New Member - Introducing Scully DKA, Pancreatitis, UTI , Kidney infection

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OnionHands

OnionHands

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Hello, all. I hope my signature shows when I post; I don't see it while typing. Anyways, my husband and I adopted Scully in 2022 knowing she had diabetes. We believe she was diagnosed in 2021 and surrendered by her prior owners due to care concerns. She was then in 3 foster homes before coming to us. We've been managing her diabetes the best we knew how, working with her veterinarian and doing glucose curves every so often. She's never been well controlled but never had any issues, outside of PU/PD.

She came to us on 3 units of Glargine BID and then moved to 2 units BID. Since she wasn't well controlled on Glargine (glucose above 400 a majority of the time), the vet decided to try ProZinc. After starting ProZinc this June, Scully started showing signs of the Somogyi effect in August. The vet wanted to try Vetsulin next, which we were supposed to start this week when we got back from our trip out of town. Then stuff hit the fan while we were gone (9/26-9/29).

Scully slipped into DKA on 9/28 and I had to coordinate with a very kind friend to take her to an emergency clinic. Her treatment there was unfortunately not great and we transferred her to a specialty hospital about an hour away. She's still there now but should be coming home today, thankfully. On top of DKA she has pancreatitis, a UTI, and a kidney infection. It's been a scary week, to say the least.

The specialty place she's at has an internal medicine doctor that took over her case and I hope we get to continue working with him after this. We will be switching her back to Glargine and forgoing the Vetsulin trial. We will also be eliminating the dry food part of her diet, opting for 100% wet instead.

I feel awful for not being more diligent with her. My husband and I thought we were doing everything right but now I know we could've done better. Scully deserves the best and I will give it to her. I just wanted to introduce Scully and I as part of that future. I'm glad to be here.
 
OnionHands said:
Hello, all. I hope my signature shows when I post; I don't see it while typing. Anyways, my husband and I adopted Scully in 2022 knowing she had diabetes. We believe she was diagnosed in 2021 and surrendered by her prior owners due to care concerns. She was then in 3 foster homes before coming to us. We've been managing her diabetes the best we knew how, working with her veterinarian and doing glucose curves every so often. She's never been well controlled but never had any issues, outside of PU/PD.

She came to us on 3 units of Glargine BID and then moved to 2 units BID. Since she wasn't well controlled on Glargine (glucose above 400 a majority of the time), the vet decided to try ProZinc. After starting ProZinc this June, Scully started showing signs of the Somogyi effect in August. The vet wanted to try Vetsulin next, which we were supposed to start this week when we got back from our trip out of town. Then stuff hit the fan while we were gone (9/26-9/29).

Scully slipped into DKA on 9/28 and I had to coordinate with a very kind friend to take her to an emergency clinic. Her treatment there was unfortunately not great and we transferred her to a specialty hospital about an hour away. She's still there now but should be coming home today, thankfully. On top of DKA she has pancreatitis, a UTI, and a kidney infection. It's been a scary week, to say the least.

The specialty place she's at has an internal medicine doctor that took over her case and I hope we get to continue working with him after this. We will be switching her back to Glargine and forgoing the Vetsulin trial. We will also be eliminating the dry food part of her diet, opting for 100% wet instead.

I feel awful for not being more diligent with her. My husband and I thought we were doing everything right but now I know we could've done better. Scully deserves the best and I will give it to her. I just wanted to introduce Scully and I as part of that future. I'm glad to be here.
Click to expand...
@Bron and Sheba (GA)
 
@OnionHands Welcome yes I can see your signature, sorry you and Scully are going to through all this. This is the best group you could ever find.
When you do switch back to Glargine can you go to the top of your spreadsheet and after Prozinc put a / and Glargine and the date you switched back.
I tagged a member who knows about DKA for you
@Bron and Sheba (GA)

A suggestion to get more eyes on your post in your title I would add after you have Introducing Scully
DKA, Pancreatitis, UTI , Kidney infection
To add this tap on the word Thread Tools to the right then tap on Edit title and add what I said then tap save

The Purina wet is 6% carbs and the Dry is 18% carbs
Do you have the U-100 syringes with half units markings for the Glargine

You can give the DM wet if you want to buy it but there is nothing special about it . I'll give you our food chart , most feed 6% carbs or less .
Most feed Fancy Feast Classic Pates or the Friskies Pate

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf


Have a hypo kit ready if needed
Med and High Carb food and have honey in your house



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



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

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.

For now you will have to follow the SLGS dosing method since you are still feeding kibble, can you add that to your signature and spreadsheet.

You can then switch over to the TR method once he's off the kibble

You can reD about the 2 dosing methods here
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Here you can read all the yellow stickys about Glargine

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
 
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Diane Tyler's Mom GA said:
@OnionHands Welcome yes I can see your signature, sorry you and Scully are going to through all this. This is the best group you could ever find.
When you do switch back to Glargine can you go to the top of your spreadsheet and after Prozinc put a / and Glargine and the date you switched back.
I tagged a member who knows about DKA for you
@Bron and Sheba (GA)https://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/


A suggestion to get more eyes on your post in your title I would add after you have Introducing Scully
DKA, Pancreatitis, UTI , Kidney infection
To add this tap on the word Thread Tools to the right then tap on Edit title and add what I said then tap save

The Purina wet is 6% carbs and the Dry is 18% carbs
Do you have the U-100 syringes with half units markings for the Glargine

You can give the DM wet if you want to buy there is nothing special about it . I'll give you our food chart , most feed 6% carbs or less .
Most feed Fancy Feast Classic Pates or the Friskies Pate

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf


Have a hypo kit ready if needed
Med and High Carb food and have honey in your house



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



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

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.

For now you will have to follow the SLGS dosing method since you are still feeding kibble, can you add that to your signature and spreadsheet.

You can then switch over to the TR method once he's off the kibble

You can reD about the 2 dosing methods here
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Here you can read all the yellow stickys about Glargine

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Click to expand...
 
Hi and welcome to the forum.
I’m only on my phone at the moment so will add more once I am home.
Before you bring her home make sure the vets give you some antinausea medications such as cerenia or ondansetron. Ondansetron is better for nausea. For that you need a script from the vet and you collect from a human pharmacy. If she is not eating well you may also need an appetite stimulant which needs be given after the antinausea medication.
Also ask for any lab results to be emailed to you. And then post them on her please.
Also ask vet if she needs sub Q fluids at home.

Once home she will need to be eating one and a half times as many calories as she normally eats. Do two main meals and lots of snacks.
Don’t skip any doses of Insulin. If you are unsure what to do post and ask for help.
Test daily for ketones. You can either use Ketostix and test the urine or get a blood ketones meter and test the blood like you do the blood glucose.
More later about all this when I get home.

I can’t see any recent BG data. Do you have any after the Prozinc insulin?
 
Diane Tyler's Mom GA said:
@OnionHands Welcome yes I can see your signature, sorry you and Scully are going to through all this. This is the best group you could ever find.
When you do switch back to Glargine can you go to the top of your spreadsheet and after Prozinc put a / and Glargine and the date you switched back.
I tagged a member who knows about DKA for you
@Bron and Sheba (GA)

A suggestion to get more eyes on your post in your title I would add after you have Introducing Scully
DKA, Pancreatitis, UTI , Kidney infection
To add this tap on the word Thread Tools to the right then tap on Edit title and add what I said then tap save

The Purina wet is 6% carbs and the Dry is 18% carbs
Do you have the U-100 syringes with half units markings for the Glargine

You can give the DM wet if you want to buy it but there is nothing special about it . I'll give you our food chart , most feed 6% carbs or less .
Most feed Fancy Feast Classic Pates or the Friskies Pate

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf


Have a hypo kit ready if needed
Med and High Carb food and have honey in your house



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



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

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.

For now you will have to follow the SLGS dosing method since you are still feeding kibble, can you add that to your signature and spreadsheet.

You can then switch over to the TR method once he's off the kibble

You can reD about the 2 dosing methods here
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Here you can read all the yellow stickys about Glargine

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Click to expand...

Thank you so much! Scully is home now and as it turns out, isn’t eating her Purina DM anyway. I’m thinking it’s because the last time she ate it she wasn’t feeling well, and so is associating. I picked up some Friskies pate and shreds because the specialty hospital had her on Friskies. I’m learning now that shreds aren’t the greatest due to the gravy content. I feel like I want to keep her on Friskies since she seems to enjoy it, but everything I’m reading leans more toward Fancy Feast.
 
Bron and Sheba (GA) said:
Hi and welcome to the forum.
I’m only on my phone at the moment so will add more once I am home.
Before you bring her home make sure the vets give you some antinausea medications such as cerenia or ondansetron. Ondansetron is better for nausea. For that you need a script from the vet and you collect from a human pharmacy. If she is not eating well you may also need an appetite stimulant which needs be given after the antinausea medication.
Also ask for any lab results to be emailed to you. And then post them on her please.
Also ask vet if she needs sub Q fluids at home.

Once home she will need to be eating one and a half times as many calories as she normally eats. Do two main meals and lots of snacks.
Don’t skip any doses of Insulin. If you are unsure what to do post and ask for help.
Test daily for ketones. You can either use Ketostix and test the urine or get a blood ketones meter and test the blood like you do the blood glucose.
More later about all this when I get home.

I can’t see any recent BG data. Do you have any after the Prozinc insulin?
Click to expand...

I didn’t see this before we picked her up, but I can definitely call the vet and ask about the anti nausea meds and sub q fluids. With urine ketones testing, I’m assuming we would need special, non absorbing litter? I will also call the vet to get labs. Her glucose since getting home yesterday has just been “high” on a freestyle libre 3.
 
It’s been mentioned, but I want to emphasize the importance of using the correct insulin syringes now that you’re switching back to glargine—

Glargine and Prozinc are different concentrations (“strengths”), so require different syringes. Glargine is a U-100 insulin (100 units per ml), whereas Prozinc is a U-40 insulin (40 units per ml).

In short, if you use the Prozinc (u-40) syringes to administer glargine, you will significantly overdose your cat.

[edited to add: you may be keenly aware of this given you’ve already used both insulins, but we’ve seen plenty of syringe confusion over the years so perhaps worth erring on the side of caution by repeating it.]
 
JL and Chip said:
It’s been mentioned, but I want to emphasize the importance of using the correct insulin syringes now that you’re switching back to glargine—

Glargine and Prozinc are different concentrations (“strengths”), so require different syringes. Glargine is a U-100 insulin (100 units per ml), whereas Prozinc is a U-40 insulin (40 units per ml).

In short, if you use the Prozinc (u-40) syringes to administer glargine, you will significantly overdose your cat.
Click to expand...

Thank you so much for the reminder. We are using the u-100 syringes and will be ordering more now that we’re switching back. We still have about a 45 days’ supply left from when we switched in June.
 
OnionHands said:
Thank you so much for the reminder. We are using the u-100 syringes and will be ordering more now that we’re switching back. We still have about a 45 days’ supply left from when we switched in June.
Click to expand...
A tip borne from experience … put the old u-40 syringes in a box or bag clearly marked u-40 and stash them somewhere high up in a cupboard where you can’t accidentally grab one. :confused:
 
OnionHands said:
Thank you so much! Scully is home now and as it turns out, isn’t eating her Purina DM anyway. I’m thinking it’s because the last time she ate it she wasn’t feeling well, and so is associating. I picked up some Friskies pate and shreds because the specialty hospital had her on Friskies. I’m learning now that shreds aren’t the greatest due to the gravy content. I feel like I want to keep her on Friskies since she seems to enjoy it, but everything I’m reading leans more toward Fancy Feast.
Click to expand...
Yes the shreds are to high in carbs , stay with either the Friskies or the Fancy Feast Classic Pates
On your signature can you add after you have Glargine started Oct and the date and year
@OnionHands
Have you picked a dosing method yet
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

When you decide add it to your signature and spreadsheet
 
@OnionHands
Can you add to your signature after you have Glargine can you put Oct 2024 like you put on your spreadsheet. I assume you started it on Oct 3rd ?, so members are aware of it , we usually look at the signature first
 
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Am I correct in that I should get a human BG reader? I have an AlphaTrak 2 right now (I know the test strips are expiring soon or already expired) and was going to get the 3 soon. Should I just get a human reader instead?
 
OnionHands said:
Am I correct in that I should get a human BG reader? I have an AlphaTrak 2 right now (I know the test strips are expiring soon or already expired) and was going to get the 3 soon. Should I just get a human reader instead?
Click to expand...
Almost alll of us use a human meter since that's what our numbers are based on
Give me one minute I'll be right back

Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
 
Last edited:
Diane Tyler's Mom GA said:
Almost ball of us use a human meter since that's what our numbers are based on
Give me one minute I'll be right back

Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
Click to expand...

You're amazing, thank you!
 
Somogyi does not exist with cats. We can link you to info on this later. The BG was too low on the 2 units dose though. I think 1 unit is not enough. I’d go with 1.75.
 
Do you have any idea of how much insulin Scully was being given while hospitalized? Do you also know what insulin they were using?

In many cases, a cat is on a short acting insulin (e.g., Novolin or "Regular" insulin) while being treated for DKA. These are not great insulin for use once the ketones are better controlled but they do a good job in a critical situation where a cat is being constantly monitored. Glargine is a very good insulin for managing your cat's diabetes. However, the down side of glargine is that it takes several days to build up in your cat's system. Dropping the dose, especially if Scully was getting a higher dose in the hospital, could be a concern. Looking at his numbers, it does look like it's not enough insulin. I would see if you can get the vet clinic to tell you what the blood glucose levels were at least during the last day your cat was hospitalized and how much insulin she was being given.
 
Are you testing for ketones now Scully is home? If not please do so.
How well is she eating?
Are you feeding lots of food and often?
I agree the BGs are too high and it looks as if the dose needs to be increased. It would be good to have some information from the vet re the last couple of days BGs.
 
Bron and Sheba (GA) said:
Are you testing for ketones now Scully is home? If not please do so.
How well is she eating?
Are you feeding lots of food and often?
I agree the BGs are too high and it looks as if the dose needs to be increased. It would be good to have some information from the vet re the last couple of days BGs.
Click to expand...

Ketone urine test strip was negative.
She’s eating great for us. Eating throughout the day.
I’ll try and get info from the hospital re: her dosage and numbers.
 
General question if anyone is still following this thread: how long did it take your DKA kitty to fully recover? Scully has been so tired (mildly lethargic) since we brought her home. She still enjoys laying next to me and will purr if I pet her but is just so low energy. I’ve called the specialty vet and her regular vet every day since 10/3 when we brought her home to report this, and no one is concerned. They believe she’s recovering as expected but *I* don’t know what to expect.
 
OnionHands said:
General question if anyone is still following this thread: how long did it take your DKA kitty to fully recover? Scully has been so tired (mildly lethargic) since we brought her home. She still enjoys laying next to me and will purr if I pet her but is just so low energy. I’ve called the specialty vet and her regular vet every day since 10/3 when we brought her home to report this, and no one is concerned. They believe she’s recovering as expected but *I* don’t know what to expect.
Click to expand...
@Bron and Sheba (GA)
@tiffmaxee
 
@OnionHands
Did you see what Elise suggested about the dose in her post above. Bron also thought it needs to be increased

tiffmaxee
Somogyi does not exist with cats. We can link you to info on this later. The BG was too low on the 2 units dose though. I think 1 unit is not enough. I’d go with 1.75
 
Could you clarify what's on your spreadsheet. It looks like the Lantus numbers are ">=400". Am I correct in assuming this is greater than or equal to 400?

It will take 5 - 7 days for glargine to build up in Scully's system. However, dropping the dose back to 1.0u was likely not a great idea. In all likelihood, a dose in the neighborhood 2.0u would have been a better option. Chances are because it takes roughly a week for the depot to form, Scully may not be getting the full effect of glargine. You may want to read over the sticky notes at the top of the Lantus board. They will give you a bigger picture of how Lantus/glargine works.
 
@Diane Tyler's Mom GA @tiffmaxee @Sienne and Gabby (GA) @Bron and Sheba (GA)

Just tagging all of you for ease of posting/replying. It looks like she was on the "regular" (short acting) insulin from 9/28-10/1 and her glucose was mostly in the 300s. Then on 10/2 they switched to glargine BID, giving 1 unit that morning. She went up beyond 400 (can't see exact numbers) throughout the day so they did 2 units that evening. The 2 units caused her to dip into the 50s by 10/3 so they skipped the 10/3 AM dose. We took her home 10/3 late afternoon and were instructed to give 1 unit BID, starting that evening.

The Freestyle Libre 3 that she has on only reads up to 401, so yes Sienne - ">=400" on my spreadsheet means greater than or equal to 400. We did 2 ear pokes yesterday but I need my husband to help and he hasn't been available much today.

I think that covers all of the outstanding questions right now. I appreciate you all so much.
 
I still think 1.75 would be a better starting dose. While Lantus takes at least 5 days to see what the starting dose will do your results are pretty high. If this were my cat I would increase if not to 1.75 then 1.5.see what others think and if course it’s your decision always. Keep testing for ketones.
 
I agree the 1 unit is not enough especially with the recent DKA.
Are you testing daily for ketones? This is really important you do so as this will tell help us if Scully is getting enough food and enough insulin.
I would increase the dose to 1.5 units now as all the BGs are over 300.
How is her appetite? I see you said she is eating well. Up to 1 and a half times as many calories as normal?

it can take a couple of weeks to get back to normal if there are no hiccups along the way but don’t ignore lethargy, vomiting, ketones, or not eating. There should be a gradual improvement each day.
 
Update: we did increase to 1.5 units last night and her glucose plummeted into the 40s. My husband didn’t wake me for any of it but was checking on her throughout the night and she wasn’t showing any outward signs of hypoglycemia. By the morning she was 400+ again. She vomited overnight and then twice more today. She still has a mild to good appetite. Otherwise acting normally, if not slightly tired. Still negative ketones when testing urine. Both of her vets that I called today weren’t too concerned and advised to just monitor, one offered anti nausea meds.

I suppose I’m not necessarily looking for help (unless you have the elusive magic answer), I just wanted to share with folks who understand. I’m tired and these last 12 days since DKA was first diagnosed have been a roller coaster. I just love her so much and want her to feel good. Thanks for reading < 3
 
Yes I would reduce to 1.25 units and see how it goes. Keep Testing for ketones. Would you be able to put ketone results into the remarks column of the SS please?
How is the appetite.? I see you say mild to good. Do you think she would benefit from an antinausea med? Post DKA kitties are often nauseated. Nausea is not always obvious.
 
@Bron and Sheba (GA) @tiffmaxee

Thank you for your responses. We are planning to decrease to 1.25u. We skipped last night’s dose as she didn’t want to eat her dinner (but did eventually eat it by about midnight it seems). This morning she’s hungry/eating and affectionate, although she did vomit again overnight. I’m going to call the vet back today about those anti nausea meds. And yes, later today I will update her spreadsheet to show when we do ketone testing.
 
OnionHands said:
We skipped last night’s dose as she didn’t want to eat her dinner (but did eventually eat it by about midnight it seems). T
Click to expand...
It is not a good idea to skip doses of insulin with a kitty who has a history of recent DKA. You could give a half dose of the insulin if she won’t eat. Cats who are fasting for procedures are given half doses of insulin.
And yes definitely get some anti nausea meds.
I’m glad she’s eating again for you
 
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