Mac has been hospitalized again, concerned they're giving too much Lantus 4u

Mac88

Member Since 2020
Previous thread for some context: Second cat just got diagnosed and is in DKA | Feline Diabetes Message Board - FDMB and Mac BG 55 5 hours after shot | Feline Diabetes Message Board - FDMB

Mac was hospitalized back in July for a week with pretty bad DKA/pancreatitis. He recovered from it and we've been managing him at home mostly successfully, keeping his BG between 200-300 and sometimes lower with around 1.5-2u lantus every 12 hours on a 90% wet food diet with only a little dry (hard habit to break). He has had what we think were a few pancreatitis flares since then where he would stop eating for a day, so we'd have to coax him to eat by trying more enticing wet food so that we could keep up with the insulin and avoid ketones. We checked with our regular vet and he basically said that as long as we keep Mac eating and drinking plus manage with insulin, we are doing what it takes to nurse him through the episodes.

All was successful until last Monday where he experienced issues breathing. He was diagnosed with asthma in 2020 and went on prednisone for it then, but we discontinued the prednisone in July when Mac became diabetic. His lungs were pretty badly inflamed last Monday so the ER vet gave him an injection of Dex SP and sent him home with steroid pills and flovent (we started the flovent that night after getting the prescription filled).

Mac then stopped eating entirely Tuesday and began vomiting, so we took him back to the ER vet after using a ketone blood tester and seeing it read "high" twice. The vet tested him and was surprised that ketones were present when his BG was 200-300 (I now know that is still too high). They hospitalized him and Mac took a couple days to eat again, but they were able to flush the ketones out and he's been negative since Thursday. He's breathing much better on just the flovent (no more other steroids) and they've given him antibiotics as they suspected a mild UTI and possibly pancreatitis.

Now the new battle is his BG has remained high, around 600. They increased him from 1.5 to 2.5 to 3 to now 4u of lantus insulin. From what I heard, he's mostly eating dry food for them, so I suspect it is high because of that, the stress of being hospitalized (his BG was high in July while there, then dropped drastically once I got him home on wet food and the right dose of insulin, 3u ended up being way too much then once he built up a depot) etc. They are wanting to keep him another day to monitor. Is 4u too high a dose? I'm super worried he'll go hypoglycemic though I know they can and will intervene if that happens.

Our spreadsheet is mostly updated, though I haven't had his readings while being hospitalized and I've written down his brother Butter's readings on spreadsheet, so I'll get those added ASAP.
 
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I'm sorry to hear Mac is back in the hospital again. Ketones can indeed register with blood sugars in the 200's. The recipe for developing DKA is not enough insulin + inappetance + infection or systemic inflammation. From Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

From what I saw in the spreadsheet, it didn't look like he was regulated, but I would like to see more mid cycle tests to say what was really happening on the dose you were giving him. Note, we determine how to change the dose of Lantus based on how low the dose is taking the cat, which means getting some tests mid cycle when the numbers are lowest. On FDMB, our dosing methods also use the same dose all the time, unless either a reduction is earned or they need more insulin. We don't change dose amounts based on preshots. My long winded way of saying the "not enough" insulin from the formula above could be present.

Has the vet made any progress on confirming or testing what type of infection or inflammation? Are they doing any treatment other than an antibiotic? Do you know which one they gave?

Without tests results from the vet clinic, it's hard to say if 4 units is too high a dose for Mac at this point in time. How closely are they monitoring his blood sugars in the hospital? Typically a vet hospital will use R or regular insulin, to supplement Lantus, instead of just raising the Lantus dose. R is a quick in and out insulin that can be used to nudge numbers down.
 
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