Poncho diagnosed diabetic 1/15

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K. Thank you for the clarification. I have no experience with DKA and/or pancreatitis was just curious if that was an option since theres the concern for vet bills.
 
We're still working out how low Poncho goes on a given dose, so I'd check at +2 and go from there.

For the fluids, it may help to have a dark background behind the bag, with good lighting, to improve the contrast.
 
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Flow rate varies too much like for needle size and needle placement. Thus, time is a very poor indicator of fluid volume. You can try placing tap at where yu want to stop . It is easier to se when the fluid level meets the tape.
 
I would like to underscore one thing here. If a cat has ketones that high and the numbers last night were not low, I'd be feeding a higher carb food and not reducing the dose. Advice to not give insulin if he's below 200 or drop the dose back really worries me for a cat with ketones that high. As @Meya14 said yesterday and I will repeat....give higher carb food....even mix karo in it if necessary to keep the numbers up and get the insulin in. No shot numbers do not apply in this case when the kitty has high ketones and still having BGs well above 100.
 
We don't know how much Poncho drops at given doses and Christoph is having trouble getting food in. A GUESSTIMATE is that 0.25 units MIGHT drop 85 mg/dL based on last night, so at 200, it could be safe to give that (ProZinc, not Lantus). It is only a guess, though. The last thing he needs is a hypo on top of everything.

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)
221 @ +10 (8:30)

so far, the max drop starting at 350-ish is about 190 mg/dL for 0.5 units of insulin. Edited to add: THIS IS LIKELY TO VARY.
 
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@Marje and Gracie I questioned this insulin advice too but I have a feeling it was meant to read that as soon as the numbers go over 200 (even if that is only at +9, + 10,etc) you give a 0.25 dose to keep it low rather than wait the whole 12 hour cycle and allow them to go up higher as we would with lantus. Ie you chase the lower numbers. I guess tonight will tell. I am hoping @Sue and Oliver (GA) will also chime in if she comes online.
 
My basic stance is ketones trumps pretty much everything. I've posted this in the past and I'm happy to reiterate -- I don't care if you have to feed a kitty an ice cream sundae to get food into a ketone prone cat -- you've got to get an adequate amount of insulin on board or you don't just have ketones, you have a cat that's critically ill with diabetic ketoacidosis. And DKA cannot be managed at home.

In other words, shoot the effective dose and feed high carb, syringe feed, do whatever it takes to get both food and the insulin in. The high carb will circumvent low numbers and provide the calories necessary to also combat ketones. DKA circumvents nothing.

BJ said:
so far, the max drop starting at 350-ish is about 190 mg/dL for 0.5 units of insulin.
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I know of no "rule" that says this will consistently happen. Cats are way too unpredictable and there are too many factors that influence the action of insulin. Furthermore, there's not enough data on Poncho's SS to draw any reliable conclusions about the nadir.
 
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I just tested @ +2.....240, but this was after I had to take Poncho down 4 flights to meet a mobile vet who was able to swing by and give him another B12 shot and we had to wait in my truck for 15 minutes so stress might have pushed his BG up.....make sense? Or was I on the low side on the dose? Plus the clinic called while I was right in the middle of the BG ear pricking......they said bring him by @ 2 for a cerenia injection. I'm still waiting for Poncho to pee for another ketone test. I'm going to have to take cat naps until this levels out. Next BG test is due at 1:45, when I'll be on the way with Poncho to the clinic for the cerenia. Wait till we get back home to BG test him between 2:45 and 3? Bad timing but he needs the meds.
 
Could you get a +3 instead of a +4 and still make the appointment?

Whilst you are there get them to give you some cerenia pills. They should have some. You don't have to always go in for the injection especially as it adds to ponchos stress. In fact couldn't they give you the pills instead anyway. Are you okay giving pills?

What did the mobile vet say?

I think with meter variance the 240 is almost the same at the preshot dose. So I think what with the food and the stress that would be as you might imagine.
 
christoph said:
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!
Click to expand...

Just looked back to check your preshot reading and I noticed that you said that you took the reading at +10 but waited till +11 to give the insulin. I think at the moment the aim is to give more insulin as soon as he does over 200 rather than wait any more time. If you did wait an extra hour it might have risen some more.
 
Ok....I wont wait next time. I'll BG test @ +3. Poncho and pills are a disaster. I had to switch him to clavamox liquid from the pills. Unless I could crush one and give it via syringe feeding. I'll call them and ask about the pills. The mobile vet had nothing to add.
BG +3 was 218 The clinic said they have no pills but that I can ask the vet for a prescription.
 
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Innova or Evo kitten foods are higher cal. Natural balance is higher cal as well, and has higher carbs and lower fat than the other two, which might work well. I think you can crush the pills and mix with a tiny bit of food (not too much in case it's hard to get in him) and syringe it.
 
Exactly what Siene said - I was GUESSTIMATING and trying to keep him safe at the same time in the ABSENCE OF MID-CYCLE DATA while trying to get the glucose down.
We have exactly 2 periods of data with mid-cycle numbers
1) the aborted curve on 1.5 units starting in the high 300s and dropping down to 60ish, at the vet which may be measures from an unknown meter or lab equipment
2) last night, where, due to that aborted curve at the vet, I suggested 0.5 units to see if it might help without sending Poncho into a hypo on top of the ketones.
And that is ALL the mid-cycle data we have.
If Christoph can't get food in and we don't know for certain how low Poncho will go on a given dose of insulin and the ER isn't an option, what do you think will work better? I'm doing the best I can for him while trying to keep Poncho safe
 
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And yes, I meant as soon as Poncho gets high enough (200), shoot the ProZinc to try to keep him as low as safely possible given the minimal data on how he responds to it.
As we collect more data about how he responds, we can tweak that to optimize the glucose control. We just need the data to be able to do it!
 
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There is no reason to yell just because others might disagree with you, BJ. We all have Poncho's safety foremost in our minds. No one wants Poncho to hypo and we wouldn't be giving the advice we are if we thought there was potential for him to do so.

As Sienne pointed out, right now the primary issue is safely getting as much insulin as we can into Poncho to prevent DKA which is costly to treat and Chris cannot afford. With Chris monitoring as he is, if numbers start to come down, there's nothing keeping him from even syringing a ml or two of karo into Poncho, if necessary. Ideal...no. But if it keeps him from dropping lower than we want, it's better than letting the BG stay too high and the ketones continue to rise.
 
I'm not as confident as you seem to be that he'll be able to get Karo in given how Poncho has been about eating.

And its not about disagreement, its about not understanding what I've meant. So I've tried to clarify, and highlight, and color code things so they don't get misunderstood.
 
@Elizabeth and Bertie I have another question that was raised by @Meya14 this morning but never picked up on. You may be able to answer.

Do/can people dose prozinc three times a day? If so how does that affect the dose? Whilst I understand prozinc is not the same as lantus I am guessing that there may be some affect of dosing earlier than the normal 12 hours. Chris gave a reduced shot at +11 after his cat got to just over 200. What,if any, are the implications of doing this again? Say if next time the reduced dose wears off at +7 and he raises over 200 ? In effect dosing three times in 24 hours.

Just thinking ahead. Sorry I know you won't know all the answers but you may have some idea.
 
Yes, it can be dosed every 8 hours (TID), earlier if needed.
Depending on the dose, duration, and cat's response, there may be some overlap. In this case, any overlap should help keep the numbers down which is desirable.
 
Cerenia is available in tablet and injection in the U.S. Some do better with ondansetron, some with cerenia and some need both. Whichever you use needs to be given every day until the appetite is back to normal. I use cyproheptadine as an appetite stimulant and just a crumb, 1/8 a 4mg once or twice a day works for nearly 16 pound Max. He has had chronic pancreatitis for 5 years and I think is having his first real episode since diabetes struck a year ago. This time it was likely brought on by a dental and having three teeth extracted. Hang in there.
 
When asked about the TID dosing, since it looked like his BS was peaking too stongly maybe dosing less (.25 or .25skinny) but dosing TID might keep him more even and still give him the insulin he needs.

Probably, prozinc is not right for him (seemed to hit too fast and hard, then wear off before next dose). This probably isn't good coverage in the long run. But until he's out of this acute situation, it's what he's got to work with.

Thoughts?
 
He either needs a different insulin, probably a depot type, or very cautious, sliding scale dosing on the ProZinc.
I'm trying to piece together the data Chris reported last night. There appears to be a likelihood of lots of unrecognized bouncing, plus the vet based the dose on eating, not on pre-shots.
 
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Hey Chris

Just wondering if you managed to get a +3 and to ask how things went at the vets? Please don't forget to update us.

Hope you are holding up to as well. Don't forget to eat and get a few naps in.
 
BG @ +3 was 218. Well, I drove to the clinic and mentioned that I had started Poncho back on insulin starting with a lower dose, and got a lecture about following their directions or find another vet......this after they stopped his insulin and gave me 2 options...a greedy specialist I can't afford or euthanasia. The tech also said the upper respiratory infection had no bearing on the curve. So they refused the cerenia injection and said if he's not throwing up he doesn't need an injection or pills. When should I check BG again? I need to add to the SS and have to buy some more BG strips. Poncho got a B12 shot but his appetite is still down. I did get 2 more cans of ad. More syringe feeding ahead.
Thank you Elizabeth and Bertie for the big hug and encouragement! I'll relay the hug to Poncho.
 
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Well, we still aren't entirely sure when he nadirs. Prozinc often has the nadir somewhere between +5 to +7 hours after the shot.
So now would probably be good. Be sure to enter it on your spreadsheet; the color coding really helps to highlight the changes.
 
I've just been following along and praying for Poncho and Chris....Hang in there Chris!! :bighug::bighug::bighug: (you can always use more hugs too!)

I know little about DKA and not much more about ProZinc, but just one thing I wanted to ask/add....IF he were to drop too low, can't you rub the Karo on the gums or give it rectally if necessary to get it INTO him?
 
If the DKA can get under control and he starts eating again, assuming there is no other underlying issues (liver disease, pancreatitis) then a cat can recover rather quickly and lead a perfectly normal (diabetic) life. Euthanasia is not a necessity due to the DKA alone. It is very complicated to treat, however, and expensive because it needs hourly attention from the Vet/techs. I think a lot of vets are misinformed, or just do not have the motivation or experience with it. I'm blessed to have a cat-only vet who is the top vet for diabetics in my area (this is probably 1/4 of her clientele). She's not a "specialist" but just a very smart lady.

It's not by far a hopeless situation, just a lot of work. And you are doing a good job.

For a timeline reference, when Max was sick his ketones were "high" when initially tested. Max was listless and wouldn't eat or really even move. We started force-feeding, subQ and insulin the day he was Dx. Force-fed for 2 days, added the anti-nausea on the 3 or 4th day, and he began eating with some forcefeeding. At 5-6 days, he was eating/drinking on his own. Watered down his food for the next week. After 2 weeks he was close to normal.

Where do you live about? Maybe someone on here can recommend a vet. You need to find someone that is willing to get meds for you at least, better if they can give good guidance and do labs as well.
 
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Ok, he's popped up to 333 and needs more insulin.
I think you could give him 0.5 units. The others might suggest 0.75 units.
If you feel confident you can get Karo syrup into him if he goes too low, go for 0.75. He needs to get the glucose down as much as possible.
 
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I'm in Kansas City MO. I have been talking to my old vet Larry Zeis in St Louis and might drive Poncho there at some point but in the meantime he's been in touch and I had SPCA fax Poncho's file. Right now Poncho is exactly as you described Max. It's heartbreaking esp when force feeding.....he looks at me as if to say "Why are you hurting me, Dad?" Just a couple days ago he was eating.....not normally but he wasn't like this. I'm still waiting to test the ketones again. Should be able to just after fluids.

Poncho's 4:45pm BG was 333. When do I test again? I need to get more test strips and get back before 6:30.
I'll do .5 but should I wait until I get back? or get the strips later .....
 
Did you see BJMs response above. You don't wait anymore you give 0.5 or 0.75 , if feel confident to handle a possible hypo, now. How long can you go out and get back with the strips?
 
He appears to nadir toward the late side so if you got a +5 from the shot, that could work.
Although, at the vet, he dropped to low levels by +4. Lets go with a +4 from the shot.
 
Yes it seems so. As he has gone higher than you want. So now you have to decide on 0.5 and 0.75. Depending on how you feel you could handle a possible low blood glucose.

An hour straight after the injection is the best time to go out.
 
Yes please. I am afraid I won't be able to stay with you all night as it's time for my bed. Please look after yourself you are doing great. Hugs to both you and poncho.

You need to carry on with the food as advised before. And keep the water intake up and test for ketones. Others will keep and eye on you.

Just in case numbers go low. Keep this link handy and follow the protocol and post up your numbers either in this thread or start a new thread. Hopefully they will go low but not too low

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Best wishes

Sarah
 
Okay I am signing off now. You are doing really well.

So to confirm you gave 0.5 units of prozinc at +7 after blood glucose rose to 333. A blood test will be done at +2 and then every two hours. If poncho drops low then the hypo protocol (posted above) is to be followed. When poncho has gone past his nadir and blood glucose levels begin to rise again above 200 then another dose is to be given (unless the consensus is otherwise). Dosage to be confirmed but likely to be 0.5 or 0.75. Please post all results here and add to spreadsheet.

Continue to assist feed and ensure hydrated (please review posts by @Meya14 ) .

Ketone readings to be taken whenever possible and the results posted and added to spreadsheet.

Chris I am sure other members will be able to keep an eye on you but if you are concerned then start a new thread with a 911. See you in a few hours. Please do eat and get some rest. Just remember to set an alarm!

To anyone else reading. Please correct me if I have got anything wrong. :)
 
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I'm here and can stay up for roughly 5 hours before I'll have to crash.

It could be another long night. If you need to nap, snag 45 minute multiples (45 minutes, 90 minutes) as a sleep cycle lasts about 45 minutes and it is easier to wake up at the end of one.
 
just want to add my encouragement Chris. With ketones it's really important to stay the course with the insulin and adjust food/carbs as needed to keep him safe.

Hang in there!
 
Just got back. Thanks Sarah....sleep well. We'll be ok.
Thanks julie and punkin
I appreciate your help BJM I'll try to get some short naps.
 
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If you shoot earlier than +12, color the cells in front with gray and note the early shot so folks don't think you missed the pre-shot.
 
Didn't want to interrupt when things were hairy but now that it's sort of 'breathing' time - CHRIS! You're doing wonderfully!! HUGS!

Lots of thoughts and prayers for both of you...
 
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