04/18 Duke AMPS - Help…not eating/drinking

[Duke’s Mom]

My Duke was diagnosed about two years ago and I have never succeeded in getting his diabetes under control. About a month ago he spent 4 days in the hospital for DKA. Since he’s been home, I learned how to take his blood glucose, and he’s been on 4 units of Lantus twice a day, 12 hours apart and he was doing okay until today. I feed him only Fancy Feast pate, about 1/2 can each time I give him insulin and about another can spread throughout the day for snacks. I did glucose readings on him every couple hours for a few days and was able to get his average down to 233. Today, I gave him his normal dose of Insulin after his breakfast, then a few hours later we noticed he was acting strange/lethargic/sick like he was when we took him to the ER. We cannot afford another $16k hospital bill so I decided to test him every couple hours today. He’s hovered right around 300 all day and he’s not eating or drinking. I’ve tried his normal food, Churu, his sister’s dry food that he loves to steal, and nothing is working. I did give him 1 more unit at 12:30pm and 1 more unit at 3:30pm, but still no change. I have not given him his regular 4 unit dose this evening because I’m afraid of overdosing. He does not look well. Please help.

*Note…the first dose I gave him today was from a new bottle of Lantus. Could the old bottle have been weaker, maybe old, or left out of the fridge too long at one point?

 

[Jessica & Indy]

I am not an admin, but I would be going to the ER and at least have him checked out. Lantus isn't a fast acting insulin, so the additional units that you gave him won't act quickly. I have been told to only give Lantus twice a day, not in between.

Hope your baby feels better soon.

 

[Wendy&Neko]

Would it be possible for you to share Duke's blood sugar data with us? There are certain things we ask people to put in their signature and blood sugar data in a spreadsheet so we can see what is happening. Details on how to do that are in this post: New? How You Can Help Us Help You! We also need to know what type of meter you are using to test.

Are you home testing him for ketones? You can get blood meters to test or use urine test sticks: Tips to catch and test a urine sample and more background reading: Ketones, Ketoacidosis and Diabetic Cats: A Primer on Ketones. Any signs of ketones above trace mean a vet visit. If we see ketones, it can also change our strategy for dosing.

Another thing that can cause lethargy and inappetence is pancreatitis, not uncommon with diabetic cats: A Primer on Pancreatitis Nausea is a symptom, where he could lick his lips, or seem interested in food but turn away. If not eating by tomorrow, I recommend a vet visit to see why he's not eating. And potentially some help with nausea medication (ondansetron, Cerenia).

How much does Duke weigh? 2 cans of FF per day seems a bit light.

*Note…the first dose I gave him today was from a new bottle of Lantus. Could the old bottle have been weaker, maybe old, or left out of the fridge too long at one point?

We've had people use the same vial of Lantus for 5-6 months, as long as it wasn't left out overnight or for the day. A new bottle will not have caused the symptoms you saw.

You probably could give at least a half dose (2 units) tonight. How is he doing now?

Lantus isn't good at "shooting down numbers". I would recommend not using giving those extra unit like you did today. Now you have an issue with nadirs not lining up. I don't know when 12:30 or 3:30 is in relation to your shot time - we think in terms of hours after the shot.

 

[Sienne and Gabby (GA)]

Did your vet suggest testing at home for ketones? You can get Ketostix (any brand) at a pharmacy. You swipe the strip through your cat's urine stream (or get urine on a spoon, etc.) to test. Once you have a sample, you follow the instructions on the container and compare the color of the strip to the coding on the container. Alternatively, you can order a blood ketone meter. Some cats are vulnerable to developing ketones if they've had a previous episode.

 

[Duke’s Mom]

Did your vet suggest testing at home for ketones? You can get Ketostix (any brand) at a pharmacy. You swipe the strip through your cat's urine stream (or get urine on a spoon, etc.) to test. Once you have a sample, you follow the instructions on the container and compare the color of the strip to the coding on the container. Alternatively, you can order a blood ketone meter. Some cats are vulnerable to developing ketones if they've had a previous episode.

Thank you! I’m ordering a blood ketone meter. I didn’t know there was such a thing.

 

[Duke’s Mom]

Did your vet suggest testing at home for ketones? You can get Ketostix (any brand) at a pharmacy. You swipe the strip through your cat's urine stream (or get urine on a spoon, etc.) to test. Once you have a sample, you follow the instructions on the container and compare the color of the strip to the coding on the container. Alternatively, you can order a blood ketone meter. Some cats are vulnerable to developing ketones if they've had a previous episode.

Thank you! I am ordering a blood ketone meter.

 

[Duke’s Mom]

Would it be possible for you to share Duke's blood sugar data with us? There are certain things we ask people to put in their signature and blood sugar data in a spreadsheet so we can see what is happening. Details on how to do that are in this post: New? How You Can Help Us Help You! We also need to know what type of meter you are using to test.

Are you home testing him for ketones? You can get blood meters to test or use urine test sticks: Tips to catch and test a urine sample and more background reading: Ketones, Ketoacidosis and Diabetic Cats: A Primer on Ketones. Any signs of ketones above trace mean a vet visit. If we see ketones, it can also change our strategy for dosing.

Another thing that can cause lethargy and inappetence is pancreatitis, not uncommon with diabetic cats: A Primer on Pancreatitis Nausea is a symptom, where he could lick his lips, or seem interested in food but turn away. If not eating by tomorrow, I recommend a vet visit to see why he's not eating. And potentially some help with nausea medication (ondansetron, Cerenia).

How much does Duke weigh? 2 cans of FF per day seems a bit light.


We've had people use the same vial of Lantus for 5-6 months, as long as it wasn't left out overnight or for the day. A new bottle will not have caused the symptoms you saw.

You probably could give at least a half dose (2 units) tonight. How is he doing now?

Lantus isn't good at "shooting down numbers". I would recommend not using giving those extra unit like you did today. Now you have an issue with nadirs not lining up. I don't know when 12:30 or 3:30 is in relation to your shot time - we think in terms of hours after the shot.

This is all very helpful, thank you! I will work on my spreadsheet tonight. I’m taking him to the vet tomorrow. He’s getting worse. Right now Duke is less than 10 pounds but he’s normally around 16 pounds of muscle. He’s never been overweight for his build. He’s normally a very active cat.