Recently diagnosed diabetic cat - seeking general advice

-Hi everyone. This is my first post. My name is Matt and my male cat, Oliver, is about 10 years old and has recently been diagnosed as diabetic. It started about 1 week ago. I noticed Oliver was extremely lethargic, drinking excessive amounts of water and generally appeared very weak. He was hiding in places he would never go before and acting very withdrawn. When he wouldn't eat and just hovered over his water bowl trying to drink I became extremely concerned. I took him to the ER last Sunday night where he was treated immediately. Unfortunately, he had DKA and needed to be treated and closely monitored. He was in the hospital until Friday night when I was able to pick him up. He is of course much better than when I took him in, but I am still a bit concerned.
-He is currently taking 4u of NPH twice daily, as prescribed by the emergency hospital. He also takes 1ml of Clavamox 62.5 twice daily, 1/2 teaspoon Renal K twice daily and Pepcid AC 1/2 tablet 10mg at night. Oliver's appetite has been very good. He is eating well, though he seems to always be hungry. They have prescribed him the Hills W/D canned food and also the dry food. I haven't actually picked up the food yet at a store, but I did purchase several cans from the hospital to get me through a few days. He was supposed to see the vet 2 days after release (today which is 2 days after Friday) but I have been unable to get him an appointment as it seems all vets nearby are closed. The earliest I could get him an appointment is Tuesday. I am a bit concerned as they wanted to test his BG levels to make sure he is responding well.
-Basically, my concerns lie in the treatment recommended by the ER. I am thankful that they have helped save my cat's life, but at the same time I am wary of some of the things they are recommending. From what I am reading, it seems like 4u is a high dose and I am not sure if that is good. Also, the food they are prescribing would not be my ideal choice. I definitely don't want him to have dry food and I would like to have him on a high protein/low carb diet but I don't want to change anything right now on my own. I want to wait to see my vet and see what they recommend. I'm basically just following the instructions given by the ER as I don't feel comfortable changing anything and don't want to jeopardize my cat's health.
-I'm not home testing by I did purchase all of the tools last night because of my concern for Oliver's health. I tried to test him but was unsuccessful. I didn't get much blood, or any. He is usually very calm and relaxed but he just does not let me touch his ears. He runs away and immediately shakes his head when his ears are touched. I had someone hold him while I tried to draw a sample but it still didn't work. I feel bad about the whole thing but I want to be able to make sure his BG levels aren't outrageous, but unfortunately it seems like it's going to be really tough.
-That's about all the information I have right now. I just wanted to get your thoughts on anything I should do or consider. As I said, his appetite is good but I'm a bit concerned that he is sleeping a lot and not too active. I haven't seen him drink much water and haven't been able to catch him urinate to test for ketones. He seems to be in good health, purrs, rolls over and is somewhat playful but I still feel like something is off. I feel like after he receives his insulin he does get tired and tends to hide. Any advice or tips you can provide will be helpful. Thanks for reading this lengthy post.

 

Hello and welcome!

So sorry about the diagnosis and the DKA hospital stay, and so glad that Oliver seems to be doing so much better!

Others will stop by soon, but here are a couple of quick thoughts/suggestions after reading your post:

1. DKA tends to take a lot out of a cat-- caregivers often report that it takes a while before they are back to 100%. It does sound like Oliver is well on the way, though, so that's great!

2. 4U is definitely a higher-than-usual starting dose of insulin, BUT: with a recent DKA, you want to be cautious about reducing that-- he needs the insulin, as well as food, to keep ketones at bay.

3. NPH is a tricky insulin to use in cats, it acts fast and hard, and wears off quickly, making it difficult to manage BG. Good for you for trying to get going with hometesting-- that is an absolutely crucial tool.

4. Tips on hometesting here. Especially important in the early stages, when it is always more difficult to make the ears bleed enough to test: make sure the ear is warm, and use a thicker lancet (26 or 28 gauge, usually labeled "for alternate sites" in the store-- the ones that come with glucose meters are usually 30 or 33 gauge, and are too thin). If all else fails with the ears, there are a small number of cats that tolerate paw pad testing, so that's worth a try if you think Oliver might be OK with that. Lastly, no matter what happens on a test, make sure Oliver gets a treat of some kind!

5. Most of us feed inexpensive grocery store canned food rather than vet-supplied "prescription" diets (which tend actually to be too high in carbs for a diabetic anyway!). Right now, though, the most important thing is that Oliver is eating well, and keeps eating well, after his DKA. Eventually you'll want to switch, but wait until you are hometesting-- switching to a low-carb diet can change insulin needs, sometimes drastically, so you don't want to do it without being able to monitor what is going on.

We have lots more advice to give around here, on types of insulin, food, and generally how to manage FD, but I think those are the main immediate points. Keep asking questions, and welcome again!

 

Hi Matt, glad Oliver is doing better! To help with the testing, try a little desensitization. Choose a spot that will be your testing spot, go there multiple times per day and rub his ears and give him a treat- don't try to test at all. Soon Oliver will be more relaxed and you can add the poke. Be sure his ear is warm, some use a sock with some rice in it heated in the microwave, if you use that, add it to the desensitization routine. If he really won't let you touch his ears, try the paw pad using the same routine. Always give a treat, even if you're unsuccessful. Also be sure you are relaxed, Oliver can sense if you're nervous and he will be too. Keep reading and asking us questions, that's the best way to help Oliver.

 

what was the readings the vet was getting?

 

I really wouldn't try to switch food to low-carb until you are hometesting and (hopefully) are able to get on a more cat-friendly, gentler insulin like Lantus after you see your vet on Tuesday. I'm also very wary of lowering the dose after a DKA without doing any hometesting, even though I agree that 4U seems high.

There are a few people on this site who have much more experience with NPH and/or DKA than I do, I'm going to tag a few of them, @Jill & Alex (GA) , @Marje and Gracie , @Meya14 to see what they have to say about this dose. Weekend traffic is generally slow on the boards, so it may be a little while before they come on.

 

Hello and welcome to the FDMB, Matt and Oliver! Unfortunately, I'm on my way out the door, but just wanted to take a minute to make a couple general comments...

If I were in your shoes, I would make testing blood glucose and testing for ketones at home a priority. It's the only way to know if the dose is too high. You also might want to take a look at these posts:

• Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

• Hometesting Links and Tips.

The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

At this time (subject to change as more information becomes available), I would not decrease the dose nor would I make any changes to diet.
My reasoning:

• Oliver requires a sufficient amount of insulin, which he's getting.

• Oliver needs to eat. He's eating W/D well so I wouldn't rock the boat at the moment. The W/D is a high carb food. The high percentage of carbs is what's probably keeping him from bottoming out. At this point, it's perfectly fine to feed higher carb foods (maybe even desirable) when you're trying to get as much insulin into the cat as is safely possible. If his appetite wanes or if he stops eating, call your vet immediately and post here for help.

• Oliver is being treated with antibiotics... I presume for possible infection. He's getting Renal K to increase his potassium levels and pepcid AC for acid tummy. He's being treated for health issues.

Oliver is on the right track. All these things should go a long way towards keeping ketones at bay!


PS -- When Alex was diagnosed, I found it pretty easy to get blood when using 25 or 28 gauge lancets. Any drug store should have them. Oh, one more thing, when the blood beads up on his ear/paw, you can always use your fingernail to scoop it up to test. That helps when the cat is squirmy or uncooperative.

 

Thank you all so much for your replies. I appreciate the input. I'm not going to be making any changes without seeing my vet first. Just a few points from reading your replies.

I'm not going to touch his diet. I'm not going to change any doses. He seems to be doing well enough to eat and function somewhat normally. I will wait for further advice from my vet.
I think I may need a lower gauge lancet. I was using the 30 but I realize this is making it more difficult.
I think I just need to get more comfortable doing it. I just tried testing him again and it went a little better but I'm still not sure. I got a blood sample but I don't think I did it right because it read 43. That would be very concerning, right?

As far as his BG levels.. I'm trying to decipher the sheet they sent home with me but it's a lot of terms I'm not familiar with. It does say "Glucose: 477H". I think I will just share the diagnosis with you because it might contain helpful information that I'm not able to get across, and many of you might be able to decipher these results better.

Diagnosis:

1. Complete Blood Count: WBC 14.79K, HCT 38.7%, Plt 470K
2. Chem: Alb 5.2, BUN 39, Phos 2.5, Glucose: 477H
3. PT/PTT (clotting times): normal
4. Urinalysis: USG 1.025, bacteria, ketones, glucose
5. Abdominal Ultrasound: Mild changes within the liver consistent with diabetes or hepatic lipidosis, ultrasound was otherwise normal.

That's what they gave me. I'm sure they have discussed the levels with me in detail but I just don't remember all of it. Right now he's resting on my bed. I just gave him a little snack after trying to test him. I praised him and pet him and he responded very well. He is quite alert and in good spirits so I feel pretty good. Testing went better this time, but was still really tough. I might have collected the blood too soon and didn't let it form because I was so rushed during the whole thing. But I think I will be able to do it successfully eventually. I found the best way is when someone holds him and I get the sample. I don't see myself being able to do it alone. I would need like 6 arms lol. Anyways, that's what I have for right now. I really do appreciate all of the replies. It means a lot to me.

 

IF HIS READING REALLY IS 43, IT'S A DANGEROUS NUMBER. can you please get another reading?? It's actually really important as hypos can be deadly. It could be a reading that is inaccurate because of too small a blood sample, but if it is acurate your cat could be in danger. Please, with determination, get another reading. Is it a human or pet meter?

 

Is he acting unusual at all? Staggering? lethargic? shaky? Those are some symptoms of hypo, but a cat can be in hypo numbers without showing symptoms until it's really serious.

 

No, he's not exhibiting any of these symptoms, just tired as usual. I will try and do another test right now.

edit: It's the ReliOn micro meter.

 

How long since the last shot?

43 is definitely a "take action!!!!" number for a cat on insulin, "action" being mostly feeding high-carb food and possibly some honey to try to bring the BG numbers up.

It's great that he's still feeling good, but we worry about where he might go from here-- hence the question about when the shot was (and thus how much longer the insulin will be going at full strength) (and hence Janet's worry above-- this is not a number that makes any of us comfortable at all!)

Congrats on your first successful BG test, by the way!

 

He got his insulin at around 8:20AM EST which would be a little less than 8 hours ago.

 

While you get the next test, I'll give a very brief outline of the strategies we use when numbers go this low:

1) feed high-carb, but don't fill him up all at once (we may need to do this for a while, easier if he is always willing to eat). We often use the gravy from canned food such as Fancy Feast Gravy Lovers-- high carb, not filling, but whatever you have on hand is fine.

2) honey or karo syrup. The real emergency supplies-- quick acting (though it wears off fast). Can be rubbed on gums for fast absorption. You can also drizzle a bit of honey on regular food to give it a "boost" of carbs.

Basically, we give a little snack, wait 20-30mins for it to hit the system, test again to see if the numbers have gone up. If not, repeat the process until they do start going up. Once they start rising significantly, we stop feeding for a while to make sure the cat is able to raise BG on his/her own without the food crutch.

Assuming he's still low at the next test, this looks like a definite indication that 4U of NPH is too much, hopefully some of the people who have used it can check in in the next four hours before the next shot is due.

 

Tagging @Gill & George and @Squalliesmom -- they are Lantus folks, but very experienced in food-steering in case we have to do some of that.

 

I tested again and it is reading 48. This can't be an error, right? I don't know what to do. Carbs quick?

 

Please post the retest BG number ASAP.

 

Feed a small snack of high carb wet food with gravy - more of the gravy than the food - and retest in 15-20 min. Post the result here as soon as you have it.

 

I don't have any with gravy. I would need to go buy some.

 

Yep, give him some more yummy snacks-- not tons, maybe just a tsp or two. If you don't have gravy, try drizzling a bit of honey or karo (even maple syrup in a pinch!) on the food for a bit of carb boost. Edit: or just the high-carb food you've got-- not the time to go to the supermarket unless someone can go for you.

To give you some reassurance: 8 hrs in, I wouldn't expect the NPH to be super-active for very much longer. But he certainly has gotten our attention!

 

Don't leave him.

If he has a good appetite, pop a drop of honey onto some of his regular food( a teaspoon)

 

Do you have honey or corn syrup (karo)? If so, put a small amount (1/8 tsp?) in a small snack of his regular food and give that.

 

Once you have given him the honey and food, wait and test him again in 20min,

You need to keep on testing at 20min intervals until he comes up. We would like to see him over 60.

 

Just got up to speed on this. All good advice from Nan & Amber and Gill & George!

Right now, feed him whatever high carb food you have in the house, just don't feed him a lot in case we need to get him to eat more, later. Any syrup-y stuff you have -honey, pancake syrup, corn syrup - can be added to his food.

 

I'm hoping that, at +8 hrs, he should be starting to rise some on his own.

 

That's what I'm thinking, too.

Thanks to you and Gill for responding so quickly to the tag! Now we have a whole crew here!

Matt, you are doing great!

 

Ok I gave him some of his food with some honey. Will try to test again in 15-20 min. I appreciate the prompt replies.

 

Keep us updated, as you get the tests.

 

I am concerned about the next upcoming shot. Obviously the 4U is too much, but as I have no personal experience with DKA or NPH I do not feel qualified to make any dosing recommendations.

 

I tagged a few people (Jill+Alex, Marje+Gracie, Meya14) earlier, but it's the weekend so I know everyone is busy. Can anyone think of others with relevant experience who might be on in the next few hours?

The encouraging thing is that Oliver's appetite and general mood has been pretty good since returning from the hospital.

 

I'm pretty sure Bobbie @Bobbie And Bubba has experience with DKA, not sure but Jayla @jayla-n-Drevon may have, as well.

 

I will tag Bobbie again--I have no experience with this other than what i have seen on the forum.
@Bobbie And Bubba

 

Thanks, Jayla, I couldn't remember whether or not you'd ever dealt with it, first-hand.

 

All I can offer is that after my guy's bout of DKA he was started on ProZinc at the usual starting dose of 1 u BID. It took him a couple of weeks to regain his strength though.

 

Did you get another test?

It's been a while, hope you are ok

 

I'm going to try tagging @Meya14 again, pretty sure she's still here.

 

Have you been able to test again? We're starting to get worried since we haven't heard from you.

 

Matt, the W/D you're feeding is considered high carb food (25%). Glad you gave him some food.

How long has it been since the last test when you got the 48 and how many hours was that from the shot?


Edited to add: Are we about 9 hours post shot now?

 

JIll, the last information we had was that he tested at 48 a little over an hour ago, and that would have been about 8 hours after his last shot.

 

Hi everyone. Sorry about the silence. I had a lot of issues with testing him. Got two errors. I did get a successful test and he's at 135. I just gave him a little bit more food with gravy as my dad was able to run out and grab some. Glad to see his levels are rising. Hopefully he can continue in the right direction.

 

He looks much better. Eyes are fully open. His head is up. Seems very responsive and alert. His appetite is very good, it seems like he cannot get enough food.

Edit: Yes about 9 hours ago he was given 4 U. Very concerned as I seriously think this is too much and I have just noticed how he behaves after his insulin.

 

Glad his numbers are up and you guys are hanging in there! We worry when we don't hear anything. Still trying to find someone who can help you with tonight's dose.

 

Hi Matt! Sorry, I think some panicked when you posted the 43. Going forward, please understand the W/D you're feeding is considered high carb food... probably has a higher percentage of carbs than the gravy food your dad was nice enough to go out and get.

I'd really like to see you test in an hour from when you got the 135. We want to make sure his numbers are staying up.

Wonderful!

I agree. This is why testing is a priority. Let's see how the rest of the cycle goes before making dosing decisions, ok?

 

I actually just received a call from the ER he went to. They wanted to check up on him. When I mentioned the low levels they suggested I bring him in right away so they can determine the correct insulin dose and check his BG levels. I'm assuming that's the best option right now.

 

If it makes you more comfortable to bring him in, please do.
Is it necessary? Probably if you're not able or available to monitor at home. It really depends on your schedule, ability to test, and availability over the next day or two.

 

That was really great of them! If he was my kitty, I would go ahead and take him in. It would be well worth it to me for peace of mind, if for no other reason.

ETA: Please let us know what they recommend, if you do take him back in to be seen!

 

Yes I am going to take him in. See what they recommend. I just worry about if he will have to stay overnight. But I am going to do it. I think it's the best thing for both of us. I really do appreciate the concern. Thanks so much. I will post an update when I have one.

 

Yes, please update when you can.
Good luck!

 

I think that's a good decision! Please do let us know how it goes, and how Oliver is doing. Sending prayers!

 

I just got home and got a tag. I do not have any experience with DKA but, Bubba had ketones that he got rid of. Jill and Alex gave the recipe for a DKA event and so glad to read that you will be taking your kitty to the vet. Good luck and keep us posted.

 

I just got home from the animal hospital. The end result is I am relieved, feeling much better, but a tad bit frustrated at the same time. Basically, what happened was when I arrived at the vet the nurse wanted to check his BG levels right away as they were concerned about his low levels. After she tested Oliver, she told me that he read 487. Of course, this is high. So she told me to wait and the doctor would meet with me. After a few minutes, I met in a room with the doctor. The doctor told me that Oliver's BG was dangerously low and that he needs to be treated immediately and stay overnight. I was shocked and baffled. I told her the nurse just told me he is at 487, how is that low? And she told me that that is incorrect that it was "43" and that he is in danger. The whole thing didn't make sense, but I trusted the doctor and thought maybe the nurse somehow made a mistake in reporting the BG. So she sets up the paperwork for an overnight stay, gives me an estimate and asks me to sign. Of course, again, it's a lot of money but when I consider the alternative I don't hesitate to sign. I say goodbye to Oliver and pay my bill on the way out. He will be ready to go home tomorrow.

A minute or two after I get inside my house I receive a phone call from the vet. She promptly apologizes to me and tells me there has been a misunderstanding. The number the nurse originally told me was the correct BG level. When the nurse saw the doctor getting ready to give him sugar in an IV she asked what the hell she was doing. It was at that moment they realized there had been a miscommunication. The doctor must have mistaken Oliver's original reading when this episode began as the level that was just taken. She apologized again and told me Oliver would be able to come home right now if I wanted to pick him up, or he can stay. I ultimately decided to let him stay so they can monitor him and hopefully see how he reacts to a lower dose of insulin. When I mentioned that I thought 4U was too high, she agreed with me especially when she learned his levels dropped that low. Although she admitted 4U is a high dose for a small cat, she told me that this was the dose he responded best to. They tried 1, 2, 3, and other various doses I'm assuming but they had the best results with 4U, so that is what they sent me home with. We are going to try 3U so that will be the new dose going forward. Since it was right before he was due for his insulin, I hope they will give him 3U tonight and be able to give me some results in the morning. He can go home in the morning and I will likely pick him up before 9 AM.

So I am struck with mixed emotions currently. I am elated that Oliver is well enough to be home, didn't require hospitalization, and is overall doing well. I'm a bit frustrated over the miscommunication and the fact that I paid a lot of money for something that isn't necessary, which I will be reimbursed for tomorrow. All-in-all I hope this overnight stay will provide me with some useful information going forward and that Oliver won't have to go through a day like this again.

Just as a closing question... Should I be concerned that his BG was 487? I understand he had been between 11-11 1/2 hours since his last dose of insulin and that he was prone to higher BG levels due to increased stress levels, but how high is too high? I'm just trying to get a better understanding of the numbers.

I really can't thank you all enough, again. The knowledge I have gained here so far and the support I have received is nothing like anything I am used to. If it wasn't for you guys today may have had a different outcome. This is probably the last update of the night. Will pick Oliver up in the AM and will continue the daily treatment. Have a good night.

 

Glad the nurse stopped the doctor. Also, 4U might have worked for them while Oliver was there but not when he came home. Most likely his BG's are higher at the vet because they're stressed. As far as how high is too high, I don't think there's a set answer but more of how long they stay in higher numbers, which can result in the DKA. Hopefully one of the more knowledgeable members will chime in .

 

bump

 

Wow. So glad that the nurse was on the ball and was able to stop things in their tracks! Yikes.

I think there's value in having him monitored at the vet overnight-- you won't have to worry about his safety all night and it gives you a break from the stress (it ended up being a pretty stressful day!) so you can regroup for tomorrow.

Couple of things: first, it's not surprising that he might have needed less insulin at home than at the vet's. Stress in cats can raise BG numbers, in some cases by hundreds of points. This is one of the things that makes it hard to determine insulin dosage in a vet's office, and one of the reasons why we are such big advocates of home testing-- until you see how a cat reacts to a particular dose in the home environment, it's hard to tell what the right dose even is.

Second: yeah, unfortunately that 487 isn't all that surprising. A lot of that is probably due to what we call a "bounce"-- when a cat's numbers go low (lower than they are used to, or even just dropping at a fast rate), their body reacts with hormones to release stored glucose into the bloodstream to counteract it. Result: numbers that go sky high after a low.

Get some rest tonight, you deserve it-- that was quite a rough intro today, going from "not testing yet" to "OK, really need to test now" in a few short hours! Check in tomorrow, we'll be looking out for you.

 

Glad everything turned out for he best - I also agree that it's just as well Oliver spends the night at the vet's. Keep us posted on his progress, and always feel free to ask questions or ask for help!

 

Hi everyone. I picked Oliver up about an hour ago. We're both home now. He was given his food and some insulin right before I picked him up at the vet. He looks really good. He was very curious and checking every room of the house out as if he had never been here. And, of course, he's still hungry and wanting to eat more. But I'm glad he is feeling better and is doing well. He seems to be responding better to the 3U but we'll just have to see how he does at home. His BGs were monitored throughout the night and he never got low at all. So all is well for now. I think we are both going to rest now. I didn't sleep well but I generally have issues sleeping. Will update when I get some more information and observations on how he is behaving.

 

So glad to hear he's feeling so much better! Hope you are able to catch a nap or something now that he's home.

It'd be good to get a BG reading when you can, too-- I know he didn't go low at the vet's but, again, vet stress can have a big impact on numbers, so he may drop again now that he's home, even on the reduced dose, so you'll want to keep an eye on him.

Welcome home, Oliver!

 

I'm glad to hear that Oliver is back home and doing so well! Nan is right, you may see his bg still drop some more, so it's a good idea to monitor. Hope yu can get some rest now, knowing Oliver is okay!

 

Thanks guys. I agree that a test is necessary. I tried to test him a little while ago and was unsuccessful. Unfortunately I just couldn't get a blood sample after pricking. I think I need to find a way to better warm his ear. I tried a warm washcloth in a plastic bag but he just wouldn't let it anywhere near his ears for more than a second. I'm going to let him relax for a bit and try again in a little while. The good thing is he is much more interactive. He isn't hiding under beds and even when he is napping he is within view. This is much more typical of his normal behavior.

Edit: Earlier today.

 

Many of us (myself included) use an old, clean sock with about 1/2 cup dry rice in the toe, tied off and warmed in the microwave until very warm but touchable. Others use any small bottle with a lid that screws on tightly and fill it with very warm tap water.

 

Aww, cute pic. He looks very relaxed and content.

To warm his ear you can try a bit of rice in a sock, that you can warm in the microwave (just don't let it get too hot) or some warm water in a small pill bottle. Sometimes you can just rub their ears for a few minutes to warm them up.

 

Well, I checked him again and he's at 84.

edit: 84 with about 7 and a half hours passing since his insulin this morning, give or take.

 

Please test before you feed/give tonight's shot, and post your reading. Oliver may be too low to give 3U tonight.

 

That's a safe number, but it makes me wonder about that 3U, given that it's been 7.5 hrs since the shot on a short-acting insulin. Hmmm.

For reference: 50-120 is the rough range of "normal" BGs for a cat when using a human meter. Please do post a pre-shot reading tonight before shooting 3U tonight-- if he's anywhere below 250 or so I would be very wary of shooting the full dose.

You are going to go see your regular vet tomorrow, correct? I don't think we've talked a lot about insulin choices. Good insulins for cats are the depot insulins Lantus and Levemir, and the long-duration non-depot insulin ProZinc. I've only used Lantus, and would recommend it (among other things, the L+L community on this site is enormous and enormously knowledgable), but they all have their strengths, and it may depend on what your vet is comfortable with. Vetsulin/Caninsulin is another in-and-out insulin, it's less dramatic in action than the NPH you are using, but similarly tricky to dose in cats-- some cats do very well on it, but I wouldn't recommend it as the first choice if you are given a choice.

 

Will test him again before food/insulin. Due at around 2.5 hours. I absolutely agree. I am going to mention insulin and see if there are other choices available. I still find the 3U to be high. I noticed when he came home from the vet shortly after he was very alert and friendly. As it neared toward peak time, he became withdrawn and was hiding again. I think we are making progress but there is still a long way to go. I will update when I have more information later. He's comfortable now, was out and socializing after a little snack for a bit but is now back to lurking from underneath the pull-out sofa in the hallway, kind of just observing.

 

He is at 175 right now. It is time for him to eat. His insulin is due in about 25-30 minutes. Do you have any dosage recommendations? Should I still give him insulin? I'm really worried that it's been almost 12 hours and he's 175 so I don't know how 3U would affect him. I'll be back in a few minutes.

 

We generally try to "stall" without eating in this situation, retesting in 15-30mins to see if the numbers are climbing. But that is pretty low for a pre-shot.

@Jill & Alex (GA) , I don't suppose you are around to help? @Bobbie And Bubba , @Chris & China , @Kris & Teasel

 

I'm here. What insulin again? Vetsulin? This is a post DKA cat so no insulin isn't the best idea but 3 u is likely too much. I think a stall up to 60 minutes in 20 minute increments is possible. There's more dose timing flexibility than with the L insulins.

ETA: Found it - it's NPH. Stalling would work with this too.

 

Kris, it's NPH, which is I think like an even more dramatic Vetsulin. I don't think I'd give more than 2.0U in this situation, I'm even wondering about 1.0U.

Is he eating well today? I know he's been doing a bit of hiding, but that may have been just him reacting to the yo-yo-ing BG numbers. We don't want to skimp on the insulin with a post-DKA cat, but I'm not sure that's the biggest risk in the very near future.

Can you monitor for a while tonight if you had to?

 

I agree that 1 u is the way to go as well. Evening testing is important.

 

• How long has your kitty been on insulin, sorry if I missed that, I am tied up with my mom right now.
• Did you change any thing since yesterday like carb count in food?

 

I agree that stalling for 20 mins and a retest to see if Oliver comes up is a good idea. I am scanning through the post since yesterday to get a feel for everything. Oliver has only been on insulin for about a week is what I am gathering? If that is correct, shooting under 200 without any data is tricky but a cat recently with a DKA history needs to have insulin.

How is Oliver eating?

 

Matt, you don't happen to know what his BG numbers were this morning at the vet before the shot, do you?

Brief history: on insulin (NPH) for about a week, most of which time was in the hospital from DKA. Just started monitoring yesterday.

At the moment, we have him at 84 at +7.5 after 3U NPH this morning, and 175 at +11.5, so maybe 20-25 pts per hour. Yesterday (first home bg tests) he was in the 40's at +8 and (after loading up with carbs) in the 400's a couple hours later. At the vet that evening, he got 3U NPH and "didn't go low" all night, but we don't have numbers that I know of.

So, we know that he responds to carbs. We'll see what Matt says about possible food changes today. I think another option (considering the DKA) would be to give more insulin but also carb him up, but this kind of thing is pretty far out of my league.

 

I'm not that confident advising about carbing and dosing a post DKA kitty.

 

Exactly my problem.

I think @Marje and Gracie might be online now, tagging just in case she is around and able to offer an opinion. (sorry for the long thread history here, Marje!)

 

Didn't get to read in time. I felt so bad after unsuccessfully testing him several times I had to feed him. He ate but I'm just not sure about the insulin. Since he came home he has maintained an almost unquenchable hunger so he's been eating very well.

 

Yes, I would like @Marje and Gracie to weigh in here too as DKA is tricky and I do believe that insulin should be administered since there was a very recent DKA but, how much, I am not sure.

 

How long has it been since the last test?

 

I posted right after the test. So a little over 30 minutes ago.

 

Can you get another test and post?

 

Yes I will try to do that now.

 

I am sorry but I'm in TX....my brother in law passed away and the funeral was today. I just had so many notifications that I checked in quickly.

I haven't kept up on what is going on with this kitty and I can't stay online so I'm a little nervous about trying to offer advice under the circumstance. I don't know how he's been eating and drinking or how long since he's had ketones.

I'm very sorry I am not able to help tonight but I don't have the time to educate myself on this kitty to be sure the advice I give is safe.

 

Are there any test in between the +7.75 and the 11.5? If he didn't go any lower, that was a nice nadir today. Can you monitor tonight carefully if you should give him 3 units? Plenty of test strips

Understandable Marje. Sending hugs and we will do the best we can tonight. Hugs.

 

Thank you...so very sorry.

 

Thanks for checking in Marje-- so sorry about your brother in law.

 

I think part of the concern is that, though none of us here presently have worked with NPH, our impression is that it's a pretty fast-acting short-duration insulin in general. So, that 84 at +7.5 might not have been the nadir-- Matt reports that Oliver was hiding and withdrawn "at peak time" (not sure when exactly that was), which is the kind of thing he was doing this weekend when 4U bid was being shot blind, before we got the 43 shocker at +8 yesterday.

 

I'm just so upset. I just pricked him two separate times and I was unable to draw blood. I feel so bad for him. I want to help him but I don't know how many more times I can do this.

 

I think 3 u is obviously too much based on PS of 175. This is a short duration insulin so if it's still hanging around at +11.5, the dose is too high. A dose of 1 u would be a minimum and maybe 2 u a maximum. This is all guessing of course.

 

You're doing great. This is really hard--- normally you wouldn't be doing this so much when you first started testing, you'd build up slowly to get a routine going, etc. Give him some treats and pets, and remember-- it's unlikely that you're actually hurting him (very few nerve endings in the ears compared to, say, a human finger) you're just kind of annoying him right now. It'll be OK.

 

Deep breath, I have been there too with not able to draw blood. Are you using a warm rice filed sock microwaved for a few seconds?

 

Matt, try and get another test. You can poke two pokes close together if the first one does not yield any blood. I had to do that tonight with my cat and I have been testing for almost 2 years. I am uncomfortable to advice you with shooting until you get another test number.

 

@Wendy&Neko can you advise? This is recent DKA kitty n 4 Units and presently taking to 3 Units today and a lower than normal PMPS. I need to sign off and get my mom ready for bed. Waiting for a second test 30 + minutes after a 175 test.

 

I just got it. He's 138 now ....

 

So he's dropping. I would not be comfortable telling you to shoot 3 units with that PMPS but, I don't think not shooting is a good idea either. Are you able to be off schedule at all?

 

So he's now lower than the previous test an hour and a half ago.

 

And, Matt, to confirm-- he's still eating the W/D canned, which Jill+Alex said was about 25% carb?

He's definitely not making it easy!

 

He still eats it but since I gave him the Friskies canned food with gravy he's been a bit more fussy. I've been trying to give him some of this as well but he mainly eats the Hills W/D.

 

What are we at now, +13? I don't think stalling is going to work. Why not feed a full meal to get food on board and give something between 1 u and 2 u of NPH with a plan to monitor for the next 3+ hours?

 

If you can afford to be off schedule, I think what I would do is feed Oliver and retest in 2 hours. If his number is above 200, I would go ahead a shoot but I don't know if I would shoot 3 units. Do you have 1/2 marks on your syringe? Perhaps 2.5 units? And test tonight to keep him safe.

ETA: Or go with Kris's plan to feed an shot a reduced shot now.

 

We are on the same page Kris. I don't have experience with DKA or NPH but I do know that not giving insulin to a kittie who is recently DKA is not a good thing. We need to hit a happy medium.

 

Yes there are half marks. I'm not sure how late I can be up, though.