? Critical condition: Help Finding right dose

C

Catlover988

New Member
Sir Pounce A Lot went from 13lb to 9 in about a month. When diagnosed a few weeks ago was on 2U insulin and continued to decline (and down to 7.8 lbs). Vet said he was one of "the most diabetic cats" she's ever saw. Apparently he's also continuously dehydrated despite drinking ridiculous amounts because his glucose is so high - apparently that's messed up his kidneys but that may recover if we get the diabetes under control. The vet gave him fluids twice and it seemed to help both times. However, it got to the point yesterday where he wasn't wanting to eat, our vet who I think is an idiot was suggesting euthenasia - she never suggested upping the insulin. At that point I said if he's going to die anyway I may as well try and fix this myself. Gave him lots of broth via syringe and got him to at least eat some non-diabetic food, then gave him 2 extra units of insulin.

Wasn't previously monitoring glucose as it wasn't suggested by the vet, we got one on our own on 10/23. I've been monitoring blood glucose and think he had way too low of an insulin dose originally and was still in the 500-700 mg/dl range most of the time. Over the past two days I've increased his insulin to ~4 or 4.5U/12 hrs and gave 225ml subQ buffered fluids to try and prevent DKA / keep electrolytes in balance since I don't have K fortified fluids or a setup for IV fluids. I'm very worried about DKA and his labs on 10/24 have some significant warning signs according to the vet. He seems better today (10/25) but I'm not sure if 4U is still too low or too high. He is literally skin and bones and needs sugar in his body or he'll die and he hasn't gone hypo yet with the dose doubling, even though some of his readings were low (lowest @ 30 which I think may have been inaccurate because I couldn't get a big enough blood drop) - I was with him the whole time and he was responsive, I gave him a couple treats that had carbs (~2g) and prompted food and his blood glucose recovered to ~220 when I next tested him a little later without him ever being symptomatic for hypo.

This is also complicated because I'm not sure the insulin monitor I have is all that accurate - seems like it needs a bigger drop of blood than I was typically getting when I first started monitoring and during the low reading (as I did it myself instead of with my wife holding him). Attached is a graph with all the results and interventions in the past couple days, any suggestions would be much appreciated. Since he seems better today and may actually be recovering some at 4u instead of 2, my plan is to hold him at 4u/12hr and do 150ml subq fluids every evening to hold off DKA, giving it when he's at or near his glucose peak (as I don't want to dilute when his glucose is lower). Keep that regimen for a few days at least and monitor to see where he stabilizes. I've accepted that if he dies because I mess this up it won't be any worse than what the vet suggested.

Here's an Imgur link to a timeline of his blood glucose and interventions. https://imgur.com/a/DeVUa1i

DeVUa1i
 
Last edited:
Thank you! How can I test? Does something like this work? https://www.adwdiabetes.com/product...yQAayAG3Y_auERZJ5iPyNYv8VFQyMzlRoCI6gQAvD_BwE

Assuming he is heading towards DKA, is there anything I can do other than try and keep his glucose as low as possible and administering subq fluids? I don't have an IV setup or way to monitor and adjust electrolytes like an intensive care hospital would.

How low does his glucose have to be most of the day to hold off DKA? Everyone says low and slow which is what the vet said but if he goes into DKA he's a goner anyway so I don't really think that's an option at this point we have to get his glucose reasonable now as I won't be able to manage a full blown DKA catastrophe and my vet would just put him down.
 
Last edited:
It's now next morning, pre-shot his glucose is 418 and he seemed stable (though very tired) all night. Doubling him up to 4u/12 hours seems like it might be working. I ran out of test strips so I wasn't able to monitor overnight. He went from 7.8 to 8.2 to 8.6 lbs over the last two days (probably mostly fluid and food in his belly, but still encouraging).

I'm live updating his glucose and interventions in the graph linked earlier here: https://imgur.com/a/DeVUa1i
 
The big climbs you are seeingis the cat's body bouncing from low numbers (or lower than the cat has become used to).

  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Dosing is based on how low a dose takes the cat. You just have to ride out the high numbers.

The catg had a low numbers event. It is imperative to drop the dose immediately. It takes just a second for a cat to go from asymptomatic low numbers to seizing.
Tagging a few people regarding what the new dose should be.

And just in case:
@Suzanne & Darcy
@Bron and Sheba (GA)
@Wendy&Neko

Readkng regarding DKA and ketones.
If you see another low number, post in the Main Health Forum and put up the red 911. Regardless of the type of insulin, low numbers are low numbers. Someone will notice and help you through the low numbers process. Always good to have a second pair of eyes.

And welcome. Waving from Canada.
 
I’m so glad that you are trying to help your baby on your own. Can you get a spreadsheet going so we can help you more? Make sure to test at every single preshot so that you know it is even safe to give the insulin. If he has a very low preshot number you would either need to skip the shot or give a token dose of half or even less of his normal dose. Have you read through the ProZinc dosing methods? Do you have a hypo kit ready? Have you read about how to handle hypos?
 
You cannot afford to assume that the 30 was a mistake because it’s dangerously low. You need to reduce the dose. Jacking the dose around by two units at a time isn’t a great idea. However, it os what it is, and I understand your panic.

can you purchase an inexpensive ReliOn blood glucose meter from Walmart? Are you in the US or Canada? In the US, the strips are $17.88 for 100.

For ketones you can buy keto stix from a pharmacy to test his urine. I purchased a blood ketone meter from ADW Diabetes Supply- the Nova Max Plus.
 
Is he eating well? In order to avoid DKA he will need to keep eating really well. And test for ketones as soon as you can get set up to do so.
 
Here are the instructions on how to create a spreadsheet:
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

What kind of meter did you say you were using? Is it a human meter or a pet meter?

What is he eating? Wet or dry food? Low carb wet food? What is his feeding schedule currently? Please give him food after the preshot tests (AMPS and PMPS, which means a.m. preshot and p.m. preshot tests). And feed him a small snack at +2 (two hours after the shot) and +4 (four hours after the shot.). The AMPS and PMPS tests should be done when he hasn’t eaten for two hours if at all possible. The reason for this is that the test number needs to be a “fasting” number which will not be elevated by food, which will inflate the Blood glucose (BG) number. This way, you will know if it’s safe to give the full dose or if a reduced dose is warranted, or even if it’s necessary to skip a shot for safety.
 
There is some information people here will need to know in order to help you. Some of it gets put in the signature (like type of insulin, type of meter, diagnosis date, any other conditions), and we have a spreadsheet where we store our blood sugar test data. Details on what goes where in this post:
New? How You Can Help Us Help You!

As far as ketones go, you can either use the ketone strips that go in the urine, you get get them at any human pharmacy, Ketostix is a common brand, or use a blood ketone meter. More information in this post: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

For now, you want him to eat as much as you can get in him, make sure he's getting enough but not too much insulin, and staying hydrated. Part of the formula for DKA includes infection or inflammation, so any condition causing that also needs to be treated. It can be as simple as bad teeth.
 
Thank you all so much. I put together a spreadsheet here which I'm updating with every intervention: https://docs.google.com/spreadsheets/d/1zNiZQh0UTBxDAdnjOoTbuOxAiqBCeSk8lxQC8gtxaB8/edit#gid=0

I also put together a graph that I'm regularly updating here: https://docs.google.com/spreadsheets/d/1zNiZQh0UTBxDAdnjOoTbuOxAiqBCeSk8lxQC8gtxaB8/edit#gid=0

Thank you all for the support. Addressing many of the questions above:
1) I do not believe he was at 30 I think it was an error. He had an appetite stimulating cream on his ear and I only got a tiny amount of blood, he was struggling as I'd messed up 2 attempts in a row (so that was the 3rd). I noticed that often if I just get a small amount of blood my reader shows "lo" due to a measurement error or gives low numbers that don't replicate on a second test. For example it showed 82 one time when he was expected to be high and I repeated it twice more and got 670's both times. He was acting perky alert and feisty at that time, he did not seem lethargic at all. I'm pretty sure I just messed up the reading and then freaked out and gave some higher carb treats because I'm new at this. Thank you Red and Rover and Suzanne and Darcy. I know if we can't get accurate data than we can't intervene correctly, so I've been working on the technique and I have a lot more confidence in recent measurements. He had 4 U when it showed 30, but again I do not believe the measurement.

2) His primary food is Purina ONE grain free: https://tinyurl.com/yphd2rne with him getting one can (3 oz, it's a small can) pre-shot morning and night, with 30 ml of Virabec hydration formula on top (https://www.amazon.com/dp/B071RC1V89?psc=1&ref=ppx_yo2ov_dt_b_product_details). He's been getting a bit of canned tuna or home made steak/salmon in between if he's getting hungry. If he is dropping fast and I'm worried I've given him a bit of the Friskies Pate Country Style Dinner (higher carb, what he used to eat) or 1-2 Temptations dry treats. I removed all dry food when he was diagnosed ~4 weeks ago. I also have 4 cans of ProPlan vertrinary Diets Critical Nutrition which is not low carb but is hyper tolerant in case he decides not to eat like he did on 10/23 as apparently it's sciences best attempt to make the tastiest cat food in existence.

Is there another suggested main food for him?

3) I am using the CERA-Pet blood glucose monitor with the cat calibration (https://tinyurl.com/mr2fmss6).

4) Yes, his routine is test - weigh - feed - administer glucose twice daily. If possible I'm pulling food 2-3 hours before his next shot so he's hungry enough to start scarfing when it's time for his injection.

5) He has been eating a LOT - as a ~7.8 lb body weight cat now (I want to cry) his weight was as high as 8.6 recently, meaning he probably had almost of pound of food and water weight in him. Hopefully he'll put some of that on.

6) The trend for him so far seems to be at that 4u he's not dropping enough and every cycle his highs and lows gets higher and higher, when he's hitting 650+ high I upped to 4.5 twice and then he's dropped to around ~100 and the cycle repeats over 36 hours with a good cycle or two followed by climbing highs and lows. I have only gone over 4 when off work or night cycle so I could monitor. This morning I tried 4.1 U (just a hair over 4) and I'm hoping we can better dial him in.

7) His insulin is Pro-Zinc. I'll try and figure out how to set up my signature tonight - headed to work shortly.

8) His teeth were cleaned a bit ago and his oral hygene is good. He had a tiny sniffle a couple days ago but it seems like it went away. No apparent infection most likely, one of his legs is swollen but I think it's fluid buildup from subq fluids. Subq fluids are being administered daily to try and keep him well hydrated, and Virabec is being added to his meals as well to help with hydration. He obviously has lots of water as well.

9) I have a hypo kit ready, luckily haven't had to use it.

He is so skinny I can literally feel his kidneys and every rib - he's a halloween skeleton cat just in time for the season! Seems better than 3 days ago though - I'm very confident keeping him on 2U constantly in 800- with lows of ~400 or so and going slow would have killed him.

Thank you, you guys are awesome. Headed into work but I'll try and monitor here as well and thank you for everything. This weekend I should be able to pull more things together.
 
Last edited:
Both the graph and spreadsheet aren't open to users who have the link. You need to change the access so others can see the data.

I'm not familiar with the Cera pet meter. The majority of us here use human meters because the pet meters test strips cost so much, and our dosing methods were created before there were pet meters.

Sounds like he's on a low carb food, so that's good.

I'm removing the 911 from the subject, as this isn't an active medical emergency.
 
You must log in or register to reply here.
Back
Top