? Post DKA, trace ketones, give fluids? (See later posts)

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Kelly Howard

Kelly Howard

Member Since 2016
Hi everyone, long story and I'll make a proper post later today, but the short version is my cat is just home from the hospital where she was treated for DKA and pancreatitis. We have been on Prozinc since last August when she was diagnosed. The vet decided to switch her to Lantus. Last night she got 1.5u and today she is 104 for AMPS. I would never shoot that on Prozinc, but I don't know if the strategy is different with Lantus? I haven't been able to do a ton of research on how the depot works.

Thanks!!
 
Kelly Howard said:
Hi everyone, long story and I'll make a proper post later today, but the short version is my cat is just home from the hospital where she was treated for DKA and pancreatitis. We have been on Prozinc since last August when she was diagnosed. The vet decided to switch her to Lantus. Last night she got 1.5u and today she is 104 for AMPS. I would never shoot that on Prozinc, but I don't know if the strategy is different with Lantus? I haven't been able to do a ton of research on how the depot works.

Thanks!!
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Well, hello, Kelly!! :D Teasel is now on Lantus. We're 3 and a half weeks into it. I see that you've had a 1:1 swap of Lantus dose compared to ProZinc dose. I lowered Teasel's a bit but he wasn't coming out of DKA. There are many experts to guide you here and at some point you'll learn to shoot a PS that low. I personally wouldn't want to do it so early in the game though.

Have you read the detailed protocols - TR (Tight Regulation) and SLGS (Start Low Go Slow)? Which one are you planning to try? It's possible to switch from one to the other at some point but you need to have a system in place to start. I can tell you that Lantus is a "slow motion" insulin compared to ProZinc and you always have to keep the depot in mind when dosing or tracking the effect of a dose. I've compared it on other posts to steering a tank instead of a sports car. It needs a different mind set and there'll be times when quite a bit of monitoring is needed because of its s-l-o-w action.

However, Teasel has improved. Have a look at his SS. He still bounces but there are long runs of good numbers.
 
Hi Kris! I was planning to send you a PM later to hear more about your switching experience. I popped on a week or so ago, before this all started, and saw that you had switched. I'm so glad he's doing well on it!

Since she has just started and I can't be home today I think I am going to skip. On top of everything she has just been through we can't have a hypo in the mix!
 
Oh, and I have skimmed but I haven't read through the protocols in detail yet. Will be doing that today now that she has officially switched!
 
Kelly Howard said:
Since she has just started and I can't be home today I think I am going to skip
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Good choice to skip unfortunately. If you can't be home there is no other choice but we will be concerned about just coming out of DKA.

Kelly Howard said:
I have skimmed but I haven't read through the protocols in detail yet
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Please do read both protocols. With DKA we usually suggest Tight Regulation (TR) but that also depends on your schedule and if Maggie is on a LC wet food diet or raw diet only. To get your mind set transitioned Start Low Go Slow is also a viable option and testing for ketones daily regardless of protocol is essential.

On either protocol that 104 will become a shootable number for you. For now I would hold the 1.5u dose but keep asking questions and sure others will step in through out the day.
 
Kelly Howard said:
Hi Kris! I was planning to send you a PM later to hear more about your switching experience. I popped on a week or so ago, before this all started, and saw that you had switched. I'm so glad he's doing well on it!

Since she has just started and I can't be home today I think I am going to skip. On top of everything she has just been through we can't have a hypo in the mix!
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There are many very experienced people on this forum to guide you. I understand the trepidation in switching though - I agonized about it for a long time.
 
Thanks everyone for jumping in! I loved the folks on the Prozinc board but I can already tell I will appreciate how active you are here :)

Like you, Kris, I have been thinking about switching for a while. I think we even discussed it a couple times! Maggie was doing much better after we found foods that didn't spike her, but she still wouldn't stay in consistent ranges. I was doing a lot of dose adjustments and I think I went a little overboard with that. Ultimately, the insulin decision was made by the ER vets, but since I was already considering it I didn't challenge them at all. I'm hoping this insulin is a better fit for her. I'm going to make a proper intro post later after I have time to do some more reading.
 
She is eating well. It took a little convincing last night, but she was just home from 5 days at the vet and it turned out she just wanted to eat alone in a dark closet! This morning, she was quite eager to eat and I actually gave her a little extra because she just about licked the bowl clean. The vet is recommending the Purina DM diet. I know the prescription diets are historically frowned upon around here, but it looks like this one is pretty good now in terms of carbs. I am not married to the idea. We used to feed Nutro, but she doesn't seem to like that right now and she's really excited about the DM wet.
 
Kelly Howard said:
She is eating well. It took a little convincing last night, but she was just home from 5 days at the vet and it turned out she just wanted to eat alone in a dark closet! This morning, she was quite eager to eat and I actually gave her a little extra because she just about licked the bowl clean. The vet is recommending the Purina DM diet. I know the prescription diets are historically frowned upon around here, but it looks like this one is pretty good now in terms of carbs. I am not married to the idea. We used to feed Nutro, but she doesn't seem to like that right now and she's really excited about the DM wet.
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I feed a blend of DM and either Fancy Feast or Friskies pates to Teasel. The DM lowers the carb average and he likes it and the Fr/FF vary the taste for him.
 
Good to hear her appetite is good. The carbs on the DM depend whether you are feeding the "Select" DM (higher carb) or regular DM. What you want to focus in with a recent DKA is calories, lots of them. The carbs are not as big a deal. You also want to get as much insulin into her as safely possible, so if it's a little higher carb food, that's OK too. The quality of the DM products is nothing special, but at this point it's more important that Maggie eat.

Since you skipped this AM, try to get a ketone test in as soon as possible when you get home today. I would like to find a dose where you don't have to skip. What is your schedule like? Are you home tomorrow? Just wondering what would happen if you faced a lower preshot tomorrow morning.
 
The DM we have is the pate so I believe that is the regular -- "select" is chunks and gravy, right?

I have a blood ketone meter and I'm planning on testing her daily, at least for the next week or so. I have not had good luck catching her for a urine test in the past though I do have some Ketostix strips as well.

I am supposed to go to work tomorrow, but working from home isn't out of the question, and may be necessary anyway depending on when I have to schedule her follow-up appt at the hospital.

I remember reading another thread where a kitty was recovering from DKA and someone recommended feeding higher carb food so that more insulin could be given, is that a standard procedure?
 
Ok -- just checked with the vet and our dr's latest appt tomorrow is 2pm, so I will be home tomorrow. Yay first Lantus curve! :)
 
You do want to try to get as much insulin in as safely possible and keep up the calories. Carbs can help you do that. As well make sure you are adding lots of water to the wet food so you can help flush out any ketones. Maybe ask the vet whether you should be administering fluids at home. If people have trace ketones, it's one of the tools you can use. Have you read Jill's post on Ketones and DKA? There are some interesting links to posts there.

Good to know you'll be home tomorrow, that may make shooting full dose easier. Also whether or not you see ketones may influence what dose to shoot. We'll want to be aggressive if you see ketones, but we also have to balance how much you can monitor. Especially since that 104 was on the AT. Post the ketones test result as soon as you can.
 
Last week I had taken her to the regular vet where they first discovered the ketones (I had not been testing her for them regularly -- bad me). At that time, the vet said we could treat with fluids at home as long as she kept up her appetite. I did that for 2 days before she decided to stop eating, and we went to the ER the next morning (2/25). She was there until last night (3/1). When she left yesterday, she was testing negative for ketones.

They didn't recommend administering fluids at home when she was discharged, though I do still have half the bag and needles from last week. I will add water to her dinner tonight.

I'm wondering if this is a good time to switch to a human meter... seems like all the documentation here favors those readings, and I certainly wouldn't mind a lower cost.

Should be home by 6pm PT and I will check the ketones then. Her shot time is at 7.
 
The choice of meter is up to you. Both the SLGS method and TR protocol were written using human meters so more people are versed in it, but we can adapt to people using the AT if that's what they want to use. We have several people here using the AT.
 
@Kris & Teasel, my AT buddy -- what do you think? What makes you stick with the AT meter?

One thing I really like about it is the very small required sample size. Are there human meters that are comparable in that regard?
 
The Relion Confirm and Micro from Walmart also use the 0.3 size blood drop. A meter made by the same company and available on ADW is the Glucocard 01. The one I linked is like the Confirm.
 
Kelly Howard said:
@Kris & Teasel, my AT buddy -- what do you think? What makes you stick with the AT meter?

One thing I really like about it is the very small required sample size. Are there human meters that are comparable in that regard?
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Hi Kelly,
I'd stockpiled a ton of AT strips when I was able to get them a bit cheaper and I'm so familiar with the BG ranges on the AT that I didn't want to change that factor as I was learning Teasel's responses to Lantus. I think the ReliOn meter is similar in the very small blood drop needed to get a reading.
 
Well, ketones are 3.0 and I know it starts showing at 2.4 or 2.5 in cats, so I'm thinking that's somewhere around trace or small? I wish I had been able to stay home so I could have shot this morning :( It's an hour early, but I took her bg and it is 478. I'm giving her food now with added water. Should I give some of the subq fluids too?
 
Since you skipped this morning, you can shoot now too. Better to get insulin into her sooner with the ketones.

Could you change your subject to add something like race ketones - fluids. or something like that. That will attract more knowledgeable eyes.
 
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