Need help! Vet too nonchalant

Brand new to all of this.. Freaking out daily. On Sunday July 1st found our 15 yr old male cat Tigger barely responsive. 4 nights in ICU for Ketoacidosis and our world turned upside down. Basically told to say goodbye because it really didn't look good. One vet could not believe he pulled thru.

Tigger was discharged with an Rx for 1.5 units of Lantus BID. He started becoming a normal cat again, eating, drinking, sitting with us. Due to other complications like possible liver disease, IBS with chronic constipation and now pancreatitis(?) it was recommended we follow up with the internal medicine specialist for a consult and glucose curve. Appt was for approx 12 days later. That am they got a BG of 96 (after breakfast and insulin) and due to Tigs reluctance to cooperate the curve was called off. Dr thinking he was already in remission. Sent home with alphtrak2 meter and high hopes.

30 hours later his BG is 560 (took it twice!). Next day it's 497. Vet restarts the insulin but only at 0.5 units BID. At midnight about +5 after dinner AND insulin BG is 177.

Next day food and insulin at 7am.
Lunch at 1-2pm. BG 91 at 4pm. (+9). What the heck??? BG 69 at 630 pm (+11.5). Spoke with vet - no further insulin. Dinner at 7 then Snack at 1130. BG 182 at 1am.

Next morning snack at 5 am. Breakfast at 730. BG 234 at 1pm. BG then 281 at 6pm before dinner.

Now we're Climbing again - 305 at 7am today before breakfast. Got home at 630pm - he had thrown up. BG 523. After dinner at 945pm BG 562. I can not figure out what this cats body is doing! I don't want to risk hypo, but DKA ain't much fun either. Please help! Tigger is my heart cat - he is so special and sweet. He walked out of the woods and into our apartment (and hearts) 13 years ago this summer. We moved 2,000 miles cross Country with this boy and I can't imagine losing him just yet!

Working on a spread sheet the minute I get the chance!

 

That sounds really confusing and frustrating!

What are you feeding him?

 

Hi there and welcome to the FDMB.

Yes. It will be really helpful and good if you can get a spreadsheet up and running.

For the time being and to be clear. Are you giving Tigger .5 unit of Lanctus every 12 hours please?
Are you testing his BG prior to any shot ? If so, are these fasting tests where there is no food intake at least 2 hours prior to the test.

 

It would be helpful if you could answer the questions Leah and PussCatPrince asked.
The recipe for DKA is not enough/no insulin, not enough food and an infection or inflammation in the body.
So it is really important you feed Tigger plenty of food, enough insulin, plenty of water and treat any infection

Are you feeding a low carb diet?
If you can start a spreadsheet that would be very helpful.
Continue to test before every Preshot and as often as you can in between. Do you have honey and high carb food in case he drops low.
Are you testing for ketones in the urine?
It is REALLY important you do after DKA. You can buy ketostix test strips cheaply at the pharmacy or Walmart. If he has any ketones above trace it is important that you tell the vet.

 

It sounds like he still needs some insulin support. That sounds very scary and confusing. I'm sure some of our experienced lantus users can help. It does sound like he needs some insulin support. Perhaps slightly less than 0.5. I'll leave the dosing to the lantus people though and just say welcome.

Please set up a signature. Click on your name at the top right corner and choose signature. Add info such as your pets name, date diagnosed, insulin type, food you're feeding, meter you use, and any other health concerns.

 

1. He is mostly eating FF pate. He also has I/d wet and Hills Fiber response dry for his chronic constipation but now that he's eating "the good stuff" I can't get him to eat much of those. Only wants FF! I should add Tigger currently weighs only 10.8 pounds. He's eating 2 cans a day. He has been a slow nibbler his whole life.

2. He is OFF the insulin. Last dose was Saturday am. We didn't do testing during the initial 12 days after the DKA. Then when his BG was 96 at the vet they stopped the insulin for the first time and sent us home with an Alphatrak2.
The next 48 hours his BG went sky high and we started 0.5 unit Lantus. He had 2 doses (pm then the next am). BG was 91 at +9 - this was fasting. Expected it to climb a bit but instead it dropped to 69 2 hours later. That's when insulin was stopped the second time. It was a Saturday night and the only place open to talk to was the emergency hospital that initially treated him. The IM vets there will email Monday am. However when they do they give no advice. Just ask how he's doing/eating/BG #'s. I respond but they haven't gotten back which is really disappointing cause they're usually so good.

3. We are not testing for ketones. . . but I want to. Strips seem harder (to me, with two mal cats that don't like you to watch them pee) but are they better than a dual meter?

4. I'm lost

 

A ketone meter will give you accurate readings for ketones in the blood sooner than they appear in the urine, so yes getting a ketone /dual meter would be great.
Here is a link to information about DKA
http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

I don't think your vet knows very much at all about feline diabetes or DKA.

Try and get a meter to test for ketones as soon as possible. It is very important we know if he has any ketones in his blood.
I think he definitely needs to go back on insulin, otherwise you risk DKA again with BSLs in the 300-500 range.
I am going to tag some other Lantus users but in the meantime I think you should start off NOW with 0.25 units (1/4unit) Lantus each 12 hours and test him during the cycle to ensure he doesn't go too low. The dose can be raised after we see how he goes on 0.25 units and at least he is getting some insulin.
You can always give some honey or high carb food if he drops lower than you are comfortable with. 68 is the take action number for the Alphatrak 2. But if you don't want it so low because you are new to this and concerned with a hypo, just keep it a bit higher. It is better for him to be getting insulin even if you have to give him higher carb food to do it.
Could you start up a Spreadsheet and add all the blood sugar levels you have taken to date and future ones please...it will help us help Tigger
Get him to eat as much as you can and add some water to the food if he will accept it, to try and get more fluids into him.
I am concerned he has vomited. If you think his condition worsens, please take him to the vet.
@Jill & Alex (GA) @Chris & China @Wendy&Neko are you able to assist here please.

 

The vet handling this is an internal medicine specialist, not his regular vet. As usual though Tigger has to be a difficult case. . . story of his life.
He seems to be eating pretty good. Drinking normal - not too much. What is a good high carb food? Until this our last 2 years were spent trying to find all meat, no wheat intestinal friendly food.
The thing about the vomiting though is it's a lifelong issue. It's a horrible cycle right now too. He's chronically constipated, eats, food has no where to go and he vomits. Now he's eating FF but really has basically given up on the Fiber response. So he's currently constipated. Vomited. Hungry again after. We used to treat with Miralax but the fiber food seemed to solve all our issues - until this.

Update: fasting (6hours) BG 482 just now.

 

I'm a little worried about doing things without the doctor's advice. I don't want them to write me off because they feel I'm going to do whatever I want anyway. But I think he definitely needs some help/insulin.

 

I know how worried you are about Tigger. It is just awful when our furbabies get sick.
But you have come to the right place for help and support. I am so glad you have found us.
Ask as many questions as you like....that is the way to learn all about feline diabetes, which is very treatable.

So you think the vomiting is his usual behaviour, not because he is maybe more unwell.?
Encourage eating and drinking if you can.
Do you think you will be able to get a meter today to test for ketones?
Also let us know when you have started the insulin please. Are you OK with drawing up 0.25 unit Lantus?

Here is a link to wet/canned foods and how many carbs in each. Try and get a variety if you can.
Medium carb is 11 to about 18 carbs, and high is 18 to about 25 carbs.
Most higher carb foods have gravy and have things such as rice, potato starch in them
I am assuming you live in the US as this is for US foods
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

Is there such a thing as zero-carb fiber that is safe to give to cats?

 

Well it is up to you what you decide to do. We are not vets but all have or have had diabetic cats which we have looked after 24/7 for often many years. Most vets do not get a lot of training about feline diabetes and we get people arriving at the forum frequently who have been given the wrong advice.
Most of us here dose our cats ourselves.
Are you able to contact your specialist now and ask them/ say you want to restart the insulin? You are Tigers advocate and you pay the bills.
If Tigger were my cat I would restart him on the insulin.

 

Plain mashed pumpkin is good for both constipation and diarrhoea and won't affect the BSL.
Either make your own by boiling pumpkin in water only, draining then mashing. Don't add anything else. Freeze unused portions and use as needed. I used to give Sheba 1/2 teaspoon twice a day .
You can also buy canned plain mashed pumpkin in the US

 

I was worried too in the beginning but I soon realised that it was much better for Sheba if I was doing the dosing because every time I needed advice it was always too early for the vet to be opened or too late and they had closed. So after I started doing it myself it became much easier and I felt much more in control of the situation. And my vet was fine with it.
The great people here will guide you and teach you.....I know it is a great leap of faith to trust a person at the other end of a computer, but this forum is a wonderful place for carers of FD kitties.

 

Plain canned pumpkin. A teaspoon added to the food. Don't give the high fiber food.... Way too much carbs. Also add extra water to his ff. If the pumkin is not enough you can give 1/8 teaspoon of Miralax.

 

Won't let me reply

 

Sorry, yes we are in US.
I will be able to go out and get a ketone meter, some high carb food and some mashed pumpkin in a little while. We treated with Miralax for 2 years - can easily go back.
I will also definitely be calling the IM vet and telling her I want to try restarting the insulin at 0.25 units. Hopefully the pharmacy can find me some syringes with half unit marks again. Could I reuse an old one, or use it to draw up a more accurate amount? I've called out of work today to watch hi closely as we restart and my girlfriend is already off tomorrow but Thursday and Friday we will both be out of house for 10 hours at least. Do you think will be ok?

 

The lantus forum has two dosing protocols described. Tight Regulation and SLGS start low go slow. Read them both and see which is a better fit for you. If you're nervous than SLGS may be more to your liking. http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Good job getting the signature up! That's helpful.

The next step will be getting a spreadsheet of any readings from the past few weeks. Here's our template. If you have any trouble setting it up let me know and I will tag someone who can set it up for you. http://www.felinediabetes.com/FDMB/forums/suggestions-tech-support-testing-area.6/

 

Don't reuse a syringe. You can buy them at Walmart. Our any pharmacy really. You need a u100 0.3 ml with half unit markings.

 

I would not reuse an old syringe.
These are the syringes you need to buy for Lantus insulin ....U100 insulin syringes. Ask for 1/2 unit markings....from walmart

 

Ok I started a spreadsheet but it is really not much info right now. Vet didnt have us test until after they called off the BG curve on day #13.
Told to stop Insulin and do spot checks. Well BG went up to 560 the next night. After a quick discussion we decided to try 0.5 units. 1st dose fine, 2nd dose
(12 hours later) seemed to drop him under 100. Lantus stopped again. Well wouldnt you know it?! BG climbed back up to 560 48hrs later.
I ATTEMPTED to give 0.25 units this am but do not have half unit marked syringes left (will try to get more today). So far it seems I may have been
unsuccessful in getting any Insulin into Tigger but I will check again in 30 min (should be about +4 on the sheet). Also received another email from the vet
to stay off Insulin if Tigger is not drinking/urinating more. She thinks we may want to stop spot checks as well - cause they are upsetting us?????????
Whats the science behind that?! Hypo is bad but he also cant afford another round of DKA . . . neither can my wallet!

UPDATE: BG down a bit to 418 now at +4

 

There is absolutely no science behind stopping testing a recently DKA cat! Or staying off the insulin. Not knowing what was happening to my cats blood sugar upset me more than the testing ever did.

Looks like you might have got some insulin in. I hope you can get the half unit marked syringes today. You can get other, but not as cheap, half unit marked syringes besides the Relion ones if you cannot get to a Walmart today.

The Lantus depot will have to build, and as it does, the numbers may continue to come down on this dose.

 

Stopping insulin all together with a history of dka and bg over 300 is just asking for trouble.

 

I know I'm brand new to this but I am pretty savvy with medical stuff (ophthalmic tech for 12 years) and I agree. DKA scares me as much as Hypo!!!
Anyway I was able to get half marked syringes but only 4 bags of BD ones from CVS - walmart told me "try a different walmart" (breathe breathe). whatever, it'll do for now.
neither had a ketone meter so i grabbed some strips but i doubt we'll get a successful test. Tigger may be older and sick but damn is he feisty! i guess i'll try a few more
pharmacies later and buy online if no luck. Best one to get? At this point price barely matters. From 7/1 til now we're probably talking about $4500 so what's a little more?!
Also, am I to understand I put the neosporin+pain on before the stick?
Update BG 380 at +6 so we're coming down, but slowly. I'd really like opinions on sticking with 0.25 units, especially if the vet emails back confident we should stop. everything seemed to be going in the right direction when we started the half unit dose on Friday. PMPS 497. 0.5 units given. BG 177 at +6. I wish i knew then to test the AMPS. But I guess if it was around 100 I would still give the insulin? Im trying to read and understand the SLGS method but I worry we're starting out all messed up already!
I dislike not having faith in his doctor
Is there an even slower way to treat? Like oral meds? Something usually not effective enough in other cats but perfect for my disaster kitty?

 

Oral meds make the pancreas work harder, which can lower the odds of going into remission. Some cats just need small doses, we even have some on 0.1 units of Lantus.

I put the Neosporin on after the stick, a little Vaseline on first to help the blood bead up better and not get lost in the fur. Dealing with dark ears,

Depending on what number you see at PMPS, and if you can get at least a before bed test tonight, i'd be tempted to try 0.25 units again tonight. Is he a grazer? Can you leave food out for him to eat if he needs it later? Perhaps even medium or high carb food.

For ketone meters, look at the price of strips. That's the pricey part. You may be able to resupply with cheaper strips on line. I was lucky that my cat was pretty predictable in the times of day she peed. Once just before I got up, sigh! So I stalked her for the one in the afternoon before dinner.

 

I order syringes from Adwdiabetes.com


https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

The oral meds don't work.

Stick with 0.25 or you can do 0.5 again for a few days (or even a skinny 0.5 (0.4)) and see how it goes. He was at 69, it's low but that's not a hypo. If that made you nervous then stick with the 0.25 for a few days first and follow the SLGS protocol as far as when to raise the dose. I know he was high today but remember it's a deposit insulin so it will build up a bit over the next few days. Now that you're testing you can adjust and steer. Keep up with the spreadsheet. Post on the lantus boards for daily support and for dosing questions. We'll get it figured out.

 

PMPS was just 58 sooooo not gonna be giving any insulin tonight! And yes, I tested twice - first time it was 52. Whats more likely here - User error? Remission? Symogi effect? He is +12 hours past a dose I wasn't even sure I got in. I can't even explain how upset and confused I am. I missed checking about 2-3 hours ago as planned because my car wouldn't start and i had to get a jump in the parking lot. Thankfully my girlfriend is home now and can take over. I am exhausted. I'd like to copy a little of the email I got from the vet, get your opinions. I cant get over how weird his BG pattern seems to be. Way too high, slowly comes down, then dangerously low. How can he be at 58 at +12 when he was 380 at +6??? I have given him some HC food and a finger of simple syrup - he seems fine - kinda like "why the hell are you putting candy in my mouth?!" Do I need to take him to vet now?

 

From the vet:
"We can try adding in his Miralax 1st as this won't affect his BG levels.

Vomiting won't always make them hypoglycemic. The only way that would happen is if he ate his meal, received his insulin and then vomited his entire meal (essentially, got insulin without food). Otherwise vomiting won't necessarily have an effect on insulin.

His level of 69 was a dangerously low level as he is approaching having seizures from hypoglycemia.

When we are getting 500 values, he could be experiencing a symogi overswing so we can't assume that those are accurate levels. It is hard to determine what he is doing right now as we've been switching his insulin doses and spot checking glucose levels, all of which can confuse the picture. My recommendation is to not give insulin right now and stop checking spot BGs. Instead, let's decide how he's doing based upon his appetite, water intake and lack of vomiting. "

 

If you haven't given him insulin then please don't give high carb food!!! He can't hypo if he's not on insulin. Some cats naturally run low. Good thing you're testing. Looks like he's trying really hard to get into remission.

 

But I did give a tiny am dose. Also I only gave half a tiny can mixed with regular FF pate. He's fine. Soft, sleepy, sociably purring in our faces. He's a hider when feeling bad.

 

Yes but that was 12 hours ago. He's not going to drop lower at this point.

 

I just wanted to pop by and say great job with the spreadsheet & that you are doing very well.

I know it is hard to not go with the vet's wishes but sometimes it is what is best for the cat , not the vet. They vet's view and approach comes from a different angle entirely , although safety and wellbeing is still at the core , as it is for us.

Once you find/have a regular diet for Tigger & have more data on your spreadsheet from the BG testing , then you will see just how he reacts & so be better able to regulate his diabetes.

I will say that no-one can decide or know how a cat is doing based on observation of appetite and water intake alone. It needs the factual tests.

 

I know this might seem obvious, but are you currently using U100 syringes? His outsized reaction to such a small dose is frustrating! The 523 with 2.5 days off insulin definitely suggests he needs insulin

 

(yes definitely U100)
I'm not even sure I got that 0.25 dose in . . . and his drop to 58 was at +12 . . . but, but, but at +6 (the supposed nadir for Lantus) BG was 380 . . . only 100 points down from the AMPS. So after that he dropped to hypo in the second 6 hours? . . . I don't understand how that can be. One set of these readings have to be artificially high/low. The same cycle happened 3 days previous when we had stopped then started again. Vet thinks this is what's causing/complicating things?! His body sees even the 305 reading as too low and "dumps sugar?" (I believe that's how it was phrased).

Since BG was so low obviously he didn't get insulin last night. Today (it turns out) he did not have someone home to watch him so we weren't able to get any numbers until just now at 7pm and there he was, back at 500 again. From what I understand the vet hopes his highs are symogi effect(?) and will lessen? I mean I guess 502 tonight is better than 580/562. However I won't be able to get multiple readings again until Saturday. I don't know what or when his highest will be. Maybe it will come down to the 400's then 300's? The thing is - that's a really scary "what if" . . . . . like I said before - Tigger can not physically afford another ICU stay, nor can we financially afford it! The vet seems to only be worried about him going hypo. I guess that's okay for her, she definitely knows more than I do, but the problem is I don't want to see DKA either. I don't know when to worry or when not to worry. I've barely slept since Friday. I've had a stomach ache for the past 3 days. It's so worrying!

So far though the one thing through out this that has been a good sign is that if I buy something it is suggested we need - it turns out not to be the case. They told me to get this special medicine compounded in the very beginning. Had it mail ordered to the house the next day. Never used it once. Told I should buy a box of syringes instead of a few bags at a time. Turns out not only do I need different ones with half unit markings, the day i bought them the Vet took Tigger off the Insulin all together. And NOW I've got a Blood Ketone Meter coming from Amazon. Supposed to be here tomorrow. Tigger's numbers will probably all be straight 150's for the next month But I still can't wait to get home tomorrow and test this boys Ketones. Any advice on when to worry about those numbers? From the responses on here about 500 levels being super high and worrisome I wonder how long before we would see any DKA symptoms?

As of right now Tigger seems pretty much normal. He's eating atleast 2 cans of FF a day, maybe 2-3. He's drinking a bit more than he normally would back in the day when he only ate wet food. One reason we didn't think anything about his original water increase was that he never drank water at all before we switched him to the all dry Fiber Response. (His brother did the exact same thing. It made sense at the time - they were no longer getting water from their food.) So that seems okay. He's social, not hiding, walking around demading attention, and scratching all the posts! You wouldn't think anything was wrong if you didn't see all his shave spots!

 

I am sorry I can't sit here and read this without putting in my two cents your cat needs to be on insulin you need to get him regulated on what the amount is and you need to do it every 12 hours with Lantus and you also need to check his blood glucose and do a curve. In my opinion do not think your vet knows what is going on and I would find another vet. In my opinion you can't keep giving insulin and then taking it away in expecting any results with a diabetic cat.I've never heard of it. Somebody tell me please if I'm wrong.

 

I know Lantus is supposed to be the best insulin for getting kitties quickly into remission, but have you considered a shorter acting insulin like Prozinc? Might be worth looking into an in-and-out insulin so you can actually dose him every 12 hours like you need to. Also, I don't personally have any experience with DKA, but I've seen it recommended I think that if you have trouble giving insulin because of hypos, that you are better off giving higher carb food and shooting insulin, than giving low carb food and not being able to shoot. I don't think it can be overstated how important it is for DKA kitties to get insulin. I hope you get your blood ketone meter soon and see some good results.

 

I am so sorry you are struggling with all of this and feeling so bad. Perhaps bringing this situation with the vet being on again, off again with the insulin needs to be brought to the Lantus Forum. There are some very knowledgeable and experienced Lantus users there who might be helpful: http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

If you want to create a thread there and refer back to this thread for information, you can link the two. Copy the URL address which is at the top of the thread, yours is: http://www.felinediabetes.com/FDMB/threads/need-help-vet-too-nonchalant.198930/
then click on the chain link icon in the top of the post (Where the B, I, U etc are. It looks like a paperclip thing) Insert your URL address there and it will be in your new thread, in blue to signify the link.

 

Ugh - the Ketone Meter is now arriving tomorrow. Great, another day of worrying.
This evening Tigger's BG is down on it's own to 457. That is the lowest it has been at the "2 1/2 days off insulin" mark. Maybe it really will continue to come down? I really can't imagine every number I've gotten is accurate. That is a 500 point swing at times! Anyway the vet said to email tomorrow with an update but I think I will write it now so it's the first one she gets in the am lol. One thing is for sure, the minute we get that ketone meter we will get it started and get a reading. If those numbers suggest anything is going on I will either demand we go back on the Lantus, discuss this other thing Prozinc, or begin treating him myself. I have the half mark syringes and 2 days off. Plenty of time to try out a tiny dose again and start the SLGS method. Do I literally start with 0.1 if I can measure it? Is Prozinc like when humans do a "sliding scale?" Also, has anyone heard of a cat going lowest at +12 and not +5-7 or whatever it should be?

thanks fur all the support!

 

My experience with Prozinc has been that dosing consistently works best. I don't use a sliding scale, though sometimes I give a reduced dose if his PS is too low. Other than that, I try to be consistent and raise or lower the dose based on his nadir, and stick with a dose for a few cycles before making changes.
Questions about Lantus dosing should go to the Lantus forum, where you'll find many experts who can give you advice. 0.1 seems like it would require a magnifying glass to draw up haha

 

Maybe someone should invent a digital liquid medication drawing thingee that measures the dose selected and puts it into the syringe Of course, maybe it already exists at pharmacies and hospitals. It might be really expensive at first to own one at home, but once upon a time BG meters were thousands of dollars and insurance didn't cover it, so most diabetics used ketostix and never had a meter.

Amazing how much better things are now than they were not too long ago (for humans). Wish FD and CD care/treatment/owner education provided by most veterinarians would catch up

 

The "5-7" for a nadir is for a typical cat. A lot of cats aren't typical. On Lantus, my Neko generally was lowest from +7 to +9, though I did spot it once at +13. Some cats nadir by +2. Except when they don't. A later nadir is often a sign of a bounce breaking cycle. That could be what you were seeing on the AM cycle of 7/24.

 

so I just got home and tested Tigger - BG is 555. The Precision Xtra meter has arrived and his Ketones read at 1.2, which the booklet says is "intermediate" for a human - "call your doctor." Of course our "doctor" happily left work at 5 and I am only able to call the emergency hospital (which is actually where this specialist works so I never need to re-explain the situation.)
So now - do I call? Is that ketone reading high enough to warrant a trip to the vet? Or do I restart a tiny amount of Insulin? Do the ketones go away? He doesn't seem dehydrated or really affected yet but if Ketones can develop rapidly what the heck are we waiting for???

 

According to this post on DKA and ketones, you start to worry around 2.4.

Keep tesing regularly, his numbers are way too high. I would think about trying that tiny bit of insulin when you can monitor. Some cats only need the smallest amounts.

 

Generally anything above trace should prompt a call to the vet, especially with a history of DKA. His numbers indicate he definitely needs insulin support and the longer he goes without, the greater his risk of having another DKA. If he was my kitty I would definitely try to get a tiny amount of insulin in him as soon as I was able to monitor.

 

I agree with the concern about ketones. I'd start him on a tiny insulin dose ASAP. If you're worried about steep dives you can feed him higher carb food to allow the insulin dosing.

 

Well, I emailed the Doctor so much they finally called me and we have a plan! (Probably because his BG's dropped a bit on their own - like I said, that's how it works for us!) With no intervention his random BG checks were 279 and 314 - not great I know but a lot better than 500+!!!! Anyway, we are going to restart half a unit of Lantus BID . . . but we are going to wait until Friday night. After 6 pm on Friday I can be home with him for 60 hours straight - hopefully 5 cycles (without a problem!) We could probably start sooner but honestly now I'm petrified of him going Hypo while we're at work! Fingers crossed. Symptomatically he seems to be doing really well - holding a steady weight, no excessive thirst or urination. Please please please let this plan go smoothly!

 

Change in plans - Tigger's BG was 377 just now and his ketone number has gone up. I know its not exactly the same for cats but everything said to worry around 2.4, and that's what it was tonight. I think it's time to act. We gave him a nice bowl of FF and a shot of Lantus at 7. Doctor said to start with the 0.5 dose but I made it a little skinny. It sounds terrible and makes me feel like a bad mother but I absolutely cannot call in to work tomorrow. The doctor also said to start off really conservative with his AMPS/PMPS #'s - if he is under 200 we are not going to give him the shot. Just until we have a good idea how he handles the dose right now. Does that seem like a good idea? Also, feed him the higher carb at dinner (with shot) or later at his midnight snack (which is closer to his supposed nadir)?

 

With increased ketones in the picture you need to get insulin into him. Feeding higher carb food is a way of giving it the cushion needed.

 

Still feeling overwhelmed. Nothing on all the DKA pages give a range - if you read the original scientific paper about the efficacy of using the Precision Xtra Blood Meter it just states "anything under 2.55 is unlikely to be DKA." So under 2.4 is like negative???? is 2.5 - 3.0(???) considered trace? what's moderate or high? Do I ever get to stop worrying?

 

No, you won't find ranges so you have to go by very general guidelines. Under 2.4 - less worry needed and the lower the number the better. Above 4 - quite definitive marker for (possible) DKA and anything higher is a serious issue. The meters are a double-edged sword: you get a ketone number but knowing what to make of it is an issue. Most vets use urine dipsticks that have a few more gradations on them than the ones we can buy in a human pharmacy. They give the vet readings like 0, 1++, 4++, etc.

Ideally, a healthy cat should give you zero to very low numbers on the ketone meter. If the numbers are low but increasing measurement to measurement you have to pay attention. Once they're at 2.4 or above you know something is going on. Above 4 - vet visit is essential.

 

Tiki Cat Ahi Tuna is zero carbs if that will help. Lilly doesn't like it as much as the Friskies Pate, which is pretty low. I get the ones that are 5 or less carbs. Lilly bounced around for a bit but I have finally settled at 2 units twice a day and it seems to be keeping her on a good track. I tried going lower and she crept up there. For her, even when her number is a bit lower, I keep her at the same dose. If I see a consistent trend to lower numbers, then I'll adjust but I don't make an adjustment based on one or two numbers. I tried that at first and she just kept bouncing around. The only time I would alter that is if she is below 50....then I'd probably delay her shot or skip one and watch her more closely. It took a couple of months to really get Lilly regulated. It was really scary at first.

 

So last night went pretty well. No low number near his nadir (it was higher in fact :/) and his AMPS was 350 so we gave a 0.5 unit dose. However, as seems to be his unusual cycle, just now his PMPS was 75 (72 the first time). Its like he can't have twice a day dosing! Has anyone heard of this? I know its probably his insulin depot or a bounce or a carryover or any other word that doesn't make it any less confusing but still. What is it with this cat?! On the plus side his Ketone number was back down at 1.2. He is eating good, but not too good. His weight is stable/up a few ounces. No excessive urination. He still drinks more than we are used to but it's pretty stable since he got out of ICU. I just don't know what I am going to do with this cat. Gravy food and retesting I guess, but in the long run, I think we need a cat nanny

 

Have you tried eyeballing a 0.25 u dose?

 

just that one time on 7/24.
AMPS 482, +2 485, +4 418, +6 380, PSPS 58. Insulin stopped again at that point :/

update: BG 265 after half a can of HC wet food.

 

Ok so here we are again. After last nights' low we feed some higher carb wet along with his normal FF. Got the BG up, but was not sure if it was too late to still shoot. Apparently he vomited all that food up sometime after 1am.(like a good 6 hours later). Demanded a snack at 4 am. Just now his AMPS was 480. Isn't that high for having vomited all the HC food? He has always been a puker so its hard to know when to worry. We have changed so many things in his routine after the ICU stay I'm sure its confusing his body. The fiber response dry was the best thing ever for his constipation/vomiting. Now he's back on the miralax and i don't think its fully working yet. Anyway he got his breakfast and shot this am - tried to eye a dose around 0.4 or 0.3. Girlfriend will be around to watch him most of the day. He seems to be drinking a little bit more than normal but again no other symptoms.

So I read and reread the SLGS directions several times, including the FAQ about holding a shot for a while if PSBG is too low. It says to wait, retest and give shot if too much time has not passed . . . but what is too much time? It also says you can try a smaller dose but I don't think I could eye much smaller. I'm sure if 6 hours have passed you just skip dose. 1 hour you'd probably give it (depending BG reading). But what about 2-4 hours? Any advice?

 

Lantus does best on a fairly strict 12/12 schedule. You can stray from that maybe up to 30 minutes if you're stalling. If it's well beyond that (1 hour+) skipping the shot is best. Because it's a depot insulin changing the time between shots too much can increase or decrease the dose overlap to the point that it acts like an increase (doses too close together) or decrease (doses too far apart).

I suggest you spend some time practicing drawing up an eyeballed 0.25 u with coloured water. That might well be the dose that could be given consistently AM and PM. Microdosing is a technique many people have to use. That includes doses as tiny an (an estimated) 0.1 u or "a drop". No vet will ever tell you this. The smallest increment they can think about is 0.5 u because it corresponds to lines on the syringe. This image shows examples of tiny doses:

Pictorial guide using a U-100 syringe marked with half units:




These extreme ups and downs in BG can't make him feel good.

 

I agree, he definitely has days that seem ok but then the next he's really good - playful, talkative and I can see the difference. I'm wondering if all of this would be happening if the vet hadn't stopped his Insulin so early on. I know its only been a few weeks but if I knew then what I (sorta) know now I would have questioned it immediately. I wonder if a decrease was more in order instead of one reading deciding he was already in remission only 2 weeks after almost dying from DKA. When we spoke to his regular vet on Friday, just to update them, she couldn't believe they stopped it like that. It really makes me wonder if all the stopping and starting didn't just make things worse. I hope now that I am sticking to SLGS as best I can, he may do better - even though we already held a shot last night. He seemed to do ok with the am cycle. AMPS 486. Tried for a 0.4ish dose. 380 at +6. PMPS 222 just now - gonna try for 0.3 because we've never given him a shot with BG this low. Does that sound reasonable?

(and thanks for all the help)

 

Hmmm, I thought I read to decrease the dose if PS # is way lower than normal. Considering his are usually in the 400's 222 seemed scary low. However his BG was 434 just now at +5 so I guess I didn't give enough . . . or any . . . can hardly tell with these tiny needles and miniscule amounts (sigh).

 

I think you've posted on the Lantus forum before. I suggest you keep posting there. It's a large forum with a lot of very knowledgeable people to guide you. They can coach you step by step through the SLGS process.