New Member and New Diagnosis

[Mookitty's Mom]

Hi.

Mookitty was diagnosed last Tuesday and hospitalized with DKA and has been on 1 unit of lantus every 12 hours for 3 days now.

I wrote in my profile a pretty lengthy description of her health issues. My baby went from around 7.5 lbs to 5.8 lbs and it took this event for her to be finally diagnosed. Vets were pointing at hyperthroidism, age, kidney disease despite none of her values being that bad. ( I have her numbers.) My trust that they are on top of things is not great.

How should a cat post DKA behave when starting lantus (1 unit) for the first time?

Her blood sugar values are still high in the 400s , has polyuria, polydipsua. She is very tired and also very hungry between 2x a day feedings. I have seen no values below 290 mg/dl.

Despite being told to do 2x feedings, I plan to start feeding her 2/3 can at insulin time and the other 1/3 can a few hours later because she has becomes incredibly uncomfortable after scarfing her food down. She acts thirsty, she yells, and gets extremely tired. It feels dangerous and she has grazed up to this point.

Her glucose curve is not scheduled till May 4. As someone who has done lab bench work, Im fairly sure I could get the numbers myself before then.

Please offer any advice you can.

 

[SaraMV]

I'm pretty sure that I've read on here that a cat who is recovering from DKA should be fed several times a day. I know for pancreatitis, my Taz needed several small meals through out the day. He currently eats 10 times within a 24 hour period.

 

[Mookitty's Mom]

I'm pretty sure that I've read on here that a cat who is recovering from DKA should be fed several times a day. I know for pancreatitis, my Taz needed several small meals through out the day. He currently eats 10 times within a 24 hour period.

Thank you for replying. Do you know if that was for a cat with negative ketones? She was hospitalized for several days and was negative for the last two of those.

If you see the thread where this was discussed please send it my way.

 

[SaraMV]

If you do a search for DKA or ketoacidosis, you'll find lots of past posts with lots of information. Make sure that you have ketone strips at home to self test. I'm sorry, I haven't read your profile yet, so I don't know if you're doing home glucose testing?

I'm sure that others will be posting shortly to help you out. I'm fairly new here, so unfortunately I'm not much help.

 

[Diane Tyler's Mom GA]

Hi.

Mookitty was diagnosed last Tuesday and hospitalized with DKA and has been on 1 unit of lantus every 12 hours for 3 days now.

I wrote in my profile a pretty lengthy description of her health issues. My baby went from around 7.5 lbs to 5.8 lbs and it took this event for her to be finally diagnosed. Vets were pointing at hyperthroidism, age, kidney disease despite none of her values being that bad. ( I have her numbers.) My trust that they are on top of things is not great.

How should a cat post DKA behave when starting lantus (1 unit) for the first time?

Her blood sugar values are still high in the 400s , has polyuria, polydipsua. She is very tired and also very hungry between 2x a day feedings. I have seen no values below 290 mg/dl.

Despite being told to do 2x feedings, I plan to start feeding her 2/3 can at insulin time and the other 1/3 can a few hours later because she has becomes incredibly uncomfortable after scarfing her food down. She acts thirsty, she yells, and gets extremely tired. It feels dangerous and she has grazed up to this point.

Her glucose curve is not scheduled till May 4. As someone who has done lab bench work, Im fairly sure I could get the numbers myself before then.

Please offer any advice you can.

Welcome Ariah
I'm going to tag a few members for you, for now we need all the information you posted on your profile
I'm going to give you a link for this
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
Click on your name ,a drop down will appear, click in signature and add all your info

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Please do not wait until May 4 to take Mookitty to the vet to for a glucose curve
You need to be testing her now
I see you live in California, you can go to Walmart and buy the human meter
The Relion Premier Classic for 9 dollars
17.88 for 100 test strips
26 or 28 gauge lancets
Cotton rounds

Our numbers are based on human meters

We also have a spreadsheet where we track our cats BG to see how the insulin is working and how low Mookitty is dropping
I'll give you the link , but if you have trouble setting it up please ask we have a member who will be glad to do it for you

You need to be seeing her more than 2 times a day
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Tagging Bron
@Bron and Sheba (GA)


Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up

Here is a video one of our members did
VIDEO: How to test your cat's blood sugar

 

[Diane Tyler's Mom GA]

@Bron and Sheba (GA)
Arian has this in her profile about Mookitty
My name is Ariah.

Mookitty:

• 15-16 year old female siamese
• Diagnosed on 4/19/22 with ketoacidosis and hospitalized
• Has hyperthyroidism and borderline kidney disease values

Treatment

• Started on 1 unit of glargine/lantus every 12 hours on 4/23/22
• Home testing with AlphaTrak2 also have a human blood glucose meter from CVS pharmacy
• I was told not to test for the first few days as she adjusts to lantus unless I see something concerning.
• Testing about 4 to 5 times a day, because I'm concerned.
• eats 2 cans of purina DM a day and 2 to 3 temptations to get her meds down

Complications

• DKA
• Weight loss
• Polyuria
• Polydipsia
• Suspected neuropathy

Other Meds:

• Methimazole (for hyperthyroidism)
• Enacard (for kidney disease)
• taken corticosteroids?
  • Only a short term shot in an emergency situation years ago

Getting Mookitty diagnosed has been a very long process. I was given the wrong impression by my vets that her symptoms were chronic kidney disease and hyperthroidism and not diabetes for a long time despite her kidney and thyroid values not being as advanced as her symptoms. Moo was on subQ's for several months before she went into DKA and was finally diagnosed with diabetes.

 

[Bron and Sheba (GA)]

Hi Ariah and Mookitty and welcome to the forum.
I’m sorry your kitty has had DKA but there is a lot you can do to help her recover fully.
Here is a plan for you to follow

• you need to give one and a half times as many calories as she normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever she will eat as eating any food is better than not eating,
• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
• Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all. You will need to buy a bottle of Ketostix from Walmart or a pharmacy and follow the directions on the bottle.
• Give antinausea medication if needed. Ondansetron is best. You will need a script from the vet for this and you get it from a normal pharmacy.
• Give appetite stimulant if needed after the antinausea medication
• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
• Ask the vet about subQ fluids
• Set up a spreadsheet and test the BG frequently
• Post daily with updates and ask for help as often as needed.

Let her eat whenever she wants as food is very important as it helps keep ketones away. Just don’t feed for the 2 hours before you test to give the dose of insulin.
If you set up the spreadsheet and add what data you have we can help you with dosing. Please don’t wait to do a curve in a week or two. Start testing every day before every dose to see it is safe to give it. Also test during the cycles to see how low the dose is taking Mookitty. The nadir or lowest point in the cycle is how we decide the dose. It’s not the preshot number that decides the dose.
If you need help setting up the SS we can get someone to help you.
It is really good she is hungry as many post DKA kitties won’t eat. So that is a good thing.

Ask lots of questions and post as often as you want. We are here to help.

 

[Diane Tyler's Mom GA]

Hi Arian and Mookitty and welcome to the forum.
I’m sorry your kitty has had DKA but there is a lot you can do to help her recover fully.
Here is a plan for you to follow

• you need to give one and a half times as many calories as she normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever she will eat as eating any food is better than not eating,
• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
• Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all. You will need to buy a bottle of Ketostix from Walmart or a pharmacy and follow the directions on the bottle.
• Give antinausea medication if needed. Ondansetron is best. You will need a script from the vet for this and you get it from a normal pharmacy.
• Give appetite stimulant if needed after the antinausea medication
• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
• Ask the vet about subQ fluids
• Set up a spreadsheet and test the BG frequently
• Post daily with updates and ask for help as often as needed.

Let her eat whenever she wants as food is very important as it helps keep ketones away. Just don’t feed for the 2 hours before you test to give the dose of insulin.
If you set up the spreadsheet and add what data you have we can help you with dosing. Please don’t wait to do a curve in a week or two. Start testing every day before every dose to see it is safe to give it. Also test during the cycles to see how low the dose is taking Mookitty. The nadir or lowest point isn’t he cycle is how we decide the dose. It’s not the preshot number that decides the dose.
If you need help setting up the SS we can get someone to help you.
If really good she is hungry as many post DKA kitties won’t eat. So that is a good thing.

Ask lots of questions and post as often as you want. We are here to help.

@Bron and Sheba (GA)

Thank you Bron, now I can stop worrying about her kitty now that you replied back . I hope you have a nice day

 

[Mookitty's Mom]

Hello Everyone. Thank you so much for replying.

I started her spreadsheet from the sporadic times I've tested her. I was discouraged from testing because her levels were predicted to be erratic as she starts lantus. However, I'm going to ignore that advice. As you can see it is very high in all spot checks.

Food Amount - She was scarfing food down before DKA. Should her food amount be [1.5 x normal calorie amount for a cat at her ideal weight] or should i just keep feeding her snack till she doesn't want more? I know a healthy 7lb cat needs about 170 a day. She is 5.8 and eating 316 calories over 24 hour period. She would totally eat more but I'm spooked about the vet's feeding instructions. I don't understand the 2x a day feedings on a long-acting insulin on an underweight cat. Shouldn't she be getting many of her calories in during peak action??

Feeding Schedule - I was told no free feed 2x at lantus dosing. So, at first I was allowing her to eat for 20 minutes (scarfed it down desperately) and then giving her a shot. She reacted horribly and would get weak, would whine, and get super thirsty. Today, I switched to feeding 1/2 can before shot time and then for the 6 hours after that giving her little spoonfuls of the other half of the can. She suffered a lot less during her morning meal today.

I'm considering buying a bunch of friskies pate and fancy feast classics and just adding hourly spoonful snacks up to 2 to 3 hours before insulin time to what she is already eating. I won't be able to do it all night but I can do it for a few hours before I go to sleep.

Ketone Testing: I ordered this and have them sticking in her litter box. I don't know if they work and the only way I'd know they would work is to maybe fast tonight...

I have subQ bags ready. Will call the vet tomorrow about her new dosage. Do I need to separate SubQs from insulin dosage time?

 

[Mookitty's Mom]

I should also note that she was ketone free for 3 days before she went home. (They only could hospitalize her in the daytime because of the area I live in. I have no car and the nearest place I could go was a 3 to 4-hour drive with an unstable cat. )She is on day 4 of Lantus. When I got her home the night before starting Lantus she was in the 500s.

I'm very frustrated with this vet. The blamed it on chronic kidney and thyroid issues up to this point when her SDMA was fine and her thyroid values were corrected with low dose meds. They had done a fructosamine test and it had been borderline and I was told to not do anything. I should have just bought a glucose meter months ago and pushed to check myself. I was too worried about being obedient to the vet. Their odd advice on how to feed her was also really off the wall.

 

[Hendrick Cuddleclaw]

yeah my vet said the same thing, you hear it time and time again it must be taught in vet school "only feed 2x/day with the insulin shot"

my boy Hendrick also had DKA and thank goodness for this forum or he might have had a second bout of DKA, following that only feed twice a day malarkey. I guess it is outdated, from a time when the insulin was much harsher or something, I believe one of the members here told me that.

 

[Bron and Sheba (GA)]

Well done getting the SS up and running and putting the data in it…..very helpful.Also the signature.

With the feeding schedule…give her a decent meal before the shot. What ever you would normally give. It’s very hard trying to get them to eat large amounts if they are not used to it. Then offer her snacks throughout the cycles except for the 2 hours preshot. We don’t want the preshot BG food influenced. It’s true that it’s best to feed in the first half of the cycle normally, but with DKA it’s really important that the cat eats plenty, so spreading it out is OK. Let her eat as much as she wants at this stage as she is underweight and hungry. That is a real plus being hungry. Often the biggest problem we have with post DKA cats is they won’t eat.

I'm considering buying a bunch of friskies pate and fancy feast classics and just adding hourly spoonful snacks up to 2 to 3 hours before insulin time to what she is already eating. I won't be able to do it all night but I can do it for a few hours before I go to sleep.

That’s OK too. Have you thought of a timed feeder for night time and when you are not there?
I would give her 1 1/2 times as many calories as she would normally eat if she was her ideal weight. If she is asking for more, I would let her have it and be very thankful she wants to eat. Once she gains some weight and the BGs drop into more normal range, I’m sure she will slow down with the food. While the BGs are high, she can’t utilise all the nutrients in the food so will need more because of that.

Ketone Testing: I ordered this and have them sticking in her litter box. I don't know if they work and the only way I'd know they would work is to maybe fast tonight...

Yes those are fine to use. But you need to catch her peeing and put the strip into the stream of urine or collect it into a container or spoon and dip the strip in. You need to read it exactly 15 seconds later against the colours on the side of the bottle.

Get a couple of more days data and then I think you will need to increase the dose to 1.25 units.
Do you have syringes with 1/2 unit markings?

 

[Mookitty's Mom]

I just ordered syringes that have u-100 1/2 units on amazon. earlier today. I'll have them before the weekend.

Should I ever try to slow her down while eating and pace it? It seems like when she was given a full can all at once it made her feel sick.

I will keep the sheet updated. I think tomorrow during her injection I'll do an every 2 or 3 hour measurement.

I guess one thing that is really concerning me is wouldn't increasing her food intake over 2 cans increase her blood sugar and make her at higher risk of DKA?

 

[Bron and Sheba (GA)]

just ordered syringes that have u-100 1/2 units on amazon. earlier today. I'll have them before the weekend.

Were they the U100 3/10 30 or 31 gauge 6 or 8 mm 1/2 unit syringes?

Should I ever try to slow her down while eating and pace it? It seems like when she was given a full can all at once it made her feel sick.

I wouldnt give her a full can at once. I would split it up and give her 1/2 before the shot and maybe 1/2 an hour later.

will keep the sheet updated. I think tomorrow during her injection I'll do an every 2 or 3 hour measurement.

Not quite sure what you mean. Do you mean you will test every couple of hours?

guess one thing that is really concerning me is wouldn't increasing her food intake over 2 cans increase her blood sugar and make her at higher risk of DKA?

Good question…. but No. I’ll tell you why.
The recipe for DKA not enough food, not enough insulin and an infection or inflammation.
So to make sure ketones don’t come back you need to make sure you give plenty of food which almost acts like a medicine, make sure you give enough insulin and don’t skip doses, make sure any infection or inflammation is being treated and test daily for ketones…also make sure plenty of fluids are being drunk one way or another.
So your main jobs at the moment are

• Feed enough food
• Dont skip insulin doses
• Make sure any infection or inflammation has been treated
• Give plenty of fluids
• Test daily for ketones.
• Ask questions if you are not sure.

If necessary the dose of insulin can be increased. Does that all make sense?

 

[Mookitty's Mom]

The syringes look like they are u100 3/10 31 gauge.

I meant testing every couple hours.

Yes, it makes sense. Thank you for reassuring me on the "overfeeding issue". This is a drastic jump off from what the technician said and I needed that reassurance.

Are there any tips or alternatives to catching her peeing midstream to collect a sample for ketones? I think that's my biggest challenge right now. I feel like I have a lot of control when it comes to the glucose checks, but not that.

Tomorrow my vet agreed for me to call and have an update. I plan to ask about subQ's, report on the spreadsheet, and talk about how Moo reacted poorly to the twice daily feeding. I'll try to convince her that in a few days she should have me do the BG curve at home.

 

[Bron and Sheba (GA)]

Yes, it makes sense. Thank you for reassuring me on the "overfeeding issue". This is a drastic jump off from what the technician said and I needed that reassurance.

We get a lot of people who are told to only feed twice a day. It’s old thinking. I was told the same thing and poor Sheba used to plead for food all day. Once I joined this forum and found out how to manage a diabetic cat, I fed her more often and she became a different and much happier cat who was better regulated.

Are there any tips or alternatives to catching her peeing midstream to collect a sample for ketones? I think that's my biggest challenge right now. I feel like I have a lot of control when it comes to the glucose checks, but not that.

You could try putting a small container in her favourite spot in the LB.
Here is a link to CATCHING A URINE SAMPLE

Tomorrow my vet agreed for me to call and have an update. I plan to ask about subQ's, report on the spreadsheet, and talk about how Moo reacted poorly to the twice daily feeding. I'll try to convince her that in a few days she should have me do the BG curve at home.

Remember Mookitty is your cat and you are paying the vet for her opinion. You are not obliged to follow it if you are not comfortable with it. You are Mookitty’s advocate….don’t let them talk you into anything you are not comfortable with. You can do a curve at home any time you want. You don’t need your vets permission to do that. It will be a much truer reading at home. Cats get stressed at the vet and their BGs are higher.

 

[Hendrick Cuddleclaw]

I remember being in this exact same position. Had only just joined this forum and the vet curve was already scheduled for a few days later, one week after starting 1u insulin 2x/day.
Everyone here said don't bother, you can do a curve yourself at home. Now, at the time, I had never done any home BG testing so that seemed crazy. Plus, the vet was saying that this curve was needed!

Ultimately, I let the vet do a curve and it was a bunch of stress on poor Hendrick for no reason. His BG numbers were stress elevated and they only bothered to test him 4 times before calling off the rest of the curve. And his ears were so bruised! They were poking the marginal vein and using an Alpha Trak 2. I thought they were doing some high-tech thing, had him hooked up to a sensor or something. Nope, just ear pokes I could do a better job of at home where he wouldn't be stressed.

there are some who say, vets push curves as a money-grab. They can charge a lot for something that is simple and takes a vet tech just a couple minutes every few hours. Great profit margins. Doesn't cost them much at all.

Looking at your spreadsheet you are already testing frequently enough that a curve is pointless, especially one at the vet where the numbers will be stress-elevated. on the 25th, you basically did a curve that spans across TWO cycles (normal curve is just one cycle, testing every 2 hours for 12 hours). Combine that day with the 26th and you have a MUCH better picture of what the BG is doing than a single cycle vet curve would provide.

You can honestly tell the vet "I'm already doing curves at home, did one on the 25th want the data?" of course the standard thing is to do a curve 1 week after starting insulin so they may not be interested in the data from the 25th but the point is, you can easily do a curve at home at the one week mark, save money, have more accurate results, and save stress on Mookitty.

 

[Mookitty's Mom]

You are all fantastic and I'm extremely grateful you have taken time to be this supportive. To some people, Moo might "just be a cat", but to me she is the light in my day and the most precious little animal I've ever had. It makes me tear up thinking about it.

I called the vet today and the one I spoke with is very happy about all the testing. She wants me to up the dose from 1U 2x a day to: either 1.5U during the day or 1U at night or 1.25U 2x a day if I can manage that measurement. She also said give her 100 ml of subQs everyday or every other day. I will be doing as close to 1.25U as possible by going below 1.5 until my better syringes come on Friday. I will start this tomorrow morning when I can monitor her as the current timing of her shots is late in the evening. (Long story short they called in the insulin last minute and it was a scramble to get it..so when I finally had it *that* became her insulin time in the morning.)

To be safe, my plan tonight is to do her normal 1 unit tonight. I will give subQs 2 hours before that. I will do the shot on the opposite side of her shoulder as the subQ injection. She doesn't have much skin to grab except there. I will set a few alarms tonight to monitor her but I don't want to up her dosage when I'll be sleeping. I heard subQs can lower blood sugar. I'll also update her measurements for tonight. She is eating a little less ravenously (she is on her hyperthyroid meds now) but she was still above 255 6 hours post shot (the shot was a bit less conservative on the 1unit line than normal because I knew she needed to go up to 1.25 soon.)

I hope I'm filling out the sheet in the way everyone else does. I dose her at 11:00 (usually 10:55ish, glucose check is at 10:30, then feed, then dose 15-20 min later). I count anything between 12-1 +1 hour post dose.

Her ketones have been negative so far. She has definitely had several times in the past few days where she seemed to be a very good mood. Lots of purring. Tail sticking up. Talkative. I'll continue to baby her.

 

[Bron and Sheba (GA)]

Yes keep the insulin shot away from the subQ site and 2 hours earlier with the sub Q fluids is a good idea.
I would start the sub Q fluids every other day to stay with to see how she manages it.

With the insulin doses, Lantus works best when the same dose is given as it then doesn’t mess with the depot.

Ate you sticking with the 11am and 11pm times moving forward ?

We all love our kitties so you are in good company here. No one thinks of them as ‘just a cat’.

 

[Bron and Sheba (GA)]

Giving subQ fluids link https://felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/

 

[Diane Tyler's Mom GA]

I agree with Bron
With the insulin doses, Lantus works best when the same dose is given both AM and PM as it then doesn’t mess with the depot.

I'm pretty sure the DM Savory Selects is 10% carbs ,we like to feed 6% and under
I'm going to tag Bron about whether you should stay with this or find a food with lower carbs
@Bron and Sheba (GA)

Here is the food chart
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/page-3#post-2934560

Most of us feed Fancy Feast Classic Pate or Friskies Pate

 

[Mookitty's Mom]

Yes keep the insulin shot away from the subQ site and 2 hours earlier with the sub Q fluids is a good idea.
I would start the sub Q fluids every other day to stay with to see how she manages it.

With the insulin doses, Lantus works best when the same dose is given as it then doesn’t mess with the depot.

Ate you sticking with the 11am and 11pm times moving forward ?

We all love our kitties so you are in good company here. No one thinks of them as ‘just a cat’.

I'm will do the SubQs every other day. I think once her blood sugar is out of the range where there is increased urination I should stop. I think 100ml was more than she needed judging from her squishiness. I think a bit less per shot is probably safer. She gets kind of a wet purr easily even when she does not look super hydrated. Fortunately, they have never reported any heart issues in her.

Understood. Will stick with 1.25u 2x a day.

I would like to stick with 11 a.m to 11 p.m to get her stable. I don't mind this schedule on my own (nightowl), but if I get a part-time job that isn't remote I will need to transition her over to something like 6 or 7 a.m. I am actually working on the job part right now. The expenses of this event was too high for an unemployed graduate student. I ended up using a CareCredit card to cover the hospitalization. I would like to learn how to transition a cat to a new schedule in the safest way possible, but right now I think I should prioritize just getting her levels into a healthy range.

 

[Mookitty's Mom]

I agree with Bron
With the insulin doses, Lantus works best when the same dose is given both AM and PM as it then doesn’t mess with the depot.

I'm pretty sure the DM Savory Selects is 10% carbs ,we like to feed 6% and under
I'm going to tag Bron about whether you should stay with this or find a food with lower carbs
@Bron and Sheba (GA)

Here is the food chart
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/page-3#post-2934560

Most of us feed Fancy Feast Classic Pate or Friskies Pate

She was fed fancy Feast and a lot of Friskies Pate before this all happened so that's good news. I was worried about the DM Savory selects too because I spent 100+ dollars on only 48 cans of it on Chewy. How soon and gradually should I change the food if she is upping her insulin tomorrow?

Chart is great. Thanks.

 

[Bron and Sheba (GA)]

How soon and gradually should I change the food if she is upping her insulin tomorrow?

Don’t do both things at the same time. Either swap the food over to lower carb and see how that goes before doing an increase. OR do the increase and see how that goes and then do the swap over with the food.

If you have the food ready to do the swap, I would do that first. You need to be monitoring closely when you do the swap over as the lower carbs can reduce this BGs quite a bit.

 

[Diane Tyler's Mom GA]

Don’t do both things at the same time. Either swap the food over to lower carb and see how that goes before doing an increase. OR do the increase and see how that goes and then do the swap over with the food.

If you have the food ready to do the swap, I would do that first. You need to be monitoring closely when you do the swap over as the lower carbs can reduce this BGs quite a bit.

Thank you Bron
@Bron and Sheba (GA)

 

[Mookitty's Mom]

Worried.

Tonight she went down to 90 right before her scheduled shot time with a 1.25 dose this morning. I did not give the shot tonight, of course. I'm feeding her now.

It's really worrying that 1/4 of a dose can do that much. I think this switch is too soon because her eating habits are not set yet. She's been eating less also from having hyperthyroid medication and because of my worries about DKA I'm not sure really what feeding schedule is appropriate. She ate a full can of food in the 12 hours between her shot but had not been eating for a couple to prep her for her preshot meal. Typically I have her eat at least one can during the day and one at night.

I think I should check how she is in the morning and go back to 1 unit if it is raised to a sufficient level once I hear back.

 

[Mookitty's Mom]

She ate a small amount and I checked her levels again. In a span of about 30 minutes the read went from 90 to 355.

 

[Bron and Sheba (GA)]

I see you decided to do the dose increase before the switch to lower carb food. In post 24 I said not to do both things at once otherwise if things went pear shaped you wouldn’t know which of them is the cause.

I thnk that the 90 was probably a bad test strip because it is most unlikely that she would go from 90 to 355 in 30 minutes. If that happens again please do another test to confirm.
Can you do another test please? I would be inclined to give the dose as I’m sure she wasn’t at 90. If you want to go back to the 1 unit and get the food sorted out first, that is fine…that is what I would do…as long as there are no ketones.
You don’t want to be skipping doses of insulin this soon after having DKA.
But please test daily for ketones.

 

[Mookitty's Mom]

I see you decided to do the dose increase before the switch to lower carb food. In post 24 I said not to do both things at once otherwise if things went pear shaped you wouldn’t know which of them is the cause.

I thnk that the 90 was probably a bad test strip because it is most unlikely that she would go from 90 to 355 in 30 minutes. If that happens again please do another test to confirm.
Can you do another test please? I would be inclined to give the dose as I’m sure she wasn’t at 90. If you want to go back to the 1 unit and get the food sorted out first, that is fine…that is what I would do…as long as there are no ketones.
You don’t want to be skipping doses of insulin this soon after having DKA.
But please test daily for ketones.

Yes. Saw the information about food after her morning dose. Will be doing the food switch first next time and keep her at 1 unit.

Her levels went up from 90 to 355 to 508 in like an hour and a half. I decided to give her a bit shy of 1 unit about an hour and 30 minutes after her scheduled time. There was a lot of panicking and reading because i was really afraid of going down too low. I wish I had given her 1 unit but i was convinced she was being super sensitive to the insulin. It is 12:58 a.m right now. Not a good situation. Im worried about her being so high.


I ordered new test strips but just ran down to only two of my pet meter strips. I have a CVS oharmacy human meter but this is terrible timing. I didn't realize i could go through them this quickly.

 

[Bron and Sheba (GA)]

levels went up from 90 to 355 to 508 in like an hour and a half

It’s possible she did drop to 90 and she is bouncing fast …up to the 508. At +5 she was 202 in the am cycle and could well have kept dropping. I would always test until you see the BG trending back up.
Can you record all those numbers into the SS please? (The 90, the 355 and the 508). Just put them one on top of the other in the PMPS column with their times. And then you start the 12 hour cycle again. So in the morning you will be 1 1/2 hours later with the shot. You can go back 15 minutes a cycle or 30 minutes once a day to get back on schedule.

I decided to give her a bit shy of 1 unit about an hour and 30 minutes after her scheduled time. There was a lot of panicking and reading because i was really afraid of going down too low. I wish I had given her 1 unit but i was convinced she was being super sensitive to the insulin. It is 12:58 a.m right now. Not a good situation. Im worried about her being so high.

I’m really glad you gave a dose. Just go back to the 1 unit in the morning.
Get that test done for ketones.
And make sure she eats plenty of food.
508 is high but plenty of cats have BGs like that before they are regulated. It will come back down.
Try and get her to eat…….over the course of 24 hours…..1 and a half times as many calories as she normally does.

I ordered new test strips but just ran down to only two of my pet meter strips. I have a CVS oharmacy human meter but this is terrible timing. I didn't realize i could go through them this quickly.

I remember being amazed at how quickly I ran out is test strips in the beginning. That’s why a human meter might be a better option…..much cheaper strips and much easier to come by. If you are using the human meter you need to indicate that in the SS as it makes a difference.
We won’t be worried if you do the swap to the human meter as long as we are aware of it and where it starts and stops.

 

[Mookitty's Mom]

Okay. I will give her 1 unit at 12:30. Then the day after start shifting back 15 min. I do want to transition her to low carb now before upping insulin. Sounds like a much better idea.. Would it be a good idea to redo a curve with my human meter and keep everything the same tomorrow (2 cycles) and if all goes as expected introduce the low carb food the day after? Also would it be best if i start a new human meter spreadsheet and add it to my signature?

I'm testing for ketones. I haven't been able to catch her pee yet but ive used soaked litter (putting minimal amounts in the box) and a puddle she made. So far, there has been nothing. I found a special hydrophobic litter used for this purpose. It arrives tomorrow. Symptom wise she does get thirsty but her walking and energy have been much better than day 1 of lantus.

I have a lack of understanding on feeding timing. Should i just encourage eating all day and let her graze? Should i ever take the food away a few hours from her shot to make sure she eats "enough" before it? Not sure what enough is or how recently before a shot she has to eat.

 

[Mookitty's Mom]

Should I be scared of it dropping again tonight?

 

[Bron and Sheba (GA)]

Would it be a good idea to redo a curve with my human meter and keep everything the same tomorrow (2 cycles) and if all goes as expected introduce the low carb food the day after

If you want to swap to the human meter just indicate when you are starting. I will ask @bandits mom to come and help you organise that.
I would start the transitioning of the low carb tomorrow. Don’t do it too fast. Do it over a few days. There is no need to do a curve first…just monitor closely.

Also would it be best if i start a new human meter spreadsheet and add it to my signature?

Are you going to stay with the human meter now? @Bandit's Mom will be able to sort that out for you.

I'm testing for ketones. I haven't been able to catch her pee yet but ive used soaked litter (putting minimal amounts in the box) and a puddle she made. So far, there has been nothing. I found a special hydrophobic litter used for this purpose. It arrives tomorrow. Symptom wise she does get thirsty but her walking and energy have been much better than day 1 of lantus.

I’m glad she seems better. Just keep up with lots of food, no skipping of insulin (if it’s lower than 200….stall, don’t feed and test again in 20 minutes and post and ask for help. Also change the subject line to reflect your position. Also lots of fluids……I know you are doing sub Q fluids so that is good…and testing the urine for ketones. Those are the key things you need to be doing at the moment.

have a lack of understanding on feeding timing. Should i just encourage eating all day and let her graze? Should i ever take the food away a few hours from her shot to make sure she eats "enough" before it? Not sure what enough is or how recently before a shot she has to eat.

If you are more comfortable letting her graze, that is fine. Or if you would rather offer her snacks every couple of hours, that is fine too. Just don’t feed for the 2 hours before the pre shot test as we don’t want the BG to be food influenced. Each snack should be about a tablespoon..
You can decide how much she needs to eat each cycle and divide it into the preshot meal and the snacks during the cycle.
For the pre shot meal which you can give immediately before the shot, I would give an ordinary sized meal she would eat. the onset of the insulin ( the time it starts to work to bring down the BG) is around 2 hours after the shot so as long as she has eaten well before that time you will be fine.

Should I be scared of it dropping again tonight

As long as you are testing the BG you are in control of the situation. If she is dropping too fast, you can always feed her to try and stop a drop.
She has dropped quite a bit at +2 and that can indicate an active cycle…where the BG continues to drop down further. So I would test again at +4 or +5 to see where she’s at. Can you manage that? It will depend what that test is, if you need to test further. You can tag me when you get the result or tag bandits mom. I could be asleep by then. To tag someone you use the @ and then start typing in their user name. A box will come up with name options. Click on the one you want . So it should look like this @Bron and Sheba (GA)

 

[Mookitty's Mom]

If you want to swap to the human meter just indicate when you are starting. I will ask @bandits mom to come and help you organise that.
I would start the transitioning of the low carb tomorrow. Don’t do it too fast. Do it over a few days. There is no need to do a curve first…just monitor closely.

Are you going to stay with the human meter now? @Bandit's Mom will be able to sort that out for you.

I’m glad she seems better. Just keep up with lots of food, no skipping of insulin (if it’s lower than 200….stall, don’t feed and test again in 20 minutes and post and ask for help. Also change the subject line to reflect your position. Also lots of fluids……I know you are doing sub Q fluids so that is good…and testing the urine for ketones. Those are the key things you need to be doing at the moment.

If you are more comfortable letting her graze, that is fine. Or if you would rather offer her snacks every couple of hours, that is fine too. Just don’t feed for the 2 hours before the pre shot test as we don’t want the BG to be food influenced. Each snack should be about a tablespoon..
You can decide how much she needs to eat each cycle and divide it into the preshot meal and the snacks during the cycle.
For the pre shot meal which you can give immediately before the shot, I would give an ordinary sized meal she would eat. The onset of the insulin ( the time it starts to work to bring down the BG) is around 2 hours after the shot so as long as she has eaten well before that time you will be fine.


As long as you are testing the BG you are in control of the situation. If she is dropping too fast, you can always feed her to try and stop a drop.
She has dropped quite a bit at +2 and that can indicate an active cycle…where the BG continues to drop down further. So I would test again at +4 or +5 to see where she’s at. Can you manage that? It will depend what that test is, if you need to test further. You can tag me when you get the result or tag bandits mom. I could be asleep by then. To tag someone you use the @ and then start typing in their user name. A box will come up with name options. Click on the one you want . So it should look like this @Bron and Sheba (GA)

I will stick with the human meter after the next measurement.

I used the human meter on the same sample at ~+2 after her shot. The numbers vary quite a bit (alphatrak: 416. Human: 590). I will check again at +4. She has eaten a few times since her shot. How far of a drop is cause for concern?

 

[Mookitty's Mom]

I reread instructions from the beginning of this thread. I made a mistake. When i saw 90, i gave her food. Then I tested shortly after that and got values in the 300s and 500s. She was eating between. I let her have her dose based on that.

 

[Bron and Sheba (GA)]

I will stick with the human meter after the next measurement.

I used the human meter on the same sample at ~+2 after her shot. The numbers vary quite a bit (alphatrak: 416. Human: 590). I will check again at +4. She has eaten a few times since her shot. How far of a drop is cause for concern?

Normally the alpha track meter runs higher than the human meter not the other way around.
If u are using a human meter a drop of 100 points in an hour is enough to tricker a bounce so feeding during the cycle helps stop that but not always.
It’s unlikely that she would drop down into the 100s from such a high preshot…….especially when she hasn’t done so yet and she had a smaller dose than 1 unit but he things to look out for a bit drops in an hour and fast drops and drops that go under 100 and are still dropping….if that all makes sense. You will get to know what to look out for as you learn. Up until then just post and ask for help.

reread instructions from the beginning of this thread. I made a mistake. When i saw 90, i gave her food. Then I tested shortly after that and got values in the 300s and 500s. She was eating between. I let her have her dose based on that.

Normally when you stall, you don’t feed. However the amount of feed you fed her was not enough for the BG to go to 355 in 1/2 hour.
Just keep testing the BG this cycle and you will be fine. Remember if you are concerned about anything just post and ask for help. And don’t forget to tag someone to get their attention.

 

[Mookitty's Mom]

Last alphatrak measurement: 508. She isnt feeling well. When her blood sugar is really high she lays on the floor.

@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

Last alphatrak measurement: 508. She isnt feeling well. When her blood sugar is really high she lays on the floor.

@Bron and Sheba (GA)

Poor girl. Let’s hope it starts to come back down soon.

 

[Mookitty's Mom]

And should i buy a new human meter in the morning? Its worth it if it will track well with other people's data.

 

[Mookitty's Mom]

Poor girl. Let’s hope it starts to come back down soon.

Whem should I check her next? Should i sleep a little? She bounced up when i approached her to drink some water and be petted. Then she went to bed.

 

[Bron and Sheba (GA)]

And should i buy a new human meter in the morning? Its worth it if it will track well with other people's data.

I’m not familiar with the human meter you have so can’t pass an opinion. But you can buy a ReliOn premier Meter from Walmart for $9 and a box of 100 test strips for $17.88

Whem should I check her next? Should i sleep a little? She bounced up when i approached her to drink some water and be petted. Then she went to bed.

I don’t think she will drop this cycle now. I would leave some food out for her to eat and go to sleep.
I hoping her BGs will drop again tomorrow but if she’s bouncing they could stay up for a few cycles. Just keep up the food, fluids and testing for ketones. You can start reducing the time from tomorrow morning by 15 minutes to get back on schedule.

 

[Mookitty's Mom]

Preshot glucose with Relion Premier Voice Meter: 525 mg/dl
@Bron and Sheba (GA)
@Diane Tyler's Mom
+2 hour glucose with a Relion Premier Voice Meter: 335 mg/dl after 1U glargine.I think I should check hourly as this is a pretty rapid drop, right?

Snacked a bit on lower carb food (wasnt as interested in the normal food so its been flavored with new). Not eating a whole lot. Lying around and acting hyperglycemic.

 

[Bron and Sheba (GA)]

Preshot glucose with Relion Premier Voice Meter: 525 mg/dl
@Bron and Sheba (GA)
@Diane Tyler's Mom
+2 hour glucose with a Relion Premier Voice Meter: 335 mg/dl after 1U glargine.I think I should check hourly as this is a pretty rapid drop, right?

Snacked a bit on lower carb food (wasnt as interested in the normal food so its been flavored with new). Not eating a whole lot. Lying around and acting hyperglycemic.

That is a big drop so test often until it slows down.
Try and get her to eat more if you can….if she won’t eat the lower carb food let her eat the other.
I don’t like her just lying around much. Is she lethargic?
You may have to increase the dose of insulin and worry about the amount of carbs in the food later if the BG remains high.
Try and get a test for ketones please.

 

[Mookitty's Mom]

You are a saint.

I just updated the sheet. Her +3 is 302. Maybe test at +5? How often should I check depending on the situation? For example, if she drops by 100 in an hour look every 30 minutes ? every hour? What rough rule would you go by based on different drops?

She has been snacking intermittently through this, which is good. As far as lethargy she doesn't seem to be permanently lethargic. She has done the ground laying twice today and once I pet her or offer food she gets up. She is normally tired and napping given her age.

I actually think she might like the low carb (friskies pate) more because that was her normal food before diagnosis but I've been only mixing bits in or giving her snacks of it out of an excess of caution. I let her choose between the two just now and she is going for friskies. Just so you know, I do have transdermal mertazapine on hand. It is unopened. I had her on it before all of this.

Ketones were negative this morning and have been negative since I started testing, thankfully. She definitely is not behaving or walking in the way she did when she was sick. It came in stages of severity. It took a long period of her meowing in the middle of the night for water (to be accompanied at her drinking fountain or to be given water from the shower) for her to reach a phase where she got really sick. I think the past 5 days she has been the most calm at night that I can remember in several years. Her eyes definitely indicate that she is more hydrated. Compared to where she was before the DKA episode I think she looks healthier and more content. But I can't be sure.

About dosage, she is eating less than before in a way that looks more like her normal pattern of grazing. I'm concerned about upping it tonight given she doesn't want to eat as much, especially after last night. I got less than 3 hours of sleep last night and for the nights before that it's been about 4ish. I don't think I can handle staying up all night tonight to watch an upped dose. My mental function is declining. There is also the additional factor of what reintroducing her thyroid med might have done with her. She has been only on the full dose of that for 3 days now and I know she has to be on it for a while before she gets tested for her T4 values.

 

[Bron and Sheba (GA)]

I just updated the sheet. Her +3 is 302. Maybe test at +5? How often should I check depending on the situation? For example, if she drops by 100 in an hour look every 30 minutes ? every hour? What rough rule would you go by based on different drops?

She looks like she is slowing down but keep testing until she stops dropping. Post if you are concerned. Yes, test at +5.
Every cat is different but if the drops are substantial test a gain in 1 hour or if you are concerned 30 mins. We usually do the 30 mins when the BGs get lower around 100. Have a look what the BG is and how far she has dropped in the last hour. Then if you take 100 off that for the next hour and you are concerned about where she might be in an hour, then test. Feeding her will help slow the drop. And higher carb food helps slow it further. Does that make sense? . But we do want her coming down into better numbers too.

Ketones were negative this morning and have been negative since I started testing, thankfully

good!

About dosage, she is eating less than before in a way that looks more like her normal pattern of grazing. I'm concerned about upping it tonight given she doesn't want to eat as much, especially after last night. I got less than 3 hours of sleep last night and for the nights before that it's been about 4ish. I don't think I can handle staying up all night tonight to watch an upped dose. My mental function is declining. There is also the additional factor of what reintroducing her thyroid med might have done with her. She has been only on the full dose of that for 3 days now and I know she has to be on it for a while before she gets tested for her T4 values.

Test for ketones again before the PMPS if you can. If she is negative ketones we can delay the increase. What are you doing about the food?
Is she having the low carb now or still having the higher carb food?

 

[Mookitty's Mom]

I believe so.

Ive already introduced the low carb food. Also she get her fluids tonight.

 

[Mookitty's Mom]

How should i perceive her bg values now that it is a human meter?

 

[Bron and Sheba (GA)]

How should i perceive her bg values now that it is a human meter?

The human meter typically runs lower than the alpha meter. The higher the number, the bigger the difference. As it gets lower the difference is less.
If she drops under 100 just let us know so we can help you. Down to 50 on the human meter is safe numbers but we don’t want her dropping lower than that. Just keep the SS updated so we can see and keep asking questions

 

[Diane Tyler's Mom GA]

The Relion Premier Voice Meter is fine to use, I see the test strips are 17.88 for 100
If you want to buy a back up you can get the Relion Premier Classic for 9 dollars
It uses the same test strips for the Voice one


https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103
If they don't have it in the store just order it online, but they should have it
If you are staying with The Relion I would also put that in your signature
Relion as of, then the date
Just tap on your name ,drop down will appear tap in signature then add it and tap save

 

[Mookitty's Mom]

@Bron and Sheba (GA)
A couple of hours ago I tested ketones in wet litter with three strips. In one strip I detected a small bit of pigmentation that didn't cover the entire square. It could be something in the litter, but out of caution I think I should up her dose in some way. I've been able to rest a bit and staying up till her next cycle stops dropping will be fine. We have gravy food with starches, dried cat food, and karo syrup on hand if she gets low.

I am thinking either trying 1.25 again or a fatter version of 1 unit that's slightly less than that. The top of the plunger part of the syringe I use to line up with the tickmark of her dose weirds me out. It has a bumpy texture in the center that I ignore in my measurement.

I drew an image of how I'm looking at dosing zoomed in. Hopefully, that explains what I think skinny and fat 1 U is and what those bumps look like. When the cat is this little I think this matters.


i should note that as I've been doing this I've been improving on my bubble removing technique but it could still improve. What i do is measure her amount first with air, push the air into the insulin bottle, slowly pull the plunger further back than her dose, flick the syringe and push the plunger back up to remove the bubbles and to arrive at my dose.