Insulin increase and Diet

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Ninja & Baby said:
The attached clip sounds like Ninja.....like most of you have already stated.

The Vet's office called last night and obviously they haven't even looked at him. They are to assess him this morning. . . . . .
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That's my take on it but I'm not a vet, just the mom of a bouncy cat who easily gets stuck in high numbers. That led to his DKA episode in March last year at the end of his first round on Lantus.
 
Yes that is exactly what we are referring to. I'm guessing the dose of insulin was too high all along and what you ended up with was a cumulative effect. His BG didn't come down so they shot more insulin while he was still hyperglycemic from previous doses and you end up in a vicious circle. This is the problem with cats and vets offices. The stress factor can elevate the BG by 100 points or more in some cases but the vet has no idea how much of the BG reading is "real" and how much is stress induced which leads to them prescribing too much insulin. Something we see around here a lot unfortunately. :(:(:(
 
I need advice. I went to the vet's office to check on Ninja. As far as I could tell, they've done nothing for him. They are still giving him 2 u of vetsulin. His BG was 732. It appeared they weren't even giving him fluid. The vet wasn't there so I was not able to get any information. I was told he would call me later. I've spent nearly $2000 trying to get him straightned out in the last 6 weeks and he's worse now than when he started. Should I switch vets? Am I jumping the gun?
 
Ninja & Baby said:
I need advice. I went to the vet's office to check on Ninja. As far as I could tell, they've done nothing for him. They are still giving him 2 u of vetsulin. His BG was 732. It appeared they weren't even giving him fluid. The vet wasn't there so I was not able to get any information. I was told he would call me later. I've spent nearly $2000 trying to get him straightned out in the last 6 weeks and he's worse now than when he started. Should I switch vets? Am I jumping the gun?
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My personal opinion is that horrible high of 732 is a bounce from far too high a dose of insulin. His body can prop it up only so long and then he'll crash to very low numbers. That's the big worry. Unless/until you get really good information from the vet about what's going on and a good treatment plan outlined, I'd get him home as soon as you can (if he's otherwise OK) and start experimenting with lower doses. At the same time, you could call other clinics to ask how many FD cats they treat.
 
I need advice. I went to the vet's office to check on Ninja. It appeared that nothing has been done for him. They are still giving him 2 u of vetsulin. His BG was 732. I saw no signs they were giving him fluids. The vet was not there so I could not get any information. I've spent nearly $2,000 and 6 weeks and he is worse now than when I started. Would I be jumping the gun to switch vets? Should I wait?
Kris & Teasel said:
My personal opinion is that horrible high of 732 is a bounce from far too high a dose of insulin. His body can prop it up only so long and then he'll crash to very low numbers. That's the big worry. Unless/until you get really good information from the vet about what's going on and a good treatment plan outlined, I'd get him home as soon as you can (if he's otherwise OK) and start experimenting with lower doses. At the same time, you could call other clinics to ask how many FD cats they treat.
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I'm going to go get him. How much do you think I should give him tonight?
 
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Ninja & Baby said:
I need advice. I went to the vet's office to check on Ninja. It appeared that nothing has been done for him. They are still giving him 2 u of vetsulin. His BG was 732. I saw no signs they were giving him fluids. The vet was not there so I could not get any information. I've spent nearly $2,000 and 6 weeks and he is worse now than when I started. Would I be jumping the gun to switch vets? Should I wait?

I'm going to go get him. How much do you think I should give him tonight?
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In the interest of not burning any bridges you might ask to speak to the vet to see what he/she's thinking, not that it should change your mind. If there was no DKA in the picture I'd say try 1 u. However, it might be better to go with 1.5 u tonight and tomorrow AM to see what happens. You can lower it more if needed.
 
Update: I went to pick up Ninja. The vet wanted to talk to me. He said we had two choices: try another insulin in a lower dosage or keep him over the weekend and purge all insulin from his body. At that point, he said sometimes the pancreas kick in. I chose to try ProZinc at the lower dosage and see what happens.
 
Ninja & Baby said:
Update: I went to pick up Ninja. The vet wanted to talk to me. He said we had two choices: try another insulin in a lower dosage or keep him over the weekend and purge all insulin from his body. At that point, he said sometimes the pancreas kick in. I chose to try ProZinc at the lower dosage and see what happens.
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ProZinc is a good insulin. It's an in-and-out insulin like Vetsulin (no slow release depot like Lantus) but is gentler: slower in onset and lasts about 12 hours in most cats. What lower starting dose did the vet suggest?
 
Kris & Teasel said:
ProZinc is a good insulin. It's an in-and-out insulin like Vetsulin (no slow release depot like Lantus) but is gentler: slower in onset and lasts about 12 hours in most cats. What lower starting dose did the vet suggest?
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He said I should give him one unit every twelve hours.
 
Ninja & Baby said:
He said I should give him one unit every twelve hours.
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That's a good starting dose. :) I think trying the ProZinc is a better plan than stopping insulin for the weekend. This is exactly what plunged Teasel into DKA when his insulin was stopped. The plan was 48 hours off Lantus with a restart after he got stuck in high numbers. After 24 hours of no insulin, Teasel started a DKA episode.
 
I was afraid to take the insulin fasting route. He said it would be rough on Ninja, and I'm not sure he could endure the ordeal. He's so thin and stressed and frail. I was suppose to watch him after the injection but he has hidden and I can't find him.
 
Just catching up now. Didn't get any alerts since yesterday morning for some reason!:mad::(

I agree with a reduced dose of insulin but the rationale for changing to another insulin right now escapes me. The immediate goal is to get Ninja's BG down. At least with Vetsulin you know how he acts and what his numbers have been so far which gives you some history on which to make dosing decisions. IMHO changing insulin at this point in time just complicates things more because you have no idea how he will react to it. You are going to have to monitor him very closely even if that means closing off other rooms or keeping him in one particular room so you can find him.
 
MrWorfMen's Mom said:
I agree with a reduced dose of insulin but the rationale for changing to another insulin right now escapes me.
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I think I left out part of the story. The vet said he withdrew insulin for 24 hours and Ninja's numbers didn't drop. I reported earlier that he had been receiving 2 units of vetsulin. That is what the nurse told me because that was what was written on the board. I assume the vet knows what's going on but who knows. That's the reason I agreed to the ProZinc.

His BG this morning was 541 which was +13 since his last shot. I did notice that his water consumption is down. I don't know if that is from the lowered dosage, the different insulin, or he is just shutting down. I kept trying to get him to eat. I finally gave up and gave him 1u since his BG was 541.

I have been trying to get a check on ketones but no luck yet. Just not drinking and peeing as much.
 
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There are so many things going on here that it's hard to know what to do:
  • he needs insulin and you gave him 1 u of ProZinc
  • he needs food so you might have to isolate him like Linda suggested and even try syringe feeding meat/broth baby food and also give water by syringe
  • he needs to have urine ketones checked. A litter box in the room you put him in will help and you'll have to watch him so you can catch him at it.
  • give some serious thought to taking him to another clinic for a second opinion. I'd call around and ask if they're experienced in treating diabetic cats.
I'm sorry if this list feels like pressure. We're trying to give you some concrete things you can do to help Ninja.
 
That makes a bit more sense except that if this is insulin induced hyperglycemia then it will take longer than 24 hours to clear his system. If he is not eating, then what we'd normally do is withhold or reduce the dose of insulin because there is no food on board for the insulin to work with. If his numbers don't come down more today, I wonder if a further reduction of dose might be in order. Has he eaten yet?

I'm surprised his water intake is down. Check his scruff to make sure he is not getting dehydrated again and syringe some fluid into him if need be. Please make sure you test him to see what his BG is around +3 or +4 post shot. It's vital to keep tabs on him right now. And I agree with Kris that a second opinion would be a good idea.
 
I don't know if you saw my spreadsheet, but Ninja's BG was Hi at +2. It went up after I gave him his insulin. I think you are right, Linda. Maybe even a lower dose is in order. I am syringe feeding him hourly...just a little at a time. ...I would tell you how much but it is a big syringe and I am giving 10??? I don't know enough about syringes to know what it is..I guess ml's??? Does that sound reasonable? I just talked him into peeing--negative for ketones. I think he may be constipated. It appeared he was trying to poop and nothing came out.
 
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So glad to hear he peed and has no ketones. Constipation could cause some BG elevation but certainly not that much so keep an eye on him. I guess the big question is when did he last have a bowel movement? Has he gone since he came home? Has he eaten enough to go? If you are syringing food into him, that too will bring his BG up a bit. Mixing some water into the food you are syringe feeding will help some. I don't know whether your measurements in the US on baby syringes would be in ml or oz. Does the syringe have "ml" stamped on it beside the 10? If so that is milliliters.
 
I see it now. It is ML. I don't know when he's had a BM.....not since he's been home. I don't think he's eaten enough to have a BM, but he thought he needed to go. Do you think the insulin injection could have raised his BG?s Any ideas on constipation relief?

I am going to work with Ninja this weekend and if he's no better on Monday, I'm going to get a 2nd opinion....ASAP!
 
Ninja & Baby said:
Do you think the insulin injection could have raised his BG?s Any ideas on constipation relief?
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Right now it's hard to tell what's causing the BG to stay up especially when you are using a new insulin for which we have no history. Yes it was a smaller dose but it is a different insulin. Check his BG again around +4 and see where he's at. ProZinc has a slightly later onset than Vetsulin so until you get a few more readings, we are just guessing.
As for constipation, I'd be reluctant to give any laxative right now but you could try some pumpkin mixed into his food. It has to be plain pumpkin and NOT pumpkin pie filling. It's good for constipation as well as loose stools as it adds bulk.
 
Is there another vet you can take Ninja to? The HI BG may be making him nauseated. I'm really not sure this is something you can deal with at home. I'd expect him to be coming down at least a bit and he really hasn't moved that much and is up again after the insulin. I really think he needs some intense monitoring right now.
 
MrWorfMen's Mom said:
Is there another vet you can take Ninja to? The HI BG may be making him nauseated. I'm really not sure this is something you can deal with at home. I'd expect him to be coming down at least a bit and he really hasn't moved that much and is up again after the insulin. I really think he needs some intense monitoring right now.
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I agree. This is making me worried. Glad the recent ketones test was negative, but there is something going on here.
 
I do not want to leave him at a vet. The last overnight visit to the vet was very stressful on him. Even the vet said he had gotten very ornery which is not like him. I'm afraid he will just shut down altogether if I drop him off again.
 
I don't know about just dropping him off again, but it would be good for a vet to check him out, ideally a second opinion rather than the first vet [edited for clarity]. If the problem is simple constipation, they may be able to give him something for it to get it resolved, and then there is always the possibility of something more serious, like a blockage that he can't clear on his own. Or maybe he has some kind of infection going (though you'd think the other vet would have caught that), but the point is, there's something causing these ultra-high numbers, and it might need vet care.
 
Paula, I realize you are concerned about his wellbeing at the vet but the problem is that we don't know exactly what is happening here and with the DKA recently we don't want to decrease the insulin too much but also don't want to perpetuate what looks like hyperglycemia due to the insulin. This is a fine wire to walk and I just don't think it's safe to try to handle this at home. Nor are we equipped to coach you through it because we are not vets and quite frankly this has gone beyond anything I've seen before. If he can't hold down food/water then he's going to be set up for another bout of DKA. Urine doesn't show ketones immediately so I strongly urge you to take him to at least get a second opinion.
 
The new vet was very discouraging. She thinks he has a mass in his abdomen. My other vet did x-rays and never mentioned it. She said he is dehydrated. I'm going to ask her to give him some fluids and something for nausea and take him home. I asked her if his numbers could be high because of too much insulin and she had no idea what i was talking about.
 
If she is just palpating and he is constipated, that could be what she is feeling so don't despair. If the other vet did xrays and didn't see anything seems unlikely he has a mass. Get him well hydrated at the vet and if blood ketones are clear, I'd skip the insulin tonight to see if that brings him down some. Then you can re-start insulin at a low dose (lower than 1u) and work to get him leveled off. I'm feeling for you Paula and we'll stay with you and help as best we can.
 
Well then did she suggest the possibility of an enema to clean him out. That could be partly responsible for elevated BG as well as his vomiting. He was dehydrated before and is again which certainly explains how he would get constipated.
 
She didn't have any helpful advice!!! All I got out of it was a bag of fluids and a shot for nausea....and that's what I asked for. She did say she could keep him for several days to put him on an insulin drip. . . . . .uhhhhhh, really????????? And I could have gotten that deal for the bargain price of $600!!

I'm thinking at this point why am I even giving him insulin? It isn't helping and for all I know it is making it worse. Does he need to be weaned or can it be cold turkey or just a lower dose?
 
Ninja & Baby said:
She didn't have any helpful advice!!! All I got out of it was a bag of fluids and a shot for nausea....and that's what I asked for. She did say she could keep him for several days to put him on an insulin drip. . . . . .uhhhhhh, really????????? And I could have gotten that deal for the bargain price of $600!!

I'm thinking at this point why am I even giving him insulin? It isn't helping and for all I know it is making it worse. Does he need to be weaned or can it be cold turkey or just a lower dose?
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If you can get him over this hump and get the constipated issue under control, a low dose of insulin is what to try next.
 
Deep breathes Paula. If Ninja got something for nausea then maybe he'll eat on his own. If not, you can give him some food via syringe. I take it she showed you how to give SubQ fluids? Did she check for ketones? If I were you, I'd skip the insulin tonight and see if that doesn't bring his BG down somewhat. Test him once tonight to get a baseline starting point. Even if it's HI you'll know when you get an actual number that it's coming down. Let's play this You could get some Mirolax to help with his bowels but I've never used it myself and I'm not sure I'd want to do that till he's eating on his own again. I think for now I would work on getting his fluids up. Keep in mind that if he's really dehydrated, that would affect his weight quite a bit so don't despair over the 6 pounds. Water is heavy.

I think you are going to have to take this one cycle at a time right now. I really think the first goal has to be to get him rehydrated and get that BG to come down so he feels better. The dehydration alone will cause some elevation of BG.
 
MrWorfMen's Mom said:
Deep breathes Paula. If Ninja got something for nausea then maybe he'll eat on his own. If not, you can give him some food via syringe. I take it she showed you how to give SubQ fluids? Did she check for ketones? If I were yo
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I feel like a cat chasing its tail. They gave him one unit of fluid and said to give him one unit twice daily. He did seem to feel better pretty quickly after that. I'm thinking that some of this could have been avoided if I'd had SubQ fluids all along.

No, she did not check his blood glucose nor did she check his ketones. She wouldn't look at my spreadsheet either.
 
Paula, I'm sorry. I've been following this thread and was waiting for you to get back from the vet this evening. I know having a sick kitty is very, very stressful. If the vet felt hard fecal matter, you could try giving Ninja a little coconut oil, olive oil, unsalted butter, or even some hairball gel... something to see if you can get things moving. That and fluids may help. By the way, I don't know why, but some cats will eat a little if you have the food bowl ready to put in front of his face the minute you get done administering fluids.

I understand the reasoning behind Linda and Chris' suggestion to skip tonight's shot, but I'm not so sure I agree. Skipping shots isn't a good idea with kitties who have had DKA recently.

Have you tested his BG lately? If he's high enough to shoot, if I were in your shoes, I would get some insulin into him even if it's just a half dose.

You might find something helpful in these posts:
I'd definitely talk to your vet tomorrow about having an ultrasound done to determine if there is a mass in his abdomen.
Ninja & Baby said:
They gave him one unit of fluid and said to give him one unit twice daily.
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I'm a little confused by this. How much is one unit of fluids? 100 mLs... to the first mark on the bag?



Just some thoughts for your consideration...

 
Jill & Alex (GA) said:
I'm a little confused by this. How much is one unit of fluids? 100 mLs... to the first mark on the bag?
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100 mLs every 12 hours (1st mark on the bag). Thanks for the suggested reading, and ideas on constipation. I will definitely check it out!

I haven't checked his BG since 4 p.m.. It was Hi then.

I have some mirtazapine that I had forgotten about for appetite. There's some good ideas. I never thought of making little meat balls and putting it in his mouth.
 
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Ninja didn't get an evening shot, and I didn't check his BQ. I checked him this morning and it was Hi. I don't know whether to shoot him or not. Like I said earlier, it's not doing any good. He was in much better health before he ever started insulin. He was thin, but he did eat. He drank a sizable amount of water, but that didn't get out of control until he started insulin. I don't know what to do. My gut instinct says to just stop and see what happens. He's about dead as it is. He's dying anyway. I want to keep up the nausea pills and fluids and I will do some syringe feeding.
 
Hi Paula--

Don't give up. Ninja had some great days last week, he's got a lot of fight left in him. I really think that the problem could be something simple that just hasn't been effectively addressed yet-- my guess is still constipation. I have to say, I'm kind of irritated that the vet you saw yesterday didn't even suggest an enema to try to get things moving and see if that would help. Between that and the lack of any interest in even looking at the spreadsheet or considering the role of insulin in Ninja's treatment, I'm not impressed at all with that vet and I'm glad you didn't leave Ninja with them.

I wouldn't stop the insulin, especially after a skip last night-- I don't think insulin the root of his problems and as @Jill & Alex (GA) says, he needs the insulin to fend off another DKA. Even a reduced dose would be better than nothing.

Please try the coconut oil/unsalted butter/olive oil, and/or add a bit of pumpkin to Ninja's syringed food, to see if you can get things moving. I'd also strongly consider taking him back to the vet today, and asking for a more thorough assessment of the mass-- an ultrasound can help to determine if it is just hard fecal matter, and to see if there is some kind of obstruction in there.
 
Ninja & Baby said:
Ninja didn't get an evening shot, and I didn't check his BQ. I checked him this morning and it was Hi. I don't know whether to shoot him or not. Like I said earlier, it's not doing any good. He was in much better health before he ever started insulin. He was thin, but he did eat. He drank a sizable amount of water, but that didn't get out of control until he started insulin. I don't know what to do. My gut instinct says to just stop and see what happens. He's about dead as it is. He's dying anyway. I want to keep up the nausea pills and fluids and I will do some syringe feeding.
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Paula, I don't know what to say except Ninja needs insulin according to that test and the others on your spreadsheet... tests over the last several days. He's been HI for days now. It sounds like Ninja is very sick and there's undoubtedly more going on than we know. I can't tell you what to do, but one thing we do know from his BG tests is he does need insulin.

Just sharing from my experiences with Alex...
When Alex was very sick and wasn't expected to live (acute renal failure and severe liver disease), the only thing I could control was her blood glucose. I do think it made her more comfortable while she was fighting for her life. Against all odds, she rallied and lived another four years after that. Over the next four years she had several serious health issues, but it was extremely obvious she felt better when her blood sugar was controlled through it all. Unfortunately, cancer ended up getting her in the end. :(

If you truly think Ninja is dying, please read through this post: http://www.felinediabetes.com/FDMB/threads/making-the-decision-help-to-know-when-and-how.131915/
http://www.felinediabetes.com/FDMB/threads/making-the-decision-help-to-know-when-and-how.131915/
Making "The Decision": Help to know when and how.

It has helped me and many others assess our kitty's condition and quality of life. Maybe there's something there that will help you decide how to proceed.

Please, let us know how we can help...
 
Paula, I'm with Nan....extremely disappointed in the vet you took Ninja to last night. I also don't think you should give up on him. He got through the DKA and is a fighter.

In looking over the SS again, I still think he is hyperglycemic because of too much insulin. Granted we don't have a number of pre-shot readings early on but it looks like Ninja may have gone very low on the night cycle of the 8th leading to the low AMPS of 139 on the 9th. I think this is when the hyperglycemia started and was continually being perpetuated with the 1u doses.

Since withholding insulin last night made no difference I think the next logical step is to give him insulin to see if that will bring his numbers down but I also think the 1u may be too much. I'd be inclined to try 0.5u to see if that helps get the numbers down at all. Keeping him well hydrated is going to be key here too as that will help bring his numbers down so get as much water/fluid into him as you can orally as well as giving the SubQ fluids as directed.

You know Ninja better than anyone else but I really think it's worth trying a smaller dose of insulin to see if that helps before you give up. :bighug::bighug::bighug:
 
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