11/28/24 New Member (Kinda)

Status
Not open for further replies.
Kelley and Merlin

Kelley and Merlin

Member Since 2020
Hi, my name is Kelley. Merlin and I were part of this forum back in late 2020 when he was first diagnosed. We were fortunate and after only a few weeks he went into remission and has been off insulin since that time. Last week we had a DKA experience (I think) and he was in and out of the ER and vets office for 5 days. I’m at a point where I can’t afford to take him back to the ER and his vet is out until next Tuesday (when we have a follow up appt). In the meantime, he just started Lantus yesterday and has now had four 1-unit doses. I just gave him the fourth dose and his BS right before was 538 human meter (Reli On) and 597 Alpha Track 3. I didn’t have to do this long enough with him in 2020 to become comfortable with it and right now I’m feeling exhausted, scared, and financially drained. I’m worried about not seeing the vet until Tuesday with these BS readings. His ketones last week were 6.8 I believe at the highest. They were 2.4 when he came home from the ER on Sunday. Yesterday at the vet when he got the first dose of Lantus they were back up to 4.2 and I’m worried they are still climbing. I don’t know what to do. Any advice is appreciated.

Kelley and Merlin
 
Hi Kelley and Merlin and welcome back. It is stressful and overwhelming especially if you have something like DKA in the mix. We can help you.
If Merlin had DKA there are several things you need to be doing. It sounds as if you have a blood ketone meter so that is good.
I will list below what you need to be doing.
  • 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 Merlin won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating. How is his appetite at the moment?
  • 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 such as cerenia or ondansetron
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Merlin will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids
  • Set up a spreadsheet and test the BG frequently. If you need help with setting up the SS I will ask @Bandit's Mom to help you. She is great.
  • Post daily with updates and ask for help as often as needed.

If he has just started Lantus, it is going to take up to 5 days for the depot to fill and the full effect of the dose to be felt. Was he on another insulin before the Lantus in the hospital?
If you can get the SS set up asap that will make it much easier for us to see what is happening.
Your main Jobs are making sure he is eat lots of food, so offer it often, making sure he gets the insulin dose, and testing at least every day for ketones. If the ketones are above 2.4 I would test more often. Have you tested for ketones today? We don’t want the ketones to be increasing.

How does Merlin seem in himself? Is he lethargic? Drinking a lot? Any vomiting or diarrhoea?
 
Hi Bron,

I do not have a blood ketone meter. What is a good one? The vet tested him yesterday when he was in the office and they were 4.2 (back up from 2.4 on Sunday afternoon when discharged from the ER).

Merlin is eating great. Since he left the ER on Sunday afternoon I had been feeding him 2Tbsp of baby food meat every four hours around the clock from Sunday afternoon until last night. Each meal (6 per day) I added 2-3 Tbsp of water and made a soup. He loves it. Yesterday the vet said to cut him back to 3 bigger meals a day. So I’m doing that now, same baby food and water, just three bigger meals. Should I go back to 6 smaller meals?

He has gained a pound since he first got sick last week.

He started grooming himself again yesterday.

He got subq fluids at the vet yesterday.

It is very stressful for us both to test his blood glucose. This evening’s test was horrific and his 597 reading might have been elevated some from stress.

He has started going to the water bowl repeatedly tonight. In the last hour he’s gone probably 6+ times.

No vomiting or diarrhea. Actually think he’s been constipated but finally pooped today.

I’m feeling really helpless with the vet closed and inability to afford another trip to the ER.

The vet gave him one dose of Lantus last week and then he went to the ER for the weekend. The ER kept him on an IV but no insulin bc they were afraid it might go too low. Yesterday was the earliest he could see the vet again after the ER trip and the vet started the Lantus again, which he’s now had 4 doses.

He seems close to his regular self. More so than during the ER time, but I’m worried about these BS levels and ketones..
 
Last edited:
Kelley and Merlin said:
Yesterday the vet said to cut him back to 3 bigger meals a day
Click to expand...
Please don’t do that. Give him the 2 main meals and then lots of snacks during the day and evening. It is food that helps keep ketones away…that and insulin …and fluids. I’m delighted to hear he’s eating well. That is a real plus.
I can imagine how frustration it is for you at the moment.
Did the vet comment on the ketones back up to 4.2? That is a real concern for me.
You can buy a blood ketone meter if you like but that will take a few days to get..I’ll list below some options for that.
What I would do at the moment is get some Ketostix from a pharmacy so you can test the urine for ketones. It is really important we try and keep the ketones at bay. You will need to collect a urine sample for Merlin and test the urine. Make sure you read the result at exactly 15 seconds and if you can post a photo of the result next to the colours on the side of the bottle, that would be great. To do that you wil
Need to copy and paste the photo..any issues let me know.

Just use one of the glucose meters, otherwise it is too confusing. If you have enough strips I would use the ReliOn meter.
I’ll give you a couple of links to help you.. when you test him for the blood glucose, give him a little snack of food in a bowl and let him eat while you test and see if that helps.

HOMETESTING HINTS AND LINKS

Collecting A URINE SAMPLE
 
Blood ketone meters. The strips are quite expensive, about a $1 each so not sure if you can afford it? They are useful if kitty is hard to collect a urine sample from.
Novo Max Plus
Precision Xtra Plus Blood and Ketone meter
Abbott freestyle ketone meter

More information on DKA

Keep asking questions. I am in Australia and will be around for the next 6 hours then I can ask someone else to keep an eye out for you if needed. :)
 
I just talked to the ER. They want me to bring him in but I just can’t afford it. They said give him another unit of Lantus (he got his pm dose at 9:20 pm and it’s now 12:20am). I’m scared to. I took his BS again just now on an Alpha Track 3 and it was 439. Do you think it’s safe to give another unit? They said he probably needs to be on 2 units starting in the morning at the usual time.
 
Kelley and Merlin said:
I just talked to the ER. They want me to bring him in but I just can’t afford it. They said give him another unit of Lantus (he got his pm dose at 9:20 pm and it’s now 12:20am). I’m scared to. I took his BS again just now on an Alpha Track 3 and it was 439. Do you think it’s safe to give another unit? They said he probably needs to be on 2 units starting in the morning at the usual time.
Click to expand...
It is very possible he needs more insulin. It is not ideal at all to give more insulin during a cycle but when dealing with DKA, some rules go out the window. Let me try and contact @Wendy&Neko to see what she thinks about the extra insulin.
 
I’ve also contacted Wendy via PM to try and contact her before she goes to bed. It’s late where she lives. One of us will get back to you asap.
 
Thank you. I feel like it’s coming down already. I’m wondering about waiting until morning at the time I should normally give it and if it’s very high trying 1.5 units. Looking forward to what you and Wendy think.
 
How is Merlin? Is he active? Eating lots of food?
Still drinking a lot?
When you say you think it’s coming down already…what are you referring to?
 
He just got up and walked into my office where there’s another cat bed. Hasn’t gone back to water bowl recently. He had a huge meal at 9:30 so I haven’t offered anything late tonight. I said it’s coming down bc at 9:20 it was 597 (possibly falsely elevated though due to stress) and at 12:30 (30 minutes ago) it was 439.
 
Kelley and Merlin said:
He just got up and walked into my office where there’s another cat bed. Hasn’t gone back to water bowl recently. He had a huge meal at 9:30 so I haven’t offered anything late tonight. I said it’s coming down bc at 9:20 it was 597 (possibly falsely elevated though due to stress) and at 12:30 (30 minutes ago) it was 439.
Click to expand...
Ok. We want it to be lower than 439. That’s still too high.
I would offer him a snack sometime this evening even though he ate well earlier. We don’t want him to be sick so smaller snacks more often. you are doing a good job looking after him:)
 
Kelley and Merlin said:
What are your thoughts on another unit now or waiting till morning?
Click to expand...
With DkA it’s really important that Merlin is getting enough insulin and enough food. That is what will combat the ketones. But giving insulin during the cycle is risky.
I would rather get Wendy’s input first.
Are you in a position to test the BG closely if we agreed?
 
I am able to test BG. The later it gets though the more hesitant I am to do it bc he’s due for more insulin in 8 hours.

Also, I’ve ordered keto stix and they will be delivered in about an hour and a half.
 
Ok I’ve heard back from Wendy. She’s not keen to give a dose now. I think you would end up exhausted as you would have to monitor very closely today and tomorrow.
However she is quite happy for you to give 2 units tomorrow ( and I agree).
So what I would do is
  • Keep Up the snacks (with 5mls water added) overnight
  • Test an hour earlier than the dose is due in the morning and if the BG is still high, I would give the 2 units at +11 … that is one hour earlier than the schedule …that will mean you are an hour earlier from now on so I hope that doesn’t stuff up your days but I think it’s important we get on top of this
  • Test at +2 and +4 tomorrow so we can see how the BGs are going.
  • Give 2 units each cycle unless he drops under 50.
  • Post frequently. I’m going to ask @Bandit's Mom and @tiffmaxee to keep an eye on you after I go offline in about 4 or 5 hours and I’m sure Wendy will look in as well
How does that plan sound?
 
Good morning. We just woke up (well I did). I’ve been such a bundle of nerves. Merlin’s BG just now on the AlphaTrack is 433. I’m about to feed him. I’m super nervous about giving the 2 units. Just checking in to see if you still think it’s the right course. Yesterday his morning BG was 516, so it is lower today.

Yes, I believe I still have access to that spreadsheet.
 
I think the 8:30 test (reading 433) was wrong. Maybe I didn't get enough blood. Because he had 2 units right after and now his BG is 576. I got a good sample this time by putting a spoon of baby food in front of him while I took his blood.
 
I've gone through my notes and the vet/ER paperwork and updated the spreadsheet BG/insulin/lab info as best as I can.

No luck on the keytones yet. I put something in the litter box that I thought would maybe collect some urine but he peed on the mat right outside the litter box instead.
 
Thanks for putting all that information into the remarks column of the SS. That is very helpful to know. You were not always given the best advice by the vet in my opinion.
I’m glad you gave the 2 units this morning. It will take time for it to bring down the BG as it is a depot insulin so it will take a few days for the depot to fill and for the full effect of the dose to be felt.
If he pees on the floor again you can dip the ketones test strip into the puddle of urine.
How is he this morning? Still eating well? Not lethargic?
 
Hi Bron, thank you again for all of your help and encouragement. It has been quite a day. I just tested Merlin (636 Alpha Trak and 515 Reli On). I'm still trying to get a reading on both as my vet requested so I can have a good idea of how big a discrepancy there is between the two meters in case I'm ever stuck just using the Reli On. I just gave 2 units. I'm about to update the SS again. I've been so worried all day because numbers are all over the place and I don't know what to believe is the true reading. I called a vet near me (since my usual vet is out until Tuesday). I asked if he would prescribe a Libre CGM and he did. Merlin is wearing it now. Of course it is just sending me notifications that his numbers are critically high. Maybe if I can get them down to a more reasonable level, I will find it to be helpful.

Tonight was the only successful BG test so far, and that is because I sat an open jar of baby food chicken in my lap and it kept him busy long enough for me to do what I needed to do.

He did finally pee in the litter box and I was able to use the ketone dip sticks. It came back as the tier right above negative called "trace - 5". I did two strips just to be sure and they both came back the same.

Still eating well. Not drinking a crazy amount but still going to the water bowl. Not lethargic.

Can you explain a little more about "depot insulin" and what that means?

I've attached a pic of Merlin that I just took a few minutes ago. Excuse the floors, I have two dogs and it has been raining. :)

upload_2024-11-29_20-35-26.png
 

Attachments

  • upload_2024-11-29_20-35-26.png
    upload_2024-11-29_20-35-26.png
    452.3 KB · Views: 129
What a gorgeous boy he is. And sitting so nicely to be photographed!
First of all I am delighted and relieved to hear the urine ketones are down to a trace. You have done a really good job getting them down with the extra food and now the increased dose of insulin. Getting that ketone test is so important… would you mind putting that result into the remarks column of the SS please?.

If you have the libre on, I would not bother testing manually at the moment unless it drops under 100. The libre can be unreliable if under 100.
The libre is a human meter which the vets accept so I’m not sure why your vet also wants to see the pet meter numbers. It is a lot of extra stress for both you and Merlin at the moment to have to do that. I would take a break from it and concentrate on other things and try and get some rest as well.

Don’t expect immediate results from the increase in dose just yet. Not all cats respond immediately. The important thing is he is getting the increase in dose and the ketones have reduced. He is also eating well and not lethargic. So I would call that a really positive update.

HERE is an explanation about the insulin depot in insulins such as Lantus.

Looking at the SS…you are not using the pm side of the spreadsheet. Did you mean to put the latest 2 units into the AM cycle or should it go into the PM cycle?
And do you have any results to put in during the cycles?
 
Hi, thank you for letting me know I was filling in the SS incorrectly. I've fixed it back to 11/27 when I first started giving insulin injections. I do not have any post injections readings (except for today based on our discussion last night when we agreed to taking +2 and +4 readings this morning). The vet told me to not worry about taking BG readings right now except at the 12 hour insulin injections times.

Regarding the Libre, are there discrepancies in the numbers it gives for cats since it is actually designed for humans? Also, the vet that wants the Alpha Trak and Reli On readings is out until Tuesday. I asked another local vet today to provide the Libre because I felt so unsure of what Merlin's numbers really were. I think the regular vet will be ok with it. We will see her on Tuesday.

I've added today's ketones to the SS. Just to clarify, they were 6.8 at the highest last week, came down to 2.4 lowest while in ER this past weekend, and had started to climb back up to 4.2 on Wednesday. I'm unsure how to interpret the Trace 5 reading today because I think of trace as not significant, but 5 is higher than it has been since the weekend and a number I thought was dangerous.

Thank you for the information about the insulin depot. That is helpful in understanding how this works.
 
Kelley and Merlin said:
Hi, thank you for letting me know I was filling in the SS incorrectly. I've fixed it back to 11/27 when I first started giving insulin injections. I do not have any post injections readings (except for today based on our discussion last night when we agreed to taking +2 and +4 readings this morning). The vet told me to not worry about taking BG readings right now except at the 12 hour insulin injections times.
Click to expand...
Thanks for fixing up the SS.:)
I would encourage you to get tests in during the cycles because the nadir (or lowest BG number of a cycle) is what Lantus dosing is based on. It is not the preshot number. So if you can get a test in sometime between +4 and +6 most cycles, that will tell us how well the dose is working.

Kelley and Merlin said:
Regarding the Libre, are there discrepancies in the numbers it gives for cats since it is actually designed for humans
Click to expand...
Until the last several years when pet meters came into being, every vet used a human meter. And our dosing methods are based on the human meter. The human meter tends to read a bit lower than the pet meters and there is not a comparable chart so really there is no use trying to compare the two. Personally I like the human meters much better and they are much cheaper to use and the strips are a lot cheaper than the pet meter ones. On a human meter the normal BG for a cat is 50-120. If using a pet meter it is 68 -150 (approximately). The higher the reading the bigger the difference is between the two.
Kelley and Merlin said:
I've added today's ketones to the SS. Just to clarify, they were 6.8 at the highest last week, came down to 2.4 lowest while in ER this past weekend, and had started to climb back up to 4.2 on Wednesday. I'm unsure how to interpret the Trace 5 reading today because I think of trace as not significant, but 5 is higher than it has been since the weekend and a number I thought was dangerous.
Click to expand...
The urine testing is not the same measurement as the blood testing. So a trace (5) on the urine test is not the same as a 5 on the blood test.
With the blood testing, anything above 2.4 is very concerning.
With the urine test, a trace is not great to see but it is probably about a 1.5 if you compared it to a blood meter. But that is guesstimating. The important thing is the ketones are going down not up.
Keep trying to get a daily urine test at the moment as that is the best way for us to see if he is getting enough food and enough insulin.
It is great he is eating well…keep up the snacks …
Many post DKA cats are nauseated and find it hard to eat.
 
Hi, first thank you for the above! That is so helpful and this is all starting to make more sense to me now.

I happened to wake up (3am here) and gave Merlin a meal (more baby food meat and water soup). I remembered the Libre and looked at the app. This is the first time it has been low enough to give a number, which makes me feel better. It was at 353 while he was eating, then briefly went to 379, and is currently back at 354. This is within a 15 minute window. He’s sleeping now. The above numbers are at +7.25 after 2 units.
 
Last edited:
Update, I forgot the vet said the Libre has about a 10-minute lag. I monitored it (out of curiosity) for 30 minutes after Merlin ate and it slowly rose. At the 30-minute mark it finally hit 400 and started reading High again. He’s sleeping peacefully and I’m going to try to do the same. :)
 
Well, so much for the Libre. I went to Wal Mart and when I got home I was getting a sensor error and looked and it was still adhered in one spot but the rest was loose and the needle was out. Didn't even make it 24 hours. So frustrating.
 
Big progress! Just took a +6 reading from Merlin and his numbers are 172 (Alpha Trak) and 159 (Reli On). Not sure how I should handle his 8pm dosing. The vet had said to hold the 1 unit if he was under 280. Now I'm giving 2 units. Should I still hold if he is under 280? If he's over 280, should I give 1 or 2 units? We have 6 hours until it is time for his PM dose.
 
Yes that is progress.
I am sorry about the libre They do fall off sometimes. Can you get another test in at around +8 so we can see how it’s going?
I would stay with the 2 units unless he drops under 50 at any point. Remember the dose is based on the lowest point in the cycle, not the Preshot
We need you to be testing during the cycles though.
 
That 172AT/159 Relion is fantastic progress! :cool:. I agree with Bron, barring any surprises later today, I'd stick with the 2 unit dose. Even the most conservative of our dosing methods doesn't suggest the dose be reduced unless a cat goes below 90. With recent DKA and showing ketones we tend to be less conservative.
 
Don’t be afraid of lower Preshots than you have been seeing. A lower Preshot does not mean you will see the big drops during the cycles that can happen with high Preshots. Have a look at other people’s SS.
Have you been able to get another ketone test in?
 
His PMPS @ 7:45pm was 621 (Alpha Trak) and 573 (Reli On). I gave 2 units at 8:00pm. He just peed but went on the absorbent puppy pad under the litter box (he doesn't like that I have something in the box to try to catch his urine). I ran in there and when I saw it, I grabbed 2 keto stix and one at a time pressed them into the moistness of the pad. I know it isn't ideal. Both looked negative to me. Not sure how accurate it would be like that.
 
Kelley and Merlin said:
ran in there and when I saw it, I grabbed 2 keto stix and one at a time pressed them into the moistness of the pad. I know it isn't ideal. Both looked negative to me. Not sure how accurate it would be like that.
Click to expand...
It is probably accurate. Well done! Very pleasing to see negative ketones! Keep doing everything you are doing. It’s working.
If you can get a mid cycle test again that would be great.
 
A tip for you on Lantus. The +2 (or for some cats a bit later) test is a good indicator of how the cycle will go. If the +2 is about the same as the preshot, it'll be a normal Lantus cycle with some downward movement. You may need more testing. If the +2 is higher, it'll be a bounce cycle and time to hit the pillow for the night. Given those blues today, this is a possibility. If the +2 is quite a bit lower than preshot, then that's an very active cycle needing more monitoring.

Having said that, nothing wrong with getting a mid cycle test. Once you learn Merlin's patterns on Lantus you'll get a better idea how he's going to react and maximize your sleep.
 
Hi Bron and Wendy. I just tested Merlin +6.25 @ 2:15am, his numbers were 491 (Alpha Trak) and 473 (Reli On). Sorry just seeing Wendy's post about +2 readings. That is good to know. I so wish his Libre hadn't come off.
 
Also, curious if anyone puts the Libre on their cat themself or if you have a vet do it. My daughter is a geriatric nurse, I’m sure she could help me.
 
Bandit's Mom said:
Here it is:
I'm going to tag @Staci & Ivy who uses the Libre and might be able to help with any questions you have wrt the Libre.
Click to expand...
Hi Kelley and Merlin,
I’m just reading and catching up on your situation.
I’ve been using a Libre 3 on Ivy for about a year and a half and I’m pretty comfortable with using it. I also test with a handheld meter when she hits LO readings most especially.
As mentioned previously there is a discrepancy between when you see LO readings and what the glucometer reads. I use a contour next, but it could be any handheld human meter.
I do install them myself and I keep several on hand because as you’ve noticed, they can fail or be pulled off at any time and I don’t want to have to wait to have someone else put it on and be without data or have to take Ivy somewhere. It’s one more stressor.

It’s truly not that hard to put on. You just have to follow the directions very carefully. Once you’ve done it one or two times you will be very comfortable doing it.
It sounds like Merlin pulled the Libre off if I had to guess. I keep a tube top on Ivy, but I had a T-shirt on her. She just didn’t like the T-shirt. But most cats tolerate them quite well.
Merlin may get used to wearing a Libre (and then you maybe wouldn’t have to use a T-shirt, but then again you might always have to keep one on if he likes to pull the Libre off, which is counterproductive of course.)

I started out with the Libre 2 and moved to a Libre 3 about a year and a half ago. (I got her her own phone that stays with her at home and I can monitor her 24/7, the data is sent directly to my own phone through the Libre Linkup App)

***I strongly recommend learning about how to use a Libre from the Facebook group Freestyle Libre for Dogs and Cats.***
They have so much valuable information, guide guides, tutorials videos, and everything you will need to learn about using a Libre sensor.
Plus a vet office tends to use glue to install them and it is highly recommended not to use any glue.
The glue can kill the sensor and it’s terrible on their fragile skin.

I hope this helps. Please ask questions if you have them.

Sending you all the best wishes. You’re doing great!!
:bighug::bighug:
 
Hi everyone,

First, thank you for all of the wonderful information that has been sent since I posted his numbers last night. I'm late getting today bc I received a call a little after 7:00am that my dad fell and couldn't get up. We called the fire dept to help get him up and I think he is ok. I'm about to go back to their house (only 2 blocks away). He fell 11/27/23 (just had his one-year anniversary) and broke his hip. I was so scared it was going to be a repeat of that. He is a transplant patient and has Parkinson's and the whole hip thing caused so much confusion. The fire fighters agreed to avoid the stress of the hospital for him and if we think something could be broken we will take him to urgent care for xrays.

Ok, all of that aside (deep breaths)...Merlin's numbers this morning at 8:30am were 420 (Alpha Trak) and 414 (Reli On). I'm cautiously optimistic as these are the best morning numbers since he has been home. I will be coming back home in a little bit to get some in-cycle numbers. I will catch up on the above comments then.

Thank you all for so much help and patience with us as we learn how to handle this.

:bighug: Kelley and Merlin
 
Kelley and Merlin said:
Hi everyone,

First, thank you for all of the wonderful information that has been sent since I posted his numbers last night. I'm late getting today bc I received a call a little after 7:00am that my dad fell and couldn't get up. We called the fire dept to help get him up and I think he is ok. I'm about to go back to their house (only 2 blocks away). He fell 11/27/23 (just had his one-year anniversary) and broke his hip. I was so scared it was going to be a repeat of that. He is a transplant patient and has Parkinson's and the whole hip thing caused so much confusion. The fire fighters agreed to avoid the stress of the hospital for him and if we think something could be broken we will take him to urgent care for xrays.

Ok, all of that aside (deep breaths)...Merlin's numbers this morning at 8:30am were 420 (Alpha Trak) and 414 (Reli On). I'm cautiously optimistic as these are the best morning numbers since he has been home. I will be coming back home in a little bit to get some in-cycle numbers. I will catch up on the above comments then.

Thank you all for so much help and patience with us as we learn how to handle this.

:bighug: Kelley and Merlin
Click to expand...
So sorry about your Dad. Hope he’s ok!!
Breathe!!
:bighug::bighug::bighug:
 
Status
Not open for further replies.
Back
Top