911 on Feline Health

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Critter Mom

Critter Mom

Member Since 2014
Hi all,

There's a new member on Health with a 911 - Mike and his cat, Webster (just back from hospital after being treated for DKA).

AMPS unknown (AMS at vets)
+7 47 - fed some Temptations treats and a little food (carbs not yet known)
+8 106

(human meter, I think).

viewtopic.php?f=28&t=128488

I'm not confident enough to assist, especially with no data. Can somebody help Mike and Webster, please?
 
Re: 911on Feline Health

Thank you critter mom for posting this here. ;-) Webster looks fine is acting normal. I'm about to check his levels again at hour 2 since the initial low reading.
 
Re: 911on Feline Health

Only too glad to do something to help, Mike. I've been in the same boat as you and other members came to help me. Glad that Webster's doing OK. Will check back on your other thread later for updates.


Thank you, Amy, for coming to help Mike and Webster.
 
Just wanted to add that mike will need further advice about tonight's dose so if someone could pop in to look at the thread that would be great.
 
Tested about 45 mins ago and hes up to 280.

He had ate about tablespoon of Hills prescription diet a/d that I had left out a few minutes prior to testing and then another tablespoon after I took the latest reading. I would imagine that this raised his bg levels. Its great to see him finally eating once again. He had to be force fed while in the the hospital for the past 4 days. He's home and seems very content right now.

I will check his levels again (+11) shortly and then once again to get the PMPS. The vet wrote out for 1 unit 2 times per day. As advised by others, this may be too much at this point so I am very hesitant to administer 1U after seeing him drop to 45 today.

I'll post my next two readings within the next hour and a half. At 9PM (eastern time) I will have to make a decision - 1U, 1/2U, none? I'll post my numbers and hope that someone can advice.

You guys are great! Thank you so much for being here, even on a Saturday night.
 
Welcome to Lantus Land!!

I was reading your thread on the Health board and you were getting great guidance there.

With a cat that is newly recovering from DKA, skipping a shot is not a great idea. One of the big contributors to the development of ketones is not enough insulin. This is a vulnerable time for Webster. Even though he may be ketone-free right now, ketones can develop very quickly. Given that you've got a bounce that's starting and the drop into the 40s, I'd reduce the dose to 0.75u. You may want to get some early tests in -- I'd suggest starting with a +2 and +3 just so you know where the cycle is going.

There are some basics that are helpful to keep in mind for a kitty that's recovering from DKA:
  • Like Amy suggested, pick up some ketostix at the pharmacy. Test as often as you can stalk your kitty to the letterbox. Alternatively, Novamax makes a glucose/ketone meter. There are several other brands around, as well. Even though the strips are expensive, getting at least a test a day for blood ketones will let you rest at night knowing that Webster is not throwing ketones. Either a meter or ketostix are fine. Just stay on top of the ketone situation.
  • Add water to Webster's food. Add as much as he'll tolerate. Water helps to flush any ketones from his system.
  • Make sure he's eating. Lack of calories also contributes to the development of ketones. If Webster isn't eating, he's burning stored fat as fuel and this form of metabolism produces ketones. It honestly is OK if you need to feed high carb or highly calorie dense food if that's what he'll eat. If he's feeling better and eating his regular food, that's great! But, if you need to give him the kitty equivalent of a hot fudge sundae to get him to eat, then do it!

This is a very active board and we have people here on both East and West coasts and points in between as well as members from Europe. (I can't remember if we have anyone from other continents around at the moment.) In other words, there's usually someone around if you need help. People are also very generous with their time and their knowledge. We've all been new at this dance and understand how overwhelming the first weeks can be. It does get easier -- really!
 
15 mins until his shot. His BG dropped slightly to 337. Check spreadsheet for past numbers.

Should I go with 1/2U? 3/4U? Please advise.
 
The Tight Regulation protocol would have you decrease to 0.75 units. He's bounced high enough that it could be OK to do that. You'll still want to check at +2 hours after the shot, to see if he's dropping by then.
 
Are you able to monitor tonight? Do you have plenty of test strips?

Was today his very first shot of Lantus, Mike? Or was he getting it at the vet's?
 
From his first posts,I believe he had urine glucose and ketones in his blood, so he would have been getting some kind of insulin. It isn't clear if it was full blown DKA, but the cat was at the vet for a few days, which suggests it was possible.
 
julie & punkin (ga) said:
Are you able to monitor tonight? Do you have plenty of test strips?

Was today his very first shot of Lantus, Mike? Or was he getting it at the vet's?
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I will monitor it for a few hours after I give the shot. I have 40+ strips left.

From what I understand, he has been getting .5U doses for while in the ER. They mentioned recently upping it 1U so I believe he had 1u at least once or twice.

This will be my very first time giving him any shots.
 
BJM said:
From his first posts,I believe he had urine glucose and ketones in his blood, so he would have been getting some kind of insulin. It isn't clear if it was full blown DKA, but the cat was at the vet for a few days, which suggests it was possible.
Click to expand...

Yes, he had DKA. Was at the vet for 4 days. They said his Ketones were high and were only recently at low levels today.
 
I think I'd go with the 0.75u that Sienne recommended. She's very experienced. With DKA not far in the background, you want to get enough insulin into him. As long as he's eating, and you can monitor, I'd go ahead.

I'll post this so you can shoot and then add some info for you.
 
Mike:

There's not a "best" answer to your question. Here's how I see it.

If Webster was getting Lantus at the vet's office, it makes a difference in terms of whether there's an insulin depot vs. if today was his first shot of Lantus and the numbers dropped into the 40s.

IF you opt to shoot 0.75u, you may need to stay up for quite a few hours should the numbers turn back around and head down rapidly.

If today was the first ever shot of Lantus, there may be some virtue in shooting 0.5u. Personally, I'm concerned about the possibility of ketones and too little insulin.

This is a bit of a dilemma. Shooting the larger dose may mean a busy night of testing. Shooting the smaller dose and there's always the potential of ketones. I know what I would do but I'm also very experienced with Lantus and managing low numbers and I have a lot of data regarding how my cat reacts to insulin. I'd shoot the 0.75u but that's where my comfort level is. I don't think that any of us can make this decision for you.
 
the reason I asked whether or not this was Webster's first dose of Lantus is because Lantus is what's called a "depot" insulin. That means that when you shoot, some goes immediately to work and some forms a precipitate and builds up in the body. Then that precipitate sort of slow-releases. There is a good description of how it works here. The important take-away is that it builds up in the body and so the same dose will have a stronger effect as you keep shooting it. Not sure that makes sense, but my point is the first shot on Lantus would have less of an effect than the 4th shot at the same dose.

I'd get a +1 and a +2 (a test one and two hours after his shot) and let's go from there.
 
julie & punkin (ga) said:
I think I'd go with the 0.75u that Sienne recommended. She's very experienced. With DKA not far in the background, you want to get enough insulin into him. As long as he's eating, and you can monitor, I'd go ahead.

I'll post this so you can shoot and then add some info for you.
Click to expand...

Yes, He's up in the 300's which is far above 200. I went with 3/4U. He didn't even notice the needle going in. The worst part was feeding him his antibiotics and pain meds afterwards with an oral syringe. He did not like that ONE bit..

I suppose I will check him at +2 and +3? or sooner?
 
sometimes posts come fast and furious when you've got a situation like this going on. Go ahead and refresh your browser and you'll see some new posts. :-D

good job giving your first shot!
 
julie & punkin (ga) said:
sometimes posts come fast and furious when you've got a situation like this going on. Go ahead and refresh your browser and you'll see some new posts. :-D

good job giving your first shot!
Click to expand...


Excellent. Thanks everyone for the help. I'm going to check him at +1, +2, +3 and so on. Will keep my sheet up-to-date.
 
Great job shooting and testing tonight, Mike - Webster is lucky to have you! Giving meds is the pits...after years of doing insulin, I swear I'd rather do a shot than liquid or pills any day!
 
Sienne and Gabby said:
Mike:

There's not a "best" answer to your question. Here's how I see it.

If Webster was getting Lantus at the vet's office, it makes a difference in terms of whether there's an insulin depot vs. if today was his first shot of Lantus and the numbers dropped into the 40s.

IF you opt to shoot 0.75u, you may need to stay up for quite a few hours should the numbers turn back around and head down rapidly.

If today was the first ever shot of Lantus, there may be some virtue in shooting 0.5u. Personally, I'm concerned about the possibility of ketones and too little insulin.

This is a bit of a dilemma. Shooting the larger dose may mean a busy night of testing. Shooting the smaller dose and there's always the potential of ketones. I know what I would do but I'm also very experienced with Lantus and managing low numbers and I have a lot of data regarding how my cat reacts to insulin. I'd shoot the 0.75u but that's where my comfort level is. I don't think that any of us can make this decision for you.
Click to expand...

Yes, that's the concern I suppose. He needs enough insulin to prevent the formation of Ketones yet we don't want him to drop low as he did today. Seems to make the process even trickier.

BTW, Should I refrigerate my now open lantus pen? I got the pens to prevent wasting 1/2 a bottle and am using the pen as a vial.
 
Amy&TrixieCat said:
Great job shooting and testing tonight, Mike - Webster is lucky to have you! Giving meds is the pits...after years of doing insulin, I swear I'd rather do a shot than liquid or pills any day!
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He's never growled at me... Until tonight.
 
I have to do twice daily pills with Trix, and the same thing here...sometimes she hisses and growls at me, and never did it before. But, they do know we're helping.

Sienne did ask a couple more good questions up a few posts, so we can fill in the blanks about Webster....
 
Sienne and Gabby said:
Are the antibiotics (ABs) a liquid? Which AB and what pain meds? Was Webster diagnosed with pancreatitis, too?
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Both pain meds and antibiotics are liquid. The antobiotic says Clav/Amox while the pain meds say Buprenorphine. No diagnosis of pancreatitis. They just gave antibiotics as precautionary.
 
I apologize if I miss anyone suggestions. Lots of good information coming to me at once with time of the essence. I try to respond to everyone.

Thanks for all of the help.
 
Antibiotics (you've got clavamox which is combo that contains amoxycillin) and pain med (we call buprenorphine/buprenex "bupe" for short) are commonly prescribed for pancreatitis. Usually there isn't pain associated with ketones. There's lots of pain associated with pancreatitis. Pancreatitis is also not an uncommon cause for diabetes.

The bupe should go either in the cheek pocket or under Webster's tongue to be most effective. It needs to be absorbed by the mucous membranes.

It's best to keep the Lantus pen in the refrigerator. I'm on day 80 with my pen. Keeping the pens refrigerated will prolong the life of the insulin. Most of us keep the pen someplace other than the door of the refrigerator since there's more temperature variation on the door. I keep my pen in one of the crispers. Just keep it somewhere where it doesn't get overly jostled about.
 
Mike, not sure if anyone has given you the "recipe" for ketones. It's "not enough food + not enough insulin + infection = ketones."

Ketones are little devils that want to come back. So your job is to interrupt that equation. I hope the vet told you how important it is to keep him eating, even if it's higher carb food than is idea. The insulin dose can be adjusted to compensate for extra carbs. If they didn't identify a specific infection, they may have given the clavamox/amoxicillin to try to get whatever is going on.

Sometimes liquid antibiotics have sugar added in them. If you're not positive they compounded it without sugars, I'd give a call tomorrow and just double-check on it.
 
julie & punkin (ga) said:
Mike, not sure if anyone has given you the "recipe" for ketones. It's "not enough food + not enough insulin + infection = ketones."

Ketones are little devils that want to come back. So your job is to interrupt that equation. I hope the vet told you how important it is to keep him eating, even if it's higher carb food than is idea. The insulin dose can be adjusted to compensate for extra carbs. If they didn't identify a specific infection, they may have given the clavamox/amoxicillin to try to get whatever is going on.

Sometimes liquid antibiotics have sugar added in them. If you're not positive they compounded it without sugars, I'd give a call tomorrow and just double-check on it.
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Thanks for the explanation.

The vet stressed that food is important regardless of type of food at this stage. I'm just trying to get him keep eating and get the correct amount of insulin going.

Time for a BG check.. Keep you posted.
 
You are probably seeing the effect of a bounce + food. And, if the AB was compounded with sugar syrup, that's contributing to the rise in numbers. (If you taste a drop of the AB, you may be able to tell if there's sugar in it.)
 
that points to a bounce. Did you see i linked the explanation for you in your last post on Main Health? It's his liver responding to the low numbers today.
 
julie & punkin (ga) said:
that points to a bounce. Did you see i linked the explanation for you in your last post on Main Health? It's his liver responding to the low numbers today.
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Yes, I saw that earlier. I didn't get around to reading the referenced link at the time but am going back right now to read it. Thank you.
 
Okay. I'm going to run to Walmart to get some aquarium gravel so that I can collect a pee sample so that I can keep an eye on his Ketones. Be back in less than an hour.
 
I'm back. Swapped out his clay litter for aquarium gravel. Hope to check his ketone level tonight. I also stocked up on strips while I was out. Should be good for a while now.

Just checked his BG. It's at 420, down 50 points.

How many more time should I be checking it? I feel so bad. His ears have several pricks. Better get accustom i suppose? :-|
 
When would you typically be going to sleep? With where his numbers are now, I'm not too worried. I you turn in after an hour or so, unless there's a dramatic change, I'd one last test and go to sleep.
 
Sienne and Gabby said:
When would you typically be going to sleep? With where his numbers are now, I'm not too worried. I you turn in after an hour or so, unless there's a dramatic change, I'd one last test and go to sleep.
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Usually in another hour or so. It will be hard to sleep if I'm worried about him. Might be another couple hours.

How quick will this insulin drive down these numbers? I mean I don't want to go back to 45 where I was earlier but a high number such as 420 makes me nervous. Then again, I know very little because all of this is new to me.
 
Bounces can last up to 3 days. How long they last depends upon how dramatic the cat's body's response to the lower numbers was. As a cat gets used to normal numbers the bouncing usually lessens. Typically they don't go as high and the bounces don't last as long. Since this is Webster's first bounc, we don't have anything to compare to.

You've got to sleep. If you're worried, you can set an alarm and get a test in another couple of hours.

Has anyone suggested you get Neosporin ointment with pain relief? That stuff is amazing at taking the owie out. I used to put it on Punkin's ear every night, then wipe it off in the morning and it was like his ear healed overnight. Every night. If you haven't gotten it yet, I'd get it tomorrow and try it out. The directions say "slather" - use enough - then you do want to wipe off the excess so it doesn't goo up your test strip.

The ointment works great at helping keep the blood from soaking into his hair/skin and the pain relief is what gives relief. There is a cream available too, but I think most people use the ointment.
 
Hi Mike and Webster,
I've been following your adventure, but didn't want to get in the way of the good advice you have been getting. I just want to say "welcome"! Most of us put a little Neosporin with Pain Relief on our cats' ears; you can do this from time to time during the course of the cycle, and always after the last test of the night. This helps the ears heal. Some prefer the ointment, others the cream. If you use the ointment during the day and evening, when you are still testing, make sure to gently wipe it off before the next test. Leave it on at night.

You are doing a great job!

Ella & Rusty

p.s. I see that Julie just told you about Neosporin with Pain Relief (while I was typing). Good luck!
 
julie & punkin (ga) said:
Bounces can last up to 3 days. How long they last depends upon how dramatic the cat's body's response to the lower numbers was. As a cat gets used to normal numbers the bouncing usually lessens. Typically they don't go as high and the bounces don't last as long. Since this is Webster's first bounc, we don't have anything to compare to.

You've got to sleep. If you're worried, you can set an alarm and get a test in another couple of hours.

Has anyone suggested you get Neosporin ointment with pain relief? That stuff is amazing at taking the owie out. I used to put it on Punkin's ear every night, then wipe it off in the morning and it was like his ear healed overnight. Every night. If you haven't gotten it yet, I'd get it tomorrow and try it out. The directions say "slather" - use enough - then you do want to wipe off the excess so it doesn't goo up your test strip.

The ointment works great at helping keep the blood from soaking into his hair/skin and the pain relief is what gives relief. There is a cream available too, but I think most people use the ointment.
Click to expand...

Thanks for educating me on what a bounce is. This can offer an explanation into what may be going. I guess the only way to make any sense of this is to keep detailed records and see if there is a noticeable trend.

I plan on skipping this hour and check it at perhaps +4 or +5.

I suppose I'll hold his dose down to .75U tomorrow morning as long as his AMPS numbers are okay.

As for the Neosporin, I'll be on it! Thanks!
 
Ella & Rusty & Stu(GA) said:
Hi Mike and Webster,
I've been following your adventure, but didn't want to get in the way of the good advice you have been getting. I just want to say "welcome"! Most of us put a little Neosporin with Pain Relief on our cats' ears; you can do this from time to time during the course of the cycle, and always after the last test of the night. This helps the ears heal. Some prefer the ointment, others the cream. If you use the ointment during the day and evening, when you are still testing, make sure to gently wipe it off before the next test. Leave it on at night.

You are doing a great job!

Ella & Rusty

p.s. I see that Julie just told you about Neosporin with Pain Relief (while I was typing). Good luck!
Click to expand...

Thank you. I appreciate it. :smile:
 
If I'm reading right that was a fairly large drop in the past 1.5 hrs. Can you feed him now and leave more food available when you go to bed? I'll look in on you in another hour.
 
So I swapped out his little for aquarium gravel. Over the past 2 hours he looked at his box but would not pee in it.

I put the litter back into his box and what do you know?? He jumped in and started peeing.

I quickly grabbed the closest thing to me which happened to be a ziplock bag and threw it under his bum mid stream. I was able to collect a small puddle which I used to wet the ketone test strip.

The test indicated no ketones. That a relief. :-D Hitting the sack. Good night and thank you everyone once again.
 
julie & punkin (ga) said:
If I'm reading right that was a fairly large drop in the past 1.5 hrs. Can you feed him now and leave more food available when you go to bed? I'll look in on you in another hour.
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Food has been left out and h has been snacking well off and on. I'll try again in a little while. Getting tired..
 
I'm thinking it's 1am for you. You could probably sleep for 2 hrs if you want. It looks like he's clearing the bounce quickly. I'm in Oregon and can be here in 1 or 2 hrs for you. Tell me what you want. I promise it won't be like this every night.
 
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