POST DKA

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Lauren Gates, Feb 26, 2020.

  1. Lauren Gates

    Lauren Gates Member

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    Feb 16, 2020
    Hi All,

    George is a newly diagnosed diabetic, he is currently getting 2U 2x a day with lantus insulin.

    He started limping on his front foot so I took him to the vet today which she told me it could be arthritis or a strained muscle in his shoulder. She prescribed him gabapentin (.55ml) every 12 hours and onsior once a day. We just started this medication tonight after he ate and before his insulin shot.

    2 hours later I noticed a lot of dandruff on his coat and he gave me quite a meow near his food bowl, so i decided to check his glucose. When I checked the glucose with my alphatrak it was 52... I have never seen it this low, I gave him some food and waited 2 hours to check him again, now it is 50, even lower!

    I gave him a little more food, now I am worried that his glucose is going to continue to drop all night and we are not even at the 6-8 hour mark when it can be the lowest...

    Anyone had any experience with giving their cat gabapentin? Wondering if that is what is causing his glucose to drop so much.
     
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  2. sandscout

    sandscout Member

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  3. sandscout

    sandscout Member

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    Lauren, this is important:
    From the Lantus board-
    If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
    • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
    • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
    • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
    • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
    • Test in an hour and follow the same steps.
    DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

    In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus, Basaglar, and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

    Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.

    P. S. 2 units 2x a day seems like a high dose of Lantus to start, esp. for a newly dosed diabetic.
     
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  4. Lauren Gates

    Lauren Gates Member

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    Feb 16, 2020
    Yes I do, i just wasn't sure whether to give it to him or not if he would eat. I tested his glucose one more time and it is up to 87 now. Makes me feel a little better, definitely going to call the vet in the morning and check his levels before giving his insulin shot.
     
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  5. sandscout

    sandscout Member

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    Is he eating? and do you have some high carb food on hand?
     
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  6. Lauren Gates

    Lauren Gates Member

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    Wow thank you for all of the information I did not know any of that stuff...
    He is eating really well, very quick to eat. He seems responsive that is why I did not understand the low levels from before.
     
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  7. sandscout

    sandscout Member

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    Lauren, I don’t know how to do a link on here, but if you go back to forums and click on the Health Links Forum, then read the 3rd sticky down, “HYPOS-THEY CAN KILL”, that will give you more information about what happens when your kitty dips into dangerously low numbers. A good idea to print out for times like these-also do a search for “ Hypo Kit”- it’ll give you an idea of a few things to have on hand in your cupboard in case this should ever happen again :)
     
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  8. sandscout

    sandscout Member

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    Can you get another test?
     
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  9. Lauren Gates

    Lauren Gates Member

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    just checked George again, 30 mins after the 87 reading and it is going down again, now at 78. I am now giving him some higher carb food with honey on top.
     
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  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Hi. Sorry I didn’t see this tag earlier.
    If you get a BG number again in the future under 68, you need to give some high carb food, about a teaspoon, and test again in 20 minutes to check that the number is rising not falling. If it is still falling or not risen, high some more high carb food. You can also give a drop of honey if the number is not rising.
    Your kitty has earned a reduction in dose down to 1.75 units twice a day. Please take the reduction at the next insulin shot.

    Are you testing before every shot to see it is safe to give the shot?
     
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  11. sandscout

    sandscout Member

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    You want to make sure that the meal is “just” big enough that he will have enough of an appetite to come back for more; that is, small, HC meals with the honey (the honey’s effect doesn’t last long) in 30-40 minutes so you can get another test. Keep testing every 30 to 40 minutes until you see his numbers moving in an upward trend.
     
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  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    The 78 is a safe number. You could just give ordinary low carb food and test again in 30 mins
     
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  13. sandscout

    sandscout Member

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    Apr 27, 2018
    Thank you, Bron.
    Lauren, I have to sign off now, I’ll check in tomorrow morning. Good luck to you and George. :)
     
  14. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    How "newly diagnosed"? Most cats should start at a dose between .5 and 1 unit twice a day
     
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  15. Lauren Gates

    Lauren Gates Member

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    No, the vet never told me to test before shots. She has been pushing the freestyle libre on me. Since being diagnosed George has been there for 2 glucose curves the first one she upped his dosage from 1 unit to 2 units twice a day so in total from 2u to 4u... seemed like a large jump. The second time he went in for another glucose curve she said it seemed good but she wasn't sure?!
     
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  16. Lauren Gates

    Lauren Gates Member

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    He went into DKA on jan 30th (which is when we found out about the diabetes), staying in the animal hospital for 4 days and came home on 1u of lantus glargine.
    After coming home we took him back to the vet, she switched his food to hills d/m and did a blood glucose curve. She said his numbers were still to high in the 400-600 range so she switched him to 2u and asked him to come back in 2 days for another glucose curve. The 2nd glucose curve he was in the 100-200 range. She did state that his curve was a little abnormal that his number was lower when he got there in the morning and then got higher as he was there.
     
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  17. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    That's to be expected….tests that are done at the vet's office are unreliable due to vet stress...just like our blood pressure is higher at the doctor, our cats react to stress by their blood glucose going higher.

    We also don't recommend doing dose changes in whole units. Going from 1U to 2U is a 100% increase! That's like a human going from 30U to 60U! We only recommend doing dose changes in .25 unit increments.

    I'd strongly urge you to drop back to maybe 1.5 and get a test at home before every shot and then test at least once mid-cycle (5 to 7 hours after the AM shot) and at least a "before bed" test on the PM cycle.

    Do you have syringes with half unit marks?
     
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  18. Lauren Gates

    Lauren Gates Member

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    no, with the lantus pen it is only whole units... I asked the vet about switching to something with a syringe and she just said she would not recommend it since we would have to start the whole process over..
    also thinking about switching vets. I understand that my cat can sometimes not be the easiest to deal with but it feels that they are just brushing him off because he might scratch or bite them.
     
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  19. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    DKA makes a big difference. Can you change your subject line to say. 'Post DKA' please.
    When you get a kitty home from hospital it is really important to do the following things
    • Test daily or more often for ketones. You can do this by buying a bottle of Ketostix from Walmart or a pharmacy and dipping the test strip into the urine and testing exactly 15 seconds later. Anything above a trace and you need to talk to the vet about it.
    • Your kitty needs to eat 1 1/2 times as many calories as he normally does. This helps keep the ketones away. Food is like a medicine after a cat has had ketones/DKA.
    • If your kitty will not eat you need to ask the vet for some antinausea meds such as cerenia or ondansetron.
    • You need to be home testing the blood glucose levels so we know what the BG level is all the time and your kitty is getting enough insulin. It is very important that your cat gets enough insulin to keep the ketones away.
    • Encourage fluids.
    I see you only have a Lantus pen. Can you go out and buy some 1/2 unit syringes. And while you are there you need to pick up the Ketostix. It is really important they are checked at least once a day.
     
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  20. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    What food was he eating before hand? Is that wet or dry d/m you are feeding?
     
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  21. Lauren Gates

    Lauren Gates Member

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    just did another test 30 mins after the 78 reading and it is rising we are now at 129!!

    How long until I test again?
     
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  22. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    You can probably wait an hour on the next test.
     
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  23. Lauren Gates

    Lauren Gates Member

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    Feb 16, 2020
    wow my vet told me nothing about any of this!! How frustrating!
    to get syringes do I need a prescription?
     
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  24. Lauren Gates

    Lauren Gates Member

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    Before he was on hills prescription diet metabolic and urinary.
    He had a urinary blockage when he was 3

    He is currently on the hills d/m dry. He has always been good at drinking water and more of a dry food eater than a wet.
     
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  25. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    You can buy insulin syringes from Walmart.
    ReliOn 31 gauge, 6mm, 3/10 ml U100 1/2 unit syringes.
    They also have ReliOn Prime human glucose meters, ReliOn lancets 26 or 28 gauge and some cotton balls to put behind the ear to test.
    Get the Ketostix there as well.
     
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  26. Lauren Gates

    Lauren Gates Member

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    He was a little overweight before the DKA around 18 lbs and after he was 11 lbs. She told me to feed him less food, sticking to a strict diet to keep him at target weight. I'm feeling like she has not had much experience with diabetic cats.
     
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  27. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    When you get a chance, can you set up a spreadsheet please. If you have any trouble we can help you
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    Also if you can set up your signature. It is in the top right of this page under your user name.
    Info about that and other things for new members here
    http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

    Info on how to home test here
    http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
     
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  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    No, he needs to eat a lot more at this point to get over the DKA completely
     
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  29. Lauren Gates

    Lauren Gates Member

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    thank you for all of the help!
    It has been tough finding good information
     
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  30. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I believe the d/m is lower carbs than the S/O (which is horribly high), not sure about the m/d. When you switched him to lower (relatively speaking) carb food, his insulin needs would have dropped. Ideally with cats with urinary issues, you want to feed low carb, preferably lower phosphorus wet or raw food. Water is key.

    Good guess, you want recently DKA cats to be eating at least 1.5 times their normal amount of food.

    Are you testing at home for urinary ketones?
     
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  31. Lauren Gates

    Lauren Gates Member

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    no, I was not told not to worry about the ketones. Someone else just said that so I will add it to my list for sure.
    He was acting very hungry and licking his bowl clean after every meal... I voiced my concern to the vet and she said to be very strict on the food and to not give him more.
     
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  32. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    The M/D hills dry is 17% @Wendy&Neko and the d/m if it's Purina is 13%
     
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  33. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Do you have a scale at home? You can get baby scales which are good for weighing cats too. I'd ask the vet what she thinks is his ideal weight, but at this point you should be getting some good calories into him. Here is a post on DKA that might help you understand what is happening.
     
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  34. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Thanks Bron, so his carb% went down quite a bit.
     
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  35. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    You wouldn't be "starting anything over"....you just use a regular insulin syringe and pull the insulin out of the pen. We don't use the special pen needles.

    syringe in pen pic.jpg syringe in pen close up.jpg
     
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  36. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
    UtiCare
    Monoject
    Carepoint
    Sure Comfort
    B/D

    They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)
    Relion syringes.jpg
     
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  37. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    The recipe for DKA is not enough insulin, not enough food and an infection or inflammation.
    So to treat DKA and post DKA you need to make sure there is enough insulin ( testing will tell you...also by testing for ketones), making sure he is eating enough....this helps stop ketones reforming, and making sure the infection has been treated.
    Was he put on antibiotics?
     
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  38. Lauren Gates

    Lauren Gates Member

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    yes, we have a scale I have been checking him about once a week.
    I need to do better at keeping a written log of everything.
     
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  39. Lauren Gates

    Lauren Gates Member

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    yes he was on antibiotics after leaving the hospital. He took them twice a day for about 4 more days.
     
  40. Lauren Gates

    Lauren Gates Member

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    Feb 16, 2020
    Will look for those tomorrow. In the morning I will probably just give him 1 unit after testing his glucose. What do you think is a good number?
    Or should I say what number is too low to where I should just skip the shot all together?
     
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  41. Lauren Gates

    Lauren Gates Member

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    I don't know if everyone saw the beginning of my post or not. George started limping very slightly on Saturday, Monday when I got home he was full blown limping and favoring his right front paw. I took him into the vet today and she prescribed him Onsior and gabapentin. I never saw George fall so I'm not really sure what caused the limp, in seems to be in his paw that he is favoring it. I was also wondering if the medication could have been the cause for low BG. I hate I did not test him before giving him the medication for the first time tonight...
     
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  42. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    If he was in pain and the pain has been relieved that can lower the BG but if you have also reduced the number of carbs it is probably that or it could be a combination of both.
    If he is hungry now give him more food. We want him to eat.
     
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  43. Lauren Gates

    Lauren Gates Member

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    just tested BG again after an hour he is still rising at 148.
    we are 7 hours after his insulin shot.
    Good to call a night or do another test in an hour?
     
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  44. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I think you are good to get some sleep.
     
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  45. Lauren Gates

    Lauren Gates Member

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    THANK YOU SO MUCH EVERYONE!

    Will keep you posted in the AM on how he is doing.
     
  46. Deb & Wink

    Deb & Wink Well-Known Member

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    So when you get some sleep, come back tomorrow refreshed.

    Then getting some information in your signature and our standardized spreadsheet setup will be important.
    You can track lots of information on the spreadsheet. Not simply the blood glucose tests, but also what food your cat is eating, his weight, other medications. All sorts of helpful data.

    Bron gave you those directions on how to set up the Spreadsheet (SS) already. Look back at post #27.

    Posts are always numbered in the lower right hand corner, at the end of each reply back and forth.
     
  47. Deb & Wink

    Deb & Wink Well-Known Member

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  48. Lauren Gates

    Lauren Gates Member

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    Just woke up and tested George before eating his BG is at 596.. going to give him his 2 u of insulin this morning since it is so high
     
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  49. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I know you've been swamped with information. I want to add another bit.

    Please do not give Onsior or longer than 3 days. It is not meant for long term use and if you (or your vet) goes to their website, they very clearly state it is not recommended for pain management (or anything else) for longer than 3 days. It is a nonsteroidal anti-inflammatory and is hard on the kidneys.

    With Lantus, dosing is based on the nadir, not the pre-shot number. Think about where the 2u took George yesterday! I'd consider the 1.5u if you can do that -- I'm not sure you can with the pen.
     
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  50. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Lauren. Please do not give the 2 units of insulin as the dose is too high for him. He is bouncing this morning from the low numbers yesterday.
     
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  51. Lauren Gates

    Lauren Gates Member

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    oh no I wish I would have seen this before...
    I am thinking about not giving him the gabapentin this morning, that might have been what lowered it so much last night as it was his first dose.
    I tested him after food and it was already going down to 554
    gave him the 2u of insulin, and will retest again in an hour.

    I HAVE to go to work today, should I leave food out? I will come home to check on him at lunch and test as well
     
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  52. Lauren Gates

    Lauren Gates Member

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    Yesterday was the first time taking onsior and gabapentin at dinner with food and insulin shot following.
     
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  53. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Yes you should leave food out. Is he a good eater?
    As you don’t have a SS set up yet we can’t see when the low numbers occurred. Are you able to get home at other times to test him as well? . If he comes off the bounce he could drop low again.
    When do you have to go to work... +what?
     
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  54. Lauren Gates

    Lauren Gates Member

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    yes he is a good eater.
    I have to leave for work in about an hour, I was going to test him right before I leave which would be +1 after she shot
    Will be home for lunch at the +6 hour
     
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  55. Lauren Gates

    Lauren Gates Member

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    I really feel like the medication is what threw his numbers off so bad, he has been on the 2u shot for about 2 weeks now doing good with it.
     
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  56. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Dosage needs change all the time. Just look at some SS, so we can’t say for sure it was the pain meds. The safe thing to do is to reduce the dose of insulin. As soon as you get the syringes, and test for ketones, we can work out a dose for you.

    Are you able to get home at any other time to test the BG? From what you said in your first post today, the BG dropped low around +4, is that correct?
     
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  57. Lauren Gates

    Lauren Gates Member

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    Okay, I will do the SS tonight to get all of the information in. getting the syringes and ketostix today as well.

    I can not get home any sooner maybe an hour, which would be at +5.
    yes, it was at +4 last night that he dropped.
     
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  58. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I would leave plenty of food out for him to eat. And give him a snack before you leave. Is he the only kitty? Will he graze or eat it all at once?

    He is gorgeous btw.
     
  59. Lauren Gates

    Lauren Gates Member

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    okay, I will do. Yes he is the only kitty in the house, he is typically a good grazer if he knows it is there.
    Thank you!
     
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  60. Lauren Gates

    Lauren Gates Member

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    just tested George again, at the +1 hour we have went back up from (554 after eating) to 595. (he was 596 before food this AM)
     
  61. Lauren Gates

    Lauren Gates Member

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    Feb 16, 2020
    We are now at the +4 1/2 mark tested his glucose and it is at 487.
    Wondering if the level could be high due to his pain in his paw?
    I called vet found out the gabapentin had flavoring in it and she said it could have caused the low BG and to stop using it but she was not sure...
     
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  62. Deb & Wink

    Deb & Wink Well-Known Member

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    Pain can increase the BG levels some.
     

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