Help! Post DKA - Insulin Amounts

J4CKS

J4CKS

Member Since 2026
Hello Everyone,

Really hoping for some help + guidance,

Earlier today I had to admit our 12yo M cat, Caesar to an emergency vet for 48-72 hours due to DKA. Similar to other posts here, we're filled with stress and worry. Based on early diagnosis, it was due to insufficient insulin that caused it. He was started on an IV for fluids and electrolytes, rapid insulin for help his BG, pain meds and an anti-nauseant.

For the last 3-4 days he was showing signs of DKA (increased thirst, some lethargy, mixed feelings on food, etc) and it wasn't until last night/this morning we realized the severity of it. I'm hoping we "caught it" in time, it was only the last 24 hours we saw his appetite go down, would still run to us for treats, etc. It was the increased thirst that gave it away.

History:

He was originally diagnosed with diabetes 2.5 years ago and he's been super stable and progressing well for the last 2 years:
Food: Purina Pro Plan DM
Insulin: Lantus (glargine) 0.5 units once per day (morning)

*I realize this is an incredibly low dosage. With a switch to Purina DM and having a Freestyle Libre getting constant glucose readings, our original vet continually lowered his dosage from 3 units twice per day, to the 0.5 dosage over a 6-8 month period - even stating the potential to stop giving insulin injections at all, as the DM food kept his BG in check.

**3 months ago we took him in to our (new) vet for glucose curve (the series of tests for the entire day) since he was starting Atopica due to some overgrooming issues (another story). The results were great, his BG was stable (still on the 0.5 units once per day).

We're really hoping his time at the emerg vet helps him and gets his health stabilized - we just need help preparing for the afterwards care once he's home. I've been reading over some of the forum posts here such as "Ketones, Ketoacidosis and Diabetic Cats," etc. Trying to put together a list of everything needing to be done and what I need to learn.

- At home glucose testing kit (haven't done before) vs another Freestyle Libre (at first, worked great, he's been able to get the last 2 off within 24 hours)
- Ketone Testing Kit (probably go with the urine testing rather than the blood testing)
- Food + Calories is important - feeding 1.5x calories per day - will probably stick with the DM food + treats
- Keep hydration up - water access, extra water in food, etc. Do you think at home fluids/IV would be required?
*located in Canada if that helps

Just trying to learn as much as possible and what is most important while been so worried and stressed since it really came out of no where.

Thanks y'all
Jack + Caesar
 
Hi Jack and Caesar and welcome to the forum.
I’ve read your post and am sorry you are both going through DKA but he’s in the best place at the moment.
I’ve only just got up (I’m in Australia) and I need to feed my hungry crew and get a few things done but I’ll get back to you soon about how to be prepared for when Caesar comes home
Bron
 
Hi again Jack
I can see you have done some research of our information which is great.

I’m glad you are open to doing home testing of the glucose levels as this is really important. There is no need to buy an alphatrak pet meter which the vets will most likely recommend. An ordinary human meter is perfectly safe and good to use and the human meter is what all our data is based on. The pet meter is a relatively new meter and until then all vets used the human meters. The pet meters are very expensive to run (the test strips). I will tag @Wendy&Neko re Canadian meters and food as she lives in Canada.

I see the vet was only giving Lantus once a day. Lantus is twice a day insulin for cats as they have a much faster metabolism than humans. Rather than giving it once a day it is much better to lower the dose further and give it twice a day. However with the DKA, I’m sure the dose will change.

So here is what you will need to be doing once Caesar comes home:
  • you need to give one and a half times as many calories as he 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 Caesar won’t eat the low carb food, feed him whatever he 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.
  • Give antinausea medication if needed
  • 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. Yes ask the vet if Caesar can have sub Q fluids at home. His heart will need to be checked by the vet to ensure it is ok for him to have them.
  • Set up a spreadsheet and test the BG frequently
  • Post daily with updates and ask for help as often as needed.
 
Hi Bron - thanks for the reply - appreciate all the information! Didn't realize Lantus was a twice per day insulin so that's good to know. I'll get the spreadsheet ready to go for once he's back.

*quick update: got a call from the vet, he's doing good! Got BG stabilized around and under 15 mmol/L (~270 mg/dL), didn't give an exact value. Ate full meal + snacks when offered, probably thanks to the anti-nausea meds. Ketones remained high so he's staying admitted for another day.
 
Well done getting the SS up and running. I noticed you had put SLGS as the dosing method. After DKA the dose of insulin may have to be changed more than once a week so TR would be a better option, but we can worry about that when Caesar comes home.
I’m glad he is improving and eating. That is a real plus.
Can you ask what the ketone level is?
And when he is discharged, ask for all the paperwork to be emailed to you. You have paid for it so you are entitled to have it and it will be helpful for us.
 
Hello and welcome from the west coast.
For human meters, you are basically looking for something that needs just a small blood drop and as cheap as possible test strips as that is what you go through. Freestyle LIte occasionally has sales on test strips, and I managed to get a meter free when I bought my first set of test strips. Other manufacturers also sometimes offer that. Shop around, diabetic product prices vary a lot.

As far as food goes, there are lots of off the shelf options. DM is just dietetic management, not diabetic management. It doesn't do anything special for diabetes from any of the other commercially available low carb products. Except higher price and not great ingredients. Most pet food stores like PetValu or Petsmart have lots of available options. This older food list has a number of products also available in Canada. Since it's older, it doesn't have a lot of the newer products. At his point with DKA, you just want something he'll eat enthusiastically. What was he eating before his diabetes diagnosis?
 
@Bron and Sheba (GA) Sounds good - I'll switch that over and read up on TR too! Getting the correct insulin dosage is definitely going to be a question mark - especially have a baseline of previous dosage and already being on LC wet. I'm curious to see what the vet recommends. Still unsure why the DKA event happened. I know diabetes can change at a moments notice. One theory we have is that we just adopted a second cat (6yo, F) 3 weeks ago and she eats Hill's Science Dry and Friskies Wet (she's a super picky eater). Caesar is a fiend for her kibble and food and has gotten bites in during feeding time. That's on us for not supervising closely enough.

Update: another good night for Caesar! Ate every 4 hours overnight which is good! BG levels are still stabilizing / in a better range. Didn't eat breakfast at 8:00 am (US Central), they think that's because of his consistent eating overnight. Going to keep him for the afternoon and monitor BG. Potentially able to take him home this afternoon/evening. Asked about Ketone levels - the person I talked to didn't have an exact value to give me. All they said was they were/are lowering and into the normal range. Whether that's under 0.2 mmol/L I'm unsure. I'll follow up this afternoon for an exact value + when they tested last.

Hi @Wendy&Neko nice to meet you guys as well! For meters, I'll mostly likely get either the Freestyle Lite or Contour NextGEN depending on availability around me! The emerg vet put a CGM (Libre) on him, so we have a little breathing room between discharge and getting a meter in case I order one online, for example. Will most likely get one in person. Testing strips sure are expensive here in Canada.

As for food, when Caesar was originally diagnosed in 2024, we transitioned him to FF Pate (was originally on dry when adopted in 2023). FF started off really well, lowering his BG, but he developed fairly bad bowel movements and diarrhea. Took about 3 weeks for vet visits, plain chicken, pumpkin, etc to get it under control. During that time we switched over and tried the DM food, and it just happened to work. Became one of those instances where it worked, so why try and switch (again). Trust me, wish I didn't have to pay $3.75 / can lol. I'll ask what type of food they've been giving him at the vet and use that as a baseline too for when he first gets back!

Quick additional question - for tracking his ketone numbers, I'll definitely be getting the KetoStixs for urine testing (cheap and nice to have). What's your guys opinion on getting a Ketone Meter instead? Specifically looking at the Keto-Mojo (online only) to test both glucose and ketone levels. Little more $$ due to the ketone strip costs but having the immediate + number reading vs a colour reading seems good to have!

Thanks again for all the information and responses! I'll be sure to get all the info from the vet as well!
 
I have one quick note on the Libre, please make sure it’s actually working before they send you home with it on Caesar.
Vets tend to install them and use glue which is a definite no no. It tends to make the sensor shut down and then be useless.
Many people find this happens once they get home, so just ask if they used glue and make sure it’s giving you readings before you leave the hospital.

If it does shut down, it’s useless to you and I just wanted you to be aware of that.
If it does shut down, you can always contact Abbott for a replacement. If you wanted to do that just make sure not to tell them it’s for a cat or they won’t replace it.
(Hopefully it will work fine so you have an idea what’s happening with his glucose!)

Best of luck and hoping he comes home soon and has a quick recovery 💓
 
Staci & Ivy said:
I have one quick note on the Libre, please make sure it’s actually working before they send you home with it on Caesar.
Vets tend to install them and use glue which is a definite no no. It tends to make the sensor shut down and then be useless.
Many people find this happens once they get home, so just ask if they used glue and make sure it’s giving you readings before you leave the hospital.

If it does shut down, it’s useless to you and I just wanted you to be aware of that.
If it does shut down, you can always contact Abbott for a replacement. If you wanted to do that just make sure not to tell them it’s for a cat or they won’t replace it.
(Hopefully it will work fine so you have an idea what’s happening with his glucose!)

Best of luck and hoping he comes home soon and has a quick recovery 💓
Click to expand...

Will do! That's good to know about the glue - never knew that! Libre's were our choice of BG tracking when he was first diagnosed so we've been through a couple of them to say the least, some lasted the full 2 weeks, other maybe 48 hours until he took them off :/
 
J4CKS said:
Will do! That's good to know about the glue - never knew that! Libre's were our choice of BG tracking when he was first diagnosed so we've been through a couple of them to say the least, some lasted the full 2 weeks, other maybe 48 hours until he took them off :/
Click to expand...
Good job, glad you are familiar with using a Libre.

I use them 24/7 with my cat who won’t allow constant testing.
(I poke her if she’s very low to make sure she’s safe).

If you need more information, you can read this page
Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats
 
UPDATE:

Hello everyone! The vet gave the all clear to take Caesar home tonight. He's bounced back well from the care over the last 3 days/nights.

New Insulin: 1 unit every 12 hours. (Lantus, Glargine).
BG was a little high when tested once he was home (~330). Gave squeeze treat and ate full dinner at 8:00 pm (US Central) Grazed on food over ~30 minutes. Will see if he wants to eat more in an hour or two (like everyone has said, more calories, the better). Retested BG 1+ still at the ~330 range, however, I know the Lantus will take 2-3 hours to take effect. Hoping part of the high readings is home readjusting to home life and the stress of being at the vet.

Will be picking up BG meter and ketone testing sticks tomorrow - want to start tracking those asap. Will be ordering a Keto-Mojo in the future for better readings. Currently has CGM (Libre) for the next week, barring him taking it off / it stops working.

Now it becomes a longer journey of getting him regulated again. Vet wants to bring him in 7-10 days for a blood glucose curve to ensure insulin dosage is appropriate (rather do at home TBH since the stress of the vet can alter BG readings)

For the future / updates should I start a new thread? Potentially under the Lantus thread? Also have the spreadsheet updated!

Jack + Caesar
 
Fantastic news that Caesar is home again! And great to see his numbers start to move down. As the Lantus depot builds, the numbers will get even better.

If you haven't already, I'd recommend reading the yellow starred Sticky Notes at the top of the Lantus forum. Including the one that describes the two dosing methods used here. See if you can decide which dosing method would suit your goals for Caesar and your lifestyle. As long as he's eating low carb wet or raw he can do either dosing method. Once you've got that figured, feel free to start posting over there.
 
Congratulations on Caesar coming home! That’s such great news 🥰
We will look forward to seeing you both on the Lantus forum.
Please post daily if you are able so we can follow along and help you 😻🐾
 
Little help!

Overnight from 3am onwards, the CBG monitor tested as "HI" indicating over 450 - little nervous about this since he just came home from the DKA. His lowest was 239 at 12am / 1am. He's scheduled to get his insulin in ~45 minutes so hopefully that brings it down. Energy levels seems okay - not hiding away or anything at the moment. Did drink from his dish twice since being up (don't want to overthink this). Just a little stressed since the vet indicated he was doing super / recommended the 1 unit for insulin, yet his reading still come in this high.

Just wanted to get someone's thoughts / words of advice so I don't overthink anything. Potential to up his dosage?
Will be getting a blood glucose meter and ketone strips today too (but won't be able to test until later tonight due to work)
 
Update:

After going to his water dish for the third time since I've been up (approx 1 hour) decided to feed and give insulin 30 minutes early. Will test BG in a little bit to see what his numbers are at. Little stressed out seeing him drink that much - indicated the DKA this past weekend.

only ate approx 20% of his breakfast at the start, gave squeeze treat (enthusiastically ate) and out the remaining on his breakfast - only really really ate the treat on top. Called the vet, they basically said keep an eye on him throughout the day and continue to check his BG. Little nervous
 
Last edited:
J4CKS said:
Little help!

Overnight from 3am onwards, the CBG monitor tested as "HI" indicating over 450 - little nervous about this since he just came home from the DKA. His lowest was 239 at 12am / 1am. He's scheduled to get his insulin in ~45 minutes so hopefully that brings it down. Energy levels seems okay - not hiding away or anything at the moment. Did drink from his dish twice since being up (don't want to overthink this). Just a little stressed since the vet indicated he was doing super / recommended the 1 unit for insulin, yet his reading still come in this high.

Just wanted to get someone's thoughts / words of advice so I don't overthink anything. Potential to up his dosage?
Will be getting a blood glucose meter and ketone strips today too (but won't be able to test until later tonight due to work)
Click to expand...
J4CKS said:
Little help!

Overnight from 3am onwards, the CBG monitor tested as "HI" indicating over 450 - little nervous about this since he just came home from the DKA. His lowest was 239 at 12am / 1am. He's scheduled to get his insulin in ~45 minutes so hopefully that brings it down. Energy levels seems okay - not hiding away or anything at the moment. Did drink from his dish twice since being up (don't want to overthink this). Just a little stressed since the vet indicated he was doing super / recommended the 1 unit for insulin, yet his reading still come in this high.

Just wanted to get someone's thoughts / words of advice so I don't overthink anything. Potential to up his dosage?
Will be getting a blood glucose meter and ketone strips today too (but won't be able to test until later tonight due to work)
Click to expand...
It’s very normal when their BG is high to drink more and pee more.
It’s good he did see some downward movement overnight on the Libre. I know he’s bounced back up again and you are worried.

You may want to start a new thread on the Lantus forum and use the drop-down prefix of a? And put in your title “dose help needed”

Please link this post for continuity so others can see what’s been going on.

You can also add the question to this title on this thread so that you can get some attention and some answers on dosing.

My inclination for this morning is to leave the dose the same until you get some answers from someone who is trained to give you dosing information.
@Marje and Gracie @Sienne and Gabby (GA) can you help here?

Please make sure he has plenty of water available today if you will be leaving him at home and going to work. He will probably drink a lot.
We don’t want to increase tutor of liquid quickly from one dose to the next because it might increase the depot too quickly and take him too low. You would want to be around and able to test him and make sure he is safe, you don’t want to be giving back to back, increases every cycle in a row. I hope this makes sense.
 
J4CKS said:
Update:

After going to his water dish for the third time since I've been up (approx 1 hour) decided to feed and give insulin 30 minutes early. Will test BG in a little bit to see what his numbers are at. Little stressed out seeing him drink that much - indicated the DKA this past weekend.

only ate approx 20% of his breakfast at the start, gave squeeze treat (enthusiastically ate) and out the remaining on his breakfast - only really really ate the treat on top. Called the vet, they basically said keep an eye on him throughout the day and continue to check his BG. Little nervous
Click to expand...
You mentioned in your first post he’d been on 0.5u Lantus once a day. Is that what his dose was when he was admitted to the hospital? Were they giving him Lantus twice a day and at what dose? And how many consecutive cycles has he gotten that dose? Lantus is a depot insulin and I want to be sure he’s got a good depot so we can fast-track his dose if need be. If they have given him several cycles of 1u then we can increase his dose but because the SS only shows 2 cycles, we need to be sure we don’t jump the gun on the depot.

As soon as you can let me know that info, I can advise on the dose.

In the meantime, keep up with lots of extra calories and fluids. Are you giving him subq fluids at home?
 
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