along with the cat being on a dextrose drip. As the kitty is recovering, they transition to a longer acting insulin (often Novolin or Humulin N). Some vets will even ask you to bring your Lantus so they can use a basal/bolus approach. The basal insulin is Lantus and they use R as a "booster" or bolus to bring the numbers down. While it's possible to do this at home if your cat isn't critically ill, you would need an member with experience in using both Lantus and R to guide you through the process.

Dropping the dose back to 1.0u makes no sense. The numbers weren't great at 3.0u. What was the dose at the vets regardless of what basal insulin was being used?

 

[Bron and Sheba (GA)]

Yes I saw it mentioned recently but don't remember who said it or if it would apply in Dewey's case. I believe it involved ketones being present though.

@Bron and Sheba (GA) @Nan & Amber (GA) was it one of you?

If a kitty has come home from hospital after DKA it is not a good time to change over to a depot insulin from Vetsulin or Novolin (or whatever they were discharged on) until ketones are well and truely out of the picture.
With pancreatitis without the complication of DKA or ketones I think it would be ok to swap over, but probably a good idea to test for ketones in the urine daily for a few days especially if the BGs are high. I agree with others that dropping to 1 unit makes no sense.

 

[Kristin and Dewey]

I really appreciate all the advice! I do want to be clear that Dewey never had ketones. He was sick with probable pancreatitis (resolving when we went to the ER, or maybe a chronic case), gastroparesis and gastroenteritis. Some liver enzymes were high (Due to pancreatitis?). As for insulin history, Dewey was placed on Vetsulin at 3u to start, increased to 4u after a week and a vet glucose curve with high BGs, and then increased again to 5u after another glucose curve at the vet's after two more weeks. I started reading on here and then changed from high carb dry food to Tiki Cat wet food and decreased the dose to 3u because of the food change. I then read further about going slowly and increasing in small increments every 3 days. I read about missing the optimal dose so I started back at 1u and slowly increasing. I was later told that I should have increased to 3.5u instead of going back to 1u and starting over so I had misunderstood. I had increased back up to 3u and was about to increase to 3.5 the day Dewey got so sick, vomiting tons, then dry heaving and having liquid diarrhea all over himself. That is when I took him to the ER. He was only there a day. He had a normal stool and was eating great with no signs of DKA. The vet said it was not the typical case of pancreatitis but that something was going on there. I brought him back for an appointment 5 days later and that is when she changed the insulin to Lantus 1u. I assume you all are right about the dosing but the vet wants me to keep him where he is until I do a glucose curve and report to her in a week. While I know she may be wrong I don't want her to get mad enough to refuse treatment. She is so much better than my vet and I live in a small community with limited choices on specialists. With that said his numbers are as bad as ever. I was hoping after the depot was established they would drop some. I do feel quite worried about it because I don't know what I should do. I am stuck between a rock and a hard place because I want to give him a proper dose but don't want to burn bridges with a vet that seems pretty good overall.

 

[Critter Mom]

Good synopsis of the story so far, Kristin. Thank you!


Mogs
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[Tomlin]

Hi Kristin,

Pancreatitis &/or other inflammation causes blood glucose to increase and it can be substantial, so even if a depot is established you will see higher numbers. With that being said, the internal medicine specialists will typically adjust the dose during a flare to manage the increase in BG, but it has to be done carefully because as a flare starts to resolve and inflammation decreases, the BG will also decrease and then there is the risk of the dose of insulin being too high. This is more of an issue with a depot vs short acting insulin. Every cat is different so the extent of the increase in BG during a flare as well as how fast or slow it decreases will vary.

Do not be afraid to express concerns with your current internal medicine specialist and establish a working relationship with them. If you hear, read or think something different from what is being recommended by your specialist, most do not mind explaining why they are approaching treatment a certain way. It is also ok to ask them to reach out to internal medicine specialists who are sub specialists in endocrinology/diabetes. One other option that is always available, is for you to to do a phone consult through Cornell University’s Feline Health Center’s Camuti Feline Health Line:https://www.vet.cornell.edu/departm...ealth-information/camuti-consultation-service). You are able to email records to them and ask for an internal medicine specialist to do the consult-let them know the situation. There is one specialist currently working the service who is a sub specialist in endo. There is also another vet who does calls with the service who is extremely knowledgeable & has extensive experience treating feline diabetes. Again, do not hesitate to have an open discussion with your current specialist &/or express concerns. If they are good, they will always welcome your questions as well as offer discussions about your concerns. They will welcome your desire to learn and involvement with treatment & care . Even if they said to call in a week & you want to call tomorrow to go over the plan, go ahead and do so. Believe me, I have done this MANY times and no one became angry or upset .

Hang in there! It is really, really great that Dewey is eating ! Eating can be a serious problem with pancreatitis & one of the early management issues/struggles so the fact that he has a healthy appetite is fantastic! Best to you and Dewey!

 

[Kristin and Dewey]

Hi Kristin,

Even if they said to call in a week & you want to call tomorrow to go over the plan, go ahead and do so. Believe me, I have done this MANY times and no one became angry or upset .

Thank you, Tomlin! I believe I will call tomorrow and see what she thinks of the numbers so far. I may try the consulting option, too, if I feel uneasy after I speak to her. You are so nice to take the time to comment, as is everyone here trying to help. I am so grateful to all of you. If I am a little neurotic about it please forgive me! I just love my little guy so much.