? 01/15 Stormy. Do I skip/give Lantus at 193? Not eating

So sorry this post is not formatted correctly but I feel like I don't have time, as it is about time to give Stormy's insulin. I do not have a spreadsheet set up yet or many readings, I'm sorry! That was my plan for this weekend. My next post will be better I promise.

Some background information:
Stormy (18M) is newly diagnosed diabetic and spent 4 days in the hospital this week for pancreatitis, after starting Lantus last week. He was discharged on Wednesday and he still is not eating on his own so I am having to syringe feed. It's been a struggle to get all the calories he needs in him, he gets frustrated easily. I last fed him 2 hours ago, and I will be going to sleep shortly so I will not be up to feed him during the night. Also, he does have an ear infection, eye infection, and a UTI right now.

I am wondering if I should give insulin tonight. He is on 1 unit of Lantus twice a day. I have just started today to test at nadir (I think is what it's called? 6 hours after shot). And I just did his preshot test and it was low (for him) so I am wondering if I should skip insulin for tonight. It was at 193. My only concern is POSSIBLY him going into DKA if I skip it. He was off insulin for about a day while in emergency hospital and he was fine, but it makes me nervous to skip it. It also makes me nervous to give it, as I literally can NOT afford another emergency vet visit. I maxed out my Care Credit this week. I haven't been able to feed him as much today, as he was at my vet for a few hours getting subq fluids.
Here are his previous tests I have taken since he has been home:

Wed PM preshot: 322
Thurs AM preshot: 328
Thurs PM preshot: 293
Fri AM preshot: 302
Friday +6: 159 (sorry not sure how to format this. it was 6 hours after i gave lantus)
Friday +11: 189
Friday PM preshot (now): 193

I just called the emergency hospital he was at and they suggested giving half a unit tonight and see where he's at tomorrow. But it makes me SO NERVOUS to give him any insulin as I know he won't be eating and I will be asleep. If I give it I will set an alarm to get up and check his BG during the night. But again, I can't afford another trip to the hospital so if he's low I literally don't know what I would do besides rub syrup on his gums.

Any help would be appreciated! I hope I gave all the necessary information. Again sorry for the terribly formatted post

 

Link to your previous thread - https://www.felinediabetes.com/FDMB/threads/should-i-give-or-skip-insulin-tonight.241470/

Does he have a history of ketones or DKA?

 

Oh sorry, I meant to add that link! Thank you. I have so much going on right now I feel like I can't remember the simplest things. Can you tell by all my posts I am paranoid because I am new at this? LOL.

But no he does not. The first emergency vet I went to on Sunday had stopped insulin completely for about a day and a half and he told me "he's not going into ketosis so he must be making some of his own insulin." Which I don't know how accurate that is, but he did not have any ketones during that time. And his BG back then was around 400ish.

 

I don't know if you can give insulin if you are not going to be able to feed and test him at night. Let me see what others think.

@tiffmaxee
@Bron and Sheba (GA)
@Wendy&Neko

 

Honestly I am SO nervous to give insulin I think I would rather be on the safe side. This is the lowest I have ever seen him, and there is no guarantee I will be able to feed him enough tonight. He gets mad very quickly when syringe feeding. But I will see what others say, as I still don't really know what I am doing. Thank you

 

Without a spreadsheet it is very hard to advise you on dose.
I’m sure @Bandit's Mom would help you get one set up so we can help you.

Are you giving anything for nausea such as cerenia? Or ondansetron?
If you gave him the 0.5 unit as suggested by the vet at ER, you would need to syringe feed him before the dose is given, and can you get up in say 3hours and test and syringe feed him again? I would not give a dose if you can’t get up and monitor him at least once.
Cats who are fasting for a procedure are often given a half dose.

 

After things have calmed down a bit, let me know if you'd like me to do this for you.

Didn't realize there was a second Bandit's Mom around. Slightly different ID than mine!

 

Sorry I didn’t notice the wrong Bandits Mom came up for me to press!

 

I know, this would be easier with a spreadsheet, my apologies!
He is on cerenia, yes. And an appetite stimulant (along with some other meds)
But yes I was planning on syringe feeding 20mL before I give insulin. I definitely can get up and test and feed him again, but I don't know how much I'll be able to give him. And I really don't know if I'll be able to get any sleep if I give it. I will be so worried about him, but I want to do what is best for him. When the doctor told me to give half a unit I almost started crying because it just gives me so much anxiety.

I have some nonabsorbant litter and ketone test strips if needed. Clearly I am leaning towards not giving it because I just don't know if I can handle giving it without being able to monitor him much. I don't want to sound selfish but I just have felt so overwhelmed lately. But I also don't want to put him at risk just because of my anxiety

 

Thank you!! I just haven't even had time to look into it at all, with work and Stormy and everything else going on this week. I can probably figure it out but if I have questions I may need some help! Thank you so much

 

I do understand your anxiety. It is really hard in the beginning especially if you have a kitty who is sick and /or not eating.
Will he eat any other food apart from his current food do you think? some cats will eat some dry food after being sick where they won’t eat wet food in the beginning of the recovery.
Eating trumps everything so if you think he would eat some “unsuitable for diabetic cat food” give it to him.

Can you collect a urine sample and test for ketones now...is that possible. But try him with some food first.

 

No he really isn't eating anything. I went and spent like $70 on all different kinds of food yesterday and he has only licked one thing (and that was only like 5 licks). But I have given him every flavor and variety of food you can think of and the only thing he will sometimes drink is his cat milk (CatSip brand). I will try some of his dry food now to see if he eats it.

I MIGHT be able to test for ketones now but my problem is that once he uses it once, I don't know if I can use it again. Like it's just a disposable litter box with aquarium rocks in it and if he goes in it once and I test it, how will I know if he goes again later? Or what if he goes in the same spot twice and I'm testing a mixture of two urine samples? Does that make sense?
Or should I test now (if he goes) and then just go buy another litter box and aquarium rocks tomorrow morning to test again?
If I leave the box out tonight and he goes in the middle of the night, how long after he goes can I test for ketones? I have so many questions oh my gosh. I'm sorry.

 

Asking lots of questions is fine...that is why we are here.
Can you put a small plastic container under him when he pees?
Or can you just put some of the aquarium rocks in the LB? You wouldn’t want to mix up the pees or you wouldn’t get a true test.

There is another antinausea medication called ondansetron which works on a different pathway to cerenia which may work for Stormy. It can be given at the same time as cerenia and can be given 8 hourly if needed.as k you vet about getting that as well. Cats recovering from pancreatitis can be nauseated for a while......try not to worry too much. He will start to eat again and the. Things will be much easier. I would get your SS set up as we can help you a lot with dosing and also with recovering from pancreatitis.
Here is a link on how to stimulate kitties appetites.
https://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

 

Thank you for the link. I think I have tried a lot of those options, but he is such a picky eater he won't touch it still. However, he is eating his treats today which he would not before.
So I just looked at his litter box (with the regular, clumping litter) and it looks like he urinated not too long ago - probably sometime within the last hour. So he most likely will not go again anytime soon (he normally only goes about 3-4 times a day).
I can't put just some of the aquarium rocks in, because I only have one litter box to put them in. (I have nowhere to empty his regular litter box and then also would have no litter left). Sorry, this is so hard to explain. But I think my plan for right now is to syringe feed him 20mL, not give insulin, and set the litter box with aquarium rocks out tonight. I will wake up during the night to see if he went, and if so I will test it. Then I will try to maybe soak up the urine with paper towels or something so that if he goes in it again later in the night, I can test it again. Hope that makes sense. Do you think that would be okay?
If I test his BG when I wake up around 8 or 9am and it is high, should I give insulin then even though I normally do it around noon/midnight?

Someone else just told me about that med today, but I am hesitant to start him on any new meds since he is on like 7 or 8 meds right now and Cerenia has always worked for him in the past. But I may talk to my vet about it if he isn't eating soon. Thanks. BanditsMom is helping me with the spreadsheet so hopefully I will get that set up here soon.

 

Is there a reason you shoot so late? If you were to shoot earlier say 8am/pm or 9am/pm, you can get some tests in before bed.

Since you skipped the shot tonight, you can choose a "new" shooting time tomorrow and shoot at that time every AM and PM.

 

Not really, it just works easiest with my schedule. But I think 10am/pm would also work and would make it easier to get more tests in. I'm normally up until about 2 or 3 anyway. I will start doing it earlier tomorrow since I am skipping tonight. Thanks!

 

I see @Bandit's Mom beat me to it....
If you don’t give the dose of insulin tonight you can shoot when it suits you. I agree that an earlier time would be much easier than 12 :12 as long as it suits you.

 

Thank you both so much. It is way too late to give insulin now anyway, so I am just going to set up his non-absorbing litter box and go to sleep. Thank you so much for all of your help, and I will be sure to fill out my SS!

 

If you would like to start posting each day on the Lantus page, we can help you and it may alleviate some of your anxiety. There is a great group of knowledgeable supportive people here who can give you help and support.

We do a new post each day on the Lantus forum. In the subject line you put the date, name of kitty and AMPS/or PMPS.
So 1/16 Stormy AMPS 200. Then whatever you like in the thread. Hope we see you here

 

Thank you!! I had heard it is good to post daily, but I am not sure what to post besides when I have a question. However, I will have to look at other posts on this page to get an idea. I will start posting more often; I always have so many questions. Thanks again!

 

By posting daily people will get to know you and Stormy and offer support, especially if you also reach out to others. I’ve made some wonderful friends here.

 

I ended up not giving insulin and I tested his urine at 6am and 10am - no ketones. His BG was 400 at 10am so I gave his regular dose with food. Will start testing way more often today so I can figure everything out easier in the future. Thanks again!