Insulin increase and Diet

Discussion in 'Feline Health - (The Main Forum)' started by Ninja & Baby, Feb 14, 2017.

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  1. Ninja & Baby

    Ninja & Baby Member

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    My cat has been in the hospital for four nights. He is home now. The vet increased his insulin level from 1 unit to 2. However, I'm pretty sure he was eating Hill Science Diet for Diabetes during his stay. Now, he's home with me, and I feed him no more than 6 or 7 % carbs....usually less. I'm thinking Hill Science Diet is around 20%. The vet said his BG never hit below the mid 200s. Since he's back on his low carb food, is 2 units of insulin going to be too much?
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Maybe you could play it safe and try increasing by only 0.25 u at a time. You'd get to 2 u eventually (if necessary) but Ninja would be safer.
     
  3. Ninja & Baby

    Ninja & Baby Member

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    That's a good idea. I didn't think about asking the vet this morning.
     
  4. Nan & Amber

    Nan & Amber Well-Known Member

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    Since you are using Vetsulin, there isn't as much trouble with switching doses around as there would be with a "depot" insulin. I suspect you are correct that he'll need less than he did at the vet (between stress and the higher carb food elevating his BG). I worry about reducing the insulin right after a DKA episode, however-- you definitely don't want a repeat of that, and insulin is a major weapon to keep ketones down.

    Another option would be to shoot the 2.0U, but monitor very closely (BG tests at least every two hours to at least +6 after the shot tonight) and be prepared to intervene with high carb food.

    How long until you would normally shoot? I would like if some of the more experienced members could weigh in here on the pros and cons.
     
  5. Ninja & Baby

    Ninja & Baby Member

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    I won't shoot until about 7 p.m. eastern time. It is currently 5:21 p.m. Like you said, Nan, Ninja is currently recovering from an episode of DKA.
     
  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Was the Hills at the vet dry food or wet? There is a difference in the carbs but not quite so stark between the wet foods as there is with the dry vs. wet. Did the vet say Ninja had DKA? If so, it's important to give enough insulin. I'd be hesitant to back off on the insulin anymore than absolutely necessary but also keeping in mind that he could have been running a bit higher just from stress at the vets. Check his pr-shot BG tonight and depending on that we can help you decide. First you need to be sure about the difference in carbs. Hill M/D dry is 18% carbs. If he was eating the wet Hills we'll check the carbs in it for comparison.
     
  7. Ninja & Baby

    Ninja & Baby Member

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    They were giving him both wet and dry food. The vet said he had DKA, but it wasn't really a full-blown case. He said he checked him this morning and his urine was clear of ketones.
     
  8. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I checked the Hills M/D wet food carbs and it's 16.3% YIKES! Never would have imagined it would be that high. So yes you are definitely going to have to monitor closely and perhaps drop the dose slightly. If pre-shot reading warrants, he's eating well and you can monitor tonight up to about +6 if need be, then I'm thinking 1.5 units but let's see what his pre-shot is before making any final decisions.

    I bet Ninja is happy to be home and Baby is happy to see him!:cat::cat:
     
  9. Ninja & Baby

    Ninja & Baby Member

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    There's a black cat that looks just like Ninja hanging around the house. He thinks he's tough. He has Baby convinced, but Ninja isn't scared of him. When I got him out of the car, he was fighting me to get to the offending cat. I got him in the house and locked him in. He's been mad ever since. He enjoys a good fight.

    Should I check his BG before or after his evening meal?
     
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  10. Nan & Amber

    Nan & Amber Well-Known Member

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    That's hilarious! Though, of course, not if he actually gets the chance to fight, then it is scary. But it's definitely a sign that Ninja is feeling better!
     
  11. Nan & Amber

    Nan & Amber Well-Known Member

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    Oh, sorry-- missed the question at the end!

    Test before the meal, definitely-- you want to get a number that is not influenced by food. Post for feedback. If the number seems too low to shoot, we may want to wait 20-30mins and test again-- again, best if there's no food on-board yet, we'd be interested to see if he's moving up or down on his own.
     
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  12. Ninja & Baby

    Ninja & Baby Member

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    Thanks, Nan!
     
  13. Ninja & Baby

    Ninja & Baby Member

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    I just checked his BG. It is 340.
     
  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Ok the big questions now are how well he eats and how long you can monitor tonight. At that pre-shot you could give him the 2u as long as you can monitor to at least +5 (about MN your time) and possibly longer if need be. This is a tough call because you need to keep his BG down as much as possible and if he was staying around the 200s at the vets at nadir on 2u it should be fine. I'm always a bit dubious about what the vet considers nadir....some think it happens at a specific time in the cycle:rolleyes: while others know it moves and test more frequently to find the real nadir.
     
  15. Ninja & Baby

    Ninja & Baby Member

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    I asked the vet about that, and he said it can vary. It can be at one time on one day and somewhere else the next. I guess I will have to have him sleep with me so I can monitor him.....the cat....not the vet.:stop:
     
  16. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Ok stop it Paula, I darn near choked on my wine with that crack! :p You have lucked out and have a SMART vet! YEAH! :joyful:That gives me far more confidence about shooting the 2 units.
     
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  17. Ninja & Baby

    Ninja & Baby Member

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    :) Sorry! I couldn't help myself!!
     
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  18. Yong

    Yong Well-Known Member

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    Glad to hear Ninja is back home with his family :cat:
     
  19. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Paula, I am assuming you gave Ninja his 2u of insulin. If you can get a test at +1.5 to +2 hours post shot it should give you an idea of just how fast Ninja is dropping. Post your reading and I will check back in about 9pm. to see where he's at. :)
     
  20. Ninja & Baby

    Ninja & Baby Member

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    Sorry, Linda. I just now saw your post. That was a very nice offer. Yes, I gave Ninja his 2u of insulin. I never did test him again. I have cameras in my house that send me emails when it captures motion along with pictures. Ninja tends to ramble at night so I set my phone to alert me when new emails came in reporting movement. Anytime I heard an email come in I knew it was him because Baby was in bed with me. I listened to notifications until about 2 a.m. o_O When I saw the picture of his face buried in the food bowl, I figured he was OK and it was time for me to get some sleep.
     
    Last edited: Feb 15, 2017
  21. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    That's quite the set up you have there and certainly a help for monitoring Ninja but I wouldn't trust that as an indicator of whether Ninja's BG is running too low or not.

    I know testing is a bit difficult right now but without testing you really don't know what is happening with Ninja and you need to know how low he is going and how fast to determine the best dose of insulin going forward. It's important to note that cats often go lower overnight than they do during the day too and for that reason, even though I know my cat pretty well at this point, I make dose changes only when I can reliably monitor usually on a day cycle. You didn't have that choice last night with the recent DKA as it's vitally important to give enough but not too much insulin right now to keep ketones out of the picture. It's a balancing act that can only be managed with testing.

    There are cats who show no outward signs of hypoglycemia and don't even head to the food bowl to correct the situation. They can suddenly be in a full hypoglycemic episode which can be tough and sometimes impossible to deal with at home. That is why we suggest testing early in the cycle to see how much the BG is dropping. That testing gives you the ability to steer kitty through the cycle, determine if more monitoring is needed or to abort the cycle altogether if monitoring is not possible. Vetsulin can and does pull the BG numbers down very quickly and last night you gave a higher dose based readings the vet was getting which can be elevated by stress along with a food change so even more important to monitor with all those changes to the program.

    Ninja's BG may start coming down now that he is home, recovering and on the lower carb food so going forward, it's important to test between +1.5 and +3 whenever possible especially before bed to keep Ninja safe. If you are out all day at work, testing at these times is not possible but that just makes getting those tests in the evening even more vital. Any data you can get is good data. It all helps to give you a picture of how the insulin is working for Ninja and that will give you the tools to make dosing decisions going forward and keep Ninja safe and healthy.
     
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  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Looks like you didn't get a pre-shot reading this morning, gave insulin and then got the HI reading at +3. This could very well be indicative of Ninja going low last night and/or possibly having been lower this morning when you gave the insulin.

    This is what we call a bounce and it's a normal response to BG levels that kitty is not accustomed to, BG dropping very quickly, or even possibly going to unsafe low levels. With a diabetic who has become accustomed to higher BG levels the defence system can be activated earlier than it would in a non diabetic cat. When the body decides the BG is too low or dropping too fast it sets off the release of other hormones that cause glucagon to be released into the bloodstream resulting in higher than usual readings. Bounces can take up to 3 days to clear the system and make regulating the cat more difficult.

    I cannot emphasize enough the importance of testing before shots and getting some mid cycle tests to keep Ninja safe and to bring numbers down slowly and steadily so that triggering of the body's defence system is kept to a minimum. It not only will keep Ninja safe but it will make getting him regulated much easier.
     
  23. Ninja & Baby

    Ninja & Baby Member

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    Here is what I am wondering. I left out a small bowl of Evo Kitten and Cat Food. His BG was Hi. The last time he ate Evo the same thing happened. Coincidence?

    Also, I didn't test him this morning because he was guzzling water. I felt sure he was high. Inevitably when he is drinking like that, his BG is through the roof.
     
    Last edited: Feb 15, 2017
  24. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Evo dry food is supposed to be about 8% carbs and is considered to be one of the acceptable dry foods carb wise however there have been other members report that it has caused elevated BG levels. I wouldn't totally discount it playing a small role but I wouldn't assume it's the only explanation either especially since Ninja was eating Hills which is even higher in carbs at the vets. A slight increase from the food I could understand but not such a substantial one.
     
  25. Ninja & Baby

    Ninja & Baby Member

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    You're probably right about the bouncing, but I'm also curious about the Evo. Tapioca Starch is the 3rd ingredient. Isn't that high in carbs.

    Just checked BG again at +5 and it was still Hi. Just to make sure I was not getting inaccurate reading, I took my own BG and it was 96. Probably not a monitor problem.
     
    Last edited: Feb 15, 2017
  26. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    You're right. Tapioca is high in carbs and it concerned me too because in my cat's food it's the second ingredient and her food is 15% carbs. I started her current food after EVO became unavailable in Canada so have compared the two and I've personally seen no difference whatsoever from food influences in my cat. Now that said every cat is different and I don't think my girl is particularly carb sensitive. Some cats will react to even small increases in carbs while others don't seem to be effected much at all. Ninja may be more sensitive but I still don't think it should be assumed to be the culprit in this situation. An hypothesis yes and something to keep an eye on but without testing both before and after feeding it vs. other food it's only an assumption.
     
  27. Ninja & Baby

    Ninja & Baby Member

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    Sigh . . . . .I'm so afraid he's going top develop ketoacidosis again. Is there any significant difference in testing with Alpha Trak vs a human glucose meter?
     
  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    The two meters will give different readings, with the human meter reading lower. The difference becomes larger at high BG numbers and less when BG is lower. On either meter, high is too high. It's the low numbers you have to watch for hypo - below 50 on a human meter and below 68 on a pet meter like AlphaTrak.
     
  29. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Paula, the AT2 meter will read higher than a human meter and the difference get larger the higher the BG but using a human meter is perfectly safe. Note that the human meter will read HI at a lower BG (it doesn't have the same range as the pet meter) so if you were using an AT2 meter you might have got an actual number but it would still have been very high. The only advantage to using the AT2 meter is that your results will more closely equate lab values but it is very expensive to use (strips are about $1 each) and really not necessary when we have reference numbers to use with human meters.

    Testing both BG and ketones is key to keeping Ninja from developing DKA again. Check his urine at least daily right now and get BG tests when you can. You need to get that BG down and right now it's really looking like he's bouncing big time. Keep him off the dry food if possible but make sure he eats.
     
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  30. Ninja & Baby

    Ninja & Baby Member

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    Thank you guys for your help!! I don't know what I would do without you. I took up all dry food earlier today. I have some Fancy Feast Classic Chicken out for snacking. I keep thinking Ninja probably needs all food removed until his meal time this evening, but he is already so thin.
     
  31. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If he likes the Fancy Feast let him eat several small meals between shots, just take up the food 2 hours before. If he's thin he needs the calories and post DKA, eating enough is essential.
     
    Last edited: Feb 15, 2017
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  32. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Ditto to what Kris said. Right now you can let Ninja have the food he wants (within reason) and just adjust the insulin accordingly. It's more important to get enough food into him and to put a bit of weight back on him right now than to worry about what that might do to his insulin needs.
     
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  33. Ninja & Baby

    Ninja & Baby Member

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    Sounds like a plan!!
     
  34. Ninja & Baby

    Ninja & Baby Member

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  35. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    That HI continuing all day is a bit concerning. Is there any chance you might have given a furshot this morning? It's happened to most of us at some point or another and all you can do is wait for the next shot time. If you haven't tested for ketones today, I would definitely do so. I take it Ninja is eating well and on his own. Any other signs he might not be feeling well.
     
  36. Ninja & Baby

    Ninja & Baby Member

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    I guess I could have given a fur shot. I ran my hand through his fur and I didn't feel anything. I push the needle until it stops and then depress the plunger. Is that correct? I asked my first vet about a shorter needle and she wasn't open to the idea. I'm trying to get urine for a ketone test, but he's not in the mood. He is eating fairly well, but he doesn't appear to feel very well.
     
  37. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You're injecting correctly. Also, kitties can take a while to recover from DKA. It's very hard on them.
     
  38. Ninja & Baby

    Ninja & Baby Member

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    I am attaching a picture of an old syringe. Please let me know if it is at the correct marker for 2 units. I think it is ......but better safe than sorry. Also, he tested negative for ketones.
     

    Attached Files:

    Last edited: Feb 15, 2017
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  39. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, that's correct.
     
  40. Ninja & Baby

    Ninja & Baby Member

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    Thanks, Kris. I thought so.

    I checked BG at PMPS +1.5 and still Hi
     
    Last edited: Feb 15, 2017
  41. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Paula it was just a thought and I was just speculating. It's just that kitty can shift a bit and the needle shifts too. It's likely you would have noticed a wet spot if he didn't get any insulin but if he got some, it might have dissipated enough or even leaked out after you checked.
    Can you get another test at about +1.5 hours post shot tonight? I would also double check the meter on yourself again first though. I have no idea what your meter does but I have a meter that for some reason reads high when the battery is running low. I always keep an extra meter battery or two in my box of supplies.

    There are no shorter needles in U40 syringes. While some of us using human insulin do use a slightly shorter needle, you run a slightly higher risk of fur shots. Our needles come in 2 lengths and I am a whiz at fur shots with the shortest ones! :rolleyes:
     
  42. Ninja & Baby

    Ninja & Baby Member

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    I just did a PMPS at 1.5 and it was still hi. I checked mine as a comparison and it was 94. Is it possible that something is wrong with the insulin? Also, he tested negative for ketones.
     
    Last edited: Feb 15, 2017
  43. Nan & Amber

    Nan & Amber Well-Known Member

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    I was just writing a post about that. How does your insulin look? Any clumps? Are you mixing it well before drawing it out?
     
  44. Ninja & Baby

    Ninja & Baby Member

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    The insulin looks fine. No clumps. It is a tad cloudy looking. I roll it around between my hands before I inject. I did forget and leave it out for about 30 minutes one time.
     
  45. Nan & Amber

    Nan & Amber Well-Known Member

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    I haven't used Vetsulin, so I'm not deeply familiar with it, but my understanding is that it needs to be mixed gently before use, and should be somewhat cloudy, with little particles suspended in the liquid, but shouldn't have big clumps or sediments. If the vial is relatively new and has been treated well, it shouldn't be bad, but it does happen, rarely. Doesn't sound like there are any screaming red flags here-- other than the high numbers, of course. It is worrying that he's been "HI" all day.
     
  46. Nan & Amber

    Nan & Amber Well-Known Member

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    It is good that he's eating well today-- that is a big help.
     
  47. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes. I find that string of HIs odd too. How old is this bottle of Vetsulin? Sorry if you've said before ...
     
  48. Ninja & Baby

    Ninja & Baby Member

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    I would discuss this with my vet but the vet doesn't believe in home testing. I am at a loss what to do.
     
  49. Ninja & Baby

    Ninja & Baby Member

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    As far as I know it is new. I got it when Ninja was first diagnosed....January 26, 2017. The expiration date is 12/2017.
     
  50. Nan & Amber

    Nan & Amber Well-Known Member

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    Did you get it from your vet or from an outside pharmacy? If from your vet, does it look like original packaging?
     
  51. Ninja & Baby

    Ninja & Baby Member

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    I got the insulin from the vet and it appeared new.
     
  52. Nan & Amber

    Nan & Amber Well-Known Member

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    OK, still doesn't sound like any super-obvious problems, so I guess let's see what the next test brings. Come on down, Ninja!!!
     
  53. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Has he eaten only Fancy Feast today, no dry at all?
     
  54. Ninja & Baby

    Ninja & Baby Member

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    Nothing but Fancy Feast today.
     
  55. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Well then I have no idea what's going on. Seems very weird ...
     
  56. Ninja & Baby

    Ninja & Baby Member

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    I am very frustrated. I have no idea what to do since I can't tell the vet what I'm doing. Any ideas?
     
  57. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    What do you mean you can't tell the vet what you are doing? Is he against testing at home? If so, relax. What you do at home is your business. If he gives you a hard time just ask him if he'd give a baby insulin without making sure it was safe to do so because Ninja is the same as a small baby. If you weren't testing you wouldn't know he is running high which is important information. And if he tries to tell you that is stress from testing, point out Ninja wasn't exactly unstressed when in the vets for days either.

    ETA not getting alerts properly right now. Just noticed vet is not in favour of home testing. in previous message.
     
  58. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Here's a thought: the 2 u dose might be too high and he's bounced up to high numbers. You jumped from 1 u to 2 u with nothing in between. There's concern about dosing high enough because of the DKA but maybe the good dose is somewhere between 1 u and 2 u and you've zipped right past it. You could try 1.5 u tonight to see what happens. Another thing that people do after DKA is to feed higher carb food to be able to give higher insulin doses to keep ketones at bay. Maybe the 2u dose is too high for the low carb Fancy Feast and he's bouncing because of that.

    So maybe try:
    1. dropping the dose to 1.5 u OR
    2. keep the dose at 2 u but feed higher carb food for a few cycles - maybe FF with gravy.
     
  59. Nan & Amber

    Nan & Amber Well-Known Member

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    Was he getting 1U or 2U when at the vet's and eating the higher-carb food?
     
  60. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I think he may very well be bouncing but I hate to think he bounced hard enough to stay HI all day. He was eating EVO dry until this morning which while not high carb does have tapioca which caused Paula to question if that was the problem. If he is already running high, giving more carbs is not a good idea IMHO. I do however wonder if dropping the dose to 1.5u might be in order.

    Is the insulin cloudier looking than usual? If so it may be that the insulin has started to go bad. 30 minutes unrefrigerated shouldn't make it go bad but you never know if it might have been left out before you got it.
     
  61. Ninja & Baby

    Ninja & Baby Member

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    I don't know if it is cloudier than usual. I have nothing to compare it to.
     
  62. Ninja & Baby

    Ninja & Baby Member

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    I think he was getting 2 units at the vets office, and it sounded like he was responding to it. He was responding at home somewhat before he went to the hospital
     
  63. Nan & Amber

    Nan & Amber Well-Known Member

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    How about another test-- are we somewhere around +2.5 or +3 now?
     
  64. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If he was responding to 2u at the vet's and possibly eating higher carb food there too then the highs you're getting now make no sense. Maybe you could call them and ask for his BG numbers while he was there and what he was eating. Do you have a spare battery for your meter that you could put in to see if that's the problem? We can't rule out an insulin issue either.
     
  65. Nan & Amber

    Nan & Amber Well-Known Member

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    Kris, I think Paula did a test on herself and got a reasonable number, so unless she got really really unlucky, it doesn't seem like a monitor problem. Although, if you've got a spare battery then yeah, why not try it! This is really puzzling....
     
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  66. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Could Ninja be getting into high carb contraband?
     
  67. Ninja & Baby

    Ninja & Baby Member

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    Yes, I tried it twice on myself. I do have a "new" battery...meaning I have no idea how long I've had it and I see no expiration date on the package. Ninja has gone upstairs to bed. I'm not going to check him again tonight unless he comes downstairs before I go to bed.
     
  68. Ninja & Baby

    Ninja & Baby Member

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    No, I have it all put away.
     
  69. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Worth a try?
     
  70. Nan & Amber

    Nan & Amber Well-Known Member

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    It'd be good to get at least one more number tonight if you can.
     
  71. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    This is indeed puzzling and concerning. Did you check your meter manual for any other trouble shooting suggestions although with it testing properly on you, I doubt that is going to help.

    Please try to get another test in tonight. If Ninja remains HI by tomorrow morning I think a call to the vet is in order. And if the vet gives you a hard time, just point out you think it's better to know now that his BG is not moving and is very high than to risk another bout of DKA. If the vet argues with a sound argument like that, it might be time to find a vet who does support home testing.
     
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  72. Ninja & Baby

    Ninja & Baby Member

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    AMPS=Hi
    That was with the new battery.
    :banghead:
     
    Last edited: Feb 16, 2017
  73. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    What jumps out at me when I look at Ninja's SS is that the numbers increased when the dose was increased.
    So, I don't think we can rule out the possiblity that the dose is too high.

    Here's my thinking:
    Previously, on a preshot of 382 Ninja was given one unit of insulin. 12 hours later his blood glucose was 139.
    Subsequently, on a preshot of 340 Ninja was given two units of insulin. The numbers the following day were 'Hi'.

    There is no depot with Vetsulin. The insulin is 'in and out' (and often 'in and out' within 8 - 10 hours), so there is usually a good reason for there being a low number - like that 139 - at preshot.
    Sometimes a low number at preshot means that the pancreas is working a bit, and is maybe able to extend the cycle once the blood glucose has dropped sufficiently low.
    Sometimes, though, a low number at preshot means that the dose is too high. And it may well be that there was a lower number earlier in the cycle.

    If, if, IF the 1 unit was too much at that preshot 382, then wouldn't it follow that the 2 units would be way too much at a preshot of 340 (assuming the same food is being fed, etc)...? ...And couldn't it be the case that the blood glucose dropped low enough to cause significant, lasting rebound....?

    Just my 10 cents....

    Linda, Kris, Nan, what do you think?
    @MrWorfMen's Mom , @Kris & Teasel , @Nan & Amber
     
  74. Ninja & Baby

    Ninja & Baby Member

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    You've got me. It make sense, but what do I do? I do not want to cause harm, and I have no idea where to start or stop. Do I need to worry that this is causing lasting damage during this short time period? Is it OK to let this going on for a little while longer to see what happens as long as there are no ketones and he is eating?

    Update: AMPS +1.5=582 Yay!!!! Ha ha. Kinda dumb to celebrate 582. At least it has dropped to a readable level.
     
    Last edited: Feb 16, 2017
  75. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    @Elizabeth and Bertie I agree with you that it might be that the dose is too high. I sort of alluded to the possibility that he was HI yesterday possibly from going to low the night before and we all angsted a bit about the dose the first night home. There is so much muddling/complicating the picture here. And the DKA only serves to further complicate the picture. I think we can assume Ninja was stressed at the vet and yet he got to a nadir of 200 at the vets on 2 units but he was eating higher carb food there which may have helped to balance things out.

    I think dropping the dose to 1.5 units tonight might be a good idea to see if that brings his numbers down more and get Ninja back on track. Your thoughts?
     
  76. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Paula, I see Ninja was still high this morning but had dropped some to 582 by +2? (can't tell exactly when that test was taken) which isn't much but definitely better. Can you test again at +3 or +4 to see if he has dropped further. We really need to get a handle on things to help you keep Ninja safe and healthy.
     
  77. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I was thinking that the dose might well be too high as well. However, there's concern about Ninja being post DKA and needing insulin at a high enough dose. Because Vetsulin is so amenable to dose changes because there's no depot, a trial at 1.5 u might be helpful.
     
  78. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I see that small drop but I'm not sure it's significant enough to call it a lowering due to insulin. Might be more a meter variance thing. Here's my thinking: being stuck in high numbers isn't a good thing post-DKA, whether the numbers are high due to too low a dose or high due to bouncing. We've wracked our brains trying to figure this out and I think a trial of 1.5 u this evening is the only thing left to do.
     
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  79. Ninja & Baby

    Ninja & Baby Member

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    Yes, Linda, I'm going to check again probably around +4. His reading this morning of 582 was at +1.5. That is the reason I put it in the middle of the Unit 1 and Unit 2 cells. That helps me to be able to keep up with the time better since there's no 1.5. Is there an easier way to note 1.5? All this is so confusing.

    I am thinking this Hi has lasted so long we can probably rule out Evo causing a problem???
     
    Last edited: Feb 16, 2017
  80. Ninja & Baby

    Ninja & Baby Member

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    You are absolutely right!! When the dose increased, so did Ninja's BG!!! When he was at 1 unit, the numbers were running lower. I think by the time he got started on insulin he was already dehydrated and headed into DKA. So the dosage may have been right, but it was too little too late to undo the damage????
     
  81. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hi Paula,
    You can enter those in between times right in the cell where the BG goes. Example: 548 at +1.5. You then have to go up to the little paint can icon in the tool bar to properly colour in the cell and reverse the text to white using the text colour tool if needed.

    The dosage might have been fine but the other factors - dehydration, not eating, etc. - tipped him into DKA. Are you game to try 1.5 u tonight?
     
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  82. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I agree Kris....that lower number could just be meter variance but I'm hoping we see a bit more movement during those early cycle hours. FINGERS CROSSED!
     
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  83. Ninja & Baby

    Ninja & Baby Member

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    I am willing to try 1.5 but want to wait to make a decision until I see his numbers later on today.
     
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  84. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Good idea.
     
  85. Ninja & Baby

    Ninja & Baby Member

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    Update: AMPS +5=Hi

    I got my nerve up and sent the spreadsheet to my vet. The nurse said he was currently in surgery and she would have him look at it and call me back.
     
    Last edited: Feb 16, 2017
  86. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Ok Paula.I think we are all agreed that the dose is in all likelihood too high. Tonight's number permitting (and it doesn't look like that will be a problem), reduce the dose to 1.5u and then test him at +1.5 and again at +3. By then you should be seeing a drop in his numbers if the dose was too high. Right now you need to view testing Ninja the same way you would giving him medicine. Even if Ninja decides it's bedtime, testing has to be done. It's really the only way you are going to figure out what is going on and how to get Ninja back on track.
     
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  87. Ninja & Baby

    Ninja & Baby Member

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    :( Ninja is back at the vet's office. He is in surgery today so he will see Ninja when he has a chance and will call this afternoon.
     
  88. Nan & Amber

    Nan & Amber Well-Known Member

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    What happened???? He was doing well other than the numbers, I thought?????
     
  89. Ninja & Baby

    Ninja & Baby Member

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    He was doing ok, but he was drinking and peeing a lot. I sent the spreadsheet to the vet and he wanted me to bring him in so he could figure out what is causing his high numbers.
     
  90. Nan & Amber

    Nan & Amber Well-Known Member

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    OK, I think it is good to rule out some additional underlying issue, esp. with the threat of ketones looming. Just the high numbers alone probably explain the drinking and peeing.
     
  91. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I'm so sorry to hear he's back at the vets but I would make sure you ask the vet specifically if it's possible that the dose of insulin is too high. Unfortunately some vets do not accept that cats get what is called Somogyi effect (rebound hyperglycemia/bouncing) and will simply suggest increasing the insulin more which if the dose is too high simply makes matters worse. I would also make sure he knows Ninja was eating lower carb diet at home than at the vets. As Eliz said earlier, when you look at the numbers, bouncing because the dose is too high seems a very likely explanation. Even the 1u may have been too high because he never did get a good drop in his numbers. Some cats need very little insulin and a starting dose of 0.5u may have been more appropriate for Ninja. Please keep us posted.
     
  92. Ninja & Baby

    Ninja & Baby Member

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    My vet seems to know about the Somogyi effect because he was telling me about it. That makes me feel a little better. I think all of you are right. Everything was going pretty well at the vet. The minute his dose was doubled, his BG spiked. I kind of wish I had not taken him and just lowered his dose tonight, but when it gets close to the weekend I start to panic because I know I will be out of luck unless I go to an emergency vet.....and they won't know his history.
     
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  93. Nan & Amber

    Nan & Amber Well-Known Member

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    Totally hear you on the emergency vet thing-- I've definitely jumped the gun a few times just because I didn't want to be in the position of having to take my cat in to the ER if I waited a couple days. Worth it for the peace of mind, too. Glad Ninja is doing well!
     
  94. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I think you made the right decision. When DKA has been in the picture, better to jump the gun than risk having to take him to the ER. :bighug:
     
  95. Ninja & Baby

    Ninja & Baby Member

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    Thanks to all of you for the emotional support. I am pretty low right now. My poor little Ninja is away from home again, and I feel so bad. I keep hoping the vet will call soon, but it's looking unlikely.
     
  96. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Waiting for news is always so hard but you know he's being cared for! Snuggle with Baby tonight. We're all sending healing thoughts to Ninja! And for you and Baby.......
    graphics-hugs-061298.jpg
     
  97. Ninja & Baby

    Ninja & Baby Member

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    Thank you, Linda!! Waiting is hell!!! If only they would call, text, or email and give me a few words of information. . . . . .

    Your hugs are greatly appreciated!!! :bighug:
     
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  98. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hoping for good news/info.
     
  99. Yong

    Yong Well-Known Member

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  100. Ninja & Baby

    Ninja & Baby Member

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    The attached clip sounds like Ninja.....like most of you have already stated.

    The Vet's office called last night and obviously they haven't even looked at him. They are to assess him this morning. . . . . .
     

    Attached Files:

    Last edited: Feb 17, 2017
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