? Well, I'm back, new Sugar Cat ;) (Need dosing advice)

[Darcy and Jonesy]

Hello again,
Although my "bio" says Darcy and Lebowski, it is now "Darcy and Jonesy". (Lebowski is charming all the girls at the Bridge)

Here's the situation, long story long, Jonesy spent three days last weekend in the emergency vet for ketones. It was at that time he was diagnosed diabetic. When he was sent home on Sunday, he was ketone free. As he was not yet eating for anyone else, they sent him home to get him eating again, which he did.

The vets said to not yet start him on insulin, but to run a curve (which I did at home on Monday). I then called in the numbers to the vet Tuesday and was advised to start him on 2 units of Lantus that night.

Here is a breakdown as to how these past few days have gone. I'm sorry but I have NOT YET entered this information into the spread sheet. (I'm actually typing this from work right now)

Tuesday PM, tested at 322, I shot only ONE unit (contrary to vet advice)
Wed AM, tested at 367, I shot 1 unit again
Wed PM, tested at 317, I shot 1.5 units
Thursday AM, tested at 358, I shot 2 units
Thursday PM, tested at 344, I shot 3 units
Now, last night (Thursday) I tested him a few hours later, he'd dropped down to 266
Friday morning (today) he tested at 108! I did NOT shoot. I tested him 90 minutes later and he was still dropping (108) As I live alone and could not miss work, I gave him kibble (which he loves)

****EDIT: Friday PM, he's gone from 108 up to 400

My question is this (I'd said, long story long ) WHAT DO I DO TONIGHT? Should I just see how he's doing and update my post? I'm hoping somebody can help me out here.

Thanks so much! I wish I could say it's GREAT to be back . . . heeheee

Darcy and Jonesy

 

[Bron and Sheba (GA)]

Hi Darcy and Jonesy, Welcome back.
If you could set up a SS for Jonesy that would make it much easier to help you. And update and add Jonesy to the signature. Thanks.
I’m sorry Jonesy ended up in hospital with ketones. I was very surprised they sent him home without any insulin because insulin is one of the main things that will stop ketones forming.
To prevent ketones reforming this is what you need to do:

• Make sure Jonesy is getting plenty to eat. Low carb food is best for diabetic cats, as I am sure you know. But the most important thing is he will eat, so if he will only eat food that is not low carb at the moment that is fine as we need him to eat.
  
• Try not to skip any doses of insulin. It is really important Jonesy gets insulin twice a day. We need to find a dose that lets you shoot both am and pm. You need to test inbetween the shots to see how low the dose takes him as that will determine the dose. Lantus like consistency so chopping and changing the dose will only mess up the numbers.
  
• Give extra fluids in his food. Try a teaspoon to two of warm water in each lot of food. Give frequent small meals throughout the day and night.
• Test daily for ketones in the urine. It is much safer to catch any ketones early and deal with them then to wait until he presents as sick and you find out he has a lot of ketones which can quickly become ketoacidosis (DKA). Buy a bottle of Ketostix from Walmart or a pharmacy and collect a urine from Jonesy and dip the test strip in. Check it against the colours on the side of the bottle exactly 15 seconds later. Anything above a trace needs vet attention. Put the results of the ketones test in the remarks column of the SS please.

For the dose tonight, test when you get home and post the result and we will help you decide what dose.
A couple of questions.
What food are you feeding him now?
How is his appetite?
Are you leaving him food out during the day for him to graze on?
Is he the only cat in the household and will any other cat take his food if it is left out for him?
Are you still using the Bayer Contour Next human meter?
Do you have honey or karo and some high carb food in case of low numbers?
Can you tell me how many hours until PMPS so I can watch out for you please?
Bron.

 

[Chris & China (GA)]

Hey Darcy! Nice to see you again but sorry for the reason!!

First thing...remember that Lantus takes 5-7 days to fill the depot before you will know what kind of results you'll get with the starting dose so you went up too fast.

How much does Jonesy weigh? The starting dose is based on weight so if you'll let us know, we can give you a better idea of where to start (over)

 

[Darcy and Jonesy]

Hey Darcy! Nice to see you again but sorry for the reason!!

First thing...remember that Lantus takes 5-7 days to fill the depot before you will know what kind of results you'll get with the starting dose so you went up too fast.

How much does Jonesy weigh? The starting dose is based on weight so if you'll let us know, we can give you a better idea of where to start (over)

Hi Chris!
Thanks for the reminder about the depot. I've been panicking about him possibly getting the ketones back. I guess I wanted to get his numbers down FAST. He is a chonky 16 pounds! Yup. Fat boy.

A bit of history, he is a former feral who I've been feeding/sheltering outside for the past 3 winters. Just this spring he allowed me to finally touch him, now, he's a former feral, inside only for the rest of his life (other than on a harness) He chonked up the last winter as he was free feeding on dry food. When I brought him in, the ONLY kibble he was getting was about two tablespoons of Urinary dry as I was trying to get him and my other guy Vinnie to bond. (Vinnie wishes Jonesy was frozen in a snowbank somewhere . . . he hates him ) I was giving them eat a bit of kibble under the door of a glass door on Jonesy's room.

BTW, I tested him about 15 minutes ago when I got home, he's shot back up to 400. I honestly don't know what to do re dosing with this super wonky numbers. Unfortunately I have to work tomorrow all day, but will be home Sunday and Monday to monitor (Will go reply to Bron's message)

 

[Darcy and Jonesy]

Hi Darcy and Jonesy, Welcome back.
If you could set up a SS for Jonesy that would make it much easier to help you. And update and add Jonesy to the signature. Thanks.
I’m sorry Jonesy ended up in hospital with ketones. I was very surprised they sent him home without any insulin because insulin is one of the main things that will stop ketones forming.
To prevent ketones reforming this is what you need to do:

• Make sure Jonesy is getting plenty to eat. Low carb food is best for diabetic cats, as I am sure you know. But the most important thing is he will eat, so if he will only eat food that is not low carb at the moment that is fine as we need him to eat.
  
• Try not to skip any doses of insulin. It is really important Jonesy gets insulin twice a day. We need to find a dose that lets you shoot both am and pm. You need to test inbetween the shots to see how low the dose takes him as that will determine the dose. Lantus like consistency so chopping and changing the dose will only mess up the numbers.
  
• Give extra fluids in his food. Try a teaspoon to two of warm water in each lot of food. Give frequent small meals throughout the day and night.
• Test daily for ketones in the urine. It is much safer to catch any ketones early and deal with them then to wait until he presents as sick and you find out he has a lot of ketones which can quickly become ketoacidosis (DKA). Buy a bottle of Ketostix from Walmart or a pharmacy and collect a urine from Jonesy and dip the test strip in. Check it against the colours on the side of the bottle exactly 15 seconds later. Anything above a trace needs vet attention. Put the results of the ketones test in the remarks column of the SS please.

For the dose tonight, test when you get home and post the result and we will help you decide what dose.
A couple of questions.
What food are you feeding him now?
How is his appetite?
Are you leaving him food out during the day for him to graze on?
Is he the only cat in the household and will any other cat take his food if it is left out for him?
Are you still using the Bayer Contour Next human meter?
Do you have honey or karo and some high carb food in case of low numbers?
Can you tell me how many hours until PMPS so I can watch out for you please?
Bron.

 

[Chris & China (GA)]

He is a chonky 16 pounds!

OK, the starting dose would be 1.8 but we usually like to start a little lower. How do you feel about going back to 1.5U and holding the dose for a few more days so we can see what's really going on?

 

[Darcy and Jonesy]

Hi Bron,
Thanks for the reply! I will absolutely update my profile, hopefully tonight.

I suspect the reason he was sent home is he wouldn't eat for them or me when I'd go there As we know, he needs to eat, so he was sent home with no insulin plan. I will pick up some Ketone test strips on the way home tomorrow. (Walmart? I'm in Canada)

He is currently eating Fancy Feast, pates only. He tends to like the chicken and beef flavours. He also gets at least a bowl of cooked chicken each day. This past week, he's also been getting chicken baby food. For the past two days, as he's been eating a little better, I've been watering THAT down too to get more water in him.

He always has food left out for him, but only legal stuff like wet food or chicken. I gave him kibble this morning as I was afraid of a hypo yet couldn't stay home to monitor. He's not the only cat (two others) but he is in his own room due to my other boy who hates him *face palm* See the notes below in Chris's comments. It explains that Jonesy is a former feral. So he is the only one with access to his food throughout the day.

Yes to the Bayer Contour Next meter!

I do have some gravy foods, but will pick up some corn syrup. (Ironically, only about a month ago I tossed my unopened bottle from Lebowski's days)

I've already done his late day test and he came up at 400. Not sure what to do now re dosing??

 

[Darcy and Jonesy]

OK, the starting dose would be 1.8 but we usually like to start a little lower. How do you feel about going back to 1.5U and holding the dose for a few more days so we can see what's really going on?

I'd be fine with 1.5 units, my fear are those damn ketones. How quickly can they reform if his numbers are high? I'm super gun shy now . . .

 

[Chris & China (GA)]

How quickly can they reform if his numbers are high? I'm super gun shy now . . .

Do you have some urine ketone test strips?

 

[Bron and Sheba (GA)]

Darcy is going to pick some Ketostix up tomorrow @Chris & China (GA)
As long as you are feeding plenty of food and giving enough insulin, hopefully the ketones won’t form. If you are testing you will know when they start and can take action. I agree 1.5 is a good dose.

 

[Darcy and Jonesy]

Darcy is going to pick some Ketostix up tomorrow @Chris & China (GA)
As long as you are feeding plenty of food and giving enough insulin, hopefully the ketones won’t form. If you are testing you will know when they start and can take action. I agree 1.5 is a good dose.

@Bron and Sheba (GA) and @Chris & China (GA) I just checked online and it says they (Walmart) are out of them, I hope I don't have trouble finding them I'm not clear if that was one store in particular? Or if they maybe don't ship to Canada?? I'll try to track them down.

Bron, did you see my reply to you? It's been awhile since I've been in this forum. I apparently only commented in my thread, but didn't actually reply to your questions

 

[Chris & China (GA)]

Any pharmacy with diabetic supplies should have urine ketone test strips. The "brand name" is Ketostix

 

[Darcy and Jonesy]

Any pharmacy with diabetic supplies should have urine ketone test strips. The "brand name" is Ketostix

Thanks Chris! I'm at work right now, but I've called my Walmart and he has a box on hold for me! (Whew!!)

Just an fyi, last night (pm) he was at 400 and I shot 1.5 u, this morning he was still 392 I shot 1.5 . . . ugh . . . I'm going to develop diabetes dealing with HIS! LOL His appetite is not great, he'll eat when I put some on my finger and then "lead" him to the bowl.

He's not drinking a lot of water though, which is odd . . . I've been giving him watered down baby food (chicken) which he enjoys. Do you think that may be keeping his numbers high?? I know he needs to stay hydrated, and needs nutrients. He's not even scarfing down his beloved chicken.

Anyway, just rambling . . . back to work for me

 

[Darcy and Jonesy]

Until I get a spread sheet going for Jonesy, tonight's PMPS is 384, shooting 1.5 u

 

[Bron and Sheba (GA)]

Is Jonesy having any anti nausea medication such as cerenia or ondansetron? If he’s not interested in the food he could be nauseated. Cats frequently are following ketones and DKA. If you aren’t using them I’d ask the vet for some as it’s very important he eats.

 

[Chris & China (GA)]

He's not drinking a lot of water though, which is odd . . . I've been giving him watered down baby food (chicken) which he enjoys. Do you think that may be keeping his numbers high??

If you're adding water to his canned food (or baby food) he's getting extra fluid that way but you might try syringing some extra to help keep those ketones at bay.

Baby foods that are "meat only" are fine for diabetics. The Gerber has a little tapioca starch (if I remember right) but it's not enough to cause problems. China's favorite in the baby foods was the ham and I've heard a lot of others here say the same about their furkids.

 

[Mimis mom]

I saw Lebowski crossed the bridge, I’m sorry to hear that. When did it happen? I notice his SS is still up and then it stops- did he get OTJ or what happened?

 

[Sienne and Gabby (GA)]

Sorry you're back Darcy!

Please remember that with Lantus, you're dosing is based on the nadir, not on the pre-shot numbers. At least from the way you're describing your dosing, it sounds like you're trying to "shoot down" the high numbers. This isn't a good strategy with Lantus (and forgive me if I'm making an incorrect assumption). Have you been able to get any spot checks?

Like Bron mentioned, it's important to allow the depot to stabilize which means being consistent with your dose. Likewise, please don't skip a shot. With a kitty that's so recently post-DKA, getting insulin into Jonesy is crucial. Food and fluid are also essential. I'm assuming you're adding water to Jonesy food. The added water helps to "dilute" the ketones. The food prevents the metabolic pathway that drives the development of ketones from taking over.

 

[Darcy and Jonesy]

Is Jonesy having any anti nausea medication such as cerenia or ondansetron? If he’s not interested in the food he could be nauseated. Cats frequently are following ketones and DKA. If you aren’t using them I’d ask the vet for some as it’s very important he eats.

Hi Bron,
He was not given any anti-nausea (which surprised me honestly . . . ) but he has been given the "cream" Mirtazapine to apply to his inner ear. That has helped with his appetite for the past few days. Yesterday evening, even though his numbers were high, he was becoming more "himself", ya know? More social, ate fairly well.
FYI, this morning his number dropped all the way down to 95.4!!! I'm NOT shooting any insulin, and I'm home all day to monitor!

 

[Darcy and Jonesy]

I saw Lebowski crossed the bridge, I’m sorry to hear that. When did it happen? I notice his SS is still up and then it stops- did he get OTJ or what happened?

Hi Mimi!

Yes, sadly it was just about a year ago. It was kidney disease that finally took him I had stopped filling the spreadsheet as honestly, he was pretty steady with his numbers. This new guy, Jonesy, is a former feral who I'd been feeding as an outside guy for three years. Not last summer but the prior summer, I had him TNR'd. I fed and sheltered him. Then, this past spring, he let me actually TOUCH him! Blew me away! So after a couple months, he was doing great, becoming more trusting.

As I'd decided I need to move to a smaller house (with less stairs, and lower price) I knew, NOBODY is going to care for this outside cat. I knew he wouldn't have a chance in any of the rescues as really . . . who is actively looking for a cat who only trusts one person? So . . . although I knew I really couldn't afford a third cat, I brought him in.

My other guy, Vinnie, LOOOOVED Lebowski, and no question, he was missing a friend. So before I brought Jonesy inside, I wanted to ensure they'd get along. For at least a month I had both of them at the back door, door cracked a few inches, each getting treats. Not a single swat, growl, nothing! I brough Jonesy in (he had an XXL dog crate) and the first night everything was great! I ended up bringing Jonesy into my front porch, and he and Vinnie were sitting "butt to butt" in the window <3 Then, I went into the living room for something and all hell broke loose . . . Vinnie was after Jonesy. It was horrible. So now, Vinnie hates Jonesy

Jonesy has his own room and I will put Vin away and let Jonesy out. But it is hard . . . I'm hoping once I DO move that the neutral territory will help them get used to each other.

 

[Darcy and Jonesy]

Sorry you're back Darcy!

Please remember that with Lantus, you're dosing is based on the nadir, not on the pre-shot numbers. At least from the way you're describing your dosing, it sounds like you're trying to "shoot down" the high numbers. This isn't a good strategy with Lantus (and forgive me if I'm making an incorrect assumption). Have you been able to get any spot checks?

Like Bron mentioned, it's important to allow the depot to stabilize which means being consistent with your dose. Likewise, please don't skip a shot. With a kitty that's so recently post-DKA, getting insulin into Jonesy is crucial. Food and fluid are also essential. I'm assuming you're adding water to Jonesy food. The added water helps to "dilute" the ketones. The food prevents the metabolic pathway that drives the development of ketones from taking over.

Hi Sienne,

Yup. You nailed it. I panicked and was absolutely trying to "shoot down" the high numbers. Chris and Bron helped me determine that he needs to be on 1.5 u and that's what I've been shooting for the past couple days. I've just posted another thread though, as this morning he was all the way down to 95.4 from 383.4 last night. So now I'm assuming . . . no shot until his pmps . . . assuming? *shrugs* I'm home all day today and tomorrow, so can keep a close eye on him.

I do add extra water to all my cat's food. I've been doing that for years so it is absolutely a habit now. One of the "better" habits I have! LOL