New at this...skipped dose

My fifteen year old cat, Motor, was diagnosed with diabetes about two weeks ago. A quick background...over the past year I had noticed changes in her behaviour but they were so gradual, I chalked it up to her being an older cat until more recently they became more obvious. She was always thirsty and began running into the bathroom whenever I ran a bath to drink water from the tub. If I was in the bathroom and not running water, she would lay down in the tub. Her fur began matting and she developed dandruff. She was losing weight.

Other than those things she seemed her normal self. I had planned to take her to the vet for blood work sometime in the near future but it didn't seem urgent to me. Until one day she was desperate for water. She would not stop drinking. She wouldn't leave her water bowls side and would fall asleep with her head resting on the bowl. If she did walk, she wouldn't walk very far and would slowly lower herself onto the floor as opposed to her normal flopping on her side. Called the vet immediately. She went in the next morning for blood work and the next day was diagnosed with diabetes.

She was started on one unit of Prozinc, twice a day. The first week wasn't the easiest as Motor has never been on scheduled meals times. Only dry food, left out all day and night and she ate when she wanted. She was switched to Moist food and I attempted half a can of friskies, morning and night. She never ate all of it in one sitting but knowing that she would eat the rest within a couple hours after her insulin, I never missed a dose. Also in the beginning I was told to feed her, give her insulin, and then check her BG two hours after, so I don't have much info regarding her levels up until a few days ago when I decided myself that it made more sense to also check her before giving her her shot. (I have attempted to fill out a spreadsheet as best as I could with what info I have so far).

Did a glucose curve last Friday and after seeing her dip to 1.8 at one point and then shooting up to 20.3 throughout the day, I took it upon myself to cut her dose in half. Continued with the 1/2 unit until speaking with the vet on Monday, who recommended changing her dosage to the 1/2 unit as well. So for the past few days I have been checking her BG before food & insulin, feeding her and then giving her the shot. Her numbers have been between 7.0 and 10.3.

This morning though when I checked her BG, it was sitting at 3.1 and she doesn't want to eat much. I tried giving her a handful of treats and while she normally gobbles them down, I had to push her to eat them all. I did not feel comfortable giving her any insulin so she has missed her dose this morning. I will be checking her BG again here shortly. My biggest concern is keeping her on her schedule but if her numbers are high when I check them again, should I give her the shot then or wait until her scheduled evening shot no matter what her numbers are now? She also tested positive for ketones so keeping her with high BG levels for any amount of time is also a big concern for me.

Thoughts?

 

Just checker her BG again and it's at 3.3. Only gone up by 2 in roughly four hours and 14 hours since her last insulin dose.

 

Welcome Mcandi and Motor
Would be very helpful to add some more information in your signature:
There is a limit of 2 hard returns; you may separate pieces with commas, dashes, | etc.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

We also do Pre-shot tests (AMPS / PMPS). Make sure Motor has not eaten for at least 2 hours prior to this test so the number is not food influenced. When did you change her diet to wet food? It is possible she may become a diet controlled diabetic . As for the curve you did that 1.8 is in hypo territory so she "bounced" and that's why numbers went up to 20.3. Glad you reduced the dose and the Vet agreed. The 2 days of data you have are very nice numbers and her staying green today, might be earning her another reduction to 0.25U but only if her numbers permit, and obviously 3.1 does not permit. Also, if her numbers to jump back up (they might bounce again) do not give another shot until scheduled time. Stay on schedule . For the ketones: When was the positive result? Did you check test strip in specified time? (They get darker if you let them sit out) Is it above trace? Also, those blues are not high numbers. Just look at my SS lol. I'm sure others will chime in soon.
Sorry for the bombard of questions, please ask any more you may have! We are a support group for Motor and YOU!

 

It may well be that the change from dry food to a wet low carb food may have made a BIG difference in the glucose levels. DO NOT SHOOT at that number. Thank goodness you DIDN'T listen to the vet and started checking preshot readings. A shot at that level would definitely put her into a serious hypo which could have had very serious consequences. If you have not yet fed please retest again in 20 minutes and post with the number. If you have already fed, then an option would be to wait 2 hours without more food and retest to see if the numbers are coming up to a shootable level. If this would not upset your schedule it might be the best idea because of ketones showing before.



You can post with the next test number for dosing advice. When testing before a usual preshot time, make sure you haven't fed within 2 hours before the test so that food does not influence the glucose numbers. If the numbers are higher at the next usual shot time, then please post on one of the forums I listed for some advice on how to proceed.


ETA Since she has tested positive for ketones it would be a good idea to do ketone testing at home with urine ketone strips. Normally a kitty with ketones should not miss an insulin dose but the 3.1 (56 US) is too low to shoot.

 

I will add more info to my signature shortly

She started on wet food two days before she was diagnosed because she wasn't eating her regular dry food so I bought her the wet food to try and entice her to eat.

She tested positive for ketones I believe the 22nd of March, the day before her diagnosis because she was kind enough to provide a urine sample when she was having her blood taken but she had the ammonia scented breath for at least a couple months before that date just didn't realize why. I don't test her myself. This info came from the vet after getting her results back.

 

Welcome! You've done very well with Motor considering you're only two weeks into this journey! Yong and Tuxedo Mom have given you a lot of good information.

 

Did I post in the wrong forum?

 

No...my error.. I read the forum listing wrong...so I removed the blurb about posting since you are exactly where you should be

 

Testing for ketones at home is easier than you think. You can buy test strips at any human pharmacy. Walmart has their own ReliOn brand and there are others. I use Bayer Keto-Diastix. Here are some ways to test:

• hold the end of the strip in the urine stream when Motor is using the litter box
• hold a shallow long handled spoon under her backside as she pees
• cover her favourite area in the litterbox with a couple of layers of plastic food wrap and push a few depressions into the wrap to collect urine.

Yes, you're in the correct forum for ProZinc advice. You can also post in the main health forum when you have general questions.

 

I'll definitely start testing at home as I have no way of telling if that part has improved other than smelling her breath. Which seemed to improve but over the past few days may be getting bad again but hard to tell as she is eating wet food now which makes her breath a bit stinky as well :/

Is it possible that the food had been making a difference but the dosage she was on is what made her numbers bounce all over? Because when she was on one unit 2x a day, she been super high a couple of times, the highest being 29.9. And now being on a lower dose is making the difference the food could be making more obvious? I hope that makes sense as I'm sort of coming up with these thoughts as I'm typing them.

 

Also, thank you to all who have replied. I was worried about her missing a dose and have been feeling super paranoid about everything I'm doing. It's only been two weeks but it feels like months with the lack of sleep and stress. You all have eased my concerns a bit

 

They don't always have a distinctive breath smell when they're producing ketones. My guy didn't.

Absolutely. Too high a dose can cause their body to overreact in such a way as to dump stored glucose into the bloodstream as a protective measure against too much insulin.

That can be hard to separate out. If a cat is started on insulin while eating only dry food, a switch to wet low carb food can act to lower BG. Then, the insulin dose that was OK for dry food is too high and possibly cause bouncing or a hypo.

We ALL understand the stress of dealing with this. You've come a very long way in a very short time though. Give yourself a big pat on the back.

 

Hi and welcome! You're doing great already! And now you have a whole bunch of diabetic kitty parents to help you out! Skipping the dose was definitely the right thing to do. Kris is right, take a minute to breathe and be proud of the good decisions you've made for Motor!

 

Wow! What great numbers you've been getting! So glad you decided to start testing preshot as you definitely don't want insulin in him when he's that low!