Sick kitty, not DKA ....in hospital, home!

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nancy and payne

nancy and payne

Member Since 2010
For those of you who have followed Payne's FOURTH DKA episode, she is home and doing well .... my question is about her dose. When she was in ER they gave her 40u of R over two days but no Lantus .... when she went into DKA she was on 3u b.i.d. for 12 days, down from 12u of pzi she had been on for months. Later I need to go into why she has only gone DKA on lower doses of insulin but now I need help with her dose.

Yesterday when I picked her up in the afternoon, they had given her 4u of Lantus at 9AM and he wanted me to give her 5u at her evening shot but that didn't seem right to me, so I only gave her the 4u. My question is even though she was on a high dose of insulin in ER, it wasn't Lantus .... isn't he moving her up too fast? he feels Lantus can be moved up by 1u at a time ....she has never run low #'s but I had been able recently to get them in the 200's.

I am just going to give her the 4u this AM but how long do I need to wait because he thinks that if the DKA is related to her not getting enough insulin a day, then he wants to get her back in the 12u? daily. And since we are not looking for the sweet spot, just trying to get more insulin into her, is there a different protocol? When she was on 12u daily, some of that was R.

Thanks for the input, she looks worn out, poor baby and once again her civvies are hissing at this strange cat! ohmygod_smile
Nancy and Payne, loving being home!
 
Re: Sick kitty, DKA ....now home, dose question ....

Hi guys .. so glad payne is home now! I don't have much in the way of advice for what you are looking for .. I am sure others will be here soon to explain things ... Just wanted to bump this up and say I'm hoping this is the last bout of DKA payne ever has!
 
Re: Sick kitty, DKA ....now home, dose question ....

The type of insulin determines how fast it works in the body, so changing types may or may not result in a lower daily dose. It should, however, result in more stable glucose levels.

Typically, a dose is held 3-5 days before stepping up/down, as you need the shed to stabilize at the new dose.
Given her recent DKA, I suspect the vet wants the insulin increased more quickly.

Edited to remove subsequent text.
 
Re: Sick kitty, DKA ....now home, dose question ....

ps. Your spreadsheet link isn't working, or I'd look at it.
 
Re: Sick kitty, DKA ....now home, dose question ....

Hi Nancy & Payne. We are so glad that Payne is home. Your question is complex and should be answered by some of our most knowledgeable people and I'm sure they will be along shortly. I would only like to bring up the question of Payne's previous PZI dose vs. her Lantus dose. It seems as if Payne was on a huge dose of PZI (you say some of those units were R; do you know how many?) Was it PZI Prozinc? (there is more than 1 kind of PZI; PZI Vet is discontinued, but you can still get various types of compounded PZI, I believe). Anyway, the issue of dose approximation might be important: how does PZI compare to Lantus unit by unit? Was your PZI a U-40 insulin? (Lantus is a U-100 insulin and needs to be given in a U-100 syringe. If you were using U-40 syringes with Lantus, your Lantus dose would be way too much.) I hope one of our experts will be able to help you out. I have no experience with DKA, but many people here do.
Good luck, and I hope that you can get everything straightened out.

Ella & Rusty
 
Re: Sick kitty, DKA ....now home, dose question ....

Before we switched to Lantus on 3/9 she was on ProZinc 2.5u b.i.d. with 1.5u b.i.d. that SS is https://spreadsheets.google.com/ccc?key ... l=en#gid=0 I know that ProZinc is a U-40 and that Lantus is a U-100 ....I had just ordered new U-40 syringes! I know this is complex, what I really need to know is for a high dose kitty is there a different protocol for increasing the dose on Lantus, esp. one who has just gone through DKA? He seems to feel this needs to be done in 1u increments to get the dose up. My SS should be working.
Thanks
Nancy
 
Re: Sick kitty, DKA ....now home, dose question ....

Hi Nancy: I glad she is home. I'm sure Libby or Sienne will be along later (they both work) and help you. Meanwhile, this was posted in another condo the other day by Sienne regarding dosing with high numbers,

According to the revision in the Tilly Protocol (this happened over a year ago), you can increase the dose in as short a time as 4-cycles and if nadirs are consistently over 300, you can increase the dose by 0.5u.

Hope you have a good day.
 
Re: Sick kitty, DKA ....now home, dose question ....

BJM said:
Given: 40 units over 2 days = 20 units over 1 day = 10 units q. 12 hours of R
Maybe this might work:
8 R : 1 Lantus for 9 units total (not 10 - want some room to reduce odds of adverse effects!)
7 R : 2 Lantus
6 R : 3 Lantus
and so on.
Click to expand...
I will look at your spreadsheet when I can (I'm at work) but I want to say NO NO NO NO NO don't give 8 units of R. Unless Payne is an acro cat (and maybe even if she is), that amount of R will kill her. They can do it at the vet because they have IV dextrose available, and they might have been using it while they were giving that amount of insulin. That IS the proper way to treat a DKA cat in the hospital.

I think Nancy already realizes this because she has used R in the past, but R and Lantus are very, very different insulins and the doses cannot be compared in any way. My acro cat is on 11 units of Levemir, but even 0.25 units of R can drop her too much. I gave her 0.5 units once, and I doubt I will ever give her that much again. There are indications on your SS that even 1.5 was too much R. I promise I will come back to you after work, ok?
 
Re: Sick kitty, DKA ....now home, dose question ....

I want to underscore Libby's advice. 8u of R could easily be lethal. I'm not sure what BJ was basing that suggestion on. A dose of R needs to be VERY carefully worked up. (Nancy -- sorry if I'm preaching to the choir and you know this. There are many people who lurk or who are newbies to the use of insulin and would blithely go out and purchase R and shoot a whopping dose to bring down numbers. Needless to say, it's a bad idea.)
 
Re: Sick kitty, DKA ....now home, dose question ....

I have used R A LOT! and I would never shoot that much! especially adding it to an insulin that builds a shed.
What my concern is ... did the 1/2 reduction in insulin (even though they are different insulins) create an imbalance that eventually caused the DKA, once again? When she was on high doses she never went into DKA. There may be other factors at work (low K, still haven't ruled out pancreatitis) but are higher doses somehow protecting her from DKA and how can we get up more on Lantus. (vet wants to move faster)

Payne is a very unusual diabetic cat. She was Dx and immediately went into DKA a day later on 1u b.i.d. Spent 7 days in ER came home for 2 days went DKA again stayed on 1u spent 5 days ER, came home for three days went into DKA again spent 3 days in ER dose upped to 3u ProZinc b.i.d. plus 1u R b.i.d. After that we had ketones but were always able to stay out of DKA by using more (not 8u!) R and SQ .. for 19 weeks she did not go into DKA. Then we changed vets and insulins and her dose was reduced to 2u b.i.d. then vet decided to raise to 3u b.i.d. because of her history ..... 10 days later we could not keep her out of DKA, although she has responded really well to Lantus .... well, except the DKA thing ohmygod_smile
Nancy and Payne, so happy to be home!
 
Re: Sick kitty, DKA ....now home, dose question ....

libby, thank you for your comments about R!
BJM, with all due respect, your R advice is very dangerous.

nancy, i'm happy to hear payne is home!

i have a few questions which may help myself and others when offering suggestions. i haven't been on the board a lot lately so i apologize in advance if you've already answered these questions.

  • has any infection been found recently? if so, is payne being treated with antibiotics?
  • do you have sub-q fluids you can administer to payne if necessary?
  • is payne eating well?
  • do you have an ample supply of karo, hc foods, bg test strips, and ketostix on hand?
  • are you available to monitor payne closely?

when a kitty is as prone to developing ketones and falling into DKA like payne, adequate insulin becomes a necessity. "protocol" will often be thrown out the window. probably one of the best spreadsheets i can use as an example is grace's: http://spreadsheets.google.com/ccc?key=0Ah416fWwiPUwdHc0RzFnRkVZaHlwNkRSYjlVSVpVWkE&hl=en#gid=0. you'll notice how hollis had to "ride the edge" with grace by continuing to give her enough insulin when by "protocol standards" the dose should have been reduced. instead, hollis fed the curve using high carb foods and sometimes karo to the lows rather than decreasing the dose.

have you done any spot checks since shooting 4u into this morning's ps number of 284? a few spot checks today will yield more info.

if payne were my cat i wouldn't hesitate to increase the lantus dose to 5u bid as your vet suggested (unless 4u is dropping her enough).
i think her starting dose of lantus was probably too low. however, i would test, test, test and would be prepared intervene if necessary.

i have to wonder if there's some underlying cause of infection somewhere... something that has yet to be discovered.
 
Re: Sick kitty, DKA ....now home, dose question ....

hi Nancy

I'm glad to see the updates and that Payne is home.
a quick question, would you be able to get a couple of spot checks in before PMPS today? I'm not sure if you are home, but if you can ok?
that will help those helping you out.
 
Re: Sick kitty, DKA ....now home, dose question ....

just stopping in to say truly glad Payne is improving!

celi & binks
 
Re: Sick kitty, DKA ....now home, dose question ....

BJM said:
Y'all, did you notice I said MAYBE, and asked you to chime in???
Click to expand...
BJ, with all due respect, this is not the think tank. If you wanted to toss out an idea like this, that would be the place to do it....not here, where there are newbies reading and not necessarily posting. Someone following such a dangerous strategy would most likely kill their cat.

In addition, *I* have no personal experience with R or DKA, so I clearly state that when I respond to such questions in a thread like this. It is both dangerous and irresponsible to give someone the impression that you have the knowledge and experience to guide them when you don't.
 
Re: Sick kitty, DKA ....now home, dose question ....

Hi Nancy glad Payne is home...

This forum uses a modified protocol and you are getting some really good advice. In Payne's case it might be beneficial to review the older protocol... http://www.tillydiabetes.net/en_6_protocol2.htm

Phase 1 The cat should be monitored closely on the first 3 days on Lantus/Levemir: do curves between the AM and PM-doses, e.g. AM pre-shot, +3 hours, +6 hours, +9 hours, PM pre-shot. Generally the starting dose is kept for 3 days. Test for ketones daily. Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours).
Click to expand...

and this part here too:

Phase 2 Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
Click to expand...

And of course....Test, test, test....
 
Re: Sick kitty, DKA ....now home, dose question ....

Okay let me try. During the first 8-9 days on Lantus I did a curve almost every day. On the 11th. day she went into DKA. We also checked for ketones, which she always seems to throw off, periodically. On Sunday when she went into DKA she went from moderate down to small, very weird. Interesting the vets checked her ketones on the same meter I have .... :o

She has not been tested for any of the high dose conditions, that was next on my list, in fact I was reading the stickys last night. No infections. I do have SQ fluids and Payne is eating well! she loves her food! I have plenty of everything but Payne has never run low, never. I do monitor close butdon't want to put her through more than she needs, or around 3X a day. At this point I am not trying to lower her #'s I am trying to keep her out of DKA .

My vet is rooting for pancreatitis, just so we have "something" to treat ..... ohmygod_smile I am so confused I am almost ready to go back to ProZinc because I understand it and it doesn't need to be watched so close AND I understand how it works! not sure if I answered all the questions but I may go off in search of a drink, even though I don't drink!!
Nancy and Payne not liking the talk about "more" tests!
 
Re: Sick kitty, DKA ....now home, dose question ....

I like Jill's idea of increasing to 5 units BID and monitoring. To keep the ketones at bay, you're going to have to give Payne enough insulin. You're giving her a lot less insulin than she was getting with Prozinc and R, and the fact that she got ketones tells us that the amount you were giving was not enough. There is no way you would have know that, but now that we DO know it we need to prevent it from happening again. That means being more aggressive with dose increases, and possibly re-introducing R if the situation warrants (not all the time). Her numbers so far on 4u aren't bad but there is room to do better.

You're not going to understand this all at once. That's ok, that's what support groups are for. :YMHUG:
 
Re: Sick kitty, DKA ....now home, dose question ....

She doesn't look good and I have a call out to the vet but when I checked her BG at +8 it was just 260.
I don't know how R would mix into it all now but if it were pzi I would give her R now. I think she should either get 5u or 4u+1uR for her PM dose .... see what the vet says. I hate this not understanding how this works!! She looks so sad ....
Nancy and Payne :YMSIGH:
 
Re: Sick kitty, DKA ....now home, dose question ....

Here is the way we introduce R in Lantus Land:

1. Start with a tiny dose - 0.1 units. You can even give that now if you want to (it's ok to give R at +8 with Lantus because it might help keep the numbers from rising until PMPS). Given the fact that Payne has had R before, I think you could probably get away with shooting 0.25 as your initial dose instead of 0.1, but you HAVE to test hourly after giving it so we can see what it is doing.

2. After giving the the small dose of R, test at +1, +2, +3 (and +4 if the +3 still isn't rising). You are looking to determine the onset, nadir, and duration of R in your cat, and also how far that dose drops her.

3. Depending on how she reacts to that dose of R and what her PMPS number is, you might be able to give another small dose of R at PMPS.

4. You also need to work on learning the onset, nadir, and duration of Lantus in your cat. You can give R at different times in the cycle, but you want to be sure you don't give it at a time when the nadirs of both insulins could come at the same time. It also can be tricky if the R is nadiring at the same time as Lantus' onset. For example, for most cats giving R between +2 and +4 would be a really bad idea. That is why we start with a miniscule dose of R at first, just to be safe while we figure out the curves.

If 0.1 units doesn't do anything, then next time you might want to try 0.25, and so forth. Eventually the goal is to develop a sliding scale for the R, but for now don't worry about that. For now you're just collecting the data that will help us figure out the scale later. Make sense?
 
Re: Sick kitty, DKA ....now home, dose question ....

She is sick again but has no ketones. Checked her urine none and used the ketone meter 0.2 no ketones. But her eyes are big and round and she looks sick but her numbers are still in the yellow .... the problem with testing so much is I have a cat that hates to be tested. (and yes, we have read everything, tried more) And now I have a cat who is sick and all I'll be doing is testing her .... I know the #'s are important but there must be a compromise? I also have a house full of animals and kids that also need my attention. I have spent five months mostly doing only her ... reading, reading, reading and she has been through this war with much fight and vigor, I don't want to put her through 10 tests a day. I think Lantus is superior to pzi for her, look at her #'s, but is it worth making her life miserable? Now I'm sad ..... :YMSIGH:
 
Re: Sick kitty, DKA ....now home, dose question ....

I don't know what to suggest about testing. It is a necessity, especially with a cat that's ketone-prone.

Numbers in the yellows does not rule out ketones or DKA. A couple of weekends ago, Choco had an episode of DKA with numbers in the 200s. It's more a matter of not enough insulin. Like Jill suggesting, if you're seeing a kitty that clearly doesn't feel well, there's the possibility of infection. I know the vet is waiting for the pancreatitis test results. You might want to find out if there's anything you can do while you're waiting for those results or if it's worth getting any additional blood work.
 
Re: Sick kitty, DKA ....now home, dose question ....

I don't want to get in the way but just want you to know Payne is in our thoughts and prayers and we hope you can find the answer to make her better soon.
 
Re: Sick kitty, DKA ....now home, dose question ....

Nancy, you and Payne have been through a great deal and it is normal to get discouraged. But please know that everyone here wants the best for your girl. She will get better. Try to get some sleep tonight and hold your kitty close. There's a lot more to the FD experience than testing. After Payne gets stabilized you will develop a routine that works for you both and it won't be terrible.

Thinking positive, healing thoughts for you and Payne tonight,

Ella & Rusty
 
Re: Sick kitty, DKA ....now home, dose question ....

Oh Nancy and Payne,

After reading you condo, my heart goes out to you guys. I will keep you in my thoughts and prayers. I hope Payne will feel better soon.
 
Re: Sick kitty, maybe DKA .... going back to hosp.

It has been a terrible 24 hrs. .... she is sick but wasn't showing ketones at all yesterday and just an hour ago she tested off the wall, so we are going back ...... the only problem is we are in the midst of a terrible storm and there is an alert on all the bridges. It's going to be at least an hour or hour and a half before I can get there. Lightening just started, great! But the new vet is fabulous! It is his day off and he is calling and trying to get to the clinic when we do, plus he listens to me. Keep us in your prayers.
Nancy
 
Re: Sick kitty, maybe DKA .... going back to hosp.

Sending healing vines for Payne. What a rough time of things she is having. Please drive safe.
 
Re: Sick kitty, maybe DKA .... going back to hosp.

((((Nancy)))) ((((Payne))))

I'm so sorry Payne is sick again, I'm keeping you in my thoughts. Please drive carefully and update us when you can....
 
Re: Sick kitty, maybe DKA .... going back to hosp.

(((Nancy)))..send tons of prayers and healing vines for your sweet baby. Please be careful!
 
Re: Sick kitty, maybe DKA .... going back to hosp.

Sending prayers, positive thoughts, white light and snowflakes. Please keep us posted.
 
Re: Sick kitty, maybe DKA .... going back to hosp.

:YMHUG: Hugs, Support & Love from us to you (((Nancy))) (((Payne)))
 
Re: Sick kitty, maybe DKA .... going back to hosp.

oh no, not again. :sad:

More healing vines are on their way to Payne. Fight, girl, fight!
 
Re: Sick kitty, maybe DKA .... going back to hosp.

sending prayers and healing energy to Payne...and please hang in there, little one!

celi & binks
 
Re: Sick kitty, maybe DKA .... going back to hosp.

Prayers & Healing Vines for Ptnes--Hoping for good news..Thinking of you.
 
Re: Sick kitty, not DKA, but very bad....in hospital

Thank you all, she is back in the hospital, not quite DKA because her pH was still normal but her ketones were high. The vet thinks she has pancreatitis but her ??pancreatic enzymes?? were 25.5 and should be 5? I am very upset because he tried to have the "talk" with me and no way! we've gotten through worse stuff than this and we're not quitting now!

He did comment on how well I managed her diabetes and I said it was all because of the feline diabetes list, they have taught me everything and what I do know is we are not done .... so keep us in your prayers, I will have more later, but it is your prayers we need. Thank you.
Nancy and always Payne .....
 
Re: Sick kitty, not DKA, but very bad....in hospital

((((Nancy - Payne)))) Prayers, snowflakes, positive thoughts and white light. Fight Payne, Fight. You can do this. Please update us when you can. Glad you stuck to your guns. Many kitties here have survived this. HUGS
 
Re: Sick kitty, not DKA, but very bad....in hospital

Nancy --

FWIW, pancreatic enzymes (i.,e. lipase and amylase) are not good indicators of pancreatitis. They are far more reliable indicators in dogs but very unreliable in cats. The definitive test is a spec fPLI. I'm hoping this is the test that your vet sent out for analysis the other day. (Idexx is the lab that runs the test.)
 
Re: Sick kitty, not DKA, but very bad....in hospital

We are praying for you. Update when you can. I would also request the newbie kit. It has supplies and a great method for testing BG to make it easiers.
 
Re: Sick kitty, not DKA, but very bad....in hospital

Sending your sweet girl tons of prayers and snowflakes...come on Payne..you can get better!
 

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Re: Sick kitty, not DKA, but very bad....in hospital

We are sending many healing prayers and thoughts your way, Nancy and Payne...
 
Re: Sick kitty, not DKA, but very bad....in hospital

(((((((Nancy & Payne))))))) You can do it, Payne! Sending our prayers and positive thoughts for a good recovery. Lots of healing vines and snowflakes are on the way to you tonight.
Nancy, you are doing so well. Hang in there. Payne will get better soon.

Ella & Rusty
 
Re: Sick kitty, not DKA, but very bad....in hospital

Praying for you. I hope things get better...

MJ&Donovan&Butthead
 
Re: Sick kitty, not DKA, but very bad....in hospital

Praying! I hope between the vet and the wise people here, Payne is home and flourishing soon. She's a fighter. Thinking about her tonight...so sorry for all that's been going on.
 
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