DKA Survivor--New to Lantus--Need Advice

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WenDawg

WenDawg

Member Since 2014
Hi everyone--I just picked my cat of from the vet today after being there since Sunday night. He was basically lifeless when I found him due to an infection and DKA, but after close to a week at the vet, he has mostly recovered. But, the vet has now switched the insulin (PZI to Lantus), he is also on Clavamox for the infection and I'm having trouble getting him to eat.

I don't have a spreadsheet for him yet as he's only been home a few hours, but when I just tested him for his PMPS he was at 48 (I tested 3 times and got 48, 50, 48). If he was still on PZI, I'd know how to handle this, but being new to Lantus and him just recovering from such a traumatic health event, it all just makes me a little nervous. The vet seemed a little torn about what to do as well and didn't want me to shoot if I couldn't get him to eat or when his number was so low, but was also worried about his BG spiking from not shooting. So for right now, I'm just holding off shooting and looking for suggestions.

I have not had time to review a lot of past posts due to all of this happening so fast. So any advice would be appreciated.
 
Welcome to LL. I'm not experienced enough to advise you, but I'm sure someone with more experience will be along soon. It might be a good idea to add "Urgent. Do I Shoot?" to the title of this thread. The experienced people scan the titles to see who has an immediate need. I hope the evening goes well for you and Abernathy.
 
When a cat is newly out of DKA, it's really important to get the insulin into them. That's too low for you to shoot, though. Are you at shot time right now?

Let me get some more eyes on you so we can give you the best possible advice.
 
If you can stall without feeding and test again in 15 minutes, that would be best right now. We want to see a rising number without food influence.

Another option is to shoot a BCS (Big Chicken Sh*** shot). What dose of Lantus is he on and how long has he been getting Lantus?
 
Do you know what type of infection? Clavamox is an effective AB, but it is also well known to make cats nauseous and vomit. There are other Abs that are less harsh on the cat, but it depends on what the infection is.
 
Thanks everyone! I'm now an hour past shot time. He did eat a small snack and is currently at 99. But, I'm guessing that is food induced rise. He has only been on Lantus for 1 day. They started him really high at 2 units twice a day because he was running so high. They did a BG Curve on him before leaving and he never dropped this low, but he was also in that high stress environment.

He has a UTI and they are waiting for the culture to comeback to see if they need to switch the meds. They said they put him on this to cover the infection until the get the results. The vet also said not to give him the antibiotic if I didn't get him to eat a full meal. So, I've not done that either.
 
Ann & Tess said:
More questions: do you have plenty of test strips, high carb wet food, honey or karo?
Click to expand...

Yes I've got all of that.

I'm heading into the night/bedtime and am worried about something going wrong in the middle of the night when I'm not awake.
 
Not sure how familiar you are with Lantus - it builds up in the body and it can take 5-7 days for initial depot to form and for us to see what the dose will really do. So having low numbers on the second day is telling.

Can you reliably stay up with him if he has low numbers tonight?
 
That is a high starting dose. Lantus works a lot differently than PZI, the dose is based on the nadir, th lowest the insulin will take the BG, not on the preshot value. It also takes several days before you will see the full effect of the dose. Lantus builds up a reserve in the body (we call it the shed) and until that is established,(initially 5 to 7 days) you won't see the full effect of the insulin. If you are seeing this much effect already, it is just too much for him.

My Tess is prone to UTIs, usually from e-coli. Orbax has been very effective and doesn't make her nauseous like the Clav does. It also comes in a liquid so is pretty easy to administer. Not one of the cheaper ABs though.

Got to go, shot time here too. BBL
 
julie & punkin (ga) said:
Not sure how familiar you are with Lantus - it builds up in the body and it can take 5-7 days for initial depot to form and for us to see what the dose will really do. So having low numbers on the second day is telling.

Can you reliably stay up with him if he has low numbers tonight?
Click to expand...

I'll be honest, this has been a traumatic week for me and I'm exhausted. So, sadly, I just don't know how reliable I will be trying to stay up with him. That's really why I'm scared to shoot anything, but also understand that I don't need his BG skyrocketing either.

He has eaten a snack for me, but not a full meal like he previously did prior to getting sick.
 
Ann & Tess said:
That is a high starting dose. Lantus works a lot differently than PZI, the dose is based on the nadir, th lowest the insulin will take the BG, not on the preshot value. It also takes several days before you will see the full effect of the dose. Lantus builds up a reserve in the body (we call it the shed) and until that is established,(initially 5 to 7 days) you won't see the full effect of the insulin. If you are seeing this much effect already, it is just too much for him.

My Tess is prone to UTIs, usually from e-coli. Orbax has been very effective and doesn't make her nauseous like the Clav does. It also comes in a liquid so is pretty easy to administer. Not one of the cheaper ABs though.

Got to go, shot time here too. BBL
Click to expand...

Great suggestion on the antibiotic. I was wondering if it might be making him not feel good. I can call vet in the morning about that.
 
the general rule of thumb with a cat recently out of DKA is that it's really important to get the insulin in, even if it means that you feed high carb food. DKA isn't necessarily related to high blood sugar - so the issue isn't just about him going high if you don't shoot. it's abou the need to get insulin into him.

Would you be able to nap and wake back up? I know all of us understand the exhaustion issue, but no one would want him to be alone and in low numbers if you fall asleep.
 
julie & punkin (ga) said:
the general rule of thumb with a cat recently out of DKA is that it's really important to get the insulin in, even if it means that you feed high carb food. DKA isn't necessarily related to high blood sugar - so the issue isn't just about him going high if you don't shoot. it's abou the need to get insulin into him.

Would you be able to nap and wake back up? I know all of us understand the exhaustion issue, but no one would want him to be alone and in low numbers if you fall asleep.
Click to expand...

So what amount should I shoot? While the vet said 2 units, I'm thinking with him being so low, I need to drop that amount.
 
I want to do a quick summary to make sure we have the essentials down here:

Sir Abernathy, DKA from Sunday - today at the vet's (5 days)
previously on PZI since diagnosis 8/2014
UTI, on clavamox while doing a culture
One day on Lantus 2.0u (2 shots or ?)
+13 (13 hrs since this morning's shot he's at 99)

Is all that correct?
 
sometimes when you've got A Situation, the posts will come at the same time. Just want to make sure you see my previous post.

How much does Sir Abernathy weigh? - and if he is overweight, what would you guess his ideal weight would be?
 
julie & punkin (ga) said:
I want to do a quick summary to make sure we have the essentials down here:

Sir Abernathy, DKA from Sunday - today at the vet's (5 days)
previously on PZI since diagnosis 8/2014
UTI, on clavamox while doing a culture
One day on Lantus 2.0u (2 shots or ?)
+13 (13 hrs since this morning's shot he's at 99)

Is all that correct?
Click to expand...

Yes all above is correct.
The dosing is 2.0 units twice a day
He weighs 9 pounds (at this weight he's pretty thin)
I'm at 13.5 hours since last insulin shot.
He's at 133, but has been eating a little bit of food.
 
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at 9 lbs, his starting dose on Lantus would be 1.0u if he were newly diagnosed. With a past on PZI, we would take into account the dose he had on that. What was it? Was he getting good control with it with your recent dose, ie, how low would that dose take him? If you were giving him a lot more than that of PZI, that might change the suggested Lantus starting dose.

I don't have personal experience with DKA, but I am looking at some of our reference materials and can tell you that it's extremely important to get the insulin in, even if it means giving all high carb food.

I think if he were mine, I'd give him 1.0u of insulin. Then I would continue to test him and pull out the high carb food to keep him safely over 50 - i'm assuming you're using a human glucometer. Are you?

It's really hard when you're exhausted, so I'd try to catch a nap in between tests. I'd test him at +1 to see where he is. Lantus typically onsets about 2 hours after you shoot. I can't say what will happen after you shoot and you really do have to monitor him in this situation.

It's up to you, though. this is what I would do, but you're the person there.

Connecting with your vet is another option that you should keep in mind. It's too bad he wasn't more stable when you got him home.
 
On PZI, it was roughly up to 4 units twice a day and when I would do a curve, it would usually take him into the 80-90's at nadir.

Yes, I am using the Relion meter from Walmart.

This is great info. Thank you!!!
 
ah, ok, that changes things.

Still - the 2u got him into the 40's right away, so at least while his appy isn't 100%, i think i'd drop the dose for tonight. You may need to increase it as his appetite returns.

What do you want to do.
 
I'm going to give him 1 unit. I've got the higher carb food out, so I think that he will be OK. But, I'll set me alarm to check on him. Thanks again. I appreciate the advice.
 
I'll watch for you tonight. Our custom is that if someone encourages you to shoot, they also stay with you. Can you get a +1 to see where he's going? Don't want him to take a dive without letting us know he's got one planned!
 
WenDawg said:
Great suggestion on the antibiotic. I was wondering if it might be making him not feel good. I can call vet in the morning about that.
Click to expand...
I'm not saying that Orbax is necessarily the right choice, that depends on what they fins w/ the C&S. Just that there are other choices.

Sorry I had to leave, but Tess (and Emma and Izzy) are hard task masters. I'll be around tonight for a while too. I think your plan is a good one. Julie really knows her stuff, you'r in good hands.
 
Welcome to the Lantus/Levemir forum. I'm sorry to hear your guy has been sick. Is he eating at all?

Sometimes, we can get a quick response on lantus....even on one dose. We generally think that it has to build up a depot but it doesn't always. I often wonder if a cat that's been on another insulin can get a little bit more of an onset from lantus at the beginning than if they were just starting from "scratch" on lantus and never had another insulin before.

I think shooting 1u tonight was a wise decision. Since we don't know if that is a really good dose for him or whether it's just the reduced eating that's causing low BGs...or both....it's better to be cautious.
 
Thank you to everyone for your advice. I truly appreciate it!!!!

I shot 1 unit. Before I shot, he was at 195. It's now +1 and he's at 240. I've left food out for him, so I think he'll be fine.

Thanks again.
 
Before you go to bed....just want to post quickly for you. The 240 can be a food spike...it's not that big of a number. If you can grab a test before you go to sleep.....hopefully at least the +2 or even a little after, then you'd know for sure if he's going up or not.

If his +2 is similar to the preshot, he might come back down and have an active cycle. If it's alot higher, then you can hit the sack and leave food out.
 
How are you and Sir Abernathy doing this morning?

Did your vet suggest that you test for ketones? You can buy Ketostix at any pharmacy. They are urine dip sticks that will let you know if ketones are present. They are an inexpensive form of prevention that are good to have on hand if you have a cat that has recently been ketoacidotic. There are also blood ketone meters but the strips are expensive. They are a more reliable means of testing although most of us use the ketostix.

The basics of ketones involve a cat not getting enough insulin couple with not eating and the presence of an infection/inflammation. It's why we were interested in making sure your kitty was eating. If Sir Abernathy's appetite doesn't immediately pick up, you may want to discuss adding some meds to help relieve any nausea (many here use Cerenia or ondansatron) and an appetite stimulant (e.g., mirtazepine or cyproheptadine). You need to control any nausea first before giving an appetite stimulant. You also might want to try something like baby food. Many cats find baby food irresistible and it will get them eating. (You want either Gerber or Beechnut Stage 2 -- it's broth and a protein, no onion or other veggies).
 
Hi everyone. I just wanted to thank everyone again for your help that night. I truly appreciate all the suggestions and feedback. I have created a new thread with an updated spreadsheet. If anyone is interested in taking a look and giving feedback, I'd appreciate it. His numbers are still all over the place.
 
When my DKA kitty's infection started to clear up, I had really wacky numbers for a week 50-500 in one day, and then they started to be normal quickly. The good thing that I see on your spread sheet is that he has a response to the insulin (not just all high, all the time). He's looking good at the +4 to +6, but preshot values are very high. It almost seems that the lantus is wearing off too early in the cycle (usually there is an overlap from one dose to the next).

Lantus in a cat that was close to DKA doesn't work as well as in a non-sick cat. The time release mechanism of lantus depends on the body's pH so the alterations in pH that happen in DKA can change the effectiveness. Levemir works differently and does not depend on pH for it's time-release. You might see his numbers change once his electolytes/pH become more normalized.

Also, maybe the infection is still present, or there is a second infection going on?

It's very important at this stage to get his numbers under 300 to prevent dehydration and another DKA episode.
 
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