Advice please - Post DKA

[DArcey and Buddy]

Hi friends!

@Bron and Sheba (GA) @Chris & China (GA) @JanetNJ

Last night I gave Buddy insulin (99% of the time, it is my husband that does it, he is the pro). It was not a fur shot- I always feel her fur and it’s wasn’t wet- but I feel like I do something “wrong” and it just doesn’t absorb properly when I do it (sometime it does, but occasionally when *I* shoot, it’s like she didn’t get insulin at all.) Case in point, she never went down below her pre-shot value last night. Now we are at +6, and her ketones are at 0.7, which while not high enough to panic yet, are the highest that they have been in weeks.

So my question is- do we wait another 6 hours before giving insulin again?! I really don’t know what to do. It really seems as though she didn’t “get” insulin, and I’m scared for how high her ketones will be in 6 more hours...

Here is the link to the last thread: https://www.felinediabetes.com/FDMB/threads/buddy-dka-recovery-new-thread.251931/#post-2843844

 

[Sue and Luci]

Hi Darcey, I'm not an expert on Prozinc, but it looks like Buddy may be bouncing from those lower numbers he had earlier in the day yesterday.

Is he eating/drinking? I would not give insulin based on the numbers at present.

Removing my question about frequency of Prozinc: From the stickies on the Prozinc forum:
PZ generally lasts 12 hours (“duration”) resulting in a “curve” of BG numbers, downward around mid-cycle, then back upward toward the end of each 12-hour cycle. For this reason, it’s dosed twice a day.

 

[DArcey and Buddy]

Yes, we give insulin every 12 hours.

Yes she is still eating at drinking thank goodness.

I really don’t think this is a bounce, just because this never happens to her mid-cycle no matter how low she went the cycle before. And it ONLY happens when I shoot. About 50% of the time that I’m the one giving the insulin, it’s like she received no insulin at all.

I’m just so worried and distraught. Prior to her DKA, I wouldn’t have worried, but a month ago she missed one dose and we spent $10,000 getting her better and almost lost her in the process so I am freaking out.

 

[Sue and Luci]

Yes, we give insulin every 12 hours.

I really don’t think this is a bounce, just because this never happens to her mid-cycle no matter how low she went the cycle before. And it ONLY happens when I shoot. About 50% of the time that I’m the one giving the insulin, it’s like she received no insulin at all.

I’m just so worried and distraught. Prior to her DKA, I wouldn’t have worried, but a month ago she missed one dose and we spent $10,000 getting her better and almost lost her in the process so I am freaking out.

Well, you said the area was not wet so it's not likely that it was a complete miss - there is some layover from the previous cycle for insulins so even if you did miss it's unusual to see the numbers go up and stay up unless there's something else going on (teeth issues, infection, etc.) I've seen kitties go into a bounce and stay there for days - I wouldn't rush to give insulin unless it was a short acting insulin and that's a whole different ballgame.

Try to take a deep breath and ride it out.

 

[Sue and Luci]

Yes, we give insulin every 12 hours.

Yes she is still eating at drinking thank goodness.

I really don’t think this is a bounce, just because this never happens to her mid-cycle no matter how low she went the cycle before. And it ONLY happens when I shoot. About 50% of the time that I’m the one giving the insulin, it’s like she received no insulin at all.

I’m just so worried and distraught. Prior to her DKA, I wouldn’t have worried, but a month ago she missed one dose and we spent $10,000 getting her better and almost lost her in the process so I am freaking out.

When will you be moving to the Prozinc forum? There are a lot of experienced members there - perhaps one of them can help you?

 

[DArcey and Buddy]

When will you be moving to the Prozinc forum? There are a lot of experienced members there - perhaps one of them can help you?

That’s a good point! I can post there instead, sorry about that!

Okay, we will try to breathe and ride it out. Thanks for the help

 

[Sue and Luci]

That’s a good point! I can post there instead, sorry about that!

Okay, we will try to breathe and ride it out. Thanks for the help

No need to apologize...I'm just hoping there are some regular Prozinc users there who could help/support you during this time. Since I'm a long term Lantus/Levimer user I'm a bit out of my depth...but I remember how it is - try not to panic. Let's hope there are some regulars on the Prozinc forum who will be able to better advise you on how to handle situations like this.

I hope you and Buddy have a better day soon!

 

[DArcey and Buddy]

No need to apologize...I'm just hoping there are some regular Prozinc users there who could help/support you during this time. Since I'm a long term Lantus/Levimer user I'm a bit out of my depth...but I remember how it is - try not to panic. Let's hope there are some regulars on the Prozinc forum who will be able to better advise you on how to handle situations like this.

I hope you and Buddy have a better day soon!

Thanks. In the last hour her ketones have gone up again, to 0.9, and I’m very concerned that we could be getting ourselves into another DKA situation. She almost died last time after one missed shot and now I’m really doubting myself.

 

[Steve & Jock]

If ketones are going up and glucose is up above 20.0, I would be giving at least a half dose of Prozinc for sure. You're around to watch so hypo is much less of a danger than DKA. Get some insulin in there and food and water I say.

 

[DArcey and Buddy]

If ketones are going up and glucose is up above 20.0, I would be giving at least a half dose of Prozinc for sure. You're around to watch so hypo is much less of a danger than DKA. Get some insulin in there and food and water I say.

Thank you! We are at +9.5 now, so we are going to wait till +10 or + 10.5 and shoot the full dose. We are comfortable shooting two hours early in this situation and monitoring very very closely. A hypo is scary but DKA was so horrible!!!!!

 

[Diane Tyler's Mom GA]

If you ever need to tag a prozic user you can tag
@JanetNJ

 

[JanetNJ]

Yes, we give insulin every 12 hours.

Yes she is still eating at drinking thank goodness.

I really don’t think this is a bounce, just because this never happens to her mid-cycle no matter how low she went the cycle before. And it ONLY happens when I shoot. About 50% of the time that I’m the one giving the insulin, it’s like she received no insulin at all.

I’m just so worried and distraught. Prior to her DKA, I wouldn’t have worried, but a month ago she missed one dose and we spent $10,000 getting her better and almost lost her in the process so I am freaking out.

I'm really surprised she's throwing trace ketones since she's being shown into the greens. I'm not sure what to tell you to help that other than feed her as much as she wants and encourage her to drink a lot. Add extra water in her food.... Or extra bowls on rooms that she hangs out in... Maybe try a fountain. The extra water may help flush the ketones out quicker.