Help! Can't control his BG!

Arthur has chronic pancreatitis, which we suspect caused his diabetes a few years ago. It flares up occasionally and causes major issues like DKA, hepatic lipidosis, etc.

Being basically broke, I coordinated with his vet this time around (DKA, refusal to eat) to work on him at home. Antibiotics, sub-q fluids, syringe feeding, insulin. He came around, and as of last night he was basically normal.

The only problem has been that I have been unable to get his BG levels down. Prior to the episode, he was taking 2u of Lantus twice a day. I have been testing him at least three times a day (Alpha Trak II) and adjusting his insulin based on that, per instructions from the vet. As I couldn't get his BG numbers to go down, I was giving him more insulin, up to 7 units a day.

As of this morning, he suddenly refused food (last night he wolfed his food down as normal), and when I came home from work he was just laying on the floor. His BG was 521. It has ranged between 300s and "hi" over the last several days, apart from one reading of 180. Today he is showing "small" (15mg/dL) ketones in his urine again, which explains the refusal to eat and the lethargy.

After searching, I came across threads on this forum saying that increasing his insulin was actually a bad thing that could have caused his spikes. I wish I had known that sooner. I thought I was doing the right thing.

My question is, how do I fix this??? I can't hospitalize him, I don't have the money, but anything that can be done at home I can do.

 

@Bobbie And Bubba can you help maybe because this regards Lantus?

 

How long ago was his last DKA and how fast were you raising the insulin?

 

Can you list the dates, times of meter readings and when, how much insulin you gave ?

 

He hit high numbers (dark purple) on the ketone sticks about 2 weeks ago. It went to negative again as of a week ago, and is now at small.

I can't give you all the insulin readings right now, I have to track down his notebook, which seems to have disappeared. I would say generally 2u in the morning before I go to work, 2u in the afternoon when I get home, 2u before bed. Previous to his crash it was 2u in the morning and 2u at night.

How fast? Too fast, apparently. If it was really high, I added another unit. If it was still sky high, I added another unit. I feel terrible, because generally I wouldn't raise it so much so fast, but we were trying to control the DKA.

 

Lantus is only given every 12 hours. You will need to find the nadir (lowest reading) of a 12 hr cycle. Usually its about 6 hrs after shot. Adjustments to dose are then done but not every day.

There are lots of informative stickies here. You should read them and familiarize yourself with them.

 

I know this, but it's not really helping me right now. I'm asking for advice on how to reverse the high BG-too much insulin issue we have going on.

 

Hello and welcome. I can't advise on your dosing sorry but I can tell you, you are in the right place.

Let me just explain why people need your doses and bg levels. They need those so that they can advise you as to what to do.
The doses and bg show patterns as to how kitty responds to insulin (a curve) this means any recommendations anyone can give you to your problem depend on them seeing this to get an overall picture of what's going on. Without knowing that information then they can't see what advice to give. They are the main picture of what's going on. I hope that helps explain why people need to know before giving advice.

 

Are you able to post his glucose readings and the times of the readings since you increased him from the 2 units twice a day as well as when you increased his doses?

 

I understand, but I don't have the answer to that right now. I was asking specifically about how the high doses of insulin cause the spikes in BG and how to address that. Is it best in that instance to revert to lower doses? Should that happen slowly or quickly? I have no experience with that phenomena myself.

I don't have his log. One of my family cleaned the table up and put it...somewhere. I can't answer those questions. All I am asking about right now is an explanation of how that works and how best to reverse it. I understand the specific time and dosage information is missing.

 

Again that would depend on what his normal readings would be on his usual doses and how he's reacting as you upped the doses higher.. It could be a bounce, it could be it could be any number of things it's like asking what's wrong with an engine without being able to see it, all people could do would be guess. Guessing isn't good with this sort of thing...

 

Yes giving to much insulin to fast can cause glucose toxicity. If I read correctly your post above you gave 2u 3 times in 24 hr. When was the last time you gave any?

You can't give anything to counteract or render the insulin ineffective. It has to deplete on its own. Let me find some info and I'll attach it. Give me a few minutes.

 

Well maybe, but I don't know how this works with DKA, is it a option to either stop insulin for one cylce right now and start over at the next cycle and begin with the dose you've started with.??? and than build the insulin up slowely

@Woodsywife is this an option considering the DKA story?

 

Here is some information on toxicity.

http://www.felinediabetes.com/FDMB/...-what-is-it-what-should-i-do-about-it.144381/

 

The DKA is tricky. It's not good to skip insulin normally. We don't have enough information on Arthur yet.

When was the last DKA episode? When was last insulin shot.

 

I know it's tricky but in this case when the dose is too high sometimes it's best to start over from 0 again to slowely build up the insulin...
I'm not familiar with DKA so that's why I was asking.. but with kitties without DKA it's often recommended to skip the cycle and start over with the starting dose.

 

@lisam, when was the last time you tested your cat's blood sugar? If it was not recent, please test now if possible and post the result here. Also, how long ago was his last shot? Had he eaten before the shot? Has he eaten since the shot?

 

@lisam,

Honey breathe, we are trying to help you. We don't know enough yet. When was the last DKA? When was the last shot you gave? I understand you can't locate his log book yet. Right this minute Arthur is okay, take a breath.

 

@Ruby&Baco With DKA you need food, fluids and insulin on board but I'm not familiar with depot insulins so I'll leave it to the experienced Lantus users to advise. @lisam you will get good advice here so please stay with us and post those numbers, there are a few users experienced with this situation and I'm hoping they will be able to join the thread as well.

 

Nice to see you Lucy, hope she comes back.

 

Thanks. I hope so, too, it definitely sounds like she could use some help.

 

The hard truth is that if he's showing more than "trace" ketones, he needs to be hospitalized where they can use faster acting insulins to get his blood glucose down as well as put him on IV fluids to flush the ketones out...as well as possibly other treatment

DKA is nothing to fool with.....If you're on Facebook, contact Diabetic Cats In Need....they may be able to help you with some of the vet bills

If not, send an email to jenna@dcin.info (Jenna Marie Watts)

 

I know this, only if this is an overdose in insulin you can not give more and more and more. You need to step back and give less or skip a cycle. But it makes this situation really hard because of the dka

 

I put the info on his last tests and food in the OP. I can't tell you anything more than that.

I can't hospitalize him, since I can't afford it, so that just isn't an option. Because he's been hospitalized before a couple times, and I had to tap charity resources for those, I can't do it again. He will be rejected, both for a second request and for his prognosis. They don't like to give money to a cat that has cyclical crises.

He's in deep trouble, I know that much. He's laying on the floor in the way he only does when he's in trouble.

Edit: His last test was at about 4, he did not eat before it since last night, I fed him about 1.5 oz by syringe after. Last night he ate two cans of food, and his BG was "hi," as in too high for a reading. But last night he was acting normally. I would guess the time of his test last night was around 11pm, I gave him 2u then. I gave him 2u at about 7am this morning, but he refused to eat. His BG this morning at the same time was (best of my recollection) in the 300s.

 

Test him now and post here

 

403

 

That's good as far as he is not hypo. When was his last shot?

 

Have you contacted Diabetic Cats in Need?

 

He's only had hypo once in all the time he's been diabetic, and that was years ago. He definitely tends far more towards the high end when he gets into trouble. Hyper has been our issue for the last week.

His last shot was 2u at 4pm when I got home. I didn't think to look up this stuff until after I did it, unfortunately.

I have not contacted anyone for assistance, given that I've exhausted all resources in the past.

 

We've helped others with similar circumstances, but we need more information in order to be of any help.

First things first...
since you've familiar with DKA, ketones, and HL you know it's imperative to get food and water into Arthur. Also giving fluids administered subcutaneously. Normally we suggest feeding at least his normal amount amount of food plus half of that. The idea is to increase/provide a more than adequate supply of calories.
This might help:
Syringe/Assisted Feeding (Video and Tips)

Secondly...
Dosing: Get a spreadsheet put together as soon as possible. Directions are here:
FDMB SPREADSHEET INSTRUCTIONS and UNDERSTANDING THE SPREADSHEET/GRID.

There are several of us who are familiar with using Lantus under these type of circumstances, but current data is necessary for us to help you. If you could enter at least the last several weeks of data you have in our spreadsheet, it would be extremely helpful.

Third...
Post in the Lantus & Levemir Insulin Support Group for help. I'm leaving town for the weekend, but I think you'll find the ladies there to be a big help. Not only can they help with a kitty throwing ketones, but they're also familiar with kitties who may require higher doses of insulin than others as well as insulin resistance. They're also familiar with using a bolus insulin (a fast acting insulin called Humulin or Novolin Regular insulin - aka - "R") in addition to the basal insulin (Lantus) to help bring numbers down when a long-acting insulin isn't doing a good job.


If you need any supplies or prescriptions from your vet, please get them before the weekend. Many vets have irregular hours on holiday weekends.

Obviously, vetting Arthur would be best, but if not possible... well, let's just say this is what I would do if I were in the same boat and could not find any financial relief anywhere.

Good luck! Sending positive thoughts...

 

DCIN is different. Contact them with the info above. They only help diabetic cats.

Have you tested ketones lately? You will not give any insulin until 4 am. Where do you live?

 

Most meters have a memory with date, time and reading. Maybe you could get at least a few days data from there. The trick is if you remember how you dosed him.

 

Thank you, I will post in that forum as well. If I find the log I will have plenty of info, if not...all I can give is current and my best estimates of what has been happening.

My vet is great with getting me supplies to help him at home, so I will ask her about the short-acting insulins and when to administer them at home.

I have in the last few weeks gotten him through a DKA episode - sky high ketones, lethargy, dehydration, refusal to eat, etc. - from home with the insulin, syringe feeding, and sub-q fluids. I will call the vet in the morning and ask for a new stack of stuff before the weekend.

I tested his ketones about 4 as well, I did all this when I got home from work. I just got another 1.5 oz food into him, and I'll give more in a bit.

I can never figure out how to get the memory readings properly off the meter.

 

Just did a new ketone test, it has worsened to moderate (40mg/dL).

It looks like DCIN no longer helps new applicants with anything but insulin and blood testing supplies, which I already have.

 

If he is eating and getting fluids that's a big step. Do you give subq fluids?

 

Yes, we have sub-q fluids. I will need a new bag tomorrow, but he still has 150ml left for tonight. I gave him 100ml this morning at 7.

 

If you get to the point of using a fast acting insulin as a bolus, PLEASE ask for help in the Lantus & Levemir ISG. I've seen far too many vets suggest home doses of R that are far too high... often resulting in kitty dropping too fast and too low. And the problem with that is all it does is set the kitty for a bounce... throwing kitty right back into high numbers. It becomes a vicious circle!

You can probably find an online manual for your meter.

Not good, but you already know that.
Please contact DCIN imediately. They may be able to help. Send an email to jenna@dcin.info (Jenna Marie Watts) or go to Diabetic Cats in Need on Facebook.

I have to log off. Others are around to help. Will check back with you later tonight.

 

Please DO contact DCIN, even if you have had help in the past. It can't hurt, the worst that can happen is they say they can't help, and that won't put you in any different situation than you are, now. I have to agree with Chris, I think Arthur should be hospitalized if at all possible, especially in light of the long holiday weekend. In the meantime we will try to help you as much as possible.

 

That's not true (their blog doesn't list everything they do)....Please just contact them....they have helped quite a few cats in DKA and needing hospitalization

 

Please Please contact them. It doesn't hurt to ask. Where are you located?

 

I emailed them, I live in Massachusetts.

 

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

For your reference I have posted the link to the TR protocol for you which shows how to increase aggressively on lantus (sounds like you are testing enough to apply this protocol) You increase the amount given every 12 hours not the frequency of dosing with this depot insulin.

I agree with Jill that it sounds like some fast acting insulin is needed on top of the lantus to get the numbers down. When you post in the lantus forum put something about needing help with R in the title so that those with experience with this insulin see it quickly.

You will need to set up the spreadsheet so those that are helping you can see what's happening so I would get that ready ASAP. Let us know if you have any difficulty as there are people that can help with that - I think Chris is one of them.

 

Good. Keep us posted on the DCIN issue. Are you adding extra water to his food? When did he eat last?

 

I will work on the spreadsheet and take a look at the lantus info, thank you.

I add a little water to his food, enough to make it soft enough to syringe feed. Too much and it is watery and won't stay in his mouth, but I go right up to the line on that.

I'm about to syringe feed him another can, I hope. The food I use to syringe feed is grain free Blue Buffalo kitten food.

 

The Novolin R insulin can be bought at Walmart Pharmacy for around 25 dollars without an RX.

 

If there is a vet clinic open that is close by the Hill's a/d food is very easy to syringe. I have been using it the last 5 days and it works very well.

ETA It is a prescription food, which I don't normally advise, but for syringing it works so much better than any of the others I Have tried

 

I don't generally have a problem syringe feeding the food. A shot with the hand blender after some added water makes it pretty smooth.

Novolin R is the fast-acting insulin, correct? I'm guessing I would only give .25u at a time, and then check again how long after?

 

Syringe some plain water too, you want the fluids in him. Just be careful and go slow because it's thin.

 

@Bobbie And Bubba can you add some help with DKA and R isnulin since you have been through his before

ETA Or if you know other member with experience with this any help would be appreciated

 

@lisam ....I contacted Jenna by Facebook message....she said for you to get him to a vet and DCIN will help with the bill....She's in class right now and can't get away

 

do NOT start R at home without having someone with a lot of knowledge in using it helping out.....it can be VERY dangerous otherwise

 

Bubba had moderate ketones and we did use the R however, he did not go into DKA. I had help from Jill and Libby with the R dosing and I am not qualified to guide some one using it. I do know that I was started a very small dose.10 unit and was increased as it was monitored how he would react. Jill mentioned she is leaving town this weekend but perhaps @Marje and Gracie could help guide lisam and Arthur with the use. Or even maybe @Doodles & Karen as she has used R.

Unfortunately, am heading out of town for the weekend tomorrow and won't be around much. If @lisam could get the Novolin R from her Vet or Walmart, she could start posting on Lantus Forum tomorrow and ask for help with shooting R. But as mentioned, the SS needs to get up and going so dose advisor have a clear idea of what has been given.

 

I know this probably doesn't help, but I understand the stress of being unable to afford another vet visit. I know you mentioned Novolin R, and that you live in MA...and like I said, this probably won't help, but I live in Rhode Island and I have a bit of Novolin N left over as well as Humulin N, so if f it turns out you need to switch insulin to either of those, you're more than welcome to have them. I've kept them in hopes that I can help someone else in need.
I'll leave the rest of this discussion to the folks who know best. Good luck with Arthur.

 

@Chris & China Chris, you're awesome!
@lisam, please take Arthur to the vet as soon as possible!

 

I will try to get hold of her later or tomorrow. I appreciate the intervention, but without knowing how much help they are able to give, I can't bring him to a hospital and commit myself to an amount I can't cover myself.

I will continue to test, feed, and get fluids into him tonight. I will contact the vet in the morning and get him in to see them as soon as I get home from work. I desperately wish I could just take him first thing, but I just started a new job two days ago, and I cannot take off this soon without jeopardizing it. And if I don't have a job, I certainly can't afford to take care of Arthur.

I'll hold off on the R and discuss it with the vet tomorrow.

 

I just sent you a private message @lisam

Look at the top right for your "Inbox"

 

Once DCIN commits to caring for a cat, they pay the entire bill.....That's what Jenna has done by telling you to take him to the vet

 

@lisam - Trust DCIN's word - they've done the same for me. I'm REALLY terrified that if you don't, you're going to lose Arthur tonight or tomorrow. Reading back thru all this, he's headed into bad territory and I don't think you can chase it hard enough at home. NOT that you can't do it, it's all just so far ahead of you right now like a runaway freight train.

Are you sure your insulin is good?

He's likely fallen into hypo numbers and shot back up because of the liver dumping sugars but you've not caught it.

Don't worry about answering me if you can head to the vet with him....

 

Take him. It will be okay. He might not wait for you to get out of work tomorrow.

 

For those of you following....Lisa is on her way to Tufts

Now if you can help DCIN with her bills, they will need it! They're already behind on the other cats they've helped!

 

Please keep us posted when you can. And the very best of luck and all the fingers and paws that are crossed here for Arthur.

 

Are they going to start a fundraising page?

 

Glad you were able to talk her into going.

 

Yes I'm sure they will, but they currently have one going called The 7000 Donor Challenge that will help refill the coffers

 

Thank heavens! Please keep us posted if you hear anything.

 

Wonderful! I'm so happy to hear Arthur is able to receive the treatment he needs!

 

Can I donate to this being in the u.k? I'd like to give something to help Arthur.

 

Anyone hear anything yet?

 

No word yet. I should have gotten an update by now but haven't. I called but the doc isn't available at the moment. Either way I will go there after work to see him and hear what is up. Thank you all for the support and concern, I will post when I know anything.

 

This is my sweet boy taking a nap and apparently having happy dreams.

 

He is beautiful. Look at the smile on his face. Prayers and hugs sent.

 

BG is coming down but they are very concerned about his persistent anemia (one of the things I brought him to the vet for a week and a half ago). They did tests and are doing an ultrasound this afternoon.

 

Update: Arthur has chronuc pancreatitis (which I'd already figured out), which flared up and also caused a bleeding ulcer, which caused his anemia. The pancreatitis caused the insulin resistance and DKA. He is responding well to treatment and should be home in a day or two. He doesn't have cancer, which was our biggest fear. I will have the vet train me to give rapid acting insulin, since that's the only thing I haven't done to head off what are and will always be occasional serious flare ups.

I am so grateful to DCIN and you guys for connecting us and providing support. It's hard when your pet is so sick, but there's no money in the bank.

 

Glad to hear he is doing ok, please keep us updated.

 

WOOHOO!! Not cancer and you know what it is! I was SO very worried about him last night.

We have several members that have lots of experience using R insulin along with base insulin - you'll have lots of support here on an hour by hour basis if needed!

HUGS!

 

Good news it's not cancer. Make sure you get anti nausea and pain meds or scripts so you can order and keep on hand. Those two are key in pancreatitis treatment. They can be compounded to flavored suspension (sugar free) so you can syringe in if needed.

When he is back home, if you check in here daily, as already said there are many who can help with the R. It is tricky. You have many here to help you with all kinds of things.

 

Wonderful news that Arthur is doing better, you have a firm diagnosis (and it's not the "C" word) and he's responding well to treatment!! I'm not sure you really want to take a lot of advice from the vet regarding using R considering vets seem not to know a whole lot when it comes to treating diabetes. We have lots of people here that have cats with chronic pancreatitis (as well as occasionally acute) that can help you control that...You shouldn't need to use R except in very specific circumstances and it can be dangerous if not used properly. At least when they're at the vets, if they mis-use it, they have access to IV glucose....at home you're not going to have that.

Isn't DCIN wonderful?? They are one of the greatest organizations I've ever come into contact with!!

 

The docs at Tufts were all fantastic, and they were thorough and respectful. The doc discussed the R with me at my request and vetted me (no pun intended) pretty carefully before agreeing I could handle it. We discussed the very specific circumstances. It's basically the only thing we didn't do that could have helped keep him out of the hospital (to do it earlier, not after ketones show).

DCIN was really awesome. I'm exhausted, but I'm about to text Jenna now. So, so glad my kitty is coming home! And I feel blessed - another cat in DKA was there too, but not responding well to treatment and having seizures. There but for the grace of God...

 

What a beautiful cat, or shoud I say handsome

 

I am SO glad to hear that Arthur is recovering well, and that he doesn't have cancer! We were all so worried about him. DCIN is indeed a wonderful organization. I know you must be incredibly relieved.

He certainly is a handsome fella!

 

Arthur continues to improve, I'm hoping he comes home tomorrow. He got some off-IV time and was happy to walk around. He also got to do one of his favorite things:

 

How wonderful is that, I have a kitty who loves shoes. Hope you get to bring him home. It's a good idea to get copies of his treatment.

Did you ever find his log book?

 

That's so cute!

 

I can't find the book, I suspect someone was too thorough in his cleaning.

But Arthur is off the iv today and hopefully coming home tomorrow

 

Good news, glad he is doing well. Guess you have to start a new book. Maybe you can get your ss up before he comes home.

 

@lisam -

I'm so glad that Arthur is feeling better and that the oh-so-wonderful DCIN was able to help you both.

My Saoirse also has chronic pancreatitis. I strongly recommend that you ask your regular vet to give you a supply of ondansetron (for nausea) and an appetite stimulant (e.g. cyproheptadine) so that you'll have the ability to respond at home to any signs of nausea or inappetence without any unnecessary delay. It could make a world of difference to management of Arthur's chronic pancreatitis issues, reduce his risk of going into DKA or developing complications with fat deposits in the liver. Saoirse gets ondansetron twice a day now as a matter of course. It is a marvellous medication and it has saved her life. Twice.

Here are some links to resources that I found invaluable in learning how to manage Saoirse's pancreatitis. I hope you'll find them helpful, too.

IDEXX Pancreatitis Treatment Guidelines

Nausea and Appetite Problems - Symptoms and Treatments

If you can stretch to it, a course of B12 injections can be a great help. Even one or two doses can give a boost when a flare is at its worst.

I wish Arthur a very speedy recovery.


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