Caesar - Dosing Help Needed - post DKA

J4CKS

J4CKS

Member Since 2026
link to previous thread: Help! DKA Diagnosis

Hi Everyone, need some help with post DKA dosing:

Quick Background:
- diagnosed in 2014, switched to LC wet, initial dose of 3 units / day (Lantus), lowered dosage to 0.5 units once per day (as advised by our vet). Continued to be dosage for last 18 months. Had been doing really well!
- 04-24, had to admit to emerg vet for 3 days --> DKA event, high level of ketones, high BG, due to lack of insulin.
- discharged on 04-27, were able to drop ketone levels and stability BG.

Current Routine:
- sent home with CGM (Libre) - have used before during initial diagnosis
- Insulin: Lantus (glargine) 1 unit, twice per day (8:00 am, 8:00 pm US Central)
- vet advised to do a curve in 7-10 days to see if insulin amount is appropriate;
- continued with LC Wet

04-28 AM
- CGM came in as 'HI' indicated 450+ BG, was frequently drinking from water dish. As @Staci & Ivy kindly pointed out, the increased thirst is fairly normal due to the high BG;
- posted earlier - worried about possible DKA relapse;
- grazed on morning food, energy seems to be 7/10;

Dosage
- need help figuring out possible dosage increase, if necessary. Obviously, I don't want to do anything rash and crash his BG. Guess I'm still worried about what happened over the weekend.
- continue with the 1 unit, twice per day. Being depot "acting" insulin, we'll see some better results over the next couple of days?


Just wanted to get some feedback and insight from the community.
 
J4CKS said:
link to previous thread: Help! DKA Diagnosis

Hi Everyone, need some help with post DKA dosing:

Quick Background:
- diagnosed in 2014, switched to LC wet, initial dose of 3 units / day (Lantus), lowered dosage to 0.5 units once per day (as advised by our vet). Continued to be dosage for last 18 months. Had been doing really well!
- 04-24, had to admit to emerg vet for 3 days --> DKA event, high level of ketones, high BG, due to lack of insulin.
- discharged on 04-27, were able to drop ketone levels and stability BG.

Current Routine:
- sent home with CGM (Libre) - have used before during initial diagnosis
- Insulin: Lantus (glargine) 1 unit, twice per day (8:00 am, 8:00 pm US Central)
- vet advised to do a curve in 7-10 days to see if insulin amount is appropriate;
- continued with LC Wet

04-28 AM
- CGM came in as 'HI' indicated 450+ BG, was frequently drinking from water dish. As @Staci & Ivy kindly pointed out, the increased thirst is fairly normal due to the high BG;
- posted earlier - worried about possible DKA relapse;
- grazed on morning food, energy seems to be 7/10;

Dosage
- need help figuring out possible dosage increase, if necessary. Obviously, I don't want to do anything rash and crash his BG. Guess I'm still worried about what happened over the weekend.
- continue with the 1 unit, twice per day. Being depot "acting" insulin, we'll see some better results over the next couple of days?


Just wanted to get some feedback and insight from the community.
Click to expand...
Here’s what I posted on yesterday’s condo since that is where I was tagged and I didn’t search for a new one today:

“ You mentioned in your first post he’d been on 0.5u Lantus once a day. Is that what his dose was when he was admitted to the hospital? Were they giving him Lantus twice a day and at what dose? And how many consecutive cycles has he gotten of that dose? Lantus is a depot insulin and I want to be sure he’s got a good depot so we can fast-track his dose if need be. If they have given him several cycles of 1u then we can increase his dose but because the SS only shows 2 cycles, we need to be sure we don’t jump the gun on the depot.

As soon as you can let me know that info, I can advise on the dose.

In the meantime, keep up with lots of extra calories and fluids. Are you giving him subq fluids at home?”
 
Marje and Gracie said:
Here’s what I posted on yesterday’s condo since that is where I was tagged and I didn’t search for a new one today:

“ You mentioned in your first post he’d been on 0.5u Lantus once a day. Is that what his dose was when he was admitted to the hospital? Were they giving him Lantus twice a day and at what dose? And how many consecutive cycles has he gotten of that dose? Lantus is a depot insulin and I want to be sure he’s got a good depot so we can fast-track his dose if need be. If they have given him several cycles of 1u then we can increase his dose but because the SS only shows 2 cycles, we need to be sure we don’t jump the gun on the depot.

As soon as you can let me know that info, I can advise on the dose.

In the meantime, keep up with lots of extra calories and fluids. Are you giving him subq fluids at home?”
Click to expand...
That's correct! His dosage when admitted to the hospital was 0.5u, once per day. They initially started him on fast acting insulin (dosage unknown) to treat the high BG. Once that was under control, they switched over to a Glargine Insulin. To my best knowledge,

Glargine Dosages:
04-26 AM 0.5 units
04-26 PM 0.5 units
04-27 AM 1 unit
04-27 PM (home) 1 unit
04-28 AM (home) 1 unit

So really, he's only been on 1.5 cycles of the 1 unit, so like you said, I doubt he's developed a good depot yet and don't want to jump the gun.

His appetite has been only okay this morning, ate ~70% of his breakfast + some treats - wish he had a bit more of an appetite. Been drinking well. Been sleeping most of the morning. Just took 3+ and still reading as 'HI', so not sure what to think about that, hoping to see it drop down. No subq fluids (yet?) the vet didn't mention them during his discharge. Considering taking a look at some antinausea medication as @Bron and Sheba (GA) suggested earlier.

*update: went out and bought him the DM pate (currently have the DM chunks in gravy, we switch every couple of weeks when he gets bored of one). Ate 3/4 (full serving) of a can almost immediately lol. Guess he was just being picky...
 
Last edited:
J4CKS said:
they switched over to a Glargine Insulin.
Click to expand...
I want to be sure I understand this. Did they stop the Lantus while he was in the hospital or did they give the Lantus along with the fast-acting insulin (which is what we do here…..we don’t stop the Lantus)? It’s important to know so I understand if his depot was drained. They should have given you very detailed discharge papers so you can see what they gave him and when. If they didn’t, I would call and ask them to email them to you.

But…he is still building the depot and I’d like to see him at one more dose at 1u before we increase. Let’s see how today and this evening looks and I will post some dosing thoughts for you later today.

I would definitely see about getting:
—cerenia
—ondansetron
—perhaps MiraTaz

The first two will help address any nausea from different modalities. The third is a transdermal appetite stimulant but you want to be sure you, at least, have ondansetron on board before you use the MiraTaz. While I suggest that if he’s not getting 1.5x his normal calories, I’ll leave it up to you but it can be a big help.

Subq fluids can be very helpful but if you have any thoughts his heart might not be tiptop, I’d just try to get as much water in him orally by adding to his food, giving tuna juice as long as it is just water based, or homemade bone broth as long as he does not have any kidney issues.
 
Marje and Gracie said:
I want to be sure I understand this. Did they stop the Lantus while he was in the hospital or did they give the Lantus along with the fast-acting insulin (which is what we do here…..we don’t stop the Lantus)? It’s important to know so I understand if his depot was drained. They should have given you very detailed discharge papers so you can see what they gave him and when. If they didn’t, I would call and ask them to email them to you.

But…he is still building the depot and I’d like to see him at one more dose at 1u before we increase. Let’s see how today and this evening looks and I will post some dosing thoughts for you later today.

I would definitely see about getting:
—cerenia
—ondansetron
—perhaps MiraTaz

The first two will help address any nausea from different modalities. The third is a transdermal appetite stimulant but you want to be sure you, at least, have ondansetron on board before you use the MiraTaz. While I suggest that if he’s not getting 1.5x his normal calories, I’ll leave it up to you but it can be a big help.

Subq fluids can be very helpful but if you have any thoughts his heart might not be tiptop, I’d just try to get as much water in him orally by adding to his food, giving tuna juice as long as it is just water based, or homemade bone broth as long as he does not have any kidney issues.
Click to expand...
Ou okay that’s good to know! I asked for a copy at discharge yesterday but haven’t recieved. Will call today and ask! I’ll be sure to tag you with the new information!

Based on the itemized invoice and call notes, no glargine insulin was listed in 04-25, only fast acting. On 04-26, 0.5 units of glargine given in AM, determined wasn’t enough. Given fast-acting during the day. 1 unit of glargine given in PM. On 04-27, 1 unit of glargine given in AM, fast acting insulin also listed.

Wish I had more details to give.

ended up eating a full serving of food 30 minutes ago! Looks like we might be okay without the anti nausea / appetite stimulants. I’ll be sure to add more liquids into food and treats.

Really appreciate all the info and help !
 
J4CKS said:
Ou okay that’s good to know! I asked for a copy at discharge yesterday but haven’t recieved. Will call today and ask! I’ll be sure to tag you with the new information!

Based on the itemized invoice and call notes, no glargine insulin was listed in 04-25, only fast acting. On 04-26, 0.5 units of glargine given in AM, determined wasn’t enough. Given fast-acting during the day. 1 unit of glargine given in PM. On 04-27, 1 unit of glargine given in AM, fast acting insulin also listed.

Wish I had more details to give.

ended up eating a full serving of food 30 minutes ago! Looks like we might be okay without the anti nausea / appetite stimulants. I’ll be sure to add more liquids into food and treats.

Really appreciate all the info and help !
Click to expand...
Sounds good. I’ll be out most of the day but we won’t change dose before tomorrow so any other info you get & can post helps. It sounds like they only missed a couple of cycles of Lantus but with only shooting once a day before that, you were draining his depot every day. Not your fault….poor vet advice. And they should have been using the fast-acting insulin with the Lantus all along. We have a lot of experience doing that here. If we feel we can’t get him into better BGs fast enough, we can talk about doing it but it takes a lot of attention and monitoring.
 
Hi @Marje and Gracie ! Got some information back from the vet - I'll outline each day and what was given:

04-24 (admitted to vet - diabetic ketoacidosis, BG 19.8 mmol/L, Ket 4.3 mmol/L)
AM:
0.5u Lantus, home.
13:30
Toronto Insulin (per unit) x 1
Maropitant 10mg/ml Inj (Emavert) x 0.56
Buprenorphine 0.5mg/ml Inj x 0.22
16:30
Toronto Insulin (per unit) x 1
23:24
Buprenorphine 0.5mg/ml Inj x 0.22

04-25
02:02
Toronto Insulin (per unit) x 1
04:20
Toronto Insulin (per unit) x 1
05:59
Buprenorphine 0.5mg/ml Inj x 0.22
10:02
Toronto Insulin (per unit) x 1
13:56
Maropitant 10mg/ml Inj (Emavert) x 0.56
Buprenorphine 0.5mg/ml Inj x 0.22
18:06
Toronto Insulin (per unit) x 1
21:52
Buprenorphine 0.5mg/ml Inj x 0.22
Toronto Insulin (per unit) x 1

04-26
00:07
Toronto Insulin (per unit) x 1
04:20
Toronto Insulin (per unit) x 1
06:14
Toronto Insulin (per unit) x 1
Buprenorphine 0.5mg/ml Inj x 0.22
10:00
BAR, did not eat this morning - is he full or not feeling well? Was eating well until now. Will give 0.5 U glargine and monitor.
14:34
Buprenorphine 0.5mg/ml Inj x 0.22
Maropitant 10mg/ml Inj (Emavert) x 0.56
20:45
Toronto Insulin (per unit) x 1
21:58
Toronto Insulin (per unit) x 1

04-27
06:11
Toronto Insulin (per unit) x 1
08:45
BAR. Eating and drinking normally. Switched on glargine. Controlling BG. If fine RTG
13:45
Maropitant 10mg/ml Inj (Emavert) x 0.56
Toronto Insulin (per unit) x 1

*notes: based on the clinic summary it's a little difficult to summarize when glargine vs fast-acting. I believe the "Toronto Insulin" is fast-acting. As you said earlier, vets will use fast-acting and a glargine simultaneously to control the BG. Glargine was for sure given on 04-26, and I received a call discussing how they were upping the dosage to 1u on 04-27. I'd assume previous doses of glargine on 04-24 and 04-25 would have been 0.5u

Hopefully this is a little helpful! PM: GB still running "HI," coherent, greeted me at door, remains tired but more present. Ate dinner in single sitting!
 
J4CKS said:
Hi @Marje and Gracie ! Got some information back from the vet - I'll outline each day and what was given:

04-24 (admitted to vet - diabetic ketoacidosis, BG 19.8 mmol/L, Ket 4.3 mmol/L)
AM:
0.5u Lantus, home.
13:30
Toronto Insulin (per unit) x 1
Maropitant 10mg/ml Inj (Emavert) x 0.56
Buprenorphine 0.5mg/ml Inj x 0.22
16:30
Toronto Insulin (per unit) x 1
23:24
Buprenorphine 0.5mg/ml Inj x 0.22

04-25
02:02
Toronto Insulin (per unit) x 1
04:20
Toronto Insulin (per unit) x 1
05:59
Buprenorphine 0.5mg/ml Inj x 0.22
10:02
Toronto Insulin (per unit) x 1
13:56
Maropitant 10mg/ml Inj (Emavert) x 0.56
Buprenorphine 0.5mg/ml Inj x 0.22
18:06
Toronto Insulin (per unit) x 1
21:52
Buprenorphine 0.5mg/ml Inj x 0.22
Toronto Insulin (per unit) x 1

04-26
00:07
Toronto Insulin (per unit) x 1
04:20
Toronto Insulin (per unit) x 1
06:14
Toronto Insulin (per unit) x 1
Buprenorphine 0.5mg/ml Inj x 0.22
10:00
BAR, did not eat this morning - is he full or not feeling well? Was eating well until now. Will give 0.5 U glargine and monitor.
14:34
Buprenorphine 0.5mg/ml Inj x 0.22
Maropitant 10mg/ml Inj (Emavert) x 0.56
20:45
Toronto Insulin (per unit) x 1
21:58
Toronto Insulin (per unit) x 1

04-27
06:11
Toronto Insulin (per unit) x 1
08:45
BAR. Eating and drinking normally. Switched on glargine. Controlling BG. If fine RTG
13:45
Maropitant 10mg/ml Inj (Emavert) x 0.56
Toronto Insulin (per unit) x 1

*notes: based on the clinic summary it's a little difficult to summarize when glargine vs fast-acting. I believe the "Toronto Insulin" is fast-acting. As you said earlier, vets will use fast-acting and a glargine simultaneously to control the BG. Glargine was for sure given on 04-26, and I received a call discussing how they were upping the dosage to 1u on 04-27. I'd assume previous doses of glargine on 04-24 and 04-25 would have been 0.5u

Hopefully this is a little helpful! PM: GB still running "HI," coherent, greeted me at door, remains tired but more present. Ate dinner in single sitting!
Click to expand...

If you can be there to monitor and feed if he drops, I would increase his dose to 1.5u (every 12 hours) tomorrow unless you see BGs below 300 tonight. If you see BGs between 200-300 tonight, I’d increase to 1.25u every 12 hours.

I won’t be around tomorrow until later in the day but if you have any questions, just post.

Toronto insulin is what we call “R” or regular insulin here. It is a fast-acting insulin which has a duration of about four hours.

Just keep on with the extra calories and water. Did you get any info on giving him cerenia (aka Maropitant) or ondansetron?
 
Marje and Gracie said:
If you can be there to monitor and feed if he drops, I would increase his dose to 1.5u (every 12 hours) tomorrow unless you see BGs below 300 tonight. If you see BGs between 200-300 tonight, I’d increase to 1.25u every 12 hours.

I won’t be around tomorrow until later in the day but if you have any questions, just post.

Toronto insulin is what we call “R” or regular insulin here. It is a fast-acting insulin which has a duration of about four hours.

Just keep on with the extra calories and water. Did you get any info on giving him cerenia (aka Maropitant) or ondansetron?
Click to expand...
Sounds good! 1.5u sounds like a good idea, I won't be home, but my partner will be to keep an eye on him + check his BG levels. I'll see if I can figure out a how to increase by 0.25u as our U100 syringes only increase by 0.5 unit intervals. Did a little reading, but don't think it'll be necessary at this point - ate his entire dinner in one sitting + some extra. Consistently drinking water still too.

I've attached an export of the CGM Libre over the weekend and today - you can really see him riding the 400s over the last 24 hours.

Screenshot 2026-04-28 214716.png
 
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