Questions

SSSMom

SSSMom

Member Since 2018
Hello,
My cat is recovering from pancreatitis and DKA.
She is on Lantus and has been for around 5 years.
We are completely out of whack right now due to her illness. We were force feeding her for 5 days up until Wednesday and have been giving her lactated ringer here and there along with Cerenia and Mirtazipine for the past 1.5 weeks.

She is acting more or less normal. She still has ketones coming and going (haven't caught any pee but I smelled it on her breath last night).

Should I just completely throw out my numbers and wait until she's better to try to do anything? She has had some hypo numbers and some nutty numbers in the 550s. I am having a hard time deciding what to shoot her. We shot 4-5 hours late yesterday because she was hypo (but acting normal for the most part) and then 12 hours later this morning at 5:30am EST.
My vet said to shoot her 3 units which seemed nuts given her numbers, so we haven't. We've been going between 1 and 2 for the last week.

Let me know what you think.
Thanks!
 
With DKA in the past and ketones it’s never good to skip insulin that much I know. I’ve not dealt with DKA. What protocol are you following? Recovering from DKA is not a protocol. Fluids now and then makes no sense to me. I’d add as much water to her food as she will tolerate and still eat. Sounds like she has a lot going on. What do you mean by semi-ambulatory? Is she getting nausea medication? Has she had an active hypo? Lantus likes consistency so all the skipping around will not build a depot. Sorry she has so much going on.
 
Last edited:
tiffmaxee said:
With DKA in the past and ketones it’s never good to skip insulin that much I know. I’ve not dealt with DKA. What protocol are you following? Recovering from DKA is not a protocol. Fluids now and then makes no sense to me. I’d add as much water to her food as she will tolerate and still eat. Sounds like she has a lot going on. What do you mean by semi-ambulatory? Is she getting nausea medication? Has she had an active hypo? Lantus likes consistency so all the skipping around will not build a depot. Sorry she has so much going on.
Click to expand...

Hello, I didn't say that I skipped insulin. I don't shoot insulin when she's in the 40s. You're saying I should? I am definitely interested in hearing what #s would be a good low # to shoot insulin at if its not 40 because I don't feel comfortable. I delayed insulin 5 hours when she was hypo.
We aren't following a protocol right now as I am lost and that's why I am posting. We are keeping her alive and without ketones.
Fluids here and there means I don't give fluids when her bg is 40 or 50 because I don't want her to die of hypo.
Ambulatory means able to walk. She is semi-ambulatory. She has previous injuries from being hit by a car when she was feral and doesn't walk well or much.

What do you mean by all the skipping around? You mean dose changes? I am confused about what dose to give her as I'm not going to give her 3u which is what my vet suggested since she's going so low. Do you have another suggestion for me? Thanks in advance!
 
With that 44, a reduction should have been taken. I think I would have held the 1.25 until depot was re-established. That was a big jump in dose at one time. Anyone else care to chime in?
 
Olive & Paula said:
With that 44, a reduction should have been taken. I think I would have held the 1.25 until depot was re-established. That was a big jump in dose at one time. Anyone else care to chime in?
Click to expand...

Thanks for this info! I was scared to do a permanent reduction but I want to learn! Can you tell me why? Before her DKA/Pancreatitis, she was on 2u for a long time with testing before shooting every other day.
 
Adding, I was also scared because her other numbers are so high. Is that not the right thing to do?
 
Kristy Ann again, keep in mind I don't use lantus, but I did look at your ss. It looks like you are giving 2 in the morning and 1.5 in the evening. And changing the dose a lot. It looks like 2 may be too much. I might try the 1.5 dose both am/pm (of course lowering if he earns a reduction) and see what happens. I think those wacky high numbers are caused by some bouncing from going low. Lantus works best when you can do the same dose am/pm. Have you had a chance to read through the dosing protocols at the top? Take a look at the yellow stickies.
 
SSSMom said:
Adding, I was also scared because her other numbers are so high. Is that not the right thing to do?
Click to expand...
Pretty sure this higher numbers are bounces from going low. His body is releasing stored glucose to keep from going too low.
 
JanetNJ said:
Kristy Ann again, keep in mind I don't use lantus, but I did look at your ss. It looks like you are giving 2 in the morning and 1.5 in the evening. And changing the dose a lot. It looks like 2 may be too much. I might try the 1.5 dose both am/pm (of course lowering if he earns a reduction) and see what happens. I think those wacky high numbers are caused by some bouncing from going low. Lantus works best when you can do the same dose am/pm. Have you had a chance to read through the dosing protocols at the top?
Click to expand...
Yes, I did read all of them the other day as well as the other pinned posts. So, if you lower the dose, you keep it low? I don't understand "bouncing" thing. So she bounces high because she went to so low? I thought you lower it once... maybe that's my mistake here.
 
SSSMom said:
So, if you lower the dose, you keep it low?
Click to expand...
Yes. If they earn a reduction that becomes the new dose. So if you were doing 2 am/pm and it went too low, I believe protocols would say they earned a reduction. So the new am/pm dose would be 1.75 until they earn another reduction or the numbers creep up and need to be
Raised.

Have you decided if you want to do TR (tight regulation) or SLGS (Start low go slow)? Whichever protocol you choose would tell you how long to hold a dose.
SSSMom said:
I don't understand "bouncing" thing. So she bounces high because she went to so low?
Click to expand...
Exactly! It's the body's way of protecting itself by releasing stored glucose. I have a bouncy kitty, too.
 
Janet responded about the dosing. You have been moving between 1.25-2. You need to pick a dose to stick to unless a reduction is needed and that 44 on a human meter calls for a reduction with a under one year diabetic. With a long term it’s three times under 50.
 
JanetNJ said:
Pretty sure this higher numbers are bounces from going low. His body is releasing stored glucose to keep from going too low.
Click to expand...
JanetNJ said:
Yes. If they earn a reduction that becomes the new dose. So if you were doing 2 am/pm and it went too low, I believe protocols would say they earned a reduction. So the new am/pm dose would be 1.75 until they earn another reduction or the numbers creep up and need to be
Raised.

Have you decided if you want to do TR (tight regulation) or SLGS (Start low go slow)? Whichever protocol you choose would tell you how long to hold a dose.

Exactly! It's the body's way of protecting itself by releasing stored glucose. I have a bouncy kitty, too.
Click to expand...

Thanks. Given that she is recovering from DKA, it was my understanding that I want as much insulin in her as she will tolerate because the insulin counteracts the ketones. Is that not correct? I'm sorry that I wasn't clear in my first question, but I permanently lower it now while she has trace ketones? This is the big mystery to me!

Can I start a protocol while she is sick? I like the SLGS one, but I am afraid to with DKA and like I mentioned/wanting to have insulin in her--my vet is telling me to do 3u twice a day and my family member vet (who knows a lot about felines and diabetes) is telling me to start at 1u twice a day and do curves every other week to determine dosing.
 
Doses go up and down throughout the journey. No one dose to give forever.

Bouncing happens 1. Cat starts hitting lower numbers it's not use to and body panics an releases stored up glycogen which will cause higher numbers again for awhile. 2. If there is a large drop in numbers in short time (i.e., 329 to 50 in 3 hrs). 3. Sometimes a long stretch of the greens they are not use to can cause higher numbers next day. Ollie did this on 7/1 beautiful 24 hrs of greens with blue preshots. Then right up to higher numbers.

Lantus is based on lowest dose during the 12 hr cycle. But it doesn't mean you change dose each shot time.

I think as others said above, you need to lower dose since reduction was earned and hold it unless a test indicates another reduction is earned, OR numbers are climbing and increase is needed. The protocol you follow will determine when and how much. Ollie has been between 4.5 and 8.75u for 2 yrs. Up and down, up and down, but she has many issues that causes the changes. Lately we are on the downward slide. Pretty safe bet with her it won't last and we will go up again.

You don't want to skip or miss insulin, not just as much as she can handle, but enough to keep her in as normal range as possible. Not enough causes DKA, and starts to damage other organs mainly the kidneys. To much can be deadly. That's why the home testing.
 
Olive & Paula said:
Doses go up and down throughout the journey. No one dose to give forever.

Bouncing happens 1. Cat starts hitting lower numbers it's not use to and body panics an releases stored up glycogen which will cause higher numbers again for awhile. 2. If there is a large drop in numbers in short time (i.e., 329 to 50 in 3 hrs). 3. Sometimes a long stretch of the greens they are not use to can cause higher numbers next day. Ollie did this on 7/1 beautiful 24 hrs of greens with blue preshots. Then right up to higher numbers.

Lantus is based on lowest dose during the 12 hr cycle. But it doesn't mean you change dose each shot time.

I think as others said above, you need to lower dose since reduction was earned and hold it unless a test indicates another reduction is earned, OR numbers are climbing and increase is needed. The protocol you follow will determine when and how much. Ollie has been between 4.5 and 8.75u for 2 yrs. Up and down, up and down, but she has many issues that causes the changes. Lately we are on the downward slide. Pretty safe bet with her it won't last and we will go up again.

You don't want to skip or miss insulin, not just as much as she can handle, but enough to keep her in as normal range as possible. Not enough causes DKA, and starts to damage other organs mainly the kidneys. To much can be deadly. That's why the home testing.
Click to expand...

Thank you. This is helpful. So, it is my understanding that when you have DKA, you use insulin much more--to regulate regular blood sugar and then to destroy ketones. I think that's where I am at a big hang up. That I should want to give more/keep it higher. But you're saying that the dosage should only be based on bg and not present ketones? Sorry--I just want to be completely clear before I disregard my vet's advice and the emergency vet's advice.
 
SSSMom said:
Given that she is recovering from DKA, it was my understanding that I want as much insulin in her as she will tolerate because the insulin counteracts the ketones. Is that not correct?
Click to expand...
Hi, it is the case that insufficient insulin is a contributory factor in the development of ketones in those kitties who are susceptible. For this reason, it is certainly important to try to ensure that the kitty has 'enough' insulin (and also enough food - insufficient food can also be a factor. If there's not enough available food the kitty's body tries to break down fat for energy; and that produces ketones). But if the blood glucose drops 'too' low then the insulin dose does need to be reduced, albeit with caution (or, in some situations - as I understand it - the carb content of the food may be increased, but I'm a bit hazy on this...). It's a matter of finding a balance...
I'm going to tag a member who has VERY much more knowledge and experience of ketones and DKA than I do, @Bron and Sheba (GA). She's in Australia, and so may not be able to comment until tomorrow ('tomorrow' in Northern hemisphere time, I mean).

SSSMom said:
She still has ketones coming and going (haven't caught any pee but I smelled it on her breath last night).
Click to expand...
You could consider getting a ketone blood test meter, and these are VERY much more accurate than testing pee. The ketone tests are done the same way as blood glucose tests. I'm not sure which ones are used in the US (is that where you are?) but I'm sure others will chime in with suggestions.

Chin up. I do understand that it is hard. But you are doing great. Reassuring (((hugs))) to you.
 
Last edited:
Yes you can and should start protocol now. Definitely not the 3 units, but I think you could do 1 safely as the 1.25 looks like it dropped to the 44. Keep that dose at least 3 days unless it proves to much. Re evaluate after the 3 days and see where you want to go.

Your sort of correct. You don't give an insulin dose based on ketones. You give insulin because of ketones. But the insulin dose is based on glucose tests. Once dosage is consistent, no infection of any kind (even pancreatitis), and cat is eating, and glucose begins to stay lower, the ketones will leave. Extra water in food or subq fluids will help keep them flushed. But must be cautious with subq.
 
I use a blood ketone meter. Works just like a bg meter. I bought it on amazon. I use the keto MOJO meter, but there are others. The ketosens got good reviews add well. The benefit is you don't have to catch them peeing and it gives you an accurate on the spot number any time you need it.
 
No reason not to go with SLGS. Your reduction number will be under 90. Take the reduction and then stick with that dose for a week unless another reduction is earned. Only caveat is not to take back to back reductions.
 
Thanks all. Super helpful. I've been so lost thinking that I need to try to keep my insulin #s maxed out and not understanding how to move forward.
I bought a blood meter the other day but it hasn't arrived yet. We've been doing urine testing for years and I haven't hated it until now when I urgently want a number and can't catch any pee.
Can't wait to only shoot 1u tonight!
 
SSSMom said:
Thanks all. Super helpful. I've been so lost thinking that I need to try to keep my insulin #s maxed out and not understanding how to move forward.
I bought a blood meter the other day but it hasn't arrived yet. We've been doing urine testing for years and I haven't hated it until now when I urgently want a number and can't catch any pee.
Can't wait to only shoot 1u tonight!
Click to expand...
I might start at 1.5. What does everyone else think??
 
JanetNJ said:
I might start at 1.5. What does everyone else think??
Click to expand...
Yes. We take .25 reductions normally so I might even consider 1.75. If you shoot less than that and numbers go up dramatically please post for guidance as to dosing. If would be good to start posting on the Lantus board as well and link this post
 
tiffmaxee said:
Yes. We take .25 reductions normally so I might even consider 1.75. If you shoot less than that and numbers go up dramatically please post for guidance as to dosing. If would be good to start posting on the Lantus board as well and link this post
Click to expand...
I thought I was on the lantus board. Can you please point me to it? Thanks!
 
I’m so sorry. You are in the right place. When I saw people not familiar with Lantus I assumed but was wrong. I ordinarily only check the Lantus board but lately have been checking both. So sorry to confuse you.
 
I can't say if it should be 1.5, that dropped her to 51 in the evening without having insulin that morning (7/11). As long as you can test and monitor.......
 
SSSMom said:
Adding, I was also scared because her other numbers are so high. Is that not the right thing to do?
Click to expand...

Think of it as the pancreas is under attack. It's going to have good days and bad days. As it starts to heal, rest and recover the good days will start to lengthen. it takes time to find the happy medium. You will get there and you will begin to understand as you go along.
 
Olive & Paula said:
I can't say if it should be 1.5, that dropped her to 51 in the evening without having insulin that morning (7/11). As long as you can test and monitor.......
Click to expand...

Can you please check my spreadsheet again? One of my numbers was deleted. I think I accidentally deleted it when I added a remark. We shot 2 in the PM of the 11th. She missed one dose, and since we delayed 5 hours, I added it to the PM dose.
 
With all the dose changes, I agree I'd start at 1.5 and hold that dose for at least 6 cycle (unless she drops below 50)

Lantus craves consistency and works best when the dose is the same both AM and PM.

With ketones in the picture, you don't want to skip unless it's absolutely necessary due to dangerously low PS numbers but one thing to remember, when we're dealing with a recently DKA kitty, even if you have to feed a high carb food for safety, it's important they get at least some insulin.
 
Olive & Paula said:
What insulin are you using? Humulin (on ss) or Lantus (signature) and I think you mentioned it above.
Click to expand...

We are using Lantus and have been for quite a few years. In my spreadsheet, I mention Humulin in some of the notes because the emergency vet was pulsating with Humulin.
 
Kristy -- welcome to FDMB and the LBL board.

I'm going to apologize in advance if I'm being repetitive but I want to be very clear about one issue -- DKA trumps just about everything. It is life threatening. First and foremost, are you testing for ketones? There are 2 ways to test: you can test for urinary ketones or blood ketones, the latter of which requires a ketone meter. If you are not testing, please make a trip to the pharmacy and get a package of Ketostix. It is the best preventative test you can have. I am worried that you smelled ketones on Simone's breath. That is never a good sign. Any level of ketones above trace is more than what you should try and manage at home. In many post-DKA kitties, they can easily re-develop ketones which is why people here are being very cautious.

Ketones typically develop due to some form of infection or inflammation + not enough calories + not enough insulin. It sounds like you understand the basics. However, due to the "not enough insulin" part of the equation, it is risky to skip a shot. If pre-shot numbers are lower than expected, you can stall -- do not feed Simone -- and see if numbers are rising. For example, you didn't shoot the 77 at AMPS on 7/12. The +1 was 137 which could be a very shootable number. Offhand, I can't really figure out why you shot some lower doses (e.g., PM dose on 7/9).

Someone commented above that some of the numbers (e.g., those in the 40s) would warrant a reduction. That's not the case. Your kitty is a long term diabetic. IF you are following the Tight Regulation Protrocol which is a more aggressive approach to dosing and what I would recommend in a post-DKA cat, long term diabetics do not get a dose reduction until their numbers drop below 40 or they are in the 40 - 50 range on 3 separate cycles. That said, we put safety above pretty much everything including DKA. It can be challenging to try to weigh what to do with low numbers in a cat that is prone to ketones. Stalling or shooting a temporarily reduced dose may be necessary or it may be worth considering propping the test numbers up with food. Each situation can be different.

On your spreadsheet, you note that Simone had a "hypo." Was she experiencing symptoms of hypoglycemia or are you referring to low numbers? We make a distinction between a symptomatic hypoglycemic episode vs low numbers.



@Olive & Paula - the SS says Lantus. It's possible that they were using Humulin (likely R) when Simone was hospitalized. It's commonly used with DKA and other health issues since it's short acting.
 
Hi, Thanks for the response.
We do test via urine strips but have multiple cats and my daughter has an ear infection and is demanding we hold her, and we're both working today. So, we think she probably peed but we haven't been able to catch or dip it. I ordered a blood ketone meter last week and it has yet to arrive. Luckily, the smell went away from her breath and she almost took my eye out a couple hours ago when I pried her mouth open to check.

Yes, prior to being hospitalized for DKA, she had symptoms of hypo. More recently when she had the numbers in the 40s and 50s, she was cold (wanted to lie outside and it is 100degrees here) and lost some of her pretty pink coloring. We force fed. We were told that we need to be careful with the calories because of her pancreatitis (so not propping the numbers up with food as much as we'd like to). She is free feeding her regular friskies pate and tiki cat. We water down the friskies.

We lowered the dose that couple times because we were worried of long-lasting effects of hypo and didn't want her to hypo again. Didn't know that changing the dose would be so detrimental according to this group. I now understand.

So, she's due for a shot in 1h and just tested at 437. We gave her her friskies because she's acting like she's starving. She was fasting for 2h before that. What do you suggest we shoot?
 
I will try to read up on the tight regulation protocol, but I'm not sure that I'm going to have time today. I studied the SLGS one and feel comfortable.
 
Sorry I didn’t answer the tag earlier. I see you have been given lots of good advice. I agree with Sienne that DKA trumps everything. I think you would be better following TR at this point as you may need to adjust the dose if ketones appears.
You can always rub honey or Karo her gums if she drops low and won’t eat.

I think you would be fine to give the extra calories to prop her up’. That is what is needed withDKA. Simone needs up to 1 1/2 times as many calories as normal to combat the ketones and for you to be able to give the insulin. That is the treatment needed when you get home with a DKA kitty. And a lot of DKA kitties have pancreatitis.
Are you offering multiple small meals during both cycles? :bighug:
 
Last edited:
Bron and Sheba (GA) said:
:spam:Sorry I didn’t answer the tag earlier. I see you have been given lots of good advice. I agree with Sienne that DKA trumps everything. I think you would be better following TR at this point as you may need to adjust the dose if ketones appears.
You can always rub honey or Karo her gums if she drops low and won’t eat.

I think you would be fine to give the extra calories to prop her up’. That is what is needed withDKA. Simone needs up to 1 1/2 times as many calories as normal to combat the ketones and for you to be able to give the insulin. That is the treatment needed when you get home with a DKA kitty. And a lot of DKA kitties have pancreatitis.
Are you offering multiple small meals during both cycles? :bighug:
Click to expand...

Appreciate the response. Yes, she is eating SO much. Prior to her hospitalization, she was eating 3x a day, about 8oz of Friskies pate watered down with equal parts water and food and she ate/drank it all. Now she's eating maybe 5x a day, a little bit of a smaller meal, but probably 10oz or so and I included Tiki Cat to mix it up a bit for her.
 
SSSMom said:
Appreciate the response. Yes, she is eating SO much. Prior to her hospitalization, she was eating 3x a day, about 8oz of Friskies pate watered down with equal parts water and food and she ate/drank it all. Now she's eating maybe 5x a day, a little bit of a smaller meal, but probably 10oz or so and I included Tiki Cat to mix it up a bit for her.
Click to expand...
You are doing a really super awesome job with her!!
 
All sounds good. When you post tomorrow would you please include the date, her name, amps## in the subject so we know it’s you. Oh. And link this post to the new one. Thanks. I hope there’s even more improvement tomorrow.
 
You must log in or register to reply here.
Back
Top