New member - Ace recovering DKA, dosage woes

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Amanda & Ace

Amanda & Ace

Member Since 2022
Good evening all,

First, I am so thrilled to have found this group. You all are so knowledgeable and I have been lurking for quite some time!

Ace was diagnosed with diabetes back in January. He showed classic signs like drinking and urinating a ton. We started on Lantus right away at 2 U twice a day. He did really well and his behavior was totally back to normal. FFWD to May and he was back to his excessive drinking and urinating. Then early this month, he stopped eating and was extremely lethargic. He spent 4 nights at the emergency vet for DKA (he had a UTI and ketones in urine of course). He has been home now for about 10 days. While in the hospital, they said his BG was typically in 200s-300s. When he was sent home, he had the handy dandy Libre Freestyle, so I checked his BG obsessively. His behavior continues with the excessive drinking and urinating and he seems to always be hungry no matter how many snacks I give him between ‘meals.’ He eats a mix of FF pate and the dry royal canin glycobalance (i know i know, it’s high carb but i was trying anything to get him to eat again at the DKA onset). His BG while the freestyle worked was always in the 300s. No noticeable nadir that I could gather (lowest was 280s and that was only twice and the highest was 370s). I decided to try the TR method and did 6 cycles at 2.5 U and then upped it to 3 U and have been doing that ever since (so probably about 4 days so far). The freestyle libre stopped working over the weekend so I finally got a regular BG monitor (Relion) with test strips today. I first tested early this evening and it was in the upper 300s. Then I tested again before his PM shot and it was 406 (this was at least a few hours since he had food)! I just tested him again +2 386.

Anyhow, I’m just at a loss of what to do. I’m terrified of him going into DKA again. It seems like he’s insulin resistant or something. Should I refill his insulin in case the Lantus pen I have is defective or something (and it’s not user error, I am religious with the methodology thanks to the tutorials on here!)? Should I lower his dosage? Should I keep everything as-is and just monitor longer? Should I cut the dry food entirely?

We have his DKA follow up appointment with his regular vet on Thursday, so I’m curious to see what she says. But thought I’d come here for some advice first so I know the right questions to ask :)
 
For reference, I’ve provided screenshots of the Freestyle Libre output for average BG for 8 days.

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Hi Amanda and Ace and welcome to the forum! I am glad you have decided to post instead of just looking!
Can you tell me...are you testing the urine for ketones still?
If not, I would strongly recommend you go out and buy a bottle of Ketostix today and start testing the urine daily for ketones so we can see what is happening in that department.
Im glad you have started to home test the BGs. That is great!
Make sure you test before every dose of insulin and again during the cycle so we can see how low the dose is taking Ace.

Here is a plan for post DKA kitties. I know he has been home for 10 days but I would still make sure you are doing all these things for him.

  • you need to give one and a half times as many calories as he/she 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, don't 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. Ondansetron is the best antinausea med. You will need a script from the vet and you buy it from the human pharmacy.
  • 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...you have set up the SS which is great.
  • Post daily with updates and ask for help as often as needed.
Testing daily for ketones helps us to see if Ace is getting enough insulin and enough food and enough fluids. If the balance is right, there should be no ketones.
He may need more insulin but until we can see some data, we cant say.
Are you able put in the last 2 weeks BG readings from the sensor?

The dry food is probably keeping the BGs higher but eating is more important at the moment, so if he wont eat low carb food, you will have to give him whatever he will eat. Do you think he could be nauseated?
Here is a link to STIMULATING KITTIES APPETITE

I will be around for several hours so if you have any questions please ask them
Bron
 
Thanks, Bron!

I am going to test for ketones today. Just lurking to catch Ace while he's using the litter box.

I wasn't able to get a good blood sample this morning to do the pre-shot test, but I did test +3 and it was 268, which is better than it has been. I also went in Ace's SS and populated it with the numbers from the Freestyle Libre from the previous week.

I don't think he's nauseated. He will eat his pate, but just prefers the dry food.

I'll report back with ketone results and PMPS BG.

Thanks again!
 
Hi and welcome. My boy Hendrick also suffered a DKA episode, he was hospitalized for two days ($4800, oof) but made a full recovery and 6 months later he is a diet-controlled diabetic feline! All credit to the angels here at the FDMB and their massive repository of collective knowledge and experience. What a resource, seriously I don't think there is any like it on the entire planet. You found the best place there is to get Ace well again. Glad you're here and I'll see you around the forum.

ps Ace is adorable! What is his history, how did you meet? :D
 
Hi, Kyle and Hendrick! Thank you for the warm welcome. I am so happy to hear Hendrick has recovered so well. That gives me some comfort and encouragement! Is Hendrick a Siamese? He is gorgeous! My parents and my sister both have 2 Siamese each :)

I got Ace when he was a kitten (he is now 11). I visited the kitten room at my local shelter at the time and he was the first one to run up to me. It was love at first sight! I adopted him and his brother, Gary (SNL fan over here). He’s always been a healthy guy, albeit a bit overweight. It wasn’t until this year that he’s had health issues. Fingers crossed we can get him more regulated!
 
Yes he is a Blue Point Siamese, I got him from my mom when he was a kitten along with his brother Shylo. She used to have a litter or two a year of kittens around.

Anyway an older cat of hers had a litter, her last litter ever -- just two kittens. Hendrick and Shylo. So obviously I couldn't separate them! Shylo makes a guest appearance in Hendrick's OTJ video:

Hendrick is 10 years old so about Ace's age. I'm sure if you trust in the TR method and follow the guidance of the gurus here at the FDMB you can get Ace regulated. You seem like you have the dedication and commitment required, I respect that.
 
Thanks for adding the extra BGs Amanda. That is helpful.
We recommend any increases and decreases are made in 1/4 unit increments if you are seeing BG in the yellow or blue range.
As I said, it’s really important that he eats a lot of food at the moment as we need to get those calories into him. Low carb is better but if some dry has to be added to make sure he eats, that is Ok at the moment.
Just be aware that the removal of any dry food will effect the BGs and they will drop.
You can try other low carb foods …it doesn’t have to be FF pate. Have a look at this FOOD CHART and see if you can see any foods that are 10% carbs or under (most feed carbs around 4-7%).Ace might like a variety!
 
Thank you! I will certainly keep hunting for some of those foods on the list to see if we can find some new favorites. I’ll also try to keep better tabs on how much dry food he is getting so I can see any correlations with the BG.

Ace has his check up tomorrow, so I’ll let you know what the vet says.
 
Amanda & Ace said:
Ace has his check up tomorrow, so I’ll let you know what the vet says.
Click to expand...
If the vet suggests an increase in dose, I personally would get a few more tests in at 3 units before increasing as it is possible he is dropping lower on the 3 units and then bouncing back up again.
Also getting the ketone test done will tell us if you have the food and insulin dose right as well, or if things need adjusting.
 
Amanda & Ace said:
I forgot to mention I did do the ketone test and it was thankfully negative!
Click to expand...
That is great news! Continue to get a daily test at the moment please if you can.
That means that the insulin dose and the food you are feeding are keeping the ketones at bay, so keep doing what you are doing. Are you adding some warm water to the foods. A teaspoon each snack?
 
Try and get a couple of tests in during the pm cycle if you can.
If the BG drops lower than the preshot by +2, that is an indication that it could well be an active cycle and could drop further, so try and get another test in.
 
Ace had his follow-up with his normal vet yesterday and he checked out well! The vet was really pleased to know I was starting to home test. She was encouraged with the timing and value of his nadirs and said to keep doing what we're doing and to always try to test around the nadir time. She recommended we come back about every 3 months to do a quick urine check to make sure he doesn't have a UTI so we can get ahead of it if so. Not much else to report back right now on that front.

I plan to do some more tests during the PM cycle moving forward. Just trying to get the hang of the testing in general and figuring out what works for us. You guys have some awesome resources on here!
 
That is good to hear. Keep doing the extra food and fluids and testing for ketones. Testing for ketones is your early warning system if things are going backwards.
We need to get those BG numbers down to better number so try and get as many tests in during the cycles as you can.
I’ll get you to start posting over in the Lantus forum where you will get a lot of help.
You post daily over there so the posts don’t get long. Post like this.. 7/8 Ace AMPS xxx and then a question if you want. I’ll tag @Bandit's Mom and @tiffmaxee so they can watch out for you.
 
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