New member: seeking symptom and dosage advice

Georgie and Jinx

Georgie and Jinx

Member Since 2020
Hi everyone, I’m Georgie, a new diabetic cat mother struggling to understand symptoms, BG numbers and seeking dosage advice.

Jinx was admitted to hospital just before Christmas presenting with dehydration, lethargy, neuropathy and loss of appetite. He was shortly diagnosed with diabetes, DKA and low potassium, administered fluids, potassium and given Lantus during his 24 hours in hospital.

When discharged, the nurse did not give me any insulin to support Jinx and recommended I get in touch with my local vet to decide on a long term insulin treatment plan. At the time it felt wrong and I pressed to have some back up insulin in case Jinx’s symptoms returned before I could get to my vet, however I was denied as Jinx’s symptoms were supposedly stable. I was able to get into my vet the following afternoon, but by this time his symptoms deteriorated beyond when we presented at hospital. Dehydrated, no appetite, neuropathy, lethargy, high BG 24 and ketones present.

My vet suggested I put him on 1 unit of Lantus immediately and manage his symptoms from home. Jinx responded to the insulin quickly, regained appetite and I was able to stabilise him at home to some degree over the next few days.

My vet cancelled Jinx’s follow up appointment on Christmas eve. This was a very scary as I knew Jinx was still very sick, so quickly learned how to home test and started trying to learn everything I could. Jinx blood work one week on from initial test still had high BG and ketones but the vet seemed to offer no treatment for this but to increase his insulin to 2 units morning and night. So off I went, in hindsight this should never have happened. I didn’t realise how serious the situation was, but trusted the vets advice.

Since then, I feel like I have been going around in circles with Jinx. Every day feels like a roller coaster, I’m barely sleeping, cancelled Christmas travel and haven’t left the house since 20 December to monitor him. Jinx appetite has returned, he has put on weight, regained muscle control of his back legs but his BG doesn’t seem to be stabilising. I’ve been doing everything I can to keep him hydrated but every second day he seems to have a spike where his numbers are high, he drops all urine and built up hydration and his behavioural symptoms return. I purchased a ketones reader this afternoon which had his ketones rated at 0.3.

Jinx has been on low carb, raw diet since this began. I am lucky he is a good eater, so no issues with him eating before insulin. I’ve also been feeding small meals throughout the day to fatten him up as he was anorexic and had lost almost 2kgs through this ordeal.

I’ve increased his BG testing and started Jinx's spreadsheet in hope that you might be able to offer me some advice with what I should do next as Jinx and I are running out of energy to continue like this. I am really confused as his symptoms often don’t match his BG scores, so I’ve lost trust in myself to accurately judge the situation.

Any advice, tips or guidance would be really appreciated. If I am doing anything wrong, or could be doing anything better – please let me know. Thanks so much. Georgie and Jinx.
 

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Welcome. I love the name Jinx! I can’t see your spreadsheet. You need to give permission.
You have been through the ringer. To send a cat home that was DKA without insulin is outrageous. Are you testing for ketones with either a meter or urine test strips? Great you are home testing. If you can give us permission to see the spreadsheet we can help more. If you need help @Bandit's Mom can fix it for you.
 
Thank you! Its good to be here :) Hopefully I have fixed the permissions spreadsheet, so you can now see. I purchased a blood ketones meter today, I have another cat so figured this would be easier and hopefully more accurate. I was horrified once I read up on DKA and realised the situation I was in. I think I got really lucky with keeping him hydrated and fed.
 
Hi Georgie and Jinx! You are doing a great job getting your spreadsheet (ss) signature line set up and researching! You will find the members on this board have vast knowledge about feline diabetes! One thing for future situations is I noticed on your spreadsheet you gave what’s called a fur shot or partial fur shot(not all of the insulin made it into kitty). When that happens you do NOT want to give a second shot because you have no way of knowing how much insulin actually got into the kitty with the first shot and you Might end up giving too much insulin with a second shot.
Ask questions ... we have all been at the same start line before so we can empathize about the steep learning curve!
 
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Hi Georgie and Jinx and welcome to Fdmb......so glad you found us.
You have done a fantastic job with Jinx despite the vet cancelling the follow up apt and to not give insulin on discharge when he was in DKA is outrageous!
It’s great you are hometesting and have a ketone meter....both these will monitor Jinx and keep him safe.
I would test for ketones twice a day at the moment and put the results in the SS and on the thread so we can see.

The recipe for DKA is not enough insulin, not enough food and an infection or inflammation or stress on the body. So to treat it, those three things have to be addressed.

With the food.........give him small frequent meals throughout the day and evening......food is really important in the recovery of DKA. He needs 1 1/2 times as many calories as he would normally eat at the moment.

With the insulin, I agree with @tiffmaxee, you would be better doing the TR method as we can increase the dose more quickly if needed.
Test before every shot and again during the cycles so we can see how low the dose is taking Jinx.

Did they treat him for any infection or inflammation when he was in hospital do you know?

Fluids are also very important so if he will tolerate it add some water to his meals to make them a bit soupy.

Post every day and we will help you.
Ask as many questions as you need to. You have been through a rough patch but have landed in a very knowledgeable and supportive place.

Georgie,I have just seen that you are in Australia.......me too! :)​
 
Georgie, just been looking at your SS and I see Jinx moved and you lost some of the insulin. That has happened to most of us at one time or another.
We recommend never giving more insulin when you have given a fur shot or have lost some of the dose when the cat has moved.
It’s because one can’t tell how much is lost and to give more can be dangerous.
Far safer just to chalk it up as a fur shot and give the next dose in 12 hours time.
 
Thanks everyone,

I knew I had messed up last night with the double dose, Jinx had been so good with shots that when he flinched I panicked. Never again.

I've been watering all Jinx's meals down and he is still accepting them which is great! In terms of inflammation, they did not treat this in hospital but my vet gave him a long form antibiotic last week to clear up anything that could be underlying. Will then do liver and pancreas scans if nothing changes in a week or two.

@tiffmaxee @Bron and Sheba (GA) thanks for the guidance on dosing, I will research the TR method tonight. I need to buy new syringes to increase to a half dose will try to find tomorrow. I feel very out of my depth with this information, so having a sounding board is SO reassuring - thank you!

@Bron and Sheba (GA) which state are you from? I hope you haven't been caught up in COVID madness over the holidays.
 
I am in Sydney and the northern beaches so have been in lockdown, but we are OK

You can’t buy half unit syringes here in Australia. But you can buy from the UK and they take about 7 to 10 days to arrive. There is a link in the info I sent you for Aussie Caregivers with the site to buy them.

What are the syringes you are using at the moment?
I used a magnifying glass to draw up the 1/2 and 1/4 unit doses with the 1 unit syringes.
 
Thanks @Bron and Sheba (GA). Glad you are ok in lockdown, I was in lockdown for months in Melbourne, so I know how you feel. I've purchased some of those half unit syringes. Hopefully they don't take too long to arrive. I've been using the Lantus pen which I've been having mixed results with. Having to hold Jinx while the pen releases is difficult. My boyfriend got some syringes today but they were 1ml (100 units) and too big for me to confidently measure a dose with. They're such tiny amounts and I was too scared to try. A question about ketones, this morning Jinx measured 2.6 KET which I panicked about but tested him again early afternoon and he has gone down to 0.4 KET. Is it normal to have such fluctuations within a day with ketones?
 
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Georgie and Jinx said:
Thanks @Bron and Sheba (GA). Glad you are ok in lockdown, I was in lockdown for months in Melbourne, so I know how you feel. I've purchased some of those half unit syringes. Hopefully they don't take too long to arrive. I've been using the Lantus pen which I've been having mixed results with. Having to hold Jinx while the pen releases is difficult. My boyfriend got some syringes today but they were 1ml (100 units) and too big for me to confidently measure a dose with. They're such tiny amounts and I was too scared to try. A question about ketones, this morning Jinx measured 2.6 KET which I panicked about but tested him again this morning and he has gone down to 0.4 KET. Is it normal to have such fluctuations within a day with ketones?
Click to expand...
I’m glad you have ordered the 1/3 unit syringes.
Can you return the 1ml syringes your boyfriend bought? They are too big. The U-100 3/10 30 or 31 gauge, 6 or 8 mm insulin syringes are the ones you would need until the others arrive.
I see you increased to 3 units this morning. That is a very big increase. We recommend increasing by 0.25 units (or 1/4 unit) increments. Did your vet suggest that? Vets frequently suggest 1 unit increments. Make sure you test frequently during the cycles. As the depot fills you will see the full effect of the 3 units. I would try and get some of the syringes I suggested and drop the dose back to 2.25 units. You will have to eyeball the amount but I used to do that all the time with the help of a magnifying glass.
How long were you giving the 2 units?

With the ketones 2.6 is getting up to the amount where you need to be concerned but if they have come down again, that is good.
Are you feeding frequent small snacks through out the day and evening? And giving extra fluids?. If he is not great at extra fluids it would be worth while asking about doing subQ fluids at home....I know a lot of vets in Australia are not proactive in offering subQ fluids at home for some reason so you may need to ask. Test at least twice a day for ketones at this point in the recovery of DKA.

How was Jinx this morning when the ketones were 2.6? Was he active and alert or lethargic?
 
@Bron and Sheba (GA), we've found a place that sells smaller syringes and will get them tomorrow morning until the others arrive. Yes, after knowing I had no way to administer the 2.5 on my own I called my vet and he recommended going to 3 units. I've been testing him today and he has remained quite high, will continue vigilant testing tomorrow and drop back to 2.25 units. Jinx has been on 2 units for six days now with little reduction in his BG levels, prior to that 1 unit for four days.

As for ketones, Jinx is getting frequent small meals through the day, anything outside my 2 hour testing windows and more at night. I have been watering down his meals but i feel like he probably needs extra fluids. I will call my vet tomorrow and ask for that, they have been very chill about everything which annoys me. Is it difficult to administer at home?

Jinx was a bit slow this morning but alert, when I tested for ketones but it is hard to know because I woke him up and got him up from bed to test. He slept a bit more through the morning but still ate throughout the day and now he is up and about.
 
Georgie and Jinx said:
@Bron and Sheba (GA), we've found a place that sells smaller syringes and will get them tomorrow morning until the others arrive. Yes, after knowing I had no way to administer the 2.5 on my own I called my vet and he recommended going to 3 units. I've been testing him today and he has remained quite high, will continue vigilant testing tomorrow and drop back to 2.25 units. Jinx has been on 2 units for six days now with little reduction in his BG levels, prior to that 1 unit for four days.

As for ketones, Jinx is getting frequent small meals through the day, anything outside my 2 hour testing windows and more at night. I have been watering down his meals but i feel like he probably needs extra fluids. I will call my vet tomorrow and ask for that, they have been very chill about everything which annoys me. Is it difficult to administer at home?

Jinx was a bit slow this morning but alert, when I tested for ketones but it is hard to know because I woke him up and got him up from bed to test. He slept a bit more through the morning but still ate throughout the day and now he is up and about.
Click to expand...

Have you looked at the two dosing methods we have..tight regulation and Start Low Go Slow.
They are at the top of this Lantus Page.
I would recommend you go with the TR because of the recent DKA diagnosis..
TR allow you to increase each 3 days if necessary instead of 7 days with SLGS.
You are testing enough to do TR.
When you decide, could you put it in your signature please.

Keep feeding him small frequent meals...that’s good. As much as 1 1/2 times as many calories as normally eaten is needed post DKA.
Here is some information about ketones and DKA
https://www.felinediabetes.com/FDMB...and-diabetic-cats-a-primer-on-ketones.239971/

Sub Q fluids is not hard to give. It’s just a matter of putting in a large needle scruff of the neck and letting the fluids run in. They run in quickly so it only takes about 5 minutes. Here is a link to how to do which Marje made.
https://www.felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/
 
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