in DKA recovery at home, bg not dropping, increase insulin?

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equine99

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So per previous posts, we're now continuing to recover from DKA at home. I gave her about 90 cc's of subq fluid today at 1pm and then again tonight at 1am, and she seems to be re-hydrating well and has her appetite back and is drinking water. Unfortunately, her insulin seems to be completely ineffective. this morning before taking her into the vet she was 301, so I gave her 0.4units. With some spots tests throughout the day, I don't think she ever dipped below that. Tonight I gave her 0.6 since I wanted to be more aggressive and that also seemed to do nothing, so I gave 0.2 more, 3 hours after the first dose, and she still hasn't dropped at all. Tomorrow morning, I may give a whole 1 unit, but is that too big of a jump? I do NOT want her bg to be high right after our run in with DKA, and so far there hasn't been any drop, and the vet is closed for the long weekend. Any thought on this?
 
Re: in DKA recovery at home, bg not dropping, increase insul

In our discussions on the PZI forum, we have thought you need to increase and hold the dose 12 hours, with no dosing in between. (it just clouds the picture). I think I would increase to one unit at your next preshot (as long as she is still in the 300 range) and hold that dose for a few full 12 hour cycles. That should help us figure out how the insulin is working.

And be sure to test for ketones often.
 
Re: in DKA recovery at home, bg not dropping, increase insul

Well, I was doing that before, just not getting a lot of mid cycle readings, but since she just had DKA, when I saw that her numbers weren't dropping at all (and were, in fact, increasing) I thought I'd rather get her numbers down than do this methodically to find the right dose for her, as I'm not convinced that she's out of emergency mode just yet. So this morning her PS was 369, so I shot a full unit. Hopefully that will do at least something. I saw some of the other SS's that looked like mine, where nearly all of the PS and mid-cycle numbers were all in the 300's, and they increased doses but it didn't seem like it did anything, so I'm really hoping that won't happen here. If it does though, maybe that's a sign that she needs to switch to a different type of insulin?
 
Re: in DKA recovery at home, bg not dropping, increase insul

Yes, you could change insulin. But I would dose the ProZinc twice daily 12 hours apart for a while at one unit to see what happens. Then the next thing would be to increase by .25 or .5 units and see what happens. 300s are not awful numbers for preshots. If she doesn't go down midcycle in a few cycles, then you certainly should increase.

This is not a fast process. Her body has to "learn" to use the insulin and respond to it. She has had so many things going on. I would suggest letting her settle in. As long as you are testing for ketones, she should be safe.
 
Re: in DKA recovery at home, bg not dropping, increase insul

Are you giving the fluids and the shot in the same general location? I've read recently that when giving fluids, using another location to shoot the insulin was recommended. Bob's fluids were given in the scruff area. His shots were not. I also read that insulin can be less effective in a dehydrated cat, and once the dehydration was under control, the insulin seemed to work more effectively.

Carl
 
Re: in DKA recovery at home, bg not dropping, increase insul

I'm giving the insulin a little higher up in her scruff, and the fluids farther down, and I'm only giving the fluids at least 4 hours post shot. Where else can you give insulin shots? I'm open to trying other locations. Her dehydration is greatly improved. The er vet estimated it as 12% and when I was at the vet yesterday morning he estimated 4%. Since then, she's gotten 200 ccs of fluids and has been drinking on her own, so I think must be better by now. When she was at the vet getting humulin R she was responding well to the insulin and dropped into the 100's and then stayed in the 50-60's for 6+ hours after it should've been out of her system, then overnight jumped back up into the 300's. This morning her PS was 369, and every test I took yesterday said that her insulin wasn't doing anything, as she rose after her shot.

update: at +3, she's at 358--possibly down a little, or the same. at least she hasn't risen. She seems fairly hydrated so for the sake of not getting in the way of the insulin, I'm going to wait to give her her fluids until I come home a little later today.
 
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