At a complete loss- increase, decrease or change insulin?

[Mathilda and Maverick]

So, Maverick is suffering diabetes, pancreatitis, IBD, early kidney failure, and has been incredible ketone prone- and yes had DKA two times. His last bloodwork also showed low potassium levels so he's been getting that supplement for a while. Due to all the recurrent ketones- he had them pretty much daily, and we had to stay on top with the subQ- I increased insulin and ketones disappeared. We have not had to give fluids for a long time to flush ketones, but numbers increased to more constant 300-400. Maverick has been a bouncer, even with the ketones in place, but numbers been staying pretty consistent (except for tonight).

Now, obviously hes not gaining weight, but not quite loosing any either. My worry is the he seems to be showing some early signs neuropathy- he's now twisting his back-feet significantly while walking and isn't very strong in backlegs. Neuropathy would make sense with those high numbers and last bloodwork result. Now, he is getting the Zobaline, and potassium supplement Renal K+, and I know that his diabetic also need to be regulated again. But how the heck do I do that- should I increqase dose even though that seems to contribute to higher numbers? Or do I decrease does and risking ketones and DKA? To be clear with the ketones, he used to stay between 3.5 and 5.9 (and monitor only measures 5.9), and giving subQ on a daily to keep ketones at bay is not doable in our family. Should I ask to switch to prozink insulin? I also very recently noticed issues with two his teeth so I am very worried. Would he survive teeth surgery and recovery?

Maverick was lower than in a long time tonight 101/120s, and he didn't eat well, 0.2 ketones- I only gave him 2.5U and now I'm anticipating a bounce and are very worried. Any help, recommendations appreciated!

 

[Diane Tyler's Mom GA]

So, Maverick is suffering diabetes, pancreatitis, IBD, early kidney failure, and has been incredible ketone prone- and yes had DKA two times. His last bloodwork also showed low potassium levels so he's been getting that supplement for a while. Due to all the recurrent ketones- he had them pretty much daily, and we had to stay on top with the subQ- I increased insulin and ketones disappeared. We have not had to give fluids for a long time to flush ketones, but numbers increased to more constant 300-400. Maverick has been a bouncer, even with the ketones in place, but numbers been staying pretty consistent (except for tonight).

Now, obviously hes not gaining weight, but not quite loosing any either. My worry is the he seems to be showing some early signs neuropathy- he's now twisting his back-feet significantly while walking and isn't very strong in backlegs. Neuropathy would make sense with those high numbers and last bloodwork result. Now, he is getting the Zobaline, and potassium supplement Renal K+, and I know that his diabetic also need to be regulated again. But how the heck do I do that- should I increqase dose even though that seems to contribute to higher numbers? Or do I decrease does and risking ketones and DKA? To be clear with the ketones, he used to stay between 3.5 and 5.9 (and monitor only measures 5.9), and giving subQ on a daily to keep ketones at bay is not doable in our family. Should I ask to switch to prozink insulin? I also very recently noticed issues with two his teeth so I am very worried. Would he survive teeth surgery and recovery?

Maverick was lower than in a long time tonight 101/120s, and he didn't eat well, 0.2 ketones- I only gave him 2.5U and now I'm anticipating a bounce and are very worried. Any help, recommendations appreciated!

Tagging experienced members
By the way what dosing method are you following TR or SLGS ?
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

@Wendy&Neko
@Bron and Sheba (GA) but she hasn't been on lately but will try anyway
@Marje and Gracie

 

[Mathilda and Maverick]

Thank you! We are SLGS but it’s been hard to follow to a T due to outside variables such as ketones, subQ that’s been impacting BG, ear fungus, and bouncing

 

[Mathilda and Maverick]

Thank you! We are SLGS but it’s been hard to follow to a T due to outside variables such as ketones, subQ that’s been impacting BG, ear fungus, and bouncing

As well as the other illnesses of course, so much to consider

 

[Wendy&Neko]

On our spreadsheets that 101/126 tonight should be coloured blue, not green.

also very recently noticed issues with two his teeth so I am very worried. Would he survive teeth surgery and recovery?

That is a question for the vet. And perhaps a dental vet specialist would be a good idea. They do extra monitoring and are used to dealing with more complicated animals. Neko was pretty complicated with CKD and HCM, as well as the diabetes thing for a couple dentals. Infection or inflammation from bad teeth can raise the blood sugar numbers, so it would be a good idea to have it taken care of. Cats with bad teeth are hard to regulate.

Does he still have an ear fungus? If so, what are you treating it with. You were using Tresaderm in your last post here, but it has a steroid which can raise numbers.

should I increqase dose even though that seems to contribute to higher numbers? Or do I decrease does and risking ketones and DKA?

Any higher numbers from an increased dose would be due to bouncing. Bouncing is not a bad thing. In order to reduce the amount of time he bounces, you need to find a dose where he spends more time in good numbers and gets used to those numbers again. More insulin can also lower the height of the bounces. When there is a history of DKA and ketones, you do not reduce the dose.

 

[Diane Tyler's Mom GA]

Thank you! We are SLGS but it’s been hard to follow to a T due to outside variables such as ketones, subQ that’s been impacting BG, ear fungus, and bouncing

Can you add SLGS to your signature and spreadsheet up top Thanks

 

[Mathilda and Maverick]

On our spreadsheets that 101/126 tonight should be coloured blue, not green.


That is a question for the vet. And perhaps a dental vet specialist would be a good idea. They do extra monitoring and are used to dealing with more complicated animals. Neko was pretty complicated with CKD and HCM, as well as the diabetes thing for a couple dentals. Infection or inflammation from bad teeth can raise the blood sugar numbers, so it would be a good idea to have it taken care of. Cats with bad teeth are hard to regulate.

Does he still have an ear fungus? If so, what are you treating it with. You were using Tresaderm in your last post here, but it has a steroid which can raise numbers.

Any higher numbers from an increased dose would be due to bouncing. Bouncing is not a bad thing. In order to reduce the amount of time he bounces, you need to find a dose where he spends more time in good numbers and gets used to those numbers again. More insulin can also lower the height of the bounces. When there is a history of DKA and ketones, you do not reduce the dose.

Thank you so much for the reply!

Yes, I'll change the color-thanks for pointing that out!

I am about to contact a pet dental specialist here today. How was your cats recovery? When discussed dental work with vet earlier (then extraction of a tooth that I now anticipating being at least 2 teeth and a cleaning), the concern with Maverick has been that he may not make it through it, and if he does, we are worried about a complicated recovery. I have a 3 months old baby, two toddlers, traveling husband, and no family in the area. Maverick is my baby, and I have been wholeheartedly taking care of him through the years of diagnosis, but with my current work load and health, I simply can't go through another several weeks of syringe feeding, loads of vet visits and caring around the clock again- I'd go completely under. So managing the aftermath of a dental really worries me.

He is clear of the ear fungus- I was aware of the steroids, and very worried about that but I'm glad it worked out. I did increase insulin at that time as the steroids seemed to affect the BG- and I increased more since then, the concern now is that I may have missed the sweet number as he is no longer on the meds. But then he also has the added teeth issue.

Looking back, he seems to be doing better on lower dose- but then he threw ketones often. The number has been high for quite a while, but then he occasionally get a lower number, and the backlegs conditions really worrying. I do not think it's a clear cut case where an increase is needed- if I am overdosing him, that can also keep the numbers high- right? And the constant high affect his backlegs.

How long time does it typically take for a cat to get used to the low numbers again? During these almost 3.5 years, Maverick has been in "lower numbers" a lot but always seems to react negatively to it- bouncing, vomiting - when in low 200s to 100s- which really does not seem to be that low.

 

[Mathilda and Maverick]

Can you add SLGS to your signature and spreadsheet up top Thanks

Thank you! It should be added now-let me know if it did not work

 

[Wendy&Neko]

How was your cats recovery?

She was one tough cookie. One dental was a tooth extraction, that one was a piece of cake. The second one was a sudden bony growth on her jaw that needed to be removed. That was a much trickier surgery. Both times she came home and demanded food right away. I gave her just a little bit at a time, watered down and soft. She also had good pain meds (buprenorphine). No food syringing required. Her BG's did go up a bit after the dental due to inflammation, so I increase for a week and a bit until her numbers told me the inflammation was coming down. Dental vet wanted a follow up to see how her mouth was healing, about a week later. That was it.

His numbers going up now may be due to tooth inflammation/infection. The possible neuropathy and ketones showing up are also clues his insulin dose is too low.