Poncho diagnosed diabetic 1/15

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Hi. I am up again now. I am not experienced in the way that BJM is but I will help where I can.

So you have given some insulin and he has had some food? Now we need to try to flush out the ketones. You have been assisting with his water intake as well haven't you but not sub q's?
 
I hope @Meya14 doesn't mind but i am going to quote her advice from other threads that I hope you will find useful. Obviously was was talking about cat but hopefully you will get the general principles of treating DKA.

Meya14 said:
My cat when he was diagnosed had severe DKA. Since my husband and I are both nurses, in order to save on costs, keep my cat happy, we chose to treat at home with the vets guidance. The main thing with DKA is the body is "starving" due to lack of insulin and burning fat which throws their metabolism out of wack and causes dehydration.

The key to treating DKA is Insulin + High carb foods + fluids + electrolytes + nausea control/appetite stimulant.

Ideally, you should NEVER reduce insulin during DKA especially if they are not eating, because lack of insulin is the cause. The body is not able to use carbs/protein as energy without insulin. The cat should be syringe fed every hour with high cal/higher carb wet food to maintain calories. Subq fluids (lactated ringers - which has electrolytes) and a potassium supplement given orally should be done at least daily, sometimes 2x/day depending on intake. You can do these at home, it's not much more complicated than learning to give insulin.

If she doesn't get the calories to stop her body from burning fat, the DKA will get worse. Insulin may need to be increased as well.
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Meya14 said:
Angie, keep force feeding her with the highest calorie wet food you can find. If her blood sugars are still high, you will need to increase the dose in order to keep them below 250. What insulin is she on? You should be testing her BS frequently, as it can jump around. Feeding more is better than reducing insulin in DKA.

Keep giving 20-30ml of fluids every 2 hours or so -> Aim for 300ml/day of fluid and one can of food per day (more food is better).

You should find a vet who will provide guidance/assistance and take into account your financial situation. You really need to have access to medications/advice for diabetes in general, and for acute episodes like this.
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Is there a humane society vets near you that might be able to help?
 
Yes, at this point, your cat needs to be eating -every hour-, if this means force-feeding/syringe feeding, then that is what should be done. I don't have a lot of experience with prozinc so I can't give you dosing advice, but with the ketones you have, any reduction of insulin will cause the ketones to increase. If you have to add syrup to the food to keep his glucose up, that is better then reducing insulin. Test BS every 2 hours or so.

A cat in DKA needs at least 6 oz of food - 1 large can (high cal/higher carb food - try kitten food) and 300ml or more of fluids each day. If the vet will show you how to do subQ fluids, you may be able to shorten the length he has to stay in the hospital if you take him in. DKA is very serious. If your cat does not get the calories, fluids, and insulin his health could deteriorate quickly. Start immediately with feeding and fluids.

Other things he will need - ask your vet about:
potassium suppliment
anti-nausea medication
pain meds

Ideally, you need to keep the blood sugars below 300 without going too low. Use food to steer the sugars up if he starts to go low.

For others on here.... what is the duration of prozinc for your kitties? Does anyone dose 3X a day in smaller amounts?
 
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christoph said:
I just gave sub q. BG was 378 on Relion Confirm Last insulin was Wed afternoon @ 1 unit which caused a drop to 37. What dose .5?
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For info the last reading tonight before insulin was 378 and he was given 0.5 units of insulin. Before that the vet had recommended stopping the insulin so none since Wednesday. Hopefully another reading will be coming soon.

Christoph the main aim now is calories and water, even if that means waking him up and assist feeding. Are you able to do that.

@Meya14 here is the prozinc protocol. It doesn't mention 3 times that I can see

http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/
 
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If 0.5 units twice a day was the last good dose, then start there. You may need to increase once you get some food in him.
 
I'm going to check BG again. He is sleeping soundly curled up on his side and looks very comfortable.....almost hate to disturb him. It seems like he has been slowly giving up through this whole thing and he has been so stressed out at the clinic.....never been away from me in his 14 years. Anyway he has gotten close to 300 ml of subq and I forced fed him the ad critical care food about 20 ml.....fought me the whole way..... and he ate a little on his own. I think the vet should have lowered the dose instead of cutting him off for good. That probably raised the keytones because he was beginning to eat better. I generally don't like or trust vets anymore.
 
I am not sure that it was but the higher reading did cause sudden drops below 50 according to christoph. Without a chart it is difficult to know but I think we felt it was a good starting point. BJM tried to gather the info so far.

BJM said:
These are all the tests you've reported. Without specific times, it is a tough to see what is happening.

"his BG was always between 350 and high 400s with a couple @ 155 and 167"
- using glucometer

"The night before I took him for his 1st curve his BG was 379."
- using glucometer

"The next morning before I took him it was 60"
- using glucometer

"His morning pre-shot BG was 379 and afterward next test was 166, then next it had dropped to 37"
- could have been a lab machine OR a glucometer
- This seems to be a curve, and if so, the tests would likely have been 2 hours apart. If so, we can list it like this:
AMPS ~ 379; 1.5 units ProZinc
+2 ~ 166
+4 ~ 37

Tonight: 378 mg/dL about 11 pm, No insulin on board
- using glucometer
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@christoph do we have a latest reading ? How is the feeding going?
 
christoph said:
I'm going to check BG again. He is sleeping soundly curled up on his side and looks very comfortable.....almost hate to disturb him. It seems like he has been slowly giving up through this whole thing and he has been so stressed out at the clinic.....never been away from me in his 14 years. Anyway he has gotten close to 300 ml of subq and I forced fed him the ad critical care food about 20 ml.....fought me the whole way..... and he ate a little on his own. I think the vet should have lowered the dose instead of cutting him off for good. That probably raised the keytones because he was beginning to eat better. I generally don't like or trust vets anymore.
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I don't think the lack of insulin helped. Your vet probably doesn't have much experience of this. An emergency vet would probably have seen more cases. Now you have the info to know what to do then at least you can give it ago or advocate for your cat at the vet.

It's great that you have got fluids and water into him. Testing his ear might not disturb him too much but you will need to get more food into him I think.
 
I gave him his last .5 shot at 10:45 last night after BG@378. Last dose before that was Wed afternoon @ 1 unit and he dropped from 379 to 37 in 4 hrs. I'm going to try to feed him again after BG.
 
I was getting ready to post BG and shot history when I got the keytone reading, so shifted to panic mode. I'll try to get that done soon.
BG @2:15 am 229 on the Relion Confirm. Will check again at 4:15 am Not hungry so will syringe feed.
 
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Christoph,
Stopping the insulin probably did contribute, also if there is infection that needs to get resolved. Your vet doesn't sound too confident in treating diabetic cats, there may be one in your area more experienced?

You are doing a good job. Keep doing what you are doing, and maybe call your old vet in the AM and see if he can guide you or knows a good vet in your area? If you take him someplace inpatient, make sure they have treated DKA cats before.
 
christoph said:
I was getting ready to post BG and shot history when I got the keytone reading, so shifted to panic mode. I'll try to get that done soon.
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You are doing great. Please don't think I am trying to push you at all. I know you have your hands full.
 
Thanks Meya14 and phlika29. I really appreciate the help and so does Poncho. The vet in question dropped the ball twice before and I called her on it. Poncho has an upper respiratory infection I've been treating with 3 antibiotics and is better. I thought that might have messed up the curve because it was peaking at that time before antibiotics. The vet was made aware of some nasal sniffles when I first took him in but disregarded it then while in ICU had sniffles and left eye was oozing mucous and disregarded again. Phlika29, I don't think you're pushing me......you're very helpful and if you were pushing me I wouldn't mind.....it would help keep me alert in this chaos. Thank you. Will update again.
 
Here's the history. After diagnosis put on IV for 1 1/2 days, released with prozinc dose between 1 and 1.5 depending on amount food eaten. Had trouble with appetite.
1/19 BG@10:45pm 390 bad appetite 1 unit
1/20 recheck BG@2:45am 205
1/20BG@10:30pm 364 1.5 units
1/21recheck BG@ 2:50 AM 155
1/22Starting to crash. Put in ICU ate ok with regular insulin 1-1.5 units I assume
1/24 BG@8:30pm 155 1.5 units (Before I found this site)
1/251.5 units@9:00am
1/25BG@9:30pm 457 1.5 units
1/26BG@9:30am 168 1.5 units
1/26BG@9:45am 475 1.5 units
1/27BG@10:30am 487 1.5 units
1/28 vet visit...3 day pain iject
1/27 sedated BG@10pm375 1.5 units
1/28BG@10am 294 1.5 units
1/28 Good appetite, no BG test 10:30pm 1.5 units
1/29BG@11am 165 1.5 units
1/29Good appetite no BG test 11pm 1.5 units
1/30no BG test 11am 1.5 units
1/30BG@10:30pm 348 1.5 units
1/31 pain inj @9am BG@10:30am533 1.5 units started sneezing....vet disregarded
1/31BG@10:30pm361 1.5 units
2/1BG@ 10:30am 373 1.5 units
2/1Switched to seafood flavor good appetite BG@10:30pm 471 1.5 units
2/2upper resp. worse BG@10:30am 498 1.5 units
2/2 good appetite BG@10:30pm 379 1.5 units
2/3 curve scheduled today BG@ 9:30am 60 gave food no shot rushed to vet. Finally given antibiotics for full blown upper resp infection
2/3 pm no shot new curve scheduled 2/4
2/4 2nd curve attempt failed preshot BG379 given 1 or 1.5 units 2nd BG166 3rd BG 37 Told no more insulin, consider specialist or euthanasia
All along Poncho had a so so appetite so did some force feeding but probably not good diet overall except where noted. I don't think he could smell his food until the seafood flavor 2/1
 
Thanks. Do we have a mid cycle reading for today. We need that to help decide on the next dose. Will review the info above.
 
Sorry just seen your second BG reading for today.

So today so far

PMPS (evening preshot) was 378
+3.5 (2.45 am) was 229
+5 (4.30 am) was 180

You have given 300 ml of sub q's and have force fed ?? Food.

Is this round up correct?

So far so good. Can you get another reading in another 2 hours. Are you okay as it is the middle of the night where you are. It would be great to get another reading if possible. If we were to bring the next dose forward by an hour or two would that suit you? Am I correct in that the next dose is due 10.45 am so in approx +7 hours ? Do you dose at the time on purpose?

Finally try to keep the antibiotic dosing regular as it helps keep the dose level in their system. Keep up with them but make sure to follow the instructions. Ie if it says give with food, then give with food.

Keep up with the syringe feeding.

Finally to feel it is very important to get some more anti nausea medication for the next few days. Either ondansetron or cerenia tablets.
 
@Elizabeth and Bertie I see you are online. You may have more experience of prozinc. Can you comment as to how well the reduced dose of 0.5 is working in relation to Poncho 's blood glucose? He previously tanked on 1.5 u it's twice a day so the vet said to just stop the insulin.

At the moment he is showing high ketones and unfortunately the cost of treating at the vets is prohibitive for christoph. So we advised to try 0.5 units. He has had sub q's and syringe food. If you look back a few posts you will see the roundup of the last few days BG results and my roundup of today above.
 
Yes, the numbers are correct. I'll be up for good....can't sleep anyway. Next reading is 6:30. I always dosed his sister around 11am/pm since I'm a night owl so just continued the tradition. I'll see if I can get some appetite pills. I'm thinking if I can keep him stable I might drive him to my old vet in St Louis Monday morning. I don't know any other vets here and don't trust them generally speaking. The syringe feeding is so traumatizing to him I can only get 10ml in him before he almost shuts down. How often at that amount should I feed him without stressing to the point of harm? The food is the prescription food ad critical care so I assume it's concentrated.
 
Yes @Elizabeth and Bertie 0.5 unit. Are we nearly where we want to be taking into account that the 1.5 was too high but we have ketones and a reduced amount of food intake

@christoph Is it in a tin? Does it say how much is needed at all? @Meya14 talked about getting at least one tin per day. But more is better. I think just doing 10ml at each go is fine. How many would he need to get through a tin? That is what I did. I think an anti nausea tablet would help him accept it easier. Please try to get some.
 
So far the blood glucose has dropped by 50% by +5 on this dose. That's a 'nice' drop.
And it's probable that it will drop a bit more too in the next hour or so. But the rate of drop between the last two tests was nice and gentle. This is looking good to me so far....
(I agree it would be good to get another test.)

Sarah, thanks so much for collating the info in the posts above (definitely one of your many strengths!).

Re Prozinc; I've not used it, but have used two different PZI's and they're sort of in the same 'family'.
 
@christoph so it sounds like we are in the right ball park on the dose, please post up the next BG result when you have it. Post up the food brand if you can't find the info on the packet and we can look it up.

When it comes to the next dose make sure you get a pre dose reading and then unless someone tells you otherwise give the same amount as before. The feeding is so important as meya explained, with ketones you need to be able to give insulin and to be able to give that safely you need to make sure they can eat. You also need to get that infection under control by keeping the antibiotics consistent.

You have enough sub q's for the rest of the weekend?

Finally Don't forget to get another ketone reading when poncho next goes for a pee. Make sure you measure exactly when they say to take a reading as it will continue to develop.
 
Glad you're still hanging in with us.
I'm glad the 0.5 units of ProZinc is working.
How's his breath smell?
You can check for moderate to severe dehydration by gently pulling the scruff of the neck and releasing. If it snaps right back, he's doing well: if it stays pulled up - tented - he's dehydrated. With higher glucose levels, it goes out in the urine and pulls water out of the body.
Were you able to get the YouCaring fund set up? If yes, ask if you may post it here - in your signature will show with every post.
 
BG @ 6:30 am 160
The food I'm syringe feeding is Hill's ad critical care in 5.5oz can but instructions are "as directed by vet.". I fed him another 10 ml.....it's so stressful for him it's scary.....but he gets over it. I'm waiting and watching for him to head to the litter box for another ketone test. I think I have 700 ml of fluid left so will have to get more. When I picked it up they said I need to give 100ml per day so I hope they don't balk.
 
Thank you for hanging in with me.....I couldn't get thru it right without all the help. When I try to smell his breath I can't smell much because of the smelly food which I feed him and gets all over his face as he protests. I'll clean him up and try to detect the ketone smell. I got the fund set up so I'll try to get OK'd for posting on here. I'll be giving more fluids soon. Should I test again 8:30am or wait till shot time 1o:45am?
 
Is it this food? Can some one advise on this I am not so good with calories,etc.

Chris how much does poncho weigh? By the look of it my 5kg cat would need 1 1/2 cans per day if you follow schedule 2 for feline hepatic lipidosis. But they indicate you can work up to it. So I would estimate that at least a can per day and you can dilute it with water if it makes it easier to syringe. But again someone can advise better I think

http://www.hillspet.com/products/pd-feline-ad-caninefeline-critical-care-canned.html

I think the nausea might not be helping with syringe feeding. Sorry I know I am repeating myself but if you can get something g for that cerenia or ondansteron that would be great.

I think 100ml sub q per day is about average.

Insulin level still seems okay.

+7 is 160. If you can get another at +9 then do. Please take care of yourself though. And make sure you have more strips for the next cycle.
 
Go ahead and test now. If he's high enough, you can shoot a little early with ProZinc.
 
Yes phlika29 that's the food. I've read that the prescription foods aren't really any better then the average pate from Friskies or Fancy Feast. Poncho was a little over 8 lbs last Sat.....up 1 lb from admission time, but don't know present weight.
So, BJM, test now at 9 hrs from last shot and shoot .5 if over 200? Or wait till about 8:45 or 9ish central time....around +10? First shot was 10:45. What's my no shot threshold....200? I'll need to go to pick up anti nausea meds if they'll give them to me and there will be no one to watch Poncho....like an hour's time and they close at 3. What's the best time to leave Poncho for that length of time?
 
Let's list the numbers from last night using our +# from time of shot
348 @ pmps (10:45); 0.5 units
180 @ +6 (4:30)
160 @ +8 (6:30)
so far, the max drop starting at 350ish is about 190 mg/dL for 0.5 units of insulin.
We can use that to estimate a dose, based on what you get as a pre-shot.
We might figure that 0.25 units (eyeballed) could drop him around 85 mg/dL.
We want him to stay safely above 50 mg/dL on a human meter.

No shot if under 200 mg/dL.
If you can get U-100 syringes, you can measure smaller doses.

 
But with increased ketones we need to get insulin into poncho. So my understanding that there is no option of not giving insulin. Or maybe you mean don't give the shot until he goes over 200.

I personally would have thought it better to keep to the schedule or bring it forward just a little and give 0.5 rather than give it very early but give a reduced dose of 0.25 and have him higher for the whole cycle. Again maybe I am reading it wrong. Or perhaps if you catch it at a lower blood glucose level then I guess it stays lower throughout the whole cycle. This is where my knowledge gets sketchy. It would be great if someone could clarify.
 
I have a keen eye for measuring but will look for u-100 if needed. The pre shot BG was 378, if that makes a difference in the calculation...if not then shoot .25 if over 200 at +10 or +11, +12?
 
There will be a variable drop based on the insulin dose and starting glucose.
You don't want to keep the ProZinc dose static or you'll run into a hypo situation on top of everything.
What you can do is stall until the number is shootable.
If he is 200 and 0.25 might drop him 85 mg (estimating here), and you can monitor him, you could shoot.
We don't know how much he'll drop based on less than 12 hours of data.
 
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Chris it sounds like you understood it just fine. BJM has lots of experience with insulins so I would listen to her:).
 
What you might wind up doing is "chasing the numbers". As you collect data on response (we really need to get that spreadsheet set up), every time he gets to a shootable level at around +8 to +12 hours, you shoot if he's high enough based on your data.

This can be done with ProZinc; it is NOT something you do with Lantus or Levemir!

And speaking of the spreadsheet, instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
So by chasing the number and shooting as soon as you get over 200 does that mean Chris always gives 0.25 dose or is it more complicated than that?
 
" shoot .25 if over 200 at +10 or +11, +12?"
Yes. And be monitoring at +2 or +3 to observe drop and be prepared to intervene.

We're still working out how much drop Poncho gets at starting glucose levels. I am guessing/estimating about 85 mg/dL for 0.25 units; I don't KNOW that. We need to collect more data to work this out.
 
phlika29 said:
Can some one advise on this I am not so good with calories
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Can't help with the calorie requirement, but I wonder if that's something that the vet might advise on for free (if they're feeling kind)...

Hill's A/D is higher carb than we'd normally feed a diabetic: According to Binky's list it's 13% cals from carbs, (with 33% coming from protein, and 54% from fat)
http://binkyspage.tripod.com/CanFoodNew.html

But the important thing here is to keep getting food into the kitty.
Hills A/D does contain an increased amount of potassium apparently, and also B vitamins. And it's consistency makes it easy to syringe.

Is Poncho eating any food on his own?
.
 
Chris

I can set the SS up for you and fill in the numbers from this thread. All I need is for you to have a Google account (which is free) and the email address associated with that Google account. If you look at the SS link BJ gave you above, you will see the link for getting a google acct if you don't have one. It will take me two seconds to set up his SS and just a little longer to put in the numbers and doses.

I'm going to send you a private message to get your Google email address. You will see a red letter up on the right by "Inbox". Click on Inbox and you'll see your messages.

Another good food to give via syringe is Iams Max Calorie. It is very high in calories and low in carbs. It is prescription so you'll have to see if your vet has it.

Even though I've assist fed many cats, I found this video very helpful:

Also check with the vet on the potassium because lactated ringers solution does contain it but the vet will know if he will need additional potassium.

Sending prayers for recovery.
 
Ok. His BG @ +10 was 221 so will give .25 @ +11 and monitor. He's not eating on his own.....just very out of it. I called the clinic re anti nausea and had to leave a message so they might ignore me. I'll also try my old vet and see if they can call in a prescription. Thank you all so much!
 
I would err very cautiously with holding insulin at this point. If you have to shoot a very reduced dose, or give him syrup in the food to keep the numbers up while still shooting, you should do that. It seems counterintuitive, but more insulin is what his body needs and in order to give more insulin, the insulin needs a substrate to work on (food). Carbs are OK until he is out of the woods. Ketones will increase if your cat doesn't have insulin for half the day if you skip a shot.

The critical care food you have right now is perfect. You need 1 can a day at least. Usually this is like 1-2 syringe-fuls of foods every hour. That was tolerable for my cat when he was sick. It was a struggle, but once we got the cerina, it was much easier. You are in the hardest part, but cats can bounce back quickly as well, usually feel much better after about 2 weeks of supportive foods/fluids.

What subQ fluids are you giving? Is it 0.9% Saline or Lactated Ringers? If you are giving 300ml a day, split this up into 2 doses. 300ml is hard for kidneys to process all at once.

Pain meds may make a difference as well. Pancreatitis can cause nausea and discomfort. People here I think use an injectable? Can anyone comment?
 
Cerenia - for nausea and vomiting - can be injected. (It's available in tablet form for dogs in the UK. I think that it may be possible to get it in tablet form for cats in the US but I'm not certain). I think the effects of Cerenia can last a couple of days in some cats.

GENERIC ondansetron is also good for anti-nausea support. (NB Zofran, the branded version of ondansetron is extortionately expensive.) Ideal for home treatment.

Buprenorphine is recommended by IDEXX for pain management, and several members here use it for their cats with pancreatitis (including me on occasion). Some members here inject. Others like myself can only get an Rx for the liquid bupe which is given sublingually.

Cyproheptadine (antihistamine) can be used for appetite stimulation - really needs to be used in conjunction with anti-nausea meds (to avoid cat becoming distressed from feeling compelled to eat something that's making it queasy, and also to avoid potential future food aversions).
 
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It might help if appetite is slightly off, or it might not. Saoirse used to like it at first, but it nauseated her and then she wouldn't go near the stuff. Another member whose cat has pancreatitis reported her cat experiencing a similar reaction to FortiFlora.

If the nausea's really bad and the cat is highly inappetent, then based on my experience and reading about the experiences of others here the supportive meds are the way to go when a kitty's struggling with food. (They can make the world of difference.)
 
Meya14, the sub q is lactated ringers, which I just gave.....really hard to see where the fluid is at in the bag....I wish the fluid had color. Are there any tricks, like counting seconds with the flow wide open or 1/2 open? I don't want to give more than 150ml at once but it's hard to determine the level. I just gave Poncho his +11 shot of .25......kind of hard to eyeball but I'm sure I got it right. Next up is another round of forced feeding.....poor guy. I only had 1 can of ad and it's 1/2 gone since yesterday so might need to substitute. I do have 2 cans of Purina EN Gastroenteric but it's not as easy to draw into the syringe and push out without a blender which I don't have yet. I'm wondering if the clinic will call back about the cerenia since they cut us loose Wed. They did give me the fluids yesterday but getting the feeling I'm a bother.
So where can I get the FortiFlora? Anything OTC for nausea in case the clinic doesn't come through?
 
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