Is cat ok? BG lower, not eating, weak

[TommyS]

https://www.felinediabetes.com/FDMB/threads/5-14-22-new-member-tommy-starting-insulin-soon.263298/

Last Glargine shot was at 12:15 today. BG at 4:30 was 214. BG at 8:30 is now 181.
Today is day 5. He is on 1/2 unit every 12 hours.
Day 1 he started at BG 303.
Should I worry? He is very thin and needs to eat.

Also, the vet said we want numbers in the 200's?
Good thing we didn't start cat at 2 units a day like he was going to.
I am using AlphaTrak for now.

Not sure I should give dose at 12:15? Will see if he eats.

 

[FrostD]

Yes still give the insulin if he is above 200, you have room. Do try to get him to eat what you can.

Do you have ketone test strips? Weakness, lethargy, inappetence are all signs of DKA which is worrisome (also signs of other things like pancreatitis, but DKA is most important to rule out quickly).

 

[Bron and Sheba (GA)]

Hi Lisa,
Tommy does look thin in the photo. Untreated Diabetes can cause this but hopefully once the insulin starts to to work, he should put on weight.
How much is he eating at the moment and what are you feeding?
Are you giving snacks every couple of hours during the cycles, except for the 2 hours before the preshot BG?
it’s really important that that cats eat and eat well. Here is a link to STIMULATING THE APPETITE


it would help a lot more if you could set up a spreadsheet so we can see what is happening with the blood glucose (BG).
Here is a link to o the spreadsheet HELP US HELP YOU

 

[TommyS]

Yes still give the insulin if he is above 200, you have room. Do try to get him to eat what you can.

Do you have ketone test strips? Weakness, lethargy, inappetence are all signs of DKA which is worrisome (also signs of other things like pancreatitis, but DKA is most important to rule out quickly).

He was 181 just now. So don't give it if he's under 200?
Will test urine with ketostix next chance I get. He had no ketones before starting insulin.
Does the insulin change that?

 

[TommyS]

Hi Lisa,
Tommy does look thin in the photo. Untreated Diabetes can cause this but hopefully once the insulin starts to to work, he should put on weight.
How much is he eating at the moment and what are you feeding?
Are you giving snacks every couple of hours during the cycles, except for the 2 hours before the preshot BG?
it’s really important that that cats eat and eat well. Here is a link to STIMULATING THE APPETITE


it would help a lot more if you could set up a spreadsheet so we can see what is happening with the blood glucose (BG).
Here is a link to o the spreadsheet HELP US HELP YOU

I do not have those cycles down yet. But yes he gets treats low carb, low carb wet food. Yes he was not this thin 2 months ago and the vet said we could wait to start the insulin and try diet. He was 15 lbs and now 7.

 

[TommyS]

Hi Lisa,
Tommy does look thin in the photo. Untreated Diabetes can cause this but hopefully once the insulin starts to to work, he should put on weight.
How much is he eating at the moment and what are you feeding?
Are you giving snacks every couple of hours during the cycles, except for the 2 hours before the preshot BG?
it’s really important that that cats eat and eat well. Here is a link to STIMULATING THE APPETITE


it would help a lot more if you could set up a spreadsheet so we can see what is happening with the blood glucose (BG).
Here is a link to o the spreadsheet HELP US HELP YOU

You won't see much happening in spreadsheet right now. Its day 5. Working on it though.

 

[FrostD]

He was 181 just now. So don't give it if he's under 200?
Will test urine with ketostix next chance I get. He had no ketones before starting insulin.
Does the insulin change that?

If he's under 200, stall without feeding and post here. It is better to give some insulin (i.e. a partial dose) if at all possible.

No, but ketones can form at any time. The recipe for DKA is not enough insulin (i.e. unregulated) + inappetence (or not enough calories) + underlying stress/infection/inflammation.

How much food is he getting per day? How many calories?

 

[Bron and Sheba (GA)]

Yes he was not this thin 2 months ago and the vet said we could wait to start the insulin and try diet. He was 15 lbs and now 7.

That is terrible advice from the vet! If a cat is diabetic they need to be started on insulin.

He was 181 just now. So don't give it if he's under 200?

Have you fed him yet? If not, stall dont feed and test again in 20 minutes

 

[TommyS]

Hi Lisa,
Tommy does look thin in the photo. Untreated Diabetes can cause this but hopefully once the insulin starts to to work, he should put on weight.
How much is he eating at the moment and what are you feeding?
Are you giving snacks every couple of hours during the cycles, except for the 2 hours before the preshot BG?
it’s really important that that cats eat and eat well. Here is a link to STIMULATING THE APPETITE


it would help a lot more if you could set up a spreadsheet so we can see what is happening with the blood glucose (BG).
Here is a link to o the spreadsheet HELP US HELP YOU

Last Glargine shot was at 12:15 today. BG at 4:30 was 214. BG at 8:30 is now 181.
Today is day 5. He is on 1/2 unit every 12 hours.
Day 1 he started at BG 303.

 

[Bron and Sheba (GA)]

Last Glargine shot was at 12:15 today. BG at 4:30 was 214. BG at 8:30 is now 181.
Today is day 5. He is on 1/2 unit every 12 hours.
Day 1 he started at BG 303.

We really need to see a spreadsheet to be able to help you properly. 5 days of data is a good amount for up to see what is going on.
In the meantime, have you stalled and not fed?

 

[TommyS]

If he's under 200, stall without feeding and post here. It is better to give some insulin (i.e. a partial dose) if at all possible.

No, but ketones can form at any time. The recipe for DKA is not enough insulin (i.e. unregulated) + inappetence (or not enough calories) + underlying stress/infection/inflammation.

How much food is he getting per day? How many calories?
No idea how many calories. He just got antibiotic for tooth too. But no ketones before started insulin.
So you are saying don't feed him if under 200?
I was told to feed a lot due to weight loss.
Thanks. Trying to follow

 

[TommyS]

We really need to see a spreadsheet to be able to help you properly. 5 days of data is a good amount for up to see what is going on.
In the meantime, have you stalled and not fed?

Why shouldn't I feed him? Can you explain that please? He is on a low carb wet diet and very thin.
He feeds freely. I make sure there is always wet food in dish.

 

[TommyS]

We really need to see a spreadsheet to be able to help you properly. 5 days of data is a good amount for up to see what is going on.
In the meantime, have you stalled and not fed?

THIS IS MY SPREADSHEET RIGHT NOW OK? I am aware I need to set it up. A person is working on it.
Last Glargine shot was at 12:15 today. BG at 4:30 was 214. BG at 8:30 is now 181.
Today is day 5. He is on 1/2 unit every 12 hours.
Day 1 he started at BG 303.

 

[TommyS]

So far I understand ketones are bad but can somebody please tell me what do I do if he has them in next test? Thanks

 

[Bron and Sheba (GA)]

Why shouldn't I feed him? Can you explain that please? He is on a low carb wet diet and very thin.
He feeds freely. I make sure there is always wet food in dish.

We recommend not feeding for the 2 hours before the preshot BG so that it is not food influenced. Otherwise you can free feed.

Last Glargine shot was at 12:15 today. BG at 4:30 was 214. BG at 8:30 is now 181.

What was the preshot BGthis morning?.
Did you give it at 12.15 today?
You say the time is now 8.30? That is not 12 hours after the last preshot unless I am not understanding you.

 

[TommyS]

Is it normal for a cat to lose its appetite when starting Glargine? Will it go back to normal on its own? thanks

 

[TommyS]

We recommend not feeding for the 2 hours before the preshot BG so that it is not food influenced. Otherwise you can free feed.


What was the preshot BGthis morning?.
Did you give it at 12.15 today?
You say the time is now 8.30? That is not 12 hours after the last preshot unless I am not understanding you.

I am not understanding you. I am not at that point of a testing schedule pre shot, etc. Working on it. Vet told me to test 4 to 6 hours after insulin.

 

[TommyS]

We recommend not feeding for the 2 hours before the preshot BG so that it is not food influenced. Otherwise you can free feed.


What was the preshot BGthis morning?.
Did you give it at 12.15 today?
You say the time is now 8.30? That is not 12 hours after the last preshot unless I am not understanding you.

This is what I can tell you...
BG at 4:30 was 214. BG at 8:30 is now 181.
Shot was given at 12:15 yes.

 

[TommyS]

Is it normal for a cat to lose its appetite when starting Glargine?
Problem is my cat is already deathly thin

 

[TommyS]

What do I do i

Yes still give the insulin if he is above 200, you have room. Do try to get him to eat what you can.

Do you have ketone test strips? Weakness, lethargy, inappetence are all signs of DKA which is worrisome (also signs of other things like pancreatitis, but DKA is most important to rule out quickly).

What do I do if he tests positive for ketones? Thanks

 

[Bron and Sheba (GA)]

I am not understanding you. I am not at that point of a testing schedule pre shot, etc. Working on it. Vet told me to test 4 to 6 hours after insulin.

Yes , it is a good idea to test during the cycle so you can see how low the dose is taking Tommy. So you are saying that you gave the dose of insulin this morning (I don’t think you told us what the BG was at that point), then the BG went down to 214 and 181. But you are not ready to give the insulin at this point? Is that correct?
This is why it is so important to have the spreadsheet set up so we can see at a glance what is happening and no mistakes can be made.
I will ask @Bandit's Mom to look in and she will be able to set up the spreadsheet in 5 minutes for you.

it normal for a cat to lose its appetite when starting Glargine

Yes cats often can not want to eat in the beginning…this happened with my cat Sheba but you must keep trying with any food to get him to eat. It is really important he keeps eating. Even food other than low carb food at this point.

far I understand ketones are bad but can somebody please tell me what do I do if he has them in next test? Thanks

If there are ketones present in the urine I would tell the vet. Because that means that Tommy is not getting enough food or enough insulin.

We need to get you set up properly with the SS and if you will post daily we can help you a lot more.

 

[FrostD]

Trace ketones are not as big a concern, but definitely tell the vet and keep getting as much food and water into him as you can. Don't get me wrong they are still a concern, but you can try to manage at home vs ER trip.

Anything higher than trace we consider an emergency.

Especially with the antibiotic due to possible tooth issue you want to keep an eye on ketones.

Now we understand you don't have spreadsheet yet and someone is helping you with it. Just from the earlier post it sounded like you had one with about 5 days of data. I think we're all on the same page now. Shots are 12 hours apart - so I'm saying if at your next shot time (should be about 12:15) he's under 200 let us know.

Can you define "a lot" of food? Can you try to calculate calories please?

The other challenge is unregulated diabetic cats (like Tommy) need even more calories to begin with, as their body cannot fully process food due to lack of insulin (their own body or what we give them).

Does he have any other issues at the moment? Any other health conditions, medications? Other symptoms like diarrhea or vomiting?

Does he seem nauseous? Licking lips, grinding teeth, hanging out by his bowls but not actually eating or drinking?

Does he seem in pain? We call it the meatloaf position - all legs tucked under, head kind of low, eyes maybe squinty/closed.

 

[Bandit's Mom]

This is why it is so important to have the spreadsheet set up so we can see at a glance what is happening and no mistakes can be made.
I will ask @Bandit's Mom to look in and she will be able to set up the spreadsheet in 5 minutes for you.

Hi Lisa, I will send you a PM with the details I need to set up the spreadsheet. Look for it in the Inbox at the top right corner of this page.

 

[Chris & China (GA)]

Hi Lisa, I will send you a PM with the details I need to set up the spreadsheet. Look for it in the Inbox at the top right corner of this page.

Already got it set up. Was waiting for some information

 

[TommyS]

Yes , it is a good idea to test during the cycle so you can see how low the dose is taking Tommy. So you are saying that you gave the dose of insulin this morning (I don’t think you told us what the BG was at that point), then the BG went down to 214 and 181. But you are not ready to give the insulin at this point? Is that correct?
This is why it is so important to have the spreadsheet set up so we can see at a glance what is happening and no mistakes can be made.
I will ask @Bandit's Mom to look in and she will be able to set up the spreadsheet in 5 minutes for you.



Yes cats often can not want to eat in the beginning…this happened with my cat Sheba but you must keep trying with any food to get him to eat. It is really important he keeps eating. Even food other than low carb food at this point.



If there are ketones present in the urine I would tell the vet. Because that means that Tommy is not getting enough food or enough insulin.

We need to get you set up properly with the SS and if you will post daily we can help you a lot more.

Thanks so much. Spreadsheet is almost up.
Tested for ketones this am and there are none but urine is pink.
Gave insulin this am and he ate a little.
Skipped last night since he wouldn't eat and BG was low.

 

[TommyS]

Trace ketones are not as big a concern, but definitely tell the vet and keep getting as much food and water into him as you can. Don't get me wrong they are still a concern, but you can try to manage at home vs ER trip.

Anything higher than trace we consider an emergency.

Especially with the antibiotic due to possible tooth issue you want to keep an eye on ketones.

Now we understand you don't have spreadsheet yet and someone is helping you with it. Just from the earlier post it sounded like you had one with about 5 days of data. I think we're all on the same page now. Shots are 12 hours apart - so I'm saying if at your next shot time (should be about 12:15) he's under 200 let us know.

Can you define "a lot" of food? Can you try to calculate calories please?

The other challenge is unregulated diabetic cats (like Tommy) need even more calories to begin with, as their body cannot fully process food due to lack of insulin (their own body or what we give them).

Does he have any other issues at the moment? Any other health conditions, medications? Other symptoms like diarrhea or vomiting?

Does he seem nauseous? Licking lips, grinding teeth, hanging out by his bowls but not actually eating or drinking?

Does he seem in pain? We call it the meatloaf position - all legs tucked under, head kind of low, eyes maybe squinty/closed.

He got an injection of Covenia for tooth but that was 5/17.

 

[FrostD]

Thanks so much. Spreadsheet is almost up.
Tested for ketones this am and there are none but urine is pink.
Gave insulin this am and he ate a little.
Skipped last night since he wouldn't eat and BG was low.

Pink urine is not a good sign. Can indicate UTI, bladder infection, etc. I realize it is Sunday, will your vet let you run a urine sample to them first thing tomorrow morning?

If you can afford an emergency vet trip I'd consider it, if it is a UTI it can progress to bladder and kidneys quickly.

Watch him for fever.

 

[TommyS]

Pink urine is not a good sign. Can indicate UTI, bladder infection, etc. I realize it is Sunday, will your vet let you run a urine sample to them first thing tomorrow morning?

If you can afford an emergency vet trip I'd consider it, if it is a UTI it can progress to bladder and kidneys quickly.

Watch him for fever.

Thank you. But he just got Covenia antibiotic on 5/17 for tooth?
I just saw it could just mean he wasn't eating enough?

 

[FrostD]

It could have a number of causes. I would catch another sample and refrigerate it and bring to vet tomorrow. They usually want it within 24 hours of catching the sample.

Convenia is more for wounds/abscesses, it can treat UTIs but only for specific bacteria. So if it's anything other than a very specific bacteria it won't do anything.

 

[TommyS]

I wonder why all of a sudden he would have a UTI after Covenia and Gargline.
Do you know how soon after Covenia he can get another antibiotic? I know its a 2 week antibiotic
Thank you

 

[Chris & China (GA)]

Do you know how soon after Covenia he can get another antibiotic

He can have a different antibiotic at any time. Convenia is a hot topic here and most of us won't use it in our cats. Here's some information on "Convenia...worth the risk?"

The big problem now is it does sound like there may be a UTI if he's peeing pink urine but because the Convenia is still in his bloodstream, it would throw off any results you could get from running a culture and sensitivity. Any time you suspect a UTI, your vet should check for bacteria in the urine and if they find some, they should send it off for a culture (to identify the specific type of bacteria that's causing the problem) and sensitivity (to find out which antibiotic works best to kill that specific bacteria)....but the C&S has to be done before antibiotics are started. The vet can pull the urine out of the bladder with a thin needle and send it off for the C&S and then go ahead and start the cat on a broad spectrum AB until the results come back but if they prescribe an AB before knowing for sure what bacteria is causing the problem, it skews the results and there's no way to know if the one they prescribed will actually kill off all the bacteria causing the problem.

I would be testing for ketones at least once a day. Not eating + not enough insulin + infection/inflammation is the recipe for DKA and that can be very expensive to treat (and isn't always successful)....but if ketones are caught early, it's much more likely to have a good outcome.

 

[Chris & China (GA)]

From PM:

BG was 331 at 725 am and 314 at 630 pm

What time do you shoot? It's important for the shots to be as close to every 12 hours as possible. With Glargine, you can Test/Feed/Shoot all in about 5-10 minutes.

How much did you give? 0.5 unit? (half unit)

First, you don't want him to eat for the 2 hours immediately before shot times so that when you test, you get a number that's not influenced by food. Then you test and if he's over 200, you feed him to make sure he's at least willing to eat and then shoot, usually with his head in the bowl. Glargine doesn't usually start to "kick in" for 2-3 hours after it's given so if he doesn't want to eat all his food right away, he has time to graze.

Also, by doing it in that order, IF he tests under 200 (at first), you can stall, DON'T feed and test again in 20-30 minutes to see if the number goes up. That's a pretty good indication that the last shot is wearing off. As you gain more experience and data, you learn to shoot lower and lower numbers.

It's not a good idea to skip just because he didn't eat. That's a good way to end up with a DKA. You might give a smaller dose, but as long as he's high enough, you should give at least a token dose. Here's a good explanation of why you should give insulin even if he's not eating.

He did not have blood in urine until after he started Gargline and got Covenia.

Starting insulin would have nothing to do with blood in the urine. More likely is he has a urinary tract infection. Diabetic cats are very prone to UTI's because of the sugar in their urine. It's wonderful food for bacteria.

Did you read the information I linked in your thread about Convenia? It's not really meant for infected teeth in the first place and although can sometimes be used for UTI's, if the bacteria causing the UTI isn't sensitive to it, it's not going to do any good.

 

[Chris & China (GA)]

↑

BG was 180 last night and he wouldn't eat so no shot. Thats too low right?

Not necessarily. If you get a Pre-Shot under 200, stall, DON'T feed and test again in 20-30 minutes. It's also a good idea to use that time to post on the board. I usually suggest a subject line like "STALLING! NEED HELP!!" to get somebody's attention. Once somebody has agreed to watch out for you, you go back and "edit" the subject line to something less urgent.

A good "normal" subject line would be something like:
Date, Tommy, AMPS ###....and as the day goes on, if you get another test in, you'd add it to the subject line....like "5/23 Tommy, AMPS ###, +5 ###, +9 ###"

↑

Another person here said I have to wait for urine test and another antibiotic now because of Covenia in his system?

That was me. Yes, having the Convenia in his system means a culture and sensitivity test wouldn't be accurate but if he still has blood in his urine, he needs to see the vet. Blood in the urine is never a good thing but there are also lots of things that can cause it other than infections. This page on Urinary Tract Diseases is worth reading. (any time you see blue lettering in a post, it means it's a link for you to click to go read something we think would be helpful)

If you take him in tomorrow, make sure they test him for ketones! Ketones can be detected from a blood test or a urine test.

Please do start a new thread soon. People are concerned about you and Tommy and have been asking me about him since I've been the one posting on your original post the most.

We aren't supposed to give advice privately either (which is why I copied what I told you here into your thread). There are lots of experienced people here that want nothing but to help you and Tommy!

 

[TommyS]

↑


Not necessarily. If you get a Pre-Shot under 200, stall, DON'T feed and test again in 20-30 minutes. It's also a good idea to use that time to post on the board. I usually suggest a subject line like "STALLING! NEED HELP!!" to get somebody's attention. Once somebody has agreed to watch out for you, you go back and "edit" the subject line to something less urgent.

A good "normal" subject line would be something like:
Date, Tommy, AMPS ###....and as the day goes on, if you get another test in, you'd add it to the subject line....like "5/23 Tommy, AMPS ###, +5 ###, +9 ###"

↑


That was me. Yes, having the Convenia in his system means a culture and sensitivity test wouldn't be accurate but if he still has blood in his urine, he needs to see the vet. Blood in the urine is never a good thing but there are also lots of things that can cause it other than infections. This page on Urinary Tract Diseases is worth reading. (any time you see blue lettering in a post, it means it's a link for you to click to go read something we think would be helpful)

If you take him in tomorrow, make sure they test him for ketones! Ketones can be detected from a blood test or a urine test.

Please do start a new thread soon. People are concerned about you and Tommy and have been asking me about him since I've been the one posting on your original post the most.

We aren't supposed to give advice privately either (which is why I copied what I told you here into your thread). There are lots of experienced people here that want nothing but to help you and Tommy!

Thanks. Got it.

 

[TommyS]

Pink urine is not a good sign. Can indicate UTI, bladder infection, etc. I realize it is Sunday, will your vet let you run a urine sample to them first thing tomorrow morning?

If you can afford an emergency vet trip I'd consider it, if it is a UTI it can progress to bladder and kidneys quickly.

Watch him for fever.

This has me concerned because we have to wait to test urine until Covenia is out of his system. Vet said the 2 weeks it lasts for plus another few days. Does this sound correct?
He is not my favorite vet and I question his choices so far.

 

[FrostD]

Unfortunately I don't know, I just know they couldn't culture it while antibiotics are in his system. They should at least be able to look at it to tell you if there's blood, white blood cells, protein, other things