01/23 Lucy AMPS 307 +4 >500 +11 >500 PMPS >500 +2 490

Red83

Red83

Member
Hello! I have been managing my cat's diabetes ~5 weeks, and both our lives have been intermittently unmanageable ($4000+, stress, quality of life). I am reaching out for help. Context:
  • After DKA regulation 01/01 he fit criteria for regulated, but you will see a oddity in his numbers due to other events: stress from ER/vet visits, running from insulin shots/hours late, trying to transition food, asthma attacks, etc.
  • 2 x hypo events (01/22, 01/17)
  • This has been really problematic due to reoccurring/unknown other health issues
  • Questions, suggestions, etc. much appreciated but no criticism please! [1]

Questions:

1. How do you advise I change the insulin/food portion for a switch from 27% carb wet food to low carb?
  • I read Pierson's article but it is not specific about how much to drop the insulin dose, and it's unclear if it was written with Lantus in mind.
  • I already know what food I'm generally looking for due to excellent articles


2. Is it really safe for me to transition to home testing via pricks, or should I just stay on the Libre CGM until his numbers are more consistent??

  • His BGs have been so erratic I had 3x Libre in a row installed and planned to move over to Relion Confirm / Dario monitors.
  • It is cost prohibitive ($70/wk + vet visit) but need to counterbalance me/the cat in the ER/stressed....


4. When you see very low numbers/no symptoms and feed 1 tsp honey, how much do you see/expect the BG to go up?
  • When I got to the ER and his BG was 86, the vet said 2.5tsp of honey could not have caused the rise from <40.
  • I fed 2.5tsp because after 1tsp + waiting, nothing appeared to happen with his BGs and I didn't know if BG could be so low that 1tsp had no effect.
  • I took him to the ER because after I fed him honey he wouldn't eat anymore and honey is temporary. It seems likely if I had not panicked and just enticed him with food his #s would've gone up and no ER would've been necessary.



P.S. Thank you for all of the helpful articles and threads this community has made, many of which I have read 5+ times to get to this point. I couldn't have gotten here without you!

[1] I have been going through my own extreme medical emergency since early Jan and any criticism will be very counter productive right now. More stress/triggering => more mistakes => more cat in hypo/DKA OR taking the cat to the ER when he is fine (which also causes days of BG swings and poor regulation).
 
Hello and welcome. Going through DKA with a kitty is definitely a stressful experience. Thankfully one I didn't have, but many people here have. You've had an extremely steep learning curve, but you've come a lot further than I did in 5 weeks when I started. It's good to see your spreadsheet set up already. Good job! Did you use the template from our site? There are a few differences from what I am used to. For example, we use white for the background where there is no data entered. Lime green is reserved for numbers under 50 if you are using a human meter. That lime green leaps out at us. Is it possible you can switch the background colour?

One other thing, and this isn't meant as a criticism, but more an explanation about how we think. We are used to reading spreadsheets where data for the oldest days is on the top, and the most recent day on the bottom. I am used to seeing patterns in the data numbers, and I find it more difficult to deal with data in reverse order of what I'm used to.

I will try to answer your questions as best I can.
Red83 said:
1. How do you advise I change the insulin/food portion for a switch from 27% carb wet food to low carb?
Click to expand...
I would suggest starting with replacing 1-2 tsp of his current food with the low carb food, and slowly up the percentages from day to day. Generally we don't reduce the dose in anticipation, but wait for the numbers to be our guide. It looks like you've selected TR as the dosing method, but you need to be feeding an all low carb wet or raw food diet to follow TR. In the meantime, while you transition, you can follow SLGS. That means reducing if he goes under 90, and that will give you a little bit of a safety margin too as you reduce the carbs in his diet. Once you've transitioned all his food to low carb, you can switch back to TR.
Red83 said:
2. Is it really safe for me to transition to home testing via pricks, or should I just stay on the Libre CGM until his numbers are more consistent??
Click to expand...
Using the Libre is a more recent, but welcome addition to the tool box for testing. It can be a life saver for people who have newly diagnosed cats, fractious cats, have problems testing for one reason or another, or those going away on holidays with petsitters who don't test. Having said that, those of us who started with diabetic cats more than a few years ago, all started with home testing via pricks. So it is safe to do so if you want to switch. One thing we have noticed with a number of the Libre's is that in the lower number range, the Libre tends to test lower than blood glucose meters. You might what to start trying to hand test when you see lower numbers on the Libre, and see what the differences are. Some people found the Libre gave the numbers than said reduce the dose, but the human meters did not.
Red83 said:
When you see very low numbers/no symptoms and feed 1 tsp honey, how much do you see/expect the BG to go up?
Click to expand...
The answer to that is ECID or every cat is different. Some cats are carb sensitive and only a little bit of carbs sends them skyrocketing, others aren't carb sensitive at all and need a lot of carbs. To learn where your cat fits it, keep track of when you feed extra carbs and how much, and you'll start to see how he responds. Most people use a drop of honey, not a tsp - which is a lot of honey. Other people use higher carb foods to bring up the numbers. You might want to hang onto some of that higher carb food he is currently eating.

Carbs can take 20-30 minutes to go from the food bowl to the blood stream to increase numbers. Not sure how long until it's shows up on the Libre. Those 20-30 minutes seem like forever when a kitty is in low numbers. Any time you see low numbers, do post here and we can help you through that.

I see Bron will be answering. That's great, she's very helpful for people who's kitties have had DKA.
 
Hi Lucy and Lucifer. Am I correct in thinking that Lucifer is the kitty and Lucy…you are the Mom?
I can see that Wendy has answered your questions.
I am sorry you have had to go through DKA when you have had you own health problems. That must have been really hard to cope with:bighug:
Would you mind if I asked @Bandit's Mom to change the background colour of your spreadsheet to white ? It would make it a lot easier to see the lower BG numbers. At the moment the background colour is the same colour as the very low numbers.
And would you be happy if we changed the SS to the oldest at the top and the most recent at the bottom….this is on no way a criticism at all but as we are used to it being the other way around it would stop any confusion.

It looks like Lucifer is bouncing at the moment after that BG of 35 yesterday. That could last up to 6 cycles.
Yes it is safe to move to a hand held human glucose meter like the ReliOn meter. Do you need some tips on how to hometest? Or are you OK with that?

With post DKA kitties we usually suggest the following
  • you need to give one and a half times as many calories as Lucifer normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,
  • Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
  • Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all. If you have not been testing for ketones, I would recommend you start to test, as testing for ketones is an insurance policy against DKA. To test for them you will need a bottle of ketostix from Walmart or a pharmacy. Then you need to collect a urine sample and dip the test strip into the urine and read the result against the colours on the side of the bottle exactly 15 seconds later.
  • Give antinausea medication if needed …how is his appetite? Is he eating plenty?
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Lucifer will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids if you think he is dehydrated.
  • Post daily with updates and ask for help as often as needed.
Please keep asking questions as we are very happy to help you. We are here 24/7.
Bron
 
Thank you so much for your prompt, thorough, and compassionate responses!! It has been hard and just hearing from you helps me to feel supported through this.

I am happy to change my spreadsheet sorting around to make it easier for other folks and will fix that later today. I made the spreadsheet exclusively (since I have the Libre) for others to read so I am happy to invest time into making sure it is useful. I will also fix the BG color. I did use the template from this website, but I'm not using Google which may have caused some of the differences.

Wendy & Neko, I REALLY appreciate your guidance!! The info about Libre, honey and carb response times and dosages, ... Extremely helpful! I will switch to SLGS until the food is switched over.

Bron & Sheba, thank you for all of your advice and sympathies! Good to know about how long the bouncing can last. I had just raised the dosage to 2.5 so I lowered it down to 2.0 for 2 cycles, and am back to 2.25 now. I haven't started hometesting yet (strips come tomorrow), and I bet I will have lots of questions after that. I didn't know that we want to keep feeding to avoid ketones. I guess I was thinking that food gets converted to glucose which can make high BG levels worse (contributing to DKA).

"If the BG is not high enough to give the dose... stall, dont feed" -- This is helpful, because stalling (for other reasons) has led to big changes in his insulin administration time (and my sleep schedule sanity) and I started to think I should shoot or skip on time, but this advice is something different.

I have ketostix and will move up testing to daily.

My baby kitty had a ravenous appetiate for YEARS but now I have a hard time getting him to finish meals (barely 1 5.5oz can a day), which scares me because I'm worried that if he goes hypo he won't eat. (Which makes me want to go back to feeding 2x a day just so I know he will eat...). I thought this was due to regulation, but it sounds like you are thinking it is nausea.

He also seems to have a harder time eating lately, to the point of not being able to consume dry kibble and for wet, I have to keep using a knife/spoon to move the food around to be in one big clump (versus spread out flat along the edges of the bowl, plate, etc.). Sometimes he seems to try to use his paw to dig it out, not very successfully. Have you seen anything like this? I was thinking about buying a lot of the treats and items suggested for stimulating appetite in the stickies.

Since in the hospital 1/1 my kitty's voice changed several octaves lower, his esophagus seems swollen and it led to $$$$ expenses including a future appointment where they may sedate him to checkout the area. I just read on catinfo.org about the harms of dry-pilling, and now am worried that the simplest explanation is the hospital staff dry-pilled him, something got stuck there, and now it's been irritated...
 
Here is a link to HOMETESTING HINTS AND LINKS

And a link to SUGGESTIONS TO STIMULATE THE APPETITE

It does sound as if Lucifer could have nausea. It is very common after DKA and a lot of kitties need anti nausea medications for a while until things settle down. I would ask the vet for some cerenia or Ondansetron tablets. Ondansetron is better for nausea so see if you can get some of those. They are a human medication so the vet may have to write a prescription and you collect it from the pharmacy. Cerenia is given one a day and Ondansetron can be given 3 times a day. They can be given together if needed as they work on different pathways.

It’s important that Lucifer eats plenty of food…so don’t go back to just feeding twice a day. See if things improve with an antinausea medication. It is better to let him eat any food at the moment, even food that is not low carb, than him not eat.

The two most important things that will stop him getting ketones again and possibly DKA are food and insulin. Ketones develop in the body when there is not enough insulin and not enough food and the body starts to use fat for fuel and the byproduct of this is ketones. Extra fluids also help flush out the ketones. Does that make sense?


.
 
Red83 said:
I am happy to change my spreadsheet sorting around to make it easier for other folks and will fix that later today. I made the spreadsheet exclusively (since I have the Libre) for others to read so I am happy to invest time into making sure it is useful. I will also fix the BG color. I did use the template from this website, but I'm not using Google which may have caused some of the differences.
Click to expand...
Welcome to FDMB! :-) If you need any help with porting your SS data to our Google Sheets format, I will be happy to help. For some reason it took a while to open on my computer (Windows PC).
 
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