le sigh. up 160 to 600 in an hour after tiny dose increase

So at +10.5 she was 441--I decided to give her her shot a little early, and decided to increase her dose a little bit up to 0.8, and in an hour she shot up to "hi", so I re tested and got 600 (!). I have never seen 600 before, so this is not okay. Yes, the 441 was before eating, but I don't think eating 1/2 a can of ff should lead to a 160 increase. I'm thinking about not giving her a shot tomorrow at all just to see what her body does without it. Is that an awful idea? It'd be like one fur shot.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

You're right. It would be like a fur shot. I am not sure if one cycle will tell you much but yes, you could try it. Be sure to test for ketones.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

maybe a full day then? depending on if we're super high or if she seems to be decreasing?

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

but I can't imagine that it can get much worse than 600?

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I have to admit, Kathryn, I don't understand what is going on with her. She got better numbers with one unit early on but now they are pretty awful. They do look like she might be getting too much insulin, but if she is diabetic she needs insulin. I would think if she doesn't need insulin, any dose would send her crashing.

I would not try your experiment for more than two cycles.

Originally, I thought if we could get her on a normal 12/12 schedule on a standard dose, she would show some normal numbers and we'd have a direction to go.

Tell us again: no dry food or treats? Where are you drawing the insulin up on the U100 needles? How do you handle the insulin? I am wondering if there is something wrong with your insulin. What does it look like? Do you roll it to mix it up before injecting?

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Well, I skipped one shot, and she was lower PS than she had been the last 4 days. I didn't want to skip one more shot, so I gave her 0.4--1/2 the dose that shot her up to 600.

I'm starting to wonder if the insulin has gone bad too. It's never been left out, and I roll it to mix it. I use u100 needles, where one unit is actually equal to 0.4 units, so when I was giving one unit I was using my old u40 needles and just giving one unit, but now with my u100 needles, I just gave "one unit" which is actually 0.4 units.

She's only eating wet food--lately just the ff classics.

I really hope the 0.4 dose works--I'm just about out of other ideas.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I have no advice - Sue has a better mind for this stuff but I wanted to say Hang in there - this can be so frustrating but you are doing your best and you kitty knows that - something will start to work just hang in!

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Could this be the wrong insulin for her? And is it ProZinc or PZI?

Perhaps she is having a reaction to whatever is in it - diluent, stabilizer chemicals, insulin molecule, etc. ProZinc is supposed to be very similar in molecular structure to a cat's own insulin, but it isn't always the right insulin for the cat. Something to discuss with the vet.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

She is on ProZinc, not PZI. Yesterday morning I got a good pee sample and she had the low end of moderate ketones, and was looking a little limp, so I brought her into the vet and he didn't seem overly concerned. We discussed her dosing and decided to up it further, as he thought the dose was too low to be causing the inverse curve and that it was more likely that it was way too little and the PS food was what was making her rise (which is entirely possible).

So I upped the dose to 1.2 (per the vet's suggestion), and it seems like that's going a lot better, though she hasn't eaten since last night so it could be a combination of it working better and her not eating. She drank some water but then puked the water up, so I gave her subq fluids this morning (3.5 hours after her insulin) and then I just came home at lunch and it looked like she'd just about absorbed it all so I gave her more. This way she'll still get some hydration to help clear the ketones out of her system and she won't be able to puke it up since it isn't in her tummy. She's back down in the 300's but that isn't nearly enough, so I'm contemplating bumping her up even more, maybe to 1.4 depending on where she is pre-shot this afternoon (somehow got onto a 4am/4pm schedule--ugh).

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Some folks have used 1/4 tablet of regular Pepcid (not the complete) to help with the stomach issues.
And are you doing fluids based on vet advice? Just checking - it is possible to over do them (and I'm studying fluid and electrolyte balance in my pathophysiology class right now!).

Its so nice that ProZinc can be dosed based on what you see!

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hello Kathryn,

So sorry about the ketones and Snowflake feeling poorly. In my opinion, it's urgent that she eat. I have read on this board repeatedly that with ketones 3 things are absolutely necessary: 1. eating 2. hydration and 3. enough insulin. Of course, vet care. A lot of cats cannot resist Fancy Feast classics or Forti Flora sprinkled on top of their food. Have you tried those? Some kitties have an issue with beef - my Pudge vomits when given beef.

My Pudge's blood glucose would go much lower when he didn't eat every 2 to 3 hours. His BGs also would shoot up high when he ate a big meal. He did and does best on small frequent meals of low carb canned food. Pudge was on ProZinc until he went into remission several weeks ago - we were on tid and he went OTJ at 1.6 units (of course, that's as dosed on ProZinc, meaning U-40 syringes, or equivalent to 4.0 units on U-100 syringes). My old computer stalls when I try to read an ss. I know now that you are posting in U-40 units. We have not been back for an OTJ party, yet, because I do not want to jinx his remission :lol: nailbite_smile

Sending you and Snowflake hugs and best wishes,
Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Thanks for the advice--the sub q fluids are just saline I believe, and don't contain any electrolytes. Since she wasn't drinking anything and the last dose had already been absorbed, I thought another couldn't hurt, but maybe I shouldn't have done it so soon.

She absolutely refused to eat, including a/d which is usually my food of last resort, or the one I use if I need to mix it with antibiotics, so for now I'm focusing on getting her enough insulin and keeping her hydrated. When she was at the vet she didn't eat overnight and all day while she was on the IV and when she got home she had her appetite back, so I'm hoping that it'll come back after I've gotten the other two parts in control.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Er ... saline contains sodium, an electrolyte, in solution.

You may need to syringe feed if she continues to be uninterested. If it has been more than a day, she may need to go on a feeding tube.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

oh wow you are totally right! I hadn't read the package and it has a bunch of different additives! 9 hours after the last sub Qs, I just gave her another 25--just a little. I tried to syringe feed her but I don't know how much she ate and how much got stuck in the fur on her chin. Certainly she got some of it down, but the entire size of what I attempted to give her was probably 2 tablespoons, so maybe she got one tablespoon of that? and it was mixed with water so it could go in the syringe. Despite the fact that the vet wasn't concerned yesterday, I'm going to bring her back in tomorrow morning and practically demand that she be put on an iv. I caught her peeing, and her pee still is at moderate ketones, which is where she was yesterday when I brought her in. I just tested her bg and she was at 330 at +5--a huge improvement from the 400's and 500's we were in before, but still not great. I think I may up her insulin a bit more for her next dose. I just wish she'd eat something :\

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I wonder if the not eating is her body's way of trying to get her bg down on its own?

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn,
no, her NOT eating is not a function of Snowflake trying to get her BG lowered. It's much more likely due to her feeling awful because of ketones and diabetes. Upset stomach? She needs food to have the very best chance of getting better. Diabetic cats don't use nutrients appropriately and when you add not eating on top of that, it creates a really difficult difficult situation. She can survive with higher BGs. Ill cats have a rough time surviving without eating. Good thing you syringe fed her - every tablespoon will help. Good for you that you got some food in her. Give her more even if a little at a time. It will help her tremendously. And, I bet, you'll feel better knowing that she's gotten some in her tummy (and her fur! ;-) )Perhaps, she'll eat some off your finger? I just noticed that you do feed her FF classics.

I'm also in CA - Los Angeles area. Off to bed. Take care. Best wishes and hugs, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

my first thought, high numbers, not eating, was pancreatitis.

You are already giving fluids, and they should be just fine. Many cats get 200cc or more a day, so keep track of your daily total.... if you give fluids and feel the bulge under the skin from the fluids is gone within an hour or less, they were needed.

You can try Pepcid AC... regular strength 10mg and give only 5mg for a daily total. Cut the tabs into 4 pieces; you can give am and pm, and it should help with the stomach if just upset.

What about pain meds? Talk to your vet about possibly testing for pancreatitis....you do see lack of interest in foods and very high BG numbers, but the test needs to be done at the time of the flare.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I had to give Bob many sub-q fluids treatments several times a week for a couple months. What my vet gave me was "lactated ringers" with added potassium, which isn't the same as just "saline".
Here's what was in it.
Overview

Do your fluids list percentages of what is in the bag? I think my bags matched the above list, except the potassium was 10mmol/L...but not 100% sure.
Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hi Kathryn,
how is Snowflake doing today? Hope she's doing better and you got some sleep.
All the best, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I've been using Veterinary plasma lyte-A, ph 7.4 multiple electrolyte injection type 1 usp.

I just got back from the vet and got some humulin r, so I've made the commitment to staying up with her until she's regulated. He advised me that it's okay to give up to 200 cc's at once, and basically said as soon as she's absorbed it, give more. In the last 3 days she's gone from 6.2lbs down to 5.6lbs--BIG difference for a tiny little kitty. Here's to hoping the humulin r will get her bg's down where they need to be. gave my first im shot and it was much easier than I expected it to be.

clarification: 200 cc's of the fluids, not the insulin

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

R Humulin? What dose???

Edited to add: she is following vet instructions for the Humulin R

That is very tricky insulin, and very small doses can drop the glucose like a rock.
You need to be test and monitoring

Also, it lasts roughly 4 hours.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I've talked about this extensively with my vet. I've given 0.5 units twice so far--the first PS number was 430, and two hours later she was 392. I'm planning on waking up every 2 hours to check her bg, and will stop giving when she hits 250.

This is a last resort, as nothing else has worked and she is literally dying before my eyes, and I can't afford $2k to put her in the ER over the weekend (where they would just be giving humulin r anyways).

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

OK - Just checking! Maybe describe the instructions you have so folks don't freak! Is it in addition to the ProZinc or by itself?

Got the Pepcid?

And hang in with the syringe feeding - she needs some food to go with the insulin.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I did not get the pepcid, as I have no idea how I'll get her to take it (she's so resistant to pills). I'll give another go at getting some food into her now.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

It is by itself (gave it to her at +13 after her last ProZinc shot), and I'll be checking her bg every hour or two hours (not giving shots closer than every 2 hours). I'm giving the shots im, in 0.5 unit doses, with a u100 needle since the humulin r is u100. And I won't give a shot into anything under 250 (so I'll wait an hour and test again and see what happened, so if in an hour it has risen above 250, I will give another 0.5units

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

OK good - wanted to be clear about the R instructions, so everyone knows you're being safe and following vet guidance.

If you've an oral syringe, the Pepcid can be placed in the oral syringe, the plunger inserted, a bit of water sucked in to dissolve it, and optionally, a bit of smooth food to cover the taste a bit when administered.

Hang in there.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Seeing progress on the spreadsheet

from 430 to 341 (20% reduction, so more than just meter variance)
in 5 hours with 3 separate doses of R for a total of 1.9 units.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

yes! I'm quite happy about that, but I don't think it's enough. Do you have experience with R? Do you think upping it to 1 unit for the next dose in an hour would be too much? I want her to get at least into the low 200's tonight to give her poor system a break, but I don't see that happening at the rate we're going.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn, no experience with Humulin R, but I have posted your question on the health board with a 911 ikon. I think someone will be along to help you. Hang on. You're doing good. Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I did end up giving 1 unit, and will re-test in 20 min after it's been an hour. I just finished syringe feeding her a bit, and as I held her afterwards she managed to muster up enough energy to give a little tail wag, so I think she's improving. The last reading I got for ketones was on the light end of moderate, while she had been on the dark end of moderate, so that's a slight improvement.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn, I'm so glad. What a splendid little warrior you have! And so are you! Snowflake must be glad about the food in her tummy, but I know how time-consuming, tough on both participants, and messy syringe feeding is. You must be exhausted and so very worried. Glad you are a fighter. I did post your question on Lantus tight regulation. We'll see if someone with R exp can give some input. Unfortunately, my old computer freezes if I try to open an ss. Not that I could help with R. Lower mod K!!! A little wag! Great! She loves you! You love her! That's what can help greatly in an illness. Cuddles and teeny hugs.
Hugs, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

thanks so much for the words of encouragement sophie! It means a lot knowing someone is "here" while I'm going through this. She's down to 307 from 430 after 7 hours, so that's a huge improvement. I'm just hoping to see some 200's soon. Very glad that this happened to be on a weekend night when I can stay up all night with her.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn, good news re the numbers coming down. Thank heavens for weekend nights! What would we do without them? You're doing an awesome job. Snowflake might not like syringe feedings but they are just plain good for her. I always think of them as equivalent to moms having to take reluctant children to a dentist or doctor. Has to be done. I'm glad to be here. You get some sleep. You need rest to be able to help Snowflake. I'm glad to be here. I can sleep in the morning. Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I believe I have heard that in small increments, you want her to eat about 1 and 1/2 times what she normally eats per day.
Best of Luck to you. I will be checking in from time to time, and keeping you two in my prayers.
Please tell me you have karo or honey and HC just in case that R insulin makes her dive bomb too fast.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Dear Kathryn,

I shall, too, keep you and Snowflake in my prayers. How is the rest of the night going? It's well after 7:00 AM on the East Coast now so I'm sure members of the PZI breakfast club will be stopping by to help you. Perhaps, you'd like to go back to your 1st post in this thread and edit the subject line to include the 911 ikon. This will get more eyes on your message.

I do so much admire your fighting spirit and send you, and Snowflake, tons of love. I'll sign off but will check back throughout the day. All my best, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Please contact DCIN for help with costs. Ketones above trace levels are not easily managed at home nor would I recommend it. Venita had posted elsewhere that she may not be available today. This link to the DCIN Facebook page gives e-mail addresses for others who are involved with DCIN (Diabetic Cats in Need) who can assist.

I'm going to preface this by saying I've not used R myself. I have watched it being used. I'll try to get some experienced R uses to chime in.

First and foremost, R is powerful. Let me restate this -- it's VERY powerful. It acts fast and is strong. You need to test often and you will need to do a curve with R. If you don't, you risk hypoglycemia in a way where it can be hard to intervene at home. If I'm scaring you, it's only to make sure you understand you are using an insulin that is very different that PZI (a basal insulin) and R needs to be used with the utmost respect. R is a bolus insulin -- it's meant to be used in conjunction with your basal insulin (PZI). A cat is typically started on a very small dose -- 0.1u, and then a curve is done with the R before making a dose change. It's action lasts about 4 hours. The dose is then systematically worked up.

I'm nervous that your vet started you at 0.5u of R. I'm even more nervous that you increased the R to 1.0u. Please test every hour (or more frequently) when using R.

Is Snowflake eating? Infection + not eating + not enough insulin is a recipe for ketones. You may need to be raising your PZI dose. From all of the high numbers earlier in the month, it looks like you are not giving enough PZI. Please discuss this with the folks on the PZI forum since I can't help you with your insulin dose. (I'm a Lantus user.) From your SS, you note there was blood in Snowflake's urine. Is there a UTI and is it being treated? Is the blood in your cat's urine from something other than an infection? There's nothing on your SS regarding an antibiotic.

If Snowflake isn't eating, please ask for help with assist feeding. Food is absolutely essential if you are trying to manage the ketones. You may even need to feed higher carb food if that's all that Snowflake will eat. You can manage the higher carbs with more insulin. Food is a priority or you will have even more problems to deal with.

Please contact DCIN. IMHO, you really can't manage this at home. The vets do more than just give R when treating ketones. You need to have blood levels for electrolytes run to make sure they are titrated properly. Potassium and phosphorus levels that are out of whack can kill your cat. Please get Snowflake checked out both for electrolyte levels and for an infection.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hi Kathryn -

Just saw this thread and wanted to offer a few comments.

When Grayson had the Moderate ketones, we did the lactated ringers. We shot 100 mL 2x/day, +/- 2 hours or more before or after shot time. I may have shared that with you earlier.

Someone mentioned pancreatitus. The not eating, high BG and infection are justification for ketones. In addition to the fluids (and I'd get the lactated ringers) you probably need her on an antibiotic. Just in case she's got a crazy idea about going DKA.

I've not used R, but Nancy & Payne, also in CA, has and can probably help w/ your dosing if she's around.

Wishing you both the best. I know it's really difficult to see them struggling, and it's exhausting on you. Hang in there!!!

Lu-Ann

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

You really should never give more than 150 mls at a time. Fluids are good when needed but too much at a time can overload the heart and make the kidneys work harder. You would do much better to give her 150 mls a.m. and another p.m. She's tiny and that is just too much. Advice given to me from a Critical Care vet when dealing with a CRF kitty. Been through several DKA bouts with Mishka but never at home......always at ER with an IV line in and all electrolytes being monitored. Hope your little girl is better today.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

okay, about two weeks ago we went into the er with the exact same symptoms. They did all of the bloodwork and found that she had moderate ketones, so they put her on an IV and began dosing humulin r. They dosed first 1 unit then lowered to 0.5 units as she began to respond to it. They didn't offer her food or water. I then transferred her to my regular vet in the morning, who continued with the IV and continued with the humulin r at 0.5 increments. They did not test her electrolytes doing this process (I'm sure they would have billed me for it if they had), and when she came home she had her appetite back and began to improve significantly.

While there they also tested her urine for bacteria and put her on an antibiotic for 10 days, though when we got the test results back, there was no infection. I took her in for a follow up a week later and he ran bloodwork and said her kidneys were functioning normally and the only thing he didn't understand was the blood in the pee.

This morning her bg is hovering in the very low 100's range and it's been 6 hours since her last 0.5 dose, and when I tested her pee about a half hour ago it was in-between moderate and small ketones (down from the dark side of moderate). While he said that it was okay to give up to 200 cc's at once, I haven't ever dosed anything more than 100.

The way my vet described DKA to me (and Snowflake only ever got to moderate ketones) is that basically the unregulated diabetes means a lot of excess and unutilized sugar floating around, which leads to her body breaking down muscle and fat for fuel which produces ketones and acids that pour into her system. those in combination with the sugars are toxins which make her feel sick so she doesn't want to eat or drink. flush the toxins and control the excess sugar and she'll feel better and then we just have to get her eating again. So that's exactly what I'm doing from home.

I've given her some more sunQ fluids (apx 35 or 40 cc's) this morning and will be syringe feeding her in a few minutes. She does seem to be doing better and is now holding her head up while she rests (which she wasn't doing before).

As to the financial assistance, I don't think I'd qualify for it, as I do technically have the money in terms of dollars in a savings account, I just can't justify spending $65 each shot (what it costs when you combine the shot and the blood test) up to thousands of dollars when it's something I can do from home.

Again, I did talk about this extensively with my vet and he was on board. He's open on Saturdays so I'm going to call him with an update and maybe take her in later in the morning.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I didn't see this until this morning but I agree with Sienne, you should contact DCIN and then find a new vet. Any vet that doesn't react to moderate ketones, is walking a very rocky road. The last thing you want to deal with is DKA, and seeing ketones is the first step.

I have extensive experience with R but it can help OR bite you in the butt! (also in CA you can buy at WalMart or such much cheaper than vet no RX needed.) I am afraid of the ketones most of all. DKA is very expensive, in CA it can range from $4000+ .... contact DCIN, you need help. I can guide you with the R BUT all you need is 2nd. thing, not eating, high BG, etc. to team tag with the ketones to start DKA and it can happen fast!

I am also in Northern CA and I will keep an eye on you but you need a good vet to help you stay out of DKA, R is not the only thing that a vet uses in treating and it becomes impossible to treat at home. And listen to Hope, SQ fluids help but should not be given in such high amounts, another thing your vet messed up on.
Good luck!
Nancy
contact DCIN

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

DKA is not that logical .... all you need are the right conditions and it begins BUT it starts with ketones, you are already on that road.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I'm so relieved you and Snowflake made it through the night; I had to crash due to a sleep disorder.

When I was looking over your spreadsheet, to me it seemed that Prozinc stopped working well after the double dose on April 16th.

would you consider switching to a different insulin such as Lantus or Levemir? Both require very consistent dosing at 12 hour intervals with very careful time changes for daylight savings time and dose adjustments based on mid-cycle tests around +5 to +7, when the lowest point is likely to occur.

Edited to add: After this issue is resolved - not right now - who whould think I meant right now??? seriously folks.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I don't think this is a matter of the insulin not working -- I don't think there's enough insulin on board. Further, a more intermediate acting basal insulin may be preferable in this situation (vs. a long-acting insulin, such as Lantus or Lev). It's easier to give ProZinc on a more than twice a day basis, if that's necessary. You can't do that with Lantus or Lev. (ETA: Well, you can dose Lantus or Lev TID but it's hard on the schedule.)

Nancy -- thank you!! I don't have your expertise with R. I do have experience with ketones and DKA and I couldn't agree with you more. Ketones can develop quickly and don't require high numbers to do so.

Blood in the urine (hematauria) is most commonly due to a UTI. It can also be from sterile cystitis. When Snowflake was in to the vet, was a sterile urine sample drawn via a needle (cystocentesis) and a culture and sensitivity (C & S) run or did the vet just look at the urine sample under a microscope? I'm betting it was the latter since it takes 2 to 3 days for a culture. You need a sterile draw and a C & S to make a diagnosis; you can't always make a UTI diagnosis by looking at a urine sample. The C & S will tell you what the bacteria is and then an appropriate antibiotic that targets that specific bacteria can be given. If a follow-up urinalysis was done, it has to be done at least a week, preferably 2 weeks after you stop the antibiotics otherwise, you can get a false negative reading. Hematuria can also result from bladder stones, kidney infection, or other kidney-related problems.

Again, I agree with Nancy. I think finding a better vet would be helpful. There are any number of vets who are uncomfortable treating diabetes and even more who are less than adequate at dealing with ketones. If you do take her in to see your vet, at the very least, you need chemistry panels for electrolyte balances to rule out DKA and blood work to rule out an infection.

If you need help with assist feeding, Karrie/Maverick is a great resource. She recommends a Yahoo group on this topic but you can always send Karrie a PM.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I do see now that I wasn't giving enough insulin before, and I agree with that. I was just very hesitant to increase the dose as she smaller doses had worked so well for her before and I didn't want to push her into hypo. Towards the end I think she was also dehydrated which made the insulin less effective.

The first time she went in they ran full blood work (several things were out of the normal range) and when I brought her in for a week check in they ran partial bloodwork (everything was normal or just barely outside of normal). They did draw urine and sent it out for a full culture and they found no bacteria in it--that's why my vet was stumped, since her bloodwork came back normal (no kidney failure). Maybe bladder stones?

I strongly prefer to stay on pro zinc, as realistically my schedule really does not allow me to stay to a very close 12/12, and at this point in my life (25, single, budding career) I cannot let my cat dictate my life.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Some good news--I don't know why I didn't think to do this before, but I just got her to eat some canned people tuna! I saved the tuna water and mixed it with some water and then mixed it back into the meat, and that actually managed to perk her interest. Earlier, she cleaned herself for the first time in a couple of days, so I also take that as a good sign. Next step is I'm going to give her another 50 cc's of fluids and will keep checking her bg.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I looked at your condo earlier, and should have posted this but didn't for some reason, thinking you were following your vet's instructions: I would be very careful with the R and only give it maybe every 6 hours, if needed, and only give as little as possible. When I give a bit of R to J.D., the first hour usually brings him down a little, and around +2.5 is when I really see the action of the R. And, often the R will affect his next cycle. But, J.D. is on Levemir, so Shadow may react differently.

When J.D. was hospitalized with DKA, I was visiting him and was peering at a chart attached to his cage, and questioned the numbers and asked if that 26 listed there was his BG. It was, but they also had him on a dextrose drip at the same time, and were monitoring him constantly. They took the chart down after that, so I never saw it again.
I'm just saying that at the vet, they use R, but they are constantly monitoring and probably are giving dextrose at the same time. Just be very careful and respectful with the R. And, besides the greater possibility of hypo, when using R, if you give too much, her liver may react and she may bounce up high. That's just something livers do to "save" them from what the liver "thinks" is lower numbers than usual. Also, you need to be careful of giving R, when a cat is on the way down from a bounce, as it can make her dive down way faster than normal.. you'll need to test, test, test.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I was following my vet's advice. He initially told me to start with one unit, but I told him I remembered her getting it in 0.5 units, so then he said that would be fine as well. If you look at my ss from last night/today, she only dropped as low as 90, and she just peed and it gave a ketone reading of "small". When I did give the one unit, she was at 320, so she had quite a long way to fall before she got into dangerous numbers. It is now almost a full 12 hours since her last dose of insulin and she's holding below the 200 mark, so I think that the actions I took last night were effective in getting her back down in an emergency situation.

I want to make it clear that I'm not planning on using the R as a long term insulin--I just needed to get her regulated quickly to get her past the last few days and to give her poor little body a break from dealing with all of that extra glucose. Once she goes above 225, I'll give her a half unit of the prozinc, since I don't want to over do it in case she's extra sensitive, and then I will see how she does. If it's obviously not enough and she's up above 300 at +6, I'll probably administer a few drops of the R to bring her back down, but I'll cross that bridge when I get there. That's also something that I did discuss with my vet, and he agreed that it sounded like a good game plan.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Okay. I just want you to be careful. How is she feeling? How is she eating now? Much better, I hope.
My cats used to love tuna water poured over their dry food, back when they got dry food.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Thanks for the information. It helps to round out the picture. (Sorry if you've had to repeat yourself. Since I don't venture here unless someone posts in Lantus for help, I'm not familiar with Snowflake's background.)

I'm very relieved to hear that your latest ketone reading is so much improved. While it's enormously reassuring, please stay vigilant!

I'm glad your vet was thorough with diagnosing the UTI. With kidney infections, sometimes you don't see changes in white cell counts or other lab values until the infection is well advanced. They are usually diagnosed by ultrasound. My sister just went through this with her cat and figuring out what was wrong took a while.

One of the things to remember is that if you see that Snowflake isn't feeling well, while your impulse may be that less insulin may be needed, if there's an infection, inflammation or any thing that is stressing our cats' systems, more insulin may actually be needed. (The physiological response to stress is to increase the output of a stress hormone -- cortisol -- that increases BG levels.) The changes you were seeing, those red and black numbers, may have been a clue that all was not good! It's often best to increase the insulin to counteract the high BG numbers but you do need to monitor because if it is an infection and your cat responds to antibiotics, numbers can drop in a hurry.

Am I correct in assuming that you are giving R only or are you giving both R and ProZinc? Depending on what you're doing, how you use R will differ. Dyana was assuming you were giving both R and ProZinc.

Just a note about tuna. Please make sure there's no soy in the tuna you're using. Soy isn't good for kitties and some brands of canned tuna do have soy in their broth. If tuna is a favorite, you might want to see if you can find tuna or bonito flakes. I know Petco carries them as to Japanese markets (it's an ingredient in soups).

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

hi kathryn. sending hugs across the miles. you must be exhausted!
i'm happy to see the amount of ketones has dropped from moderate to small and hear she's eating. adding water to foods being fed, insulin, and sub-q fluids will help.

just stopping by to offer a suggestion...
you mentioned your plan to shoot a half unit of prozinc once snowflake reaches 225. you might want to consider lowering that number. as you've seen with snowflake, a kitty can be throwing ketones at 160 or 460. numbers mean nothing when it comes to ketones. when a cat is throwing ketones, it's an indication of an inadequate supply of insulin. when lantus/lev users are faced with a similar situation we encourage them to get as much insulin into the cat as safely possible... even if it means feeding high carb foods to prevent kitty from plummeting. it's all about providing more insulin.

as sienne and dyana mentioned, once you switch to using R as a bolus and prozinc as the basal insulin the game plan changes. it sounds like you're aware of that.

just my thoughts...

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn
You said you are shooting the R doses "IM". What muscle are you shooting into? And did the vet show you how to draw back on the the syringes once it is "in" to make sure there is no blood coming back into the needle? Bob got over 100 IM injections of PZI, and I only hit "blood" one time, but it can happen.

Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hello Everyone,
many thanks to all who responded with the great information for Kathryn and Snowflake. I don't know if I'm able to express what my heart feels: your generosity of time and clarity of expression is much appreciated. I've learned a lot, as I keep forgetting that low BG numbers can also mean ketones. I'd send each and everyone of you a PM but my computer is having issues today so I keep losing my WIFI connection. Thanks!!!

Kathryn, so glad to see you and Snowflake have made progress. You're doing a splendid job. And so is your little munchkin!! You got her when you were a child! You two must be so attached to one another. Lovely! I'll be 70 in September and remember a lot of wondrously wonderful kitties in my life. Yet, the one I remember very clearly is my first one, his name was Purry. Not that I loved him the most, though maybe I did. Just remember him with great fondness.

Take care Sweetie. Best wishes, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Agreed--thank you everyone for your time and concern! I realize my tone might come off a little defensive at times, so I want to make sure I say thank you

I just got home (once she started eating I decided that I needed to get out of the house, so I went to the movies with a friend for a while. When I got home she was 222, so I gave her 0.6u of ProZinc. To clarify, before, I was NOT overlapping prozinc and the R, when I gave the first R shot, it had been 13 hours since her last dose of prozinc. Tonight I'll keep testing and if she gets above 250 after +3, I'll do a micro dose of R to tap it back down, and know to give more prozinc next time.

Bob, I am doing the im shots into the muscle on her back between her ribs and hips with a tiny little 31 gauge needle, and I am drawing back to see if there's a vein (I ride horses and at the barn they do injections frequently, so I'm relatively familiar with how they generally work). Thanks for checking though

And Snowflake is actually my second or third cat--My very first cat was the wonderful family cat we had when I was born, Suzy, who lived to a ripe old age of 17 and she will always hold a special place in my heart of what a cat is *supposed* to be. My second cat was Flowers (yes, with an "s"--I named her when I was 5...). She was the first cat that was "my" cat, but sadly passed away at 7 from kidney failure. I got my two girls now the summer after Flowers passed away, when I was 11, so I've had them for more than half my life up to this point. I love them to tears, but no one tells you how much cats with impact your life later on, when you're 11 years old... (re: getting apartments, going back to grad school, moving abroad, etc).

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Good evening Kathryn,
do not hesitate to post any questions, you might have. Tonight more members are aware of the difficulties you are facing and might be checking up on you. Last night, I didn't post a clear enough message on the Lantus Tight Regulation forum but they were much too nice to say anything publicly.

How's Snowflake doing? Don't want to place extra burdens on you, but post anything you want: questions, doubts, needs for hugs and support, or sighs! It will all be welcome. OK?

I'm so happy you reminisced a bit. Kids come up with the best names. Elegantly simple and to the point! My Purry followed my sister and me to school and at around the half way mark he'd turn around and go back home. We never determined how he learned this.

Holding you and Snowflake in a tight hug all through the night. All my best, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hi Kathryn -

Still having computer problems, so I've been scarce again... Looks like you got up w/ many experienced folks, including Nancy & Payne w/ the DKA & R experience, and several others. Thanks to all of them!!!

When Grayson had the moderate ketones, I stayed on top of them w/ fluids, but no R. I continued the increases (Feb 23rd if you care to see how quickly I raced up the charts, AND continued the fluids. He never stopped eating, so that was a really good thing to hold onto.

I'll reiterate what's been said above - you're doing a great job w/ Snowflake. Be sure to post updates, and anything any of us can help you with.

Lu-Ann

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

To post another update:

I don't think my 0.6 u prozinc dose last night was enough, so I gave 0.25 of r twice and when I woke up at +13 from prozinc, but +9 from r, she was at 109 and had a voracious appetite (yay) and wolfed down an entire half a can of fancy feast! I overslept so i don't know how low she got while i was asleep, but she's acting just fine so I don't think she went hypo. Tested her pee again and she's on the low side of trace, so I will take that!

I have no doubt in my mind that she's only doing this well because of the R. I don't think she would've lasted as long as it would have taken to get to the right dose of prozinc. As soon as she hits maybe 180, I'll give her a full unit of prozinc, since the 0.6 wasn't doing the job, and keep going from there.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn,
Just peeked at Snowflake's SS. You shot 1u of Prozinc at 10:45 your time, and then it looks like you gave .3u of R at +4? Can you get a +5 or +6 test? I'm just concerned that both insulins will "nadir" around +6 or so, and you might see a bigger drop than expected.

Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hi Kathryn. Almost trace is good :thumbup

Please be careful not to shoot the R when the R would reach it's nadir at the same time as the PZI, as she could really drop fast with two insulins pulling her down at the same time.


For instance: when giving R with Lantus (and the common Lantus +6 nadir), we would try to give the R at PS time, and then the R would nadir around +2 to +3 and not at the same time as the Lantus nadir at +6. And if more R was needed, we would generally wait until after the Lantus nadir at +6, to give any more R. ECID.


Is she feeling better, acting better?
I'm glad she's eating. Keep eating, Snowflake.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I did think about whether or not to give the R before giving it, but since her numbers were higher than her PS number (and in her history, when that happens, usually she never drops), I decided that the amount of prozinc wasn't doing anything, and she needed the help. I was heading out the door, so I couldn't delay giving it, and when I got home she was 219, so I don't think she dropped a lot. I'm going to give 1.4 prozinc for her next dose to see what happens, and will bump it up a few hours to get her closer to a 7am/7pm schedule.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hello Kathryn,
glad to see you posting. I may have missed this info in one of your posts, but did your vet determine that Snowflake was not in DKA? On basis of what tests? I know next to nothing about DKA and ketones, so thought I'd ask for clarification and learn something. It seems to me that you have a good theoretical knowledge of ketones. How are you finding applying that theory to everyday situations, that is, theory vs practice?? As a parent, I always found the theory of child raising much easier to grasp than apply. As the saying goes, the devil is in the details! Exactly like what you wrote about experience teaching you how a kitty will affect many areas of your life later on. Can't in the beginning guess how how a given situation will unfold - its many wrinkles, curves, and zigzags.

Another thing, do you have light Karo syrup to use in hypo situations (rub on her gums, etc.)? Higher carb cat food with gravy to feed the gravy to Snowflake in a hypo? Sorry, if you posted this before. This worries me.

My WiFi keeps on disconnecting. AT&T seems to have problems in my area, so I don't know if I'll have connection later. You and Snowflake will be in my thoughts. Always, all my best wishes and many hugs, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn
Did she eat at PMPS when you gave the 1.2u pro zinc?
Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Bob, yes, she's got a great appetite now--she's been eating pretty much whenever I put food in front of her.

I don't actually know the exact scientific details of dka, but I believe it's just basically a way of saying that her system is filled with toxins (ketones and acids) that are the byproduct of her body breaking down itself for fuel, which makes her feel sick since these toxins are damaging her internal organs/system/are too much for her little body to cleanse itself of when she's not eating or drinking.

No, there was no formal test done to determine whether or not she was in it--I'm not sure if a specific test like that exists--but she had high-moderate ketones and had stopped eating in drinking on her own. So I flushed her system with fluids and used the R to bring her diabetes in check so her system didn't have as much to deal with at once.

And yes, of course I have hc food/syrup around the house--isn't that part of insulin 101?

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hi Kathryn,
It's Carl... Bob is the kitty, and while he does try to post occasionally, it usually looks something like this -fghtthnbxhfxjgctsyryuuQwef23 jiknbgthbyfutaugxjcihvouîhbffgbftxgcjgcigcydxfswqwcAazxerf£€¥√°±

Good that she's eating well !!!
The reason I asked - the higher numbers in the first 1-3 hours after the shot are most likely from the food raising the BG before the insulin's onset. It seems to be a pattern on her SS more often than not. I totally understand you wanting to chase the higher numbers away with the R, but not sure the timing is right or safe. Adding R before the nadir of the pro zinc is risky.
I am hoping one of the experienced R users chimes in, but I seem to remember reading in other threads that the R is added when ketones are above trace as an "emergency" treatment to push the BG down to get rid of the ketones, and shot after the normal nadir of the primary insulin?
I know that in an ER environment, they give R by IM or IV, but they also are monitoring around the clock and doing IV "sugar" drips to combat the insulin as needed.
Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn:

There actually are lab values that will tell you if a cat is in DKA. Electrolyte values, specifically potassium and phosphorus, are abnormal. In addition, pH has shifted in the acidic direction (i.e., metabolic acidosis). It's why I was asking you about electrolyte values earlier. Electrolytes need to be titrated very carefully. There is a very narrow window between what's good and what's life threatening. A cat that is experiencing ketones is not necessarily in DKA. Increasing levels of ketones does markedly increase the risk for DKA developing, though.

I just want to underscore Dyana's point to be careful when giving a bolus shot of R. You need to know when the nadir from Prozinc occurs in relation to the nadir from the R. You want to avoid these overlapping otherwise, numbers can really tank. You might want to drop a note to Nancy/Payne regarding the nuances of using R with Prozinc since most of us who are stopping by are more familiar with Lantus.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Hi Kathryn. Good morning. I'm glad to hear the Snowflake is eating so well cat_pet_icon Good Girl, Snowflake.

Until you have a lot more data on how Snowflake reacts to R doses at certain times in the cycle and certain dose levels, I would be getting those hourly tests in after giving the R.

Carl is right in his concern that you don't want her to dive down too fast or too low. Just keep up the testing, okay?
Like, I would not leave the house for an extended period after giving a dose of R.
Hopefully, soon, you won't have to give any R.

This is just my opinion, others may say differently.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Good morning, Kathryn!

So glad Snowflake is eating! Thanks for the info. You strike me as a very organized person. I asked about the hypo kit because it turns out that people forget to buy them or use up their hypo kit supplies and forget to replenish. I've been on this board since January, but on at least two occasions during bad hypo situations members didn't have enough counteracting supplies. Had to rush out to the store: very scary scenario. I'm glad you called me on it though :smile: my daughter tells me that, at times (I always correct her to say "on very rare occasions :lol: ) I leave half of my reasoning in my brain ;-) !

Although my extra sweet Pudge never went hypo, when his pancreas was kicking in he went down to 46 BG. I opened 6 of my 8 cans of gravy FF. Swearing under my breath, muttering how does anyone get a teaspoon of gravy out of these %#@**** cans. Took me a while to replenish .

Hope you are getting enough rest. Best wishes to you and Snowflake, Sophie

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

:thumbup so happy to hear the ketone level is coming down and her appetite is good!
are you able to get any spot checks today?

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Oops! sorry Carl! I know better--it was just early in the morning and I was in a rush!

I actually administered the shot at the same time, as Dayna, who uses R, mentioned that that is what she does sometimes (R will peak around +2 or +3 while prozinc won't peak until +6--by that time the R will have worn off). During the week it is extremely difficult for me to get mid-cycle readings, as I work full time, so night time is really the only time I can get them.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Kathryn,
Go back and read what Dyana said again. She said, I think, that she gave the R at "PS time" so that it would peak by +2 or +3, and then be worn off by the normal insulin peak time of +6. The way I read your SS, you shot the R at +3, which means it would have peaked at +5 to +6, which is exactly when the Prozinc would have been peaking. That's what we were warning against and concerned about...the Prozinc and the R both peaking at the same time. Her liver might protect her against that for a while, but at some point it might not be able to continue to do so. If that happens, she could crash, which is really bad especially if you aren't home to catch it in the middle of the cycle. We're just scared for you and Snowflake...

Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I did that in the context of the prozinc dose still not being enough--if you look at the difference between ps and nadir on previous days with the same dose, it was practically negligible, and each time I did that she had risen from her PS number. If she had appeared to be on a downward trajectory in any way, I wouldn't have done that.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Laser night's SS notes (you keep excellent notes, by the way ), say that you gave 1u of R at PS, and another 1u of R about two and a half hours later. If that is the case, then this morning's number is encouraging, I think. The R would have been gone hours ago, so her BG really didn't skyrocket with no juice on board.
A negative ketone test right about now would be awesome to see!

Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Yes, I think last night worked out well--and thanks--once I realized you can add comments to the google doc, I was able to keep much better track of things (like adding time, etc). For those of you who don't know, you right click the cell and do insert comment, and then you can see it whenever you hover over the cell.

This morning I gave her 1.6u of Prozinc, and when I got home at +6 she was 416--so I'm just about at a point where I think it may not be the insulin for her, since she is responding to the R and apparently not at all to the prozinc. So since we're at +6 with the prozinc, I gave her a unit of R. Won't be home until later tonight, so I'll have to see how she does with it.

And last night I got a ketone reading of somewhere between trace and negative--I really couldn't tell. So I'm going to keep going with the R as long as the prozinc isn't working or until I get a new insulin. Tomorrow morning I think I'll try 2 full units of the prozinc just to see if ti does anything at all.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

While they do NOT have a 1:1 dose relationship, if you add up how much R you've given over a cycle and compare it to what you've been giving with ProZinc, I think the increase of ProZinc makes sense.

Did you ever have an x-ray or ultrasound of her bladder and kidneys? if she has any kind of stone, that could cause blood in the urine, as could interstitial cystitis.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I didn't have an ultrasound or x-ray done, as I'm really trying to keep the costs as low as possible. If money were unlimited, I'd tell them to run every test they could think of , but it isn't. Maybe in a few pay checks once I've replenished a little savings, I'll have an x-ray or ultrasound done.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I would try to be home to test and monitor, if I was increasing the dose like that. But, I don't know ProZinc.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Agree, and insulin type doesn't matter. Percentage wise, it's a large increase that should be monitored.
Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Well I do not have the option of staying home to test.

So my choices are, give a dose that I know does nothing (1.6u resulted in a rise of 170 from PS to +6), and expect to have to come home to give R, or give 2.0 and still come home at +6 to test and then maybe give R. Staying home to test isn't an option for me tomorrow.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

I can understand you thinking that way. But just 8 weeks ago, she was responding amazingly to micro-doses of Prozinc. She was living in the blues and greens on 1u or so per day.

I know a lot has happened since then. It's just odd to me that a cat would respond so well to tiny doses at first, and go from there to where you are at right now. She's getting 4 times as much Prozinc per day, plus the R, and still giving you scary high numbers. There has to be something else besides "just diabetes" going on in her body.

I'm clueless.
Carl

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Here probably more information than you want on ketones and DKA:

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

Wow that's a lot of information about ketones!

I wonder if she has developed some sort of resistance to prozinc, since the R is still working to bring her down. My vet (who has been practicing for almost 40 years) said that sometimes their immune system will attack the insulin and dis-arm it so to speak.

This morning she was "hi" so I gave her a unit of R and two units of prozinc. I just got home and at +5, she was 359, so I have a feeling the prozinc is completely ineffective at this point. I gave her a unit of R and will have to talk to my vet about switching insulins. I am so glad that I have the R though, so I can at least get it down for a time, even if it isn't consistent throughout the day.

Unfortunately, my other cat was being incredibly annoying and in the way this morning, and for the first time I accidentally forgot to put the insulin (both of them!) back in the fridge. It's been 5 hours and they are back in there now, so I'm really hoping they both didn't spoil during this time!

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

To tide you over until you can get to the vet, Humulin N lasts roughly 6-8 hours in cats.

Used by itself, you generally do best on dosing every 8 hours which is hard on the schedule.

 

Re: le sigh. up 160 to 600 in an hour after tiny dose increa

It seems like the R has been lasting about 8 hours a go with her, so I think I may just keep using it until my next vet appointment.

I think she may also still be a bit dehydrated, so I've given her 100 cc's and will try do give that each day for a while. Maybe once she's completely hydrated, the pro zinc will start to work again.