Just rushed Toonces to the vets...now what?

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Janet

Member Since 2014
I'm hoping it comes down more..I will check again at +6
Janet


I smelled ketones in her urine, she uses a pee pad so it was very evident. She was hiding under the bed and her breath smelled of keystones. She,s hospitalized on iv for overnight.

I had just increased her from 3.5 to 4 this morning and her readings were ps 426 + 3 408 +6 410


Her vet was out of town but called me and had me take her in.. He will call me around 6:00 and he will probably want to switch her to the dog insulin...I don't know what to tell him. Should she stay on 4 units for two more days and then increase by 1/2? She was up to 9 units of prozinc and her nadir never went lower than 421.http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=111762
 
Re: 1/13 Toonces ps426+3 408 First day at 4 units

Good luck with the dosecrease! :-D I hope Toonces brings you some nice lower numbers soon. Have a good day!
 
Re: 1/13 Toonces ps426+3 408 First day at 4 units

C'mon, Toonces. Head for the pink. It's a much nicer color than red. Of course, you would look even better in yellow, but let's take this one step at a time. :smile:

Hope you see some better numbers at +6.
 
Re: 1/13 Toonces ps426+3 408 First day at 4 units

Hi there :cool:

glad to see you and Toonces here in Lantus Land.
Better numbers are ahead . . .
Good luck with the new dose!
 
Re: 1/13 Toonces ps426+3 408 First day at 4 units

Welcome again to Lantus Land Janet and Toonces!

When you do your daily condo (post), we like for you to go ahead and add the link to the prior days condo so people can easily go back to see some of the history. Just copy the address in the address bar for your post from the day before, and Paste it between the YOUR LINK HERE[URL] Here's your co...ediabetes.com/FDMB/viewtopic.php?f=9&t=111762

Good luck with the dosecrease!!
 
Janet --

If you mean Humulin N or Novolin N as "dog insulin," no -- these are not types of insulin that are recommended by the American Animal Hospital Assn for cats. Either Lantus or Prozinc are recommended. Here's the link to their recommendations for the treatment of diabetes in cats (and dogs). Your vet should be familiar with these guidelines.

Ketones do not develop just because numbers are high. The basic recipe for ketones is infection or inflammation, not enough insulin, and not eating. It may be that Toonces needs more insulin. There are shorter acting types of insulin, such as Humulin R (we refer to this as "R") that can be given in addition to Lantus to help to lower Toonces BG levels. This is often what vets do when a cat is hospitalized. They will either use R every 4 - 6 hours (it's very short acting) or combine it with a longer acting insulin. So, the kitty get a shot of the basal insulin (the insulin that works longer) and a second shot with the short acting (or bolus) insulin. If Toonces was on 9.0u of Prozinc, I'm not sure why your vet so drastically reduced the amount of Lantus you are giving your kitty.

What is very important is to find out if Toonces has some infection going on. A urinary track infection, a dental problem, etc. all make a cat that is prone to developing ketones even more vulnerable.
 
Sorry to see Toonces isn't feeling well. Sounds like taking her to the vet was a good decision. Keytones are nothing to mess around with. I hope she feels better soon. No advice on the dose, but we'll bump you up to the top of the list for visibility.
 
Janet I would insist that he use Lantus. You have the right to have your cat on the insulin that you choose. I wouldn't worry about dosing now just getting enough insulin to bring down those numbers along with plenty of fluids and syringe feeding if need be. If they can draw blood they should to rule out or confirm infection but first an foremost is to get rid of the ketones. What Sienne said about the R is a very useful tool as well...I hope your vet will use it.

Is there a state of the art animal hospital near you?

I was wondering how you've avoided it with numbers that high and was going to ask if you've been testing for ketones as I had a VERY ketone prone kitty and I got distracted. I am so sorry
 
Glad you sprung into action and got Toonces to the vet.

I'll add my voice to the information Sienne has provided regarding the choice if insulin. I know it's hard in the thick of a crisis to question your kitties vet.
A print out in hand of the information Sienne linked to would be a good thing to have.

I can also confirm the basic recipe for ketones Sienne provided- infection+not enough insulin+not enough calories and it is indeed the case that all diabetic kitties, regardless of their BGs, are susceptible. There is some infection/inflamation going on somewhere.

FWIW, I spent a long time battling ketones and DKA with Black Kitty early on. After the second episode of DKA a veterinary internist strongly recommended I switch him to Prozinc. I stuck with Lantus.

Hang in there - and hang in here too :cool:
Lots of folks to offer support & share experiences with you and help you navigate these strange and scary waters.
 
Caryl , when the prozinc didn't work the vet started her o Lantus at my request and I requested it after reading about it here. He told me he is not familiar with Lantus and he will put her on anything that I request and that's why I,m asking....I have no idea what to tell him now so please if any one could advise me. Toonces was severely dehydrated by the time she got there......he probably will check her for infection but isn't it the high glucose what's causing ketones?

The reason he started her low...3units is because he didn't know how she would respond to Lantus after being on such a high dose of prozinc...
 
Hi again Janet :cool:

:!: Please see the earlier posts by both Sienne and myself , where you will find important information & guidance.

Both of us have first hand experience with DKA.

FWIW - I personally would stick with Lantus.

You are doing great. Remember to breathe.

Keep us posted.
 
She will probably be hospitalized all day tomorrow...should I have him increase the Lantus to 4.5? She just started the 4 units up from 3.5 today...is it too soon to up it to 4.5 in her situation? Also, she will probably get an antibiotic shot tomorrow and how will that affect the insulin? Again, the vet is open to my suggestions but I have absolutely no idea what direction to take...probably the stress of being there hooked to an iv all night has her bg even higher.

Please don,t be concerned about giving me wrong answers...you guys are really Toonces last hope.

I have a headache.
 
(((Janet)))

You don't want to try to micromanage your vet's treatment of ketones. If you're not comfortable with how this is being handled, is there someone your vet can consult with? Ketones/DKA can be managed in a few ways and a great deal depends on your vet's experience with certain types of insulin, whether Toonces has ketones in his urine or whether this is diabetic ketoacidosis (DKA). You vet should have run bloodwork to determine whether electrolyte levels are effected.

Like Black Kitty, my cat, Gabby, is a DKA survivor. When she was hospitalized, they have her on an IV for fluids and were giving her frequent shots of Humulin R. (They may have been using Humulin N, as well, but this was before the AAHA guidelines were published.) Often, relying on shorter acting insulin while a cat is in the hospital and being monitored 24/7 is a very acceptable course of action. I included other info on DKA management in my earlier post. You can discuss your vet using Humulin R or Humulin N by itself on a frequent dose basis or in conjunction with Lantus as a basal/bolus insulin combination.
 
Sienne, the vet just called me...he tested Toonces bg and said it was 358 at +9. He said he will test her at pmps at 9:15.
He also said he will run a full CBC profile on her in the morning to see what is causing her problem.

358 is the lowest number Toonces has ever had since being diagnosed 10/23/13....so I am now hopeful that Lantus alone will work for her.

Thank you to you and all who responded to me.

Janet
 
Im sorry I didn't respond again too. I had a procedure today and fell asleep. I have had also been through several bouts of DKA with Alex and since everything had been posted I just stressed the importance of insulin, food, fluid and getting rid of the ketones. Ketones are complicated and can be caused by many things but usually by untreated hig bg level or infection.

It sounds like your vet is doing the right thing so far and hoping that Toonces's numbers come down even more. Finding out why they have been so high is also important...or would be to me.

Hugs to you :YMHUG:
 
((((janet)))) what an ordeal!

I hope your vet will seek guidance from another vet on how to address Toonces dosing while she's at the hospital. I agree Lantus or Levemir (which is newer to use in animals, but very good) are the best for cats. I'd keep her on the Lantus and give it a chance to do its work. It's a good insulin.

We're cheering you guys on from Oregon. :YMHUG:

We'll be looking for your updates.
 
Just keep in mind that it takes Lantus a while to work. It's a depot-type of medication. The depot needs to form and stabilize before it can really have an effect on numbers. It takes about 5 - 7 days which is where Toonces is at this point. Like I said, the vet can use a bolus insulin to help the numbers come down a bit more if necessary.
 
I agree with Sienne.....I would talk to my vet about giving her a bolus insulin but they will need to check her frequently. Those of us in this forum that use a bolus with lantus will typically check every hour that the bolus is effective. As Sienne said, for "R", it's four hours and for "N" about six. Do they have her on IV fluids because that is really, really important.

No, the high BG alone does not cause DKA. DKA is caused by not enough insulin + infection + not enough food/water. It's really important in DKA to try and get the BG down with the bolus insulin. Also as Sienne said, sometimes the vets will stop the basal insulin and give the bolus more frequently. If they are shooting a basal and bolus at the same time, they have to be careful that the nadirs don't overlap. I think that is why many will just stop the basal insulin (like lantus) and then they have the freedom to shoot the bolus every 4-6 hours as needed.

Was she eating and if she stopped, when did she stop eating? Is he going to syringe feed her or make sure she gets food or will he allow you to do it?

Is there someone in the clinic overnight to watch her?
 
Marji, the vet called me at 9:30 and said her pmps was 380. She is eating good..he said she ate 1/2 can of food so he gave her the pm shot of 4 units. he will know more after her tests in the morning. She is on an iv drip. She never did lose her appetite, which is good. Since this is a new low for Toonces since she was diagnosed, he wants to leave her on Lantus and see how her numbers are tomorrow.
 
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