Introducing Alistair

Hi everyone,
My 16 y/o baby was diagnosed with diabetes at the end of September after going into diabetic ketoacidosis. It was very sudden--his glucose was fine three months earlier and he hadn't shown any symptoms like weight loss or increased appetite. He was hospitalized for 3 days. He already had a bit of HCM but it was asymptomatic. However, the DKA treatment exacerbated that into congestive heart failure and he is now on furosamide.

In the hospital, they stabilized his glucose on one unit of Lantus a day. I did a glucose curve later that week, and the numbers were sky high. His dose was increased, without much effect, and then increased again and again. For the last few days, he has been taking 3 units morning and night. This morning was the first time he has had a normal reading since being diagnosed, so I didn't give him the injection.

One issue is that since he left the hospital, I have been struggling to get him to eat normally. It seems that the furosamide makes him feel bad (pimobendan was way worse). He has CKD and used to love the royal canin prescription renal kibble. However, I need to find a food that will be good for both diabetes and CKD. Currently, I'm getting him to eat small amounts of fancy feast pate.

I have put his numbers in the spreadsheet. There are also some days that I tested that where the meter may not have been working correctly. His insulin dosing has been as follows:
9/29-10/7: 1 unit/day (in one dose)
10/7-10/15: 2 units/day (in 2 doses)
10/15-10/20: 4 units/day (in 2 doses)
10/20-present: 6 units/day (in 2 doses)

Thank you!
Alexander

 

Welcome Alexander and Alistair. You will find lots of information about Lantus, a good diet for both the diabetes and the CKD, plus a wonderful supportive community. I'm sorry that Alistair suffered from DKA which is a very serious and life threatening condition. His recovery should be undertaken with great care so that he doesn't have to go through that again.

I am very glad that you are testing Alistair's blood sugar at home, and consistent testing is going to help the advising members see enough data to offer suggestions and input. Alistair needs to be tested before every injection, to be sure it's safe to "shoot", then during the 12 hour cycle between shots..every day. You should not skip testing because gathering this data is the only way to know how the insulin is working, and if Alistair's blood sugar is dropping to a lower than optimal level.

Please review this document: New? How you can help us help you

Please create a new thread in the Main Health forum HERE to get more eyes on your questions and issues. This forum is only the welcome mat, and more members monitor the Health forum to be of assistance. You can copy the message here and start a new thread there, then just paste the message. Please be sure to include in the title that Alistair is recovering from DKA.

I suggest you visit the Lantus forum HERE and begin reading the yellow tagged stickies at the top of the forum. This is valuable information about how Lantus works, how it works best with a consistent dose (not based on the pre-shot blood sugar level, but on the lowest BGs in the cycles measured over a period of time before increasing or decreasing). It looks like you have raised doses of insulin based on pre-shot numbers and then skipped a dose with a low BG, which disrupts the build up of the depot and interferes with the gentle, long acting action of this kind of insulin. Raising the dosage by such huge amounts is not recommended. We recommend increasing or decreasing dosage by 0.25 or 0.5 Units to not bypass the best dose. This is very important Alexander, with a DKA kitty and the sooner we can get experienced eyes on helping you help Alistair, the better.

Knowledge is power and you will find the information and advice you need here to help Alistair get the best benefit of the insulin and a good diet to support his health. DKA recovery is very important and needs extra vigilance. Alistair needs to eat well and have enough insulin, but not too much, for his body to recover from that very serious condition.

@Sandy and Black Kitty
@MrWorfMen's Mom

 

Welcome!

I’ll just make a few points:

• Post DKA, it is more important that he eats and gets plenty of calories than what he eats. I know you want to watch phosphorus levels in food due to the CKD but even with CKD, it is said the best food is the one the cat will eat; he needs at least 1.5 times his normal amount of calories right now.....whatever he will eat
• Because his dose was taken up so fast, it’s possible it’s too high; when a dose is too high, it can cause the BG to drop low which, in turn, causes the liver to release counter-regulatory hormones which drive the BG up. If you aren’t testing to catch the lows and the dose keeps getting raised, it’s an issue of safety.
• With a DKA cat, you want to avoid skipping shots; we have options here to help you. You should shoot any BG of 150 or above (and eventually much lower after you have data). If you get a 150 or lower, stall without feeding and post in the Lantus forum so someone can walk you through it.
  
• Lantus can not pull down high numbers very well; I’m surprised the vet didn’t use a bolus insulin to get the BG down.
• It’s important to get tests at night as well as during the day. We urge you to always get the preshots, 2-3 tests during the a.m. cycle, and at least a +2 and before bed test in the p.m. cycle.

At this point, I would leave the dose and test so we can see how low he goes and whether the dose needs to be adjusted.

please let us know your questions but it’s really important he gets plenty of food and liquid (add extra water to his food), the right amount of insulin, and that any infection be addressed.

 

Thank you so much! I had an incredibly hard time getting info from the vet--he actually got visibly annoyed that I was asking so many questions about the mechanics and procedure. He didn't even touch on any of what either of you said about how it works and how it should be titrated.

Thanks to the meds he's on, I've been lucky to get half is normal number of calories into him for the last month (and when he was on pimobendan, the only way I could get him to eat at all was eating a couple of treats at a time out of my hand). He's pretty weak still--his legs are quite wobbly. Do you think that is why?

I will head over to the Lantus forums but just quickly, with a BG of 155, I should have still given the whole 3 units? I was on my way to work and worried he'd become hypoglycemic while I was gone.

 

You’re welcome.

If you had been there to test, it would have been best to give insulin. But if there was no one to test, I wouldn’t have had you shoot and leave. Lantus is a depot insulin so even shooting a half dose would have needed some monitoring. I do need to reiterate that skipping is not a good option for him. The more data you can get, the sooner we can get him to a good dose.

 

I am hoping that someone is going to advise you about the dose. I alerted @Bron and Sheba (GA) to look in, she is in Australia and monitors the board pretty well in "our night time". She will be back online soon and hopefully can provide additional info.

Unfortunately, many vets just aren't very educated in Feline Diabetes...but the folks here are!

Please copy your post here, start a new thread in the Main Health forum, paste the message and let's get you the help you need, OK?

 

See my post #3 towards the bottom on dose

 

Hi Alexander and Alistair amd welcome to the FDMB. I'm so glad you made it over from the FB page!
I'm sorry the vet was not much help to you.....it's a familiar story a lot of the time.
You have had lots of great information from Lou and Marje about how to deal with DKA in the recovery stage.

It is really important that Alistair eats well and often.
I know it can be hard following DKA so try him with whatever he will eat at this point. Food is like a medicine when they are recovering from DKA. Try small amounts often.
I will send you a link on how to stimulate kitties appetite. Also if you have cerenia, I would give him that if you are not already doing so. Another good antinausea medication is ondansetron. You could ask the vet for some of those too.
http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

Are you able to ask the vet for his path results that were taken while he was in hospital and any since.........they are yours so you are entitled to them. Ask them to email them to you. Marje is excellent at reading the results.

The leg weakness could be from general weakness following DKA, not eating enough, some neuropathy, or possibly a low potassium in the blood. Has Alistair had any blood tests since coming out of hospital?

As Marje said when recovering from DKA we really don't want you skipping doses if at all possible because the insulin, along with the food helps keep the ketones away.
How often are you away from the house working? Is it daily?
If you are unsure about shooting, please post and ask for help.
Change the subject line (at the top of your thread) and say something like "HELP. Preshot xxx do I give insulin?" Or something like that.

Are you testing for ketones in the urine?
Following DKA it is really important that ketones in the urine are monitored as that is the first sign that things are not right again. It's like an insurance policy.
What you need to do is go to a pharmacy and buy a bottle of Ketostix and then collect a urine sample from Alistair.
Dip the test strip into the urine and read exactly 15 seconds later in a good light. Anything above a trace needs vet attention.
A daily ketone test is important at the moment.
If you could put the results in the remarks column of the SS that would be very helpful thanks.. we always look at the SS and the signature when helping..

So your aims at the moment are:

• Get Alistair to eat as much as you can
• Make sure he is also getting some fluids....you can add some warm water to the food if he will let you
• Give the insulin twice a day. Post and ask for help if you don't know what to do.
• Test before every shot and during the cycles. We want to catch any drops in BG levels. Cats often drop lower at night so get a before bed test and if it is dropping you will need to set the alarm and test again.
• Test daily for ketones in the urine.

I would print off this thread so you can refer to it when needed.
Bron

 

Sorry for the delayed response. I work outside of the house 5-6 days a week and I'm kind of on thin ice right now, unfortunately, because I took off a fair amount of time during the last month for Alistair.

He has had blood tests. His electrolytes, including potassium, were fine.

He is currently on cerenia. He also started taking metoclopramide 2 days ago and it has made an enormous difference. He's more interactive, eating more, and his legs are even steadier (perhaps because he's eating more).

Do you mean do a daily update in the SS for a ketone test? I will have to get some strips.

Thank you so much. I will copy over to the main health forum now. I can't believe how helpful this message board has already been!

 

Just stopping by to welcome to you and Alistair and send a wave from Toronto.

Testing for ketones daily is recommended. If Alistair is shy about his LB habits, there are meters available that allow you to check for ketones from a blood sample including the Nova Max Plus and Freestyle Precision Neo.

 

@Karson Yan This site is for folks with diabetic cats. I take it you have a diabetic cat and if so, we'd love to know more about him/her so if you could post an introduction of your own in the Welcome forum that would be great. This particular thread belongs to another member.
If your interest is solely aquarium fish, this community is not going to be of any benefit to you as our interest is in felines.

 

@Karson Yan -

As noted in MrWorfMan's Mom's post (#12), this entire message board is devoted to diabetic cats. If you are attempting to generate business for your acquarium site, we consider that spam. If you have a diabetic cat, please start a new thread and introduce your diabetic cat and yourself. If not, please delete your post. If we don't hear back from you within 48 hours, I will assume you posted in error and I will delete your post above.