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You want to draw up insulin so that the black stopper on the plunger is just below the Zero line on the syringe (the very top wider line closest to needle).
 
Hello Sally! I just wanted to say that Kingy is beautiful, and you are taking such good care of him. Once he gets past the constipation, I think you'll see how much better he's feeling already.
 
MrWorfMen's Mom said:
You want to draw up insulin so that the black stopper on the plunger is just below the Zero line on the syringe (the very top wider line closest to needle).
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That may not be applicable to all syringes. I have some syringes where with the plunger all the way depressed the end of the plunger is ~0.2 units below the zero mark and sme as high as ~0.2 units above the zero mark. I eyeball very low doses by how far the plunger is moved. The key is consistency in doses, not the absolute dose.
 
Hi, beautiful kitty! Have you tried Miralax mixed in with his food? About 1/8 tablespoon should do the trick to get his poop moving. It's perfectly safe and used on Dusty all the time.
 
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Larry and Kitties said:
That may not be applicable to all syringes. I have some syringes where with the plunger all the way depressed the end of the plunger is ~0.2 units below the zero mark and sme as high as ~0.2 units above the zero mark. I eyeball very low doses by how far the plunger is moved. The key is consistency in doses, not the absolute dose
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I agree Larry but the point is to skinny up the dose she's been giving so while we won't know if it's 0.10u or 0.2u, it will be less than what has been given before. The marking on the syringes aren't consistent even in the same box sometimes so unless one uses calipers, it's tough.

I was in a hurry last night and should have suggested drawing up what Juls perceives to be the 0.10u using coloured water in a used syringe and using it for comparison to keep the dose consistent because as you said, consistency is more important than absolute accuracy.
 
Hello Everyone,

I wanted to share some of Kingy's triumphs and updates! Vet said that, based on his U/A from Monday, the DKA is resolved! We are so happy about that! He had another assist with the constipation today so that has improved, but is not 100% just yet. We have added Miralax and Lactulose. I was hesitant about the Lactulose because I see it is contraindicated in diabetic cats, but vet said we can correct for it as we go. Poor Kingy also has a UTI so that might be part of why he wasn't even trying for his litter box. He got a shot of Convenia for that.

We had our first furshot today, too. So, unfortunately, my data for today is not very helpful. Now that the DKA is resolved, is it too early to ask for the Lantus or should I still wait another week or two for that? I have also started looking at some of the low carb food lists. His food before the cancer was low carb so I hope it can be an easier switch. After that, he wasn't eating much so we tried to entice him with whatever junk food he was willing to eat.

Thank you for the kind compliment, Juls and Dusty! Miralax was added today.

Linda, thank you for the clarification about the dosing - I will make that change with his next shot. My syringes don't have that marking so the descriptor you and Larry provided was helpful.

I will update once that dose is due.

Thanks again, everyone <3
 
I am sorry Kingy has a UTI. The convenia shot is not the best antibiotic for a UTI in my opinion. An oral a/b such as clavamox would have been better. Did the vet send off the urine sample for testing to see which antibiotic it was sensitive to do you know?

You will need to test daily for ketones still, particularly now he has a UTI and with the fur shot today. Even though the DKA has resolved Kingy can still be prone to getting ketones at the moment.
Fur shots happen to everyone so don’t stress about it but do test for ketones.

I have asked a couple of others people about changing over to Lantus/when is a good time and will get back to you on that. In the meantime I would speak to the vet about lantus and get it lined up.
I’m glad the constipation is resolving.
 
Thank you for asking, Bron. I will be sure to keep testing for ketones - that way, there is early detection while he's still at risk. Yes, the urine sample was sent for a culture but did not give any results yet. I think we go back to the vet on Friday so I will ask about the culture results and see if we can get him on a better a/b.
 
Sally_ said:
Thank you for asking, Bron. I will be sure to keep testing for ketones - that way, there is early detection while he's still at risk. Yes, the urine sample was sent for a culture but did not give any results yet. I think we go back to the vet on Friday so I will ask about the culture results and see if we can get him on a better a/b.
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Convenia lasts for 2 weeks so the vet probably won’t give you another at this point.
Can you ask about the Lantus as well ?
Still loving the steep slippery slide I see.
 
I absolutely will ask about the Lantus. Will it be an appropriate time to make the switch?

Yes, and his slides are with being fed before and after injection as well as at hour 1... I really look forward to the Lantus soon.
 
Hello Everyone,

I'm sorry I have been MIA, my mother was in the hospital and I was spread really thin and an incoherent mess. She is home now, luckily. I have felt so horribly about not giving an update sooner but have good new...

Kingy has been doing very well in a lot of ways!

He did start giving us BM's and has been mostly regular with that, thankfully. His BG levels have also mostly been in the high 100 and low to mid 200 ranges and he hasn't needed his insulin injections. I was shocked by that! But the vet said he could be going into remission and reaffirmed not to give it to him if he's not over 300. I don't really know if I am convinced that in the same month as DKA it would possible for him to go into remission, but I am glad that he has had stable BG levels and that they are low enough that he is not at risk for ketones right now. Still, I have been checking his Ketostix and they continue to be negative daily as well as his BG levels a few times a day.

If he really has gone into remission, I have all of you to thank. I could not have helped him in any way without every single one of you.

However, this didn't happen before diabetic neuropathy started to set in... he was weak in the back legs but also shaking his front paws, which really bothered everyone. Vet said to try gabapentin, against my better judgment, which made him a zombie even at the lowest possible dose. We took him off that after a day and that was the day he needed insulin again. But I was reading about high doses of methyl B12 and started him on that. He seems to be responding to that but is still not really moving much and today is acting like he does when he has GI upset. It made me wonder whether B12 supplements can be an irritant to the stomach, especially with his IBD. I was also reading that topical CBD oil can help and I started that too.

Does anyone know if oral B12 supplements can be irritating to the GI system? I've been giving high doses since it's nontoxic, but it makes me wonder if it's bothering his already sensitive stomach and intestines. Is there anything else I can do for the neuropathy in the meantime?

Thank you all so much. I have been so grateful and touched by the kindness and helpful support from this group that it has helped me get through an insane few weeks.

Thanks,
Sally with Kingy
 
What type of B-12 are you giving?

Sally_ said:
But the vet said he could be going into remission and reaffirmed not to give it to him if he's not over 300.
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I totally disagree with your vet. 300 is too high and as long as he's running that high, the chances of getting his neuropathy under control is pretty much nil. The most important thing to do to give him the best chance is to get his blood glucose numbers down into a more normal range.

I'd strongly suggest you find a vet that will give you a better insulin like Lantus, Basaglar, Levemir or ProZinc. Vetsulin is more of a dog insulin. It tends to hit cats hard and fast and then wear off before the next shot it due.

A normal cat's BG should be between 68 and about 150 (on the AlphaTrak). At those levels, not only can the pancreas possibly heal and resume working (true remission) but the nerves in his legs that are being destroyed by the high glucose levels can start to repair themselves.
 
Hi Chris - The oral B12 is methylcobalamin and his injections are cyanocobalim. He's been on both for about a year and a half but I increased the oral ones, the methylcobalamin. I actually want to change his injection also to the methylcobalamin but it's been hard to find.

I am glad you shared all of that information, I thought I was supposed to get him in the 150-250 range and always under 300. He has been clustering mostly around the 150 range but has not had readings over 225 in awhile, except for the day with gabapentin. Hitting him hard and fast and then wearing off was exactly what was happening for him with Vetsulin. I asked vet for Lantus twice and she said she will give us a script for it but to wait another few weeks first given how recent the DKA was. But I didn't know he was supposed to be in the 68-150 range at that time so I didn't ask her what to do in the meantime. Kingy's parents are scared to change the vet (everyone else they went to kept saying to euthanize him a few months ago when he had the pancreatitis flare up because they thought it was his cancer progression, but imaging showed otherwise) but I will keep looking and see if I can call it a "second opinion" of sorts.

If his BG is to be in the 68-150 range, when should I be giving him insulin? I'm scared to give it when it's at 300 because of how far it dips so quickly. When he had the gabapentin, he went from 300 to 88 in two hours and that was with me feeding 30 min before, at injection, and an hour after. I guess that's where the Lantus comes into play, it works differently. I will reach out to another vet I used to work with with my cat (I lost her in April after an 18 month battle with kidney disease) tomorrow to see about Lantus and see if she is aware of the right ranges.
 
Do you have test strips to test the urine for glucose? These are different from the test strips for checking ketones. Some urine test strips check for both.

A BG of 300 is too high not to give insulin.
A BG in the 200's is too high not to give insulin.
BG spilling into the urine means there is too much glucose in the blood stream and kidneys are filtering it out.

With DKA in Kingy's past history, not giving insulin is risky. (Another DKA episode)

You might try a very tiny dose of the Vetsulin, such as 0.1U (not 1.0U) if you are around to monitor and BG test. Until you can get a better insulin from your vet. (NOT the NPH type insulins like Novolin or Humulin, as those are awful for cats.)
Prozinc, Lantus, Levimir are the better insulins for cats. Get the Lantus in the insulin "pen" or mini vial.

There are regulated BG ranges and then there are normal BG ranges. Excerpt for you from this document.
What is Regulation?
  • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
  • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
  • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
  • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
  • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
  • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
Hope your mother is more back to being her usual self and doing better after her hospital stay. That must have been such a worry to you.
 
Info for you on smaller doses.

Fine dose gradations:
  • 0.5U = exactly half a unit
  • 0.4U = skinny 0.5 touching the line
  • 0.3U = skinny 0.5 with daylight under the line
  • 0.2U = fat zero with daylight over the line
  • 0.1U = fat zero barely touching the line
Pictorial guide using a U-100 syringe marked with half units:

someinsulin-1.jpg

01unit-1.jpg

025unit-1.jpg
 
It is with the deepest sadness and joyous relief that I share the passing of my precious Kingy this afternoon at 3:33 - angel numbers. His unflagging spirit and warrior strength was an inspiration and he has been a gift in the lives of all he touched. Fly whole and free, my beautiful boy! Your Queen welcomes you home!
 
Sally_ said:
It is with the deepest sadness and joyous relief that I share the passing of my precious Kingy this afternoon at 3:33 - angel numbers. His unflagging spirit and warrior strength was an inspiration and he has been a gift in the lives of all he touched. Fly whole and free, my beautiful boy! Your Queen welcomes you home!
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Oh Sally I am so so sorry to hear about Kingy. My heart is breaking for you right now. You took so good care of him and I'm sure he knew it. I am looking at his pictures again and I am so heartbroken for you and your mom. He is no longer suffering and is probably romping around like a little kitten again. May I asked what happened
Fly high sweet Kingy cat_wings>o
 
Sally_ said:
It is with the deepest sadness and joyous relief that I share the passing of my precious Kingy this afternoon at 3:33 - angel numbers. His unflagging spirit and warrior strength was an inspiration and he has been a gift in the lives of all he touched. Fly whole and free, my beautiful boy! Your Queen welcomes you home!
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So sorry to hear about Kingy. His pictures are very handsome and reading your posts you did an awesome job of being his mom. It's never easy to see them go. Those darn little furballs weasel their way into our hearts. :bighug:
 
Lighting a ring of candles in memory of your beloved cat Kingy.

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Sally, I am. SO sorry to read that Kingy has passed away. Such a shock to read this.
You looked after him so well
Fly free sweet Kingy and lamd softly at the rainbow bridge:rb_icon:cat_wings>o
 
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