Someone suggested I post this here - was posted in general feline health. I don’t know what to do. My fur baby’s numbers skyrocketed, and I can’t afford to bring him in if he has ketoacidosis. If he has to do emergency vet visits, I just don’t think I can handle that on top of everything else. The expensive insulin, expensive food (he won’t eat the cheaper stuff anymore), the crazy amounts of cat litter we’re going through. I tested him for ketones last night, the test strip was only trace amounts, of anything. He’s still eating and drinking, although he’s being picky about the food, which is unusual. He hasn’t pooped since yesterday, and those were tiny. I saw him try last night, but nothing came out. No puking. What do I do? I work, I’m not home often, I don’t have anyone who can help me, so I can’t manage a tight regulation regimen, but someone suggested he might need to be fast tracked on the dose. Please help! He was hyper sensitive to touch and testing day before yesterday, hence no entries.
I directed @Gingembre1 here and mentioned fast tracking. I'm worried about the risk of ketones with the high BGs and thought that fast tracking might be in order, TR at the very least. I have no experience with that though. I'll leave it to the Lantus pros.
I'll let the experts chime in, but eating and only traces of ketones is much better then not eating and higher ketone numbers. If he is plugged up some that can raise numbers as well. He could be one of those cats that has high insulin requirements as well. Some of the kitties are in double digit doses. Fast tracking could be a good idea, but with SLGS I am not sure, especially if it is hard to test. Maybe a weekend would be a good time to test it out if the more experienced members think it is a viable option. It sounds like he is tough to test and the gaps in the SS make it more difficult to see the whole picture, more so when they are in lower numbers then Mr. Meow Meow. Pre-shot tests are important, especially with an increase.
Thank you everyone! I ended up taking him to the vet because he started throwing up and was super constipated. They felt like we should switch to a new insulin since he hasn’t budged on the Lantus. Here I go with starting all over again!
Did she say which insulin she wanted to switch to? Lantus and Levemir are the 2 long lasting insulins. Most users find either of these to work well and provide a gentler "time release" action compared to other insulins like prozinc or vetsulin which tend to have a sharper and shorter duration. I always took my vets advice with a grain of salt... My vet had a lot of questionable advice mixed in with the good. The boards here helped me understand why it is sometimes good to go with or against a vets recommendation. Most have limited training in diabetes and are not as up to date on new treatments as we are here.
If he was constipated that's would account for the higher numbers. Lantus is regarded as one of the best insulins. Considering your dose is really low I would think you just need to resolve the constipation and raise the dose. What did they switch you to?
They switched me to NPH. I don’t know what to do? I still have tons of Lantus left, and it’s clear from the boards here that not many people are on NPH. But he doesn’t seem to be responding to the Lantus? He pooped at the vets office, and they gave him some sub-cutaneous fluids. I also got fluids so I can give him IV fluids at home if needed. He seems to be feeling better.
He's not at the right dose yet which is why you aren't seeing much response. When you're in high numbers for a while it can takes a bit more insulin to find the breakthrough dose to see some action. I'm glad he's feeling better. Try adding extra water to his food and a teaspoon of plain canned pumpkin.
It's your call but people here would recommend sticking to Lantus. If you have a lot of it - and it's expensive - that's one practical reason. He's only been on Lantus since 16 November, less than a month. We'd generally recommend trying an insulin at least 6 months to get a feel for whether it's working for your kitty, barring an obvious incompatibility like allergic response, etc. That long trial is needed because many kitties take months to settle after insulin therapy is started. You're in that very, very early phase.
I'd stick to Lantus and use an agressive dosing method. You want to read up on dealing with low numbers so you're ready if your agressive dosing works "a little too well" ;-). Read the TR protocol and start with that, but you can up the dose faster than the FDMB version recommends -- particularly if ketones are on board. Check out the "Tilly" version of the protocol which allows for increasing the dose more rapidly than 0.25ui every 3-5 days if the cat is in high numbers. You will want to be monitoring BG closely though, so if you're going to be away from home for long stretches you might have to be less agressive (risk more ketones and less hypo). You'll want to make sure you get food in him, and err on the side of "more insulin" rather than "less insulin".
First of all, a couple housekeeping notes. Here is the link to your previous post here, for continuity. http://www.felinediabetes.com/FDMB/threads/help-amps-492.207709/ Second, could you remove the 911 from the subject in your first post. We like to reserve the 911 for medical emergencies, which this isn’t yet. However, switching to NPH, a shorter acting insulin, with trace ketones in the picture might turn into a problem. I second the others in the idea of sticking to Lantus for now. Besides the fact that you have paid for it and have a lot, it’s a better insulin for cats. You just haven’t got to a good dose yet. My Neko got up to 8.75 units, Wes’s Jack got over 30. If you can monitor closely, which means a test every preshot plus one other each cycle, we can fast track you up to a better dose. I see a couple preshot tests missing on the spreadsheet. We strongly recommend getting a test every preshot to make sure it’s safe to give insulin. The test somewhere in the middle of the cycle gives us an idea how low he is going on that dose. We determine how to change doses based on those low points. If you can get a test somewhere in the middle of the cycle during the day today, a preshot test and one before bed tonight, and you don’t see anything below 300 in those tests, you could increase to 2.5 units. Trace ketones mean we nee to be a bit more aggressive, What food is he eating now? What is he reject8ng? Maybe we have some suggestions for you.
Pure pumpkin daily can help. Miralax is also an option. My previous kitty got both pumpkin during the day and miralax at night. Every single day. My current kitty is proving to be a bit more difficult, she can't move it down and out. We are now trying pumpkin and miralax with her. Alone neither worked well.
Unfortunately mid-cycle testing isn’t possible for me as I work full-time, and live alone. The most I can do is get a shot in when I get home plus the pre-shot, but I usually don’t get home until an hour before shot time. I can do an extra PM shot occasionally, but the best I’ll be able to get there is a +3. On the weekends I try to do more testing when possible. Should I still proceed with fast tracking? My cat has only been below 300 once, but that was after an escape where he ended up eating a ton of dry food and he was puking a ton the next day. He has rejectsd all Fancy Feast and Wild Calling. Currently he’s only interested in Tiki Cat and some varieties of Weruva, which are both expensive.
Take a look at some member's spreadsheets. I've seen lots of kittys that seem to be stuck in high numbers for months until they hit a breakthrough dose and then it's like magic and they start earning reductions. Test daily for ketones and add water to his food. You will get there.
A +3 test in the evening is good data to have. Fill in the gaps on your day(s) off. Many people here are away from home for many hours during the work week.
Testing at other times, besides mid cycle, is still valuable information. What is your morning schedule? Do you shoot and get out the door? Or is there a little time after shot time to maybe get. +1, or even a +11 from the night cycle? Let’s delay that increase until tomorrow night, when you can monitor and have the weekend for more testing. Fast tracking likes to see four cycles of data, so we may have to do a not quite so fast track. Have you tried any of the Rawz cat food? Or does he like the shreds/chunks better than pate?
Thank you! This is so helpful. I can probably get in an AM +1 on most days. And I’ll start his next increase tomorrow night. Should I go for a 0.5 unit increase, so up to 2.5? I haven’t tried Rawz, but it does seem like it’s a texture thing for him. He is preferring chunks/shreds to paté right now. Is Rawz a pâté, or shreds/chunky?
Just add small amounts at first. Start with 1/4 tsp of pumpkin twice a day (I put it in the two biggest meals at shot time) and 1/8 tsp twice a day (I put this in overnight meals) and work up to 1/2 tsp slowly.
Welcome...and as soon as you catch your breath - look at Nelli's SS - https://docs.google.com/spreadsheet...Z2V6upp4Co0X0IWaAHXN2JAnQ/edit#gid=1182885903 Lots of high numbers - in the beginning - took a little while...but once she got going...take a look...doing so much better now.
I can usually only do preshots and then a +4 before bed. Then I get extra readings in days off and the weekend. My cat loves Tiki cat After Dark line... It is pricy at $19/12 cans. Luckily she likes fancy feast too. Will yours eat Friskies pate? Or maybe mix the ff classic and Tiki together?
The Rawz is pate, so probably not an option. Oh well, join the foods guessing game most of us play. Yes, up to 2.5 units, unless you see another yellow before then. Have you read the Sticky Note on doing TR with a full time job? Whether or not you do TR, there are some good tips for being away all day. For example, if you get a +1 where he is going down, you might leave some snacks for during the day. An autofeeder, if you can use one, helps to keep them safe. Or if he’s a grazer, you can leave extra food out. Food is our best tool to keep them safe.
@Sue and Luci ... Nelli is embarrassed you are drawing attention to her SS ... just kidding. @Gingembre1- seriously just ask, publicly ... I was Sooo ready, at my wits end >>enough is enough I said! no more increases! Freakin magically as every member who had gotten to know Nelli said... “No! Oh no, Krystina... Nelli is doing ok, she needs her insulin!!! This is a marathon not a... (forgot what :-\)!, Nelli abruptly made a turn ! Well dang, the attention/ slap in my face straightened me out and UP quickly. Nelli is doing great, has amazing support here, attention here and, most importantly so many people who care... Hang in there... you have a wealth of guidance, suggestions and, caring peeps here .
