Not sure if I should give insulin, post-DKA cat with <200 BG pre-shot

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Chloe E.

Chloe E.

Member Since 2022
Hello,

I am new to this forum and fairly new to the feline diabetes world (diagnosed 18 days ago). Oscar was in the vet hospital with DKA recently (he deteriorated a couple days before the vet was going to have us start insulin), only got discharged 6 days ago. Today we had our first successful at-home blood test, and have tested a few times throughout the day. We are at 11.5+ and I just took his BG in prep for his insulin shot (the first time I’ve been able to do so), but it was 103 mg/dL. From what I’ve read this is too low to give insulin, but he is also post-DKA so I’m not sure. I’d give the vet a call but they’ve closed several hours ago. He also hasn’t fed in a couple of hours - the vet has told us to only feed him just after we give insulin… we have been breaking the rules a bit there. We have been giving him those meals twice a day and adding snacks/little meals throughout the day since he’s post-DKA and needs to gain weight back (dropped from 13 lbs to 7.5 lbs). We just gave him a can of wet food since he was crying and it is mealtime anyway. I’m guessing I shouldn’t give him a unit right now, but what is the best route of action here? Wait another hour and retest? Give half a dose? Any help would be greatly appreciated. Oscar is acting totally normal, very active, and he behaved very nicely during his ear prick.
 
First off I would feed several small meals each cycle. Only feeding twice is old school or else your vet might not be used to Lantus.

His dose is too high. With SLGS a reduction is earned if under 90. Please test again and let’s see if he goes up. Post results. With DKA you are correct skipping is not good.

He has lost a lot of weight. He needs to beat a lot, get insulin, and stay hydrated to prevent a return of DKA. Have you tested for ketones?
 
tiffmaxee said:
First off I would feed several small meals each cycle. Only feeding twice is old school or else your vet might not be used to Lantus.

His dose is too high. With SLGS a reduction is earned if under 90. Please test again and let’s see if he goes up. Post results. With DKA you are correct skipping is not good.

He has lost a lot of weight. He needs to beat a lot, get insulin, and stay hydrated to prevent a return of DKA. Have you tested for ketones?
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I am seeing online that two meals a day isn't appropriate. The only struggle right now is that our other cat absolutely cannot have wet food, or he has diarrhea. So we can't keep wet food out unless Oscar is isolated. My husband is working from home right now so he can figure it out, but he does have to go into the office some days.

The vet didn't mention anything about reducing his dose based on blood sugar, so that's why I came here. I told her that we would be testing BG at home starting ASAP. Maybe she didn't think I was serious about it?

Since it's been 30-45 minutes since he ate, I'll go check BG again now. We tested urine for ketones 1-2 times per day when he got discharged, and we haven't seen any for a week. His BG meter also says "ketones" if there are ketones present, but I don't trust that as much as the urine test. So the answer is that I am pretty sure no ketones.
 
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Just checked his BG, it is 161 mg/dL. He is still in the process of eating his evening meal.
 
Hi and welcome to the forum.
We can help you manage Oscars post DKA recovery.
Can you tell me if you can test during this pm cycle if we go ahead and give a dose of insulin?
Do you have some high carb food at home and honey or Karo if it is needed?
can you tell me what the food was you fed Oscar just now please? Was it wet or dry food and do you know the carbohydrates content?
ETA I see it was wet food. Do you know the carb content?
 
Bron and Sheba (GA) said:
Hi and welcome to the forum.
We can help you manage Oscars post DKA recovery.
Can you tell me if you can test during this pm cycle if we go ahead and give a dose of insulin?
Do you have some high carb food at home and honey or Karo if it is needed?
can you tell me what the food was you fed Oscar just now please? Was it wet or dry food and do you know the carbohydrates content?
ETA I see it was wet food. Do you know the carb content?
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Hi! Sorry, I just went to the pharmacy to pick up more BG test strips. Typing a response to your questions now...
 
Bron and Sheba (GA) said:
Hi and welcome to the forum.
We can help you manage Oscars post DKA recovery.
Can you tell me if you can test during this pm cycle if we go ahead and give a dose of insulin?
Do you have some high carb food at home and honey or Karo if it is needed?
can you tell me what the food was you fed Oscar just now please? Was it wet or dry food and do you know the carbohydrates content?
ETA I see it was wet food. Do you know the carb content?
Click to expand...

Thank you! I appreciate it a lot. I was planning on staying up pretty late tonight anyway, so I can test during the PM cycle. I have both honey and maple syrup ready to go if we need it. Oscar has been eating Purina DM wet food and Friskies pates/shreds. When I type nutrition info into this website, it says that the Purina food is <1% carbohydrates and the Friskies are generally 2-5% (the one he ate an hour or so ago is the Purina DM). We have dry food on hand that is >20% carbs, though he doesn't like it much.
 
Chloe E. said:
Just checked, he's up to 217 mg/dL.
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Ok. That’s good. But the BG (blood glucose)is food influenced so we need to keep that in mind.
The 1 unit is keeping him pretty low, which is good but we don’t know if it has been dropping lower when you were not testing, so I think it would be best to reduce the dose to 0.75 units. I will post a picture for you to see how to draw up 0.75 units. If you are unsure you can take a photo of it and copy and paste it here for us to check..the 0.75 units is half way between the 1 unit mark and the 0.5 unit mark.
We will get that done first then I will tell you about how to manage post DKA and also talk to you about dosing methods….we like to have post DKA kitties doing TR…tight regulation …so that we can adjust the dose more quickly….more about that later.

can you post when you have given the 0.75 unit dose please?:)

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Bron and Sheba (GA) said:
Ok. That’s good. But the BG (blood glucose)is food influenced so we need to keep that in mind.
The 1 unit is keeping him pretty low, which is good but we don’t know if it has been dropping lower when you were not testing, so I think it would be best to reduce the dose to 0.75 units. I will post a picture for you to see how to draw up 0.75 units. If you are unsure you can take a photo of it and copy and paste it here for us to check..the 0.75 units is half way between the 1 unit mark and the 0.5 unit mark.
We will get that done first then I will tell you about how to manage post DKA and also talk to you about dosing methods….we like to have post DKA kitties doing TR…tight regulation …so that we can adjust the dose more quickly….more about that later.

can you post when you have given the 0.75 unit dose please?:)

View attachment 64502
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Sorry, last reply had the wrong info so I deleted it. I gave the 0.75 units at 10:15pm. We have U100 syringes that don't have half unit markings, so I just went 3/4 of the way between 0 and 1.
 
Chloe E. said:
I did not! So sorry about that. It's U100.
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I typed U40 and meant to delete it before I posted my reply. We have U100 syringes. I do give animal vaccinations at work so I promise I'm not totally clueless, just got my numbers mixed up. Again so sorry
 
Chloe E. said:
I typed U40 and meant to delete it before I posted my reply. We have U100 syringes. I do give animal vaccinations at work so I promise I'm not totally clueless, just got my numbers mixed up. Again so sorry
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Ok. Phew!!
It’s just that U40 syringes will deliver 2 1/2 times as much Lantus insulin as a U100 syringe.
We have twice in the last couple of weeks had people arrive here who have been given U40 syringes instead of U100 syringes for Lantus.so it does happen.

Can you get a +1 and a +2 reading please and post it here and in the SS..
I would feed him a good snack of food every couple of hours except for the 2 hours before the preshot BG as we need that to not be food influenced.
I will post the information about post DKA care shortly.:)
 
Bron and Sheba (GA) said:
Ok. Phew!!
It’s just that U40 syringes will deliver 2 1/2 times as much Lantus insulin as a U100 syringe.
We have twice in the last couple of weeks had people arrive here who have been given U40 syringes instead of U100 syringes for Lantus.so it does happen.

Can you get a +1 and a +2 reading please and post it here and in the SS..
I would feed him a good snack of food every couple of hours except for the 2 hours before the preshot BG as we need that to not be food influenced.
I will post the information about post DKA care shortly.:)
Click to expand...
Absolutely! We will certainly test at least at +1 and +2.

Thank you in advance for the info. The emergency vet basically just said to give him a unit 2x per day and make sure he’s eating enough to gain some weight back. We have a glucose curve scheduled with the vet on the 16th, but I’m starting to wonder if it might be better to just get the data at home? They also want to do fructosamine again. I don’t understand why as I haven’t researched it much. I thought we just needed fructosamine initially to confirm his diagnosis. But anyway, that’s pretty much the only info they gave us. Primary vet called to say the same thing.
 
You don’t need to have a curve done by the vet which would be stress influenced no doubt. Much better to test at home. Don’t waste your money as home testing is more reliable. Likewise the fructosamine. It’s just an average over the past couple of weeks and you will have that by home testing. Politely decline. Many people don’t test at home and so bring their cats in fir curves. The few people I know who did that never got their cats controlled and all were going outside of their boxes.
 
Chloe E. said:
Absolutely! We will certainly test at least at +1 and +2.

Thank you in advance for the info. The emergency vet basically just said to give him a unit 2x per day and make sure he’s eating enough to gain some weight back. We have a glucose curve scheduled with the vet on the 16th, but I’m starting to wonder if it might be better to just get the data at home? They also want to do fructosamine again. I don’t understand why as I haven’t researched it much. I thought we just needed fructosamine initially to confirm his diagnosis. But anyway, that’s pretty much the only info they gave us. Primary vet called to say the same thing.
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You don’t need another fructosamine test done. They are very good for diagnosis but if you are hometesting you don’t need another one as they are just an average of the past few weeks and don’t give highs and lows …just an average.
And I would cancel the curve at the vet. You will get much better and more accurate tests done at home and Oscar will not be stressed. They won’t feed him enough there either during the day and his BGs will be higher there due to stress.
The dose of insulin is based on the nadir of the cycles and also with a DKA cat, if there are any ketones present in the urine.
 
tiffmaxee said:
You don’t need to have a curve done by the vet which would be stress influenced no doubt. Much better to test at home. Don’t waste your money as home testing is more reliable. Likewise the fructosamine. It’s just an average over the past couple of weeks and you will have that by home testing. Politely decline. Many people don’t test at home and so bring their cats in fir curves. The few people I know who did that never got their cats controlled and all were going outside of their boxes.
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That all makes sense to me! I know that I’m the one in charge of his care, but I get nervous that I won’t be able to keep getting an insulin prescription if I do things the vet doesn’t like.
 
Chloe E. said:
That all makes sense to me! I know that I’m the one in charge of his care, but I get nervous that I won’t be able to keep getting an insulin prescription if I do things the vet doesn’t like.
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You wont need another script for ages...make sure you keep it in the frig in a container. don't shake or roll it. It will last 6 months.
 
Did you get a vial or pen? A vial will last you 5-6 months at least snd by then you will either have lots of data to support your decisions or he will be diet controlled. My vet is very experienced and never did a curve except after the first shot. He saw I knew what I was doing and reminded me to email the spreadsheet every few weeks if I forgot. I wish I could clone him. Blame it on finances if your vet asks. Once the vet sees your spreadsheet in a few weeks it should not be an issue.
 
Here is the plan you need to follow for the next few weeks until Oscar is well past DKA.

  • you need to give one and a half times as many calories as Oscar 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
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Oscar will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids if he is not drinking well or looks dehydrated.
  • Test the BG frequently
  • Post daily with updates and ask for help as often as needed.
You can feed any low carb wet food, there is no need to feed prescription foods. I will attach a link to suitable foods. Look for foods that are 10% or less Carbs. Most of us give 4-6 % carbs.
FOOD CHART

Also here is a link to setting up the hypo kit which you will need to do asap if you haven't already done so. You will be able to find some suitable higher carb foods in the list of foods I sent you above. Try and get some medium 11-15% and high carb 16 and above.
HELP US HELP YOU


 
BG is 224 mg/dL an hour after the insulin shot. Behaving normally and being cute. Going to try to test urine for ketones if I can catch him using the litterbox, lol
 
tiffmaxee said:
Did you get a vial or pen? A vial will last you 5-6 months at least snd by then you will either have lots of data to support your decisions or he will be diet controlled. My vet is very experienced and never did a curve except after the first shot. He saw I knew what I was doing and reminded me to email the spreadsheet every few weeks if I forgot. I wish I could clone him. Blame it on finances if your vet asks. Once the vet sees your spreadsheet in a few weeks it should not be an issue.
Click to expand...
We got a vial and started refrigerating it right away. Our vet said that it would last longer than 28 days if refrigerated, but didn’t specify exactly how long. Good to know we have at least a few months supply!
 
Bron and Sheba (GA) said:
Here is the plan you need to follow for the next few weeks until Oscar is well past DKA.

  • you need to give one and a half times as many calories as Oscar 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
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Oscar will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids if he is not drinking well or looks dehydrated.
  • Test the BG frequently
  • Post daily with updates and ask for help as often as needed.
You can feed any low carb wet food, there is no need to feed prescription foods. I will attach a link to suitable foods. Look for foods that are 10% or less Carbs. Most of us give 4-6 % carbs.
FOOD CHART

Also here is a link to setting up the hypo kit which you will need to do asap if you haven't already done so. You will be able to find some suitable higher carb foods in the list of foods I sent you above. Try and get some medium 11-15% and high carb 16 and above.
HELP US HELP YOU

Click to expand...
Thank you!! That food chart is especially awesome. Oscar loves his wet food but gets a bit picky.
 
Bron and Sheba (GA) said:
I think you will find the Purina DM is higher than 1%. More on that later.
Can you check the BG again please?
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You are definitely right about this, apparently the Purina is 13% carb on a dry matter basis. Which I guess is good for now since he’s willing to eat it, but we won’t get anymore
 
Chloe E. said:
Oscar loves his wet food but gets a bit picky.
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Most cats can be picky:rolleyes:, especially after an illness like DKA. You are lucky he wants to eat. Many post DKA kitties need an antinausea and an appetite stimulant to eat in the beginning.

Is someone always around to feed Oscar the snacks? If not you might want to look at getting an automatic timed feeder for him as it is really important he gets all the food he needs. Did you see post 27?
 
Chloe E. said:
You are definitely right about this, apparently the Purina is 13% carb on a dry matter basis. Which I guess is good for now since he’s willing to eat it, but we won’t get anymore
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You will need to be careful when you swap to a lower carb foods that the BGs don't drop too much. You will need to do it when you are there to monitor closely. It is fine for him to have the DM for now if he is eating it...the most important thing is he eats ...eating something trumps everything.
 
Bron and Sheba (GA) said:
Most cats can be picky:rolleyes:, especially after an illness like DKA. You are lucky he wants to eat. Many post DKA kitties need an antinausea and an appetite stimulant to eat in the beginning.

Is someone always around to feed Oscar the snacks? If not you might want to look at getting an automatic timed feeder for him as it is really important he gets all the food he needs. Did you see post 27?
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He was on an appetite stimulant, honestly we stopped giving it to him because he cried all day unless he got 4x the number of calories he needed in a day. His appetite has still been great without the stimulant.
Currently my husband is home most days and can give Oscar food whenever. We also have a second floor that we don’t spend much time in (it gets kinda hot) that the cats love, so we might leave Oscar in there with food during the day. We have put a litterbox up there, and he already associates the upstairs with food lol. He also doesn’t really like the other cats, so he wouldn’t mind being isolated as long as he gets human time
 
Chloe E. said:
He was on an appetite stimulant, honestly we stopped giving it to him because he cried all day unless he got 4x the number of calories he needed in a day. His appetite has still been great without the stimulant.
Currently my husband is home most days and can give Oscar food whenever. We also have a second floor that we don’t spend much time in (it gets kinda hot) that the cats love, so we might leave Oscar in there with food during the day. We have put a litterbox up there, and he already associates the upstairs with food lol. He also doesn’t really like the other cats, so he wouldn’t mind being isolated as long as he gets human time
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That sounds like a good plan with the first floor. NO, he doesn't need the appetite stimulant.

Chloe E. said:
What is post 27?
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If you look at the right side of the page next to 'like' and 'reply' you will see a number. That is the number of the post.
 
Bron and Sheba (GA) said:
That sounds like a good plan with the first floor. NO, he doesn't need the appetite stimulant.


If you look at the right side of the page next to 'like' and 'reply' you will see a number. That is the number of the post.
Click to expand...
Ohh gotcha, I’m on mobile so not sure if I can see those numbers I’m assuming post 27 was the one you shared with all the DKA info?
 
Bron and Sheba (GA) said:
You may well have to stay up longer than that if he is dropping lower. Remember I asked you if you could monitor this cycle if we gave the dose?

Beautiful photo. Why did they shave his leg?
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Understood. But we do want him to go lower, no? I mean, that is what the insulin is for. And I was told earlier this morning that Lantus doesn’t show its full effects til 4-6 hours anyway, so I’d assume we will still go down more overnight. I’m willing to stay up, just thought that since he is consistently in the 200s that a hypo episode was less likely

I think they had fluids going into that leg? Or maybe a catheter that could continually be used to check blood? Can’t quite remember. I know he had stuff stuck into one front leg and one back leg. They shaved off a chunk of fur in his tail too. I didn’t really question it honestly
 
Chloe E. said:
Understood. But we do want him to go lower, no? I mean, that is what the insulin is for. And I was told earlier this morning that Lantus doesn’t show its full effects til 4-6 hours anyway, so I’d assume we will still go down more overnight. I’m willing to stay up, just thought that since he is consistently in the 200s that a hypo episode was less likely

I think they had fluids going into that leg? Or maybe a catheter that could continually be used to check blood? Can’t quite remember. I know he had stuff stuck into one front leg and one back leg. They shaved off a chunk of fur in his tail too. I didn’t really question it honestly
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Love the avatar photo!
It depends on the cat as to when the nadir takes place and nadirs move around day to day. Cats like to keep us guessing.:rolleyes:
Yes we do want it to go down but we don’t know how he will respond to the dose as we have no previous data to go by and you did feed him when he had the low preshot and the preshot was food influenced so we need to take all that into consideration while watching this cycle. Does that make sense?
 
That makes sense. But I was talking about this with my husband earlier - isn’t the curve always going to be food influenced? How can I tailor his feeding schedule to minimize that?
 
Chloe E. said:
That makes sense. But I was talking about this with my husband earlier - isn’t the curve always going to be food influenced? How can I tailor his feeding schedule to minimize that?
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It is only the preshot BG we need to worry about as far as food influenced is concerned as we need to make sure the BG is safe to give the dose. When you do a curve, you just go ahead and feed as you normally do during the cycle, as we need to see how he is responding to the dose of insulin in his normal day to day life and that includes his snacks.
 
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