1/14 McKenna - Not sure what's going on

[Dallas]

Yesterday was a rough day. Probably the roughest we've had so far. I'm guessing a lot of it is related to food, but I'm not positive. Either way, I'm not really sure how to proceed.
We had issues getting food this week, so McKenna was switched a couple of times. Yesterday, I thought I would just switch her to something I could get from the grocery/pet store instead of only from my vet. So I bought Fancy Feast.
I gave her a can last night at 9:30, which is her usual time to eat. It was a Fancy Feast Classic Pate. She ate half of it, then started throwing up. She threw up 4-5 times, although the last one was just a bit of froth. So, she basically emptied everything she'd just eaten.
I checked her BG. It was 726. For some reason I thought I'd give her the insulin shot first, then get her a can of Royal Canin to eat. It didn't occur to me she might not eat it. She didn't. She wanted nothing to do with it. So now I'm freaking out because I just gave her a shot of insulin and she has no food in her system.
I thought maybe she just needed some time for her stomach to settle, so I put my baby to bed, then offered it again. Finally, about 2 hours after the insulin, she ate. I checked her BG right after. It was 472.
This morning, her AMPS registered as HI on the monitor. Which means it's above 750. I gave her .75u and checked her again an hour later. It was 644. I've been checking her every hour.
I've been trying to follow the SLGS protocol, but I may switch to TR because I'm really concerned about the severely high numbers.
Where do I go from here? Is the best thing to do at this point, keep everything as is, monitor her through the day and see where we are?

 

[Doodles & Karen]

We always link our previous post to make it easier for others to see the history. http://www.felinediabetes.com/FDMB/threads/1-13-mckenna-low-bg.171319/#post-1870198

Because of that 88 yesterday it was advised to reduce her dose to .75u but see you shot 1u again last night and this morning. Lantus is dosed on how low they go not the preshot so it's important to reduce her dose to .75u tonight.

I also see 4 times recently you gave insulin without testing at preshot. Please, don't do that. We need to make sure their BG is at a safe number to shoot.

McKenna is bouncing from the 88 yesterday. Bounces can take 6 cycles to clear. She may feel a bit yucky in those numbers and having a big swing in BG's like she has the last day & 1/2. Sorry about the vomits from FF. Food changes can sometimes do that. No need to test every hour in these high numbers but every few hours is a good idea. She might be on her way to breaking the bounce.

Bouncing - 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).

 

[Wendy&Neko]

I'm glad you reduced her dose this morning. She is probably feeling really yucky from the high numbers she's bouncing to. This will pass. In addition to seeing green she's not used to, she had a really steep drop last night - both can cause bouncing.

In the mean time, you don't need to test so frequently when they are so high. You can probably wait another three hours or so. Or maybe even wait until PMPS. She's not going anywhere dangerous this cycle. Save the test strips for the low numbers.

Check the Fancy Feast ingredients. Many of them have fish in it, which is a common allergen.

 

[Doodles & Karen]

I'm glad you reduced her dose this morning

Sorry, missed that...my mistake.

 

[Jill & Alex (GA)]

I've been trying to follow the SLGS protocol, but I may switch to TR because I'm really concerned about the severely high numbers.

I can certainly understand wanting to switch to TR, given high numbers and McKenna's recent DKA history.

Forgive me if the question has been asked, but are you testing for ketones? If not, it would be a good idea to start. If McKenna begins to throw ketones, it's much easier to nip them in the bud than to endure the expense and trauma of having her go into full-blown DKA.

The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses. That means you'll want to make sure she's getting an adequate supply of insulin, is eating well, and has received treatment for any illness and/or infection.

More than you probably ever wanted to know about ketones: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

Tips to catch and test a urine sample

Blood ketone meters: Nova Max Plus or Precision Xtra Blood & Ketone meters


If McKenna begins to develop ketones, please let us and your vet know immediately. If it should happen, the usual protocol rules go out the window in an effort to keep ketones at bay and there are a few other things we can suggest which will help.

Where do I go from here? Is the best thing to do at this point, keep everything as is, monitor her through the day and see where we are?

After having a cat who survived DKA (had it once and never again), but remained prone to developing ketones, my suggestion is to gradually transition her to a low carb wet food so her tummy won't get upset. Not eating/inappetance is one of the key ingredients to developing diabetic ketoacidosis. We want to keep her eating. If she continues to vomit, I'd keep her on the WD if it doesn't upset her stomach and adjust the insulin accordingly.



Note to those offering suggestions or advice:

I think this set of circumstances has the potential of turning into one where "the rules" may have to be bent to successfully avoid another incident of DKA.

For example (given the recent DKA history) and if McKenna's person is able to monitor, perhaps it might be a better idea feed a higher low carb food to keep her from bottoming out rather than reducing the dose on an 88 (AT)? Or perhaps continuing the WD is that's what she'll eat and more importantly, keep down? ​

FWIW, just thinking out loud...

 

[Wendy&Neko]

Jill brings up a good point. If you have been testing for ketones, it's good to put the test results into the Remarks section of the spreadsheet. And then we'll stop asking you if you are testing too. That's also a handy place to put any notes on changes to food. If you were feeding m/d (listed as 14% on Dr. Lisa's list) yesterday when she got the 88, then switching to lower carb food, that can impact what numbers you'll see.

 

[Dallas]

We always link our previous post to make it easier for others to see the history.

Sorry, I didn't know how to do that. Will do so in the future.

I also see 4 times recently you gave insulin without testing at preshot. Please, don't do that. We need to make sure their BG is at a safe number to shoot.

I had run out of test strips and couldn't locate more to purchase locally, so I had to wait for the ones I ordered to come in, which took an extra, unexpected day. I guess I'm new to all of this and feel like I have no idea what I'm doing. I had just gotten the BG Monitor and didn't realize how fast I had blown through the strips. I'm ordering an extra box to keep on hand.

my suggestion is to gradually transition her to a low carb wet food so her tummy won't get upset.

Are there any foods you can recommend? I am at a loss as to what to feed her. The vet at hospital discharge said to put her on Hill's W/D. Our regular vet said that is too high in carbs, so either M/D or Royal Canin. She loves the Royal Canin, but we cannot afford to feed her that long term. I don't want to risk the Fancy Feast again. For now, I will keep giving her the Royal Canin Diabetic wet food, but I want to transition her gradually, so I need to get something else on Monday. I'm thinking maybe Wellness?

For example (given the recent DKA history) and if McKenna's person is able to monitor, perhaps it might be a better idea feed a higher low carb food to keep her from bottoming out rather than reducing the dose on an 88 (AT)?

I have no problem being able to monitor her (now that I have strips and more on the way, to be safe). I feel like 2u was a good dose for her and the 88 was more related to food. She has been consistently high for a full week of monitoring BG. I feel like we need to get those numbers down or she's going to be in a dangerous situation soon.

From what I've read, I know it is important not to change insulin doses frequently. However, I'm wondering if I should move her back to 2u, since I feel pretty confident the 88 was due to food. Would this be harmful in any way? If I did this, I would give her 1u tonight, 1u in the morning, and start doing a 12-hour curve at that point to see how it affects her. This feels like the right move to me, but I'd like some input from people with more experience. Should I just hold at 1.75u for a few days to make sure she's stable? (Although that would keep her in extremely high BG levels for another few days)

Also, do I feed her, take a BG reading, then insulin? Or BG, then feed, then insulin? I'm starting to realize there are a lot of details my vet didn't think to tell me. I have been feeding, the BG, then insulin.

 

[Gussie's mom (GA)]

Hi
The sequence is test, feed shoot
T/f/s
You test first because you want the number to be the BG uninfluenced by food.then feed and then shoot so there is some food onboard when you shoot.
Many of us found it easiest to test, then feed and shoot while our cats are eating..that's what I did with my Gus..
Hang in there, it will all make more sense as you do it often

I will let more experienced folks address you dose question...

 

[Doodles & Karen]

Sorry, I didn't know how to do that. Will do so in the future.

No need for apologies here. Just wanted to mention it and we're glad to help.

I guess I'm new to all of this and feel like I have no idea what I'm doing. I had just gotten the BG Monitor and didn't realize how fast I had blown through the strips. I'm ordering an extra box to keep on hand.

Don't feel bad at all. I shot blind with no testing for the first 5 months and yes, almost killed my cat. This board saved Doodles and me too frankly...you're doing great.

 

[Doodles & Karen]

Should I just hold at 1.75u for a few days to make sure she's stable? (Although that would keep her in extremely high BG levels for another few days)

I think you mean hold the .75 (not 1.75) and then go back to 1u (not 2u). Since she's bouncing even if you increase tonight and tomorrow she could still stay in higher numbers for up to 6 cycles since it could take that long for her to clear it. If it were me I would hold the .75u for at least 6-8 cycles or until she clears the bounce which may be sooner than 6 cycles. See what her numbers are and if needed bring her back to 1u. If you can post daily for a while it will help. I do understand the concern about DKA as Jill outlined but we don't know if she was lower and how much lower than that 88. 68 on AT is the reduction point with TR so there's not much room there. Also if you are going to be switching food I might hold off on that or go super slow as that can impact her insulin needs.

By all means, see what @Jill & Alex (GA) and @Wendy&Neko say as they are the most experienced. Just wanted to toss that out there before I head to bed.

 

[Wendy&Neko]

There is lots to learn here and you are getting tossed into the graduate course on Feline Diabeties. Don't worry, we all remember what it's like to be new.

Are you testing for ketones regulary with urine dip sticks? With her past history of DKA, that's an important piece of the dosing puzzle. As Jill said, if there are any ketones present, then a better approach might be to go back to 1 unit. 88 was still a safe number.

As for food, there are quite a few options under 10% carbs. Have you looked at the list on catinfo? I fed my girl some of the Wellness Grain Free at some point. The Ziwipeak are a really high quality food. I also had IBD and kidney disease in the picture so had a lot more limitations. Most of the time I fed raw food.

 

[Dallas]

I am testing for Ketones with urine sticks. Well, I started 2 days ago. So far, they are negative, so that's in our favor.
I have spent a lot of time looking at that list, I just am not sure what else I am looking for besides low carb.

I think you mean hold the .75 (not 1.75) and then go back to 1u (not 2u).

Since we did 1u last night and .75u this morning, wouldn't her dose be 1.75u? And if we moved back to 1u evening, 1u morning...that would be 2u?

 

[Doodles & Karen]

Since we did 1u last night and .75u this morning, wouldn't her dose be 1.75u? And if we moved back to 1u evening, 1u morning...that would be 2u

We go by the dose given every 12 hours so the recommendation is going back to the 1u tonight and holding that dose unless she goes under 68 on AT. I'm about to sign off for the night but will look for you in the morning. Keep asking questions it's the only way all this will eventually make sense

 

[Wendy&Neko]

I am testing for Ketones with urine sticks. Well, I started 2 days ago. So far, they are negative,

That's great news!

I just am not sure what else I am looking for besides low carb.

What you are looking for depends on the cat. If McKenna has no other secondary conditions, then just buy something low carb, less than 10%, and be driven by price, availability, and quality of food you want to buy. And most importantly, what the cat will eat!