? 12/28 Peter UPDATE DKA!-Vet tech ordered a curve and was OK with us giving him sub-q fluids.

See Below for 12/28 update

12/27 Peter earned two (at least) reductions recently. I was worried that his numbers are high (430 yesterday) and now I got a 1.1 on a KETONE BLOOD strip. He had a DKA mid October with vomiting and an emergency vet visit. The thing is that he is alert, eating, playing and drinking as usual; he does not look sick, quite the opposite.

How concerned should I be? Is this an emergency. I shot him 1.5u tonight in panic.

I could give him sub-q fluids as I was given the stuff to administer it after his emergency in October?

I will try to call the vet tomorrow, but they might only be able to be reachable on Monday.

 

2.4 is supposed to be the DKA threshold (under 2.4 isn't DKA; over 2.4 might be but might not be, depending on how well the cat maintains normal blood pH when ketones are up), but obviously with a history of prior DKA it would be good to keep an eye on it. The higher insulin dose tonight would probably help bring ketones down, but also could bring BG lower. If it were me I would monitor BG carefully tonight and recheck ketones in the morning, but call the vet (or ER if there's one nearby) asap if he shows any symptoms of concern. Other more experienced people may have different advice, though.

 

Is there a reason why you are following SLGS instead of TR? With TR you would not reduce unless 3 drops in the 40’s on three different cycles or one drop under 40.

 

When I was first looking for treatment help, I decided to do SLGS because it looked like, it could be easier to do together with a job. Now I am home all the time due to coronavirus. Is one preferable over the other?

 

It looks like he bounced after the 83 yesterday morning. You will need to monitor closely tonight after shooting 1.5 U in case he comes off the bounce as the 1.25 dropped him to 83 yesterday. The extra insulin will probably help the ketones though!

You could give some subQ fluids if the vet is OK with him having them, but I would wait until after nadir in case he is coming off the bounce as some kitties will drop lower with subQ fluids aboard.
You could give extra oral fluids in the meantime.

I would also give extra food as that helps with keeping away ketones.

TR is a better method to do if your kitty is ketone prone or has had DKA as you can increase the dose more often then SLGS and the reduction BG is 50 not 90, although being a long term diabetic he would need three drops under 50 or one drop under 40
you can read about the two methods in the sticky at the top of this page.

 

Thanks Bron. You beat me to it.

 

So do I understand it correctly that TR might be better for Peter? From his data I wonder if DKA is more of a worry than a hypo (not to say, that hypo is not a huge concern). Between a rock and hard place...

Peter is acting very much himself, asking for food and playful as usual. I fed him a snack today with lots of water, per your suggestion.

I opened a new box of Ketone blood strips and either I am doing something wrong or they are defective, because I went through 4 already and none was able to suck up enough blood. I am only getting error messages. I might need to set up a camera to catch him going to his litter box and catch a urine sample.

 

His dose is being changed much too often resulting in wonky numbers I think. Why dud you give 2 units last night. Lantus is not dosed based upon the preshot bg. The preshot bg tells you if it’s safe to shoot. The nadir tells you how to dose. I do believe TR is safer with a cat that’s had DKA.

 

Here’s your previous post. We link condos for continuity.
https://felinediabetes.com/FDMB/threads/12-24-peter-amps-322-11-5-151-pmps-126.240491/#post-2705613

 

I agree with @tiffmaxee, you need to stick with the one dose unless your kitty drops under 50 in which case you reduce the dose by 0.25 units. Now that you have shot 1.5u why don’t you stay with that dose and see how Peter goes.
I would encourage you to get at least a before bed test in every night to see if he is going to drop lower. Cats often drop lower at night.
If the before bed test is the same or lower than the preshot, I would set the alarm and get up and test later to see Peter is safe.

Are you feeding several small snacks during the am and pm cycles as well as the main meals before the preshots?

 

I will be feeding him small snacks now. The main meals - I should test after he eats and shoot then?

 

You test before he eats. You need to pick up food two hours before insulin so that the test is not food influenced. You test to see if it’s safe to shoot. Then you feed to make sure he will eat. Then you shoot. Most do all within about 10 minutes.

 

Morning shot delayed by an hour. In the morning looked listless, ate a bit less and drank more, no play. Checked Ketones. Sadly, Peter's ketones are 3.3 on a human blood strip! Called vet ASAP. Vet technician asked for a curve in the evening to see if needs to adjust dose (whomp...whomp) She asked to test hydration (snapping the skin back) It was slow. She said we can give Sub-Q fluids. Peter got 100ml at 11. Grumpy about it, but perked up, playing a bit and resting now. We are worried, but monitoring him now is easy. Other things that I can give him is appetite stimulant pill, potassium pill, anti-acid (all that from the previous emergency stay). Yikes!

 

Have you tested to see if the ketones are still present?
It is really important to keep testing the ketones.
Try and get Peter to eat as much as possible as food will help keep the ketones away........give frequent small snacks except for the two hours peshot.
Do you have any antinausea pills such as cerenia or ondansetron to give him to help the nausea if he won’t eat?

How close are you to the PMPS?

 

Just like you wrote, he has been eating really well. Small snacks through the day. I am hoping to get the ketones down with insulin and food. I have antinausea and appetite stimulant from the Vet in October but so far he was eating really well without them so saving those for another day.

I will check ketones tomorrow as he is likely to use the litter box after his sub-q fluids. He is looking better, but probably not out of the woods. I am concerned what it will take to keep him from falling into DKA on one end and hypo on another. NO FUN.

 

Are you able to get any more tests in overnight? It would be good to get another pm cycle test in if possible.
The Main things you can do to stop ketones reforming are

• to do as you are doing and give small frequent meals often. Are you also feeding during the PM cycle as well?
  
• Don’t skip insulin doses and increase when needed.....we can help you with that.
• Test at least once daily, if you can test twice daily that’s even better early on in the DKA recovery. If
• Encourage extra fluids
• Give subQ fluids when needed.

 

Yes I gave one snack at night. He is looking much better but I will give him sub-Q for two more days
He is at 250 this AM and I want to give him 2 u (I did last night after 330). I know I am supposed to keep the dose, but he has been so high...and the ketones. Reading what to do in a sticky.