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

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I’m thinking I’ll get a +4 and if it looks good then I’ll head to bed. Tomorrow I’ll probably get a 12 hour curve during the day.
 
110 mg/dL, not too far off from his last +4. He’s doing well, I’ll keep an eye on him til we’re both asleep. But I think we are good at least til the morning
 
Good morning! Just got a AMPS BG of 125. We gave him a nighttime meal but he probably devoured it quickly, which means he’s basically fasted for the last 8 hours. I’m going to call the vet since they’re open, but I’m think 0.75 units will be a good option
 
Chloe E. said:
Good morning! Just got a AMPS BG of 125. We gave him a nighttime meal but he probably devoured it quickly, which means he’s basically fasted for the last 8 hours. I’m going to call the vet since they’re open, but I’m think 0.75 units will be a good option
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Ah, actually they are closed Sundays, don’t know why I thought they were open a few hours in the morning… whoops. Anyway, I’m going to give 0.75 + food and we will do a glucose curve today. Honey/syrup/high carb food are on standby if we need them.
 
I think he may be bouncing today from the lower numbers yesterday and last night. And with that low AMPS number, we really don't know how low he may have dropped last night.
 
You need to stay with that dose Chloe unless he drops under 50. The dose is based on the nadir not Preshot.
As Suzanne said looks like he is bouncing today so no real point in doing a curve. I think he most likely dropped lower last night.
Is he eating well?
Any ketone test results today?
 
Bron and Sheba (GA) said:
You need to stay with that dose Chloe unless he drops under 50. The dose is based on the nadir not Preshot.
As Suzanne said looks like he is bouncing today so no real point in doing a curve. I think he most likely dropped lower last night.
Is he eating well?
Any ketone test results today?
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Thanks for checking in! He’s eating very well. I think he’s already had 2.5 cans today (I’ll check with my husband) and he still wants more. Being very active and behaving normally. No ketone results as I haven’t caught him going #1, but hopefully tonight.
I’m a bit reluctant to give the 0.75 tonight instead of 1, just because these numbers have been so high. Do you have any articles or anything about bouncing? I haven’t been able to find much. Not that I don’t trust you, I’d just like to understand it better
 
Chloe E. said:
I’m a bit reluctant to give the 0.75 tonight instead of 1, just because these numbers have been so high. Do you have any articles or anything about bouncing? I haven’t been able to find much. Not that I don’t trust you, I’d just like to understand it better
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There is an article about bouncing but I will need to search for it.
Bouncing happens when a diabetic cat drops too fast, too low, or lower than the cat has been used to.
When this happens the body ‘panics’ and thinks it has to save itself and dumps stored glucose and regulatory hormones into the system which sends the BG up high. There is nothing you can do about bouncing except wait it out.
Bouncing is very common in newly diagnosed cats. Bounces last from 1 to 6 cycles. It doesn’t mean they need more insulin and when they come off the bounce, they will go back to the lower numbers….until they bounce again.
So please stay with the 0.75 units. Apart from the dose not being needed to be increased, Lantus likes consistent dosing and if you chop and change doses, you will mess up the depot and have wonky numbers.
When he comes off the bounce, that cycle can drop quite low and often late in the cycle, so you need to be aware of that.

WHAT IS A DEPOT

it’s important that we can see a daily ketone result as that will tell us if the dose is sufficient to keep the ketones at bay. Insulin, lots of food and extra fluids are the key to keeping ketones away.
 
That all makes sense. I’ll stick with the 0.75. His PM shot is in 45 min. I’ll sit with him until he decides to use the litterbox
 
PMPS BG was 256, probably a bit lower than others today because he has been asleep for the last couple hours… AKA no food. Just gave 0.75 unit and will check BG a few times before bed. Currently waiting for him to urinate lol
 
Here is some information about bouncing for you to read.

From the yellow stickie The Basics which is on the Lantus page:
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

From New Dose Wonkiness and Failed Reductions

The roll glucagen in human diabetes
 
Chloe, I would really recommend you make sure, if Oscar is dropping during this cycle that you keep testing until he has reached nadir and has started to rise. If he comes off the bounce during this cycle he could drop lower than usual.
I would suggest you look at a timed feeder for him at night so that he can get some food after you have gone to bed as it sounds as if he is one to eat it all as soon as he sees it……….I have one of those! They are not expand are a lifesaver.
 
Bron and Sheba (GA) said:
Chloe, I would really recommend you make sure, if Oscar is dropping during this cycle that you keep testing until he has reached nadir and has started to rise. If he comes off the bounce during this cycle he could drop lower than usual.
I would suggest you look at a timed feeder for him at night so that he can get some food after you have gone to bed as it sounds as if he is one to eat it all as soon as he sees it……….I have one of those! They are not expand are a lifesaver.
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I haven't heard of timed feeders for wet food. I'll have to look it up.
I am at work all day today, so I won't be able to test. I'll ask my husband if he feels confident enough to try.
The +1 drop is from last night. I don't have a +1 for today. I should be home around 4PM, which unfortunately means no reading til +8. Again, I'll try to get my husband to do it. He is already going to get a urine ketone test today. Basically he locked himself & Oscar in his office with a litterbox, haha. I waited 2.5 hours yesterday for him to decide to use the box with no luck.
 
Chloe E. said:
I haven't heard of timed feeders for wet food. I'll have to look it up.
I am at work all day today, so I won't be able to test. I'll ask my husband if he feels confident enough to try.
The +1 drop is from last night. I don't have a +1 for today. I should be home around 4PM, which unfortunately means no reading til +8. Again, I'll try to get my husband to do it. He is already going to get a urine ketone test today. Basically he locked himself & Oscar in his office with a litterbox, haha. I waited 2.5 hours yesterday for him to decide to use the box with no luck.
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https://www.chewy.com/petsafe-eatwell-5-meal-automatic-dog/dp/48079
 
oh, you also have a multi-cat household eh? Yeah that is exactly why we don't own either of those feeders lol

it is expensive but some people use a product called Meowspace to solve that challenge. We use Surefeed RFID chip feeders but they have no timers. I just work from home right now and put food in them 3-4 times a day
 
I've seen the chip feeders before - and yep we haven't purchased them because $$$. The biggest problem is that our other cat can only have dry food, or he'll have terrible diarrhea. But obviously Oscar can't have dry food. It's a struggle. My husband locks Oscar in a room to feed him during the day (he's working from home ~3-4 days per week). He absolutely HATES dry food, so we can usually keep the dry food out. The only problem is getting Oscar wet food overnight without giving anyone else wet food overnight. We have a couple of ideas.
 
Is your husband feeding Oscar during the day?
With a preshot of 125 this morning it is very likely he is dropping quite low overnight and I would urge you to please make sure you test until after nadir to ensure the BG does not drop too low.
The same with today…he is only 125 at preshot and if he doesn’t bounce, he could easily drop low.
With a preshot of 125 and with very little data it is important to get some early tests in at +1 and +2 to see what is going to happen during the cycle. You don’t want to test at +4 and find you have very low numbers.
 
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Yup, he feeds Oscar several times a day.

And I appreciate that he needs tested. It's just not possible with my work schedule.
 
Chloe E. said:
Yup, he feeds Oscar several times a day.

And I appreciate that he needs tested. It's just not possible with my work schedule.
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Then you may want to consider having a Freestyle Libre glucose sensor put onto Oscar in order to keep him safe. Once you get going with it, it's not hard at all to test a cat's ear using an inexpensive human glucose monitor. Even your husband could do it.
 
Yep I know it's easy, I feel like I've done it a million time now lol (even though it's probably just been a dozen or so). My husband just sent me a video of Oscar running around and playing with toys, saying that he's had no signs of being hypo all day. I asked him to try and get some blood. We are at +6.5, so that's less data than I'd like, but still helpful.

We have looked into the Freestyle sensor. We are probably going to get it for him at the end of the month when we take a trip for 4-5 days (I already hired a petsitter with experience giving insulin). We probably won't get it til then, just because we just spent $6,300 at the emergency vet for DKA and money is a bit tight now.
 
Chloe E. said:
Yep I know it's easy, I feel like I've done it a million time now lol (even though it's probably just been a dozen or so). My husband just sent me a video of Oscar running around and playing with toys, saying that he's had no signs of being hypo all day. I asked him to try and get some blood. We are at +6.5, so that's less data than I'd like, but still helpful.

We have looked into the Freestyle sensor. We are probably going to get it for him at the end of the month when we take a trip for 4-5 days (I already hired a petsitter with experience giving insulin). We probably won't get it til then, just because we just spent $6,300 at the emergency vet for DKA and money is a bit tight now.
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Now I totally can relate to that (the cost!) :( I'm happy to hear he's running around and playing!
 
My husband says he tried twice and he got two error messages. He said he feels like he hurt Oscar so I won't press him to try again. Clearly I will have to host a little class tonight on getting blood from the ear!
 
Chloe E. said:
My husband says he tried twice and he got two error messages. He said he feels like he hurt Oscar so I won't press him to try again. Clearly I will have to host a little class tonight on getting blood from the ear!
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Well, at least he’s willing. That’s wonderful.
 
Chloe I am wondering why you increased the dose of the insulin?
Any increases are based on the nadir not the preshot BGs and in my opinion he should he staying in the 0.75 units unless he has ketones in the urine. I think you are risking him dropping low. You are not testing at night past +3 or +4 when the BG is still dropping and cats often drop lower at night. The BG will not feel the full effect of the increase until the depot is full and then he could drop too low, or his could drop lower sooner. And not being able to test during the day because you are at work, is another reason not to increase so soon when it is not necessary. You can’t rush feline diabetes…..you will not get a result any sooner, in fact often the opposite.
If it was the vet who said to go to 1 unit, I think he/she is wrong.
Have you managed to do any tests for ketones yet.
 
Will you be going down to .75 I hope? That took Oscar into the low 60’s. As Bron said he could drop too low. If giving 1.0 I would test to see how low it takes him at night. Many cats drop even lower at night.
 
Chloe, that red PMPS is indication to me that the dose is too high and Oscar is dropping too low during the cycle and then bouncing up high at preshot. Please, please reduce the dose to 1.75 units. You are doing very little testing and are risking Chloe having very low numbers and a possible hypo.
 
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