? PLEASE HELP

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DArcey and Buddy

DArcey and Buddy

Member Since 2020
Buddy has just returned from the hospital an hour ago after four days there for DKA and severe pancreatitis. We are supposed to give her next insulin shot now, 1.5 units of prozinc, but we just tested, and she is at 50. What do we do....
 
Judy & Fritz said:
I don’t have an answer, but hopefully one of these members will. Praying for you! Do you feel comfortable stalling on the shot until you get an answer?
@Chris & China (GA) @Daddy Jack's Mommy
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Yes we will absolutely be stalling. I think it would be very dangerous to shoot now. But I’m scared too, because I really don’t want ketones/another DKA. But yes- we will be holding off shooting, monitoring her, and hopefully can get some advice here.
 
D’Arcey, you might want to redo this thread, just start another one using the blue question mark option on the little dropdown menu before you type in the title of the thread. Faster response that way, I was told.
 
Hello Buddy and Company. I responded on the Facebook post, but I'll put the same thing here.

Okay, because of the risk of ketones, it's best not to skip insulin entirely. You may want to consider a drop dose, just barely any in the syringe. You also need to get her BGL higher, do you have any high carb wet food available. Get her to eat, but not too much. You are going to want her to eat a little like every hour for the next few hours.

I see you are using prozinc and on 1.5 units. With this low, it's time to drop the dose 0.25 of a unit. Are you following SLGS or TR protocol? I also encourage you to get back in the habit of mid-cycle testing. Your AMPS on 8/2 was possibly a bounce from going low the night before, which may have contributed to the ketone development. Understand that I'm not saying you have done anything wrong, I'm just saying that mid-cycle tests are more important than ever now. As is ketone testing at home.
 
Juls and Billy said:
Hello Buddy and Company. I responded on the Facebook post, but I'll put the same thing here.

Okay, because of the risk of ketones, it's best not to skip insulin entirely. You may want to consider a drop dose, just barely any in the syringe. You also need to get her BGL higher, do you have any high carb wet food available. Get her to eat, but not too much. You are going to want her to eat a little like every hour for the next few hours.

I see you are using prozinc and on 1.5 units. With this low, it's time to drop the dose 0.25 of a unit. Are you following SLGS or TR protocol? I also encourage you to get back in the habit of mid-cycle testing. Your AMPS on 8/2 was possibly a bounce from going low the night before, which may have contributed to the ketone development. Understand that I'm not saying you have done anything wrong, I'm just saying that mid-cycle tests are more important than ever now. As is ketone testing at home.
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Thank you so much! We normally always test mid cycle and will continue to do so- for the past two weeks, we left her with my parents, and because we only expected them to test pre-shot, we told them to shoot a lower number (1.5), and that’s why there are suddenly no mid cycle tests for those two weeks. Sadly if we had been here, we may have avoided the DKA, or caught it earlier, but when I left them with instructions, I was not overly worried about ketones as she’s never previously had anything over trace in the last 1.5 years since diagnosis. We tend to test a lottttt and we will be monitoring her around the clock during this week, because it really looked like we would lose her, and the least we can do is be very very vigilant and love on her a lot!!!!

opps, edit to add- we are usually tightly regulated. While we were out of the province for 2.5 weeks, we adopted more of a SLGS approach as my parents were monitoring her, and though we insist they test, we only expect them to test prior to shots.
 
Chris & China (GA) said:
Is "now" the time you want to continue to shoot at?
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hi Chris! No, not at all! We are completely and totally flexible. We are both off work and home 24/7 and she is our only concern at the moment, so we are totally flexible and amenable to changing shot times, stalling- anything and everything that would work best for Buddy girl
 
D'Arcey Taylor said:
hi Chris! No, not at all! We are completely and totally flexible. We are both off work and home 24/7 and she is our only concern at the moment, so we are totally flexible and amenable to changing shot times, stalling- anything and everything that would work best for Buddy girl
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Then I'd wait until the BG is going up when you haven't had to feed anything high carb for 2 hours and shoot then (as long as that works for both AM and PM shots)
 
Juls and Billy said:
Hello Buddy and Company. I responded on the Facebook post, but I'll put the same thing here.

Okay, because of the risk of ketones, it's best not to skip insulin entirely. You may want to consider a drop dose, just barely any in the syringe. You also need to get her BGL higher, do you have any high carb wet food available. Get her to eat, but not too much. You are going to want her to eat a little like every hour for the next few hours.

I see you are using prozinc and on 1.5 units. With this low, it's time to drop the dose 0.25 of a unit. Are you following SLGS or TR protocol? I also encourage you to get back in the habit of mid-cycle testing. Your AMPS on 8/2 was possibly a bounce from going low the night before, which may have contributed to the ketone development. Understand that I'm not saying you have done anything wrong, I'm just saying that mid-cycle tests are more important than ever now. As is ketone testing at home.
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Sorry, I am a bit chaotic right now- we bough a blood ketone meter today (it was hard to find in Ottawa Canada, but we are using the Freestyle Libre), and we test and got zero ketones. We also tested the pee she had, out of an abundance of caution, with a ketone pee stick and it was negative as well. We will probably test blood ketones every day and urine as often as we see her pee.
 
Chris & China (GA) said:
Then I'd wait until the BG is going up when you haven't had to feed anything high carb for 2 hours and shoot then (as long as that works for both AM and PM shots)
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Okay, that sounds great to us! Literally any time of day will work for us for AM/PM shots; we will take shifts hanging out with her how high will be want her numbers to be, approximately, to consider shooting? I suppose we will probably want to reassess in a couple of hours, to see what she is at, and decide then if we are able to give the full dose.
 
I'd think as long as she was heading up, she's not going to go back down again without insulin so wherever she is in 2 hours is going to be high enough. At some point she's also going to probably bounce from dropping that low.

Let's see where she's at in 90 minutes so we have a little time to decide on a dose for tonight.

GREAT that she's negative on ketones too!!
 
Chris & China (GA) said:
I'd think as long as she was heading up, she's not going to go back down again without insulin so wherever she is in 2 hours is going to be high enough. At some point she's also going to probably bounce from dropping that low.

Let's see where she's at in 90 minutes so we have a little time to decide on a dose for tonight.

GREAT that she's negative on ketones too!!
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Perfect- she had some high carb food, and is at 73. I have removed the food, and we will keep an eye on her, and then will check 90 minutes from now to see where she is at.

I’m so so relieved that she’s negative on ketones. They were telling me it was fine to go home with 2.4, but at their last test she was 1.3 last night, and we are getting negatives (though their testing method may be more precise than ours). We are going to be very diligent about checking for them so we can catch any early.

Wonderful- thank you so so much @Chris & China (GA) , (and also @Juls and Billy and @Judy & Fritz ).
 
Chris & China (GA) said:
I'd think as long as she was heading up, she's not going to go back down again without insulin so wherever she is in 2 hours is going to be high enough. At some point she's also going to probably bounce from dropping that low.

Let's see where she's at in 90 minutes so we have a little time to decide on a dose for tonight.

GREAT that she's negative on ketones too!!
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Hi Chris!
I just tested and Buddy was at 198. So we are trending upwards. We were thinking we will give her insulin at 9pm EST. So I’m just wondering what are your thoughts on what her dosage should be?
 
I think I'd go with the 1.5 again as long as she's eating well, you're able to test and have plenty of supplies. I'd get a +2 to see what's going on early in the cycle.

Please add the fact that she had a recent DKA to your signature too because that's going to be very important in dosing decisions for at least several weeks.
 
Chris & China (GA) said:
I think I'd go with the 1.5 again as long as she's eating well, you're able to test and have plenty of supplies. I'd get a +2 to see what's going on early in the cycle.

Please add the fact that she had a recent DKA to your signature too because that's going to be very important in dosing decisions for at least several weeks.
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I just tested again and she is at 196.2 for her pre-shot, so she is gone back down slightly. I am going to hold for 30minutes and test again, and see if she comes back up.
So we will re-evaluate then I think. My wife isn’t comfortable shooting the 1.5U if she is dropping still.

I will let you know.
 
D'Arcey Taylor said:
I just tested again and she is at 196.2 for her pre-shot, so she is gone back down slightly
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That's actually the same number...remember, meters are allowed a 20% variance so 196 and 198 are the same number. You could test twice with the exact same meter, the same drop of blood and at the exact same time and get a result that's 20% higher or lower on each test.
 
Chris & China (GA) said:
Grab a +2 and go from there! I'm betting she's probably going to bounce high tonight due to dropping so low today but she may surprise us!

She's a cat....they like to be unpredictable :confused:
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Hi Chris and everyone!

At +2, Buddy is at 252. I am sitting with her, and will likely do the next test at +4.
 
I suppose I should have said “was at” 252 at +2, since we are now at +3 We are tired, lol. Will be testing again in an hour.
 
Bron and Sheba (GA) said:
Are you updating the SS? I can’t see those BGs anywhere.
Did you give a snack at +4?
I would get a +5
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I will update the spreadsheet now, sorry about that! Yes, she has access to some food and has eaten a bit. I will take a +5 reading as well. I’ll be taking tests at least every hour until she starts to come up (and more often if she starts to drop low)
 
D'Arcey Taylor said:
I suppose I should have said “was at” 252 at +2, since we are now at +3 We are tired, lol. Will be testing again in an hour.
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Just FYI....your Pre-shot number is always the number you actually shot, so if she was at 245 when you shot, that's her PMPS.....that way the + cells still correspond to the number of hours since the shot.
 
Chris & China (GA) said:
Just FYI....your Pre-shot number is always the number you actually shot, so if she was at 245 when you shot, that's her PMPS.....that way the + cells still correspond to the number of hours since the shot.
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opps! So sorry about that! I adjusted that. Hopefully I’ve done it right. Is it okay that I left a note in there in the units column, or should I move that to the remarks section.

also, just took a +5 reading, and she is at 124.
 
D'Arcey Taylor said:
s it okay that I left a note in there in the units column, or should I move that to the remarks section.
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Either way is fine or you can put 244 @ +14.5 in the PMPS cell....that shows that you stalled for 2 1/2 hours past your usual shot time.

Tomorrow morning, you can either shoot at 12 hours after you shot tonight or if you want to work your way back to a different time you can move her shots by 15 minutes per cycle or 30 minutes per day until you're at your chosen shot time.
 
Chris & China (GA) said:
Either way is fine or you can put 244 @ +14.5 in the PMPS cell....that shows that you stalled for 2 1/2 hours past your usual shot time.

Tomorrow morning, you can either shoot at 12 hours after you shot tonight or if you want to work your way back to a different time you can move her shots by 15 minutes per cycle or 30 minutes per day until you're at your chosen shot time.
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Perfect, thank you so so much for all your help. I am so glad we have you guys and this forum. The vet wanted us to skip this shot entirely, which seemed like such a recipe for disaster post-DKA.

Not 100% about timing, but we will do just that- we will either leave it at the same time, or do it 15 minutes earlier to move the time back slowly.

I am pretty happy with the fact that her BG drop seems to have slowed down between +4 and +5 (compared to the fairly quick drop between +2 and +4). Given all that she has been through in the past 4-5 days, one of us will be with her pretty much all the time, though, so we will probably keep testing until we see the numbers start to come up, and then maybe test every couple of hours to see how the go after they’ve reached the nadir.
 
Buddy is looking good. When did you last test for ketones? how is her appetite?
I’m sure you are both exhausted! :bighug: Make sure you take turns to get some rest!
 
Bron and Sheba (GA) said:
Buddy is looking good. When did you last test for ketones? how is her appetite?
I’m sure you are both exhausted! :bighug: Make sure you take turns to get some rest!
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We have tested for ketones 3 times in the 12 hours she’s been home- about 9-10 hour ago I tested for blood ketones and it was negative, and we have tested with Rhine strips both time she peed- 10 hours ago, and then maybe around 4-5 hours ago, and both were negative as well. She hasn’t peed since then, though I could do another blood ketone test. I have no idea how often I should be doing it after a DKA. We will probably test urine whenever we see her pee, cause it’s easy, why not (we can’t catch urine, but we press it down into the wet urine). We are open to any suggestions though- we truly only want what is best for her! And after the enormous bill for hospitalization, I could really care less about there comparably small cost if these strips!

at the moment she is eating very well. She has had an appetite stimulant a couple days ago, and they sent up home with a few. They didn’t send us home with anti nausea pills, which scares me, but even when I asked they said no, she should not need them, which is questionable with pancreatitis. But we should be able to see our regular vet Monday.

We also have subq fluids on hand in case any ketones do show up. We may start to give them tomorrow regardless, as her kidney values are very high, and we also want to ensure that she is staying hydrated. I’m just a little nervous because the ultrasound showed fluid in the abdomen, and I don’t know if that makes subq fluids more risky. Sorry for the tangent, I am tired! The hubby is sleeping while I monitor tonight - we are gonna both post from this account regardless of which of us is writing, to keep things simple!

thank you so so so much again for all the supper, advice- and for listening to me/us ramble!! You guys are so wonderful.
 
If the ketones are negative, testing once a day should be enough. If things changed, such as ketones showing up, vomiting, not eating, diarrhoea, you would increase that.
I think I would ask your regular vet for some antinausea medication because it is better to have them on hand …just in case you need them. This always seems to happen after hours. Either cerenia or ondansetron.
Did the vet give the OK to give the subQ fluids? You just need to make sure Buddy doesn’t have any heart issues before giving subQ fluids. I would ask your regular vet about it on Monday, unless you have that clearance already.
The kidney values may be up because of the illness and they often come back down as the cat gets better. I see you have early CRD in the signature. Are you giving some extra fluids in the food. Just a teaspoon of warm water added to each snack adds up. As long as she will tolerate it.

We are very happy to help anytime. It makes us so happy to see kitties improve and get back to their former selves!
 
Bron and Sheba (GA) said:
If the ketones are negative, testing once a day should be enough. If things changed, such as ketones showing up, vomiting, not eating, diarrhoea, you would increase that.
I think I would ask your regular vet for some antinausea medication because it is better to have them on hand …just in case you need them. This always seems to happen after hours. Either cerenia or ondansetron.
Did the vet give the OK to give the subQ fluids? You just need to make sure Buddy doesn’t have any heart issues before giving subQ fluids. I would ask your regular vet about it on Monday, unless you have that clearance already.
The kidney values may be up because of the illness and they often come back down as the cat gets better. I see you have early CRD in the signature. Are you giving some extra fluids in the food. Just a teaspoon of warm water added to each snack adds up. As long as she will tolerate it.

We are very happy to help anytime. It makes us so happy to see kitties improve and get back to their former selves!
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wonderful, that is all good to know! I’ll try to be a bit calmer about ketones, haha, and just check about once a day. But I will absolutely be checking once a day from now on!!

Buddy does not have any heart issues (or not to our knowledge- I suppose there’s always a possibility that there could be something undetected, but none have ever been flagged to us.) The was one day in the hospital this week that they said her heart beat was a bit slow, which they said might have been from the pain meds, and it returned to normal quickly as she improved clinically, and no other issues about it were flagged to us. Based on her precious medical history, our vet seemed comfortable with us giving the fluids. She also read an overview of the details of Buddy’s case from this week from the emergency hospital, though I don’t think she saw the full report with every single detail. She is the one that gave us the fluids, but I didn’t have an opportunity I ask any more follow up question before she left for the day, and I’m a bit paranoid in general about my baby!

We are mixing water into Buddy’s food. We always do, so thankfully she tolerates it well! When we feed a can of fancy feast, we mix at least half a cans worth of water into it :-) I would guess it’s about 2 tbsps of liquid added to each meal, and she eats 3-4 meal a day generally.

I will definitely be asking for anti nausea meds on Monday! Even if we don’t give them now, I think we absolutely need to ensure we have them around, now that we know how severe her pancreatitis can get very quickly. I would ideally always like to have some anti nausea meds and painkillers in the house, so we can immediately try to stop it in it’s tracks in the future.
 
Yes it’s a good idea to have the treatment for pancreatitis on hand as they don’t always get it in working hours and the sooner treatment is started, the sooner they can start to cover. Sheba used to get pancreatitis and I always know when she did because she would stop eating . Or eat very little. And because she was a great eater normally, I knew something was wrong. The treatment is supportive rather than a cure.
That is good she will accept the extra fluids in the food.

You are both doing a really good job looking after her. She is lucky to have you.
 
In addition to having ants-nausea meds on hand, I'd ask the vet for an appetite stimulant, as well. Buddy's eating but like Bron suggested, should Buddy stop eating, it will inevitably be when the vet's office is closed.
 
Sienne and Gabby (GA) said:
In addition to having ants-nausea meds on hand, I'd ask the vet for an appetite stimulant, as well.
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Thanks! We were given an appetite stimulant. She is due to get her next dose anytime today.
I think we have an appointment with our vet on Monday and we are going to discuss getting some anti nausea medication.
 
Chris & China (GA) said:
Grab a +2 and go from there! I'm betting she's probably going to bounce high tonight due to dropping so low today but she may surprise us!

She's a cat....they like to be unpredictable :confused:
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Hi Chris and everyone!

Buddy is showing some ketones now- instead of 0, she is showing 0.3. I think at this point, we are going to give 100ml sub q fluids. We want to flush those ketones out. We were discussing her heart in the comments above- looking through her report, her heart was listened too about 7 times. Six of those times, they said no murmur/arrhythmia, and one of the times they said “Suspect grade I/VI heart murmur or arrhythmia” (that was early on, and then the next five checks it said no murmur/arrhythmia). I’m so nervous and scared through this whole thing, I hope this is the right choice.
 
We rechecked her blood ketones 45 mins after the first test, and she had gone from 0.3 ketones to 0.4 ketones in that time. I’m definitely scared. We went ahead and gave 100ml subq fluids which I am praying will help. Is there anything else we can/should be doing?
 
@Chris & China (GA), Buddy’s nadir this afternoon was 194. We are now at +10, and she is at 356. So, we are starting to think ahead to shot time, and we are wondering what does we should be giving. Especially given that we did find some ketones in her blood today as I noted above. We just want to make sure we are doing everything we can to get her feeling well, improving, and hopefully getting rid of those ketones. We are still almost two hours from PM shot time, so hopefully I can confirm by then what the right/best dose to give should be :-) As always, thank you so so so so much. We couldn’t do this without you guys.
 
If it gets closer to shot time and no one has responded, do another blue ? HELP thread. I know these amazing members haves lives and pets of their own, and I’m so sorry I know nothing about DKA kitties. But I am praying for you.
 
I am going to tag @Panic and @JanetNJ asthey are Prozinc users for the dose.

D’Arcey are you using the Blood meter when you say the ketones are 0.3 and 0.4?
If so, those numbers are OK. There is no need to be concerned at that point. But keep monitoring them.
Is she still eating well?
 
Bron and Sheba (GA) said:
I am going to tag @Panic and @JanetNJ asthey are Prozinc users for the dose.

D’Arcey are you using the Blood meter when you say the ketones are 0.3 and 0.4?
If so, those numbers are OK. There is no need to be concerned at that point. But keep monitoring them.
Is she still eating well?
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Yes, those ketones numbers are with a blood meter. I just wish they were not coming up at all, as yesterday her blood showed no ketones. Hopefully we can get them back down/gone again. I did check her blood ketones again and they were 0.2 so hopefully they keep going down and go away forever! This is all so tough.

She is still eating fairly well today. Maybe not quite as well as yesterday, but she was due for her mirtazapine appetite stimulant today, so we gave that to her. The only way we can seem to get pills into her is to crush it into her food. I am confident she got at least half the pill down, (and likely closer to 3/4 of it.)

She does seem a bit more lethargic/out of it the last couple of hours. She is due for her dose of buprenorphine now, so she may be having some pancreatitis pain too, so maybe that’s a factor in her mood at the moment. We will be keeping an extremely close eye on her.
 
The higher BG numbers could be from a bounce from the low green BGs yesterday.
I would check with your regular vet if he is OK with you giving the sub Q fluids with someone hearing that heart murmur…..just to be cautious. He may suggest reducing the dose to 50 mls.
What are the urine ketones tests telling you?
 
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