7/20 New Member looking for some guidance

New member and newly diagnosed and just looking to see if anyone can tell me what I’m doing wrong, or if there is something else I can do better or differently. Gooshie is recently diagnosed, and more recently went through a near DKA episode, landing her in the hospital for about a week to get her stable. The vet thought trying Lantus would be best, as he has heard a lot of good stories about remission and this drug. She came home and we started Lantus – in the evenings, her numbers would drop into the double digits, from starting in the 400 or above range and each night in the wee hours, I would have to give her high carb food to get her back up to above 100.. then the next day she would just keep going up and up and then over 500 and my heart just sank thinking we were going into another DKA event. She was restless and not herself at all. She ate a tremendous amount of food on lantus(which was great, b/c she has lost too much!), but I think the sugar rise and fall so quickly was really uncomfortable for her. She just wasn’t herself.. after the third morning, of literally no sleep and the same pattern, I called the vet in tears asking what I was doing wrong.. we decided to switch to Vetsulin and see if her body reacted any better to that medication. We are on day 2 ½ and Vetsulin is dropping her sugar really fast in the morning as well(we started at 1.0 unit the first morning – have since dropped to .5), but then she goes right back up to the 400s.. it’s just so scary to see these numbers drop quickly and then get stuck real high.. I would do anything to regulate her. She has been switched to a low carb wet food diet. She will occasionally have a freeze dried piece of wild tuna as a treat, and some poached wild shrimp. She was a feral cat, who basically grew up on dry food, so when she decided to move in, knowing absolutely nothing about cats or nutrition, I just kept her on what she was used to. I am just feeling overwhelmed, not sure if Vetsulin is the best choice, or how to get her at least in a zone that is regulated as quickly and more importantly safely as possible. Any help, guidance, words of wisdom would be so very much appreciated. This is all so new and all so overwhelming!

 

Tagging
@Sienne and Gabby (GA)

@Wendy&Neko

@Marje and Gracie

One thing you didn't have to create 2 spreadsheets you could just use the Lantus SS and then
Then leave a blank line and put Switched to Vetsulin and start adding those numbers
I think it will be too much for members to go back and forth to different spreadsheets
Hang in there ok


Thank you ladies

 

Hi and welcome to you and Gooshie.
First of all I want to talk about the hospital stay and ‘close to DKA.’
Did the vet give you any directions for when you came home about food or testing foe ketones?

• After an episode DKA or near DKA it is really important that Gooshsie eats really well and often to prevent the ketones from forming again and progressing to DKA. So I would make sure he is eating 1 1/2 times as many calories as he normally would throughout the day and evening. You can achieve this by giving him snacks every couple of hours, except for the 2 hours preshot.
• Test for ketones in the urine every day using Ketostix which you buy from Walmart or a pharmacy.
• Don’t skip any insulin doses. If the preshot is low, stall dont feed and post and ask for help and test again in 20 minutes
• Give plenty of fluids.
• Continue with any antibiotics if there was an infection.

Vetsulin is a much faster acting insulin than Lantus and will drop the BG fast. Are you feeding a meal 30 minutes before the shots.
Lantus is a much more suitable insulin for cats…vetsulin is really an insulin for dogs but at the moment vetsulin may be better because of the recent DKA as it is an ‘in and out’ insulin whereas Lantus is a ‘depot’ insulin and the depot takes a few days to fill so you don’t get the full effect of the dose in the beginning which can be problematic with recent DKA. Once he is stable I would recommend swapping back to Lantus.

What you are seeing is Gooshie dropping low and bouncing from the fast and low drops. This is very common in newly diagnosed cats so please don’t get upset by it. I know it’s horrible seeing them in high numbers but it is the bounces that are causing the high BGs.
Bouncing happens when the BG drops too fast, too low or lower than the cat is used to and he dumps stored glucose and counter regulatory hormones into the system and the BG shoots up high. Bounces can last from 1 to 6 cycles.
I’m going to ask @Bandit's Mom if she can join the two SS together so we can see what is happening.

Can you tell me is you have been testing for ketones in the urine?
If you could get the signature done as well that would be he,Paul to tell us about Gooshie
Instructions in HERE plus other useful information
Bron

 

Hi there,
THANK YOU for all of this great information and the kindness - it so comes through and your posts have eased my mind tremendously already! I'm so grateful for you taking the time to talk me through this stuff! Vet did not suggest testing for ketones upon her return home so I will pick those up today and start doing that immediately. She has been switched to a low carb wet diet, I basically bought every cat food under 6% carbs to see what she liked best - she is eating fairly well, seems to love the Feline Natural grain free. I have also purchased young again zero cat food but am hesitant to do dry food - maybe that's not fair on my part.. it all feels like trial and error at this point. She also gets poached wild shrimp and organic turkey during the day, depending on her preference. Vet suggested clean eating as best I could. I will say while she was on the Lantus she was eating like she never has in her life(which is good b/c she lost about 5 pounds), but that has subsided a bit since the switch to Vetsulin. The water obsession, which is what caused the vet trip initially, is gone and the urine is changing, and A LOT less of it. She is getting a meal 30 mins before shot, and then I try to give her a snack(1TBL wet food) every 35 mins to an hour or so especially during the first 4 hours with the Vetsulin. it seems to help the "drop" not be as steep on the vetsulin. I do still have the lantus, and I will hold on to it (vs donating) to see if switching her back is the best option. I had never heard about bounces until I stumbled upon this forum - your description above is exactly what I have seen since the second dose of lantus, and still continue to see a bit with the vetsulin. Can't thank you enough! We are off to the vet today to get her new monitor put on(every 10 days) so I will get her numbers loaded up as soon as we are back. I did merge the spreadsheets into 1, great suggestion!! thank you both again so much!

 

Do keep the Lantus as it’s a much better insulin for cats. But I would wait until you are sure there are no ketones in the ruined for at least a fortnight before swapping over.
If you can do without the dry food I would. Even though it is a low carb food, it doesn’t have nearly enough moisture for cats 7% against 78% for wet.

 

At low does like 1/2 unit make sure you look at the zero mark on the syringe. I have seen U100 syringes w/1/2 unit markings being off by 1/2 unit. That means drawing up to the 1 unit mark means you are actually drawing up 1 unit.

 

Hi Bron,
If I wanted to switch back to Lantus after being on Vetsulin, what would be the best way to do that? Do I need to consider any after effects of Vetsulin that could occur with a switch back? I'm just so discouraged with her numbers. I don't know if we are still seeing these "bounces" , if we are seeing something else etc. There are no ketones in the Urine , but not sure how best to try Lantus again. The Lantus also scared me as she was going from really low numbers to really high.. I'm just at a loss as to what to do. If I go back to her spreadsheet, her numbers, sans the high ones on Lantus were better - we actually saw blues and greens.. I would do anything to get this poor thing regulated while we hope for remission.

 

No, Vetsulin is an "in-out" insulin and does not build up like a depot insulin like Lantus.

 

What Larry is saying is that you can make a direct switch from Vetsulin to Lantus. The Vetsulin will be out of your cat's system well before the time for your next shot.

It sounded like your vet was well meaning but hasn't had much experience with Lantus. It takes roughly 5 - 7 days for the Lantus depot to stabilize. For most cats, you won't see an immediate effect on numbers given that Lantus is far more gentle than Vetsulin. You were also seeing a much better response to Lantus -- other than the bounce back into higher numbers which is normal when a cat isn't used to spending time in closer to normal numbers.

Also, are you using U100 syringes with Lantus? (Vetsulin requires a U40 syringe.)

For what it's worth (and this may be helpful for your vet), the American Animal Hospital Assn no longer recommends Vetsulin for the treatment of feline diabetes. They recommend Lantus (glargine) and Prozinc. I attached a link to the AAHA guidelines if you want to look them over and/or share with your vet.

 

Thank you both so very much! We'll be switching back to Lantus tonight, with our fingers crossed. I do have the U100 syringes for the lantus, so we are all set on that front. All of this information is so very much appreciated and so very helpful. I can't thank you all enough!

 

Good luck with switching back to Lantus tonight don't forget to enter that on your spreadsheet like you did when you switched to Vetsulin

 

Would any of you know on the U100 syringe if .25 units is the equivalent of pulling back to the 0 line? I ordered the U100s with the 1/2 marks but they aren’t here yet. Just eyeballing the .25 and .50 is hard!

 

It depends upon the syringe. I have ad a few syringes where the Zero line was really 0.5 units. That is a bid erro if you are dosing less than one unit.

 

This is what a 0.25u dose would look like:

 

Thank you both! it is scary on these small doses.. I can't wait until the new syringes with the half marks come this week!

 

Can I ask a newbie question? At what point can I expect to see these HI numbers clear out if this is a "bounce"? she had such a great day yesterday, but all night and still now this morning she is reading HI on the meter. No ketones in Urine, but not nearly as active and alert as yesterday. I thought for sure with her morning dose, I would see these HI numbers leave by now.