post DKA with concurrent pancreatitis

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Diane M

Diane M

Member Since 2019

Diane M
Joined:
May 27, 2019
I would like to know of other members’ experiences of managing DKA/Pancreatitis, once the hospital has stabilised a cat.
Muffin was admitted last week as an emergency because she has ketoacidosis, dehydration and pancreatitis. Her diabetes was diagnosed six months ago, she’s been on ProZinc 1 1/2 units twice daily, but has not been able to stabilise her blood glucose.
After making a good recovery, I brought her home today, administered her insulin as instructed and then did a spot blood glucose and to my horror, it had gone up from 10 to 29.4! The Vet School had got it under control and now it’s right back up again.
What does this mean? Has anyone had a similar experience? What is Muffin’s prognosis is the diabetes still does not get stabilised at home? My heart is breaking.
 

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Diane M said:

Diane M
Joined:
May 27, 2019
I would like to know of other members’ experiences of managing DKA/Pancreatitis, once the hospital has stabilised a cat.
Muffin was admitted last week as an emergency because she has ketoacidosis, dehydration and pancreatitis. Her diabetes was diagnosed six months ago, she’s been on ProZinc 1 1/2 units twice daily, but has not been able to stabilise her blood glucose.
After making a good recovery, I brought her home today, administered her insulin as instructed and then did a spot blood glucose and to my horror, it had gone up from 10 to 29.4! The Vet School had got it under control and now it’s right back up again.
What does this mean? Has anyone had a similar experience? What is Muffin’s prognosis is the diabetes still does not get stabilised at home? My heart is breaking.
Click to expand...
Update: Muffin had follow-up appt at the hospital. Her blood glucose was >35! She is changing to glargine at her next dose. At the beginning of this emergency Muffin was 3.7kgs. She is now 3.0kgs. But her spirits are good. Her appetite is good. She is herself still, doesn’t seem distressed. I will be monitoring her blood glucose levels more closely and now have the strips to test for ketones in her urine. The vet school ran blood tests and, a part from the glucose levels, all seemed fine (ish). I feel so inept... is this normal??
 
Hi Diane and Muffin,
I am sorry Muffin has been so ill. I am glad he is home and eating well.. eating well is great.
When a kitty has had DKA it is really important that he gets enough food, enough insulin and enough fluids and that any infection or inflammation has been treated. Did he have antibiotics for anything when he had DKA.?
Food is like a medicine for cats when they have had DKA. Give him frequent small meals that he will tolerate. If he is not drinking a lot, try mixing some warm water in his food to make it a bit soupy..See if he will eat that.
If you can set up a spreadsheet and document all the blood glucose levels that would be a great help. Here is the link. If you have trouble setting it up, ask for help. Always test before EVERY SHOT and test during the cycle to see how low the insulin is taking Muffin.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Can you add that Muffin is post DKA please in the signature, as that is important, thanks.
What dose of Lantus is Muffin on now? It's important he doesn't skip shots having had DKA, so if he is lower than usual or (he is under 200), stall, don't feed and ask for help.

It is important that Muffin is getting enough insulin as well to stop ketones from developing again. If you can get your SS up and running it will tell us information to help Muffin.
He should start to put on weight once his blood glucose levels are more under control and he is feeling better. Let him eat all he will at the moment, except for the 2 hours before the preshots because we don't want the preshots to be food influenced at the moment.
I know it's scary at the moment for you.. He is sure to be a bit weak and have lost weight after having had DKA. We have had several DKA kitties lately and they are all now doing well. It will just take time....your time and lots of nursing and caring for him.
 
Diane, I'm sorry I can't offer anything concerning Muffin dear's issues with DKA and pancreatitis, but I am so glad to read that her appetite and spirits are good. What a relief. Someone more experienced will be able to tell you more about what is "normal" at this stage. Although I use "normal" loosely because ECID (Every cat is different).

Now, you may not have much testing data at this point in time, but if you will set up the spreadsheet and record the testing and insulin data you have now, then plug in every bit of information going forward you, and advising members, are going to be able to see the trends and patterns of how the insulin is affecting her.

Here are the spreadsheet instructions and info on understanding the spreadsheet

Since you are going to use Lantus (glargine), you can visit the Lantus forum and start reading up on that insulin and the protocols we use here. Please don't give into despair yet, Lantus is a very good insulin for cats, and with the help of the experienced Lantus users, I feel very confident that progress on getting Muffin regulated is more than possible.

Please update your signature and indicate Lantus and the dosage, so advising members know what's going on currently. Also add post DKA/pancreatitis so that advising members know about that.

We also need to know what Muffin is eating. Here is what we like to see in the signature that is attached to all your posts:
kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what she eats/any other meds or health issues she has. (Post DKA/Pancreatitis) You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished. There is a limited number of lines/characters allowed for the signature.

If you like, you can tell us more in your profile about the other kitties in the household etc.
Click on your name in the upper right corner of this page, then click on Personal Details in the menu that drops down.

Be sure to test her before every injection, and at least a couple of times during the 12 hour cycle between shots. You may not be able to do that at night, so if you can, try get a before bed test.

Deep breaths, be patient, treating feline diabetes is a marathon, not a sprint and sometimes it just takes time. :cat:
 
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Bron and Sheba said:
Hi Diane and Muffin,
I am sorry Muffin has been so ill. I am glad he is home and eating well.. eating well is great.
When a kitty has had DKA it is really important that he gets enough food, enough insulin and enough fluids and that any infection or inflammation has been treated. Did he have antibiotics for anything when he had DKA.?
Food is like a medicine for cats when they have had DKA. Give him frequent small meals that he will tolerate. If he is not drinking a lot, try mixing some warm water in his food to make it a bit soupy..See if he will eat that.
If you can set up a spreadsheet and document all the blood glucose levels that would be a great help. Here is the link. If you have trouble setting it up, ask for help. Always test before EVERY SHOT and test during the cycle to see how low the insulin is taking Muffin.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Can you add that Muffin is post DKA please in the signature, as that is important, thanks.
What dose of Lantus is Muffin on now? It's important he doesn't skip shots having had DKA, so if he is lower than usual or (he is under 200), stall, don't feed and ask for help.

It is important that Muffin is getting enough insulin as well to stop ketones from developing again. If you can get your SS up and running it will tell us information to help Muffin.
He should start to put on weight once his blood glucose levels are more under control and he is feeling better. Let him eat all he will at the moment, except for the 2 hours before the preshots because we don't want the preshots to be food influenced at the moment.
I know it's scary at the moment for you.. He is sure to be a bit weak and have lost weight after having had DKA. We have had several DKA kitties lately and they are all now doing well. It will just take time....your time and lots of nursing and caring for him.
Click to expand...

Thanks for the very helpful response...I'm afraid that I don't understand a lot of it, though. Apologies for my ignorance. What are preshots?? She is on 1 1/2 units of glargine twice daily (she had her first dose this morning). She was previously on 2 units every 12 hours prozinc. I tested her urine this morning and the ketones registed only as trace (0.5 or less) but the BG still over 20, which I expected. I haven't checked her BG with the alphatrak but will do so this evening.
She has been eating and drinking well (and pooping and peeing). I've been feeding her as much as she likes, watering it down occasionally to make it easier for her (she has no teeth).
I didn't understand what you meant about not feeding for the two hours before the preshots because I don't know what are preshots... do you mean her insulin? So are you saying not to feed her within two hours of her next jab? Should I text her BG before the jab? The vets told me to just run a curve in 5-7 days and be guided by her behaviour in the meantime. (I do know her very well and am hating myself that I entrusted her care to catsitters while I was away. That said, they did pay attention and contacted the vet while they were caring for her).
I have all of her emergency admission notes from the e-vet and then from the Dick Vet School here in Edinburgh. Would it be useful if I attached them?
Finally, I'm not sure what is meant by changing the signature to reflect post DKA...so sorry that I'm so inept. Hopefully be up to speed soon!
 
Idjit's mom said:
Diane, I'm sorry I can't offer anything concerning Muffin dear's issues with DKA and pancreatitis, but I am so glad to read that her appetite and spirits are good. What a relief. Someone more experienced will be able to tell you more about what is "normal" at this stage. Although I use "normal" loosely because ECID (Every cat is different).

Now, you may not have much testing data at this point in time, but if you will set up the spreadsheet and record the testing and insulin data you have now, then plug in every bit of information going forward you, and advising members, are going to be able to see the trends and patterns of how the insulin is affecting her.

Here are the spreadsheet instructions and info on understanding the spreadsheet

Since you are going to use Lantus (glargine), you can visit the Lantus forum and start reading up on that insulin and the protocols we use here. Please don't give into despair yet, Lantus is a very good insulin for cats, and with the help of the experienced Lantus users, I feel very confident that progress on getting Muffin regulated is more than possible.

Please update your signature and indicate Lantus and the dosage, so advising members know what's going on currently. Also add post DKA/pancreatitis so that advising members know about that.

We also need to know what Muffin is eating. Here is what we like to see in the signature that is attached to all your posts:
kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what she eats/any other meds or health issues she has. (Post DKA/Pancreatitis) You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished. There is a limited number of lines/characters allowed for the signature.

If you like, you can tell us more in your profile about the other kitties in the household etc.
Click on your name in the upper right corner of this page, then click on Personal Details in the menu that drops down.

Be sure to test her before every injection, and at least a couple of times during the 12 hour cycle between shots. You may not be able to do that at night, so if you can, try get a before bed test.

Deep breaths, be patient, treating feline diabetes is a marathon, not a sprint and sometimes it just takes time. :cat:
Click to expand...

Thanks so much! I think I corrected the title of the post to post DKA but still uncertain of what is signature??
 
Diane M said:
what is signature??
Click to expand...
Hi Diane. The signature is the light gray text that shows up under every post. I can see that you already set one up (great job!), with the following information: Abyssinians Muffin, Pumpkin, HotDog and Peanut. Muffin, 11, diagnosed 12/18 w/BG 27. ProZinc 2x daily. BG rose to 24-31. All teeth recently extracted. Alphatrak2 BG spotchecksshow continued volatility.Weightloss: 5kilo to 3.9k. Purry, playful worried about her weight. To update this, click onto your name at the top right hand side of the screen, and choose "signature" in the drop down box. And because I can't say it any better than Lou already did, follow her advice on setting up your signature, and if you'd like, you can include more info in your profile. Here is what Lou suggests:
We also need to know what Muffin is eating. Here is what we like to see in the signature that is attached to all your posts:
kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what she eats/any other meds or health issues she has. (Post DKA/Pancreatitis) You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished. There is a limited number of lines/characters allowed for the signature.

If you like, you can tell us more in your profile about the other kitties in the household etc.
Click on your name in the upper right corner of this page, then click on Personal Details in the menu that drops down.

This probably all feels very overwhelming right now, but it's worth setting up an informative signature and setting up a spreadsheet, so that the members here can can help you with dosing advice and so that we all know what's going on without needing to ask so many questions each time.

I'm sorry that you and Muffin are going through this right now. I have no personal experience with DKA or pancreatitis, but as Bron said, many cats here have gone through what Muffin is going through, and now they're doing well. Just try and remember to breathe... and take time for self care. Just do this one day at a time.

One more thing... Does Muffin have a past history of stomatitis? Is that why her teeth have been removed? If so, please include History of stomititus in the signature. I have a cat who has had all but 4 of his top incisors removed because of that. It's a horrible disease!

Best of luck to you, and keep coming back for support and to ask questions.
 
Diane, I am very sorry if I confused you at any point with my suggestions. I know it's difficult at first, we are familiar with the "lingo", you are not. You are not at fault in any way.
You have updated the signature beautifully. Muffin's pertinent information is all there that I can see, and it's very helpful.

A pre-test is just the blood sugar test before a shot. On the spreadsheet it is AMPS (AM or morning pre-shot test) and PMPS (PM or evening pre-shot test). When members first start testing we do recommend removing access to food 2 hours before testing, so that the test is not food influenced. However, if kitty is ravenous and not cooperating, then feed some and then do the test. The food given immediately before a test is not likely to affect the BG.

Please don't beat yourself up for what has gone on before or for your lack of familiarity with feline diabetes, treatment or how this board operates. You have taken care of Muffin, she is recovering, and you are going forward in the right direction by learning more.

Do read the stickies at the top of the Lantus forum. This is an excellent insulin, but needs time to work, and build up the "depot" (definition in the stickies in Lantus forum). You may not see immediate BG leveling out or drops. Give it time to do the work. There is a whole lot of information there in the stickies, and I had to read them over and over, asking questions there in that forum of the experienced members, who helped me get my boy into remission. Trust them, depend on them, they are wonderful.

So, homework is getting the spreadsheet set up, and if you have any problems, there is help or someone can set it up for you. Advising members are going to want to see her numbers before offering input. Test before every shot, and then during the day so we can see how low the blood sugar goes in the cycle. Dosing Lantus is based on the nadir, or lowest BG in the 12 hour cycle, not by the pre-test numbers.
Then start reading the Lantus forum stickies.

You aren't out there alone Diane, not by a long shot. We will be with you and help every step of the way.
 
Hi Diane, yes, Elizabeth and I are both long-term UKers here and will try to help in whatever way we can... much of the basic information you need to know is the same everywhere, but if you need to know anything about foods, diabetic supplies etc, by all means tag us.

It sounds as if you've made a great start and although it's confusing at first, it soon falls into place!

Good luck!

Diana
 
C6A7AC46-266A-44E4-8F2E-FA80BF041C1B.jpeg
Thank you all for your dedicated support and help. The University of Edinburgh Vet School hospital took care of Muffin for nearly a week, discharging her a week ago, when her weight fell to 3.5kg. Her follow up medical appt on Tuesday 16th went okish, although her BG hit 36 (having been stabilised while in hospital and discharged at 10.8) She had lost a further .5 kg and was sent home weighing only 3kg. Muffin was 4.98kg last November! Since Wed morning, I’m giving her 2x2 units lantus because her BG was so high (and she’d been on 2units ProZinc )

Anyway... on Wed I tested her urine and her BG was still in mid 20s, but the ketones were still gone and best of all, her weight went back up to 3.7kg... her weight prior to her emergency admittance. She is eating really well, drinking a lot but not hanging around in the sink wanting the taps turned on as she did previously. Her spirits are high and she is alert and playful.

I was instructed to do a curve on Monday but you’re all advising to test before every jab? I’ll try to start doing this. Luckily, I work from home, so I’m with Muffin 24/7 and am keeping a close eye on her.

I’ve obtained her full medical records, plus her e-vets emergency admittance and Vet School notes. I wanted to compare all my BG readings with what was going on at the time to see if there are any hints or patterns that may help to explain the yo-yo she’s been experiencing since December. There’s been no explanation for the pancreatitis. Is it useful, or even possible to attach a pdf file of her medical notes?

I’ll get to grips with the spreadsheet ASAP.

Thanks again for your help and patience. I’ve attached a photo from yesterday so you can see how bright she is looking and am keeping fingers crossed at all times!

Diane and Muffin
 
Yes please attach all the medical info if you can. That would be very useful.
Great to hear Muffin is eating, happy and no ketones..
Yes please test before every shot of insulin to see it is safe to give the insulin. And if you can test during the cycle around +4 and +6 that is very helpful. Also test during the pm cycle as kitties often drop lower at night,
Do you have some higher carb food and honey at home in case of low numbers?
Great photo! she is beautiful!
 
Daddy Jack's Mommy said:
Hi Diane. The signature is the light gray text that shows up under every post. I can see that you already set one up (great job!), with the following information: Abyssinians Muffin, Pumpkin, HotDog and Peanut. Muffin, 11, diagnosed 12/18 w/BG 27. ProZinc 2x daily. BG rose to 24-31. All teeth recently extracted. Alphatrak2 BG spotchecksshow continued volatility.Weightloss: 5kilo to 3.9k. Purry, playful worried about her weight. To update this, click onto your name at the top right hand side of the screen, and choose "signature" in the drop down box. And because I can't say it any better than Lou already did, follow her advice on setting up your signature, and if you'd like, you can include more info in your profile. Here is what Lou suggests:
We also need to know what Muffin is eating. Here is what we like to see in the signature that is attached to all your posts:
kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what she eats/any other meds or health issues she has. (Post DKA/Pancreatitis) You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished. There is a limited number of lines/characters allowed for the signature.

If you like, you can tell us more in your profile about the other kitties in the household etc.
Click on your name in the upper right corner of this page, then click on Personal Details in the menu that drops down.

This probably all feels very overwhelming right now, but it's worth setting up an informative signature and setting up a spreadsheet, so that the members here can can help you with dosing advice and so that we all know what's going on without needing to ask so many questions each time.

I'm sorry that you and Muffin are going through this right now. I have no personal experience with DKA or pancreatitis, but as Bron said, many cats here have gone through what Muffin is going through, and now they're doing well. Just try and remember to breathe... and take time for self care. Just do this one day at a time.

One more thing... Does Muffin have a past history of stomatitis? Is that why her teeth have been removed? If so, please include History of stomititus in the signature. I have a cat who has had all but 4 of his top incisors removed because of that. It's a horrible disease!

Best of luck to you, and keep coming back for support and to ask questions.
Click to expand...

I forgot to answer your question above...yes, Muffin had stomatitis and the second time had the rest of her teeth extracted. I’d been wondering if the diabetes is related?
 
Bron and Sheba said:
Yes please attach all the medical info if you can. That would be very useful.
Great to hear Muffin is eating, happy and no ketones..
Yes please test before every shot of insulin to see it is safe to give the insulin. And if you can test during the cycle around +4 and +6 that is very helpful. Also test during the pm cycle as kitties often drop lower at night,
Do you have some higher carb food and honey at home in case of low numbers?
Great photo! she is beautiful!
Click to expand...

Hi- thanks you- Muffin is pleased with the compliment! Yes, I have higher carb food, honey and a tube of glucose gel.
 
Diane M said:
I forgot to answer your question above...yes, Muffin had stomatitis and the second time had the rest of her teeth extracted. I’d been wondering if the diabetes is related?
Click to expand...
I have a cat with stomititis and he doesn't have diabetes. So, no, I don't believe it's connected. However, some infections can bring on diabetes in some cats. But Muffin has had stomititis for a while now, so I don't think there's a connection there.
I'm so happy to hear that Muffin is feeling a little better now. She is such a beautiful cat!
 
Daddy Jack's Mommy said:
I have a cat with stomititis and he doesn't have diabetes. So, no, I don't believe it's connected. However, some infections can bring on diabetes in some cats. But Muffin has had stomititis for a while now, so I don't think there's a connection there.
I'm so happy to hear that Muffin is feeling a little better now. She is such a beautiful cat!
Click to expand...
Thank you! I only wondered because of her ups and downs. I received all her notes from the vet, so now I have her complete medical notes from 31st December 2018, when she was diagnosed. Her stomatitis was mid-April of this year (I thought it was longer ago) and she was very poorly but having the teeth out really helped. But surely the inflammation contributed to the instability of her BG?
 
Diane M said:
Hi- thanks you- Muffin is pleased with the compliment! Yes, I have higher carb food, honey and a tube of glucose gel.
Click to expand...
I think we’ve encountered the first hypo episode...ironic, considering your last question. Since you asked that I had the glucose, etc (that I’ve now used) perhaps you can comment on the episode?
My husband gave Muffin her insulin this morning at 6.30am, fed some roast chicken to all the cats, kept Muffin in the bedroom with us and we went back to sleep. When we woke up, Muffin had vomited several piles of chicken. No nasty green or yellow biley stuff. I fed her some more and she seemed fine. We went out at around 11am, back at 12pm, fed her some Thrive complete ocean fish and settled on the bed so I could keep an eye on her as she approached +6 (the lowest point)?? I was concerned that the vomiting post shot could cause a hypo. She wasn’t quite seeming herself, and I watched her jump down from her chaise longue very gingerly, with a bit of a strange gait, and I followed her through the kitchen and realised that she was confused. Then I noticed she was twitching. I took her straight back to the chaise longue and got her to lick some of the glucose gel I had in her alphatrak2 box. She jumped down again and walked around very oddly, sniffing the ground and I brought her to her litter tray (hoping she’d pee for me to test her urine) She then sniffed the tray and began to walk in circles, about 6 times and I picked her up, put her in the tray, where she did a poop. Afterward, I fed her some ProPurina wet “junk food” (it’s not low carb) which she gobbled up. She settled back down and I managed to get a good, clear drop of blood and her meter registered 4.3mmol (or whatever it is). She’s never had a reading below 10.8 before now. We’re at +9.5 now, she’s eaten another packet of the ProPurina and is due to be fed again in 2.5 hours.
I will definitely test her again, the question is when? In half hour when she is+10? Then again before insulin? Do I give insulin? The last time vet did curve, Muffin was 10.8 at +9 and the vet gave me instructions how much insulin to give depending on her readings.. none if it was 10 or below. Two hours later, BG was 29.4 and I gave her the 2u (Prozinc at that time).
Do I apply the same logic here, depending on her readings? She had 2u lantus at 6.30am.
 
Bron and Sheba said:
Yes please attach all the medical info if you can. That would be very useful.
Great to hear Muffin is eating, happy and no ketones..
Yes please test before every shot of insulin to see it is safe to give the insulin. And if you can test during the cycle around +4 and +6 that is very helpful. Also test during the pm cycle as kitties often drop lower at night,
Do you have some higher carb food and honey at home in case of low numbers?
Great photo! she is beautiful!
Click to expand...
I posted again below/above trying to reply to you again but think I just replied to myself...perhaps you could have a look? I think Muffin went hypo an hour ago...
 
Diane, how is she acting now? Here is some info on hypos. You are using Alphatrak so the take action number is 68 or 3.77 world numbers.
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L. on a human meter)
Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
 
Idjit's mom said:
Diane, how is she acting now? Here is some info on hypos. You are using Alphatrak so the take action number is 68 or 3.77 world numbers.
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L. on a human meter)
Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
Click to expand...
Just tested her ...14.2. She is quietly sleeping. Due insulin in two hours. Should I test in two hours? Before or after food? I won’t be leaving her...didn’t join husband at the pub !
 
Just a note, if you are experiencing low numbers, or suspect a hypo, create a new thread with the title indicating you need help right now. If it's a true hypo..very low numbers with or without symptoms, then use the 911 from the prefix option in the title bar. That's going to get eyes on right away.
 
Idjit's mom said:
I know you are very busy and concerned right now, but when you can, please get the spreadsheet set up, and data entered so we can see at a glance what the numbers are, past and present.
For reference, when you can:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
Click to expand...
Is the alphatrak2 human meter? Her strips are 38- Cat only. Her lowest reading earlier was 4.3mmol but this was after she’d had her gel and some ordinary food. She is very quiet now, otherwise ok.
 
Oh yes, test before shooting, always. I am going to tag some of the more experienced members for help.
@MrWorfMen's Mom
@Wendy&Neko
@JeffJ
Post #19

You did really well, with the gel and the ordinary food. :bighug::bighug:

Bron is in Australia, it's only 1:30 AM there, so you aren't going to hear from her right now. Alphatrak2 is pet meter and will give you higher BG numbers.
Please read these:
 
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I would not shoot until some of the others have weighed in, if she was truly hypo, then she might be more sensitive to insulin and you don't want to repeat the event.

I know this is all very new to you, plus the newest change to Lantus. You have a lot on your plate and it's a steep learning curve. Read the "stickies" at the top of the Lantus forum HERE as you can. This is really going to help you get a better handle on all this.
 
From your description of the behaviour/symptoms earlier today, it certainly sounds like Muffin had a symptomatic hypoglycemic event. You acted quickly and did the right thing giving her glucose gel. Do print out those Hypo documents for future reference.

For reference, normal BG with the AT2 meter is 3.8mmol (68 US) to 8.3 (150 US). While some non-diabetic cats will have BG below 3.8, we consider that the point where you definitely need to intervene with food to prevent any symptomatic hypo events. Any time you get a low reading, if it seems out of the norm, it's good to double check. That said if symptoms are already evident, better to get some carbs/glucose into the cat and check BG right after. You also need to keep checking until kitty can maintain a normal BG without the need for any more food or glucose.

Assuming this was a hypoglycemic episode, I agree with Idijit's Mom that Muffin may be more sensitive to insulin right now. We do however need to take the recent DKA into consideration. It's difficult to suggest exactly what you should give tonight without some data to look at to see what has been happening up till now but it is evident that the dose of insulin may be too high.

Do you have BG test results for the past couple of days at least that you could post here? We have a spreadsheet we use to track out readings that is available to members only that really helps us help you especially in situation such as this. We are very data oriented here. If you could set up a spreadsheet and plot in your data to date, it would be very helpful going forward but for now, any data you can offer here would help.

Please also let us know when you last checked for ketones and what that result was, confirm the current dose of insulin is 1.5u Lantus and whether Muffin is eating well on her own.
 
MrWorfMen's Mom said:
From your description of the behaviour/symptoms earlier today, it certainly sounds like Muffin had a symptomatic hypoglycemic event. You acted quickly and did the right thing giving her glucose gel. Do print out those Hypo documents for future reference.

For reference, normal BG with the AT2 meter is 3.8mmol (68 US) to 8.3 (150 US). While some non-diabetic cats will have BG below 3.8, we consider that the point where you definitely need to intervene with food to prevent any symptomatic hypo events. Any time you get a low reading, if it seems out of the norm, it's good to double check. That said if symptoms are already evident, better to get some carbs/glucose into the cat and check BG right after. You also need to keep checking until kitty can maintain a normal BG without the need for any more food or glucose.

Assuming this was a hypoglycemic episode, I agree with Idijit's Mom that Muffin may be more sensitive to insulin right now. We do however need to take the recent DKA into consideration. It's difficult to suggest exactly what you should give tonight without some data to look at to see what has been happening up till now but it is evident that the dose of insulin may be too high.

Do you have BG test results for the past couple of days at least that you could post here? We have a spreadsheet we use to track out readings that is available to members only that really helps us help you especially in situation such as this. We are very data oriented here. If you could set up a spreadsheet and plot in your data to date, it would be very helpful going forward but for now, any data you can offer here would help.

Please also let us know when you last checked for ketones and what that result was, confirm the current dose of insulin is 1.5u Lantus and whether Muffin is eating well on her own.
Click to expand...
Right. With regard to the spreadsheet, my husband is going to set it up. My brain is so full right now that when I read the instructions I just couldn’t take it in. He’s leaving for Costa Rica early tomorrow am so he’ll do it in the next few hours.
Muffin did a pee - 17.30 - so I grabbed a reading. No ketones, but the blue green on BG suggested 5mmol which I found odd so decided to test blood. On the AT2 today: 14.14: 4.3mmol, 16.16: 14.2mmol, 17.54: 24.7 mmol. I’m concerned that the urine test strip gave low reading while the meter gave 24.7 only 20 min later.
Current dose of lantus is 2u because her reading was so high after leaving her appt on the 16th. They had said 1.5 units but with the difficulty of getting a half reading and her continuing high levels, we upped it to 2u. Now we have the .3mm u100 syringes with half markings, we can do the 1.5.
I really do think it was her vomiting up her chicken this morning that sent the BG down and this was why I was keeping an eye on her, especially around midday.
With being on my own from tomorrow, I am considering putting her into the vet on Monday for her curve...it doesn’t involve a car journey and she’s used to it there so I think the stress is minimal and, besides, I stress her out sometimes plus there are three other cats here.
The problem right now is: with her reading above 20, do I feed her now and then give her 2units??
 
@MrWorfMen's Mom would you be able to advise on the insulin dose now, adjustments or what?
@Sue and Luci start at post #19 for hypo event info
I am no expert, but Muffin got the 2 units this am, then vomited her food..that might have caused the drop in BG.
If no one responds, then err on the side of caution, Diane. Better one day too high, than one hour too low. In addition that she might be a bit sensitive to insulin because of the big drop.
I would advise, going forward as soon as you have the spreadsheet set up and data entered, to posting on the Lantus forum, it's heavily monitored and you will get more immediate responses.
 
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Regarding taking her to the vet for a curve, it's what you think is best that is important. True, for most of our cats, going to the vet is very stressful and does affect the BG data. If you think you are going to get more reliable data from a curve at the vet than you would at home, then it might be the better option. At least for now, until you and Muffin have adjusted to all the testing/shooting routine. Make sure she is eating, and getting insulin, and testing for ketones, so you don't have another DKA. She's a precious baby, and has been through the mill. So have you, and we sure want everything to settle down for both of you.
 
She vomited up the chicken but you said you fed her again? Did she vomit again or did she have food on board when you noticed the strange behaviour and got the lowish BG reading?

If she ate again, and kept that food down, I don't think you can assume the low was due to lack of food.

I frankly wouldn't be so sure about no stress involved in the vet visit. It may be that BG was elevated at the vet causing the vet to raise the dose and that dose is now too high because Muffin's BG is not usually that high. Do you happen to know what BG was at the vet on the 16th? While Muffin may be OK with the vet, what about barking dogs, strange smells etc?

I think you could try 1.5u (assuming BG hasn't dropped at shot time which seems doubtful) but get another test at +2 to see if Muffin is staying steady, rising or dropping. I'd also definitely get another test before you turn in for the night and either feed Muffin a snack again before bed or leave a little food out for Muffin to eat if she feels the need. If Muffin seems to be dropping off fast, then please post for assistance in the Health forum to be sure you get lots of eyes on your post as things are quieter on the weekends here. Also put a 911 prefix on your post if you are worried about dropping BG.

Don't be fooled by those higher readings right now. It's highly likely Muffin is bouncing which is a normal phenomenon that occurs when BG drops too fast, too much or to levels lower than kitty has become accustomed to or simply too low. Those higher numbers can last for up to 3 day for some cats so don't be reactive and raise the dose again right now. If you happen to get a positive test for ketones then by all means post and we can direct you further.

As for the urine glucose test...it tells you how much glucose is in the urine and does not correlate directly to the Blood glucose test results.
 
Idjit's mom said:
@MrWorfMen's Mom would you be able to advise on the insulin dose now, adjustments or what?
I am no expert, but Muffin got the 2 units this am, then vomited her food..that might have caused the drop in BG.
If no one responds, then err on the side of caution, Diane. Better one day too high, than one hour too low. In addition that she might be a bit sensitive to insulin because of the big drop.
I would advise, going forward as soon as you have the spreadsheet set up and data entered, to posting on the Lantus forum, it's heavily monitored and you will get more immediate responses.
Click to expand...
Thank you...I can post a new thread on the Lantus, definitely. I’ve been reading the stickies. I agree that it’s the vomiting most likely as I’ve not had ANY reading in the normal range ever. When my husband leaves, we will have six weeks of quiet time. I’ve cancelled all travel plans and since I work at home with very flexible hours, I’m in a position to keep an eye on her. Husband May have overfed the roast chicken this morning and as it’s people food might have been too rich (she didn’t get seasoned bits). But I’ve fed her a tin of Thrive Ocean Fish, which is low carb, and am going to take one more reading at 19.00 and if it’s higher than 25, will give her the dose of 2, less than that will adjust accordingly. Poor wee thing must be getting sick of holes in her ears!
Update: 18.50 BG 21.8. Think I’ll go with 1.5u?? And then watch her carefully for at least the next six hours (I stay up late)
 
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Idjit's mom said:
Regarding taking her to the vet for a curve, it's what you think is best that is important. True, for most of our cats, going to the vet is very stressful and does affect the BG data. If you think you are going to get more reliable data from a curve at the vet than you would at home, then it might be the better option. At least for now, until you and Muffin have adjusted to all the testing/shooting routine. Make sure she is eating, and getting insulin, and testing for ketones, so you don't have another DKA. She's a precious baby, and has been through the mill. So have you, and we sure want everything to settle down for both of you.
Click to expand...
Thank you- you’re very kind and comforting. Right. Deep breath (again)...
 
MrWorfMen's Mom said:
PLEASE REDUCE THE DOSE TO 1.5u tonight if for no other reason than extra sensitivity to insulin following the assumed hypoglycemic episode. The higher BG is not her normal.
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I just updated my post to say I was only going to give 1.5 as I just took another BG reading which was 21.8mmol. Thank you!
Oh: her normal readings have never made it into the teens, btw. She has never been stabilised. The Lantus is new- started last Wednesday- I’ve read about the depot, and don’t know how that affects things- but no, higher BG is her “normal.” Unfortunately.
I could give one unit to be on the safe side?
 
MrWorfMen's Mom said:
PLEASE REDUCE THE DOSE TO 1.5u tonight if for no other reason than extra sensitivity to insulin following the assumed hypoglycemic episode. The higher BG is not her normal.
Click to expand...
Muffin was grooming happily earlier and is now sleeping peacefully. I think I’ll let her sleep and check BG one more time before insulin...in case it is falling. Plus the 6.30 am 6.30 pm has been killing me and getting her back to 7.30/8.00 is much easier, particularly if she needs to see vet as they don’t open until 8am. Is this ok?? And then I’ll be in better place to judge whether 1.5 or 1 unit insulin. I won’t give 2 in any case. Thank you!
 
You can move the shot ahead without any problem. It's only if you need to move the shot time earlier that there are time constraints to avoid the potential of overdosing or having too much overlap. :)
 
MrWorfMen's Mom said:
PLEASE REDUCE THE DOSE TO 1.5u tonight if for no other reason than extra sensitivity to insulin following the assumed hypoglycemic episode. The higher BG is not her normal.
Click to expand...
I delayed Muffin’s insulin until 19.30, at which time I took blood and her BG was back up to 31.4. So in one day, 4 to 14, to 24, to 21 to 31...
I gave her 1.5u and will keep a close eye on her until at least 2am which will be +6.5
In the meantime, I’m trying to make sense of the SS and will also post Muffin’s medical records.
 
MrWorfMen's Mom said:
She vomited up the chicken but you said you fed her again? Did she vomit again or did she have food on board when you noticed the strange behaviour and got the lowish BG reading?

If she ate again, and kept that food down, I don't think you can assume the low was due to lack of food.

I frankly wouldn't be so sure about no stress involved in the vet visit. It may be that BG was elevated at the vet causing the vet to raise the dose and that dose is now too high because Muffin's BG is not usually that high. Do you happen to know what BG was at the vet on the 16th? While Muffin may be OK with the vet, what about barking dogs, strange smells etc?

I think you could try 1.5u (assuming BG hasn't dropped at shot time which seems doubtful) but get another test at +2 to see if Muffin is staying steady, rising or dropping. I'd also definitely get another test before you turn in for the night and either feed Muffin a snack again before bed or leave a little food out for Muffin to eat if she feels the need. If Muffin seems to be dropping off fast, then please post for assistance in the Health forum to be sure you get lots of eyes on your post as things are quieter on the weekends here. Also put a 911 prefix on your post if you are worried about dropping BG.

Don't be fooled by those higher readings right now. It's highly likely Muffin is bouncing which is a normal phenomenon that occurs when BG drops too fast, too much or to levels lower than kitty has become accustomed to or simply too low. Those higher numbers can last for up to 3 day for some cats so don't be reactive and raise the dose again right now. If you happen to get a positive test for ketones then by all means post and we can direct you further.

As for the urine glucose test...it tells you how much glucose is in the urine and does not correlate directly to the Blood glucose test results.
Click to expand...
I missed this post earlier! But thank you, still is useful information. I’ll definitely check Muffin at +2. But to answer the one question I missed, yes, I’m pretty sure we fed her when I saw all the food that came up and that later food stayed down; otherwise, I’d not have popped out with my husband.
I didn’t think about the urine results not being the same as blood results- thank you for pointing that out. I’d been testing whenever I caught her peeing and it had always been in the middle range whereas today it fell to the “traces” range. But no ketones, at least.
 
HERE is a document explaining the spreadsheet and how to use it. When you fill in your numbers on the World tab, the US tab will automatically populate so anyone from the US can see what's been happening and help you out as they use a different Glucose measure scale.
 
Hi Diane - you are getting some great help from Linda and Lou. So, just saying hi. And you are doing great on this big learning curve. If you guys need me on this thread, tag me again. Hugs to you Diane for keeping your kitteh safe.
:bighug::bighug::bighug:
 
JeffJ said:
Hi Diane - you are getting some great help from Linda and Lou. So, just saying hi. And you are doing great on this big learning curve. If you guys need me on this thread, tag me again. Hugs to you Diane for keeping your kitteh safe.
:bighug::bighug::bighug:
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Thank you, Jeff...really trying to get this right.
Diane and Muffin
 
MrWorfMen's Mom said:
HERE is a document explaining the spreadsheet and how to use it. When you fill in your numbers on the World tab, the US tab will automatically populate so anyone from the US can see what's been happening and help you out as they use a different Glucose measure scale.
Click to expand...
Thank you...I'll get the SS data sorted asap.
Meanwhile, Muffin's readings are all over the place. At 19.50, she was 31.4mmol, I fed her and gave her 1.5u. At +2: 24.6, +4: 22.9, +6: 27.3...I'm going to stay up tonight and complete her curve. Still feeding her on demand (to regain her weight, which she has) but thinking I should have a well-defined schedule tomorrow??
Wish us luck and thanks so much for your help.
Diane and Muffin
 
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