4/27 Pookie AMPS 380, PMPS 263 / +1=310 / +3=328 - decrease or maintain dose? 4/28 AMPS 403

wh1rlwind

wh1rlwind

Member Since 2020
Hi,
New to this group, my cat Pookie was diagosed 22 April with DKA. He has a Freestyle Libre fitted and his numbers have been very erratic lately...he weighs 5kg and is an 11 year old Burmese male.
He was started on 1 IU BID for 10 days, then increased to 2 IU BID due to continued high glucose levels.
Have just completed a spreadsheet - hopefully you can see it in my signature.
I increased his dose to 2.5 IU after 3 days as I was worried about his poor clinical signs and high glucose all day, but now his PMPS is 263 I am not sure if I should give the full 2.5 IU as worried if he goes too low during the night (he went down to 76 a couple of nights ago). I have given 2IU for now and hoping for some advice from someone please to see if I should give the rest of the 0.5 IU to be consistent?
Sorry about the random measurements, he has a CGM so I just scan it at random times during the day when I am watching him!
Thank you all so much in advance for your help...totally new at this and quite anxious.
 
Hi and welcome to you and Pookie.
I’ll just quickly say no don’t give the extra insulin and post this, then I will write some more.
Bron
 
First of all just want to say a big welcome to a fellow Aussie!
I live in Australia too...Sydney.
You have done a great job of the spreadsheet.

First of all I want to address the DKA.
How is Pookie’s appetite? Cats recovering from DKA are often nauseated and need an antinausea medication such as cerenia.
The most important things to know about Pookie’s recovery from DKA are he needs to be eating about 1 1/2 times the amount of calories he normally eats. Food is very important.
And he needs adequate insulin, so try not to skip any doses.
It is also really important that you are testing for ketones in the urine as it is ketones that lead to DKA.
The recipe for DKA is not enough food, not enough insulin and an infection or an inflammation in the body.
Did pookie have an infection? And was it treated.?
So you can see why the food and the insulin are so important. And the testing for ketones every day at the moment
You can buy a bottle of Ketostix from most pharmacies. Then you collect a urine sample from Pookie’s, dip the test strip into the urine and read the result against the colours on the side of the bottle. Anything above a trace needs vet attention. And if you get a trace you need to try and feed more food and give plenty of fluids and the insulin may need to be increased, but don’t do that on your own...we can help you with that.
If you don’t have any Ketostix, I would go out in the morning and get a bottle of them first thing and test the urine..they are about $10 or $12 a bottle. It will test the glucose and the ketones.
Not sure what the vet told you but often the vets don’t say much as all about care at home after DKA

Glargine likes consistency so it is better to not change the dose but stick with the same dose unless you need to increase or decrease.
We recommend increasing in 1/4 unit increments as it is safer for the cat and you won’t go past the best dose.

I see you have chosen to do the SLGS method. I think because of the very recent history of DKA, you would be better to do the tight regulation method as it is really important that Pookie is getting enough insulin. And the TR allows you to increase the dose every three days if needed.

it is very common for the BG levels to be all over the place like Pookie’s are, especially in the beginning.
It takes time for the Body to get used to the insulin. We call it a marathon not a race.
Cats will also bounce up high and we call that bouncing. It is caused when the BG level drops low, drops too fast or drops lower than the cat is used to. He then thinks ..’help, I have to save myself and he dumps stored glucose and regulatory hormones into his system that sends the BG skyrocketing. Bounces can last from 1 to 6 cycles and there is nothing you can do about them but wait.

can you tell us what you are feeding Pookie? How much he weighs?

I am going to send you some links below that you will find useful.
It is very stressful in the beginning but you have come to the very best place. It’s a great community with very knowledgeable people and a great community.
Ask lots of questions.

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

http://www.felinediabetes.com/FDMB/threads/information-for-aussie-feline-diabetic-caregivers.217781/

Bron
Oh he is gorgeous...just saw the photo!
 
Hi Bron,
Thank you so much for your detailed reply, you've been an absolute lifesaver! I've been quite stressed for the past couple of weeks as the vets I spoke to gave me hardly any information at all, they just said to monitor clinical symptoms and bring him in for checks/BG curves once a week or so...
I really love the Freestyle Libre, do many of you on here use it for monitoring BG levels or is it too expensive over the long term? How long do cats usually take to stabilise...or do we have to test them every time we give them insulin for the rest of their lives even if they're stable? Just a bit apprehensive as I failed miserably at getting the ear/paw blood the few times I tried as Pookie is a very nervous/skittish cat :(
To answer your questions:
- He's had a great appetite since recovery thankfully. We try to feed him twice a day at AMPS and PMPS with a snack in between..however he's been screaming for food a lot more the past couple of days due to his high BSL so we've caved and fed him a bit more...it sounds like from what you said, we did the right thing? Are we meant to measure his food or just feed whenever he asks?
- Vets couldn't find an infection (tested for UTI etc) but his bloodwork did show some sort of inflammation/infection...seems to be all good now (fingers crossed)
- Have been testing using Ketostix, luckily no ketones but just very high glucose
- He weighed 4.9kg at diagnosis and has since increased to 5.5kg...he used to eat purely Hills dry food for seniors, but switched to wet food after dental work that removed most of his teeth. I did some research on low carb wet foods available in Australia and have since only tried to buy them (Fancy Feast classics, Cats in the Kitchen, certain Dines, and Whiskas loaf which is probably not that good for him but it's his favourite for some reason?) plus homemade poached chicken breast for snacks

Thanks again for all your help, you have no idea how grateful I am!
I will read the links you sent now and also read up on the tight regulation method...I think I will only be able to do that if I continue buying the Freestyle Libres and asking my vets to put them on as I won't be able to do the ear pricks consistently enough to get good data (plus I work full time).
In the meantime, should I drop him back down to 2 IU BID? Even though he's been on 2.5 IU BID for the past few cycles?
Thank you and have a great evening/morning if you don't read this til then!
 
BSL stayed high all night and didn't come down at all according to the Libre :( 2IU this morning, should I increase back to 2.5 IU?
 
I think Pookie is bouncing from the blues yesterday. The same as he bounced from the greens on the 23rd. Bouncing is common especially in newly diagnosed cats. It can last for 6 cycles. Pookie has got used to being in high numbers and his body thinks they are now normal and when he drops down into the true normal numbers his body freaks out and dumps the stored glucose.
I would hold the dose at the moment.
Patience is the main thing I had to learn with feline diabetes.
I’ll get back to you with your other questions a bit later.
 
I am so glad you are testing for ketones. That is so important to do in the weeks following DKA, and while he is in higher numbers. Also do it any time he seems unwell. It's a really good insurance policy and if picked up early prevents a very sick cat and a lot of money on vet bills.

With the feeding, we recommend feeding before the insulin shot.....so you test, feed and shoot in that order.
You can divide the day's food up into three portions....give half at shot time and then divide the other half into 2 snacks and give at say +2 or 3 and again at +4 or 5. What ever times suit you, but best in the first half or 7 hours of the cycles. Do the same for the pm cycle as well.
Is Pookie overweight or just regaining what he lost?

I'm glad you got rid of that Hills dry food....it should be banned. It is really high in carbs and is so bad for cats. All cats need low carb food and no dry which is only 7% moisture whereas canned food is 78% moisture and is so much better for their kidneys.
I feed my cats a raw diet but low carb canned is fine and there is plenty of choice. The foods you mention above are all fine.

With the testing, several people have used the Libre Freestyle with varying success. The main problem seems to be it can fall off or doesn't last the full 14 days. As far as I know everyone swaps over to doing it themselves eventually. Unfortunately cats don't just get regulated and stay at the same BG all the time. It is really important that you test before every shot to see it is safe to give the insulin and again during the cycles to see how low the insulin is taking Pookie. Glargine dosing is based on the nadir (lowest point in the cycle) not the preshot.
I have spent hours with people who didn't test before the shot, trying to get the cat up into safe numbers again, then found their cat was in really low numbers early in the cycle.
I think you will find it too expensive to continue with the libre for too long.
Home testing really isn't hard. In the beginning it takes time for you and Pookie to get used to it all but honestly it gets super easy as time goes on. First of all you need to find a spot where you are going to test and do it there all the time. Give Pookie a small treat every time you test whether you are successful or not.
Warm the eat with some rice in the toe of a sock. Microwave to warm it...make sure it's not too hot..hold against the ear for a minute. You can also milk the ear towards the top to encourage the blood. The ears will learn to bleed...sounds silly but they grow little capillaries as you test.
Sheba used to come running as soon as she heard me at the test strips as she knew there was going to be a treat. And at night I just used to get up, test her as she lay there...she didn't move...and be back in bed in 2 minutes....unless she was low and then I had to stay up and feed her, and test again.
I would really encourage you to try again with the ears. There is a sweet spot which you will see on the link below. Put a torch behind the ear and you will see the vein running right around the ear. You need to prick between the vein and the edge of the ear. Try and avoid the vein if you can.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
 
Hi Bron!
Thanks again for all your help, you're an absolute fountain of knowledge :)
Pookie has always been a big cat (as in very big and muscular, not fat) but he lost a lot of weight (1-2kg) due to the undiagnosed diabetes..we did take him in to the vet who told us the weight loss was due to his dental issues and they removed all his teeth except one canine! So yes trying to help him regain that weight again...vet told us to slowly transition him from his free feeding lifestyle so we've kind of just been feeding him low carb cans whenever he screams for food..and stopping snacks 2 hours before his PMPS. Do most people on here weigh/measure out daily food for your diabetic cats and apportion it at set times?

My partner did the PM dose tonight and he didn't realise we had gone back to 2IU and gave Pookie 2.5 IU again..I hope it won't affect things too much...I'll see what his numbers are tomorrow morning and how he did overnight. I'm thinking of doing one more Libre after this one expires just until his numbers are a bit more stable as it's wonderful to get constant data even during the night! And thank you so much for the testing links, I had a good read and I'm thinking I'll just have to bite the bullet and start practicing and hope he gets used to it.

Have a great night and speak to you again soon, have a busy few days at work so hopefully he'll be ok and won't have to bother you too much again! Appreciate your time and patience :)
 
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