Newly diagnosed and with a burning question...

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Emily&Oliver

Emily&Oliver

Member Since 2019
Hello! I’m so relieved to learn this forum is here and hope the members of this community can help!

Long story short, my poor boy Oliver was diagnosed as diabetic (perfect blood work one month prior) after rushing him to an emergency vet two weeks ago. He spent a week there overcoming diabetic ketoacidosis and has been home almost a week with a feeding tube. He’s making progress every day and we are so grateful he’s still here.

That being said, we feel good about our routine we’ve established for him regarding his at-home glucose readings (alphatrack 2), feedings (all canned) and injections (2 units Lantus twice a day). As I continue to wrap my mind around all this, I’m stressing out about the potential of hypoglycemia. His readings are leveling out and in the morning he’s testing between 140-160 (before food).

At what reading would you hesitate to administer insulin? Thanks in advance for thoughts.
 
It seems you're testing at home and that's great! :) Those tests before food and injection are important to know if the planned dose is safe. However, it's how low a dose takes him that you need to know to judge the effectiveness of the dose (too low, too high or appropriate). Are you testing at any time in the 4 to 7 hour post shot time period? That's when we expect to see the lowest BG number because the insulin's action is at its peak.

Those are great BGs to have before feeding and injecting. It's possible that he might be dropping a bit low in the middle part of the cycle (the 12 hours between shots). If you could set up your signature and the spreadsheet we use here and fill in any test data you have it'll be a lot easier for us to advise:

Your signature is the light grey text under a post). Here's how to set it up:
  • click on your name in the upper right corner of this page
  • click on "signature" in the men that drops down
  • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
The spreadsheet instructions are here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Thank you! We are planning to do a glucose curve at home this weekend (both work full-time) but are testing twice a day currently. But until then, it sounds like we need to work in a midday reading when we come to feed him at lunch to help establish a low point? That would be 4 to 5 hours after his morning dose.

He's getting about four portioned meals a day right now - 6:30 am, 11:30 am, 6:30 pm and 10:30 pm, so his longest stretch without food is at night before his morning routine. He is reading higher in the evenings (250-370) before his second dose at 7 p.m.

I will have to look at this spreadsheet when I’m not just on my phone - thank you for the info!
 
Emily&Oliver said:
it sounds like we need to work in a midday reading when we come to feed him at lunch to help establish a low point? That would be 4 to 5 hours after his morning dose.
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That would be very useful info and you can add to it on days off. If you can't get any daytime data occasionally try to get at least a before bed test in the evening.

Multiple meals a day is generally best. Is he eating low carb (under 10% as fed) wet food?
 
Yes! He has been on Hill’s canned recovery through his feeding tube (also fighting fatty liver) as recommended by vet. He started eating regular wet food again on his own just a few days again and we are experimenting with Fancy Feast Classic/Friskies that show under 10 on the catinfo.org chart.

Poor guy really hates getting his BG taken - if only he knew it was all in love!
 
Emily&Oliver said:
Yes! He has been on Hill’s canned recovery through his feeding tube (also fighting fatty liver) as recommended by vet. He started eating regular wet food again on his own just a few days again and we are experimenting with Fancy Feast Classic/Friskies that show under 10 on the catinfo.org chart.

Poor guy really hates getting his BG taken - if only he knew it was all in love!
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Do you give him a low carb treat like freeze dried chicken when you test his BG?
 
We need to work that in now that he’s starting to eat on his own again. Do you have a recommended brand or do you make it? Thanks for all the info!!
 
OK - I hope I have set up this spreadsheet and signature correctly! I don't have much data at this time on him as he has been home less than a week, but we are working to test more.

We made the decision this morning to skip his insulin based on his blood gluclose readings pre-meal, and I really hope we made the right choice. Yesterday pre-meal/insulin, he was 203 and we gave him his 2U. About 4 to 5 hours later he had dropped to 58 even after eating a meal. About an hour later he was 63. He was alert and loving during this time, but he's done A LOT of sleeping since being home from the hospital.

This morning he read 142, so we decided not to dose and see how it goes. We both work full-time and can't stay home to monitor for signs of hypoglycemia during the day, and the low numbers were making us nervous last night. Hoping to get a reading at lunch today.

I feel like I can't get a good answer about when to give/not to give insulin. I hope we made the right choice this morning, but I see everyone says better to be high than low, so that's what we decided to go with.
 
I think it was a good call not to dose, is allways better to be safe than sorry, especially since you were not able to monitor him, usually at the beginning is recommended that if he's under 200 and you can wait without feeding for a few minutes (about 15-20 would be ok) and test again if he's going up without any food then you probably can shoot (this is called stalling) but I know that with work I know that's not always possible so skiping is ok and you can always ask for advice, since you are usuing Lantus I suggest you start posting and asking any questions you have in the Lantus Forum http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

I sugguest you take look at this information about hypo http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/ so that you are prepared and that you also prepare and have at hand what we call hypo kit http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=2354 hopefully you will never need it but I think is better to be prepared

Given the fact that he went pretty low you need to lower his dose in the next shoot you give, decreases ( as well as increases ) are usually done in 0.25 units so I suggest that according with the protocols you lower his dose to 1.75 units

Have you decided which protocol you would be following Tight regulation (http://www.felinediabetes.com/FDMB/threads/tight-regulation-protocol-tr.1581/) or Start Low go slow (http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/)?

Sorry to give so much information at once but please feel free to ask anything you want
 
Emily&Oliver said:
I feel like I can't get a good answer about when to give/not to give insulin
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Generally speaking newest members are advised not to shoot below 150 on human meter (not AT).
But DKA changes everything (for now).
Emily&Oliver said:
I hope we made the right choice this morning, but I see everyone says better to be high than low, so that's what we decided to go with.
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In general it is better to be high than Hypo but with DKA being so recent skipping the shots is risky.
Do you test for ketones?
I strongly suggest that you do - Walmart sells dip sticks (Relion brand) for about $7.
Glad to see the Etube is in the picture (it saved my cat's life when she had DKA) - truly great tool!
Do you check the insertion site daily?
If it got inflamed or infected it'll be another risky factor for the DKA recurrence.

The whole picture on dosing/ skipping etc will get clearer once you have more data collected - both BG and urine test for ketones. Try to get BG read 1.5 - 2 hours after the injection - often, not always, the +2 test will tell you where the cat is going - up or down and you plan your feeding and testing after that accordingly. You can reschedule your shot time to an earlier hours to be able to get a test before you leave the house.

Best of luck to yo u and Oliver!
@Emily&Oliver

ETA: the no shoot is 200 as @Veronica & Babu-chiri posted, my apologies for the wrong number.
 
Thanks for all the info on hypoglycemia - very useful. We have Karo but need to stock the other supplies.

Yes, we are testing for ketones and he has been negative since coming home, tested as recently as yesterday at 12 p.m. Also yes, checking insertion site daily for infection. :) Does anyone have another forum or info on DKA and skipping dosing? I have asked my vet A LOT of questions but this is one that has not come up. I've also emailed him this morning about his numbers and hoping to hear back soon.

We are using AlphaTrack2 (I will edit my signature) - does anyone know the no shoot on that? Is it still below 200?

You guys are so helpful. So grateful this forum is here. I'm about to go home and check on him and try to get a reading.
 
Thanks to all you guys for your great advice and resources! He was 130 at lunch today before a meal and his urine tested negative for ketones. Vet got back to us and agreed to lower insulin dosage based on his readings. We're continuing to test as much as we can while working this week and will get a full curve this weekend. Appreciate you all for getting us through my first post-hospitalization freak out. :)
 
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