Time to Increase for DKA kitty?

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putus_human

putus_human

Member Since 2020
Hello! Tomorrow will be my third day on my current dose (1.25 u) and I'm wondering if I should increase insulin to 1.5 units. I was trying to do SLGS, but she was DKA 10 days ago and is still getting high numbers (pre-shots in the 600's and nadirs in the 300's on a pet meter). So I'm worried about ketones (I am testing her urine, but still, we'd rather not repeat that hospital visit).

Can someone experienced look at my spreadsheet and tell me if I'll have enough data to support that increase by, say, end of tomorrow (11/10/2020)? Or else let me know what BG numbers I need to take and by when to get more data to make a decision?

I'm just nervous after previously trying to increase her dose and getting an unexpected result. My vet is convinced she needs 2 units, but you can see that when I tried to shoot 1.75 units a couple days ago it led to low values 12 hours later. I thought that meant that was too big of a jump. My vet thought that meant maybe my cat only needs once daily injections. That doesn't make any sense to me because she ended up at 600 the next morning with a 1.25 shot. And I know that it's unlikely the duration is that long with the insulin we have now (Vetsulin) and just by looking at her previous BG numbers (but maybe duration is dose-dependent?).
 
Here is your last thread for continuity
https://www.felinediabetes.com/FDMB...ime-need-advice-pmps-150.238236/#post-2675315
You are correct, your kitty needs twice a day insulin not once a day. Cats have a fast metabolism and once a day dosing does not work in cats.
Can you change the colour on the SS of the PMPS 11/07 to blue please as it will reflects how low the BG went that cycle. Thanks.
At the moment Putin could be still bouncing from the 146 on the pm preshot time of 11/07. I would wait until at least 6 cycles past that 146 to see if she drops lower again.

If she doesn’t drop into lower numbers by tomorrow night (Blue numbers) I think you could increase to 1.5 units. With SLGS the dose is usually held for 7 days but with DKA in the picture we sometimes need to move faster to get better numbers.
***this advice is for Putus only because she has had DKA and is not to be used by anyone else.

Are you testing for ketones every day still? This is very important. If you could put the results of the ketones tests into the remarks column of the SS that would be very helpful please as ketones, or lack of them, help determine how everything is going.

Can you post with the Ketone results of today please?

Please post tomorrow evening and we can see how the BGs are going before you increase.:)
 
Sounds good! I updated the spreadsheet to show blue numbers from two nights ago and added her ketone tests. We are still testing her urine every day and she is negative every day.

I will update this thread tomorrow evening to check-in before I increase :)

Thanks for reminding me of the bounce factor as well, we've definitely got a lot to keep in mind with managing Putu right now.
 
Hey all! So today Putu's pre-shots were a bit lower but still around 500 and her nadir is still around 300.

Do we still think it's a good idea to bump her up from 1.25 units to 1.5 units tomorrow AM?
 
Yes I think so unless she drops lower tonight I would go up to 1.5 units
Try and get a BG around nadir tonight if you can as we need to know how low she’s dropping overnight. She could be dropping low overnight.

ETA I think we definitely need to see a mid cycle test tonight before giving the go ahead tomorrow to increase
 
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Yes! We are trying to get her to be more consistently in the yellows, get that preshot numbers down, then work towards blue numbers. She's still way too high.
 
So I didn't get a PM mid cycle reading because I didn't see your message until this morning

I can do a PM mid cycle reading tonight.

For this morning, I could bump her up to 1.5 and keep her at 1.25 in the evening until I get that reading. Any thoughts?
 
You don't want to be chopping and changing the dose with Lantus as it messes up the depot. Stay with the 1.5 now but make sure you get a test in during the pm cycles each evening, even if it is a before bed test. If that test is the same or lower than the preshot number it could be an active cycle so you may need to get up later and test again to keep Putus safe.
 
Hey, thanks for your reply. To clarify, she's on Vetsulin right now, so is there still a depot?

Can you also explain what you mean by an active cycle? Her numbers are always lower after her shot, is that bad? I thought that's what we want to happen.

Sorry for all the questions, I'm still getting up to speed and am a bit confused by all the info. Thanks for all your help.
 
Just an update here. I got a PM midcycle reading last night after increasing her to 1.5 units. Her BG was at 322 at +4, so pretty close to her midday reading from the AM cycle, just a bit higher.

This morning her pre-shot was at 325, which is the lowest she's had since she got home from the hospital about 10 days ago. So I think that's good?

I'll check her again in a few hours to make sure she's not going too low.
 
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