DKA Hospitalization and Starting Lantus

agrey

Member Since 2025
Hi everyone!

I wanted to make a post, as my cat Misha has recently been recently diagnosed and hospitalized for his diabetes. I originally took him to the vet for lethargy and weight loss on 11.03.25, where his BG was 290 mg/dL and he presented with ketones and a UTI. The vet thought his BG wasn't high enough to be diabetes and that he might have a hole in his kidney instead, and told us to go home and change his diet to Hills Science DM while a fructosamine was sent in. After a week that came back and proved it was diabetes, but the vet still wanted us to see how he did for a while on just a changed diet since he was feeling better (I decided to go with Fancy Feast instead of Hills). I have been tracking his BG, which has been mostly around 260 mg/dL, which was still high enough for me to want to put him on insulin. I changed clinics to hopefully see a vet that knew more about diabetes, and I took Misha in last Thursday to run his bloodwork again and start him on insulin. The bloodwork came back worse than before, as his ketones were much higher (6.2 mmol/L) and his electrolytes were unbalanced, so I was told to hospitalize him as he was on the edge of DKA even though he had no outward symptoms. Misha was in the hospital for around 32 hours, and he was pretty quickly stabilized and transitioned onto Lantus.

Now, he has been out of the hospital for 2 days and has been placed on 1 unit of Lantus twice a day as well as a supplement for his potassium levels. However, I am concerned about his BG levels as they are generally higher than they were before he was placed on insulin, with AMPS BG of 380 and 350 mg/dL over the past two days. When the hospital gave him Lantus, they were able to get his BG down to 120 mg/dL but now the lowest he is going is around 270 mg/dL (I am letting him eat throughout the day to restore his weight, which might make it higher). I know Lantus needs time to build up, but I'm just concerned especially due to the presence of ketones. I am waiting to hear back from the vet about potentially increasing his dosage, as it seems low for a large cat (healthy weight: 14 lbs, current weight: 10.3 lbs) but I would love to hear from other people about their experiences with DKA and starting Lantus.
 
Hi Aleks, Welcome to the forum!

I don't have experience with DKA, but I'm going to bump up your post by asking a couple of questions: Do you know the dose they were giving Misha while he was in the hospital? Was it 1 unit? Also, are you testing for ketones at home?

Have you had a chance to read about the two dosing methods many of the Lantus users on the forum follow? They are posted here. These methods guide us in knowing when to increase/decrease doses.
 
Welcome to FDMB
You are in the right place, having Ketones is important for Misha to eat eat and, food helps Ketones, did your vet tell you that you can check for ketones at home? Lantus is a great insulin for cats is a 12-hour insulin, I see that you are home testing, it is important to test before each shot, to avoid hypoglycemia, I am happy to hear to changed Misha from the DM food to Fancy Feast, the DM food is high in carbs, diabetic cats need to have a diet of wet can food or raw between 0-10% carb (FF gravies are High carbs) therefore stick to pates, flakes and Chunky; below is a Drs food chart you will find the FF list, and many other, the third column contains the carb content, also a cat carb calculator, we are looking for Dry Carb matter % most members here use FF as well between o-10%, most feed up to 5%, keep posting we are here to help you on this journey, in the meantime I will tag a couple of members that can assist you in Lantus, DKA, and Ketones, the important thing is that FD is manageable, with the right diet, right insulin, a well-schooled vet in FD, and lots of cuddles
;) 🤗
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Cat Food Nutrition Calculator | Elizabeth C Scheyder
@Sienne and Gabby (GA)
@Wendy&Neko
 
Hello and welcome. Sorry you've been through the trial by fire so far.

Do you know which day he was started on Lantus? If you have that information from the hospital, it'd be helpful to put that on the spreadsheet. As you said, since Lantus builds up over time, knowing how long he's been on Lantus can help us. One thing that's not uncommon for cats that have just started insulin is to show some initial nice numbers, but then they go away. It's possible, Misha did that at the vet hospital and they saw that 120, but then it wasn't sustained.

Are you home testing Misha for ketones? You can get a blood meters for ketones or use urine test strips. You should be testing at least daily at this point - put the results of the ketones test in the Remarks column. Or we'll keep asking. ;) More information on ketones here: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones. Since that post was written, the Keto-Mojo meter has since been used on cats.

Misha should be getting 1.5 times his normal amount of calories. Several meals a day and night is best. Add as much water as he will tolerate to help flush out the ketones.
 
Responding to some of the above comments, the DM wet food (not the Selects) is fine for diabetics, but nothing special. It is called dietetic management, not diabetic management.

How is his appetite now?
 
Hi Aleks, Welcome to the forum!

I don't have experience with DKA, but I'm going to bump up your post by asking a couple of questions: Do you know the dose they were giving Misha while he was in the hospital? Was it 1 unit? Also, are you testing for ketones at home?

Have you had a chance to read about the two dosing methods many of the Lantus users on the forum follow? They are posted here. These methods guide us in knowing when to increase/decrease doses.
Hi! Thanks for the welcome. In the hospital they were giving him 1 unit as well. He was discharged with lower but still present ketones, and I am using urine strips at home to keep track of when they subside. As for the dosing methods, I was interested in following TR but the vet was suggesting to stay at 1 unit for 1-2 weeks. It would be great to be able to follow the protocol though and hopefully get him into remission.
 
Welcome to FDMB
You are in the right place, having Ketones is important for Misha to eat eat and, food helps Ketones, did your vet tell you that you can check for ketones at home? Lantus is a great insulin for cats is a 12-hour insulin, I see that you are home testing, it is important to test before each shot, to avoid hypoglycemia, I am happy to hear to changed Misha from the DM food to Fancy Feast, the DM food is high in carbs, diabetic cats need to have a diet of wet can food or raw between 0-10% carb (FF gravies are High carbs) therefore stick to pates, flakes and Chunky; below is a Drs food chart you will find the FF list, and many other, the third column contains the carb content, also a cat carb calculator, we are looking for Dry Carb matter % most members here use FF as well between o-10%, most feed up to 5%, keep posting we are here to help you on this journey, in the meantime I will tag a couple of members that can assist you in Lantus, DKA, and Ketones, the important thing is that FD is manageable, with the right diet, right insulin, a well-schooled vet in FD, and lots of cuddles
;) 🤗
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Cat Food Nutrition Calculator | Elizabeth C Scheyder
@Sienne and Gabby (GA)
@Wendy&Neko
Thank you for the links and extra info! I have been testing his ketones at home with strips, and they seem stable for now. And yes I'm glad I did some research before picking a food, its crazy to me that the prescription diet is not up to standards for diabetic cats.
 
Hello and welcome. Sorry you've been through the trial by fire so far.

Do you know which day he was started on Lantus? If you have that information from the hospital, it'd be helpful to put that on the spreadsheet. As you said, since Lantus builds up over time, knowing how long he's been on Lantus can help us. One thing that's not uncommon for cats that have just started insulin is to show some initial nice numbers, but then they go away. It's possible, Misha did that at the vet hospital and they saw that 120, but then it wasn't sustained.

Are you home testing Misha for ketones? You can get a blood meters for ketones or use urine test strips. You should be testing at least daily at this point - put the results of the ketones test in the Remarks column. Or we'll keep asking. ;) More information on ketones here: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones. Since that post was written, the Keto-Mojo meter has since been used on cats.

Misha should be getting 1.5 times his normal amount of calories. Several meals a day and night is best. Add as much water as he will tolerate to help flush out the ketones.
Hi! He was started on Lantus the day I took him home (12/13/25) after they used short acting insulin the day before. I've added his insulin start date and the ketone results I have so far from the hospital and home testing strips to my sheet. It looks like his ketone levels are stable since he has been released and are coming down slowly, and are at least majorly improved from last weekend. I'll try to do the strip testing everyday for more data, thank you so much for the advice!

As of today and last night, it looks like his BG levels are coming down from that initial spike I was worried about, so he might be getting used to being on insulin. He also still has a very good appetite, which is promising.
 
Excellent news he still has his appetite.

The fast acting insulin explains how they were able to get his BC down to 120 so fast before he started on Lantus. It's a common clinic approach to get the BG down fast when a kitty is in DKA or close to it.
 
Excellent news he still has his appetite.

The fast acting insulin explains how they were able to get his BC down to 120 so fast before he started on Lantus. It's a common clinic approach to get the BG down fast when a kitty is in DKA or close to it.
I'm curious, Wendy: what is fast acting insulin? Is it not something for long-term dosing?
 
The fast acting insulin is probably Humulin or Novolin R, it is a bolus insulin. Humans often take it around meal times. It is very short acting, typically 4 hours in and out. Some people with cats with IAA or acromegaly will use it, especially in higher doses, or for recent DKA cats still throwing a lot of ketones. It is an advanced technique, needing a mentor to help you out with it. There are more things to learn about when not to use R, than when to use it.
 
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