Relevant Think Tank Thread

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Joanna & Bix (GA)

Joanna & Bix (GA)

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There is some controversy (of course!) in this thread as well as some graphic stuff, so not an immediate read for anyone who is already stressed out, but I think this thread has some really good points, and good discussion of some of the issues we seem to be grappling with here a lot.

Topic is risks of DKA vs hypo, dosing controversies, etc. - Steve & Jock thread with several other expert voices (not mine!) chiming in.

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Yup, I thought that's the one you were refering to.

Here is the first post in that thread. Please read all of it before you make an opinion. I agree a lot with what is said here. I personally got tired of seeing high and flat numbers with Oscar, and have become a much more aggressive doser because I got tired of it and stopped being scared of a potential hypo. Arm yourself with knowledge and a hypo tool kit, and as long as you make small changes, you will be able to catch anything that will happen long before it becomes a life or death emergency.

The longer I do this, the more I feel like Dr. Hodgkins!

Postby Steve & Jock » Mon Jul 05, 2010 7:00 am

I am getting more and more sympathetic to Dr. Hodgkins' way of thinking, guys. Maybe this disqualifies me from giving advice, but here, from the not very scientific but very practical way of thinking, are my empirical thoughts.

1. Lots of diabetic cats get DKA, which is heartbreakingly expensive to treat and often kills. It's usually through underdosing. We see DKA deaths here, what, every month? Every week?

2. I've been here 5 years plus now, and the number of cats I've seen die from hypo is, um, less than a handful. Even on Dr. Hodgkins' site, and they are notably not very cautious about that.

3. Plenty of cats come home from the vet with an incorrect dosage, usually too much insulin, and they DON'T DIE FROM IT. They might rebound, or feel bad. But we don't get a lot of actual hypo coma reports.

4. A lot of people on this site spend weeks, months, and sometimes years starting low, going slow, and not finding a dosage that keeps their cat anywhere near euglycemia. What they get instead is outpourings of love and undertstanding, which is good but doesn't make the cat feel better.

You see where I'm going with this? The culture on this board is way too cautious on insulin dose, and the resulting hyperglycemia is leading too far in the other direction. And we still seem to view DKA as just one of those things that happens. The primary cause of DKA (look it up) is insulin shortage. And it's way more dangerous than a hypo.

I am absolutely sure that I have given Jock 20-30% more insulin than he needed on various occasions. He's handled it just fine, generally just eating a bit more. But if I had given him 20-30% LESS than he needed, he would have had a vicious circle of hyperglycemia, glucose toxicity, and dose instability. A DKA waiting for a trigger.

And that seems to be a lot more common here than a hypo.

Dr. Hodgkins used to say that cats never hypo, and it was better to shoot through rebound than to try to outguess it. We were horrified because we knew cats COULD hypo, and we had seen that rebound doesn't fix itself.

But I'm starting to think her method makes more sense anyway. It makes me really sad to see all the underdosed cats, honestly.
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While I'm not an expert by any means, what I've found with Shaikha is that she can take a lot more insulin than I think she can. Even my vet has been amazed at how much she can take without throwing a hypo, especially when she's sick. Look at her SS from 7/24 if you want to see a wild ride in BG levels for one day (not to mention dosing)! Yow. She's not your typical cat by any means, and thank goodness she's not thrown ketones, but this thread is a good cautionary reminder for myself and others that underdosing is something to be feared as well.

Just from a newbie perspective, one of the first thing that people notice when they visit the boards are the nice stickies on HYPOS -- they can kill! Since that's one of the first things you see, naturally people are going to focus on that and try NOT to give too much insulin for fear of killing their cat from a hypo. There isn't as much there on DKA, possibly because that's a much more complex and difficult subject to explain.

At any rate, I liked Joanna's starred thread on DKAs but would recommend that it be added to the stickied area so that people see that in addition to the info on hypos in the general area. In the short time I've been frequenting FDMB, there have been a number of cats going into DKA but as Steve & Jock point out, I've not seen as many hypos. Naturally balance is essential, because you don't want to give more insulin than is truly needed, but having both conditions emphasized I think is a good idea.

Then again, after reading the info on DKAs and when you should test for ketones, I probably test constantly for them with this girl! :shock:
 
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