? 08/04 Cooper 135 Recovering from DKA

[Marc & Cooper]

Hello! First post here and still very new and confused regarding my Coopers recent diagnosis with diabetes. He suffered a very scary/life threatening dka episode and has been back home for a little over a week. Started testing his bg at home and it’s consistently been in the 300s. Just had a glucose curve on 08/03 (yesterday) and they said his levels were in the 400s most of the day. Took one random bg test myself at 1am and his bg was 135 (best number it’s been since this started (previous best was 265). His dose was just moved to 3 units. If his numbers stay at 135 should I give him his full 3 unit dose??? So lost on this and unfortunately shortly after I give him his insulin in the morning I have to leave for work. Not sure if I should skip or lower or give full amount

 

[Bandit's Mom]

Hi Marc!

Welcome to FDMB.

When was Cooper's dose upped to 3U? With tonight's shot (8/3)? So he has been on 3U for 1 cycle and was on 2U before that?
How long after the shot was the BG at 135 and do you have any more tests for the cycle?
When is the morning shot due?

With a history of DKA, it's not advisable to skip shots. It's great that you are testing because we are very data dependent here. If you have the test data, could you please put into a spreadsheet so that we can help you with dosing based on the numbers? I can help you set up the spreadsheet - won't take me more than a minute to do so.
How to Create a Spreadsheet

A couple of more things:

1. Diet: Purina Pro Plan Dry is too high in carbs for a diabetic cat. They need to be on a diet which is less than 10% in carbs. Does he like wet/canned food? Will you be able to slowly switch him to a low carb canned food? If he is a kibble addict, there are low carb dry food options available (Young Again Zero, Dr. Elsey's Cleanprotein and Wysong Epigen 90). But cats need water and it's best if they get it from their food since they don't drink a lot of water. Here's an excellent website on feline nutrition by a vet - www.catinfo.org.
   
   
2. Dosing: Increases in dose by whole units is too much for cats. Here we dose with syringes (rather than pens) and increase and decrease in multiples of 0.25U. Here's a page on the dosing protocols we follow: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

There is a whole lot of more information on the stickies at the top of the Lantus forum. I don't want to inundate you with too much at the beginning.

@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

Hi Marc and Cooper and welcome to the forum.

With DKA so recently in the picture there are a few things that are really important. DKA happens when there is not enough insulin, not enough food and an infection or inflammation in the body.

• Cooper needs to be eating 1 1/2 times as many calories as he normally would. This is because food helps ketones from forming. As well as the main meals before the insulin is given, I would give Cooper a snack every two hours during the day and evening, except foe the 2 hours Preshot so the preshot BG is not food influenced.
• Don’t skip any doses of insulin, as insulin also stops ketones from forming. If the BG is not high enough to shoot, you need to stall, don’t feed and test again in 20 minutes to see the BG is rising. Post and ask for help. Make sure you change the subject line to reflect the problem eg…. BG xx stalling, PLEASE HELP. In the beginning I would not shoot if the BG is under 200 but stall as I said above.
• Get the spreadsheet set up so we can see the blood glucose levels
• Encourage extra fluids……if Cooper will allow you to, put a teaspoon of warm water in all his meals and snacks.
• If he was given any antibiotics make sure they are all given until finished.
• Test daily for ketones. This is really really important as we need to catch any sign of ketones early. To test you need to buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine sample from Cooper and test the urine as per the instructions on the bottle.
  
• If Coopers appetite is not good give an anti nausea medication such as cerenia and / or ondansetron. It is very important he eats well

At the moment, it is more important that he eats anything, rather than he eats a low carb food. Are you feeding him just the pro plan dry at the moment? Is his appetite good? If so I think I would continue with it until you are sorted out with the spreadsheet and are comfortable testing. Then if there are no ketones we can look at changing over to a low carb diet. But at the moment the higher carb food is allowing the dose to be a bit higher which is helpful in keeping the ketones at bay.
Don’t try and change over to a low carb diet on your own or before you are testing very well as a change over can drop the BGs up to 100 points and the insulin will most likely need to be adjusted.

Three units is a large dose but until we can see some data we can’t say if it is a good safe dose.
If you could get the SS set up and any BGs you have put in, that would be very helpful. @Bandit's Mom is great at setting SS and can help you if you like. We need to get it set quickly so we can help you.
Lantus dosing is based on the nadir or lowest point in the cycle so it is important you test before every shot to see it is safe to give the dose.
Also if you can test during the cycle to see how low the dose is taking Cooper, we will be able to help with the dosing.

Do you have an automatic timed automatic feeder? If not I would highly recommend you look at getting one. You will then be able to feed Cooper while you are at work.
I think I have given you enough information for now. I don’t want to overwhelm you. But please ask any questions you need, we are very happy to answer them and help you as you nurse Cooper back to health.
Bron

 

[Marc & Cooper]

Hi Marc and Cooper and welcome to the forum.

With DKA so recently in the picture there are a few things that are really important. DKA happens when there is not enough insulin, not enough food and an infection or inflammation in the body.

• Cooper needs to be eating 1 1/2 times as many calories as he normally would. This is because food helps ketones from forming. As well as the main meals before the insulin is given, I would give Cooper a snack every two hours during the day and evening, except foe the 2 hours Preshot so the preshot BG is not food influenced.
• Don’t skip any doses of insulin, as insulin also stops ketones from forming. If the BG is not high enough to shoot, you need to stall, don’t feed and test again in 20 minutes to see the BG is rising. Post and ask for help. Make sure you change the subject line to reflect the problem eg…. BG xx stalling, PLEASE HELP. In the beginning I would not shoot if the BG is under 200 but stall as I said above.
• Get the spreadsheet set up so we can see the blood glucose levels
• Encourage extra fluids……if Cooper will allow you to, put a teaspoon of warm water in all his meals and snacks.
• If he was given any antibiotics make sure they are all given until finished.
• Test daily for ketones. This is really really important as we need to catch any sign of ketones early. To test you need to buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine sample from Cooper and test the urine as per the instructions on the bottle.
  
• If Coopers appetite is not good give an anti nausea medication such as cerenia and / or ondansetron. It is very important he eats well

At the moment, it is more important that he eats anything, rather than he eats a low carb food. Are you feeding him just the pro plan dry at the moment? Is his appetite good? If so I think I would continue with it until you are sorted out with the spreadsheet and are comfortable testing. Then if there are no ketones we can look at changing over to a low carb diet. But at the moment the higher carb food is allowing the dose to be a bit higher which is helpful in keeping the ketones at bay.
Don’t try and change over to a low carb diet on your own or before you are testing very well as a change over can drop the BGs up to 100 points and the insulin will most likely need to be adjusted.

Three units is a large dose but until we can see some data we can’t say if it is a good safe dose.
If you could get the SS set up and any BGs you have put in, that would be very helpful. @Bandit's Mom is great at setting SS and can help you if you like. We need to get it set quickly so we can help you.
Lantus dosing is based on the nadir or lowest point in the cycle so it is important you test before every shot to see it is safe to give the dose.
Also if you can test during the cycle to see how low the dose is taking Cooper, we will be able to help with the dosing.

Do you have an automatic timed automatic feeder? If not I would highly recommend you look at getting one. You will then be able to feed Cooper while you are at work.
I think I have given you enough information for now. I don’t want to overwhelm you. But please ask any questions you need, we are very happy to answer them and help you as you nurse Cooper back to health.
Bron

Thank you for all this information! So I just finished setting up the SS and added all the numbers I have taken. It's not many but I just started when I got him home from the emergency hospital. I should mention he also has pancreatitis which they said also influenced the DKA episode.

• At the hospitals recommendation I have been only giving him 1/4 cup of the Pro Plan dry essentials chicken and rice food at each meal. Literally, no treats or snacks just 1/4 of a cup at insulin time. So the numbers in the SS are based off of that feeding schedule, but the poor thing is constantly crying for food at the +6 mark.
• You will see on my SS that this morning instead of the 3 units I gave him 2.5 (which I probably shouldn't have changed from 3)
• He is drinking plenty of water. I have a mini food bowl I use and I have to usually refill that at least twice in the day for him.
• They gave me a few medicines for supportive care. No antibiotics but anti-nausea medicine and an appetite simulant as he wasn't eating for me before.
• I purchased ketostix right away after I took him home from the hospital and check his urine once daily (mostly in the mornings if I can ) and so far they have come up negative each time
• He now devours his food since he isn't eating much at all.

They started him on the pro plan dry at the hospital as he wouldn't touch the wet food they had. They told me I can eventually introduce the wet version of the pro plan chicken and rice formula and either completely swap to that if he likes it or mix it up with the dry and wet since he has always been a kibble lover. I feel like I am still at a complete loss with how much and what I should be feeding him.

I re-spoke to the vet tech today who confirmed they only gave him 2 units last night because they thought he was still on just 1 unit and didn't see that the hospital changed his does already to 2 units from the initial 1. She did say that they gave him the full 1/4 cup I left them but that he only ate 75% of it. His lowest reading while there for the curve was 404 which really threw me off as to why it was so low early this am.

I am definitely going to look into an automatic feeder. Do you have any recommendations on a good one? I am just trying my hardest to make sure I get everything correct and do everything right and already feel like I am failing miserably.

 

[Marc & Cooper]

Hi Marc!

Welcome to FDMB.

When was Cooper's dose upped to 3U? With tonight's shot (8/3)? So he has been on 3U for 1 cycle and was on 2U before that?
How long after the shot was the BG at 135 and do you have any more tests for the cycle?
When is the morning shot due?

With a history of DKA, it's not advisable to skip shots. It's great that you are testing because we are very data dependent here. If you have the test data, could you please put into a spreadsheet so that we can help you with dosing based on the numbers? I can help you set up the spreadsheet - won't take me more than a minute to do so.
How to Create a Spreadsheet

A couple of more things:

1. Diet: Purina Pro Plan Dry is too high in carbs for a diabetic cat. They need to be on a diet which is less than 10% in carbs. Does he like wet/canned food? Will you be able to slowly switch him to a low carb canned food? If he is a kibble addict, there are low carb dry food options available (Young Again Zero, Dr. Elsey's Cleanprotein and Wysong Epigen 90). But cats need water and it's best if they get it from their food since they don't drink a lot of water. Here's an excellent website on feline nutrition by a vet - www.catinfo.org.
   
   
2. Dosing: Increases in dose by whole units is too much for cats. Here we dose with syringes (rather than pens) and increase and decrease in multiples of 0.25U. Here's a page on the dosing protocols we follow: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

There is a whole lot of more information on the stickies at the top of the Lantus forum. I don't want to inundate you with too much at the beginning.

@Bron and Sheba (GA)

So I confirmed with the vet today that last night they only gave him 2U. They thought he was still on just 1U so they gave him 2U but once I told them he was already on 2U they said to start 3U this morning. So that 135 reading was at 1am (technically 8/4) and his shot was given to him at 6pm on 8/3 at the 2U. I set up the SS and believe I did it right so please let me know if I am missing anything? This morning I gave him 2.5U

1. He was started on the Pro Plan dry essentials chicken and rice formula as he would not even touch the wet and few other dry foods they had for him. He probably took to this food because as a kitten this is what I fed him at home. Talking to my vet they said ideally they would like to see him transition to wet food. They said even the Purina Pro Plan chicken and rice wet is good?
2. I have the Lantus pen but draw with a syringe as I didn't like that I couldn't see the insulin going into him.

 

[Bandit's Mom]

. I set up the SS and believe I did it right so please let me know if I am missing anything?

Yes, the spreadsheet is fine Was Cooper started on insulin on 7/31 or is that when you started home testing? If it's the latter, could you please add the data for insulin given before 7/31 in the SS? I understand that you would not have any BG data but we would have a dosing history for him.

He was started on the Pro Plan dry essentials chicken and rice formula as he would not even touch the wet and few other dry foods they had for him. He probably took to this food because as a kitten this is what I fed him at home. Talking to my vet they said ideally they would like to see him transition to wet food. They said even the Purina Pro Plan chicken and rice wet is good?

Like Bron said, for now it's important that he eats. Even if that food is not suited for diabetics. Ultimately, you want to switch to a low carb food. The Purina Pro Plan DM canned is low carb (around 6%) but you need not restrict yourself to prescription food. Any low carb canned food that Cooper likes is good enough.

The food change could drop his BG quite a bit, so any transition has to be done very slowly and with careful monitoring of his BG, so that you can reduce his dose, if necessary. We have seen cats go from 3U to no insulin after a diet change.

I have the Lantus pen but draw with a syringe as I didn't like that I couldn't see the insulin going into him.

We use syringes with half unit markings so we can increase and decrease in multiples of 0.25U. With that 135 last night, you might want to hold the 2U a little longer and get tests to see how low he is going. Lantus dosing is based on nadirs.

Till they get used to lower numbers, a cat's body will react to low numbers and we call this "bouncing". We ignore the bounces and focus on the nadirs (how low the BG goes on a dose).
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

[Bron and Sheba (GA)]

Hi Marc,
Well done getting the SS up and running and filled in. Thank you,
Are you able to get any tests in during the am cycle at all or are you at work?

Please feed him several times during the day and evening, it is really important that he eats and eats well. If his body does not get enough food (carbohydrates) he will start to use the fat and protein in his body instead. And the byproduct of that is ketones. So to prevent that happening we need to make sure he eats very well.
At this point, eating trumps everything so if he wants to eat the dry, let him and once he has improved and the ketones are well in the rear vision mirror, we can swap him over to some wet food. There are plenty of other options apart from the pro plan prescription foods. The pancreatitis could be making him feel nauseated as well and reluctant to eat. Keep up the antinausea meds and appetite stimulant. Always give the antinausea first and give it time to work before giving the appetite stimulant,

Maybe go back to 2 units of Lantus seeing you got the 135 and you have to leave for work straight after the dose in the mornings. And the ketones are negative as well. Stay at that dose unless he drops under 50 and earns a reduction in dose.
Do you have any high carb foods there and honey or Karo incase of very low numbers?
That is great you are testing daily for ketones! Can you put the result of each one into the remarks column of the SS please?
Not sure which country you live in Marc to suggest automatic feeders. I live in Australia but I think the US and Canada have a Petsafe 5 which is good.
You aren’t failing miserably at all. You are doing very well.
That is good you are using a syringe not a pen.
Can you change your subject line to say Recovering from DKA please.
The most Important things you need to do are feed often, don’t skip the insulin doses, test for ketones, encourage fluids.
Bron

 

[Summer and Susie (GA)]

This is the pet feeder I use. https://www.chewy.com/cat-mate-c200-2-bowl-automatic-dog/dp/103145
You may need a feeder that will provide more than two feedings when you are gone. There is one that, I believe, has five compartments. If you are more interested in that let me know and I can tag some folks to see what is recommended.

One more thing on the Cat Mate 200. You are supposed to take the battery out when not in use. It is kind of inconvenient but I don't have useful power in my bathroom where I have the feeder (electrician screwed up and I have to turn the light switch on to get power).

 

[Bron and Sheba (GA)]

@Summer and Susie i think you may have put the wrong link in

 

[Summer and Susie (GA)]

@Summer and Susie i think you may have put the wrong link in

I did put the wrong link in but have fixed it. Thanks!

 

[Bron and Sheba (GA)]

@Summer and Susie i think the 5 compartment one would be better for Marc Do you have the petsafe link?

 

[JaxBenji]

5 compartment

I am definitely going to look into an automatic feeder. Do you have any recommendations on a good one?

I used the CatMate C500 and the PetSafe5 (I started off with one feeder and then really liked it so I ended up using one for the AM and one for the PM though you can also use one feeder for both cycles, just have to adjust the timers). The best part about the 5 compartment feeders (IMHO) is you can rotate to an empty spot 2 hours before shot time.

https://www.chewy.com/cat-mate-c500-digital-5-meal/dp/154556?
https://www.chewy.com/petsafe-eatwell-5-meal-automatic-dog/dp/48080?

The C500 comes with icepacks and has a smaller footprint than the PetSafe; it also is lighter as it uses 3-AA batteries. The PetSafe uses 4-D cell batteries.

Chewy, of course is just one supplier - I think I bought my C500 from the manufacturer directly and I think I ended up getting my PetSafe off Amazon. In summary, you can shop around.

 

[Summer and Susie (GA)]

@Summer and Susie i think the 5 compartment one would be better for Marc Do you have the petsafe link?

I think this is the one that I have seen recommended by others. Maybe others will respond. It says it is for dry food but I'm sure folks are using it for wet food, too. It takes 4 D batteries and I do not see that it has any ice pack capability if someone is going to be gone long. We need to get other recommendations if we can. https://www.chewy.com/petsafe-eatwell-5-meal-automatic-dog/dp/48079

 

[Summer and Susie (GA)]

Sounds like Susanne @JaxBenji has the better 5 compartment auto feeder.

 

[Marc & Cooper]

Yes, the spreadsheet is fine Was Cooper started on insulin on 7/31 or is that when you started home testing? If it's the latter, could you please add the data for insulin given before 7/31 in the SS? I understand that you would not have any BG data but we would have a dosing history for him.

Yes he was on insulin before. I added that and notes to everything I believe that needed them.

Like Bron said, for now it's important that he eats. Even if that food is not suited for diabetics. Ultimately, you want to switch to a low carb food. The Purina Pro Plan DM canned is low carb (around 6%) but you need not restrict yourself to prescription food. Any low carb canned food that Cooper likes is good enough.

I am running out after work to pick up some wet food. Specifically the Pro Plan chicken and rice formula. Does that seem to be an ok one for him? I was thinking of doing 1/4 cup of his dry in the AM and at lunch having someone give him a full 3oz of the wet and then at dinner time/second dose give him another 1/4 of the dry. I was thinking of attempting this on my next day off so I am home to see how the added food affects his levels.

 

[Marc & Cooper]

Hi Marc,
Well done getting the SS up and running and filled in. Thank you,
Are you able to get any tests in during the am cycle at all or are you at work?

I am currently at work. I do have a fiancé that is home all day but she isn't ready to help with this stuff yet. She used to have a horrible fear of cats, but loves him dearly just isn't comfortable with holding him or doing stuff like this. I plan on testing him right when I get home which is about 2 hours before his next dose and then again right before his 2nd dose.

Do you have any high carb foods there and honey or Karo incase of very low numbers?
That is great you are testing daily for ketones! Can you put the result of each one into the remarks column of the SS please?
Not sure which country you live in Marc to suggest automatic feeders. I live in Australia but I think the US and Canada have a Petsafe 5 which is good.
You aren’t failing miserably at all. You are doing very well.
That is good you are using a syringe not a pen.
Can you change your subject line to say Recovering from DKA please.

• I do have Karo on hand as they recommended that in case of low numbers
• I updated the chart with his ketone results in the remarks column. I believe the SS is fully done now
• I am in the US and it looks like multiple people have given me some good options for automatic feeders.
• I updated the title as well!

 

[Bandit's Mom]

I am running out after work to pick up some wet food. Specifically the Pro Plan chicken and rice formula. Does that seem to be an ok one for him?

There are few chicken and rice variants in under Purina Pro Plan. Not sure which one you mean? Here's a chart with carb% of various foods.
https://catinfo.org/chart/index.php

I was thinking of doing 1/4 cup of his dry in the AM and at lunch having someone give him a full 3oz of the wet and then at dinner time/second dose give him another 1/4 of the dry. I was thinking of attempting this on my next day off so I am home to see how the added food affects his levels.

The food change could take a few days to fully affect the BG. So if you don't see a change immediately, it does not mean there won't be any later. Before you start the food change, please test him as often as work permits, and in both AM and PM cycles (many cats go lower at night) to see how low he is going on the current dose.

Here's the SS of a cat that went from 3U to zero (remission) in a matter of days after a food change:
https://docs.google.com/spreadsheet...rJs4_u_cUBmIdGP1COrsWAOSInfdXkOQAG6hR/pubhtml

 

[JaxBenji]

Pro Plan chicken and rice formula. Does that seem to be an ok one for him?

Personally, I would try to find something else as it looks like it's around 16% carbs. You'll want to avoid things like rice and gravy as those equate to carbs. A lot of us use this food chart as a starting point - https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

For Cooper's primary diet, you'll want some low-carb choices. Low Carb (LC) is 0-10% carbs (a lot of people aim for 5% or lower). A lot of people use Fancy Feast Classic Pates but there are lots of choices. You'll also want a some medium carb (11-15%) and some high carb (16%+) (again, Fancy Feast is popular for these too, especially medium carb; I used FF gray lovers beef as high carb).

 

[JaxBenji]

lol sorry I cross posted, Bhooma @Bandit's Mom - clearly, I was taking too long to write

 

[Bandit's Mom]

lol sorry I cross posted, Bhooma @Bandit's Mom - clearly, I was taking too long to write

You have more hands-on experience with cat food in the US than me!

 

[Bron and Sheba (GA)]

@JaxBenji because of the recent DKA, we are leaving him on the current food. I know it is higher carb, but at the moment we need to make sure he is eating well and we can get as much insulin in him as is safely possible. Once we get a bit more data and are sure the ketones have gone, we can try the swap over to lower carb food.

@Marc & Cooper thats great your fiancé is at home even if she can’t test at the moment. Just making sure he eats and is ok is a big plus.
regarding the food…. If he is eating the dry food ok at the moment, can you leave him on the same amount of it for the moment while we gather some more data about his BGs and what the ketones are doing please? This will enable us to give him as much insulin as is safely possible which is so important because of the DKA.
If you want to give some of the extra snacks as the wet food you are buying that’s ok but don’t reduce the dry amount just yet. Does that all make sense?
Once we are sure the ketones are a distant memory we can do the swap over. The amount of insulin will likely drop then as well.
Bron

 

[Marc & Cooper]

@Marc & Cooper If he is eating the dry food ok at the moment, can you leave him on the same amount of it for the moment while we gather some more data about his BGs and what the ketones are doing please? This will enable us to give him as much insulin as is safely possible which is so important because of the DKA.

He is loving the dry food. I haven’t added any wet food yet. Tonight about 3 hours before his 2nd dose I gave him 1/8 of a cup to add a little more food in. Then I gave him his usual 1/4 at his PM dose. I added that info to the SS.

If you want to give some of the extra snacks as the wet food you are buying that’s ok but don’t reduce the dry amount just yet. Does that all make sense?
Once we are sure the ketones are a distant memory we can do the swap over. The amount of insulin will likely drop then as well.
Bron

I will hold off on wet until we determine it’s ok to switch him to the low carb diet as if I get him the pro plan wet that will just be much more carbs added into his diet on top of what he’s already getting in the kibble. He’s very picky so with the whole ketones and this being so new I don’t want to overwhelm him and have to try a bunch of different wet foods as I have a feeling that will be a whole new battle finding the one he likes.

I’m thinking I will give him his usual meals at dosing times (the 1/4 cups) and then maybe at +6 giving him 1/8 just to satisfy his hunger to hold him until the next dose. Does that seem reasonable and ok for now?

 

[Bron and Sheba (GA)]

I’m thinking I will give him his usual meals at dosing times (the 1/4 cups) and then maybe at +6 giving him 1/8 just to satisfy his hunger to hold him until the next dose. Does that seem reasonable and ok for now?

If he will eat more, I would give him snacks at +3 and +9 (or+8) each cycle as well as the +6. We want him to be hungry at shot time though.
The reason I am suggesting this is because we are trying to get him to eat 1 and a 1/2 times the amount of food he would normally eat. This is because food is like a medicine in DKA in preventing ketones forming. Your two main weapons in fighting ketones are food and insulin.
How does that sound?

 

[Marc & Cooper]

If he will eat more, I would give him snacks at +3 and +9 (or+8) each cycle as well as the +6. We want him to be hungry at shot time though.
The reason I am suggesting this is because we are trying to get him to eat 1 and a 1/2 times the amount of food he would normally eat. This is because food is like a medicine in DKA in preventing ketones forming. Your two main weapons in fighting ketones are food and insulin.
How does that sound?

Ok Great! So I will give him is 1/4 cup for his am dose, at +6 I will give him 1/8 cup, then at his pm dose another 1/4 and then follow that at +6 again with another 1/8. I will come up with a time to give him treats as well. In terms of treats I have on hand I have https://www.chewy.com/sheba-meaty-tender-sticks-chicken-cat/dp/137202?utm_source=google-product&utm_medium=organic&utm_campaign=f&utm_content=Sheba&utm_term={keyword} which he absolutely goes nuts for. So would giving him 1 of these a twice in between his 2 doses be good?

Also, in terms of thread posting. Should I continue to reply and get assistance through this post or do I start a new post each day? The help provided so far is so much appreciated as before coming here I felt completely clueless even with the help of the vet.

 

[Bron and Sheba (GA)]

Ok Great! So I will give him is 1/4 cup for his am dose, at +6 I will give him 1/8 cup, then at his pm dose another 1/4 and then follow that at +6 again with another 1/8. I will come up with a time to give him treats as well. In terms of treats I have on hand I have https://www.chewy.com/sheba-meaty-tender-sticks-chicken-cat/dp/137202?utm_source=google-product&utm_medium=organic&utm_campaign=f&utm_content=Sheba&utm_term={keyword} which he absolutely goes nuts for. So would giving him 1 of these a twice in between his 2 doses be good?

Also, in terms of thread posting. Should I continue to reply and get assistance through this post or do I start a new post each day? The help provided so far is so much appreciated as before coming here I felt completely clueless even with the help of the vet.

I would say those treats are high carb as they have sugar listed in the ingredients. Do you give a treat after testing the BG? Until you find a low carb one I would give one after BG tests.
There are many low carb treats on the market. Hopefully someone who lives in the US can you with that.

For the time being I would continue with this thread until it reaches around 50 replies, then start a new one. You can change the subject line any time you want to gain attention for anything. When starting a new thread, always link the previous one to the current one for continuity. We often want to go back and check things and it’s much easier if they are linked. Once we have got you more settled with everything, the food, the SS and testing the BGs etc I will suggest you move over to the Lantus page where most Lantus and levemir users post and you will get lots of support there. But we like to keep you here in the beginning to sort everything out as the Lantus page has lots of people and is busy.

I’m glad we have been helpful. We get quite a few DKA kitties here recovering after hospitalisation and many have been given little information on the care at home.
Keep asking lots of questions. We are happy to help.

 

[Marc & Cooper]

I would say those treats are high carb as they have sugar listed in the ingredients. Do you give a treat after testing the BG? Until you find a low carb one I would give one after BG tests.
There are many low carb treats on the market. Hopefully someone who lives in the US can you with that.

Since it was just +6 20 minutes ago I tested his BG and gave him 1/8 of a cup as his reward. The previous 2 tests at +2 and +4 I gave him just 3 of some tiki cat crunchers treats. I would like to get in the habit of rewarding him with a treat any time I test his blood. I have also updated his SS to reflect all of this.

Also, Is there a recommended litter or way to test his urine for the ketones? Currently he is using a tidy cat performance clumping litter and it works but doesn't seem easy to avoid getting litter pieces on it and I worry that it may be messing with the results or could mess with them. I currently just dip the test strip in the urine and try to do it before it clumps or before he covers it. Sorry if some of my questions seem ridiculous or basic.

 

[Bron and Sheba (GA)]

Since it was just +6 20 minutes ago I tested his BG and gave him 1/8 of a cup as his reward. The previous 2 tests at +2 and +4 I gave him just 3 of some tiki cat crunchers treats. I would like to get in the habit of rewarding him with a treat any time I test his blood. I have also updated his SS to reflect all of this.

Always a good idea to reward them after a test. I only had to touch the testing equipment and Sheba would come running from wherever she was in the house as she knew it meant test then treat. She had the best hearing!

Also, Is there a recommended litter or way to test his urine for the ketones? Currently he is using a tidy cat performance clumping litter and it works but doesn't seem easy to avoid getting litter pieces on it and I worry that it may be messing with the results or could mess with them. I currently just dip the test strip in the urine and try to do it before it clumps or before he covers it.

Can you slip a big spoon under his butt to catch some urine? Or partly bury a small plastic container in his favourite peeing spot.
There are marine pebbles that some people use.I would try the top two methods first.

Sorry if some of my questions seem ridiculous or basic.

There are no ridiculous questions….the only one is the one you don’t ask!

I like you are using the remarks column in the SS for additional information!
Looks like Cooper could be bouncing a bit from the blue BG yesterday afternoon. Bounces can last from 1 to 6 cycles.
Once he starts to come down be aware some cats can come down off the bounce fast so you may need to test more frequently that cycle……..keep posting and we will watch as well.

 

[Summer and Susie (GA)]

Marc, my Susie likes the PureBites freeze dried treats. The salmon, chicken and turkey. She does not like the shrimp and we haven't tried all of them. They are low carb. I don't know if Bron wants you to have treats with higher carbs but these are used by many of the folks on this site. There is also the Whole Life treats that some folks feed. Susie does not care for them.
https://www.chewy.com/s?query=PureBites for cats&nav-submit-button=
https://www.chewy.com/s?query=Whole Life cat treats&nav-submit-button=

By the way, nice to see a picture of your Cooper in the profile. Pretty ginger.

 

[Summer and Susie (GA)]

By the way, if you buy the PureBites or Whole Life make sure it is the freeze dried treats. I don't know how high in carbs some of those other treats are.

 

[Marc & Cooper]

Marc, my Susie likes the PureBites freeze dried treats. The salmon, chicken and turkey. She does not like the shrimp and we haven't tried all of them. They are low carb. I don't know if Bron wants you to have treats with higher carbs but these are used by many of the folks on this site. There is also the Whole Life treats that some folks feed. Susie does not care for them.
https://www.chewy.com/s?query=PureBites for cats&nav-submit-button=
https://www.chewy.com/s?query=Whole Life cat treats&nav-submit-button=

By the way, nice to see a picture of your Cooper in the profile. Pretty ginger.

Thank you! I am definitely going to try the PureBites treats. Cooper is EXTREMELY picky and I am hopeful he will like these. He's getting plenty of carbs from his current dry food right now so trying the treats shouldn't hurt.

Thank you! That was a picture I took while he was in the hospital for DKA and we visited him. Was so happy to see his parents and didn't want us to leave.

 

[Bron and Sheba (GA)]

Hi Marc.
I’ve just looked at the SS and you have dose to 3 units.
You need to hold the 2.5 units for at least 6 cycles to let the depot fill. Otherwise you will mess the depot up.
The exceptions to that are if you drop under 50 you decrease the dose and if the cat has had DKA and has ketones reappear, we can increase the dose sooner but you would need to have someone experienced with DKA help you with that.
He could be still bouncing from the blue the other night and when he comes off the bounce he could drop low.
By increasing so fast you are risking a hypo.

How are things going otherwise?

 

[Marc & Cooper]

Hi Marc.
I’ve just looked at the SS and you have dose to 3 units.
You need to hold the 2.5 units for at least 6 cycles to let the depot fill. Otherwise you will mess the depot up.
The exceptions to that are if you drop under 50 you decrease the dose and if the cat has had DKA and has ketones reappear, we can increase the dose sooner but you would need to have someone experienced with DKA help you with that.
He could be still bouncing from the blue the other night and when he comes off the bounce he could drop low.
By increasing so fast you are risking a hypo.

How are things going otherwise?

Hi! Thank you for checking in. Things are going good right now. Cooper is acting normal and is extremely happy that I have added more food to his routine. Seems satisfied and crying less now which is awesome for both of us!

It sounds crazy but all the pharmacies at least in my immediate area currently are out of stock on the half unit syringes and currently all I have in my home are the original ones prescribed for me which have the whole unit numbers. I tried to eye ball 2.5 between the 2 and 3 unit line but I’m worried that that would possibly mess up his numbers if I’m not consistently eyeing up 2.5 correctly which is hard to do since the syringes I have don’t have half units . Should I drop him to the 2 units instead of 3 until I can get half unit syringes? I also updated the SS as I reviewed the hospital discharge paperwork and the last day he was under their care for the DKA he was on 2 units as well. I didn’t put any information of doses for the other days because he was on “continuous insulin” for most of the time he was there. Also I just noticed for some reason I’m missing days 7/29 and 7/30 on there. I will add those now.

 

[Bron and Sheba (GA)]

Hi Marc,
I’m so glad Cooper is feeling so much better and is happy. I remember when I first had Sheba as a diabetic, before I found this site, I used to only feed her twice a day and she spend all day in the kitchen asking for food. She was SO much happier once I started to give her snacks.
For most of the years I was giving insulin, I was not able to access 1/2 unit syringes here in Australia and I used to go up and down in 1/4 unit increments.
I always used a magnifying glass which made a big difference.

Did you ask the Walmart store to look behind the counter. I have heard people say some shop assistants don’t know about the 1/2 unit syringes.
I would go back to 2 1/2 units and try and get 1/2 way between the 2 and the 3 unit mark. As long as you are consistent with the dose, that is fine.
I will post a diagram for you to see below.

The BGs look as if they might be coming down off the bounce so make sure to monitor them so you can catch any drop. You can slow a drop by feeding.
It’s great there are no ketones!

In the SS just write…..on a continuous drip in hospital …so we know what was happening. The continuous drip uses a different type of insulin so when he was swapped over to the Lantus, the depot needs to fill before you will see the full effect of the dose.

I love the photo of Cooper…he looks a sweetheart and I love ginger boys!

 

[Marc & Cooper]

Hi Marc,
I’m so glad Cooper is feeling so much better and is happy. I remember when I first had Sheba as a diabetic, before I found this site, I used to only feed her twice a day and she spend all day in the kitchen asking for food. She was SO much happier once I started to give her snacks.
For most of the years I was giving insulin, I was not able to access 1/2 unit syringes here in Australia and I used to go up and down in 1/4 unit increments.
I always used a magnifying glass which made a big difference.

Did you ask the Walmart store to look behind the counter. I have heard people say some shop assistants don’t know about the 1/2 unit syringes.
I would go back to 2 1/2 units and try and get 1/2 way between the 2 and the 3 unit mark. As long as you are consistent with the dose, that is fine.
I will post a diagram for you to see below.

The BGs look as if they might be coming down off the bounce so make sure to monitor them so you can catch any drop. You can slow a drop by feeding.
It’s great there are no ketones!

In the SS just write…..on a continuous drip in hospital …so we know what was happening. The continuous drip uses a different type of insulin so when he was swapped over to the Lantus, the depot needs to fill before you will see the full effect of the dose.

I love the photo of Cooper…he looks a sweetheart and I love ginger boys!

View attachment 62073

OMG I am so dumb I for some reason set my alarm for an hour earlier than usual. Woke up, tested his blood, fed him and gave him his insulin a whole hour earlier than I usually do! Is that ok that I did that once?? Did I mess anything up or do I have to change anything now? I usually give it at 6 and 6 and I gave it to him this morning at 5 just now. His levels are also terrible this morning

 

[Bron and Sheba (GA)]

OMG I am so dumb I for some reason set my alarm for an hour earlier than usual. Woke up, tested his blood, fed him and gave him his insulin a whole hour earlier than I usually do! Is that ok that I did that once?? Did I mess anything up or do I have to change anything now? I usually give it at 6 and 6 and I gave it to him this morning at 5 just now. His levels are also terrible this morning

Giving the dose an hour early can act like a dose increase, so monitor closely. However, apart from that, it should be OK.
If you are wanting to go back to the 6:6 schedule, you will need to do it by either shooting 1/4 hour later each cycle for 4 cycles OR 1/2 hour, once a day, twice to get forward to your previous schedule.
I see you have given 3 units again instead of going back to 2.5 units.
How is his appetite today? Any ketones?

 

[Marc & Cooper]

Giving the dose an hour early can act like a dose increase, so monitor closely. However, apart from that, it should be OK.
If you are wanting to go back to the 6:6 schedule, you will need to do it by either shooting 1/4 hour later each cycle for 4 cycles OR 1/2 hour, once a day, twice to get forward to your previous schedule.
I see you have given 3 units again instead of going back to 2.5 units.
How is his appetite today? Any ketones?

I totally missed reading that you said to try to go back to the 2.5 units as I was in a mini panic that I shot him an hour early. I will do the 1/2 hour later twice to get him back on 6/6. His appetite is still great. Ate his whole meal fast as he has been. No ketones on his usual AM test as well. Does it make sense at all that his levels shot up to almost 500 this morning?

 

[Bron and Sheba (GA)]

Does it make sense at all that his levels shot up to almost 500 this morning?

Not having got two PMPS tests in a row does make it a bit more difficult to know. Always try and get the preshot tests done to see it is safe to give the dose.
It is possible he is still bouncing from the blue BG 5 cycles ago. Sometimes the BG goes higher before it drops down off the bounce, so it is possible he might drop down today. Keep testing. Sometimes when they come off the bounce, they can come down fast and lower than normal. If you start to see lower BGs test more frequently.
He is eating well and there are no ketones,….that is good.

 

[Marc & Cooper]

Not having got two PMPS tests in a row does make it a bit more difficult to know. Always try and get the preshot tests done to see it is safe to give the dose.
It is possible he is still bouncing from the blue BG 5 cycles ago. Sometimes the BG goes higher before it drops down off the bounce, so it is possible he might drop down today. Keep testing. Sometimes when they come off the bounce, they can come down fast and lower than normal. If you start to see lower BGs test more frequently.
He is eating well and there are no ketones,….that is good.

Yeah that really bothered me not getting 2 PMPS tests in a row. Unfortunately on nights that I have a late at work (usually I rotate one day early day and one day late day) no one is able to get a PMPS. Then the first one I missed my fiancé fed him without letting me get the PMPS first.

My fiancé is going to test for ketones again today around 12 to make sure nothing pops up and then when I get home I will immediately test his blood again. Seems like one day I’m worried about one thing and the next day is something else that high 485 is scaring me.

 

[Bron and Sheba (GA)]

My fiancé is going to test for ketones again today around 12 to make sure nothing pops up and then when I get home I will immediately test his blood again. Seems like one day I’m worried about one thing and the next day is something else that high 485 is scaring me.

Good idea to test again for ketones if the BG is higher. Keep offering lots of food.
Cooper is lucky to have such a loving Dad!

 

[Marc & Cooper]

Good idea to test again for ketones if the BG is higher. Keep offering lots of food.
Cooper is lucky to have such a loving Dad!

Still no ketones! As of a few minutes ago his level was back below 400. He’s loving his extra food still and I also spoke to the dr. at the vet office who says it doesn’t hurt to add low carb wet food to his existing dry food diet as well. I have another curve scheduled in a week and a half then I’m hoping after that one I can just do the curves myself at home on days I have off from work!

 

[Bron and Sheba (GA)]

have another curve scheduled in a week and a half then I’m hoping after that one I can just do the curves myself at home on days I have off from work!

Marc, as you are home testing you would be far better off doing the curve at home for several reasons. Apart from the cost, it will be a far more accurate curve as cats get stressed at the vet and their BG runs higher because of this and it is an unnecessary stress on Cooper.
It looks like Cooper could be coming off the bounce with that drop. I would get a +11 to give you a heads up if he is dropping lower.
ETA.. Marc, you have 377 and it’s coloured yellow. 377 should be pink. Did you colour it wrong or is it a lower BG?

 

[Marc & Cooper]

Marc, as you are home testing you would be far better off doing the curve at home for several reasons. Apart from the cost, it will be a far more accurate curve as cats get stressed at the vet and their BG runs higher because of this and it is an unnecessary stress on Cooper.
It looks like Cooper could be coming off the bounce with that drop. I would get a +11 to give you a heads up if he is dropping lower.
ETA.. Marc, you have 377 and it’s coloured yellow. 377 should be pink. Did you colour it wrong or is it a lower BG?

Yeah that’s why I want to do it at home! When they told me his numbers were high 400s pretty much the whole day he was there I figured he was extremely stressed out. I’m letting them do one more curve then I told them to avoid the stress and because it’s something I can also do at home for a lot cheaper that I’ll do it at home.

When I’m home I’m trying to check his blood every 2 hours to see how the number changes throughout the time I’m here with him. I’ll definitely take a blood reading at +11 in the AM.

Yes! I mistakenly put it in yellow! I fixed that error now! I’m excited to get him some wet food and incorporate that into his diet! Hopefully the hunt for a low carb food that he will eat won’t be too much of a process.