Newly diagnosed POST DKA and this Mama is scared!

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CAB7712 said:
Should I scan him before or after the snacks?
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Others with much more knowledge may better explain this, I am fairly new as well, but..
I will say that I was a bit confused as well when i started all this as to the food/testing/injecting/snacks/ oh my!!!. It took awhile for it all to sink in..
Basically, for the morning and evening preshot check ONLY (amps and pmps) .... you want to withhold food for 2 hrs prior to doing these two tests!
As for the rest of the day and snacks and such, feed as he needs, hungry kitties need food. The smarter ones here can give you much more specifics about this.
 
You want to scan and then decide what and whether to feed. Small snacks every few hours can keep them from dropping too fast. I used to feed at preshot, onset which was around +2.5 and then +4.5. If the BG was getting low I would feed hourly.
 
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Newman has his post discharge appointment this morning at 11:00 with our regular veterinarian. I did my best to give him snacks as directed at +2/+5/+7 last night, and did get some BG levels around those times. I fell asleep and missed the +7 snack, but did wake up at around 1:45 and got a reading. SS has been updated, please excuse the $ on column R10, I have asked @Bandit's Mom to help me correct it as I can’t seem to figure that out.
I am anxious to see our vet today, I know it will be a lot of information but I am hoping for a better idea on the plan.
Newman ate well this morning, full can of FF Classic Pate, and then finished his brothers leftovers as well (about a quarter of a can was left from Puddy) and I just let him eat it. May talk to vet today about amtof food to feed at each sitting, since FF is a 3oz can, and I am wondering if I should give him a can and a half since I have noticed the past two feedings he seems hungry enough still after a full can to eat more.
Caught a urine test this morning, and the stick appeared to show negative, although it looked like a very small pin prick size of the pinkish color for trace? It was very difficult to see, but I noticed it.
Will update after appt this morning.
 
I was going to mention that two of the little 3 oz FF cans a day does not sound like enough calories. Most of those are around 80-90 calories a can

I would think Newman needs at least 200-300 calories a day esp considering he is still an unregulated diabetic. At 12 pounds it would be 240ish a day to maintain.
 
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I’m pleased the ketones test was negative. Sometimes it is hard to tell the difference between negative and trace.
Remember a post DKA kitty needs lots of food. It is food and insulin that keeps the ketones away. If Newman is hungry, I would let him eat at this point. I’m very happy to see those snacks written up in the SS.
I don’t think Newman is getting enough insulin. The 0.5 U dose is hardly moving the BGs.
I would increase the dose to 0.75 units and see how that goes. We need to get those high BGs down lower.
Let us know how you get on at the vet appointment.
 
If you're game to discussing this with your vet, you may want to ask why he chose Vetsulin. It's not a great insulin although the good news is that your vet didn't put Newman on a large dose.

If you can, it may be helpful to get Newman's weight. Your vet can certainly do this and you can then compare his weight to his previous vet appointment. It's possible the diabetes has caused him to lose weight. Between the DKA and losing weight, adding more calories may be a good idea especially since he keeps telling you that he's hungry.
 
Sienne and Gabby (GA) said:
If you're game to discussing this with your vet, you may want to ask why he chose Vetsulin. It's not a great insulin although the good news is that your vet didn't put Newman on a large dose.

If you can, it may be helpful to get Newman's weight. Your vet can certainly do this and you can then compare his weight to his previous vet appointment. It's possible the diabetes has caused him to lose weight. Between the DKA and losing weight, adding more calories may be a good idea especially since he keeps telling you that he's hungry.
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I could have sworn an earlier post said 12 pounds, now re-reading I see Newman is 15 pounds.

two little cans of FF is less than 200 calories, so I would agree he needs more even if the goal is weight reduction eventually
 
Hendrick Cuddleclaw said:
I was going to mention that two of the little 3 oz FF cans a day does not sound like enough calories. Most of those are around 80-90 calories a can

I would think Newman needs at least 200-300 calories a day esp considering he is still an unregulated diabetic. At 12 pounds it would be 240ish a day to maintain.
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I also purchased 5 oz cans of Wellness Core and Blue Wlderness pates, so I will need to look at the food list to make sure those are safe. If they are, I may try giving him a full can of that for dinner tonight. I was afraid the little cans weren’t enough, but was holding out until todays vet appt and seeing what he recommends.
 
Bron and Sheba (GA) said:
I’m pleased the ketones test was negative. Sometimes it is hard to tell the difference between negative and trace.
Remember a post DKA kitty needs lots of food. It is food and insulin that keeps the ketones away. If Newman is hungry, I would let him eat at this point. I’m very happy to see those snacks written up in the SS.
I don’t think Newman is getting enough insulin. The 0.5 U dose is hardly moving the BGs.
I would increase the dose to 0.75 units and see how that goes. We need to get those high BGs down lower.
Let us know how you get on at the vet appointment.
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I will discuss his dose with the vet today. The day before we brought him home from the ER they decided to keep him an extra night because they were giving him a full unit of insulin and his numbers dropped to 94 and then 64 after his evening dose, so they reduced to .5 and sent us home on that dose.
 
Sienne and Gabby (GA) said:
If you're game to discussing this with your vet, you may want to ask why he chose Vetsulin. It's not a great insulin although the good news is that your vet didn't put Newman on a large dose.

If you can, it may be helpful to get Newman's weight. Your vet can certainly do this and you can then compare his weight to his previous vet appointment. It's possible the diabetes has caused him to lose weight. Between the DKA and losing weight, adding more calories may be a good idea especially since he keeps telling you that he's hungry.
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Vetsulin is what the ER sent us home with on Wednesday. Hoping to discuss other options today with his vet at his follow up. Wondering if ProZinc may be a better option? Our vet said most vets use vetsulin so he has it in stock regularly, but after my research about how harsh it can be I am hoping he recommends another option.
 
also something to consider -- almost every variety of FF pate is very high in phosphorus. Not really a big deal for younger cats but as felines age a high amount of phos in the diet can put an undue strain on the kidneys. We try to stick with phos that is under 300 if possible for the group in general and under 200 for our older kitty who is 15

(we have six cats. Wait, make that 7, forgot about the new rescued stray....)
 
The Wellness Core Chicken, Turkey, and Chicken Liver, Turkey & Duck, and Kitten food are all low carb. The other flavors are medium carb. FWIW, Wellness is often higher in fat and has more calories than many other brands.

ProZinc is a good option. While most vets may stock either Vetsulin or Prozinc since they were developed for animals, human pharmacies stock Lantus (glargine) and it is widely available. If you go the glargine route, the biosimilar, Semglee, is much less expensive. You may need to call around to find a pharmacy that stocks it.
 
Vet appt Update:
Doc told us to definitely increase his food portions, and to give him snacks a few times a day during his cycle. He suggested a high fiber food (he said senior food) for the mid day snacks, but nothing too high in carbs (of course). He wants a good balance of protein and fiber for Newman. He even suggested some pumpkin mixed with the wet food for meals and snacks. He is keeping the insulin where it is for the next two weeks, as long as I keep testing negative for ketones he seems to think we can get away with the smaller dose for right now. He seems to think my libre reader is reading too high, because when we did a side by side of libre and his alpha trap 2, there was a 33 pt difference. But we are keeping it on until it runs out, and meanwhile practicing getting Newman used to the prick (he actually uses the sublingual vein of the back leg rather than the ear. He believes you get better samples there and that cats don’t fuss as much with it). He wants monitoring pretty vigilantly so that is why we are using the libre until our comfort level with the ReliOn gets better. He also said he would give us an AlphaTrax if we want one. Newman has been loving his snacks,and seems to be a bit more upbeat today. Vet said to stop all the other meds because he has been on them for 7 days, and doesn’t think a cat needs such strong antibiotics for a full 14 days. He didn’t see any signs of infection in blood work or urine,so he is comfortable stopping them (which is good because that metronidazole dose was a beast to give!). All in all, vet was happy with care received at ER, and thinks we can get Newman regulated and on his way to being his goofy self again, just takes time. He wants us back in two weeks, with a BG curve done the 24 hours before we come in so he can decide if we need to up the insulin or change it. But for now, he wants to stick with what we are doing.
 
I’ll let the Vetsulin users comment on the dose. I think 7 days of antibiotics is probably fine. I’d want to see where his BG is after a week though.
 
tiffmaxee said:
I’ll let the Vetsulin users comment on the dose. I think 7 days of antibiotics is probably fine. I’d want to see where his BG is after a week though.
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Thankfully our vet is also a very good friend of ours so we do have more access to him than most, we just do our best to not abuse that power…lol. If I feel like his numbers are still too high, I can just call him and ask what to raise dose to. I imagine if after next week we aren’t seeing much movement, I will up to .75U.
 
A 33 point difference between the vets alphatrak meter and the libre is normal and to be expected. It doesn’t mean the libre is not working
I disagree with your vet in the dose of the insulin. Newman is sitting in almost all red and pink numbers. He needs to be in blue and green numbers. Please don’t leave the dose at 0.5 units for two weeks. He has recently only recovered from DKA and needs more insulin in my opinion.
I am glad the urine ketones are negative. Please keep testing them daily and keep giving extra food. It is really important to keep testing daily for ketones. It is your early warning system that all is or isn’t ok.
A swap to a more suitable insulin as Prozinc is a very good idea. Vetsulin is not a suitable insulin for cats, it’s a dog insulin. I would push for a swap if Newman were my cat.
 
Bron and Sheba (GA) said:
A 33 point difference between the vets alphatrak meter and the libre is normal and to be expected. It doesn’t mean the libre is not working
I disagree with your vet in the dose of the insulin. Newman is sitting in almost all red and pink numbers. He needs to be in blue and green numbers. Please don’t leave the dose at 0.5 units for two weeks. He has recently only recovered from DKA and needs more insulin in my opinion.
I am glad the urine ketones are negative. Please keep testing them daily and keep giving extra food. It is really important to keep testing daily for ketones. It is your early warning system that all is or isn’t ok.
A swap to a more suitable insulin as Prozinc is a very good idea. Vetsulin is not a suitable insulin for cats, it’s a dog insulin. I would push for a swap if Newman were my cat.
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I will see him tomorrow (social visit) so I will ask him to switch us. I think he wants to see if Newman's diet change with the .5u does anything. He told me that a good goal for a newly dx diabetic cat is BG between 200-300 at first (not for long)And then we shoot for lower 2's-100's. It has only been 6 days since his crisis, so my vet believes we need to give time to see how we can regulate before making huge changes. He has been in practice for 30+ years and has focused on critical care in the past (now he does standard care bc he is getting ready to retire and hand over his practice to his partner). I do trust his opinion, but also know the importance of being an advocate for Newman. Our vet is very open to suggestions and questions, so no worries there. However, even the ER vet said like all medications, we have to give them a chance while performing other interventions as well (diet change/exercise). Newman's appetite is great, and today he has been playing with his brother and walking around more than the past few days.
Thank you for the suggestions, I appreciate you all so much! And please know that I will discuss everything suggested to my vet for sure! (He knows I'm a Nurse and knows we research everything so he knows what he is dealing with!)
 
Insulin is not the same as medication. With fd the sooner you get them regulated the better are the odds of remission. Your vet is not using the best insulin for cats. I can see being conservative with that insulin as many cats drop rapidly on it I believe. A more appropriate insulin will not be as harsh. Your vet might not be as educated on the other insulins since he’s at the end of his career. I am not saying he’s not a wonderful vet but rather that he’s is not as knowledgeable about fd. Does his practice have more dogs than cats?
 
I appreciate it can be harder when the vet is also a friend. If Newman was a diabetic kitty who hadn’t gone into DKA then it would have been fine to see if the combination of food and a bit of insulin brought the BGs down for a week or two.
But with DKA only 6 days ago, the ketones are just waiting for a chance to jump back in. So you need to be more aggressive with the insulin ( and the food) to get the numbers down into more normal BGs. I would not let them hang around in the 200-300 range if I could get them down lower myself.
The recipe for DKA in cats is not enough food, not enough insulin and an infection or inflammation in the cats body. So the treatment is to address those ingredients.
Any sign of ketones means that the food and insulin needs adjusting up.
I’m sorry if I sound as if I am banging on about this, but we see so many post DKA kitties arrive here that are not really getting the proper post DKA care and they respond so well when given appropriate care. I can only tell you what we recommend here and then it is up to you what you do.
I’m really happy to hear that Newman is sounding much better. :)
 
tiffmaxee said:
Insulin is not the same as medication. With fd the sooner you get them regulated the better are the odds of remission. Your vet is not using the best insulin for cats. I can see being conservative with that insulin as many cats drop rapidly on it I believe. A more appropriate insulin will not be as harsh. Your vet might not be as educated on the other insulins since he’s at the end of his career. I am not saying he’s not a wonderful vet but rather that he’s is not as knowledgeable about fd. Does his practice have more dogs than cats?
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I can’t speak to the number of cats vs dogs he sees, but every time I am there there is a good mix of both in the waiting room . I texted him tonight and he said we can switch to ProZinc, and I am going to show him my spreadsheet tomorrow when I see him to discuss upping the dose.
 
Bron and Sheba (GA) said:
I appreciate it can be harder when the vet is also a friend. If Newman was a diabetic kitty who hadn’t gone into DKA then it would have been fine to see if the combination of food and a bit of insulin brought the BGs down for a week or two.
But with DKA only 6 days ago, the ketones are just waiting for a chance to jump back in. So you need to be more aggressive with the insulin ( and the food) to get the numbers down into more normal BGs. I would not let them hang around in the 200-300 range if I could get them down lower myself.
The recipe for DKA in cats is not enough food, not enough insulin and an infection or inflammation in the cats body. So the treatment is to address those ingredients.
Any sign of ketones means that the food and insulin needs adjusting up.
I’m sorry if I sound as if I am banging on about this, but we see so many post DKA kitties arrive here that are not really getting the proper post DKA care and they respond so well when given appropriate care. I can only tell you what we recommend here and then it is up to you what you do.
I’m really happy to hear that Newman is sounding much better. :)
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I do believe that more insulin is probably best, especially since he is only getting 1/2 unit a time. But my question is, why would the ER send us home on that dose after his numbers dropping while he was there while they were giving him 1unit BID? On Tuesday night, we were supposed to bring him home but they said his numbers dropped to 94 and then 64, so they wanted to keep him an extra night. They dropped the dose to .5U and sent us home on that. I am now thinking I need to push my vet a bit to up the dose (I am scared to do it on my own). Any help appreciated, because I see now that maybe we are not being aggressive enough.
 
CAB7712 said:
I do believe that more insulin is probably best, especially since he is only getting 1/2 unit a time. But my question is, why would the ER send us home on that dose after his numbers dropping while he was there while they were giving him 1unit BID? On Tuesday night, we were supposed to bring him home but they said his numbers dropped to 94 and then 64, so they wanted to keep him an extra night. They dropped the dose to .5U and sent us home on that. I am now thinking I need to push my vet a bit to up the dose (I am scared to do it on my own). Any help appreciated, because I see now that maybe we are not being aggressive enough.
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Insulin needs change over time and from day to day. That is why we are strong advocates of hometesting.
Prozinc will give you a longer duration than the vetsulin which does not last 12 hours in cats, so hopefully you won’t see the high numbers around preshot that you are seeing with Prozinc.
If you are not going to swap over to prozinc for a few days, I would increase the dose of the vetsulin to 0.75 units, not 1 unit and see how that goes.
If you are going to swap to prozinc tomorrow, I would stay with the 0.5 units and see how that goes for a couple of days.
I’ll tag @FrostD as she is a Prozinc user and I am not.
 
Bron and Sheba (GA) said:
Insulin needs change over time and from day to day. That is why we are strong advocates of hometesting.
Prozinc will give you a longer duration than the vetsulin which does not last 12 hours in cats, so hopefully you won’t see the high numbers around preshot that you are seeing with Prozinc.
If you are not going to swap over to prozinc for a few days, I would increase the dose of the vetsulin to 0.75 units, not 1 unit and see how that goes.
If you are going to swap to prozinc tomorrow, I would stay with the 0.5 units and see how that goes for a couple of days.
I’ll tag @FrostD as she is a Prozinc user and I am not.
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I am going to let our vet know tomorrow that I want to switch to ProZinc. Hopefully he can get the script sent out and I can just pick it up either later tomorrow or Monday.
 
Welcome! Sorry it's under such stressful circumstances.

In the meantime I would increase to 1U with the Vetsulin. That's a larger increase than we normally take, but given the data and recent DKA he needs more insulin.

Now, a word of caution. The diet change is still fairly recent, so you may still see some further reduction in BG over the next week. That, coupled with the larger increase I'm recommending, means you have to stay on top of scanning the Libre. If you get a number below 90 that's a 0.25U reduction. If you're not sure, please tag me and I'll take a look.

If/when you get the ProZinc let us know. The dose for that will depend on the BG trends at the time.
 
(Bron's advice of 0.75U is our typical increase, you can certainly do that if 1U is worrisome to you - I'm just leaning towards the larger increase given the possibly trace ketones yesterday. They can change quickly. If you're able to get another test in and it's negative, 0.75U is the better option)
 
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