HELP!! Not enough insulin, or bouncing???

Hi everyone - I need your help/advice!! My cat, Socks, was hospitalized for about 4 days in a 24hr hospital, due to Pancreatits and DKA.. He went from acting totally normal one morning, to not wanting a single bite of food of dinner that same day - and then didn't eat for almost 5 days after that point...

I've learned now to test his urine for Ketones at home, so have been doing anytime I can catch him in the litter box.. Brought him home, test stick showed 'negative'... But we had one on Tuesday that showed 'small' amount of ketones, but as we cannot afford to rehospitalize, we kept an eye on his sugars as got them down to a more normal range, and the next day he tested 'negative' again! (We had been flushing him with lots of water down his feeding tube, in addition to a homemade electrolyte treatment) so at the very least it wasn't getting any worse.


SO, I very much need to get his levels under control truly as soon as possible to prevent the ketones from being produced further.. But we are currently dealing with quite a few variables - such as all of the meds he's on ( He's on 2 kinds of antibiotics, antinausea, appetite stimulant, all in addition to his insulin (2u BID)). He has had much softer -than-usual stools since he's been home, so one of these recent days - his BGs were much lower than usual but he had A LOT more diarrhea that day than any other day - and i've read that can make the BGs lower than usual...

& I've udpated his Spreadsheet ( I have lots of numbers from the vets but I dont know when they gave shots so I don't know what to post them as)...

But if anyone can review his sheet, we had a recent lower AMPS so i reduced his dose to 1.5u from 2u as I was worried - and I can't tell if that caused his sugars to be higher from lack of insulin that day - or if he may have gotten too low (which is what I'm thinking) and is now bouncing... but I don't know what to do as Im scared to reduce the insulin to see higher numbers, and it seems like even with high numbers for 1 days - he starts building ketones.. please help!!!

 

The priority has to be the prevention of ketones developing, are you around during the day to monitor?

 

Yes, i absolutely agree- but if i lower, it might not be enough insulin and make his BGs higher.. or if i raise (as his AM/PMPS numbers have been in the high 400s) - he could crash and keep bouncing up... I am not home M-F this week, but will be home with him until Tuesday. I am doing a BG curve tomorrow.

 

You could consider giving a higher carb food so that you are able to give the larger dose of insulin. Although it sounds counter-productive, getting a decent dose of insulin is important to help keep ketones from forming. You are giving extra fluids and the pedialyte which is good, but keeping a decent dose of insulin is also important

 

Gotcha... but at the moment as he's having loose stool issues - the vet recommended not changing his food for a bit to see if it levels out... And if I were to give a higher carb food, and he actually needed more insulin, his BGs will be through the roof high... So it seems like each way I turn there's a chance of things going more south than where they're at for now....

 

With everything poor Socks has been through and all the meds and stress I am not surprised he is having loose stools.

What sort of food are you feeding him right now?

 

I am sorry you and Justyn are having a rough time. Getting ketone tests and making sure he is well hydrated is the right course.

The curve will be very helpful - working around his meds to keep him in good levels is important. One idea - the next time you get a number like the 185, stall. Wait 20 minutes without feeding and retest. If he is rising, not falling, and close to 200, you should be able to shoot, maybe reducing the dose a little. The 1.5 looked okay that cycle, but it is a good idea to see that the number is rising, not continuing to fall.

Two units looks okay for today. Tomorrow's data will let you see whether increasing or decreasing is the best idea.

 

Yes yes the vet said to not worry exactly about them (as they havent gotten any 'looser') but to keep an eye on them of course.. He is on his food that I've had him on for a solid month prior to hospitalization -Merrick Puurfect Bistro - Chicken Pate - 2%NFE carbs.

 

Aww thanks... seems like it's just one thing after another lately, but main goal is to keep those ketones away. But that is a very good idea, and I will absolutely do that next time! And yes, I'm looking forward to the blood curve tomorrow (not the poking, just the results) to get a better idea of whats going on with him but still worried it may be not as accurate do to possible bouncing...

 

With ketones you need food, fluids and insulin, and although it sounds odd it can help to give higher carb foods when recovering from DKA to replenish the fat stores - it is complicated- if his numbers head up you have to follow with the insulin dose. Ketones develop when the body can't effectively use the insulin or the sugars are uncontrolled for whatever reason so sudden weight loss, being very underweight, infection, inflammation, the body basically starts to consume itself and the result is ketones.

 

Oh wow... I wish i knew that before switching him back to the low carb - but the issue with the higher carb food that he likes (hills m/d rx canned) - he was on 4.5u BID just to keep his highs around 400 and lows around 200... so i really didn't want to start feeding that much of a higher carb, and we couldn't keep switching due to his stomach issues...

and he's almost a candidate for all of those reasons for ketones that you listed - sudden weight loss, underweight, infection AND inflammation....

 

Did a curve on Socks' yesterday, right at 2 hours on the dot from 8am to 8pm. Curve looked great, I was surprised to see such normal numbers - and sock's has tested negative for ketones last night and this morning! Woohoo! He tested trace on Saturday morning's test but I can't believe how quickly he's been handling them as I've been giving lots of fluids/homemade electrolyte mix/and monitoring the hell out of his sugars.

BUT, this morning, I got a weirdly higher number than yesterday... And I can't understand why. I'm giving him 3/4 can with his 2u shot, then he gets the other 1/4 can 6+. I did that during the curve just to be able to see what his numbers were if i keep him on this schedule, and the numbers were still surprisingly fine.

So this morning with the higher number, I can't understand why.. Maybe his BG could have gotten low last night somehow and he's bouncing? Very confused - although I assume it's normal to see odd numbers like this for no clear reason while trying to get regulated... If anyone has any feedback about my recent numbers please let me know!

 

I am guessing he is bouncing - maybe from yesterday to maybe his cycle last night was even lower than yesterday's. Cats have difference patterns of bouncing. Some bounce immediately, some bounce for the next pre shot, some are high and flat the next day after a low. Data will help you figure out his pattern, if it is consistent.

Regardless, lovely numbers yesterday. Now for him to get used to them so he stops bouncing.

 

Please help for advice if possible.... I just tested Socks sugar pre-shot 12 hours exactly after last, and his BG was 612!!. I dont even understand how thats possible! Nothings changed... Even tested negative for ketones hours ago...Please help!!!!!!!

 

Asap too as I need to give him his next shot in about ten minutes... Fiance thinks we should give him 3u tonight vs his normal 2u as we are so worried and dont understand how this was even possible

 

It looks like a big bounce from his cycle yesterday. He had some nice blues and his body reacted by releasing some extra glucose. Without the numbers, I'm not sure whether he went low again today and this is an additional bounce. I would stick with 2 units.

 

Is it really possible that he could have bounced this high?

 

And if thats the case, would it not hurt him neccesarily if i gave him the 3u tonight and tested tomorrow to go back to 2u if able? He is just so high im so worried..

 

Sorry havent updated his spread sheet but he was high at his PMPS last night - 442

 

What were his numbers today? Last night?

 

Looking at 10/15, the cycle looks good. What has been happening since?

 

He was

383 sunday morning, 352 sun night,

360 mon morning, 284 2hrs after, AND THEN 442 after the vet trip before his pm shot! So i guess he's been high since then...

 

He was 412 this morning. Have had him on same 2u BiD and same food schedule . No changes

 

The trick is that if he is dropping low in the middle of the cycle and bouncing back up, increasing the dose makes that worse - potentially lower lows and higher bounces. With the vet visit and potential bounces, I am nervous about a big increase. We are just guessing what is happening.

You hold the syringe, you decide. But if you give more than 2 (and I would not increase by more than 0.25/0.5 at the most) I'd plan on getting a test early (+2/3) to check on an early drop and then around +6 to see if he is too low.

Bounces are hard to get your head around - the idea that more insulin can mean higher numbers. But almost every cat bounces.

 

But with his recent curve, i cant imagine how much with his numbers could change that would make him bounce so high.. He wasnt very low.. Im concerned the food he eats may not be consistent can-to-can, as thats one of the only things i can wrap my head around... Hes on Merrick Puurfect Bistro

 

Well, if you can get some tests in, increase. I don't like that he is high with a history of DKA, but I am not sure more will help.

Fill in that spreadsheet and get more data!

 

Which Purfect Bistro are you feeding? We're doing an update to the food chart, and some are low carb and others very high carb.

 

That'd be good to know and might explain the sudden spike.

 

Socks is only eating the Chicken Pate. As i had seen many are definitely not low carb! But I had emailed Merrick back in June and confirmed the Chicken Pate is 2%NFE carb.

 

Looks like he is back on track this morning. I like your am dose. Sometimes we call those odd spikes "Oh, look, a squirrel " moments. A number out of the blue (that's definitely not blue!) with no real explanation.

 

Good morning! I cant believe I havent even thanked you for all the help last night! I was busy testing him throughout the night and this morning and am glad to see his numbers are back to a safe level.. I went with your recommendation as another member also agreed with trying to reduce as its just so otherwise inexplainable - so I gave him 1.5u last night, and you can check out his SS as Ive updated.

 

Sorry meant to write more but at work. He was about 280 this morning - so i continued at 1.5u BUT i started giving him his whole can of food (rather than 3/4 with shot, then 1/4 at 6+) as im worried that could be why hes been possibly crashing as i used to give 1 full can with shot. his stomach issues havent gotten any better or worse so figured i might as well try the full can to avoid him crashing today while im at work