New Member, 3/18/2024, 14M Birman Cat diagnosed with DKA 2/27

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djett

djett

Member Since 2024
Hello! My 14y boy Gucc was recently diagnosed with DKA. Please see his history and timeline of events to now. Unfortunately I am having alot of trouble keeping his blood sugar under control

History before DKA diagnosis
  • 14 years, 11 months chocolate point Birman male neutered, 1 of 2 (also have a 7 y/o Birman male)
  • history of CKD with creatine levels ranging from 1.6 - 2.7 (avg 2.2), BUN 26 - 46 (avg 36) over the last year or 2
  • Had a full mouth extraction in 2017 for dental disease so only eats wet canned food and has been on a Hills K/D prescription kidney diet since August 2023. Free fed
  • Has feline Asthma and always has upper respiratory infections with lots of sneezing, nasal discharge etc.
  • Had a mass removed by his hip in October 2023 (turned out benign)

Here's a summary of major events to now. Please see detailed doc for more information with Freestyle libre 3 graphs and comments about feedings/dosage/readings. Keep in mind that Freestyle Libre 3 readings seem to run lower than actual readings about (20-50 maybe?), and even though it will readup to 400, the graphs
  • Tuesday 2/6 - Took him to the vet 2/6/2024 for not producing any urine/stool after multiple attempts in litter box. Urine culture negative for bacteria. Also mentioned his chronic sneezing/discharge, in which they gave 20mg steroid shot of Depo Medrol, which is a glucocorticoid and has a side effect of inducing DM
  • Friday 2/23 - started seeing him drink a lot more water, eat about 3x what he's used to eating, use the litter box more frequently, sticky urine, and a few days later wasn't really eating or drinking, became lethargic, wobbly gait, very sick looking
  • Tuesday 2/27 - Diagnosed with DKA (serum ketones 5, potassium 2.5) with a prognosis of 1/5 chance of surviving. Very lethargic and could barely walk
  • Saturday 3/2 - Discharged with ketones .2, potassium 3.3 and looked much better. Diet changed to 1/2 can of 5.5oz Hills m/d gluccosupport every 12hrs 8am/8pm and 1 unit of Glargine 15 min after each feeding. Also has a Freestyle Libre 3 sensor on him for continuous monitoring, BG was about 320 at discharge
  • Monday 3/4 - He ate only half of his meal at 8pm, BG was around 220, then went up to about 280 at 10pm and dropped to 60 by 1am. Spread honey on his gums and rushed him into the hospital where it then bounced back up over 400 (highest the freestyle libre will read). Took him back home
  • Wednesday 3/6 - Started to notice wobbly gait again and after talking to primary vet, they wanted to keep him there to monitor. That morning his BG had slowly gone down to 80 at time of feeding so I didn't give him insulin before dropping off to the vet. They free fed him and did a curve reading , gave him .5 insulin
  • Thursday 3/7 - Gave him .5 unit of insulin and brought him back to the vet for curve/monitoring and brought my insulin. They free fed him again during the day, gave him 1 unit at 1pm, and another 1 unit at 6:30pm. When I picked him up at 7 his BG was 380 and dropping. It steeply dropped to 50 by 9:30pm so I rubbed honey on his gums at 100 and rushed him into the hospital for overnight care.
  • Friday 3/8 - Potassium was down to 2.2 so I had him hospitalized for fluid treatment.
  • Saturday 3/9 - Discharged with potassium at 3.1, sent home with potassium glucconate, 2mEq to be taken every 12hrs. A new insulin dosage was given at .5 units of glargine every 12hrs after meals.
  • Thursday 3/14 - Brought him back to see how his potassium was holding and it was at 3.1 so they decided to continue the potassium glucconate supplements at 2mEq every 12hrs with food. Since BG has been over 400 almost the entire week, they increased the morning insulin dosage to 1 unit, while keeping the night dosage at .5 unit

I was initially hoping this was a temporary issue caused by the Depo Medrol shot but unfortunately his BG is still not under control and is over 400 as we speak. As you can imagine i've spent enough to buy a brand new car, and still feel like I am back at square 1. I also have an Alphatrack 3, but unfortunately I can't seem to get enough blood from him. I've pricked him at least 6 times (poor guy) with no luck or such a tiny amount that I cant get a reading. So currently I only have Freestyle Libre 3 readings, which seem to run a little low.

I would love to hear more feedback, any help would be well appreciated! I have an appointment with internal medicine on Wednesday March 20th, but i'm desperate at this point. Thank you so much for taking the time to read this I really appreciate it!

Thanks,
Devin
 
I was unable to upload my detailed document but feel free to view it here . Let me know if theres a way to post as a PDF or similar

Thanks again!
Devin
 
djett said:
I was initially hoping this was a temporary issue caused by the Depo Medrol shot but unfortunately his BG is still not under control and is over 400 as we speak.
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It is likely that the Depo Medrol causted the diabetes. It can take awhile after the shot for a cat to go into remision and frequenlty insulin is required. THus, there is hope for remission.
What only ½ unit at night?'
Do you get any blood at all from the ear sticks? Are you warming the ears before poking?
Are yo using the lacent pen? is so then try with the lancets w/o the pen.
Are you firmy baking up the ear where you poke? I use a cotton cosmetic pad since I can use that to absorb blood and apply pressure after the poke.
 
Hi and welcome to the forum. I’m sorry you and your kitty have gone through this.
With DKA in the very recent past there are several things you need to be doing.
I’ll write a list…don’t be worried about all that needs to be done. It will become routine to you very soon and there will be less to do once Gucc recovers fully from the DKA.
  • you need to give one and a half times as many calories as Gucc 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. Testing for ketones helps us see if there is enough insulin being given. It’s important that ant ketones at all are dealt with asap.
  • Give antinausea medication if needed such as ondansetron or cerenia…were you given either of these on discharge? If not you need to go back to the vet and ask for some.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids
  • Set up a spreadsheet and test the BG frequently. I will ask @Bandit's Mom to help you with this as you wil be busy with Gucc.
  • Post daily with updates and ask for help as often as needed.
The reason you are seeing the BGs go from low to high is because of bouncing which is very common and normal in newly diagnosed cats. Here is an explanation on bouncing
  • 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).
Regarding the dose…I would suggest giving 0.75 units both night and morning instead of 1 unit in the morning and 0.5 units at night. The 1 unit may prove to be too much.
Do not give the insulin more often than 12 hours apart.
Always take a reading before every dose and then again during the cycles. Your main jobs moving forward are to feed as much as possible to Gucc, test the urine daily for ketones, give him antinausea medications if he is not wanting to eat, to try and encourage fluids and to give the insulin every 12 hours. We don’t want you skipping any doses if at all possible as it is insulin and food that will keep the ketones away.

what food are you feeding him at the moment?
keep asking lots of questions. We are very happy to help you.
 
Bron has provided great information about ketone management. Ketones can show up if there's an underlying infection or inflammation + not enough calories + not enough insulin. For a newly diagnosed diabetic, their pancreas isn't producing insulin and you're not aware of the diagnosis. The two things you can manage at home are testing for ketones and food. You can test for ketones either with urine test strips or with a ketone meter. You will want to feed your cat low carb food, just more of it or use a food that's higher in calories (not carbs).

Fluids can also help. I routinely add water to my cats' food because it's good for their kidneys. With ketones, fluids helps to flush them from. your cat's system. Adding water to food is helpful. I would ask your vet about giving fluids at home if there is a concern about ketones.

Most of us use a spreadsheet to track our cat's progress. Likewise, we put information about our kitty in our signature. This is a link to the instructions in our helping us to help you post since the signature and spreadsheet are the best way we can offer guidance.
 
Thank you all for the replies and sorry for the late response, just wanted to give you an update. I think I had been way too hyperfocused on the freestyle libre values instead of focusing on consistency, eating, and how he looks overall instead of the just the numbers. I had an internal medicine consult at the animal hospital and we went with a new plan. Unfortunately Gucci is still losing weight and has lost another 1/2 lb since last week. Here's what came out of last weeks consult
  • His potassium improved to from 3.1 to 3.8 and they want to keep him on the 2mEq twice daily potassium gluconate
  • Ideally the Dr wants him to eat an entire 5.5oz can of the Hills Gluccosupport every 12 hours. He is very adamant about only feeding every 12 hours with insulin shots 15 min after which is common but differs from some of the comments and other posts i've seen on the forum. Is there a reason some prefer free feeding vs every 12hrs? Will free feeding affect insulin levles and dosage? I'm thinking of switching to the Weruva Wx Chicken Puree since Gucci doesnt have teeth, has CKD and requires low phosphorus, and requires a low carb diet for his Diabetes.
  • Since Gucci only eats about 1.2 of a 5.5oz can currently which is consistent with the amount hes eaten before the DKA, the Dr is prescribing Metoclopramide to help as an appetite stimulant. He also gave him a B12 shot last week.
  • We went back to 1 unit every 12 hours of the Glargine and have been doing that for over a week now
  • Still using the Freestyle Libre 3 sensor for monitoring. I even bought a second iPhone that I can keep at home so I can monitor remotely via the LibreLinkUp app. The doctor did mention that the sensor is usually 20min behind, not sure if anyone can conform that to be true or not since I cant find that info online. I did buy an Alphatrack 3 to get his BG, however am having issues getting blood. His ears are very dark and cant seem to get blood from them, and everytime i poke him with the lancet in his paw, a tiny bit of blood comes out. I'll stick with the Freestyle for now until I figure out how to get blood.
  • The Dr is ok with his glucose levels being high (above 400 dipping to around 350 a few times a day), and is more focused on being more consistent and making sure he eats more so he can gain his weight back

I will look for some ketone sticks so I can test at home, but all in all Gucci seems like he's ok, he's alert, interested in playing at times, has an appetite, his voice has returned to normal, and seems to be using the litterbox normally, however he is still walking a bit wobbly, still cant really jump since he's lost alot of muscle. Would love to hear your feedback.

Thanks,
Devin
 
djett said:
The doctor did mention that the sensor is usually 20min behind, not sure if anyone can conform that to be true or not since I cant find that info online.
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The Libre BG tends to lag and ear stick. See:
https://www.freestylelibre.com.au/difference-between-glucose-interstitial-glucose
However, the Libre us calibrated for humans and not cats (or dogs) and thus the interstitial BG that the Libre measures is likely different because of the differences between humans and other animals.
Note that Libre BG can be significanly different that eat sticks. For the last L3 I had on my Wiggles an ear stick showed 173 and Libre showed 71.
Tuus, I use the Libre to show trends show when I need to do an earstick, I always make decisions based on ear sticks.
 
djett said:
Ideally the Dr wants him to eat an entire 5.5oz can of the Hills Gluccosupport every 12 hours. He is very adamant about only feeding every 12 hours with insulin shots 15 min after which is common but differs from some of the comments and other posts i've seen on the forum. Is there a reason some prefer free feeding vs every 12hrs? Will free feeding affect insulin levles and dosage? I'm
Click to expand...
I’m afraid I disagree completely with your internal medicine specialist in regards to when to feed. DKA Howie a when there is not enough food, not enough insulin and an infection or inflammation present. So it stands to reason to prevent DKA those three things need to be addressed.
Only feeding twice a day is simply not enough. We recommend feeding multiple times a day. And we see a lot of kitties here with DKA. I wonder how many your consultant sees. Please give two main meals with the fuses of insulin and then several smaller snacks during all the cycles. Food helps keep ketones away.
djett said:
The Dr is ok with his glucose levels being high (above 400 dipping to around 350 a few times a day), and is more focused on being more consistent and making sure he eats more so he can gain his weight back
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I am also concerned the consultant is happy to leave the BGs above 400 and dipping to only 350.
Are you testing before every dose and then again during every cycle to see how low the dose is taking your kitty? Also testing for ketones every day is very important. That tells us if your kitty is getting enough food and enough insulin.
I would urge you to set up a Spreadsheet and your signature do that we can see what is happening. At the moment we have no idea. We are very used to helping people through the post DKA weeks but need a spreadsheet and information about ketones.
Did @Bandit's Mom contact you about the spreadsheet? There is information in the ‘help us help you ‘ link that Sienne sent you above

if you want Guce to put on weight, you need to be giving the correct amount of insulin to help bring down the BGs into more normal numbers.
keep asking questions :)
 
Larry and Kitties said:
The Libre BG tends to lag and ear stick. See:
https://www.freestylelibre.com.au/difference-between-glucose-interstitial-glucose
However, the Libre us calibrated for humans and not cats (or dogs) and thus the interstitial BG that the Libre measures is likely different because of the differences between humans and other animals.
Note that Libre BG can be significanly different that eat sticks. For the last L3 I had on my Wiggles an ear stick showed 173 and Libre showed 71.
Tuus, I use the Libre to show trends show when I need to do an earstick, I always make decisions based on ear sticks.
Click to expand...

Thanks alot for the info that makes sense. I'm failing miserably at getting BG from the Alphatrak 3, I've already went through a whole pack of the little small needles to put on the lance, have poked him a bunch of times but haven't been able to get blood or enough for a sample. He gets super stressed too so am going to stick with the Freestyle Libre 3 for now
 
Bron and Sheba (GA) said:
I’m afraid I disagree completely with your internal medicine specialist in regards to when to feed. DKA Howie a when there is not enough food, not enough insulin and an infection or inflammation present. So it stands to reason to prevent DKA those three things need to be addressed.
Only feeding twice a day is simply not enough. We recommend feeding multiple times a day. And we see a lot of kitties here with DKA. I wonder how many your consultant sees. Please give two main meals with the fuses of insulin and then several smaller snacks during all the cycles. Food helps keep ketones away.

I am also concerned the consultant is happy to leave the BGs above 400 and dipping to only 350.
Are you testing before every dose and then again during every cycle to see how low the dose is taking your kitty? Also testing for ketones every day is very important. That tells us if your kitty is getting enough food and enough insulin.
I would urge you to set up a Spreadsheet and your signature do that we can see what is happening. At the moment we have no idea. We are very used to helping people through the post DKA weeks but need a spreadsheet and information about ketones.
Did @Bandit's Mom contact you about the spreadsheet? There is information in the ‘help us help you ‘ link that Sienne sent you above

if you want Guce to put on weight, you need to be giving the correct amount of insulin to help bring down the BGs into more normal numbers.
keep asking questions :)
Click to expand...

Thanks! One of the issues i'm having is that the Dr wants him to eat at least a half a 5.5oz can twice a day and he's barely eating that, sometimes only eats 1/4th a can, and most of time around 80-90% of the 1/2 a can. When i've tried free feeding him, he eats almost nothing around insulin time, so i'm not exactly sure what to do. I would love for him to eat as much as possible, but his eating hobbits are consistent with how he's been most of his life, which unfortunately is not enough right now. do you have any recommendations for giving him more food but ensuring that he will eat at insulin time? I'm feeding him 1/2 can of Hills Gluccosupport and also bought some Weruva Wx Chicken Puree to give him if he doesnt eat enough of the hills. He also has CKD, and doesnt have teeth

I bought some ketone test strips yesterday, and this mornings test showed no ketones, although the glucose form the urine test was pretty high which is consistent with the Freestlye Libre 3 sensor readings. The last few days have been a little rough. His walking has gotten worse and he has been constipated the last 2 days, so I gave him 1/2 teaspoon olive oil which helped him pass stool, but then he threw up his entire meal and had diarrhea. He ate a little after throwing up but barely ate tonight so I went light on the insulin. I'm hoping he will go back to eating normally tomorrow morning. he's still pretty alert and doesn't look super lethargic as he did when I first brought him in, and at times is interested in the laser toy.

Please see the spreadsheet in my signature. Keep in mind these readings are from the Freestyle Libre 3 which don't read over 400. Since his values are still very high, do you recommend I bump the insulin dosage up to 1.5 or 2 units? I wanted to try 1.5 today but since he threw up and didn't eat a alot I was cautious with tonights insulin dosage.

Thanks alot!
 
Excellent no ketones. Please test again when you can especially since you have a reduced dose of insulin. With DKA in the very recent past, I would not recommend skipping or reducing the dose of insulin. Remember it is not enough insulin and not enough food that will let the ketones back into the picture. And we don’t want that.
How bad is his CRD?
You don’t need to feed the prescription food. If he prefers Weruva give him that.
With glargine, he doesn’t have to eat a lot before the dose as long as you know he will eat it over the next few hours. The onset of glargine is around +2 hours. You don’t have to follow what the vet says about him eating twice a day. That is old thinking. It is much better to eat several smaller meals throughout the day and night.
Please stay with the 1.5 Unit dose for now.
Can you set up your signature please with info about Gucci thx
 
Bron and Sheba (GA) said:
Excellent no ketones. Please test again when you can especially since you have a reduced dose of insulin. With DKA in the very recent past, I would not recommend skipping or reducing the dose of insulin. Remember it is not enough insulin and not enough food that will let the ketones back into the picture. And we don’t want that.
How bad is his CRD?
You don’t need to feed the prescription food. If he prefers Weruva give him that.
With glargine, he doesn’t have to eat a lot before the dose as long as you know he will eat it over the next few hours. The onset of glargine is around +2 hours. You don’t have to follow what the vet says about him eating twice a day. That is old thinking. It is much better to eat several smaller meals throughout the day and night.
Please stay with the 1.5 Unit dose for now.
Can you set up your signature please with info about Gucci thx
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Thanks I'll test as soon as he uses the litter box. Here are my comments/questions
  • Regarding his CKD, his creatine usually fluctuates anywhere from 1.6-2.7 with an average of 2.2, and BUN usually in the 20s or 30s.
  • How can I ensure he eats within 2 hrs? Thats the part im scared of especially because of the hypo events in the first week of March, one which I saw his glucose go from 280 to 60 in under 2 hrs after eating half of his meal with 1 unit. I'm a little nervous to free feed him and then give him a full dose of insulin at night, but I am willing to give things a try since my current situation hasnt been working. Just not sure if theres some condition to his doasge, for example if the PM reading is under 300 before feeding, give him half? I just can't afford another hypo event as well.
  • I took a look at Tanyas comprehensive list of Foods and am willing to switch from Hills Gluccosupport, however having a difficult time finding food that I can give him that supports his diabetic and kidney issues (wet food since he doesnt have teeth, carbs <10%, phosphorous under .5%). Not sure if I should be taking protein into account too since Diabetics usually require over 50% but cats with CKD require around 25-35% protein
  • I believe my Signature has been updated, but let me know if theres something i'm missing.
  • Since he's been losing alot of potassium over the month and threw up his entire AM meal yesterday and had diarrhea, Im wondering if I should double his potassium dose for the day. At initial DKA diagnosis a month ago his potassium was 2.4, back in normal range at discharge, but back down to 2.2 a week later, then hospitalized again and back up to 3.1, and to 3.8 with 2mEq supplementation

Gucci looks noticeably worse today in regards to his walking/wobbly gait. He couldn't walk to his food today so I had to bring the bowls of food and water to the bed so he would eat. He did eat a decent amount (maybe 75% of his meal) but still hasnt used the litter box, and although he looks alert, looks more lethargic. I'll continue to update the spreadsheet and see what happens!
 
Update,

Gucci has had good and not so good moments this week. He seems to be eating more, however has had a couple instances of constipation which turned into diarrhea with Lactulose. This morning noticed that he tried to use the litter box 3 times and almost nothing came out so took him to the vet. Vet didnt feel a blockage, but also took his glucose while he was there, and it was 566!! This doesnt make sense because hes been eating a low carb diet and I increased his insulin to 1.5 and even 2 units! (see spreadsheet).

Other than the bathroom issue he seems to be alert and walking ok for the most part, I just got home and he still looks to be in a little pain and couldnt pass urine just now so im a little worried about multiple things. I entered more details in the remarks in the spreadsheet. Last night when I tested his urine he had no evidence of ketones
 
Unfortunately Guccis Glucose has not dipped below 400 Since April 4th. Urine test from this morning show no ketones, but still shows Glucose between over 500. I tried again to poke him with the Alphatrak 3 numerous times, but I think i'm just going to have to live with the fact that I cant get blood from him no matter how many videos/instructions I follow, so i'll continue to monitor with the Freestyle Libre 3

I just increased the dosage again today and now to 2.5 units so hopefully he responds, it's really mind boggling that just a couple of week ago 1 unit put him into hypo, but now hes not responding to 2 units twice a day. Not sure what else to do other than keep increasing the dosage until it at least gets below 400?

Any help/feedback will be appreciated. Thanks!
 
djett said:
Unfortunately Guccis Glucose has not dipped below 400 Since April 4th. Urine test from this morning show no ketones, but still shows Glucose between over 500. I tried again to poke him with the Alphatrak 3 numerous times, but I think i'm just going to have to live with the fact that I cant get blood from him no matter how many videos/instructions I follow, so i'll continue to monitor with the Freestyle Libre 3
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Some thoughts: Are you using the lancet device that was included with the AlphaTrak? If yes, does it it have adjustable depth settings? If yes, try a higher setting and press the device firmly against the ear. If no, try one of the following: 1. freehand the lancet (carefully) without the device or 2. try a different lancet device. Some lancet devices just won't work very well. Any pharmacy sells lancet devices and matching lancets for Human diabetics. Also, some lancets are just too thin to get much blood with. A thicker lancet size would work. Look for 27 gauge lancets.

Are you warming the ear really well before poking? Warming the ear helps increase blood flow.
 
squeem3 said:
Some thoughts: Are you using the lancet device that was included with the AlphaTrak? If yes, does it it have adjustable depth settings? If yes, try a higher setting and press the device firmly against the ear. If no, try one of the following: 1. freehand the lancet (carefully) without the device or 2. try a different lancet device. Some lancet devices just won't work very well. Any pharmacy sells lancet devices and matching lancets for Human diabetics. Also, some lancets are just too thin to get much blood with. A thicker lancet size would work. Look for 27 gauge lancets.

Are you warming the ear really well before poking? Warming the ear helps increase blood flow.
Click to expand...

Thanks for the reply! Correct i've tried with the lancet that comes with the Alphatrak (made for pets) on the highest setting, and even tried it freehand. I'll try to grab a 27 gauge or one made for humans that might be a little thicker, thanks for the suggestion!

I used a method I saw online where you fill a sock with rice heated up in the microwave for 10 seconds, then put a rubber band around it and use that to warm the ear and get blood flowing, then use the ball of rice in the sock as a support when putting the lancet through. Unfortunately I didnt get any blood from that either, and its pretty difficult since hes a long haired chocolate point Birman with dark brown ears and its very difficult to even get him to stay still as he fights his way out. I also tried the paw pad both with the lancet and free, but only a small dot of blood came out which wasnt enough either and that one seemed to hurt him alot more :-(. I'm hoping I can eventually get blood out of the ear

Thanks,
Devin
 
Also regarding the 566+ glucose, is it possible a UTI could cause glucose to be very high as well? He’s passing a more urine now and closer to normal, but as I mentioned in my spreadsheet remarks he could barely produce any urine on Friday, so there’s a possibility he could have a bacterial infection.

I have an extra bottle of Clavimox that hasn’t yet been reconstituted I wonder if I should just give him that as a precautionary? My vet wants to do a urinalysis and urine culture again but unfortunately that costs about $350 just for them to tell me there’s no bacteria or that he needs Clavimox anyway.
 
Ok seems like constipation noted on my spreadsheet has resurfaced and is now severed. Hes been trying to poop for the last hour and a half and nothing, is even constantly straining and trying to poop anywhere in the house. I started him on 1/8 teaspoon of Miralax this morning, but not sure that's kicked in. His blood sugar had actually dropped below 300 today after the increase to 2.5 units, but at around 3pm he threw up all his food. I then tied to give him a hydrating gravy from the Weruva wx, and he drank it all but then threw that up again. So now I have a constipated cat whose glucose is dropping because he threw everything up and cant seem to keep food up. I'm running out of options with this cat and afraid I might have to make a tough decision in the near future. If anyone has any pointers please feel free to share
 
djett said:
I used a method I saw online where you fill a sock with rice heated up in the microwave for 10 seconds, then put a rubber band around it and use that to warm the ear and get blood flowing, then use the ball of rice in the sock as a support when putting the lancet through. Unfortunately I didnt get any blood from that either, and its pretty difficult since hes a long haired chocolate point Birman with dark brown ears and its very difficult to even get him to stay still as he fights his way out. I also tried the paw pad both with the lancet and free, but only a small dot of blood came out which wasnt enough either and that one seemed to hurt him alot more :-(. I'm hoping I can eventually get blood out of the ear
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The "rice sock" is what many people use. It might take trial and error to find how much rice you need in the sock and how long you need to heat the sock for. I have a DIY bag filled with about a tablespoon of rice and it only needs 10 seconds in the microwave. The sock needs to be warm enough so you're not burning your hand while holding it for a good minute (or your cat's ear). Wrap the sock around the edge of the ear and hold firmly in place. Distract the cat with a toy or treat while you get the ear warm. If you're able to, kneel on the floor with the cat tucked between your knees. That keeps most cats from wiggling too much.

Always reward with a treat afterwards. Cats eventually learn that if they let you mess with their ear they get a yummy treat for it.

Did you try the other ear? Some cats only have one ear that will consistently give blood with a poke.

A head lamp or bright lamp nearby might help you see the ear vein better. Or hold a small flashlight under the ear. You're not really aiming for the vein, just the space between it and the edge of the ear. The area above that funny curl at the base of the ear is a good spot to poke.
 
Not sure if it was already mentioned…but a small dab of Vaseline on the ear can help the blood bead up rather than soak into the surrounding fur.
 
Hello!! Just wanted to give an update and reach out for some advice and throw some questions out there. I really appreciate everyone taking the time to help out :)

I have kept Gucci at 2.5 units for the past 7 days and it seems as though he has bounced twice, although when his bounce seems to wear off the numbers only dip to the low 300s. With lower doses of insulin in the past he would sometimes barely even dip below 400. Over the last couple of days his numbers have been the most flat as i've seen them since diagnoses at the end of Feb, although still in the 300s.

Since it had been 7 days, I increased his dose to 3 units today, and his glucose dropped significantly very fast. I had to syringe feed him karo syrup twice today as it was rapidly falling in the 100s to get it to go back up. This happened on two occasions about 3 hours apart and i'm assuming that his glucose will be super high again for the next couple of days. It's really strange to me that only a 1/2 unit increase could cause him to plunge twice in one day when 2 1/2 units seemed to never get him below the 300s. Does anyone have any insight or advice? Still using glargine. He has looked alot better and seemed back to himself over the last few days, although I'm afraid with another bounce he will get a little more wobbly/lethargic.

I updated the spreadsheet and entered more comments as well that details the highs/lows. He pooped a little this morning, and at night produced lotss of urine. I did a urine test and although the ketones come back negative majority of the time, this time the color turned gray, which is not even on the spectrum! After searching on this forum looks like a few others have seen this and it wasn;t a real issue, so I will continue to monitor his symptoms, but he doesnt seem to have any DKA symptoms.

Thanks!
 
djett said:
Hello!! Just wanted to give an update and reach out for some advice and throw some questions out there. I really appreciate everyone taking the time to help out :)

I have kept Gucci at 2.5 units for the past 7 days and it seems as though he has bounced twice, although when his bounce seems to wear off the numbers only dip to the low 300s. With lower doses of insulin in the past he would sometimes barely even dip below 400. Over the last couple of days his numbers have been the most flat as i've seen them since diagnoses at the end of Feb, although still in the 300s.

Since it had been 7 days, I increased his dose to 3 units today, and his glucose dropped significantly very fast. I had to syringe feed him karo syrup twice today as it was rapidly falling in the 100s to get it to go back up. This happened on two occasions about 3 hours apart and i'm assuming that his glucose will be super high again for the next couple of days. It's really strange to me that only a 1/2 unit increase could cause him to plunge twice in one day when 2 1/2 units seemed to never get him below the 300s. Does anyone have any insight or advice? Still using glargine. He has looked alot better and seemed back to himself over the last few days, although I'm afraid with another bounce he will get a little more wobbly/lethargic.

I updated the spreadsheet and entered more comments as well that details the highs/lows. He pooped a little this morning, and at night produced lotss of urine. I did a urine test and although the ketones come back negative majority of the time, this time the color turned gray, which is not even on the spectrum! After searching on this forum looks like a few others have seen this and it wasn;t a real issue, so I will continue to monitor his symptoms, but he doesnt seem to have any DKA symptoms.
I wouldn't say those 2 blues you got today were hypo numbers and didn't have to give honey ,

Thanks!
Click to expand...
@Bron and Sheba (GA)
@Wendy&Neko
@Bandit's Mom
 
Last edited:
djett said:
I had to syringe feed him karo syrup twice today as it was rapidly falling in the 100s to get it to go back up. This happened on two occasions about 3 hours apart
Click to expand...
Since we don't see these numbers on your spreadsheet ,I copied what you wrote in your remarks section so members aware of it

djett said
After giving 3 units, glucose dropped significantly. Since libre is 20min behind and since it was trending straight down and dropping rapidly, I applied karo syrup at 180 and it began to go back up at around 150. It went back up to 313, then rapidly dropped again with the arrow trending down so I again applied karo syrup. It has since bounced back to high numbers


By the way can you add what food you are feeding to your signature so members know , is it just low carb wet or combo ( low carb wet and kibble )
@djett
 
Last edited:
Diane Tyler's Mom said:
if you tap on this link and look at post #32 I listed some Weruva pates for another member that's low carb/ low phosphorus.
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3124085
Click to expand...

Thank you! I actually used that to change his diet and stop using Hills prescription Gluccosupport. I'm giving him a combination of the following foods right now, and also trying to get my other cat (7 years old) to like the same so I dont have to separate them and meals. I'm currently giving him the following food which are all relatively low in phosphorus and all low carbs

Main meal - one of the following 2.8oz cans twice a day (he usually wont eat all of it but I leave it out and he will eventually come back)
  • BFF Chicken Checkmate
  • BFF Topsy Turvey
Food to supplement - When he stops eating his main meal i'll give him one of the following 3oz cans to get him to eat more. he won't eat it all but I leave this out as well and he will often come back to it
  • Weruva Truluxe steak frites
  • Weruve Wx Chicken puree
  • Weruva Wx chicken/Tilapia puree
He doesnt have teeth (see photo haha) so I have to stick with pates/purees, but luckily Weruva has some decent pate options (although pricey) that satisfy Diabetes and CKD.

Thanks!
 
The Weruva food you listed are ok. But can you just add to your signature Weruva Pate please. If you start another post eventually members need the food you feed in your signature ,they won't go searching for it in your previous posts
 
Hi. (Sorry I don’t know your name?)
You definitely need to increase the dose of insulin of 2.5 units as the BGs are much too high, especially on a post DKA kitty.
Why don’t you try going to 2.75 units?
Gucci was quite safe in the blue BGs in the am cycle. I know you were probably scared the BGs dropped. Next time this happens, feed some normal low carb food. If it continues to drop dramatically, try feeding some higher carb foods such a a gravy lovers fancy feast canned food. (I am hoping you have some of her carb foods at home in your hypo box)
This is no need to give honey or Karo unless Gucci drops under 90 (or 50 if you are following tight regulation method). I can’t see anywhere, where you indicate which method you are following. With DKA in the recent past I would recommend TR dosing method.
Here are the DOSING METHODS for you to look at.
Keep testing daily for ketones.
How much are you feeding Gucci?
Are you doing any tests with your hand held meter at all? It would be helpful if you could.
Keep asking questions
 
Bron and Sheba (GA) said:
Hi. (Sorry I don’t know your name?)
You definitely need to increase the dose of insulin of 2.5 units as the BGs are much too high, especially on a post DKA kitty.
Why don’t you try going to 2.75 units?
Gucci was quite safe in the blue BGs in the am cycle. I know you were probably scared the BGs dropped. Next time this happens, feed some normal low carb food. If it continues to drop dramatically, try feeding some higher carb foods such a a gravy lovers fancy feast canned food. (I am hoping you have some of her carb foods at home in your hypo box)
This is no need to give honey or Karo unless Gucci drops under 90 (or 50 if you are following tight regulation method). I can’t see anywhere, where you indicate which method you are following. With DKA in the recent past I would recommend TR dosing method.
Here are the DOSING METHODS for you to look at.
Keep testing daily for ketones.
How much are you feeding Gucci?
Are you doing any tests with your hand held meter at all? It would be helpful if you could.
Keep asking questions
Click to expand...

Thanks! My name is Devin, and sure I can start 2.75 tomorrow morning I think thats a good idea! The reason I started the karo syrup at 185 is because the Libre 3 is usually 20min behind and it had already dropped about 200-250mg in a little over an hr and was still trending straight down. In early march this happened twice and it eventually went down to 55, so I was trying to prevent that, and prevent it from going too low so it wouldnt bounce again. Was that a bad idea? You can be honest, I take constructive critisim very well :).

I'm still using the freestyle libre 3 to monitor with a dedicated device so I can monitor remotely when i'm gone. I tried larger lancets for my Alphatrak 3, but unfortunately just can't get enough blood, it's a very stressful and difficult process for both him and me unfortunately, he's a difficult patient when pinned down ha!

I've been taking the cautious route with insulin since I had 2 hypo events in the past and both times his potassium dipped to around 2.2-2.5 and required hospitalization which is VERY expensive here in Miami (about 2K a night on average). So i'm trying to be very cautious but have also been increasing dosage every few days if it doesnt seem to be enough. Stayed at 2.5 for about a week, i'll start 2.75 tomorrow since 3 units seemed to drop it too fast/too low

Thanks,
Devin
 
djett said:
The reason I started the karo syrup at 185 is because the Libre 3 is usually 20min behind and it had already dropped about 200-250mg in a little over an hr and was still trending straight down. In early march this happened twice and it eventually went down to 55, so I was trying to prevent that, and prevent it from going too low so it wouldnt bounce again. Was that a bad idea? You can be honest, I take constructive critisim very well
Click to expand...
Hi Devin!
I will always be honest as I want what is best for Gucci…I don’t want to criticise you at all as I know this is a big learning curve for you as you learn all about FD. I know it was for me! What I want to do is show you how best to manage the journey. We all reach for the honey or Karo when our kitty first starts dropping fast…so don’t worry about that. The first time Sheba dropped really low, I gave her so much honey she was very seedy all the next day!
Hospitalisation is very expensive so we will do all we can to help you prevent this.
Some questions…
  • Are you giving a good meal before the doses of insulin and then giving snacks during the first half of all the cycles?
  • Are you out of the house during the day? An automatic timed feeder is a good solution if you can’t be there to give the snacks. I used one for Sheba and it was a lifesaver.
  • Do you have a hypo box set up with higher carb food and some honey or Karo in case of low numbers?
  • If you are having trouble with the alphatrak meter…what about getting a ReliOn meter from Walmart. They are much cheaper to run. And you might find it easier to use.
  • Have you looked at the HOMETESTING HINTS AND LINKS. This will give you ideas on how to best approach home testing. I used to kneel on the ground and put Sheba between my knees facing the same way I was so if she tried to back away she backed into me. I had everything ready on the ground beside me and I put a small amount of low carb food in front of her while I tested her..try that.
Try posting every day so we can help you. Don’t leave it until you have an issue. And have a look at the 2 dosing methods
Bron :)
 
@Bron and Sheba (GA) I am also trying to find a solution about bouncing. I noticed you asked about a good meal before the insulin shot, is that recommended? Right now we are feeding and shooting at the same time but if feeding first and waiting before shot would curve the bounce we will try it!
 
It’s fine to feed and shoot at the same time as long as you are confident Rudy will eat. The onset of Lantus is not fit about 2 hours so as long as he eats well before then you are ok. Also snacks during the cycles is what we recommend. @SweetGreyRudy
Bouncing is very common in newly diagnosed cats. I suggest you start your own thread so we can help you with that.
 
Bron and Sheba (GA) said:
Hi Devin!
I will always be honest as I want what is best for Gucci…I don’t want to criticise you at all as I know this is a big learning curve for you as you learn all about FD. I know it was for me! What I want to do is show you how best to manage the journey. We all reach for the honey or Karo when our kitty first starts dropping fast…so don’t worry about that. The first time Sheba dropped really low, I gave her so much honey she was very seedy all the next day!
Hospitalisation is very expensive so we will do all we can to help you prevent this.
Some questions…
  • Are you giving a good meal before the doses of insulin and then giving snacks during the first half of all the cycles?
  • Are you out of the house during the day? An automatic timed feeder is a good solution if you can’t be there to give the snacks. I used one for Sheba and it was a lifesaver.
  • Do you have a hypo box set up with higher carb food and some honey or Karo in case of low numbers?
  • If you are having trouble with the alphatrak meter…what about getting a ReliOn meter from Walmart. They are much cheaper to run. And you might find it easier to use.
  • Have you looked at the HOMETESTING HINTS AND LINKS. This will give you ideas on how to best approach home testing. I used to kneel on the ground and put Sheba between my knees facing the same way I was so if she tried to back away she backed into me. I had everything ready on the ground beside me and I put a small amount of low carb food in front of her while I tested her..try that.
Try posting every day so we can help you. Don’t leave it until you have an issue. And have a look at the 2 dosing methods
Bron :)
Click to expand...

Thank you! To answer your questions
  • Yes Im giving him about 3oz (about 85 grams) of food once in the morning (around 8am) and once at night (around 8pm), but also free feeding during the day and removing bowls about 3-4 hours before meal time. So he eats throughout the day as well
  • I work from home and honestly since diagnosis havent been comfortable leaving the house for long durations, especailly since the first night I went out the house he had a hypo event. I will check on the auto feeder and see if they have them now for wet food since he doesnt have teeth, but that would be great if so.
  • I do have higher carbs CKD food on deck and karo syrup which I used twice 2 days ago to get him back up.
  • I dont think its the meter as much as the process that is making it difficult. I don't want to prick him in the paws especially since hes walking all over gooey litter, wouldnt want him to get infected, and his ears are problematic because they are always cold and dark brown. I tried different methods online including heating a sock full of rice to warm the ears and use as a backing to take his blood, but even if I can find the blood which is difficult, its usually not enough. I tried larger lancets and even poking without the lancet device but still no luck. It's only me here and he moves/fights even when pinned between the knees so i cant grab a flashlight or use my phone to find the blood on his ear.

Looks like his bounce didnt last as long as usual this time, and his glucose has gone down 200mg in the last hour and now at 193, so will continue to monitor throughout the day. Finally getting into halfway decent ranges, however since the 2.75 units is making his glucose plunge so quickly im a little nervous about maintaining that dose for tonight (unless it bounces back up in the next 4-5 hrs of course :-)). I did recently completely cut out the hills prescription food which was a little higher carbs (11% vs 8% on DMA), but it doesnt seem like just a 3% decrease in carbs would cause it to plummet so quick and fast. Perhaps I should only give 2 units tonight if his glucose stays around the 200's or low 300s?

Thanks,
Devin
 
SweetGreyRudy said:
@Bron and Sheba (GA) I am also trying to find a solution about bouncing. I noticed you asked about a good meal before the insulin shot, is that recommended? Right now we are feeding and shooting at the same time but if feeding first and waiting before shot would curve the bounce we will try it!
Click to expand...

for the same reason @Bron and Sheba (GA) mentioned, I was also told to wait about 15 min after the meal to make sure he eats before giving the insulin. Since my cat takes about 30 min to eat since he stops starts back up again with a bathroom break in between lol, this means I usually shoot 45 min after feeding, hopefully you have better luck getting your cat to eat all in one sitting.

Another reason I was told to wait before shooting is in case they vomit their food and won't eat enough to cover the insulin dosage
 
djett said:
Thank you! To answer your questions
  • Yes Im giving him about 3oz (about 85 grams) of food once in the morning (around 8am) and once at night (around 8pm), but also free feeding during the day and removing bowls about 3-4 hours before meal time. So he eats throughout the day as well
  • I work from home and honestly since diagnosis havent been comfortable leaving the house for long durations, especailly since the first night I went out the house he had a hypo event. I will check on the auto feeder and see if they have them now for wet food since he doesnt have teeth, but that would be great if so.
  • I do have higher carbs CKD food on deck and karo syrup which I used twice 2 days ago to get him back up.
  • I dont think its the meter as much as the process that is making it difficult. I don't want to prick him in the paws especially since hes walking all over gooey litter, wouldnt want him to get infected, and his ears are problematic because they are always cold and dark brown. I tried different methods online including heating a sock full of rice to warm the ears and use as a backing to take his blood, but even if I can find the blood which is difficult, its usually not enough. I tried larger lancets and even poking without the lancet device but still no luck. It's only me here and he moves/fights even when pinned between the knees so i cant grab a flashlight or use my phone to find the blood on his ear.

Looks like his bounce didnt last as long as usual this time, and his glucose has gone down 200mg in the last hour and now at 193, so will continue to monitor throughout the day. Finally getting into halfway decent ranges, however since the 2.75 units is making his glucose plunge so quickly im a little nervous about maintaining that dose for tonight (unless it bounces back up in the next 4-5 hrs of course :)). I did recently completely cut out the hills prescription food which was a little higher carbs (11% vs 8% on DMA), but it doesnt seem like just a 3% decrease in carbs would cause it to plummet so quick and fast. Perhaps I should only give 2 units tonight if his glucose stays around the 200's or low 300s?

Thanks,
Devin
Click to expand...
@Bron and Sheba (GA)
 
djett said:
. I will check on the auto feeder and see if they have them now for wet food since he doesnt have teeth, but that would be great if so.
Click to expand...
Here's some info
You can order an auto feeder to set to open at certain times for your kitty .They have them for wet food

some info on auto feeders always add a little water to the wet food
Here is an auto feeder that hold 5 slots and comes with 2 ice packs for wet food
https://www.amazon.com/Cat-Mate-C500-Digital-Automatic/dp/B01AUYLVU8/ref=sr_1_6?gclid=EAIaIQobChMIuM_y2p79_AIVDvrICh1_xAy6EAAYASAAEgJBDfD_BwE&hvadid=178540036693&hvdev=t&hvlocphy=9003521&hvnetw=g&hvqmt=e&hvrand=6990619631848479728&hvtargid=kwd-12652445711&hydadcr=10635_9894649&keywords=petsafe 5-meal automatic pet feeder&qid=1675560889&sr=8-6

Extra ice packs so you can keep them in the freezer ready to go
https://www.amazon.com/Cat-Mate-Rep...5c-bd5c-e23f6094563c&pd_rd_i=B091HTXNHR&psc=1

This one has 3 slots with one ice pack
https://www.amazon.com/Cat-Mate-Automatic-Feeder-Digital/dp/B01MXDFB28

Extra ice pack
https://www.amazon.com/Mate-Replace...cb-974a-deec2fb8a80c&pd_rd_i=B07KFP7PRG&psc=1

You can even order the stainless steel inserts for the 5 slot if you don't like your kitty eating out of plastic, from what I have heard plastic could cause acne on some cats
https://www.amazon.com/Cat-Mate-Sta...36-830d-6cc20f385409&pd_rd_i=B0B3MS1MWR&psc=1

@djett
 
Last edited:
Diane Tyler's Mom said:
Here's some info
You can order an auto feeder to set to open at certain times for your kitty .They have them for wet food

some info on auto feeders always add a little water to the wet food
Here is an auto feeder that hold 5 slots and comes with 2 ice packs for wet food
https://www.amazon.com/Cat-Mate-C500-Digital-Automatic/dp/B01AUYLVU8/ref=sr_1_6?gclid=EAIaIQobChMIuM_y2p79_AIVDvrICh1_xAy6EAAYASAAEgJBDfD_BwE&hvadid=178540036693&hvdev=t&hvlocphy=9003521&hvnetw=g&hvqmt=e&hvrand=6990619631848479728&hvtargid=kwd-12652445711&hydadcr=10635_9894649&keywords=petsafe 5-meal automatic pet feeder&qid=1675560889&sr=8-6

Extra ice packs so you can keep them in the freezer ready to go
https://www.amazon.com/Cat-Mate-Rep...5c-bd5c-e23f6094563c&pd_rd_i=B091HTXNHR&psc=1

This one has 3 slots with one ice pack
https://www.amazon.com/Cat-Mate-Automatic-Feeder-Digital/dp/B01MXDFB28

Extra ice pack
https://www.amazon.com/Mate-Replace...cb-974a-deec2fb8a80c&pd_rd_i=B07KFP7PRG&psc=1

You can even order the stainless steel inserts for the 5 slot if you don't like your kitty eating out of plastic, from what I have heard plastic could cause acne on some cats
https://www.amazon.com/Cat-Mate-Sta...36-830d-6cc20f385409&pd_rd_i=B0B3MS1MWR&psc=1
Click to expand...

Thank you so much for this info!!

UPDATE: His glucose on the Libre 3 has now dropped from over 400 at 1pm to 90 now at almost 6pm, so i'm not sure if I should start applying karo syrup again soon since its 20 min behind? its not steeply declining however dropping about 1-2mg per minute. I'll wait until its around 75 or so and hope it goes back up before applying the Karo syrup. Giving him som 28% carb CKD royal Canin now
 
@djett
Devin if I were you I would start posting on the Lantus/Glargine Board
There are more eyes in that board and post everyday
Here is the link
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

We have a certain way to post on there, you would start your title with the
Date, Gucci AMPS # any tests after that ,and you can continue with the PMPS test and any tests after that
To edit the title with adding any BG readings look to the right and tap on Thread Tools ,then tap on Edit Title and add what you want to, then tap Save.

We like you to post every day and then link your previous days post to the new one in case a member has to go back to re read something


Have you looked at the 2 dosing methods yet and pick one . When you choose one to follow can you add it to your signature and your spreadsheet up top :cat:
Each one will let you know when to increase or decrease the dose
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/




.
 
djett said:
Ahh sorry, didnt catch that, you are right, I just fixed the dates, good catch. His Glucose is now down to 86, just gave him some royal canin CKD food that is about 28% carbs I believe, so hopefully that brings it up a little
Click to expand...
@Bron and Sheba (GA)
Hi Bron I see you have been helping Devin
Did Gucci just earn a reduction by dropping under 90 ?
I gave him the link to read about the dosing methods and suggested he start to post on the Lantus Board everyday
 
Last edited:
Thank you! I'll take some time to understand how they post on that forum and start posting. After giving him the higher carb food his glucose spiked to 122, but then went back down all the way to 67. I just gave him some Karo syrup and it looks to be going back up in the 70s (now 80s) so ill continue to monitor. Cant seem to figure out the correct dosage! Either he stays above 400 95% of the time, or has a downward slope which results in karo syrup.
 
@Diane Tyler's Mom and @djett, we need to get you set up with one of the dosing methods before you swap to the Lantus forum please. your SS says SLGS but your signature doesn’t say anything. Also the signature says CRD says diagnosed Aug 2024!do you mean 2023?

With a recent diagnosis of DKA I would suggest you follow the tight regulation dosing method because we can change the doses every three days if necessary and we don’t want Gucci lingering in those high numbers.
Are you testing daily for ketones?
Is the royal canin CRD food dry or wet? If it’s dry, I would also suggest you look at getting another high carb food that is wet. Weruva have some and you can look at the phosphorus levels as well and choose one that is lower.

I can see the PM preshot has come back up to 400. I would not reduce the dose. Can you monitor this cycle?
Keep in mind that the freestyle libre numbers are not reliable when they drop under 100. That is why we like you to double check any BGs under 100 with a hand help meter. I would keep tying to persevere with doing ear BG tests.
What size lancets did you get? Size 26 is the size you need get.
Also shine a touch behind the ear so you can see the veins.
You need to try and prick between the vein that runs along the outside of the ear and the edge of the ear. Try not to restrain Gucci too much if you can as that will only make him want to get away. Make sure the ear is warm. Try humming as you do the test so it calms you and Gucci. And you can milk the ear up towards the top to encourage the blood.
Remember everyone fails in the beginning. Some people have success more quickly than others. A lot depends on the cat. Try just rubbing his ears often and giving a treat so he gets used to his ears being pricked. You could try putting a tiny bit of Vaseline on the fur first so the blood pools rather than seeps into the fur.
I failed miserably in the beginning!
What is the hand held meter you have?

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