Should I give insulin?

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ShannonandBiscuit

ShannonandBiscuit

Member Since 2019
Biscuit and I have been working on his sugar and insulin, and normally he's a great eater. Today, his sugar AMPS was 401 but then didn't come for breakfast. When he did, he didn't eat his breakfast. Seems to have diarrhea outside the box around the house in a few places. Has vomited just liquid. He looks ill and has alternated between back arched looking like trying to poop and laying down. He has an appointment in an hour at the vet, but I am wondering with a sugar of 401 since he didn't eat should I give him his insulin? Just trying to keep things on track till his appointment.
 
Shannon, I haven't used Novolin, but I have read that food needs to be on board before an injection.

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/

From the Beginner's Guide to Novolin:
It's a good idea to feed your cat an hour before giving insulin. This is to ensure there is food in the cat’s system for when the insulin starts to work, and to help ensure that the BG doesn’t drop too fast or too low. Not all cats will experience a fast BG drop with N/NPH, but until your testing data shows otherwise, it is wise to assume that this may be the case with your cat.

Is there any possibility that you would consider a different insulin for Biscuit? Novolin is less expensive certainly, but it's a very harsh, fast acting, and doesn't usually last the 12 hours between shots. I realized there is always the issue of expense and Novolin is better than nothing.

I just looked at your spreadsheet and the BG doesn't seem to be coming down that much from the reds and mostly pink BG levels. You might talk to the vet about alternatives. We can help with suggestions for cost saving if you decide on a "depot" insulin like Lantus, Basaglar or Levemir. Prozinc is also an alternative, it works like Novolin..and "in & out" insulin, but it's gentler and longer lasting than Novolin.

Good luck with the vet visit today. Please come back and tell us what vet says and you decide to do for Biscuit.
 
@ShannonandBiscuit would you please remove the 911 from your thread title. It's for an emergency like really low numbers or a hypo situation. I realize you needed an answer right away, but you have moved past the concern now. How did the vet visit go?
 
Go up to your thread title and look over to the right, "Thread Tools". Edit title to No Prefix. Save the change you made.
 
Thank you. I've changed it. Well vet visit was stressful but over. I took him in and without basically doing anything they recommended we take him to the ER hospital. They said they send their blood work out for testing and so they felt his should be tested sooner. ER stated he does have a mild case of DKA. Very frustrated. We are definitely switching him to Lantus. Basically, I wanted to switch him weeks ago when I read up on the forum on Novolin, but his vet said give it some time before switching. (our other cat is hyper thyroid and they said let's see what his numbers are when you come in for her visit) So I couldn't get the prescription for Lantus. At this point, I probably should have insisted (trust your gut.) but I caved to my vet. Hindsight though...

For now, he's admitted to the ER Hospital - She said it was a mild case and would "probably" only take 1-2 days of him being there to get him back on track. She then said he definitely should be changed to Lantus and I agreed.
Trying to not freak out. I know he "should" be fine, but I feel somehow like even with the home testing and etc that I should have seen the signs sooner.
 
Oh Shannon, first :bighug::bighug: next, he's in the best place right now. Please don't freak out, there have been many kitties though here with critical DKA and they have come through with good treatment and care. Don't blame yourself, please. That's wasted energy and guilt never went back and changed anything.

You can be prepared for his homecoming with DKA care and proper supplies. Get some Ketostix from the pharmacy so you can test his urine for ketones at home (if you feel you can get a sample when he uses the box). Read about Lantus and how it works HERE. Ask as many questions as you like or need.

I will find the info on testing ketones in urine..be right back.
 
Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):
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 favorite part of the litter box and poke some depressions in it too catch pee.
Use aquarium gravel or even lentils in the litter box
Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the color change in very good light.

If you aren't able to get urine samples, there are ketone meters that work just like your glucometer, from a blood sample. Some members use the Keto Mojo. Check online (Amazon??) for brands, models, prices. The strips are expensive, but you will know what's happening.
 
ShannonandBiscuit said:
I feel somehow like even with the home testing and etc that I should have seen the signs sooner.
Click to expand...
I didn't see it with my kitty , and she went DKA, and so many more others here, :bighug:,
no self blaming is due, please.
I am glad to hear that they assessed it as mild.
My Ducia was critical and was at the clinic for only 24h and recovered nicely.

The recovery time and home nursing might be intense for the start.
I urge you to use the time now -while B is hospitalized- and get all supplies you'll need
and read as much as you can here. You 'll be advised to follow up with your regular vet a few days in.
It'll be easier for you to establish a treatment plan with your vet if you have an idea as to what DKA recovery at home may look like. Ask us any questions.

Very best wishes for speedy recovery!
 
I am going through posts from members that have administered home care after DKA and will share what I find:

Here are the basics of recovery treatment at home:
  • kitty needs calories - up to 50% more than normal - to prevent ketone formation from metabolic breakdown of body fat and muscle (you might have to syringe feed)
  • during recovery wet food should be high enough in carbs to support a large enough insulin dose to prevent ketone formation - maybe mid range carbs (10 - 15%?)
  • insulin in a large enough dose and do not skip a dose - ask for help in deciding on a lower dose if PS is lower
  • hydration is very important - add extra water to all wet food meals and/or give subQ fluids in amounts appropriate for the kitty (be careful if there are cardiac issues - ask the vet)
  • use meds as needed: 1. antinausea/vomiting (Cerenia or ondansetron); 2. appetite stimulant (mirtazapine or cyproheptadine) if anti nausea meds alone aren't enough; 3. diarrhea meds if that's an issue (metronidazole or tylosin)
  • test urine for ketones at least once a day for the first week home or so
Know that recovery can be slow and it could be weeks before your kitty is back to normal.
****************************************************************************
This is a thread about our sweet little Alice, a kitty who was in critical DKA and you may care to read a little about what Cassandra did to help her. BTW, Alice is fully recovered, gained her weight back and is her little beautiful self again.
http://www.felinediabetes.com/FDMB/threads/home-care-after-dka.212964/

This is not meant to frighten you, quite the opposite. Biscuit is not in the same condition as Alice was, and you can be more prepared and educated than Cassandra was because she was just suddenly in the middle of that storm without any preparation to speak of. You have a few days before Biscuit comes home to get ready. Plus, you know you have people here to help you while you are caring for him.
 
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ShannonandBiscuit said:
he's admitted to the ER Hospital - She said it was a mild case and would "probably" only take 1-2 days of him being there to get him back on track. She then said he definitely should be changed to Lantus and I agreed.
Click to expand...
Are you planning on visiting?
You can try asking the ER vet for Lantus Rx.
Preferably - in a form of Solostar Pen, not vial.
:)
Do not explain/omit why your reg vet didn't; tell her you would like to have the script to start shopping around for the best price BC Lantus is extremely expensive. If you Rx w/ Solostar pen you can start calling around the nearest pharmacies like Walmart, Walgreens, CVS, COSTCO and ask if they are willing to break a pack of 5 and sell you only 1 pen, it's about $80-90 ea. The entire vial or whole pack of pens costs twice less in at Mark Marine's. The shipping might take up to over a week.
@ShannonandBiscuit
 
Thank you all so much for the kind words. I was definitely in a state yesterday. We have secured his Lantus. The vet at the ER gave us a prescription no problem. They are scheduled to release him at 8pm tonight and I'm trying to determine what all I need to have on hand. He was always a good eater. It was only that last morning he only ate maybe 1/4 of his food. They say he's eating WD at the hospital. The vet reported they had tried 1u of Lantus and that was bringing him down to 200 at the low and 330 at the high so they were going to try 1.5u and if they liked his numbers to release him tonight. I have read the posts above and I am just trying to be prepared when he gets home. We were supposed to attend a Birthday party tonight but not sure that's possible. Again - thank you all for the support.
 
So glad he’s doing well and coming home! The most important thing is that he eat and get his insulin. Ask the vet for a syringe and some AD food in case you need to assist feed, and some anti nausea and appetite stimulants can help too. Also be sure to pick up the ketostix Lou (Idjit’s Mom) suggested to test his urine for ketones.
 
Shannon, I am so very happy to hear that Biscuit is doing better and will be coming home. I think I would have a feeding syringe on hand, just in case he needs some assisted feeding. Getting enough calories into him is very important. Doesn't matter as much right now what he's eating, high or low carb..he needs to eat and diet can be assessed and addressed when he's recovered.

I would suggest that you post in the Lantus forum, regarding the increase in the insulin dose. Lantus is a depot insulin and needs a few days to a week to build up the depot, you (and vet) are not going to see immediate BG reductions. You don't want to be bumping up a Lantus dose too high, too fast, and risk a hypo.

Wendy & Neko is very experienced with Lantus and you can tag her by using the @ and then beginning to type Wendy. A little menu will come up and you can click on her user name. Bron and Sheba in Australia is on in "our" nighttime, and is knowledgeable, same for MrWorfmen's Mom in Eastern Canada.

I just read @Sharon14 response re: anti-nausea and appetite stimulant meds, very good suggestions. Have your little DKA recovery kit prepared, all right there at home where it may be needed. Then you don't have to revisit the ER clinic, run to the pharmacy etc.
 
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