Post DKA bounce, worried about doses

Mer and Max

Mer and Max

Member
Hello! This is only my second post here at FDMB so go easy on me :-) I just got my spreadsheet set up so I will be updating that as much as possible in the next few days. I will be home this weekend so I'm hoping to do a curve to see just how much he's changing changing.

Background: my fur baby Max went started going into DKA via a UTI and high BG on Christmas day. After fluid treatments at our vet and a 24 stint at the ER vet, we brought him home and have been administering subq fluids at home and monitoring him with with our vet. After a vet visit yesterday, we got some good news (he was gaining weight, his creat kidney levels had improved, she thought he looked better and brighter), and some bad news (she detected a heart murmur she hadn't heard before, though she thinks it is probably from all of the fluids he's been getting, his BUN kidney levels were still bad/same/high – she suspects kidney disease). We are also going on vacation for a week on the 23 of this month and she recommended our cat sitter be able to test him before every shot, which I really hope they will be comfortable with!

After leaving the ER vet we have gotten really high BG numbers, but they have started coming down. Our vet upped him to 4u, but there was a morning where he went down to 96, so we skipped the shot, but of course he bounced back up to "HI" in the evening.

This morning he was down to 231 so we only gave him 2u, but I wasn't 100% sure that was the right move, so I'm curious to see what happens when my husband tests him at 1 pm (we've been testing him 3x/day when either of us are home all day).

Are there any tips on dosing when the numbers dip? Or how to even out these bounces? I would love to get him more normalized and firmly out of the HI range. He's definitely still in recovery mode, it seems like a the longest marathon of a recovery, especially since he's turned into kind of a picky eater since this has all started, but every day he seems a tiny bit better.

TIA!
 
Is there any chance you will be home a day this weekend and could do a curve (test every two hours from pre-shot to next pre-shot)? I see that you have done a few in the past, but it would be nice to see what a cycle looks like at this dose and when in the cycle he is at the lowest.

Your mid-cycle tests lately have all been during the morning cycle and have all been at +6. That may be because that is all you can do, and that is certainly much better than not doing any! However, I am wondering, for example, if he went any lower than 129 yesterday. If his nadir (lowest point in cycle) is not at +6, then you are missing it every day. That is one of the reasons a new curve might help, but also, you may want to vary the mid-cycle test time some from day to day, if you can to help you get a fuller picture of things. We can't really see what is happening in the evening cycle since there are no mid-cycle evening tests at all lately. Those couple of mornings where he was low make me wonder just how low he went overnight. Some cats run lower at night.

There could be a degree of bouncing going on with him. More data would help make it clear. Too much insulin can look like not enough insulin without the full picture. Whole unit jumps are big jumps, and even if 4 was the right dose, insulin needs can change constantly, so it could be too much at this point. I suspect that his dose may need to be reduced a little to level things out, but I would personally like to see a curve, or at least a few more mid-cycle tests (including in the evening cycle), to help make it clear that that is what is needed. Not sure if the others will agree. :)
 
I agree with FurBabiesMama. That 96 at AMPS the other day suggests the duration of the 4u dose may have been extended or that Max dropped even lower in the PM cycle before that reading, either of which suggests the 4u dose may now be too high. This mornings' 231 could again be indicative of a lower BG during the night cycle or longer duration of the dose as it appears he may have bounced yesterday following that mid day cycle 129. I'd be inclined to try reducing the dose tonight to 3u to see if that doesn't flatten him out a bit. An increase of 2 units at one time is huge however with recent DKA in the picture, it's imperative he gets enough insulin so a bit more monitoring in both the day and night cycle and a little more randomly would help shed more light on exactly what is going on with Max and make dosing recommendations easier.

Are you home testing for ketones? If not, you can get Ketostix at your local pharmacy and we can provide you tips on how to get a sample to test. With the recent DKA and the possible need for some dose adjustments, checking for ketones is important as any value over trace is cause for a consult with the vet to avoid a reoccurence.
 
@FurBabiesMama and @MrWorfMen's Mom , Ill try to get some tests in tonight for sure. If you check out the curve at this point we’ve been at a pretty drastic downward trajectory. I’m due to shoot in 2 hours-ish but I’m not sure what to give him if he stays in the normal range. If he’s around 150 would it still be ok giving him 3u?
 
I also just purchased the ketone strips but haven’t tried it out yet. I think the vet checked him when he was there the other day, but we will be trying this out soon lol...
 
Wow! Max has sure been heading down most of the day, hasn't he? It definitely looks like you've had bouncing going on for some time now. That would make sense with those random lower preshots you've seen.

I don't want to say definitely give 3 units. However, if he's risen some, I'd be tempted to give him that dose. Are you okay to monitor him tonight or will you need to head to bed pretty fast? Not saying do a curve tonight, but getting a +2 or +3 might help you see where he's headed so you'll know if it's going to be an active cycle or not.
 
No I think I’d be able to get a +2 and maybe a +4! Yeah the bounce is crazy, tho he definitely acts like he feels better at the normal numbers so I appreciate that. M
 
Here are some ways to get a urine ketone test done:
  • put the end of the test strip right in his urine stream as he's peeing
  • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
  • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
 
He's dropped a lot today which is no doubt going to set off another bounce but that 154 is later in the cycle than is typical for ProZinc. Depending on the pre-shot test, I'd definitely reduce the dose tonight but by how much will depend on the pre-shot test.
 
Wow! I think I'd be inclined to reduce to 2u tonight and still get those +2, +3 and possibly +4 tests in if needed. Am I safe to assume you have plenty of strips should it be necessary to test more frequently for a bit? Do you have lots of food? Anything high carb in the house? He may bounce again but with him throwing out these lower pre-shots, I am concerned that his stores of glucose that are used during the bouncing may be dropping and we don't want to push it too far by giving too much insulin but also don't want to drop it too far either
I'll be up so I'll keep checking back in on you for a few hours to see what Max does. Please post your +2 reading.
ETA can you stall for 30 minutes to see if he is rising at all without feeding him?
 
Ok, shooting 2u! Will check back later with his +2... and yes we do have plenty of strips! And food... I’ve been giving him a mix of diabetic exercise food from the vet she wanted me to try (for his kidneys) and weruva chicken, and some dry (be when he doesn’t want to eat he still eats dry, ugh!).
 
The Hills MD is about 16% carbs (assume that's canned too?) so if he should need a high carb boost that food would be preferable to the dry as it will hit the bloodstream a little faster. Not sure what the carb level of the glycobalance canned is. Will check.
 
Good to know!

So at the +2 tonight he’s back up to 281, so he must be starting a bounce back up... crossing my fingers he won’t get crazy high, but will report back with +4!
 
So the +4 for tonight is 432. I’m guessing at this rate we might be “hi” by morning, but we shall see. Thanks for checking in... I guess this is why I’m finding it so hard to figure out how to balance him out or figure out dosing!
 
Thank you! I have read that, though it’s still hard to relate everything to our situation since we’ve had such drastic numbers!

Good news, tho last night he did get pretty night, not “hi” high! He was 532 at his AMPS but since we only have him 2u last night, we decided to try the 3u this morning (instead of 4). I just got a 255 for the + 3 this morning, and that feels pretty positive!
 
He's still dropping a lot and pretty fast which may set off more bouncing. I'd try holding the 3u dose for a few cycles (at least 2 days/4 cycles) barring any particularly low pre-shots to see if he flattens out at all.
 
Yikes. Okay, a couple of things for sweet Max: I echo what Linda said about trying to hold the dose steady for a couple of days if at all possible. 3u seems as good of a guess as any at this point. 4u is too much, 2u isn't enough. Hopefully soon we can be a little more refined with the dosing, but we need Max to settle out a little right now.

Next the food: RC Glycobalance is 14% carbs, so I would stop feeding that. The more carbs a cat gets, the less predictable their numbers are, so we recommend keeping foods under 10% carbs. Hills m/d is around 13%, so still too high. You can either return them to the vet or keep them in the cupboard if there is a hypo scenario and you need some higher carb food. The fancy feast Classics are fine. The Weruva really varies by which type, so check the food list link in my signature to make sure the ones you have are low enough to be safe.

Post-DKA it's super important to keep the kitty eating, so if it's a matter of feeding higher carb food, it's not the end of the world, but if you can start to shift to some lower-carb options it will help get those blacks and reds to fade away.
 
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