Now Jack is hypo! Help!

Status
Not open for further replies.
Jack and Jenell

Jack and Jenell

Member
My boy Jack was diagnosed with diabetes in January. My vet started him on oral meds but then Jack ended up with DKA and pancreatitis and was hospitalized for 3 nights in February. Jack came home on Prozinc 1 unit BID, but was still in the 400s-500s, so after a week we increased his dose to 1.5 units BID. His BG was better - AMPS/PMPS 300s with a nadir ranging from 90-140. This has been the case for the past 3 weeks and he has been doing great. Then on Tuesday in the span of 12 hours he stopped eating and ended back in the hospital for another 4 nights with DKA and triaditis. Jack turned the corner and the ER vet started him on an oral steroid and an oral chemo med (for what they thought could be lymphoma but could not confirm even with an aspirate). Due to the steroid, Jack's Prozinc was increased to 4 units BID. Because he has lost weight due to the DKA the vet also said he needs to be eating at least 3 cans of Fancy Feast a day. I brought Jack home yesterday and his PMPS registered Hi - over 600. So he got his insulin. This morning his AMPS was 296 (better!) so he got his shot. I've been checking him today and he has only gone up:

AMPS 296 Prozinc 4 u
+2 429
+4 564

I'm a nurse and feel like we are drowning here. His appetite is great but I'm terrified of his extremely high numbers. I've spent thousands at the veterinary hospital and don't think he or I can do it a third time. What do I do???
 
Re: So overwhelmed...need help

welcome to FDMB! Sorry you have to be here, but make yourself at home.

I'm glad you are testing at home. The best way to start getting your arms around things is to spend a few days getting tests at various times of day (and at least one at night too). Each test will help you fill in pieces of the puzzle to figure out what the insulin is doing for Jack. There are folks here who are good at interpreting the patterns for each insulin, and they will help you figure it out. I'm more familiar with Lantus and Levemir than with Prozinc, but I have learned that it is usually best to look at patterns over a few days than to put too much emphasis on any one cycle. Getting some more tests will help you see if he is staying high all the time, or going lower and then bouncing back up to high numbers.

DKA is sooooo hard and I'm sorry you and Jack are dealing with it. I did it with Lucy. You don't get the luxury of being able to ease into this like most people do. Since you are a nurse, you probably understand that DKA needs insulin, and that you might have to be more aggressive with insuluin dosing than most until he gets past this. You'll have to be able to make sure he gets enough food to offset that amount of insulin, even if that means syringe feeding. How is Jack's appetite?

It's also important to realize that when he starts feeling better, the insulin needs might decrease just as quickly as they increased. Be prepared, stock up on higher carb wet foods and keep some karo syrup handy in case you need it. I'm on my iPad and don't have all my links handy, but others will be along to post more information on the Hypo Toolkit.
 
Re: So overwhelmed...need help

How to treat hypos
Hypo Tool Box


And with DKA , you will want to run to a pharmacy ( walgreens ) and grab some keto stix....
you will want to monitor for ketones, especially with those high numbers.
If you need ideas for how to get urine samples ( not all kitties cooperate) , just ask.
 
Re: So overwhelmed...need help

Jack's appetite is great. I'm feeding him every 4 hours with Fancy Feast classics about 1/2 to 3/4 can at a time. I figure that will probably make his numbers higher but the vet said that what he needs is nutrition. I'll try to test for ketones but he goes outside to do his business. Tonight his PMPS was over 600. I gave 5 units tonight. I'm just feeling so defeated. I love my boy so much and don't know if this is just going to be a horrible cycle until it's just too much for him. Ever since we started insulin he's never been consistently less than 300.
 
Re: So overwhelmed...need help

Welcome Jack and Jenell. You've found the best place on the internet you never wanted to be.

I'm so sorry to hear about the DKA. That makes things so much more complicated.

Have you been able to get some more mid-cycle tests in since your post on Sunday? The numbers on Sunday are strange. They look like possibly a bounce if Jack went lower the previous cycle around nadir. It's possible too that the lower pre-shot numbers were reflective of the last dose still at work, and that +4 in the 500's reflects that the next dose just wasn't enough to bring him down.
 
Re: So overwhelmed...need help

I'm confused about his results as well. I did get more results:

AMPS 296
+2 429
+4 564
+6 416
+8 411
PMPS HI (over 600)

I was so distraught that I decided to bump him up to 5 units at bedtime and kept a closer eye on him overnight:

+3 after PMS 217
+6 after PMS 226

So we are back at it again. This mornings AMPS was HI.

I have an appt with the Vet today at 3:10. I know his steroid is making him so high, but I need to get him regulated ASAP. He is bright and eating but I know that he can't continue to stay this high without ill effects. Maybe he needs an experimental mid-day dose. Anyone have any suggestions?
 
Re: So overwhelmed...need help

Some folks have needed to shoot ProZinc every 8 hours (TID). To do that, take the current total daily dose you are giving, then divide by 3 to get your initial TID dose.

Also, when there is another condition, you adjust the insulin around it. How much steroid is he on? You will need to use large doses of insulin to compensate for the steroid effects.
 
He isn't too low, yet. If he's at +6, he is likely past nadir. Do you have high carb food or Karo/honey/glucose syrup if he goes lower?

Also:

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Because he's willingly eating I gave some high carb treats. I just rechecked him @ 20 minutes later and he is up to 65. Will keep checking...What's safe? Over 100?
 
He is not too low, so you can relax. And go back to your first post to remove the 911.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.
 
How many times has this dose been given? If more than 6 times, its likely to be OK though you'll want to keep an eye between +5 to +6 hours post shot when the nadir likely occurs.

If less than 6 times, you may want to decrease 0.25 units, which you'll eyeball on the syringe.

And sometimes, the exact same dose results in completely different numbers. I go for safe and shoot Gracie enough to get her down in the low hundreds, but not lower because I am not home to monitor.
 
Less than 5 times. It's such a big swing for him - from over 600 to this. I'll reduce his dose tonight. Thank you :) And it's the same for me, back to work tomorrow so I can't keep close eye on him either. I guess it's good to know his insulin is working :)
 
We try to keep dose adjustments small - 0.25 unit increases when nadirs are between 150-300, 0.5 unit increases for nadirs over 300, when the same dose has been given about 2-3 days, when using ProZinc.
 
The 58 isn't a bad #, and yes it was a bit low... Lower than what you're used to, as well as a bit scary. There's a lot of good information there with regards to ProZinc. :-D One thing to remember with any insulin is to keep the doses consistent, otherwise you'll end up with roller coaster #s, and a lot of frustration. Good luck!
 
Status
Not open for further replies.
Back
Top