New: Shane DKA kitty-starting Lantus, fixing vet dosing

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Martica and Fred

Martica and Fred

Member Since 2010
Hi ---just discovered that vet has made Shane go HYPO--just took BG this second it is 39 at +6.5

Some of you may remember me from 2005 to 2010 when I was on FDMB about my kitty, Fred, who died last October. Or you may have followed my latest post about Shane-Sebastian, the DKA kitty I rescued at the kill shelter in NYC. He has been in the vet for 10 days and I just brought him home one hour ago. I took him home against vet's advice because he wanted to 'regulate' Shane Sebastian more, but I was a little horrified at his dosing. In short, I requested that he start on a 1/2 unit. Shane is about 6 1/2 pounds (big boy, should probably be 13-14 at a healthy weight, he is skin and bones.) He is dehydrated still on top of that. They had him on IV fluids for a few days but not since and I don't think they did subQs

Anyway his next shot will be around 8:30 pm tonight and I'm going to need some help on how to correct the vet has done. In short, he started him on Lantus on Friday Dec 23 at 1/2 unit. Then this morning, Dec 27 he was at 2 1/2 units! He jumped from 1/2 unit to 2U of Lantus in 3 days.

He had been on ProZinc prior to that (2 units BID and they were only feeding him every 12h, at shot times. Also there was no one there to monitor hiim over night, so no clue what the overnight nadir ever was. And the day nadir they only took at 2pm. So no curves at all.) I got the vet records and am going to list them below as best as I can make them out. The vet was not familiar with Lantus and I brought him some of the research to read.

OK here are his numbers since 12/21 (past 6 days) (I wasn't given records prior to that)

Wed-21 Dec:
+0 8am BG 351 given 2U of ProZinc, fed low carb canned (good brands I brought or DM/they switched between them)
+6 2pm BG 96
+12 8pm BG 387 2U ProZinc, fed
- no food between say 8:30pm and 8am and no monitoring

Thu-22 Dec:
+12 8am - BG HI 2U ProZinc, fed
+3 11am- BG 483
+6 2pm- BG 131
+12 8pm- BG 399, 2U ProZinc, fed
- no food between say 8:30pm and 8am and no monitoring

Fri-23 Dec
+12 8am- BG 453, 2U ProZinc, fed
+6 2pm- BG 174
+12 8pm- BG 389 , 2U ProZinc, fed
- no food between say 8:30pm and 8am and no monitoring

Sat 24 Dec
+12 8am- BG 124 (says 'Amtrack was on 4' (not sure what that means), 1/2 U Lantus, fed
+6 2pm- BG 196
+12 8pm- BG HI 2U ProZinc (switched back), fed

Sun 25 Dec
+12 8am- BG HI, gave 1U Lantus, fed
+6 no montoring
+12 8pm- BG HI, gave 1.5U Lantus, fed

Mon 26 Dec
+12 8am- BG 346, gave 1.5U Lantus, fed
+6 2pm- BG 375
+12 8pm- BG HI, gave 2U Lantus, fed

Tues 27 Dec
+12 8am - BG 302, gave 2.5U Lantus, fed
+4 12pm- BG 214
+5 1pm- I gave him a few Halo live a littles chicken treats and a couple of small pieces of fresh chicken breast roasted
+6.5 2:30pm--HYPO BG 39--am feeding now

****. stupid vet.

ok all advice appreciated. I'm going to try not to give him corn syrup and monitor him with this food. He is eating BG quail and chicken and TOTALLY gobbling it up at this second. I just this second discovered this.
 
Hi Martica, welcome back to LL! No advice from me. Shane surely needs your love, care and attention. Bless your heart.
Liz
 
Good Grief! I agree on the vet. You sound like you know what you are doing w/ the hypo. BG is only 1% carbs so you might want to try something a little higher carb. I used to avoid the karo too, then I got to know that it wore off in 2 hours for Tess, while the HC foods would take a day. Now I know I can up her and then check again until I see a normal rise.

I think you will need to wait and see where he is for PMPS. If he is at a safe level to shoot I'd got back to his starting dose and follow the protocol. You may need to skip though to drain that shed. I hope others will be on soon with more advice, I'm only home for about another half hour.

You are in NYC time zone?
 
Hi
Yes, I"m in NYC. Unbelievable. I'm very upset--wow, talk about right back in the swing of things--he is hypo the second I get him home because of stupid dose by vet! And chances are they would not have even noticed because they only test once a day!

OK, I think I have some caro, but what is highest in carbs--these are my current food choices I have here:

Wellness (chicken and turkey)
BG (two flavors)
Merrick- Turducken (seems like this one is?)
Merrick- Cowboy Cookout
Nature's Variety- Lamb
Solsticke--the orange one--pumpkin and chicken or something--maybe that one is

:(
:(
:sad:
 
He just finished eating, didn't eat the whole 5.5 oz can. Despite the fact that he must be feeling like crap, he's washing his face.
Oh, there, he's eating again.
 
Martica and Fred said:
Wellness (chicken and turkey) Both are 4%
BG (two flavors) I don't know what BG is
Merrick- Turducken (seems like this one is?) 9%
Merrick- Cowboy Cookout 5%
Nature's Variety- Lamb 3%
Solsticke--the orange one--pumpkin and chicken or something--maybe that one is Not seeing on Janet's list
Click to expand...

The values in bold are from Janet and Binky's lists.

Please don't let him eat too much at a time. You need to make sure he has an appetite to be able to control his drop.
 
I was following your post over on Health. You are an absolute Angel to help Shane.

You are going the right thing by feeding him. Do you have some HC in case you need it?
My cats usually get 0% to 3%, and I save some 5% (Fancy Feast Chunky Turkey or Chunky Chicken) for when I want an extra push up in the BGs. I also, of course, have a variety of HC 18% for just in case. I'm sure you do, too.

I would go back to the 1/2 unit and start over from the beginning. :YMHUG: Let's see what others have to say.

Too bad, you couldn't tell the vet what they did. Or maybe, you can :roll: It might save another kitty's life, someday.
 
Oh am I glad there are more eyes on this. I had to go elsewhere to look as my computer is being backed up. Yes the Turducken is the highest of what you have. You could also try honey or any syrup for a quick boost up. What is you latest test?

I'm out the door to the Apple Store, but I think I can get on there. Dyana, Venita are you still around?
 
All I can say is you obviously know way more than that vet does - I don't blame you for being so upset. Shane is one lucky kitty to have you on his side!
 
I swear my heart rate is high and my blood pressure up. This sucks!

Just testedhiim +45 after the 39 reading and after eating nearly all of the 5.5 oz of BG...and he is 35. So I figure with the standard deviation he is actually just holding steady.

I have some NutriCal which has corn syrup in it, so I tried to rub that on his paws--he wasn't having any of it, but did lick some off the paws.

I then found some Soltice orange can--pumpkin with chicken or something...it has some tapicoa starch as a main ingredient, probably the gravy I guess. I did not see it on Binky's list but I've just given it too him and he started gobbling it up, he's eaten a bit of it now. I also squirted some nutrical in there.

The good thing is he's acting normal--and actually trying to get out into the rest of my apartment to explore. Only thing is I have to leave in 45 minutes to go teach some fitness classes. Tyring to find a sub, otherwise I"m out for 4 hours, which is not a great time to be out.

anyway, I'll rub some nutrical all over him before I leave if I have too. Am taking a BG shortly...
 
Martica,

I don`t post in Lantus anymore as I don`t have my kitty anymore but I have been following your story on health. I would be pissed if they dosed my cat at the vet with Lantus like they did Shane. If you can bring yourself to when you get things under control I would try to get a hold of someone there and tell them( I don`t even know what you would say) they should know better.
What I worry about is unsuspecting customers of theirs who bring in newly diagnosed diabetic kitty and they tell them to dose their cat like that and the customer does not know any better.
Sorry about the rant, my vet was clueless too. I hope you get Shane well soon.

Terri
 
Do you have any honey or syrup like Ann suggested? I would give him that in his food. The Soulistic is supposed to be a little higher in carbs but I don't have the exact %.

IMHO, I wouldn't leave him until he is up considerably and not coming back down. Whenever you give HC gravy or syrup/honey/nutrical, you have to worry about them turning around and coming back down.

Just continue giving him small amounts of the food and rechecking every 30 mins until he is safely up. Then you can try to go for an hour and see how he does.

I'm also on the way out but Ann asked me to check in really quick. If you look at my signature block, there is a link for "Handling Low Numbers". That should also help you.
 
I'm here, and home.
I would not leave for 4 hours. Shane may be low for a while, with all that insulin the vet gave him.
If anything, I'd say run to the store to get some HC, if you have a store within 5 minutes of you.
Also, as Venita said, you don't want Shane to get too full. So, a little bit of higher carb foods would be better than a lot of the lower carb foods. You can make higher carb food by adding a drop or two of caro or honey or maple syrup or another syrup to lower carb food. Again, though, you want to give him small amounts at a time. Like a teaspoon every half hour or so.
 
hi Martica,

due to time zone difference it's easier to always refer in +mins or hours.

Are you now at +7.15?
your right negligible difference on numbers.
what %food have you given? (diff all over world)

kitty's all vary in their sensitivity to hc.it's a watch and learn.
definitely start from scratch on the protocol.

what + from and to are you going to be away?
 
I found someone to cover 2 of my 3 classes...so I'm going to be away from 4:45-7...or +8.75 to 11

I'm going to rub more nutrical on him. Unfortunately it's all i can do There is stillmore food there to be eaten if he starts dropping and hopefully he will on his own
 
if you have no choice but to do one or other, the +8.75 is the one i'd do. your past the nadir (if he conforms to the norm) then and lantus dose gone past peak (not to say he won't be low but off the 2 the least likely to be).

do you have just normal honey in your house?
 
Welcome back.

Please add some honey or corn syrup to Shane's food. The low carb is fine but numbers are going to wobble around. You may need to keep adding HC to keep the numbers stable at a reasonable level. Is there anyone who can keep an eye on Shane while your out and keep him fed with a mix of HC/LC? Can you pick up some HC food (or have someone pick some up for you)?

When was Shane diagnosed with DKA? If this is recent, did the vet get any ketone readings and do you have Ketostix or a Precision Xtra meter? You need to monitor ketones. Shane may need higher levels of insulin to manage the ketones AND need higher carb food. However, I don't want to suggest this until you're sure what his ketone status is.

I'll go take a look on Health. Here's the link to the Health post.
 
just have to wait and see. hope he surfs at least.
will be way past time for me. I'm sure you'll watch out for him Dyana :-D
 
I'd go with the later time too and is the any way you can take him along? I used it take Tess when I taught a class and she was low. Is there an office or quiet back room you can leave his carrier in?
 
Hi Martica!

You dropped the insulin off to me in March. Thanks again. I admire the way you drive around NYC :smile: You are such a saint to have helped Shane. He is very lucky that he has you on his side. Let us know what you get for a # when you get back. As soon as you can pick up some ketone strips. You need to monitor that closely with him. Especially until he gets his #'s in check.

Letting this vet know will possibly help other kitties that go there. It's all in the delivery. :roll:

Good luck with the little guy.
 
Welcome back, Martica...
though i wish it were under better circumstances.

Shane has found an angel in you...

celi
 
Hi Martica,
I have been watching Shane over on Health. You really are an
angel.gif_thumb.jpg
for taking Shane under your loving wings.

Dyana and Sienne are the experts but the 1/2 unit sounds like the thing to do. Will be thinking of you tonight.

Pattie
 
Thank you all for all your comments and caring! This board really is the greatest.

OK, I had to leave and no one to watch him, but I put some Nutrical in his food and he actually was eating more of the Soltice when I left. Actually, it's Solstice, I spelled it wrong up above. I couldn't find it on any lists. But it has a bit of gravy so I figure that's more carby.

OK the good news:

7:30pm
*11 and he is 209 !!!!!! woo hoo! Of course, if the vet were taking this, he would see it be, oh, 250 in an hour and think--OH YES, 2.5 Units IS THE RIGHT DOSE. meanwhile, repeated hypos day after day.

OK, so he had very little carbs really. He pretty much ate 2 full cans of 5.5 oz low carb, high protein food, plus just a bit of NutriCal....so that is maybe the best scenario?

The big question...should I give him a 1/2 unit tonight at 8pm? or 9pm? or at all? sort of afraid to.....but then again, with a small dose it should be safe right? Not sure I understand how this past week might have affected his shed...or if he has one...can anyone enlighten me? I'm going to post this on the other thread too...maybe I should consolidate somehow.


thank you!!!!! feeling much better. He's purring. I have not checked for ketones. I have not seen him use the bathroom yet. Oh, is that meter that Sienne mentioned the Precision Xtra, does that do BG AND ketones in the blood? I guess if so I should just totally switch to that then (even though I've just spent $150 on test strips. I'm behind on meter technology, still using my old OTU.

are we out of the woods? should I feel safe? I will continue to monitor but sounds like things ok...he is still occasionally nibbling on the remnants of his food. I think he's pleased because they were literally starving him at the vet. He appears to have lost weight there--if the shelter weighing was correct. They had him at 7.2 lbs. After 10 days of the vet he was 6.5 last night.

OH, and when I came home, Shane had escaped from my office (it's a sliding door, no way to lock in from the outside) and he was mingling with my cats--one of them was hissing. I was trying to separate them. Might be a lost cause, there's a big desire to see what's on the other side of the door for all of them.
 
Hi Marticia and Shane,
Welcome back! Your vet did the same thing my ex vet did to Stu: switched him from the discontinued PZI to Lantus and kept upping the Lantus dose by a unit at a time every week, until we were at 7 units bid, bg numbers still high, and then a crash in numbers. I learned that often numbers can be very high when the dose is too high (not from a dose that is too low). Stu looked and acted awful. Anyway, I started Stu over with a low dose, but if I hadn't observed his condition and worried about it, I fear that those huge doses would have killed him.
You are right to pull Shane out of that vet's office and I agree with the others that you should recommend that the vet read some of the literature dealing with cats on Lantus (it's all in the Stickies, above). Maybe the vet will learn something and some other diabetic kitties will not suffer the way Shane has.

Many of the beans here use the Fancy Feast flavors with gravy (HC, 18 %) when they need to bring up bg levels. Strain out the food and feed only the gravy so as not to fill Shane up with food. YOu don't want him to be full if you need to bring up his numbers.

Good luck!

Ella & Rusty
 
I think the Precision meter takes different strips for glucose and ketones. They are pretty expensive. I just saw something you can add to the litter to check ketones on one of the sponsor link pages. I'll try to find it. Has anyone else used something like that?

Will you be home after the shot? If you will, I'd shoot the .5 or perhaps a 1 u. His shed was overly full from the increases a nd then there was NDW going on. As you know you need to hold the dose for several days for the shed to stabilize. I would definitely shoot tonight especially if the preshot number is s till going up.
 
I'm not sure now about reducing to only 1/2 unit if he had DKA. Maybe 1 unit would be better. Are you able to monitor him well, throughout the day and night? And did you buy any HC 18% food, yet?
Also, I think he might really appreciate mini meals throughout the day. Got to gain some weight back big boy.
I wish you the best of luck with him.
Let's see what others have to say about dose and see what his PMPS is.
 
He appears to have lost weight there--if the shelter weighing was correct. They had him at 7.2 lbs. After 10 days of the vet he was 6.5 last night.
Click to expand...

hello martica. using the weight based formula from the TR protocol, shane's starting dose should be 0.75u bid. we use actual weight when a kitty is underweight rather than ideal weight when figuring out a starting dose.

were you planning on following the TR Protocol? here's some of the prerequisites:

WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Some kitties adapt well to free feeding.


the rest of the info can be found in the STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL.


welcome back!



edited to add: please remove the 911 icon from your first post since there's no longer an emergency.
thank you!
 
The Precision Xtra strips are very, very pricey. I believe it's something like $5 per ketone strip. You may want the meter for immediate, blood ketone results but if it were me, I'd use urinary ketone testing (Ketostix) for day-to-day tests.

You MUST give insulin. For a cat recently diagnosed with DKA, skipping a shot can put Shane heading back to the ER. The best means of keeping ketones under control is insulin. If you have to offset the effect of Lantus dropping numbers with food, then that's what you do. I'd told Desi/Tawny & Tinkerbell that I didn't care if she had to feed Tawny a hot fudge sundae to keep her numbers up, the insulin and food was critical.

In addition to insulin, please add water to Shane's food. The better hydrated he is, the more you are diluting the ketones in his system.

I want to get some additional eyes on your condo regarding dose. Based on weight, Shane could start with a dose of 0.75u. Let's see what some of the others have to say.
 
Sienne and Gabby said:
You MUST give insulin. For a cat recently diagnosed with DKA, skipping a shot can put Shane heading back to the ER. The best means of keeping ketones under control is insulin. If you have to offset the effect of Lantus dropping numbers with food, then that's what you do. I'd told Desi/Tawny & Tinkerbell that I didn't care if she had to feed Tawny a hot fudge sundae to keep her numbers up, the insulin and food was critical.

In addition to insulin, please add water to Shane's food. The better hydrated he is, the more you are diluting the ketones in his system.
Click to expand...

i couldn't agree with Sienne more!

you mentioned shane was dehydrated. are you planning on giving fluids tonight (if you haven't already)?
 
I agree. I think starting over at 0.75 would be good.
Did you happen to pick up any 18% HC cat food today?
 
Martica here is the sticky on the shed.

shed

The Precision Xtra meter does do both but it is very expensive. It would be a good thing to have around for on the spot testing, but I agree with Sienne I would use the ketostix on a day to day basis. They are much more inexpensive.
 
is this the food you are feeding Soulistic? I don't see it on any of the lists. You can check out the carb content in food on several lists, there are links to them in the New to the Group Sticky, but i don't see Soulistic. apparently no one has gotten the detailed info from the company.
 
Thank you everyone.

OK, now at +13 he is 352
He continued to eat pretty much the entire last of that 2nd can.

OK, so then I'm going to go with 0.75 U tonight

and I am here tonight and can totally monitor him

Oh, interesting, he is now pooping and has a bit of diarrhea. What the heck does that mean? Sheesh Could it be the hypo and all the subsequent 2 cans of food, it's not too liquidy, but a bit, and not too much of it. He also peed but I didn't catch him at it.

he has also escaped out of the door 2 times now. Not sure I'm going to be able to keep him separate from the cats for very long, he now knows how to open the sliding door. Smart cat, his brain wasn't affected by the DKA :)

OK thank you all SOOOOOOO MUCH. You are lifesavers! I will report back in the morning.

thank ((((yall))))

Martica
 
Oh, another interesting thing I noticed earlier. I was holding him and smelling his fur and I smelled some insulin. Smells like they gave him a furshot...hmmm, not noted in the records. Wonder if they knew they did, and if they did, they shot him twice? anyway, sigh.

OK just gave him his shot. Good night all.
 
Good night. The runs might be from the new food he's eating. And I'm glad he's eating so well :-D
You can use some FortiFlora to help him with that if it continues.
 
It could be as you said or there was some insulin on the outside of the needle/syringe from when they were adjusting the dose. When they shot, the insulin on the syringe transferred to Shane's fur.

When you have a chance, could you set up a spreadsheet for Shane? The template is in the Tech Support Forum.
 
I slept on the floor of my little office with Shane all night (very uncomfortable) and the entire night he periodically would frantically try to open the sliding door (which I can like while inside, so he can't open it if I"m in there too). And when he wasn't doing that, then one of my other cats was trying to get in. This managed to help me stay away all night to do curves :)

So he did pretty well I think:

+13 BG 352- gave 0.75 U of Lantus
+1.5 he ate a bit of food from my other cats' bowls when he escaped from the office, not much I don't think (Nature's Variety rabbit)
+3.25 406
+ 6.25 377
+ 7.25 fed around 5 oz of Wellness sprinkled with FortiFlora, could not do BG as he was growling cuz of the food


(he continued to have the slight diarrhea all night so hopefully the Fortiflora will help--how long before it starts working?)
 
Martica and Fred said:
he continued to have the slight diarrhea all night so hopefully the Fortiflora will help--how long before it starts working?
Click to expand...
I don't really know for sure. I would think about a half day. I would put extra water in his food, to help with any dehydration from the diarrhea. And, most of us add water to our cat's food, all time.
I'm having trouble typing. I am so tired, too.
Adding the extra water to his food, will also help to keep ketones flushed.

Have a good day, today. Hope you get some rest or naps in.
 
good morning, martica. like dyana said, adding water to shane's food will help. if he's still dehydrated you might also think about administering some fluids... unless there's any heart condition i'm not aware of.
have a good day!
 
well I thought things were going well his PS +12.5 was 363

then I was all ready to give him his next shot and he growled, hissed and tried to bite at me when I tried. My third attempt was a fur shot. I don't think I got any in him because I smelled it a lot and it was only a little bit. (He has also started to growl during the ear testing.)

So I have filled up a 0.25U and still can't get at him. He now doesn't want anything done to him. And I don't have 2 people here to hold him down. I tried giving a Halo chicken treat and do it while he was eating but he still growled and tried to bite at me, the bite won't hurt but it's the fact that he's not still. He is so skinny it's really hard to lift his skin, he is skin and bones. I don't want to just shove the needle in him.

not sure what to do now?
 
Hi, Martica ~

Can you do a kitty burrito with Shane by wrapping him in a towel for both ear testing and giving his shots if necessary? I'm sure someone here can suggest how to do that. Bummer on the fur shot, but it happens. That poor, dear little guy has been through so much, Martica (and so have you), but I know you'll get him calmed down and get a regular schedule working for you both. Just takes time.

Hang in there,
Eva

P.S. I always say a "kitty taco" and my husband says, "I think you mean a 'kitty burrito', don't you?". :-D
 
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