? I'm a noob, just started hometesting, recent DKA, not sure vet's advice is best advice

Hello,

My cat Olivia is about 10 or 11. I've had her for 8 years. She began losing a lot of weight and urinating frequently in January/February and was diagnosed with diabetes. So, we started insulin therapy, Prozinc 1 unit twice a day. I took her back in a few weeks later and they upped her dose to twice a day. We discussed home monitoring, but vet didn't think it was absolutely necessary. Also, Prozac for inappropriate urination because we had some foster kittens and I think that and diabetes were causing a lot of stress. We continued onward and things seemed alright.

I went out of town 7/11 and my brother (with type 1 diabetes, so competent on care) came to stay with her and the other critters. On 7/13 he said she didn't want to eat and seemed lethargic. He stayed up all night with her and realized things were Not Good. She was admitted to the emergency vet early morning 7/14 with DKA and guarded to poor prognosis. Low temp, low ox, low blood pressure. High kidney numbers, but no other infection could be found. She pulled through and was transitioned back to long-acting insulin, was discharged to regular vet 7/16 to continue BS monitoring. Olivia was discharged to home 7/17 with same dose of 2 units BID.

So, I bought an Alphatrak2 monitor. The vet's office offered to walk me through first use, so we went in yesterday and BG was 428 the tech said her numbers were not too concerning considering she had just eaten and to only test in the 4-6 hour window after administering insulin.

However, I know my brother aims for consistency in his own numbers. I've read a lot on this website. I feel like we need some consistency. I just want Olivia to feel ok.

TLDR: So, should I be testing at specific intervals to find a curve? Should I keep dosing at 2 units? Should I discuss all this with my actual vet instead of the tech? Should I be looking for a new vet?

 

Welcome! We can help.

Are you referring to Lantus (glargine)?

This might be a good dose or not. The only way to know is to track BG at home. Many vets say there's no need to test at home but we'd disagree. Everything we do here is based on routinely testing BG and tracking numbers on a spreadsheet. A DKA episode is serious and I think you'd agree that it's time to try something different.

This is a new member's handout I put together. It covers a lot of our "basics". Read it through and ask any/all questions you have. If you're using Lantus your best place for help from people with a high level of expertise is the Lantus forum.
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It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

I am still administering ProZinc insulin BID. At the emergency vet she was not eating and they wanted to get her numbers down quickly and safely so they used a faster acting insulin then transitioned her back to ProZinc on her last evening there and regular vet kept her for a day to make sure that it was having an impact.

I set up a spreadsheet and it is in my signature, just started testing yesterday, so no a lot of data, but it's too pretty high. The ProZinc is working mid-day to get her down from the red to the yellow.

Thank you for the advice on when to test! AMPS, mid-day, and PMPS and extra if possible.

 

The way we'd approach this post-DKA is to get those BGs down faster by increasing after 3 or 4 cycles by 0.5 u. Once you start to see a lot of blue on your SS the increases can be dropped to the preferred 0.25 u.

This is a summary of post-DKA care I copied from a very knowledgeable member, @Meya:
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Some pointers for aftercare of DKA:

Feeding: Most cats will need 200-300 calories a day, a generally larger cat will probably need closer to 300 calories, aim for this amount. Calorie counts are listed on most food packaging. If your cat isn't eating this much, it's important to start intervening (syringe feeding or other means) to increase intake. Poor intake = Burning fat, which is what leads to increasing ketones. This is usually equal to 1-1.5 large 5.5oz cans. If your cat will eat dry food, put it out. Whatever he'll eat, treats, pure sugar, whatever, let him have it. You can always adjust insulin higher which is kind of what we want to decrease ketones. If you have to syringe feed, do it as soon as possible. Try and aim for small amounts of food every 2-3 hours at least.

Blood sugars: During recovery you want to aim the sugars a little higher than "normal", or aim for about 150-220ish. Too low and it's usually because kitty isn't eating enough. So for BS <150, instead of reducing or withholding insulin, try to feed some high carb stuff. This might even mean mixing honey with wet food or dry food, or syringe feeding. Consistently over 250 means insulin needs to be increased. Increase by 0.25U and see what happens in the next 24-48 hours. Try to keep doses stable, a sliding scale protocol will increase the chances of too low insulin which can increase ketones. You might have to increase a few times during recovery.

Ketone tests: Check them at least once, better twice a day. Ketones can develop VERY rapidly in < 24 hours.

Fluids: Ask your vet to show you how to do subQ fluids at home, this can make a great difference in relieving the lethargy and nausea that can happen with dehydration. Oral fluids should be about 300ml/day, this includes the amount in food. Most 5.5oz cans have about 200ml give or take. So try to replace at least 100ml extra orally.

Nausea: Nausea is the main barrier to eating. Ask your vet for an anti-nausea if you don't already have one.

Potassium: Potassium levels can go very low in DKA. This can lead to weakness, poor appetite, nausea, and heart problems. Call your vet and check what the levels were and if you need to get a supplement. If you do subQ fluids this is especially important. Also, get this retested in about 3-4 days if possible if he's still lethargic.

Recovery: Most cats won't eat on their own in the first week and require some amount of feeding support. Once they are eating some amount on their own, and insulin levels are increased to a sufficient amount, they should continue to improve and be generally back to their baseline after 2 weeks or so, minus any bumps on the road. In a study I read on DKA in cats, cats that got DKA as their initial presentation prior to diabetes diagnosis had a much higher rate of recovery, probably because there isn't an underlying infection or other illness triggering, just lack of insulin.

Weight loss: In the future your kitty is going to be at higher risk for DKA, if you decide to try a weight loss diet at some point or any time you reduce insulin, you should test for ketones.

 

Lots of great advice from Kris, so I'll just say welcome and that we are here for you.

 

Welcome!!

And ask all you need