Very New - Need Guidance (from HI to hypo to HI)

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pstanfield

pstanfield

Member Since 2021
First, I want to say hello (my name is Patty, and my furkid is Cookie), and that I am so grateful for this board, and wish I had seen this when I first took Cookie and received her diabetic DX. I was blindly following my vets recommendation and ended up in the ER with DKA. I am up to $10,000 on treatment, and I'm tapped out emotionally and financially. I discovered this board looking for solutions so that I am not back and forth to the ER.

I finally feel like I have everything I need to help get Cookie's diabetes regulated. We transitioned from dry plus wet to just wet, she was fine with that, and now she has been transitioning to low carb wet, she is on FF Classic Pate (6 oz a day). She is severely underweight, and has gone from 10# to 4.3# at last check.

Brief history - she was DX on 5/17/21, put on 1U ProZinc, to be tested in a month. Before her first glucose curve, she ended up in the ER with DKA on 6/5/21. At that point I had been giving her kibble (1/4 cup) and 1 1/2 oz of canned (Solid Gold seafood), 2 x a day with her insulin, but was transitioning to all wet. When she was released from the ER, they upped her dose to 2U and I started to just give her wet (the vet prescribed Hill's i/d wet (24% carbs) and I gave her half of that with Tiki Cat (0 carbs). She did not care for the Tiki Cat and by Saturday, her appetite kept decreasing. On Sunday, she was peeing a lot and drinking a lot of water, hiding, and acting like she was high BG. I finally got an AlphaTrak2 and measured her glucose and she was over 457. Went back to the ER, her BG was all over the place so they kept her for 2 days and then sent her home on 6/15/21 and said she seemed to be regulated on the 2U still and they were feeding her Hill's w/d wet (25% carbs).

After she came home, supposedly doing great in the ER, she went into HYPO within a couple of hours of being home, before I gave her any insulin. She was at 25. I followed the steps provided here (again, SO GRATEFUL!!!) rubbing karo on her gums, until she could lift her head, and went to the ER, who confirmed she was hypo. She came back home that same night (this was on 6/15/21). She did not have any insulin that night so I knew numbers would be HI the following morning, which they were. So I have finally been able to start the spreadsheet and did a curve yesterday with lots of notes. I tested every three hours. She went from HI(AMPS) to 267 to 163 to 360 to 647 (PMPS). After her evening dose, she went down slightly to 639, then went HI.

That is where I am totally baffled. What do I do from here? I am going to keep testing her BG (have not tested ketones at home yet, I just got the ketostix and I waiting for her to pee), but should I test her BG more often today? What should my immediate next steps be? Luckily I am a teacher and am now on summer break, so I can be home with her and test and do whatever is needed. If someone could please check out my SS and provide some guidance. Thanks so much for all that you are doing. Let me know if I need to clarify anything or if you have any questions!
 
When in the ER, her kidney values were elevated, they did an u/s and kidneys were inflamed, so they gave Clavamox in case of infection. Numbers were going down when she was released the first time, and values looked good when she was released from ER the second time. Nothing definitive though.
 
pstanfield said:
When in the ER, her kidney values were elevated, they did an u/s and kidneys were inflamed, so they gave Clavamox in case of infection. Numbers were going down when she was released the first time, and values looked good when she was released from ER the second time. Nothing definitive though.
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OK @JanetNJ

@Deb & Wink
Will probably be on here later, just hang in there , they are familiar with Prozinc
 
Hi Patty! Welcome to FDMB! Looks like you've been put through wringer so early in your FD journey!

Just to clarify, the ER put her on 2U Prozinc twice a day and fed her Hill's w/d wet (25% carbs) and she went as low as 25 on that dose? And now she is on low carb FF on the same dose? If so, 2U is way too high for her. I think she is probably boucing from that 25 from 2 days back, which is why she is higher numbers, and once the bounce clears would head lower again.
(This sticky has a detailed explanation on bouncing)


I will nevertheless wait for @Deb & Wink or @JanetNJ or @Panic to weigh in on dosing since I'm not familiar with Prozinc.
 
Bandit's Mom said:
Hi Patty! Welcome to FDMB! Looks like you've been put through wringer so early in your FD journey!

Just to clarify, the ER put her on 2U Prozinc twice a day and fed her Hill's w/d wet (25% carbs) and she went as low as 25 on that dose? And now she is on low carb FF? If so, 2U is way too high for her. I think she is probably boucing from that 25 from 2 days back, which is why she is higher numbers, and once the bounce clears would head lower again.
(This sticky has a detailed explanation on bouncing)


I will nevertheless wait for @Deb & Wink or @JanetNJ or @Panic to weigh in on dosing since I'm not familiar with Prozinc.
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Thanks @Bandit's Mom
I forget about tagging
@Panic
 
Bandit's Mom said:
Hi Patty! Welcome to FDMB! Looks like you've been put through wringer so early in your FD journey!

Just to clarify, the ER put her on 2U Prozinc twice a day and fed her Hill's w/d wet (25% carbs) and she went as low as 25 on that dose? And now she is on low carb FF? If so, 2U is way too high for her. I think she is probably boucing from that 25 from 2 days back, which is why she is higher numbers, and once the bounce clears would head lower again.
(This sticky has a detailed explanation on bouncing)


I will nevertheless wait for @Deb & Wink or @JanetNJ or @Panic to weigh in on dosing since I'm not familiar with Prozinc.
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Yes, she was put on 2U Prozinc twice a day starting 6/9/21. She went hypo after they sent her home. She had the Prozinc at the vet at 8 am, was eating while there on the Hills w/d wet. Came home at 4 pm (+8 after dose), and went into HYPO by 6:00 PM (+10).
 
pstanfield said:
Yes, she was put on 2U Prozinc twice a day starting 6/9/21. She went hypo after they sent her home. She had the Prozinc at the vet at 8 am, was eating while there on the Hills w/d wet. Came home at 4 pm (+8 after dose), and went into HYPO by 6:00 PM (+10).
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From when was she transitioned to low carb Fancy Feast from the Hills W/D? From 6/15?

Could you add rows at the top of your SS for the dates from 6/9 to 6/14 and input the dose she was given then? And any test data that you may have?
 
Bandit's Mom said:
From when was she transitioned to low carb Fancy Feast from the Hills W/D? From 6/15?

Could you add rows at the top of your SS for the dates from 6/9 to 6/14 and input the dose she was given then? And any test data that you may have?
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6/5 - 6/9 (In E.R.) - they were giving her Hill's i/d chicken and stew, and when I picked her up, they told me to give her "whatever I have at home" and sent me home with a few cans of the Hill's. They went from fast acting insulin and then transitioned to Prozinc, 2U, over the course of 4 days, while giving fluids and electrolytes, and whatever they needed to do for the DKA. I have no lab results, they will only give them to my vet, who I am not seeing anymore, and haven't had the chance since being in and out of the hospital to see our new vet.
6/9 - 6/13 (HOME) - I was feeding her some of the Hill's i/d chicken and stew and the Tiki Cat Luau.
6/13 - 6/15 (in E.R.) - they said they were giving her some "turkey and cheddar" that she was eating, and when I expressed concern at the carbs, they switched her over to the Hill's w/d multi-benefit. I asked about the carbs and they said just give her whatever she will eat, and sent me home with two cans of the Hill's w/d multi-beneift. (I put all of the Hill's cans in her Hypo toolkit, they are 24-25% carbs).
6/15 - (HOME 2 hours) - She didn't eat anything, went into HYPO, I gave her karo on her gums, brought her back to the E.R., where they gave her dexrose and saline, and fed her some chunky chicken breast. It seems like they are feeding her high carbs when she should be lower, and low carbs when she should be higher. Anyway, I brought her back home with a can of chunky chicken breast this time.
6/16 - present (HOME) I have been feeding her the FF Classic Pate, since she hasn't been on any consistent diet at all, and don't really have anything else to give her.

I can put in the original labs she had when she was first diagnosed though.
 
Bandit's Mom said:
Could you add rows at the top of your SS for the dates from 6/9 to 6/14 and input the dose she was given then? And any test data that you may have?
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Thanks for adding this history to the spreadsheet. :-)

Hopefully Deb and/or Janet will get back on dosing before your PM shot. Please continue to test her and feed her high carbs if she dips low. Below 68 is too low on the AT2.
Normally a change from a high carb to a low carb diet brings down numbers and insulin requirements significantly.

Btw, a lot of use human meters here. We test A LOT and the strips are WAY cheaper than those of the AT2.
 
Bandit's Mom said:
Thanks for adding this history to the spreadsheet. :)

Hopefully Deb and/or Janet will get back on dosing before your PM shot. Please continue to test her and feed her high carbs if she dips low. Below 68 is too low on the AT2.
Normally a change from a high carb to a low carb diet brings down numbers and insulin requirements significantly.

Btw, a lot of use human meters here. We test A LOT and the strips are WAY cheaper than those of the AT2.
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Yes, I will be looking into the human meter soon, and then I can maybe add the AlphaTrak to my Hypo kit as backup. Thank you all for being here! I am working on getting her original labs inputed as well.
 
Hi I'll be checking in here throughout the day.

What you're seeing is quite a bounce from that 25 - basically her body panicked and her liver dumped a bunch of sugar into her bloodstream. So don't let the high numbers scare you. Over time yes high numbers will be harmful, but for right now they are safer than hypos.

I personally think 2U is going to be far too much, BUT given the DKA we have to be careful not to reduce insulin too much. Please test again at +7, and hourly of she dips below 130 just to be safe.

Based on how she does the rest of the day we'll figure out what to do for the PM shot
 
Is she eating ok? Reading the notes on your spreadsheet about the water I also want to make sure she's eating ok.

Also, please make sure you give her as much low carb food as she wants to eat. It will help her gain the weight back (diabetics do not utilize food as well as regular cats) and will help guard against ketones/another DKA. Do you have ketone strips at home?
 
why in the world would they put her on high carb food. that's like a dr. telling a diabetic person to eat donuts. makes no sense.

so here's what i would do if it were my cat. NO MORE of the prescription food of any kind. Just feed the Fancy feast pate or tiki or a combination. LOWER to 1 unit. I think the high carb food was giving you the high readings, and there may have been bouncing going on. also if she had a kidney infection brewing that could have raised her numbers as well.

Test every preshot and at least once or twice mid cycle... more when you have a chance. give her a few days to stop bouncing from that life threatening low (a number in the 20's is super scary!!). If she goes too low on the 1 unit, immediately lower the dose again. Write on here if you aren't sure what to do.
 
JanetNJ said:
why in the world would they put her on high carb food. that's like a dr. telling a diabetic person to eat donuts. makes no sense. so here's what i would do if it were my cat. NO MORE of the perscription food of any kind. Just feed the Fancy feast pate or tiki or a combination. LOWER to 1 unit. I think the high carb food was giving you false readings. Test every preshot and at least once or twice mid cycle... more when you have a chance.
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It's maddening every time someone comes here with this exact same situation because of ill-informed vets and bad advice. I never get used to it. We just had one pass away the other day from DKA because of it. Frustrating and irresponsible.

I too am thinking 1U, max 1.25U, but want to see how the rest of the day goes.
 
FrostD said:
It's maddening every time someone comes here with this exact same situation because of ill-informed vets and bad advice. I never get used to it. We just had one pass away the other day from DKA because of it. Frustrating and irresponsible.

I too am thinking 1U, max 1.25U, but want to see how the rest of the day goes.
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I'd rather start at one and move up a little in a few days if she needs it.
 
FrostD said:
Is she eating ok? Reading the notes on your spreadsheet about the water I also want to make sure she's eating ok.

Also, please make sure you give her as much low carb food as she wants to eat. It will help her gain the weight back (diabetics do not utilize food as well as regular cats) and will help guard against ketones/another DKA. Do you have ketone strips at home?
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She is eating fine, yesterday she had 6 oz of FF throughout the day, she likes to graze on 3 oz for the first part of the day, and then eats the other 3 oz just before her post shot. She's had about 2.5 oz as of now.

I just bought some ketostix today, missed her peeing by about a second, got some urine from the inside of the litter box, but going to say the first one was a miss. I may have to go to the blood keto strips if I can't time it better.
 
FrostD said:
Hi I'll be checking in here throughout the day.

What you're seeing is quite a bounce from that 25 - basically her body panicked and her liver dumped a bunch of sugar into her bloodstream. So don't let the high numbers scare you. Over time yes high numbers will be harmful, but for right now they are safer than hypos.

I personally think 2U is going to be far too much, BUT given the DKA we have to be careful not to reduce insulin too much. Please test again at +7, and hourly of she dips below 130 just to be safe.

Based on how she does the rest of the day we'll figure out what to do for the PM shot
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So I just tested at +7, is the AlphaTrak2 known to bounce around at a single setting? It said 483, I wanted to confirm, so I used another strip, which read 574 and then I did a third strip and it said 368. They are all high, but why the variation?!
 
pstanfield said:
So I just tested at +7, is the AlphaTrak2 known to bounce around at a single setting? It said 483, I wanted to confirm, so I used another strip, which read 574 and then I did a third strip and it said 368. They are all high, but why the variation?!
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There can be a 20% variation in meter readings. Even from the same drop of blood. But 368 to 574 is just a bit too much
 
pstanfield said:
So I just tested at +7, is the AlphaTrak2 known to bounce around at a single setting? It said 483, I wanted to confirm, so I used another strip, which read 574 and then I did a third strip and it said 368. They are all high, but why the variation?!
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So human meters are allowed a 20% variance, pet meters generally 15%. Generally we just take a reading at face value unless it just doesn't seem right (like a cat in the 400s all of a sudden testing at 100 or something, sometimes there's bad strips, not enough blood). In that case I'd take the middle number. At these higher numbers it's not super critical what the actual number is, just the overall trends.

Edit: cross post with Bhooma. I agree it's a bit too big of a difference, probably an off strip in the mix or not enough blood. But I wouldn't worry about it
 
pstanfield said:
So I took it again, definitely enough blood, and it read at 606.
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I'd go with the 574 then. The real number is probably somewhere around there. The important thing is she's not super low!

It looks like she's bouncing again from the blue numbers she saw today; don't worry, this is very normal and may continue for awhile until her numbers come down overall.

For tonight, it is your call. She didn't go too terribly low today, so I'd suggest 1-1.5U.

The disadvantage to doing 1U is you risk ketones, especially given the recent DKA and possible infection. The advantage is it's a "safer" dose, in that there's lower risk it will drop her into greens.

The advantage to doing 1.5U is lower risk for ketones. Disadvantage is more risk of dropping her into greens, but I don't think it will.

Whatever you decide, I'd continue to test for ketones anyway, at least once a day. Anything above trace and I'd take her to the vet. As for the blood meters sometimes ADW diabetes runs a promo where you get the NovaMax Plus meter free when you buy two boxes of strips, not sure if they're doing that now.

I would also test every other hour/every 3 hours for the next day or so if you can. I know that's rough for sleeping, but cats are often sensitive to insulin after a symptomatic hypo. With the food transition and infection thrown in there, she's a little unpredictable.
 
FrostD said:
I'd go with the 574 then. The real number is probably somewhere around there. The important thing is she's not super low!

It looks like she's bouncing again from the blue numbers she saw today; don't worry, this is very normal and may continue for awhile until her numbers come down overall.

For tonight, it is your call. She didn't go too terribly low today, so I'd suggest 1-1.5U.

The disadvantage to doing 1U is you risk ketones, especially given the recent DKA and possible infection. The advantage is it's a "safer" dose, in that there's lower risk it will drop her into greens.

The advantage to doing 1.5U is lower risk for ketones. Disadvantage is more risk of dropping her into greens, but I don't think it will.

Whatever you decide, I'd continue to test for ketones anyway, at least once a day. Anything above trace and I'd take her to the vet. As for the blood meters sometimes ADW diabetes runs a promo where you get the NovaMax Plus meter free when you buy two boxes of strips, not sure if they're doing that now.

I would also test every other hour/every 3 hours for the next day or so if you can. I know that's rough for sleeping, but cats are often sensitive to insulin after a symptomatic hypo. With the food transition and infection thrown in there, she's a little unpredictable.
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Ok so I will test her every couple of hours, including through the night. It's better to know than not know how she is processing this. I am waiting for her to pee to get that ketone test, so I will update when she does that. I will wait and see on the 1.5 vs 1.0. I'm leaning towards the 1.5 though because of the recent DKA.
 
pstanfield said:
Ok so I will test her every couple of hours, including through the night. It's better to know than not know how she is processing this. I am waiting for her to pee to get that ketone test, so I will update when she does that. I will wait and see on the 1.5 vs 1.0. I'm leaning towards the 1.5 though because of the recent DKA.
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Whatever dose you choose, please test her regularly for the next couple of days. Like Melissa said, more often if below 150 or so. If she is bouncing from that low from two days back, it's possible that there is additional downward momentum in the cycle when she clears the bounce. Bounces can take up to 6 cycles to clear. Once the bounce clears, you will get an idea how low she is actually going on the dose.
 
pstanfield said:
Ok so I will test her every couple of hours, including through the night. It's better to know than not know how she is processing this. I am waiting for her to pee to get that ketone test, so I will update when she does that. I will wait and see on the 1.5 vs 1.0. I'm leaning towards the 1.5 though because of the recent DKA.
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Sounds like a plan!

And, not to scare you, but please know that ketones can develop at any time, and rather quickly. So if she even starts hinting at acting off, I'd check her. We had a cat acting off that was negative for ketones the day prior so they thought that couldn't be it, when in fact the cat had developed DKA again after having just been sent home.
 
FrostD said:
Sounds like a plan!

And, not to scare you, but please know that ketones can develop at any time, and rather quickly. So if she even starts hinting at acting off, I'd check her. We had a cat acting off that was negative for ketones the day prior so they thought that couldn't be it, when in fact the cat had developed DKA again after having just been sent home.
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So if she does come back with a trace of ketones, should that be a regular vet visit or back to the ER, provided we are within normal vet hours?
 
pstanfield said:
So if she does come back with a trace of ketones, should that be a regular vet visit or back to the ER, provided we are within normal vet hours?
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anything over a trace is time for a vet visit or er if it's out of hours. Be sure to add extra water to the food to help flush ketones. I'd also put extra bowls of water or fountains out in different areas that she hangs out in.
 
I tested her ketones and negative. I used a little cup (the size of a Jello shot) and held it under her, and was able to get a nice clean sample. She was a bit insulted, but it worked. How often should I test for ketones? Is once a day enough?
 
I don't really have anything substantive to add as Melissa and Janet are taking such good care of you, Patty, but having gone through DKA with my kitty I feel for you. I sent my Ruby to the hospital for a two night stay recently and they gave her kibble to eat with full knowledge of her diabetes, and of course her glucose levels skyrocketed. Thank goodness I could bring her home and get the situation under control. I will never bring her to any ER or hospital now without a few days worth of low carb wet food in a bag marked with her name.
 
pstanfield said:
I tested her ketones and negative. I used a little cup (the size of a Jello shot) and held it under her, and was able to get a nice clean sample. She was a bit insulted, but it worked. How often should I test for ketones? Is once a day enough?
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Some people also use a dedicated soup ladle.

I would check as often as you can for the next few days to be safe, maybe twice a day?
 
PerfumedCatMom said:
I don't really have anything substantive to add as Melissa and Janet are taking such good care of you, Patty, but having gone through DKA with my kitty I feel for you. I sent my Ruby to the hospital for a two night stay recently and they gave her kibble to eat with full knowledge of her diabetes, and of course her glucose levels skyrocketed. Thank goodness I could bring her home and get the situation under control. I will never bring her to any ER or hospital now without a few days worth of low carb wet food in a bag marked with her name.
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I hadn't even considered that, but that is such a great idea, to bring the food with you!!! That was one of my concerns, having to bring her back to the ER and having to start from scratch. I hope Ruby is doing better!
 
pstanfield said:
I hadn't even considered that, but that is such a great idea, to bring the food with you!!! That was one of my concerns, having to bring her back to the ER and having to start from scratch. I hope Ruby is doing better!
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She's doing a lot better, thank you! With DKA, it's important that a cat eats ANYTHING, but once the crisis is over, it's vital that they eat something low carb and high in moisture, even if it's a can of tuna or sardines with no salt and in spring water. It's not balanced and doesn't have all the nutrients a cat needs, but it's fine short term and better than high carb prescription foods.
 
pstanfield said:
I tested her ketones and negative. I used a little cup (the size of a Jello shot) and held it under her, and was able to get a nice clean sample. She was a bit insulted, but it worked. How often should I test for ketones? Is once a day enough?
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Once a day is fine. If you start to see it go up to a trace test more often. So happy it is neg!!!
 
I'd be inclined to suggest the 1-1.25u dosage as well. I don't have experience with advising for ketones/DKA so I'm not comfortable saying anything definite, but keep on top of it! Get a blood ketone meter like Janet suggested if the urine testing becomes more miss than hit. Cats with a ketone/DKA history are more prone to ketones developing again than cats without. I'm glad to hear you're off for the summer and can help Cookie through it. Remember to feed often throughout the day, do not limit her intake as she's underweight, let her eat as much as she wants.
 
I’m with Elizabeth on feeding Cookie more. That 6 ounces of food just isn’t enough. Please try to get her to eat more. More food is very important when a cat has had DKA. The additional food will help to stop her from catabolizing her own body fat and muscle tissue for energy. When a cat is burning up their own tissues to provide energy, the toxic byproducts from that forms ketones.

I really agree with the other suggestions on the dosage. Somewhere between one and 1.5 units.

Just be very careful to monitor closely as your cat Cookie is very sensitive to insulin right now.
 
I am feeling nervous, her BG is not going down at all, it's at 664. Is this to be expected? Should I test again at +6 or wait until +7?
 
With DKA in the picture you need to be feeding 1 1/2 times as many calories as you normally would. Food helps stop ketones as does insulin. So I would feed snacks every couple of hours to make sure Cookie is getting enough food.

ETA
I have just read in Cookies SS that she wasn’t interested in eating more than 6 oz in the day. You may need to ask the vet for some cerenia and ondansetron to help with nausea. Nauseated cats will not eat and most cats recovering from DKA will have some level of nausea. Don’t leave it and wait and see because it is very important that she eats well.
 
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JanetNJ said:
Do 1.5 in the am.
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I know nothing about Prozinc, but I wondered whether Patty should give it one more day for the bounce to clear? Or do you think Cookie is not bouncing from that 25 two days back, because she's seeing those blues in the AM cycle?
 
Bandit's Mom said:
I know nothing about Prozinc, but I wondered whether Patty should give it one more day for the bounce to clear? Or do you think Cookie is not bouncing from that 25 two days back, because she's seeing those blues in the AM cycle?
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I'm only concerned because of the ketones history. Don't like those black numbers.
 
She seems to bounce sky high overnight then come down during the AM, based on the little data we have. When cats break a bounce, the momentum often takes them a little lower than the dose normally would. So, if you can, check hourly from +3 to about +7. If for any of those tests she rises by more than 75 points you can give her a break from testing.
 
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