Doobie hit a setback on Friday of last week. His Urine Ketones spiked on his early AM home test, and he became lethargic, refused food and vomited clear liquid twice. We called the vet in the AM, they said to watch him for any changes. He was the same at 1300. After clinic closing time (6pm), with no improvement we called the Animal Hospital. The emergency hospital said to bring him in immediately, which we did. He was having a DKA crises and was in serious distress. Near death. They got him stabilized in 24 hours and ran many tests. Pancreatitis suspected and heart murmur (possibly exacerbated by high level of intravenous fluids) plus the DM. He spent 3.5 days in the hospital. Although we felt the hospital did stellar work in saving Doobie and really seemed to care, I was a little put-off by their negative attitude toward our home BG monitoring and urine testing. While they were impressed with the level of care we were providing, they suggested that we stop all the home BG & urine testing and pay more attention to the outward signs of his health. Activity level, eating, hydration, urination, etc. They didn't want a copy of our spreadsheet. Home testing, they said, often leads to untrained pet owners adjusting doses, skipping doses, etc., which usually negatively affects the long-term treatment plan. We have not met with the Endocrinology Specialist yet who they said may be more comfortable with our home care approach. Doobie, they said, needs to regularly receive his .5U d 12hrs for at least one week and only be fed prior to each Prozinc dose and then be brought back in for a BG curve in the hospital. Low readings from Human Meters must not interfere with administering the regular dose. Our Vet is willing to work with us a little more, and agreed that I should increase Doobies' dose to .7Ud12hr if he appeared stabilized on .5U based on our home testing. Doobie has gone through 3 seperate HYPO incidences. Once on dose #3 of Prozinc (1Ud12hrs), once at the Vet (during his first BG curve 585 to 46) and once during his stay at the hospital. I am not comfortable trusting them with Doobie despite both facilities being highly respected. I plan to continue all home testing because I trust my attention to detail. I am not comfortable giving Doobie Prozinc when his PS is around 100. His history is of rapid drops in BG (701 to 41 at the hospital in +2.5) and I don't want to be responsible for killing him. WHAT THE HECK DO I DO?
Oh my! First off, I'm so sorry no one was here when you first posted. We were probably all at work, but usually one or two of us check in after work. I try to always check in for emergencies at least or dosing advice that is needed for the night. This just to say that if you post and no one responds, just hang tight. Someone will as soon as they can. First off, you can ignore advice to not test at home. Lots of vets say that, they're all wrong. Obviously you want to pay attention to physical signs, but it's even BETTER if you can catch something BEFORE that from your home testing (obviously). Plus, it gives you a good baseline so you'll know what's normal and what's not when he is sick. And of course...it keeps him safe! I was lucky that my vet was all for home testing and even told me to get a human meter. Lots of people here just don't mention testing to their vet. They just listen to the advice, nod and smile, and go home and keep doing what they're doing. Some people challenge the vet (nicely!) and explain why they test and a few have converted vets to their thinking. It's up to you how you want to handle the vet aspect...but I'd keep testing either way. I don't agree at all that you should just give insulin when he's at 100. He's getting good response from the insulin, so you KNOW he's going to drop. If you gave a shot at 100, he would almost certainly drop into hypo from what I see. I mean yeah, that can change. We have members here who shoot on blues and greens but that is because they have LOTS of data to prove that their kitty needs that, doesn't drop too low from it, and they are prepared and able to handle any emergencies. I would NEVER suggest that to someone who doesn't have proof that it's simply needed for that cat and it's pretty rare that a cat will need that. The vet may have been thinking about the DKA with that advice. The recipe for DKA is not enough food, not enough insulin, and an infection. Doesn't need to be all 3...but often is. So he may have been thinking you need to give insulin to help avoid DKA and that is true. It's going to be a little trickier to manage Doobie now BUT WE CAN HELP. I think you did the right thing skipping last night...and it looks like he's doing well today. I'm hoping he'll come back up as he has in the past, because you do want to give insulin if at all possible. It looks like he has in the past. What time (and time zone!) do you shoot tonight? Someone may or may not be on, but if you can let us know when, we can try to look in if possible and you can let us know what number he's at so we can help advise. If he's 200 or above, I'd go ahead with the 0.5 for sure. As for feeding twice a day, you can feed as much as you want. My cats all graze. As long as you take up the food 2 hours before shot time, you're fine. Okay, this was long and partially just me ranting so I'm going to end here. If you can let us know what time zone you're in and when you'll shoot tonight, we can see if someone can be around, or give some advice ahead of time if we won't be.
Thanks for your response and advice. Doobie has proven, in our short few weeks with DM, that he responds very erratically to Prozinc right now. Both the vet and the hospital witnessed this firsthand. He also potentially has other compounding health issues. Pancreatitis? Heart issues? Infection? He is now on two antibiotics to eliminate infection. Potassium, to help his heart (and pancreas?). Insulin could begin working as it should if the other possible complications can be mitigated. We are in the Mountain Time Zone. We are supposed to shoot at 19:30 (7:30pm). I just caught Doobie sharing our 65lb dog's dinner about 45 min ago, so that is going to throw things off a little tonight. I didn't see that coming. She was nice to share with Doobie. I am going to test Doobie at 19:30 now, and then feed and shoot at 20:00. We are trying to move his insulin time up to 06:30 & 18:30 to match the time we used to shoot before his hospital stay. It will take a few days to move up the times to match our work schedule, rather than the hospital's. Venting: You would think all vets would welcome well-disciplined, well-informed pet owners who are dedicated to their pet family members and aren't focused on $$$. I have yet to find one? We have been to a number of vets over the last 5 years. E.g., our 5-year-old Chinook dog is one of only 30 or so breeding females in the world. Yet our previous vets pushed for early spay (and do so every time we go in), industrial foods, and the status-quo. I get it, but take time to get to know your client. I am usually very trusting and believe the best in folks, especially highly-regarded professionals. I am VERY frustrated and disappointed once again. The FDMB is the first place I've found that feels right! Thanks to all who got here before me!
Doobie is now on: Potassium Gluconate Tablet - 2 mE d 12hr (tonight and tomorrow am) Clavamox liquid - 1 mL d 12hr (not told how long) Orbax Suspension - 0.7 mL d 12 hr (not told how long) His 19:30 BG test was 186 He is eating 3 oz Fancy Feast
@Bill Robinson How is Doobie doing? I see on your spreadsheet that he JUST got home from another hospitalization for DKA. I hope he's feeling better. Some cats are just DKA-prone and the owners have to remain vigilant and proactive always; other cats go through a series of DKAs early in their diabetes journey and then never have a problem again. Here's hoping Doobie falls in the latter category. It's already clear by your notes and posts that you're both dedicated and thorough. Keep up the good work. I also see that the hospital is switching Doobie to Lantus. That is a fantastic insulin for cats, although for most cats it works best with twice-a-day shots (it appears the hospital prescribed once a day?). I strongly encourage you to check out the Lantus forum of this board and to read the "stickies" posted there ... http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/ There is a wealth of knowledge available and a lot of experienced Lantus users--including many who have lived DKA drama--who will answer questions and help you and Doobie on your journey. Best wishes and please keep us posted.
Wanted to add... Lantus is a u-100 insulin, so just want to make sure you got u-100 insulin syringes to use with it. Do NOT use any old u-40 syringes you might have had for the Prozinc (will cause you to overdose your cat). I too had a very insulin-sensitive cat who had crazy BG drops the way Doobie has. Especially in those cats, every detail matters!! Final note ... Lantus is a "depot" type insulin so its action is different than what you'e seen with Prozinc. Again, please read the Lantus stickies and ask questions.
First of all, Bill, I'm so sorry to hear that Doobie had another DKA, but relieved to see that he's back home! Second, just a clarification that when JL says to read the stickies, I think he means in the Lantus/Levemir forum, not here in Prozinc-land Best wishes with your new insulin! I hope it really helps your sweet fur baby!
Doh! Yes, that's exactly what I mean. The link provided in that post should take you to the Lantus forum. Thanks @Djamila for the clarification.
I'm so glad to read that Doobie is ok and home again.....how scary for you. I find it very frustrating when I read what the hospital vets said to you about home testing. So many of them think like that and it is a great shame because home testing is so much safer for the cat, and of course we still do watch for their eating, hydration, play, peeing etc......gosh aren't we the greatest helicopter parents around! I find the 'head in the sand' attitude by some vets very frustrating. Not all vets are like that fortunately and there are some who think home testing is great. Lantus is a great insulin for cats and I hope it suits Doobie. The Lantus forum might look daunting but everyone is lovely and supportive and you will find it as helpful as this wonderful forum.
Thanks all for your support! I spent quite a while on the Lantus forum as soon as we made the switch from Prozinc. Because of Doobies past history of instability on Prozinc the Internist at the hospital wanted to start very slow with Lantus and monitor his reaction. I am very anxious to get his BG down to avoid a third DKA and stop his ongoing weight loss. He eats almost 10oz of wet food a day but is still down to 8.5 lbs (was at 9.5lbs when diagnosed, 12lbs normally). No other acute or obvious health issues, just DM, and I believe he has had every test available for cats done on him. Poor guy! With regard to the professional's resistance to home testing, I print a copy of my spreadsheet for the hospital and Vet and issist they put it in his file on every visit. I don't blame them for being skeptical of most cat parents, but I do not allow them to ignore my info. I wore them down and the doctors finally trust our information and we are operating more as a "care team" now. They suggested we calibrate their "pet" meter with our Human meter so we are speaking the same BG language, which we did. Once we overcame their skepticism, they seem to really appreciate any reliable data they can get from us. Off to the Lantus forum I go Thanks Again All!! Bill & Doobie
