DKA Kitty Back in Hospital - Please Help!

My 8 y o female Millie was diagnosed with diabetes about 5 weeks ago. For the first month or so we were trying to get her insulin dose regulated. Last Mon. she was diagnosed with DKA. BG went from 650 to 45 and she was kept at the vet's office. She spent Mon-Thursday there. We picked her up Thursday night. We did not know at the time but the release instructions were not clear. I understood from the vet tech that Millie would get 1 unit of Lantus 1 x day, we were to test her bg 3 x day, and continue force feeding. Fri. she was OK, very weak. Sat. the same (bg was 211-344). Sat. someone from FBMB asked about her ketones (we were not aware we had to test for ketones). We tested and they were 40/moderate. Later in the evening she was in good spirits and the ketones came down. This morning BG was 411, ketones were 40/moderate and she vomited. After 2 units of insulin, fluids and food we took her to a 24 animal hospital. After being there an hour her BG was in the low 200s, ketones still elevated.

Millie was admitted and she will be staying at this clinic for a few days (not her regular vet office). Here are some of my questions and concerns regarding what we were told. The 3 day stay will cost $4,ooo+. The cost is for some of the following, which I am not completely sure about. There are some other concerns as well:
They will not force feed her even though she is not eating on her own. I know meals are important.
They want to do a chest x-ray (Millie has been recently diagnosed with a murmur; her heart 'numbers' were fine according to her vet)
They want to do an echo and have a cardiologist see her (not sure if this is necessary)
They want to do an abdominal sonogram to check kidneys, liver and pancreas (this sounds right)

Many of the animal clinics are known to milk fur parents. We want to give Millie the right care but we do not want unnecessary treatments for her. This board has been extremely helpful in the short time I have joined and I think some feedback could help with understanding what we absolutely need to do to help Millie over this hump. Feedback welcome! Thank you.

 

My guy had a bout of DKA a year ago. While he was in ICU he was given fluids with electrolytes, fast acting insulin as needed, etc. All treatment was focused on the DKA situation, nothing else. He started eating on his own fairly soon after treatment began.

Your immediate concern is your kitty's (likely) DKA resurgence so if you can have treatment limited to that the cost can be reduced. It'll still be expensive but less so. I think the chest X-ray, echo cardiogram and cardiologist assessment can be postponed - if it's even needed. It would be best to focus efforts on getting rid of ketones, getting enough insulin into her, restoring electrolyte balance and hydration status.

@Meya14 has a lot of experience with DKA and its treatment afterward.

 

I know it's costly, but if there's a legitimate concern about a heart murmur, I'd want her to have an echo and a cardiologist consult because there could be some concern with vascular overload from administering fluids. If there's a problem, it's better to know upfront. The amount and rate of fluids given could be adjusted/taken into consideration when following the usual treatment for DKA.

Given the circumstances, an x-ray and an abdominal sonogram make sense to me.

When Alex was hospitalized for DKA, I visited often and was able to get more food into her than any of the techs at the clinic. Bring whatever food she likes/will eat to the clinic even if it's not a low carb wet food. Calories consumed trumps percentage of carbs when kitty is sick. The insulin dose can always be adjusted to compensate for higher carb food if necessary.

Just my thoughts...

 

Good points, Jill. I was looking at it from the perspective of $$ and what needs doing first.

 

Just spoke to the vet from the animal hospital. Millie's bg is fine right now, ketones still present, liver enzymes high. The abdominal sonogram showed she has pancreatitis, liver issues and her GI tract is slow. I told them to do the x-ray and echo to check the heart. They said they would offer her food tonight (she hasn't eaten since this morning). If she continues to refuse food they want to do a nasal feeding tube. I wanted to come in to feed her but they won't allow it. I prefer to feed her myself. :-(

 

I would be inclined to investigate the heart murmur as well, however that's a separate issue and they can be conservative with the IV/subQ fluids if there is concern of fluid overload.

There is not often a "cause" for the DKA, unregulated diabetes itself is the cause, and there may or may not be contributing factors. I would probably delay the abdominal tests unless they can clearly outline the process that they believe is occurring.

Really, getting the diabetes under control is #1 priority to DKA prevention. Sometimes, you do have to investigate the weight loss issues if your can't gain weight which makes it hard to control the blood sugar.

Ask you vet to give anti-nausea daily if they are not force feeding. They are probably going to put her on a sugar+insulin IV which takes care of the immediate need to forcefeed somewhat. But the liver can still be damaged without food.

 

I don't have anything to add to all the good advice you've already gotten, but I'm sending prayers and healing vibes for your sweet girl and you.

 

They did the sonogram and we told them to go ahead with the other tests, this way if there is any underlying things going on we will know moving forward. Hopefully this will not happen again but this way we have all the info regarding her health status. They will 'nasal' tube her for feeding if she does not eat on her own. She was on an anti-nausea med before but still didn't eat. The doctor will call again later this evening and I'll ask about that.

 

Nothing wrong with getting all the tests done, it's just that some owners can't afford or it might cause them to make the decision to put to sleep due to costs. I'm glad you got some more information on whats going on with your kitty.

 

Any updates?

 

The costs are very high especially when you have two more chronically ill animal family members at home and yourself! It's why we were trying to scale the costs back. I think the idea to get as much information from the start is also what convinced us. Now we know her murmur is an 'innocent' one and in the future we can inform vets we are working with.

The doctor is supposed to call this morning with an update; I will go visit this afternoon.I will post here how she is doing.

 

The doctor called and said that Millie's ketone is down to trace levels, her glucose is stable and she's eating on her own, yay, yay, yay!!!! Her phosphorous and potassium are still low. They will be taking her off the fast acting insulin and putting her back on her Lantus and checking for the ketone levels. Hopefully all goes well and she can come home tomorrow. You all have been so amazing. I did a lot of reading about feline diabetes but the help and information from this board gave me a fuller understanding of what was needed. Forever grateful. <3

 

Millie is coming home today. Yesterday they were trying to get the right insulin dose set (going from the short acting insulin to the Lantus took a bit of work). We will pick her up later today with better home instructions going forward. Thanks again everyone!

 

Very good news for you and Millie!

At the risk of being too directive I hope you'll set up a home BG testing routine using ear pricks. If I'm correct, you were using urine glucose testing strips?

 

We started to use the ear pricking after the last hospitalization. We're still not that good and sometimes have to prick her several times but she's good about it (so far). We only starting doing ketone urine testing this weekend when someone on the message board mentioned it. The vet reassured us that they will give us very thorough instructions moving forward, which we welcome!

 

That's great! The ear testing does get better - I promise. You already have urine ketone testing experience.

 

I'm so glad she's well enough to come home!!!!!!!

 

I know you have much on your plate right now--For what its worth some folks have better luck using a tiny needle (25 gauge -ish) instead of a lancet to get a drop of blood.
This brand is one of the best --for fluids too
http://www.medi-vet.com/Terumo-Need...m_source=googlebase&utm_medium=shoppingengine

 

Just want to let everyone know Millie is doing really well. BG & insulin remain consistent and ketones count remain negative. She is eating really well and in good spirits. Ironically the whole hospitalization experience has turned her into a snuggle bug. Once we're better at the ear pricks, all will definitely be well!

Can we use these needles for the insulin as well? Or could we use the insulin needle to prick the ear?

 

Your blood glucose meter should come with a few lancets and you can buy more. The insulin needles tend to be too fine. You get the best result with a 26 to 28 gauge lancet - often labelled "for alternate site testing" at a human pharmacy.

 

Yes, we are using the needles that came with the meter. We are pricking her 3-5 times each time to get blood. She his starting to get pretty upset about it. A few times we've drawn blood and then the meter doesn't work. :-(

 

Are you warming her ear first? Many of us make a "rice sock" from a clean old sock that we put about a half cup of dry rice into the toe, tie it off and heat in the microwave oven until it's very warm but touchable. Some people put very warm tap water into a small bottle that has a lid that will screw on tightly.

Is your meter a type that has strips needing only a very tiny blood drop to register a result? The AlphaTrak pet meter is one but its strips are extremely expensive. There are a couple of Walmart ReliOn types (the Micro being one) that work with a tiny drop and the strips are quite inexpensive.

 

I would not use a different needle than the one that is on the insulin syringe to give insulin injections.
I suggested using a 25 gauge for the ear prick because it is so sharp and should bleed fairly easy.
It may be worth a try....if you do try the terumo needs for the ear prick be careful as they are very sharp and I have often pricked myself-- I think it may help you tho at least until kitty "learns to bleed" and has more capillaries....
Just to be clear I would use the insulin needle for insulin injections not the ear prick-

 

I warm the ears by rubbing them but I will try the rice sock instead. We are using the AlphaTrak. There are no Walmarts near me, Target & plenty of pharmacies.

 

The AlphaTrak is really good if you can fit the strips into your budget. I use it too and find it can give a reading on a very small blood drop and it doesn't time out too quickly. Make sure you get one of the tiny finger-like projections on either side of the bottom of the strip touching the blood droplet so it can sip the blood up.

 

Just to make sure I understand, for drawing blood from ear pricks....
-warm the ear with a rice sock
-use 26/28 gauge lancet labelled ' for alternate she testing'
- or use Terumo 26 gauge needles for drawing blood

Thank you!

 

Yes. The lancets that come in the AlphaTrak kit are 28 gauge I believe. You can also use 26 gauge needles.

• warm the ear long enough - 30 seconds should do - wrap it tightly over a finger (cotton makeup pad or layers of tissue behind)
• hold the lancet/needle at an angle bevel side up and make a quick little poking motion
• use the upper outer edge of the ear
• don't worry if you accidentally go through the ear - it'll heal.

Try to stay as calm and clinical as you can, all business. Lots of scritches and a treat right after.

 

I didn't mean to confuse you
Sorry
With the terumo needles I barely graze the ear they are so sharp. You may get more blood than you need

 

No worries, you didn't confuse me, I'm just easily confused!

 

What I do, since the meter gets ready pretty quick, is poke his ear first and when I see the blood drop coming out I will fully insert the test strip to activate the meter. I partially insert the test strip and sit it on the table while doing the poking

 

So sorry to hear about what you went through with your kitty and DKA. My little Ozzy also had severe DKA and this was actually how we first found out he had FD. We were absolutely devastated and he was so sick; he almost passed. Ozzy was also hospitalized for 4 days at the tune of $5K and my vet did pretty much all the same tests that your vet did. The told us the abdominal ultra sound was important because they wanted to see what else was going on and to see if other organs were involved/had damage that could be contributing to the DKA. Ozzy also had elevated liver enzymes and low potassium which he took supplementation for after his release for the hospital. A few weeks later after proper veterinarian treatment and home treatment, all his liver numbers were back to normal as well as his electrolytes and so far he has no permanent organ damage from the FD. I would say it probably took him about 2 weeks to go back to feeling/acting normal. He had been through a lot. Even just writing this I'm tearing up because it was so awful to see my beloved friend so sick and so very sad. I know exactly what you are going through. The folks on this board helped me save my kitty's life I swear and they have continued to guide us as we are still learning about FD and trying to get Ozzy regulated. He is still fluctuating up and down on doses and we had a very difficult time with switching foods to all wet because he got massive GI issues and vomited every day and had bad litter box deposits (FDMB members helped us through all this too!). It's definitely been a journey but Ozzy is doing really well today and I am soo very hopeful this will be the case for your kitty too!! Wishing you the absolute very best and PLEASE PLEASE PLEASE home monitor your kitty every single day!

 

Are there any other syringes that are recommended for pricking the ears? I wanted to try and get some ASAP and getting them from the site will take 3-9 days. Pet Meds is limited in what they carry. Amazon has some Terumo that are a different gauge. I don't know about this stuff so I can't really tell what would work best.

 

So glad your Ozzy is doing well. Millie is doing nicely as well. I have been monitoring her closely (bg, ketones, food, water, litter box use). Thank you for your story, it's wonderful how people have helped one another. Wish the vets would learn from all this experience.

 

At Teasel's diagnosis, I bought some larger gauge syringe needles to do BG testing from my vet. Why not call there to see if they'll sell you some? If they work well for you, you could ask if they'll order you a box.

 

Have you tried going to Walmart and getting the relion brand

They are only a couple dollars and you can just go in an pick them up. These are the ones we use and have since the very beginning.

Also a tip for ear pricking: usually when we prick Ozzy's ear, the blood droplet doesn't form right away. You have to apply a gentle pushing pressure from behind the poke and gently massage or press the blood up to the poke hole and out. Do not try to squeeze like you are popping a pimple or use your fingers nails; instead use the flat part of your thumb pads and gently kneed the blood up kind of like squeezing toothpaste from the bottom of the tube out the opening. This works every single time and we no longer have to heat the ear. Ozzy hated having stuff put on his ear to warm it so this always works best for us. Sometimes he likes to sit in his window bed with the window open and with the cold winter air we have been having, his ears will get cold and chilly at the tip. I simply remedy this by reaching my head down and breathing a few hot breaths of air from my mouth over his ear and same thing- works every time! You just need to experiment a little to figure out what works best for you and your kitty. You might want to rotate ears a little but some people have a favorite ear to test on. Also, it really helps to put Neosporin on the tips of the ears (both sides because you will likely poke though the ear most times) every night before bed to allow some healing overnight.

Hope this helps! Good luck!

 

Wanted to add a few other tips:

1) It might be a good idea to add some water to each meal to help keep ketones at bay and flush kitty's system.

2) Since you have a DKA prone kitty, it is advisable that you test regularly for ketones. You can do this by purchasing ketone test strips (also available for a couple bucks at Walmart) and sticking them in the urine stream of your kitty while she is going. The test is ready in 15 seconds. This can help you determine a problem if your kitty starts showing more than trace ketones so that you can do some preventative things to help avoid full blown DKA (increase fluids, increase insulin, increase food intake). As you know, DKA treatment is brutal on the pocket book not to mention life threatening for kitty, so this one small quick act can help tremendously. I remember the first time I tried to get Ozzy to take a ketone test (and even posted about it) because I thought no way am I just going to just walk up to the litter box, yank up Ozzy's tail, put a strip under his bum and he's going to pee on this stick on demand...and guess what...he did EXACTLY that! It was hilarious and a lot easier than I thought.

 

So Millie had her follow-up exam at the medical center this weekend. The doctor said she was doing really well but she was running a slight fever. She snuck in an abdominal sonogram (thank you!) and drew blood & urine. Her temp was down later in the evening. Yesterday she said all the tests were fine. She is home, happy and eating like crazy, which is good because she lost so much weight (I know I have to keep an eye on her). Also we've gotten much better at everything and the warm sock made all the difference in pricking Millie's ear! Thanks again everyone.

 

I'm SO glad she's doing well.

 

Glad to hear she's doing well!

 

Great news!

 

Is it normal for a cat to have these types of fluctuations in BG?


3/14 8:00am 79
7:30pm 479
3/15 7:35am 408
7:15pm 70
3/16 7:30am 535

We have not been given instructions regarding increasing her insulin.

 

I reread your posts and found that she's on Lantus. What dose has been prescribed? Are you using a human meter or a pet meter? If a human meter, do the strips need only a tiny blood drop to give a good reading? If you could add the following info to your signature, we wouldn't have to ask for it:

• kitty's name and age
• date of diabetes diagnosis
• type of insulin being used
• if Lantus, which dosing protocol you're following - TR (tight regulation) or SLGS (start low go slow)
• type of meter being used.

If you're willing, setting up a spreadsheet like the one we use here would be extremely helpful. It's the first thing we look at in trying to help you sort out a problem.

On the face of it these numbers suggest extreme bouncing but it's hard to know for sure without more data. The insulin dose might be too high. What was the starting dose after the DKA? Has it been raised recently? By how much? You'll get more specific advice from very experienced Lantus users if you post in that forum and put the question mark icon in front of your thread title.

 

I will try to post info near my name as suggested. I am really terrible figuring out how to use sites for posting (it took days to learn how to start a new post on here, still get confused due to some med issues myself.....).

Just tried. Where do I go to add info to my 'signature'? Is that the same as the 'avatar'?

 

I've reread more of your posts on this thread and found the meter info. On a pet meter like the AlphaTrak, the low BG danger zone is about 68. Your recent 70 and 79 are quite close to that zone. That's a good thing when a kitty has been on Lantus quite a while and you have a regular testing routine in place and lots of spreadsheet data to support what you do dose-wise. You're not there yet and these low numbers strongly suggest too high a dose for your kitty. Please post on the Lantus forum for more specific advice. I worry that your kitty might continue to go too low and end up in a hypo episode. You don't want that so soon after the scary DKA episode. I'm not trying to alarm you, just trying to emphasize the need for more monitoring and getting more advice.

@Wendy&Neko
@Doodles & Karen
@Sienne and Gabby (GA)
@Bobbie And Bubba
Again, apologies to folks I've omitted.

 

OK, so hypo is more of an issue with a DKA kitty and not the high BG? She is on 2 units of Lantus right now. We've had to change dosing time because the hops was doing it 10am & 10pm and I needed to have my husband home before he left for work. Then we had daylight savings so I don't know if this has confused the situation.

 

I added the info to the signature. I wasn't able to add whether the protocol was TR or SLGS because no one has specified. My guess is SLGS (that's how it appeared initially). We had her on 2 units before the DKA and now it is also 2 units.

 

No, a DKA kitty isn't necessarily more at risk of a hypo. A recovering DKA kitty needs adequate insulin to keep ketones at bay. The highs and lows in BG are suggestive of a phenomenon that we refer to here as "bouncing". I wrote this for someone else:

Here's how it works:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a dose prescribed by the vet and the owner isn't home testing or testing enough.
7. Many vets have little/no understanding of the bouncing phenomenon, often prescribe dose changes that are too large and/or don't encourage home testing.

The problem with a hypo is that if it's severe it can be lethal. I've suggested that the 2 u dose might be too high because of the BG dives you've seen. I suggest you start now to collect BG data as follows:

• AM and PM before feeding and giving insulin (no food at least 2 hours before) to see if dose is too high
• at least one test near the middle part of the 12 hours between doses to see how low the BG is going
• one more test at bed time because many kitties go lower at night.

The numbers you've posted tell me that you need to figure this out soon. Please consider setting up the spreadsheet. There are people here who will do it for you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

Good to know this. I am heading out but will tackle the spread upon my return. Thank you.

 

You can go to the Lantus and Levemir forum (further down the last on the main page) and start a new thread the same way as you did here. Click on the blue question mark icon from the drop down menu at the left side of the thread title bar. Maybe use a thread title like: "Need advice on strange BG numbers". In your post give the BG numbers you've asked about here and ask for input.

 

Hi there. It's hard to know what's happening with the numbers without seeing the tests numbers in a spread sheet(SS). If you could get that set up and put in all the text you have, that would be helpful. If you need help setting it up just yell and someone can you. (sadly , it won't be me as I'm a tech mo mo)

Just wondering if you changed the insulin schedule even an hour sooner than the hospital's insulin schedule, it could have acted as an increase for Millie and she is bouncing from the lows. Did you shot 2 units on 3/14 when you got the 79? And did you get any other test in prior to the PM test.

 

On these days, what time did you give insulin? Were these the blood sugar values before you gave the shot? It is very important to get some tests in part way through the cycle ( time between shots). Lantus generally produces numbers that go down starting a couple hours after the shot, to the lowest point, or nadir, somewhere in the middle, then back up again towards the next shot time. If kitty is 70 at shot time, it begs the question, how low was she a few hours before that and a few hours after. We try to figure out the Lantus dose based on how low it takes kitty, so getting some tests 4 to 7 hours after the shot are very informative. That includes night time, as our furred ones like going lower at night.

What food is Millie eating now?

 

We take her bg reading about an hour before her shot. Problem is we need to both be here to test her, she does not look having her ear pricked, but it's only the weekend that we're both here & can test.

Millie is eating Fancy Feast Classic.

 

I'd strongly encourage you to use treats as bribes when it comes to testing. The more you associate testing with a treat, the easier it will become to get tests.

Some cats who are recently recovering from DKA can easily have another episode. Because insulin is part of the treatment, you need to know how your cat is responding. The basic "formula" for developing DKA is infection/inflammation + not eating + not enough insulin. It's important to get calories into Millie as well as insulin -- as much of both as is safely possible.

 

Yes, we are giving her treats. There for a number of days it was extremely hard to draw blood, requiring numerous pricks. Now she is a bit resistant.

She is on antibiotics and has a really good appetite, eating up to three 3 oz cans of food.

I'm confused because the other posts said she may be getting too much insulin. Am I reading something incorrectly?

 

I said that the low numbers might be due to a dose that's too high. That's one possibility. I tagged the people who responded and they're giving you their input. They've touched on key points:

• The need to log data in a spreadsheet
• The need to do some testing mid way through the time between doses
• Getting a testing routine that involves treats
• Millie getting enough calories post DKA
• The difficulty in knowing what's going on with her BG without quite a bit of BG data gathering.

The dose might still be a little high. However, your immediate task is to get more test data.

 

I went to the instructions & tried doing spread sheet but I have some medical issues myself and it's affecting my reading & processing today so I wasn't able to complete. I did give her some higher calorie food and will test her as soon as my husband gets homes (two hours earlier than usual). We will try to proceed once we have that bg reading. Moving forward I am going to try to ask a neighbor to help with Millie's mid-day reading.

 

Are you both there in the evenings? Getting a test before bed is usually very informative. As Kris said, we don't have enough data to know if the dose is too much. We determine how to dose Lantus by how low it takes kitty. We don't want her going below 68. If you see her below that, you need to give her high carb food and reduce the dose.

 

We usually test around 7/7:30 in am & 7/7:30 in pm, insulin is then given around 8/8:15. The 70 and 79 were the first times her numbers were that low. I will be giving her a higher calorie food 'til this is straightened out. I sent an email to the ER hospital she was in and her (resident) vet just wrote back. She said to bring her in Friday or Saturday for a Fructosamine test. I have no idea what that is.

 

It's a blood test that gives an idea of what the average BG has been in the preceding couple of weeks. Based on that average the degree of BG control is specified all the way from poor control up to well controlled. Problem is it says nothing about how high or low BG has gone.

 

Millie ate a little around 4:00 (she's a grazer). We just took her bg and it was 61. I gave her some honey. Not sure when we should re-test (in an hour, two hours)? I am going to call her regular vet, who hasn't seen her since before the DKA.

 

Most of us test, feed, and shoot all within about a 5 - 10 minute time span. With Lantus, insulin onset doesn't occur for about 2 hours in most cats so there is no reason to test, feed, then wait for digestion to start and then shoot. If you were using a shorter acting insulin where onset is much earlier, you would want to make sure you kitty has eaten before giving insulin.

You noted that Millie eats "all flavors" of Fancy Feast. Are these the Classic pate (i.e., low carb) only? If not, it's likely that you will see some wide swings in Millie's numbers due to what the carb percentage is in what you're feeding. Most of the varieties of Fancy Feast, other than the pate style, are fairly to very high in carbs.

 

I was actually just giving her more food because she seemed hungry. Her shot is due at 8:00pm. Should we be concerned that she ate and her bg is still only 61? I called her vet but she isn't in today. We don't know the vet who is filling in but she is supposed to call back. I'm not sure what we should do, re-test at 8pm then decide how much insulin to give? Or give it regardless but also give her honey? Quite confused.

 

You need to test, feed and shoot all within 5_10 mins apart to get an more accurate reading as to whether to shoot

Without more data , it is going to be hard to know if Millie is on the correct dose. Do your best to test more when your home so we can help you help Millie.

 

First, 61 is not a terribly low number. It's safe. You just don't want number to drop below 50. If numbers drop, that's when you need to intervene with either high carb food or add a bit of honey (a few drops) to low carb food. There are instructions in this link on how to manage low numbers.

I don't know what time zone you're in to know how far from shot time you are. We count in +time -- your test at shot time is your AM or PM Pre-shot (AMPS OR PMPS) time and every hour after that for the next 12-hours is counted off. In other words, 5 hours after AMPS is +5.

It sounds like you still have several hours until your PM shot. I would re-test in 30 to 60 min so you know what's going on. You can give Millie some low carb food just don't continue to feed past 2 hours prior to shot time (unless her numbers drop below 50).

I would suggest you keep the people here on Health informed of where Millie's numbers are heading. There's a good chance that since it's toward the end of the cycle that numbers will start to rise and all will be good by shot time. If you don't know what to do at shot time, change the subject line in your first post in this thread and ask for help.

 

Sorry, someone recommended a higher calorie Fancy Feast when the kitties are hypo but I can't find the post. Not sure if it was FF Grilled? Millie really like the FF and it was hard finding a good for her so I'd like to stay with that brand.

 

The FF Gravy Lovers are good ones for when they are low. The carbs are in the gravy and you can just squeeze it out. The Grilled FF are mostly what we would call medium carb food. The gravy lovers is higher carbs.

Since you are using at AT, that 61 is lower than we want and earned Millie a reduction in dose. Do you think you could eyeball a 1.75 unit dose?

When kitty is below 68, it's a good idea to give a little honey like you did, or a couple tsp of the higher carb foods. It's been a while since you tested the 61. I would test again now. You want to make sure that the honey or gravy has prevented her from going any lower.

 

Thanks for getting back to me about the food.

Millie's bg was 61 at 5:40 and 62 at 7:40. I gave her more honey and some dry food that she likes. Her vet got back to us and said not to give insulin tonight. I am taking her in tomorrow to have the frutosamine tested.

 

If you haven't seen it yet, this chart on catinfo.org lists a number of the commonly available cat foods and their carb contents. There are several pages with Fancy Feast. Generally you want over 15+% for high carb food and under 10% for her regular low carb food. If all you have in the house is the grilled FF, I'd give a bit now. You don't want her spending much time below 68. How is she acting now?

 

Should I keep posting in this thread?

We tested Millie this morning and at 7:30 am her BG was 540. She gets her Lantus at 8 and I was considering giving her a smaller dose (1 or 1.5 units as opposed to her 2 units). Any opinions? We have an appointment with her vet at 12:00. I thought we could retest at the vet office.

I just read the TR protocol for Lantus and feel very guilty that we didn't con tin testing her last night. This is not a complaint but it's been a lot to take in in a short time, first the diagnosis and trying to get her on her correct dose, the DKA, two hospitalizations and now the low numbers. Not having an opportunity to really catch up and grasp everything we need to know. After reading the TR protocol I do want to try to set that up with her. Was wondering if I should shift the time to make sure it's a better schedule for us to adhere to (so we don't run late if we're out, etc).

 

If you don't get an answer in time here you can try the lantus group.

 

I sympathize totally with you feeling overwhelmed on your steep learning curve. There's a ton of info you have to absorb and you've had many complicating issues on top of that. Try to take it one little chunk at a time. I suggested yesterday that these big swings in BG might be due to the dose being a bit too high but, as others, have said, we need to see more data to know for sure. I don't know if this will help but a "to do" list for you might look like:

1. decide on two dosing times 12 hours apart the you can fit into your schedule consistently
2. set up a BG testing schedule like the one I described in my post #48 above
3. set up the spreadsheet we use here ASAP
4. post all BG numbers in a clear list in a post here until the SS is set up
5. go read the Lantus protocol you want to follow (TR) a few times untli it makes sense to you
6. post on the Lantus forum where the pros can see your questions.

Does this help?

 

Yes, it does. I was just writing on the Lantus thread. Thank you!