will not eat- help

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Wendy&Tiggy said:
Um stupid question but if he is at 75 why are we getting ketones? Remember all we have to go on is the "smell". I really think we need that urine sample
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Because ketones are from fat breakdown. Also if the cat isn't eating, the glucose may be low.
 
He's eating a little here and there FF morsels with gravy, but he is mostly licking the gravy. I would say he's had the equivalent of 1 can FF throughout the day. I have a ton of FF, test strips and I made a batch of syrup (boiled sugar & water).
 
That is not what we use as the guidelines and we're talking about a different situation here because of his DKA.

Have you retested and how long has it been now since he ate and you tested last?
 
Just to clarify, BG numbers do not have to be high for ketones to develop. There can be an underlying infection coupled with this kitty not eating.

I also want to underscore that IF Spot is experiencing diabetic ketoacidosis and not just throwing below trace level ketones, this can't be managed at home. Treating DKA requires IV infusion of electrolytes and constant monitoring to make sure the electrolytes are being properly titrated. None of us are equipped to run labs at home.

It is imperative that you get ketone tests whenever you can.

In a cat that is prone to developing ketones, getting insulin in is imperative. It's also critical that your cat eats. Frankly, I don't care if you have to feed your cat an ice cream sundae. If that's what he'll eat, that's fine. If he'll eat high carb food, that's fine. I do think we need to know if your cat will eat. If he's refusing to eat, it's going to be very difficult to give insulin and without insulin and food on board, you're risking ketones further developing.

Please respond to the questions that Marje raised.
 
We are scared for you and Spot.

We know you are a vet tech, but you may not be able to handle the DKA at home. It's very hard to be calm, cool, collected and objective when you are treating a member of your own family. Human doctors do not treat their own family.
 
Is that a preshot test? If yes, the dose is too high. Ideally you want a dose that may be shot safely every 12 hours.

We suggest newcomers not shoot unless the blood glucose is 200 or greater.
 
His glucose was 65 at 8pm --- 75 at 8:30, then 75 again at 10 pm. These were all pre-insulin which was due at 8:30pm. Spot has been licking his food throughout the whole time. I guess I'll hold off his insulin until I speak with the vet in the am.
 
I just have to go on record here that the worse thing you can do is NOT give a cat with DKA insulin. I'd rather you give some insulin and test every hour and prop up the numbers with HC if you have to.

I think even if he does not have ketones, you are taking a risk by not shooting something. IMHO.
 
Now he's eating crunchies. He's really acting like he is feeling fine, but I'll check it one more time in an hour, and follow him to the commode with stick. If there are no ketones, I'll wait til the morn, if there are; I'll give him a reduced dose of insulin.
 
BJM said:
Is that a preshot test? If yes, the dose is too high. Ideally you want a dose that may be shot safely every 12 hours.

We suggest newcomers not shoot unless the blood glucose is 200 or greater.
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The preceding statement may be correct IF the cat is not prone to ketones or has some other medical reason that insulin needs to be given.

I'm going on the record along with Marje. Your cat appears to be prone to developing ketones. It is imperative that you provide insulin to a ketone prone cat or you risk the cat developing DKA. The primary cause for DKA is insufficient insulin. Ketones can develop quickly and can be lethal.
 
If he's barely eating and dealing with DKA, adding insulin and causing a hypo on top of it doesn't make a lot of sense either. I think the cat needs to be hospitalized in that case.

If he is actually eating enough, you'll want to be careful with the dose.

Is he eating?
Is the glucose rising?
 
The reason we test and manage the curve with food..including HC, if needed...is to prevent a clinical hypo. That's why I said " test every hour if you have to".
 
I want to put what everyone said in context here. We are worried because we have seen too many kitties die of DKA. We want to be sure it doesn't happen here.

Please, for everyone's benefit, start testing for ketones on a daily basis using the strips. I think I gave urine catching ideas above.

Guys, how much insulin do you want her to give? I am guessing not the full dose based on the low readings?

Wendy
 
He's eating fine now- he has successfully licked the gravy out of 6 cans of FF, and got quite a bit of meat down too. I retested at midnite and it was still 75 (I even tested my blood to make sure meter was working). His ketostix was negative, so I feel a little better skipping his insulin.
He's acting like nothing is wrong- but don't worry, I won't be lulled into falsely thinking he's cured. 1st thing in the am I'll test him and call the vet.
 
It'd not unusual to get two tests the same but three is......

Are the ketostix fresh? Please be sure you stay on top of testing his ketones. I still wish you had shot....
 
So this morning his BG was 333 - after he ate, so I gave him the 3U. Keto stix are good and fresh so I'll check again today.
 
DumpsterKittyMom said:
So this morning his BG was 333 - after he ate, so I gave him the 3U. Keto stix are good and fresh so I'll check again today.
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the higher bg number was to be expected after dropping low and skipping a shot.

happy to hear your ketostix are fresh. several of the ketostix brands expire 3 months after opening the container.
my cat is ketone prone. if appropriate and whenever possible, i try to check her urine for ketones twice a day.

DumpsterKittyMom said:
I know it is a high dose of lantus, but I believe the dose is .25U/kg. His normal weight is about 23 lbs (10.5 k). He's a huge cat. his glucose was 350.
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i don't think anyone asked...
is 23 pounds an "ideal" weight for spot? in other words, is he overweight at all? the reason i'm asking is the starting dose of 3u bid does seem rather high and it left him in double digits 12 hours after only the second fourth shot. the Tight Regulation formula used to calculate an initial starting dose of lantus is based on ideal weight rather than actual weight.

"if" 23 pounds is an ideal weight for spot, the initial starting dose would be 0.25u x 10.5kg or 2.62 units. *usually* we'd suggest rounding that off to 2.5 units shot twice a day.

lantus is a depot insulin. it has a cumulative effect. one dose builds upon the next. if spot is throwing double digits after receiving only two four shots of lantus... one has to seriously consider the initial starting dose could have been set too high.
 
Marje and Gracie said:
Depends on what his BG is now. Normally if we stall, we shoot the full dose since stalling acts like a reduction.
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true, but there are always exceptions to the norm.

even with a stall... unless kitty's numbers zoomed to the moon within a reasonable amount of time... i'd have a hard time suggesting shooting a full dose without presuming the initial starting dose is "correct", some data to support to suggest shooting a full dose into a cat who is not eating as well, and knowing if kitty is actively throwing ketones... given the fact that kitty was in double digits after only the second fourth shot of lantus. too many unknowns for my comfort level, but that's not to say i advocate skipping the shot. providing an adequate supply of insulin to a kitty with a recent history of ketones/DKA is imperative.

just my thoughts...
 
BJM said:
We suggest newcomers not shoot unless the blood glucose is 200 or greater.
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another true statement, but the suggestion not to shoot unless blood glucose is 200 or greater can be downright dangerous when there's been a recent history of ketones or in a ketone prone kitty. imho, we have to recognize the exceptions when there are other complications to consider.
 
Spot's double digit reading - 75, was after 4 shots of insulin (I did not realize it was cumulative) Fri nite 3U -- sat am 3U -- sat nite 3U & sun am 3U. Sunday was really his 1st full day of eating.
I believe he was in ketosis because of not eating for so long, but I'm still trying to get another ketostix reading... he's become 'pee shy' LOL.
If you see me either repeating myself, or not answering, please forgive me. I am trying to read and absorb and re read and..... well try to remember how you were when your kitty was 1st diagnosed. It is a lot to swallow.
My 17 yo (avatar) requires a lot of attention too, and now that Spot is feeling better, it is a constant battle of 'who can get Mommy's attention the most".
 
His normal weight should be 25 lbs. When he followed me home, I thought he was a full grown adult... when I checked his teeth to see how old he was I was shocked to see kitten teeth! He is a huge cat. We laugh when we see pictures on the web of 'large cats' because Spot is every bit as big as them.
5 years ago he got to 29 lbs, so we built a floor to ceiling cat poll with shelves. I found some of those freeze dried chicken treats (which much to my dismay, I can not find anymore), and invented a game of throwing the treat down the hallway, then putting one up on the top shelf. He loved it and lost the extra weight in about 3 months!
 
Try Halo Liv A Little or PureBite treats.

Some dried meat treats in the canine section may be less expensive, though you'll need to break them into smaller pieces.
 
cat pole on far right. Ignore the mess please.... this was taken after hurricane sandy! I have a better pic on my other computer.
 

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Now he's 275 6 hours after I gave him the 3U insulin. Still no luck with the ketostix today yet, so I have to be a little more stealthy. I'm going to give him 100cc's of fluid now so hopefully I'll have a urine sample soon.
 
BG is 281. I'm thinking about slightly lowering it to 2 1/2 U. I went thru some charts and it looks like his average weight is 23 lbs.
Does anyone have any thought on this?
How often should I be testing his BG?
 
Did you get a ketone test? The result of that test will determine whether to lower the dose or not. How has he been eating, today? Good, I hope.
 
DumpsterKittyMom said:
Spot's double digit reading - 75, was after 4 shots of insulin (I did not realize it was cumulative) Fri nite 3U -- sat am 3U -- sat nite 3U & sun am 3U. Sunday was really his 1st full day of eating.
I believe he was in ketosis because of not eating for so long, but I'm still trying to get another ketostix reading... he's become 'pee shy' LOL.
If you see me either repeating myself, or not answering, please forgive me. I am trying to read and absorb and re read and..... well try to remember how you were when your kitty was 1st diagnosed. It is a lot to swallow.
My 17 yo (avatar) requires a lot of attention too, and now that Spot is feeling better, it is a constant battle of 'who can get Mommy's attention the most".
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thanks for the correction on the number of shots given. i'll fix it on my other post.

the action of the two long-acting insulins, lantus and levemir, is cumulative. *usually* we hold the initial starting dose for 5 - 7 days to see what the dose can actually do... unless there are indications a reduction is needed because the dose was set too high or kitty drops below 50 OR an dose increase is needed because numbers are high and flat or in the presence of ketones.

you can read more about the Tight Regulation Protocol here: Protocol: Tight Regulation with Lantus®or Levemir® for Diabetic Cats.
the American Animal Hospital Association guidelines can be viewed here: AAHAD Diabetes Management Guidelines for Dogs and Cats.

this is definitely overwhelming... especially at first. you've also been under pressure to get spot to eat coupled with the threat of ketones. it becomes exhausting both physically and emotionally. we understand. in spite of that you're doing great! how's his appetite today? hope he's eating well and on his own.

DumpsterKittyMom said:
BG is 281. I'm thinking about slightly lowering it to 2 1/2 U. I went thru some charts and it looks like his average weight is 23 lbs.
Does anyone have any thought on this?
How often should I be testing his BG?
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BG is 281. how many hours after the shot did you get the 281?

lowering the dose to 2.5u sounds reasonable to me, but let's see what kind of results you get on the next ketone test before adjusting the dose.

as far as how often to test goes... you'll have to let the numbers be your guide. you'll want to get random spot checks done to give you an idea where his numbers are headed in that cycle. for example, a +2 with lantus (test taken 2 hours after the shot) will often provide a clue. if the +2 is around the same or lower than the preshot number chances are you'll be looking at an active cycle. an active cycle means that you could see a substantial drop. in that case you may want to test every couple of hours until the numbers begin to rise again. if you post your test results there are many who can help guide you until you get the hang of things.

since we have members from all over the world and we live in different time zones we speak in what we call "plus hours":
amps = preshot number taken in the morning just before the shot
+1 = test taken 1 hour after the shot
+6 = test taken 6 hours after the shot
+9 = test taken 9 hours after the shot... and so on
pmps = preshot number taken n the evening just before the shot

each cycle has 12 hours in it.


edited to add: wow! that's quite a cat pole for such a handsome guy! :mrgreen:
 
OK. Spots BG was 281 11 1/2 hours after his morning 3U. It was high throughout the day, so I cut his dose back by .5U meaning I gave 2.5U which seems more appropriate for his weight. He is eating regularly, but he is waiting for me to go into the bathroom so he can use the litter box - too smart for his own good. I'll get saran wrap tomorrow so I can check his ketones, but his breath smells fruity now.
I'll finish reading everyone's post tomorrow and answer more questions...... I'm seeing cross eyed now. Strange how quickly your life can change.
Thank you everybody!!!
 
DumpsterKittyMom said:
OK. Spots BG was 281 11 1/2 hours after his morning 3U. It was high throughout the day, so I cut his dose back by .5U meaning I gave 2.5U which seems more appropriate for his weight. He is eating regularly, but he is waiting for me to go into the bathroom so he can use the litter box - too smart for his own good. I'll get saran wrap tomorrow so I can check his ketones, but his breath smells fruity now.
I'll finish reading everyone's post tomorrow and answer more questions...... I'm seeing cross eyed now. Strange how quickly your life can change.
Thank you everybody!!!
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if spot's breath smells like he's throwing ketones (fruity odor), it's more important than ever to grab a ketone test. if alex's breath smelled fruity i'd be on the phone with my vet. reducing the dose "if" spot is throwing ketones is not a good idea.

is it possible to line a litter box with a plastic bag and isolate him in a separate room (bathroom, bedroom) with the box? you could put a light dusting of litter on top of the plastic. you'd probably be able to grab some urine for testing purposes. his breath smelling fruity is concerning.

ketone odor on the breath is one of the signs of diabetic ketoacidosis.
 
Keeping Spot in one room is impossible, so I'll get saran wrap for the keto test. I also want to pick up a smaller gauge lancet. I do not smell the acetone on his breath, and haven't for the last couple of days.
This am his BG is 118 before insulin.
 
Another question..... I held off the insulin this morning (118) and tonight I'll test. If he is over 200, I will go to 2U of lantus (spoke with vet). He is eating and back to his devilish self.
About the lancet, what is the easiest way of getting his droplet of blood? I got the 26g, and if I do it lightly I don't get enough blood to test, which has brought me to this:
In order to puncture his ear successfully, I'm going straight thru his ear and into my finger (don't worry- I'm testing HIS blood- not my own LOL).
I need suggestions.... my fingers hurt and I don't want him to shy away from me touching his ear.
 
I have no problem finding the vein, I just need to figure out what size & length lancet I need, and if I should get one of those lancet holder device thing???
 
Newbies usually use 28 or 29 g. Are you going in at a 45 degree angle? Are you putting something hard ( like a pill bottle lid) behind the ear? Both give you more control.

You could try a lancet tool too.
 
I felt like I had better control using the lancet free-hand. Whatever works for you is OK.
 
When I go in at a 45° angle, I don't prick it hard enough, and when I hold something (other than my finger) against his ear; he squirms away. I need to find the right gauge, depth, and tool to use. Any suggestions would be appreciated. Unfortunately trial and error is not an option at the moment.
 
good morning! i have to admit, i'm confused. :?

last night you said:
DumpsterKittyMom said:
OK. Spots BG was 281 11 1/2 hours after his morning 3U. It was high throughout the day, so I cut his dose back by .5U meaning I gave 2.5U which seems more appropriate for his weight. He is eating regularly, but he is waiting for me to go into the bathroom so he can use the litter box - too smart for his own good. I'll get saran wrap tomorrow so I can check his ketones, but his breath smells fruity now.
I'll finish reading everyone's post tomorrow and answer more questions...... I'm seeing cross eyed now. Strange how quickly your life can change.
Thank you everybody!!!
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this morning you said:
DumpsterKittyMom said:
Keeping Spot in one room is impossible, so I'll get saran wrap for the keto test. I also want to pick up a smaller gauge lancet. I do not smell the acetone on his breath, and haven't for the last couple of days.
This am his BG is 118 before insulin.
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smelling fruity/acetone breath is one of the signs of DKA. it's why we've all been so concerned.


DumpsterKittyMom said:
Another question..... I held off the insulin this morning (118) and tonight I'll test. If he is over 200, I will go to 2U of lantus (spoke with vet). He is eating and back to his devilish self.
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it's so good to hear he's eating and acting like himself! love hearing that news! :mrgreen:
i'm glad you spoke to your vet to let him/her know what's been going on. regularly testing spot for ketones will give your vet a better idea about dosing.

DumpsterKittyMom said:
About the lancet, what is the easiest way of getting his droplet of blood? I got the 26g, and if I do it lightly I don't get enough blood to test, which has brought me to this:
In order to puncture his ear successfully, I'm going straight thru his ear and into my finger (don't worry- I'm testing HIS blood- not my own LOL).
I need suggestions.... my fingers hurt and I don't want him to shy away from me touching his ear.
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you might have to experiment with the depth selections on the lancet to find the one that works best for spot. i find it helpful to fold a tissue into a small square to place between kitty's ear and my finger. the tissue acts like a cushion and allows me to apply slight pressure when using the lancet.


most of us use a spreadsheet to keep track of kitty's glucose readings. a spreadsheet will help you spot trends and patterns as well as a place to record pertinent notes and observations. directions for setting up a spreadsheet can be found here: How to Get a SS and Link in your Signature *updated 2/13/12. ask for help if you have trouble with it. there are several members who are able to offer assistance.



i won't be able to get back here until late tonight (long work day), but don't be shy about posting if you have questions or need any help. members are very generous with their time and support.

have a good day! :mrgreen:
 
DumpsterKittyMom said:
I have no problem finding the vein, I just need to figure out what size & length lancet I need, and if I should get one of those lancet holder device thing???
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we don't aim for the vein. here's a picture of Laur and Danny's Famous Photo of "The Sweet Spot ": http://i106.photobucket.com/albums/m267/chupie_2006/testingear/sweetspot.jpg

you can also find a slew of hometesting tips and tricks as well as videos here: Hometesting Links and Tips.

using a lancet device... or not... is a matter of personal preference. i find i have better control if i use a lancet device, but others prefer poking freehand. when i first started hometesting, i was able to get blood every time with 25 & 26 gauge lancets.
 
Thank you. I have been using the booklet that came with the meter to record his BG for now. I tried the spread sheet link thing, but I think I overloaded my brain trying to figure it out. I'll have to have the BF figure it out.
 
BTW, my name is Pip.... (don't ask LOL)!
Which lancet device gives you depth options? what size needle works best when you use the device? Should I keep his insulin refrigerated so it will last 5 months?
 

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DumpsterKittyMom said:
BTW, my name is Pip.... (don't ask LOL)!
Which lancet device gives you depth options? what size needle works best when you use the device? Should I keep his insulin refrigerated so it will last 5 months?
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Any lancing pen should have depth adjustments on it.
It's not a question of which size needle works best with a lancing pen. It's a question of which lancet fits the lancing pen. As long as you buy lancets made by the same manufacturer as the lancing pen, the lancets should fit just fine.

Yes, keep the insulin refrigerated. I keep mine in the original box (to protect from light), on a lesser used shelf in the fridge (not in the door of the fridge because it's a bit warmer and shakes every time you open the door), in a coffee mug with some paper towels stuffed around the inside of the mug and the box of insulin. Mug handle gives me a good surface to grab onto. Less chance of dropping the insulin inside the coffee mug on my tile floor and shattering the vial.

With proper care, a vial of Lantus can last you 4-6 months refrigerated.
 
The WalMart ReliOn lancet pen had depth adjustments and seem to work with their lancets just fine.

Practice with both on something like an apple or your arm to get a feel for both tactics.

I have vision issues, so free-handing worked better for me - I could see where the lancet was going and felt like I had more control.
 
Thank you all for being there when I didn't know where to turn! You saved my sanity and my beloved Spot's life!
My Dad had an emergency.... just when things started to calm down with Spot.
Spot has been on 2U BID since Tuesday night and he's been testing in the 200s (220 last night and 240 this am).
What BG #'s should I be shooting for?
 
No I haven't. As soon as feasible I will get a lancet which suits our needs. The 26g he can't stand and I don't want to make him ear shy, so I'm only checking him before his am & pm insulin.
(As an aside, my boss is currently writing a book on diabetes!)
 
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