New Member - 12/21/2022 - Loki - Intro, Where to Begin, Lost & Confused

[Lauren and Loki]

Hello!

My name is Lauren, and my sugar cat is Loki. He was diagnosed over a year ago in October 2021. This entire year, 2022, has been a really complicated year for me, personally, and Loki's care has suffered for it. Now, I am finally asking for some guidance from the forum. Thank heavens this place exists. I hope to give him the life he deserves. This post is kind of long and detailed, I'm sorry, but I assume the more details the better here. I cannot remember everything at the moment, but I really need to post about him, and can always look back at his history if clarification is needed somewhere.

To begin, after his diagnosis, his vet started him on a Freestyle Libre for at-home monitoring, along with Semglee insulin, which was a new glargine-type insulin, and interchangeable with Lantus. His response to Semglee wasn't great - he generally went between very high BG readings, to some pretty low BG readings. Never a steady curve. He was just kind of all over the place, and she did not like the number of low events he was having. So the vet eventually decided to switch him to ProZinc. He did respond a lot better to ProZinc, and he wound up being prescribed 4 units every 12 hours. He did greatly improve for some time. He was eating Purina D/M wet food for awhile, until I found this forum and learned I could try Tiki Cat and Fancy Feast pate.

Not long after his diagnosis, around January 2022, things got complicated for us. His vet wound up leaving the practice, so now I had no vet. On top of this, it was at a very unstable time in my life. I was living alone, facing eviction, and was behind on basically all my bills, so I was very distracted, and Loki seemed to be doing great, so I was (not ideally) just hoping that he would stay that way until I could figure out a game plan. He was no longer using the Libre since I had no vet to report to, nor was I testing his blood with a manual reader (I have yet to learn to do so. I really want and need to learn this. I did go out and buy basically everything this forum said to buy for at-home testing, I just have not practiced it). So I do not know what his readings have been all year, and he has never had a proper glucose curve done. I have been meaning to post here for some sort of guidance since I signed up to the forum in April 2022. However, around this time, I was forced to break my lease and move in with my father, which has been extremely stressful for me. This summer is about when Loki started to develop some clinical signs that he wasn't doing amazing. Over time, he was urinating more, very thirsty and hungry, and his spine was a little more boney, and his dandruff had returned. I knew I needed to get him into a vet, but I was trying to save money to get him care.

This is all important because time waits for no one, and Loki recently had to be hospitalized on 12/12/2022. I came home that night to find him "not himself." He was not really wanting to move, and was unsteady on his feet when he did walk, had dilated eyes, and not interested in food. I rushed him to the emergency pet hospital. He was experiencing DKA (diabetic ketoacidosis), and they learned he was now suffering from Acute Pancreatitis.

They were able to get him stable, and get his ketones greatly reduced (I believe from 4.8 down to 0.3). BUT, here is where the issue starts to come to light - they had him back on a glargine insulin, and he initially seemed fine, definitely compared to how he was when he got there. They prescribed him Lantus, and they sent him home on 12/16. However, immediately upon getting him home and out of his carrier, he did not seem okay. I thought it was maybe his pain meds (gabapentin) making him a bit loopy. So I called the hospital up to ask them. The tech said that he had not had a pain med dose for almost 9 hours, and that she was sure he was having a low BG event. So I had to turn around and bring him right back to the hospital. Sure enough, his BG was low, and he had to stay in the hospital again.

This event wound up triggering my memory that he had experienced these events on glargine before. So I let the doctors know this about his history, which they did listen and take that with great consideration. They are seeing how he is not becoming regulated on glargine. Now we are basically starting from scratch, almost as if he was just diagnosed again, only this time with pancreatitis. He is currently still at the hospital. I have been visiting him everyday, and he is definitely more his normal self, talkative and loving. However, since being back at the hospital, and on glargine, his ketones are back up to 4.3 as of this afternoon, up from the lowered 0.3 after his emergency. The internal medicine specialist was quite concerned about this of course, and definitely believes he is not responding well to the glargine insulin. (Why did his ketones come down at all on the glargine, just to go back up? I'm so confused!!) But his clinical signs improving are making it all confusing and complicated. So tonight the internal medicine specialist decided to try his usual ProZinc again, 2 units I believe, and we will see in the morning how he responded. She says that the pancreatitis flare up could have triggered this whole event, and the reason for his insulin doses to have stopped working. Diet is apparently how pancreatitis is controlled, so he needs to be back on a strict diet. The "what to feed him" conversation alone is so confusing to me, and now more complicated I think because of the pancreatitis.

The doctor feels that she definitely wants him back home as soon as possible to get a better idea of his readings, since the stress of being in the hospital can effect a true curve. She says as long as Loki's ketones come down, he can come home. He does have a Libre on him now, and will come home with one.

I am glad that I now have an internal medicine specialist taking over his case, and that I no longer am worried about looking for proper care. However, the advice of the doctors versus what I read here is so vastly different. Such as, they don't think he should have a Libre on all the time, or that I should even be needing to blood test at home. I think that is ridiculous to not be testing at home, and I do not understand why this seems to be the main way of dealing with this disease. It makes me feel like I am flying blind and "shooting" (literally) in the dark. Not to mention the different takes on diet. Now Loki also has pancreatitis and I'm not sure how to handle the diet for that with the diabetes. They are telling me that it has to be treated through a strict diet, eating only twice per day. They want him on a "diabetic" diet (prescription). I'm just not sure how the pancreatitis effects what the forum says I can feed him versus just having diabetes.

Overall, I have no idea what to expect, where to begin, and am very nervous for him to come home.

Sorry for such a long post, I figured it was all important for a full picture. Thank you for reading <3

 

[Ale & Bobo & Minnie (GA)]

Hi and welcome!

I’m sorry for all you’re going through and unfortunately, even Minnie’s IM gave me advice regarding her diabetes I just knew was wrong and didn’t follow. She had a team of vets and same with her nutritionist who wanted her on high carb prescription diabetic food. As far as I know, it’s actually easier on their pancreas to have smaller meals throughout the day and with a history of DKA they need to eat well, but tagging a few more experienced folks here to chime in @Sienne and Gabby (GA) @Bron and Sheba (GA) @Larry and Kitties @Bandit's Mom

 

[Diane Tyler's Mom GA]

@Wendy&Neko

 

[Bron and Sheba (GA)]

Hi and welcome to the forum Lauren and Loki.
I’m sorry your kitty is unwell with DKA and pancreatitis. I don’t agree that pancreatitis is controlled by diet. He needs a low carb high protein diet for the diabetes. Dogs need a low fat diet with pancreatitis I think but cats do not. Feed the diet for a diabetic cat. my cat used to get pancreatitis and I fed her a low carb high protein diet.
And pancreatitis needs to be managed with Sub Q fluids, pain meds, antinausea meds.

To get ready for him coming home I would do the following:

• buy Ketostix for testing ketones. Can be bought from Walmart in the US or a pharmacy.
• Ask the vet for antinausea medication such as cerenia or ondansetron. Most post DKA kitties are nauseated for a time.
• May also need an appetite stimulant. Always give the antinausea medication first before the appetite stimulant.
• Ask the vet about giving sub Q fluids at home
• get a range of canned food for when they get home including some higher carb foods.
  
• I would buy a human glucose meter over an alphatrak meter for home testing.
• get a copy of all the path results from the Er

Once he come home I would recommend you do the following:

• you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,

• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.

• Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.

• Give antinausea medication if needed

• Give appetite stimulant if needed after the antinausea medication

• Give extra fluids. If Loki will tolerate warm water in the food, put a teaspoon into each snack..

• Ask the vet about subQ fluids

• test the BG frequently. Always test before every dose and again during the cycles.

• Post daily with updates and ask for help as often as needed.

Not sure if I have covered all your questions. Let me know if I haven’t.
Looking after him when he gets home will be time consuming for several days but if you follow the above recommendations he should improve each day. Remember food, insulin and fluids are the most important things a well as monitoring ketones daily. if he is reluctant to eat he is probably nauseated as that is very common for both DKA and kitties with pancreatitis.
I’m really glad you are going to be hometesting.
Bron

 

[Lauren and Loki]

Hi and welcome!

I’m sorry for all you’re going through and unfortunately, even Minnie’s IM gave me advice regarding her diabetes I just knew was wrong and didn’t follow. She had a team of vets and same with her nutritionist who wanted her on high carb prescription diabetic food. As far as I know, it’s actually easier on their pancreas to have smaller meals throughout the day and with a history of DKA they need to eat well, but tagging a few more experienced folks here to chime in @Sienne and Gabby (GA) @Bron and Sheba (GA) @Larry and Kitties @Bandit's Mom

Hello Everyone! Thank you so much! I apologize for my late reply, I have been getting ready for this freeze coming through all day. I’m in Texas so we have to be extra prepared

I am just so grateful for this forum and the people here. There is a plethora of amazing information. I would feel so lost without it (on top of the anxiety I’m already experiencing lol).

Loki is back home as of Wednesday night, and I have been monitoring him closely. He seems to be doing well overall. I still need to learn and practice how to blood test him at home. He currently has a Libre on him and that’s how I’m keeping up with his BG and staying sane for now. I am still reading and learning how to use the spreadsheet, but I have been writing down all his numbers and times so I can put them into the SS as soon as possible in order to get some information out there. And I will update my signature as soon as possible as well. Trying to stay on top of it all!

I am about to go to bed since I have work in the morning (as long as no emergencies happen). I will be bringing all of my information on Loki with me to work to go over what I have in order to provide feed back and answers to all the advice.

@Bron and Sheba (GA) Thank you for your detailed advice!! I will be replying with more information tomorrow. I know it is the Holiday Season, and we are all probably busy. I appreciate any time y’all take to help me at this time <3

Talk soon!

 

[Bron and Sheba (GA)]

Looking forward to seeing the data in the spreadsheet.
Please start feeding extra food straight away.

 

[Lauren and Loki]

Looking forward to seeing the data in the spreadsheet.
Please start feeding extra food straight away.

I just gave him a snack - Fancy Feast Paté Beef and Chicken (FF Classic Patés have been his main food for months now). Fortunately he does have an appetite, and he ate his snack well just now.

 

[Bron and Sheba (GA)]

I just gave him a snack - Fancy Feast Paté Beef and Chicken (FF Classic Patés have been his main food for months now). Fortunately he does have an appetite, and he ate his snack well just now.

That is great if he is willing to eat and often. A lot of post DKA kitties have nausea and struggle to eat.
Would you mind putting DKA in the signature please as it is important we know that when helping you. Thanks

 

[Lauren and Loki]

That is great if he is willing to eat and often. A lot of post DKA kitties have nausea and struggle to eat.
Would you mind putting DKA in the signature please as it is important we know that when helping you. Thanks

I just updated my signature to say DKA. I’ve included what I know so far and will update as I know more. Let me know if there’s anything else I need to add or change.

Also, the internal medicine vet wants me giving him 4 units if his BG is over 250, but only 2 units if between 200-250, along with a call to the clinic. Based on what I’ve read here about the SLGS method, I’ve decided to only give him 2 units to see how he does. I also think I should try this because his BG was low both times he came home from the hospital. He was originally getting 4 units twice a day this whole past year, but I wasn’t doing home testing, so for all I know, that was way too much insulin and could have been a main reason why he ended up in the hospital to begin with. I am wanting to do so much better going forward. He did well today after this morning’s dose with 2 units, however tonight I gave the 2 units, @7:45pm Central, and he has been reading “HI” on the Libre all night. One time it came down to an actual number, 386. Not sure what to think about this.

Thanks!

 

[Bron and Sheba (GA)]

I just updated my signature to say DKA. I’ve included what I know so far and will update as I know more. Let me know if there’s anything else I need to add or change.

Also, the internal medicine vet wants me giving him 4 units if his BG is over 250, but only 2 units if between 200-250, along with a call to the clinic. Based on what I’ve read here about the SLGS method, I’ve decided to only give him 2 units to see how he does. I also think I should try this because his BG was low both times he came home from the hospital. He was originally getting 4 units twice a day this whole past year, but I wasn’t doing home testing, so for all I know, that was way too much insulin and could have been a main reason why he ended up in the hospital to begin with. I am wanting to do so much better going forward. He did well today after this morning’s dose with 2 units, however tonight I gave the 2 units, @7:45pm Central, and he has been reading “HI” on the Libre all night. One time it came down to an actual number, 386. Not sure what to think about this.

Thanks!

Thanks for adding DKA to signature
It’s hard to give an opinion about the dose without seeing some data in the SS. Once we can see that it will be much easier. So if you can add that soon, we can help you a lot more with the dose.
It is possible the HI tonight is from bouncing if he has been dropping lower than he has been used to recently.
From the yellow stickies on the Basics

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Testing for ketones daily at the moment is really important as that will tell us if he is getting enough insulin and enough food. So get onto that asap if you can. If you can record the result in the remarks column of the SS we will be able to see it easily.

I would not jump from 2 units to 4 units based on a preshot BG. The nadir has to be taken into consideration as well. I am going to tag @FrostD as she uses Prozinc and I am not a Prozinc user.
Keep up feeding lots of snacks as well as the 2 main meals.

 

[Lauren and Loki]

Thanks for adding DKA to signature
It’s hard to give an opinion about the dose without seeing some data in the SS. Once we can see that it will be much easier. So if you can add that soon, we can help you a lot more with the dose.
It is possible the HI tonight is from bouncing if he has been dropping lower than he has been used to recently.
From the yellow stickies on the Basics

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Testing for ketones daily at the moment is really important as that will tell us if he is getting enough insulin and enough food. So get onto that asap if you can. If you can record the result in the remarks column of the SS we will be able to see it easily.

I would not jump from 2 units to 4 units based on a preshot BG. The nadir has to be taken into consideration as well. I am going to tag @FrostD as she uses Prozinc and I am not a Prozinc user.
Keep up feeding lots of snacks as well as the 2 main meals.

I will definitely work on the SS and get that up as soon as I can. Thank you for explaining bouncing, I understand that now.

As far as ketones go, these are what I bought (see pic). Are they what I should use? And is it better to run the strip through his urine stream or try to catch some in a cup?

And I definitely don’t plan on jumping to 4 units anytime soon, not without a definite reason or guidance.

How can I feed snacks throughout the day if I am gone at work? I have seen a comment about leaving out frozen canned food as it will thaw throughout the day. Is that the only way? I don’t suspect dry food is an option?

Thank you.

 

[Bron and Sheba (GA)]

Yes, those are the ketone test strips. You can either put the strip in a stream of urine or collect some in a container. Either way it needs to be read exactly 15 seconds later for an accurate result.
A lot of us buy an automatic timed feeder to feed out kitties when we are at work or asleep. You can the. Set the times you want it to open.
My mind has gone a bland on the name of the popular ones in the US. I think they are called petsafe. It’s late at night for me and I just can’t remember the name. I’ll tag @Diane Tyler's Mom as she lives in the US and will know.
Until you get a feeder I would leave some food out for him so he has something to eat, even if it is dry food when you go to work.
Eating is really important when recovering from DKA.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

Pancreatitis and DKA are not an uncommon combination. You did great by getting your kitty to the vet as quickly as you did. This is a link to our Primer on Pancreatitis. It will help fill in some of the blanks. It used to be thought that pancreatitis was related to diet. That's no longer the case. Especially with DKA kitties, it crucial that your cat eats. DKA is typically the result of not enough insulin + not enough calories (hence Bron's advice re. feeding Loki 1.5 times his usual amount of food) + an infection or inflammation (like pancreatitis).

For some cats with DKA, they are quite prone to slipping back into developing ketones easily. This is why testing for ketones is so important after a bout of DKA. Adding water to your cat's food can help to dilute ketones as can giving fluids. Obviously, adding water to Loki's food is the less complicated route. Often what is done when cats are hospitalized with DKA, they are administering a hefty dose of insulin but also keeping your cat on a dextrose (sugar solution) IV drip. The insulin helps to address one aspect of the DKA and the dextrose provides nutrition as well as prevents the blood glucose (BG) numbers from dropping too low. Since Loki now has a glucose monitor, if his numbers do get into a low range, you can bump them up using Karo (corn) syrup, honey, maple syrup, etc. What you don't want to do is to skip a shot. Ketones can develop quickly and you want to avoid that happening. As long as ketones are not getting above a trace level, you're good. And just to give you more reading, this is info on DKA.

As for home testing, this is a link to a post that has lots of information on the how to's.

The biggest issue with the Libre is that it can fail. Sometimes it just stops working. Other times, cats get clever and pull them off. Home testing can be more reliable and less expensive. Some vets have the idea that home testing will ruin your relationship with your cat. There are a huge number of people here who can tell you differently. (Also, take a look at the link to Gabby's Legacy in my signature -- post #7.) Most cats will begin to be aware that testing and giving insulin helps them feel better. Well, that and pairing testing with treats creates the positive reinforcement that works well. I'm attaching the guidelines from the American Animal Hospital Assn that addressed diabetes treatment and talks about Lantus (or the biosimilars like Semglee) and Prozinc being good insulins for cats and discusses home testing (p.10). If the vets give you a hard time, have a copy of the guidelines to share with them. (Most vets will be very surprised that you are reading journal articles and that you're an educated caregiver -- and they will likely shut up because your handing them an article from one of "their" journals). The best way to keep Loki safe is to home test.

This is the Petsafe feeder I think Bron was referring to. This is a smaller feeder that I used. There are a bunch of other models on Amazon. While they typically show dry food in them, they work with canned food, as well. There are some models that have space for an ice pack under the food tray. I always found that putting an ice cube in with my cat's food in the feeder kept it cool and moist.

Please let us know how we can help.

 

[Diane Tyler's Mom GA]

I see a lot of members use this auto feeder comes with 2 ice packs for wet food
They also add some water to the food so it won't dry out

https://www.chewy.com/cat-mate-c500-digital-5-meal/dp/154556?utm_source=google-product&utm_medium=cpc&utm_campaign=hg&utm_content=Cat Mate&utm_term=&gclid=Cj0KCQjwmIuDBhDXARIsAFITC_63x-luggpCkFZRkS8gkKWhzRbyN2QiluSdQbUAVg-nyE2iitAjCY4aAjTmEALw_wcB

Extra ice packs
https://www.chewy.com/cat-mate-c500-auto-feeder-replacement/dp/260432

 

[Diane Tyler's Mom GA]

Be sure to have these at home for your hypo kit



Such as
med and high carb wet food and some honey?


Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.

 

[FrostD]

Welcome!

Sorry about the pancreatitis (practically my most hated illness) and the DKA, that's rough.

I think the 2U for now is wise, once you get some data let us know. We don't want to hold 2U for too long if it isn't enough insulin due to DKA risk. We need about 3-4 days worth of data to see, I'm glad you have the Libre. For now the most important thing to know is if you get a number below 90 that's an automatic reduction of 0.25U.

 

[Lauren and Loki]

Welcome to FDMB!

Pancreatitis and DKA are not an uncommon combination. You did great by getting your kitty to the vet as quickly as you did. This is a link to our Primer on Pancreatitis. It will help fill in some of the blanks. It used to be thought that pancreatitis was related to diet. That's no longer the case. Especially with DKA kitties, it crucial that your cat eats. DKA is typically the result of not enough insulin + not enough calories (hence Bron's advice re. feeding Loki 1.5 times his usual amount of food) + an infection or inflammation (like pancreatitis).

For some cats with DKA, they are quite prone to slipping back into developing ketones easily. This is why testing for ketones is so important after a bout of DKA. Adding water to your cat's food can help to dilute ketones as can giving fluids. Obviously, adding water to Loki's food is the less complicated route. Often what is done when cats are hospitalized with DKA, they are administering a hefty dose of insulin but also keeping your cat on a dextrose (sugar solution) IV drip. The insulin helps to address one aspect of the DKA and the dextrose provides nutrition as well as prevents the blood glucose (BG) numbers from dropping too low. Since Loki now has a glucose monitor, if his numbers do get into a low range, you can bump them up using Karo (corn) syrup, honey, maple syrup, etc. What you don't want to do is to skip a shot. Ketones can develop quickly and you want to avoid that happening. As long as ketones are not getting above a trace level, you're good. And just to give you more reading, this is info on DKA.

Please let us know how we can help.

Thank you for your post! Currently I am concerned about ketones and recognizing a pancreatitis flare up, considering he just went through it, and am afraid of a relapse if I don’t know I’m missing something.

So, Loki went into the ER twice in one week. The night of the first discharge from the hospital, 12/16, his ketones were 0.7, which is great, right?

BUT, I had to bring him pretty much right back after getting home because of hypoglycemia (not just a low reading, he was showing clinical signs). He was there the second time from 12/16-12/21. The day before his discharge, on 12/20, the internal medicine doctor informed me, that for whatever reason, the hospital had not been testing his ketones since his return, and that they had gone all the way up to 4.3, which was concerning to her obviously. This is while he was on Lantus in the hospital, he has since been switched back to his usual insulin, ProZinc. The next day, 12/21, his ketones had dropped to 3.1, and she allowed him to come home. I thought that was still pretty high. And of course, I wasn’t told any of the advice that you have given here. They wanted me to bring him back in today to recheck his ketones, but I had to work. I have the test strips, and am waiting for him to go pee to try to check. What do I do if they’re high?

Also, he isn’t drinking a ton of water like he used to, and therefore not peeing as frequently, which I thought was good. He has been eating though. Today he seemed a little tired, and didn’t eat too much of his morning meal at first. I gave him a Cerenia and a Gabapentin in case he was nauseous and/or in pain from the pancreatitis. This is per the instructions of the vet. I did just get home and his food is basically gone. And I also do already add water to his canned food. He does seem low energy though, not very talkative, but doesn’t seem too concerning, it’s like he’s tired. He has had a some diarrhea , not watery, but like more sticky looking. His BG is currently 272, so he’s not low.

So basically that’s what’s worrying me right now. I guess I just need to test the ketones as soon as he pees, and after that I don’t know what to do if there’s a concern. I hope I am making sense, I’m trying to keep it all together. Any suggestions?

Thank you! <3

 

[Lauren and Loki]

I forgot to add that the second night he came home, 12/21, his BG was low, like 70 on the Libre. So I called the vet, and they wound up having me skip the dose that night. I’m bringing that up because it says here to not skip a dose bc of the ketones, but what if the BG is low? And was that not a good decision?

He’s eating now, and was hungry. So no issue eating right now.

 

[Bron and Sheba (GA)]

If the BG is low at preshot time, the best thing to do is stall, don’t feed and then test again in 20 minutes to see if the BGis rising.
And post and ask for help.
We don’t recommend skipping when there is DKA in the picture because it is insulin and food that keeps the ketones at bay.
Sometimes you may need to feed some higher carb food so that you can give a dose but I would only do that under our guidance.
I’ll be interested to hear what the urine ketones result is.
I’m very surprised they didn’t test for ketones when he was at the ER the second time with a history of DKA.

 

[Sienne and Gabby (GA)]

Bron provided solid information. If you can also pull up some of the test data from your meter's memory and add it to your spreadsheet, that would be helpful.

I'd also suggest a small investment. Urine ketone strips are fine if Loki will let you stalk him to the litter box. Not all cats will. There are blood ketone meters which can make testing much more efficient (and accurate). The strips are pricey but you're not testing for ketones as much as you would test for blood glucose. NovaMax and Precision Xtra are two of these types of meters. The NovaMax is available on Amazon and there are other brands of ketone meters available.

One of the symptoms I always look for with a kitty that has a history of DKA is lethargy. You know your cat. If you have any concerns, especially if you see that ketones are trending up, call the vet. It's also a holiday weekend. Murphy's law and cats are way too connected. If Loki is eating, that's a good sign. Try to add a bit more water to his food as a back-up.

 

[Lauren and Loki]

Bron provided solid information. If you can also pull up some of the test data from your meter's memory and add it to your spreadsheet, that would be helpful.

I'd also suggest a small investment. Urine ketone strips are fine if Loki will let you stalk him to the litter box. Not all cats will. There are blood ketone meters which can make testing much more efficient (and accurate). The strips are pricey but you're not testing for ketones as much as you would test for blood glucose. NovaMax and Precision Xtra are two of these types of meters. The NovaMax is available on Amazon and there are other brands of ketone meters available.

One of the symptoms I always look for with a kitty that has a history of DKA is lethargy. You know your cat. If you have any concerns, especially if you see that ketones are trending up, call the vet. It's also a holiday weekend. Murphy's law and cats are way too connected. If Loki is eating, that's a good sign. Try to add a bit more water to his food as a back-up.

I found this deal for the Nova Max Plus:
https://www.adwdiabetes.com/product...jykuJXlnfgqgJ6BxRzEqOfQe_vjbkH3saAnDwEALw_wcB

Get a free meter with purchase of 2 boxes of ketone strips. The price is $37.98. Going forward, a box of 10 strips is $18.99. The meter tests both ketones and glucose. A box of 100 glucose strips is $25.49. Has good reviews and one of the reviews is a from a cat sanctuary with 8 diabetic cats! I do have a ReliOn glucose meter already but I guess it doesn’t hurt to have a backup. Does this sound like a good deal? Do I need to get control solution as well? Is control solution always recommended for any meter, even the ReliOn? Because that’s something I haven’t gotten yet. I will order all this immediately if y’all agree it’s a good deal. Until then I will use the pee strips.

I promise I’m working on getting the SS info entered. Work has been annoyingly in the way, and now the holiday. It’s like I literally don’t care this year I just want to get this all sorted out asap. I wanted to check if it is correct that Google Drive takes me to Google Sheets to edit the SS? Any edits I make in Google Sheets will update the file in Drive, right?

I just spoke with the vet about Loki’s diarrhea; they’re prescribing a probiotic for him, I think she said it’s that FortiFlora stuff.

 

[FrostD]

I did the same with the nova max, it's what I use fo ketones and as a backup glucose meter. Strips tend to be cheapest from Walmart, there's only 10 in the container I believe so I keep a stock. The ketone meters do require a larger.blood drop, and they're expensive strips to waste, so make sure.you have a really big drop before dipping it in the blood. It comes with control solution but I've never used it, neither for the ReliOn nor the NovaMax.

Yes about the spreadsheet edits.

I would return the FortiFlora, it's not a great probiotic. S Boulardii (from any human supplement -type store) is best for diarrhea and is cheaper. Just make sure no sugar added, a lot of us use the Jarrow brand one. You'd start with 1/4 capsule twice a day and see how he does; I just sprinkle it on top.of food and my cat eats it no problem. The only catch is Boulardii does not work if the diarrhea is due to B12 deficiency.

Unfortunately pancreatitis flare and DKA look very similar. Inappetence, not drinking, loaf position, lethargic, withdrawn. Those of us with cats with chronic pancreatitis keep a bunch of meds at home:
Ondansetron for nausea
Cerenia for vomiting
Buprenorphine for pain (gabapentin is an alternative but tends to make them loopy)
SubQ fluids/supplies
Syringes for assist feeding/water
Food to syringe feed (Gerber meats baby food - just meat no additives, Hills A/D, royal canin recovery)
Pill pockets (though I just have a mortar and pestle and grind them up to add to syringe)

With those.you can at least act quickly to get him eating/drinking, but with the ketones and DKA you'd also want to take him in. The blood meter would also be a good clue, but ketones cna change very quickly.

 

[Lauren and Loki]

I did the same with the nova max, it's what I use fo ketones and as a backup glucose meter. Strips tend to be cheapest from Walmart, there's only 10 in the container I believe so I keep a stock. The ketone meters do require a larger.blood drop, and they're expensive strips to waste, so make sure.you have a really big drop before dipping it in the blood. It comes with control solution but I've never used it, neither for the ReliOn nor the NovaMax.

Yes about the spreadsheet edits.

I would return the FortiFlora, it's not a great probiotic. S Boulardii (from any human supplement -type store) is best for diarrhea and is cheaper. Just make sure no sugar added, a lot of us use the Jarrow brand one. You'd start with 1/4 capsule twice a day and see how he does; I just sprinkle it on top.of food and my cat eats it no problem. The only catch is Boulardii does not work if the diarrhea is due to B12 deficiency.

Unfortunately pancreatitis flare and DKA look very similar. Inappetence, not drinking, loaf position, lethargic, withdrawn. Those of us with cats with chronic pancreatitis keep a bunch of meds at home:
Ondansetron for nausea
Cerenia for vomiting
Buprenorphine for pain (gabapentin is an alternative but tends to make them loopy)
SubQ fluids/supplies
Syringes for assist feeding/water
Food to syringe feed (Gerber meats baby food - just meat no additives, Hills A/D, royal canin recovery)
Pill pockets (though I just have a mortar and pestle and grind them up to add to syringe)

With those.you can at least act quickly to get him eating/drinking, but with the ketones and DKA you'd also want to take him in. The blood meter would also be a good clue, but ketones cna change very quickly.

Any advice on getting a bigger blood drop? Do I squeeze the blood out a little? I have 26 gauge lancets at home, I read a higher gauge is best for beginning home-testers.

Thank you for letting me know about S Boulardii. I have not picked up the FortiFlora yet, so I guess I will tell them nevermind. Don't think I'll be able to get anything till after the holiday though.

With trying to tell pancreatitis from DKA, is the ketone level the main difference? Like let's say the BG is in good range, and there are zero or trace ketones, but the other obvious symptoms are present. Does that point to a pancreatitis flare? Or are there ketones and a low BG with pancreatitis as well?

The medicine part is worrying me - How are you able to keep those prescriptions on hand all the time? Do you just consistently ask for refills from the vet? I am just feeling apprehensive as if the vet is going to scold me or give me grief about asking for meds, especially without bringing him in if I just need a refill. Particularly, the subQ fluids have been on my mind. Not only have I never given fluids to cat, how am I supposed to ask for that? Doesn't it take a learned skill to be able to administer something like that without causing harm or infection? I'll do what I need to, just having to learn all this, and it's scaring me

 

[Sienne and Gabby (GA)]

I would see if you can get the S. boulardii from Amazon. It may be quicker. If not, at least on line, it looks like Walmart may carry the Jarrow brand.

Re. fluids: Your vet should show you how to administer them. It's truly not that hard -- it looks a bit overwhelming but it's not that much more difficult that giving a shot. Keeping your cat in one place can be a bit of a challenge. And, not surprisingly, we have videos.

A lot of the issue with meds depends on the vet. I have a cat with IBS. I rarely have had to use all of the Cerenia or other meds that have been prescribed. My vet also knows that I know what I'm talking about and if I call to say that Gizmo is having a flare up, I can stop by and pick up meds that are needed if mine are old or I've run out. Pointing out to the vet that they are not available in the office 24/7 and having back up supplies means that you can get treatment started. There are way too many times that it can take days to get a vet appointment. If your cat is prone to developing ketones, that could make the situation quite serious and result in a prolonged, expensive hospitalization or worse. And taking your cat to the emergency vet isn't cheap, either.

FWIW, Gabby was diagnosed with DKA and pancreatitis when she developed diabetes. I never had to give fluids at that time. I did much later on when she developed kidney issues. Some members will take their cats in to the vet for fluids. It's a choice.

What gets hard to tell is that pancreatitis (an inflammatory condition) can contribute to ketones developing. However, a cat can have pancreatitis and not develop ketones. For DKA, ketones, by definition, are present. There are cats who are in good BG numbers but still develop ketones. What you described -- everything numbers wise looks fine but your cat is "off" would likely point to pancreatitis. It may not be a 100% assurance, though especially if you're testing for urinary ketones. (It takes longer to get a "true" result when you measure anything in the urine.) One other difference is many cats in a full blown bout of pancreatitis are in considerable pain. (Ask any human what it's like -- it's very painful.)

 

[Lauren and Loki]

I would see if you can get the S. boulardii from Amazon. It may be quicker. If not, at least on line, it looks like Walmart may carry the Jarrow brand.

Is this the correct item? And I just realized he may be having diarrhea because he's on antibiotics (Amoxicillin)...

 

[Chrispooky12]

Any advice on getting a bigger blood drop? Do I squeeze the blood out a little? I have 26 gauge lancets at home, I read a higher gauge is best for beginning home-testers.

Thank you for letting me know about S Boulardii. I have not picked up the FortiFlora yet, so I guess I will tell them nevermind. Don't think I'll be able to get anything till after the holiday though.

With trying to tell pancreatitis from DKA, is the ketone level the main difference? Like let's say the BG is in good range, and there are zero or trace ketones, but the other obvious symptoms are present. Does that point to a pancreatitis flare? Or are there ketones and a low BG with pancreatitis as well?

The medicine part is worrying me - How are you able to keep those prescriptions on hand all the time? Do you just consistently ask for refills from the vet? I am just feeling apprehensive as if the vet is going to scold me or give me grief about asking for meds, especially without bringing him in if I just need a refill. Particularly, the subQ fluids have been on my mind. Not only have I never given fluids to cat, how am I supposed to ask for that? Doesn't it take a learned skill to be able to administer something like that without causing harm or infection? I'll do what I need to, just having to learn all this, and it's scaring me

@Lauren and Loki fortiflora is not good as a probiotic however it is good to have around as a food enticer. It works almost everytime for my boy. He has chronic pancreatitis so I keep fortiflora, ondansetron, & gabepentin which I haven't used yet for pancreatitis flare ups, Cerenia is good to have as well. My boy takes Proviable DC for a daily probiotic. Some members also use visibiome as a daily probiotic.

 

[Sienne and Gabby (GA)]

Yes -- that's the Jarrow's S. boulardii. And yes, the antibiotics are likely the cause of the diarrhea. If you give a probiotic, you have to separate the AB and the probiotic. You don't want to give them at the same time.

@FrostD or @Chrispooky12 - do you recall how long to separate the probiotic and antibiotic and which goes first?

 

[Lauren and Loki]

One of the symptoms I always look for with a kitty that has a history of DKA is lethargy. You know your cat. If you have any concerns, especially if you see that ketones are trending up, call the vet. It's also a holiday weekend. Murphy's law and cats are way too connected.

So, Murphy’s Law strikes again. Loki and I are at the ER for a third time since 12/12…Merry Christmas! Lol

He has been a little lethargic the last few days since getting home from his last hospital stay. You’re thinking “okay maybe he’s just exhausted from all the poking, noises, and stress..” This thread covers everything I’ve been worried about the last few days. But I came home from work today and found vomit. He also really hadn’t eaten his food, about half of it. I called the specialist hospital and they said to give a cerenia and gabapentin, and to monitor for any more vomiting. Well, 10 minutes after giving the pills he throws up again. The pills hadn’t even dissolved. So I called back and they said to bring him in. I told them to make sure they monitor his ketones since they were 3.1 when he was discharged last time. So between the diarrhea, vomiting, and ketone worry, I’m wondering if he’s having a pancreatitis relapse, or maybe it wasn’t even subdued because of the ketones. I don’t know. The good thing is his BG has been pretty decent since being home. I’ll wait to see what they say, he just was taken back. Based on all this, is there anything I should ask for medicine wise while I’m here? There are lists of stuff listed here I will review, just want to see if there’s anything else I should do.

Thank you to every single one of you for all the advice so far, especially on this holiday weekend <3

 

[Lauren and Loki]

Yes -- that's the Jarrow's S. boulardii. And yes, the antibiotics are likely the cause of the diarrhea. If you give a probiotic, you have to separate the AB and the probiotic. You don't want to give them at the same time.

@FrostD or @Chrispooky12 - do you recall how long to separate the probiotic and antibiotic and which goes first?

That is great information, thank you!! Would never have known.

 

[Chrispooky12]

Yes -- that's the Jarrow's S. boulardii. And yes, the antibiotics are likely the cause of the diarrhea. If you give a probiotic, you have to separate the AB and the probiotic. You don't want to give them at the same time.

@FrostD or @Chrispooky12 - do you recall how long to separate the probiotic and antibiotic and which goes first?

I don't know if this is the correct answer but I don't give Panzer his probiotic until 2-3hrs after his antibiotic.

 

[Lauren and Loki]

UPDATE:

We just left the ER, Loki is doing fine. Based on the fact that his diabetes is seemingly better regulated the last couple days (thanks to this forum!), they believe he’s just still experiencing residual side effects of the pancreatitis. His ketones are down to 0.9! I was so worried about that. They gave him a Cerenia injection, and are sending us home with more Cerenia, and added some Ondansetron too. I was told I could give Cerenia and Ondansetron at the same time. Is this advised based on experience or should I pick one or the other? Heading home to give Loki his nightly injection, and then to my moms for some type of Christmas Eve

Thanks everyone!

 

[FrostD]

Yes I was always told 2-3 hours for antibiotic vs probiotic spacing.

Like Sienne said, the meds thing really depends on the vet. I keep a stock of meds and just ask for refills as needed, but thankfully my vet is understanding and knows that I know what I'm doing (and also realized people can't keep spending $600+ every time they have to go to the ER on a weekend/night/holiday). Some are hesitant with the pain meds.

*I forgot an appetite stimulant in my list above - Mirataz or ciproheptadine. Sometimes the water from canned tuna (plain water, not broth or anything toxic to cats) or parmesan cheese also entice them to eat.

Yes you can give both Cerenia and ondansetron, they work on different pathways. Med timing is key - you want to make sure he's not in pain and/or nauseous before trying to get him to eat. It's a delicate balance - the pain and nausea meds all take about 1-2 hours to work. The appetite stimulants often work pretty quickly but it depends which you get Antibiotics often need to be given with food, then you also have the probiotic. Fluids should be given in separate location from the insulin.

So my suggestion: give the pain and nausea meds 1-2 hours before his main meals - so this should be 1-2 hours before AM and PM shots. Give the antibiotic with his first snack (around +2 to +3) then the probiotic with his next one (+4 to +6). Be very careful as some of the meds are only once daily. You'll probably need to sit down with pen and paper to figure out the best approach. If you need help, just let us know which meds he has and what the frequency is for each.

Welcome to FD, DKA, and pancreatitis I know it all seems overwhelming but once you figure out the plan of attack you find a groove. Hopefully it's just acute pancreatitis and not chronic.

Merry Christmas!

 

[Bron and Sheba (GA)]

Cerenia is once a day and ondansetron can be given three times a day (8 hourly)

great the ketones are down to 0.9.

It’s not uncommon that post DKA , cats can be nauseated and not want to eat. I would give the antinausea medications routinely for a few days.

keep feeding as much as you can.

 

[Sienne and Gabby (GA)]

You did great! It's not only a delicate balance with timing all of the meds, it's a delicate balance when you have a cat that's recovering from what can be a life threatening illness coupled with a painful inflammation and then diabetes is icing the cake. When it all happens at once, it's overwhelming. Erring on the side of caution can be essential especially when this is all new. Hopefully, among your Christmas presents is that Loki is stabilizing and you're not feeling like your brain is going to explode!

Melissa (FrostD) gave you great information on how she handles her cat's meds. We will often encourage members to get prescriptions for ondansetron and Cerenia. As noted, they work on different pathways and are safe to be given in tandem. (Just an FYI, ondansetron is a human medication -- Zofran. If your vet is out of stock, you can get it at a pharmacy.) Both DKA and pancreatitis can make a cat nauseated for different reasons. It sounds like the ER vets are sensitive to cat issues and are giving you what you need to manage what's going on with Loki.

Bron's advice to keep feeding Loki is also on target. I'd think about small meals that you're spreading out. Along with the timing of the meds, it's helpful if the anti-nausea meds start working ahead of an appetite stimulant (mirtazepine or cyproheptadine). It's no fun to be nauseated and then feeling like you're starving. It's a great way for a cat to develop a food aversion. Small amounts of food will tell you if Loki is hungry. Approaching the food with lip licking/smacking is a sign of nausea.

 

[Bron and Sheba (GA)]

How are things going with you and Loki, Lauren?

 

[Lauren and Loki]

How are things going with you and Loki, Lauren?

Hey there, thanks for checking in! Sorry for being away, holidays really throw you off!

Loki seems to be doing great! He is seeming more like himself. I am currently at work on an overnight shift, and am reading instructions for the SS so I can enter Loki's data, and then maybe y'all can tell me how he is actually doing! Lol, but he definitely is doing better!

I have a couple questions regarding the SS and my work schedule: So I currently work night shifts every Tuesday, Wednesday, & Thursday from 8pm-8am. A real inconvenience for diabetes! This means I have to give Loki his PM shot before I leave for work, so I give it at about 7pm, this way I have about a half hour to watch his BG before leaving. But since I don't get off until the next morning at 8am, he can't get his shot until about 9am. That's 2 hours later than he "should." Although my vet says not to worry too much about it, they also tell me not to test lol....so I have two worries; 1) On the mornings I get home from a night shift, he gets his AM shot about 2 hours later than he should (9am), & 2) he will get his PM shot 2 hours earlier than he should (7pm). That's a lot of time in Diabetes World. How concerned should I be? I suppose it all depends on his BG readings?

And regarding the SS with this time issue, do I put +14 in the AMPS slot? And then for the PMPS, do I put +10 since it will be at 7pm? Just wanting to make sure Loki's SS is understandable.

I hope this makes sense! I have such a strange schedule.

 

[Bron and Sheba (GA)]

Yes I think all makes sense.
No data in the SS yet though …once we can see it, it will be much easier to help you.
What are you doing about food while you are at work for Loki? Do you have an automatic timed feeder?
It’s important he has access to food for the 12 hour apps you are not there.

As far as giving the insulin is concerned…you just have to do the best you can with your shifts. It’s not ideal but it is what it is.
I would give the dose just before you leave…ie closer to the time you leave. 1/2 hour watching him is not going to tell you much. If you give it close to 8 or whenever you leave, it won’t be such a gap in time for the next dose. And then give the dose as soon as you have tested and fed when you get home. You don’t have to wait after feeding to give the dose with Prozinc. You just need to make sure he will eat.

I will tag @FrostD about the time difference of the shots just to be sure as I am not a Prozinc user.
.

 

[Lauren and Loki]

I have been feeding him Fancy Feast Classic pate's as his diet, and I leave a can's worth out while I am gone. I always add additional water to the canned food as well. So he gets about 4-6 cans per day. Sometimes he gets the Fancy Feast Petites pate if he isn't too hungry, which is half the amount of 1 regular can, or if I'm home, I'll give one of those as a snack.

Since I'm using the Libre 2 right now as a reader, some readings I need to enter on the SS are "HI," which on the Libre 2 means it is over 400. Which color do I mark that in the SS? The 400-499 range color, or the >500? I don't know what these readings actually are, if they are actually over 500 or not.

Thank you!

 

[Lauren and Loki]

I live with my Dad right now, so he also is helping me with feeding, when he is home. I'll be moving in with my mom and step-father soon, and they are home much more often so I will have their help with feeding eventually too.

 

[Bron and Sheba (GA)]

If the HI reading is over 400 then colour code it the 400 colour. Just put a note in the remarks column of theSS saying that HI means over 400 so that we know it doesn’t read higher. Thanks

 

[Lauren and Loki]

Everyone, my SS has been updated finally!

I have a few important numbers from the Libre overnight that I need to enter when I get home that went into the low 100s-high 80s I believe. I'm at work and had my dad scanning Loki before he went to bed.
Sorry if my "remarks" section is overflowed with info, it's the only way I know how to keep track.

Let me know if I should start a new thread!

Thank you!

 

[Sienne and Gabby (GA)]

It's up to you about starting a new thread. We try to keep the number of posts in a thread to less than 50 otherwise, there's too much to read through. When you do start a new thread, include a link to this thread since it contains all of the background on Loki.

The good news is that with your schedule, Prozinc is a better choice of insulin than glargine (especially given that Loki doesn't seem to respond well to glargine). You can adjust doses more easily with Prozinc. I'm also tagging Melissa (@FrostD) as she's more familiar with Prozinc than I am. If you look at the dosing sticky for Prozinc, there's a section on the Modified Prozinc Method that discusses dose adjustments.

What you're spreadsheet is telling me is that Loki is bouncing. Every time he drops into blue or green numbers, he bounces back into the stratosphere. While this is truly annoying to us (and the wide swings in blood glucose may make Loki feel less than spectacular), it's not dangerous as long as his ketones are OK. It's a normal phenomenon and the more accustomed he gets to those lower numbers, the more the bouncing will slow down.

 

[Hendrick Cuddleclaw]

bouncing can be very frustrating to work through, just hang in there. It can take a long time for a cat's system to settle down and get used to being in lower numbers again.

 

[Lauren and Loki]

Thank you, I was just starting to read on the dosing for ProZinc, but wanted to finish the SS. I will look at it again later tonight!

He is definitely bouncing! LOL...I will be keeping an eye on the ketones! He is seeming more like himself the last couple days, which I'm happy to see. Does sticking with the 2u dose seem appropriate at this time? Also, I am wondering with my schedule, if different dose amounts in the morning and evening would make a difference? Maybe something to consider? Guess time will tell!!

SS Question: when testing more than once in an hour, and the number results are in a different color range, which color do I choose for the cell? Example: 96 @ +6, 107 @ +6.5

 

[FrostD]

The time difference should be ok in most situations. I like having the 30 mins to watch him, only because that way you can make sure he's eating.

The main concern is if he's lower than usual when you're getting ready to give a shot. You'll need to make sure BG is flat or rising heading into shot time...I don't think that will be an issue but you just never know.

Sometimes the cycles end up lopsided because of this - shooting earlier AM often means a lower AMPS, and then later PM usually means higher PMPS. For now continue to give the same dose for both shots, but eventually we may see different doses are needed AM vs PM depending on how he reacts.

Re: colors, I always code for the lowest color.

The 2U seems ok for now since he's feeling better - but if he starts getting inappetent again you probably want to consider a reduced dose when that happens. Right now I'd say that's about 1.5U, but things change quickly.

 

[Lauren and Loki]

The time difference should be ok in most situations. I like having the 30 mins to watch him, only because that way you can make sure he's eating.

The main concern is if he's lower than usual when you're getting ready to give a shot. You'll need to make sure BG is flat or rising heading into shot time...I don't think that will be an issue but you just never know.

Sometimes the cycles end up lopsided because of this - shooting earlier AM often means a lower AMPS, and then later PM usually means higher PMPS. For now continue to give the same dose for both shots, but eventually we may see different doses are needed AM vs PM depending on how he reacts.

Re: colors, I always code for the lowest color.

The 2U seems ok for now since he's feeling better - but if he starts getting inappetent again you probably want to consider a reduced dose when that happens. Right now I'd say that's about 1.5U, but things change quickly.

Okay so it’s my first attempt since his hospitalization at seeing how he does with my schedule and try to keep him truly regulated. I gave his PM shot last night at 6:45pm, then got home from work this morning and gave it at 8:45am, so that’s 14 hours later. His was at 395 at time of injection. Looking at the Libre graph, looks like he started to come down around noon. Libre “Low” alarm goes off at 4:40 and says he is 65. Which doesn’t necessarily mean low on a libre right? But I get him some food, and he’s eating. 20 min later at 5pm, he’s at 152. I hope he’s okay to dose by the time 7:20 comes around. My dad will be here tonight to watch him. Maybe I will need to lower by 0.25 tonight? This is what has me worried about my schedule, at least maybe until I can teach my family what to do and they feel comfortable. In the long run, actually, maybe lowering the morning dose would’ve been better since 9am-7pm is shorter than what he needs overnight (14 hours, 7pm-9am).

This is the 3rd time he’s gone down into these lower “regular” numbers. I know you said 2U seems okay for now, but his bouncing is making me nervous. If possible, is anyone able to be online around 7pm central time to advise me if needed? If not, or no one sees this before then, it’s okay. Thank you!

 

[FrostD]

Fortunately/unfortunately you'll have to weigh the risks on this one. In a normal situation, I'd say yes reduce by 0.25U if that is more comfortable, especially with the 65. When someone can't be around, I take that at face value because better safe than sorry. The downside is the recent DKA, we want to make sure he has enough insulin.

My two cents - all things considered, if it were my cat I'd reduce. That's twice now he's gone low on this dose, according the the Libre. The first one I chalked up to not feeling well/eating normally, but now that it happened again when he's well is a different story.

Remember nadir is what determines dose, we don't have a lot of control over duration . So no matter what you do, you aren't going to make the Prozinc last 14 hours (very few cats get that kind of duration even when regulated). Increasing dose doesn't increase duration, rather lowers nadir even more.

The only way to help duration is:
(1) slow down any early drops in BG in the hopes of avoiding a bounce. You don't have quite enough data just yet for me to be able to help you with this yet. Sometimes he has big drops, sometimes not. I would just try to make sure he has a snack available around +2/+3.
(2) try not to feed much after nadir when insulin is wearing off. I would not worry much about that right now because post DKA, it is more important than he eats. His nadir is +4 to +6 ish, and 8-10 hours is a long time to go with just light snacks.

 

[Lauren and Loki]

Fortunately/unfortunately you'll have to weigh the risks on this one. In a normal situation, I'd say yes reduce by 0.25U if that is more comfortable, especially with the 65. When someone can't be around, I take that at face value because better safe than sorry. The downside is the recent DKA, we want to make sure he has enough insulin.

My two cents - all things considered, if it were my cat I'd reduce. That's twice now he's gone low on this dose, according the the Libre. The first one I chalked up to not feeling well/eating normally, but now that it happened again when he's well is a different story.

Remember nadir is what determines dose, we don't have a lot of control over duration . So no matter what you do, you aren't going to make the Prozinc last 14 hours (very few cats get that kind of duration even when regulated). Increasing dose doesn't increase duration, rather lowers nadir even more.

The only way to help duration is:
(1) slow down any early drops in BG in the hopes of avoiding a bounce. You don't have quite enough data just yet for me to be able to help you with this yet. Sometimes he has big drops, sometimes not. I would just try to make sure he has a snack available around +2/+3.
(2) try not to feed much after nadir when insulin is wearing off. I would not worry much about that right now because post DKA, it is more important than he eats. His nadir is +4 to +6 ish, and 8-10 hours is a long time to go with just light snacks.

Thank you for your responses @FrostD !! I did decide to reduce by 0.25U, as best I could eyeball, I need to get syringes with a halfway mark. His BG was 212 at the time I had to give it, and then 259 15 minutes later when I was leaving. I felt that was a safe bet. My dad is home and checking on him/scanning to update me for the next few hours. Loki does have food out, and my dad is going to leave more out before he goes to bed.

Thank you for bringing up nadir, dosing, and duration, I am understanding what you're saying and the connection between it all a bit better now. I look forward to understanding duration better down the line with more data.

 

[Lauren and Loki]

@FrostD - I did tag you in my other thread, but here's the link to it so you know it's attached to this thread and is directly tied with the discussion we had here about my work schedule issue

https://www.felinediabetes.com/FDMB/threads/bg-44-on-libre.272392/

Going forward, I will probably create a new thread about Loki, and just post the link to this thread there to start. Thank you to everyone in here for all the information, advice, and support!