? 9/16 Cape, Recent DKA, Still HI at home. Should I use R

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jaysonguy, Sep 16, 2020 at 10:50 AM.

  1. Jaysonguy

    Jaysonguy Member

    Joined:
    Feb 16, 2017
    Cape, when healthy, eats very well and takes just about 1 unit of Lantus every 12 hours to keep her in the 90-120 range. She's 11 or 12 years old.

    Cape went to the hospital on 9/10 because she was a little lethargic and wasn't interested in eating. The ride to the hospital was about an hour and fifteen minutes and she traveled incredibly poorly. She was hyperventilating and open mouth breathing and eventually was just laying on her side in the carrier nonresponsive.

    Once at the hospital they found ketones and couldn't get her blood sugar under 500, her kidney values were off and so were her electrolytes. They took her off her Lantus and used fast-acting insulin to try to manage her as well as giving her antibiotics and fluids. She just laid in the hospital and was pretty catatonic for the first 72 hours. On 10/13 she started looking brighter and her sugar was around 400. They put her back on her Lantus and did additional insulin and she started to eat overnight into 10/14. On 10/14 her ultrasound showed no signs of kidney disease and the doctor thinks that she had damage either from dehydration or physical injury and she needed to rest at home. She was eating normally and her blood sugar was down in the 200's.

    I asked for her to be sedated when we discharged her on the evening of 10/14. No word was given to the doctor and when asked when we arrived we were only given one 50mg capsule of gabapentin that we had to empty about half in her mouth. Her Lantus shot was already an hour late when we got her. She was already upset in the car and it went downhill from there. Getting her home took hours trying our best to keep her calm and she was catatonic again and unresponsive. Her sugar was HI yesterday and she felt awful and I shot with 2 units. Repeated tests only gave results of 540/570/550 which is within the error range of not getting away from HI. We're syringe feeding her but she's drinking and we're doing 30ml of SubQ fluids every 12 hours.

    Overnight she was more active walking around but shaky and weak. Today she was 530 when we started our day and then 488 before her Lantus and after some syringed food and Lantus she's 530 one hour afterward. I wanted to check to make sure she's not dropping too fast. I need to check her sugar in a half hour and that will be 2 hours since her Lantus shot. Her breathing is still a bit faster than normal but I think we're dealing with a mixture of her already not feeling great plus the trauma of traveling. I was told that before she was discharged she was eating well and walking around.

    Thank you for any help.

    Here's Cape's newest data. I don't have much, just from when she was at home. The week before the hospital she crept up from 90-120 to about 120-140 but I figured she was fighting off the virus in the house. When she was 239 on 10/11 I knew something was wrong.

    NEW CHART, VERY LITTLE

    EDIT: She was at 488 one hour after her Lantus
    EDIT: She was at 377 two hours after her Lantus
    EDIT: She is at 480 three hours since her Lantus
     
    Last edited: Sep 16, 2020 at 2:44 PM
  2. JaxBenji

    JaxBenji Member

    Joined:
    Jul 10, 2020
    Hi! Welcome (back?) - so sorry to hear about Cape. I don't have advice to offer but I'm sure some experienced folks will weigh in. To get more eyes, you can edit your title and pick the ? from the drop-down. Hang in there :bighug:
     
  3. Jaysonguy

    Jaysonguy Member

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    Feb 16, 2017
    Thank you very much for your advice.
     
  4. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    Sounds like a rough time!

    Do you happen to have an updated SS out there somewhere so we could see what's been going on and for how long?
     
  5. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    @Wendy&Neko has some experience using R but she usually comes on later in the day.

    Hang in there Jason.
     
  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    I won't give dose suggestions, especially about R, without an up to date spreadsheet. It is possible for you to add at least the last two weeks of test data? Maybe @Chris & China (GA) can help you get set up with a new 2020 tab for Cape.

    You need to go slowly and carefully with R. You need to understand low the Lantus is working in Cape now, what her normal onset and nadir are. The R action is layered on top. We don't use R to make a huge drop in numbers, as drops over 100 can cause a huge bounce and you'll end up with higher numbers again. The use of R must be done with caution. If I can see test data of Cape on Lantus before her vet visit, that might help me understand how the Lantus is working in her.
    We don't use Lantus to shoot down high numbers, but rather look at the nadirs to determine how to change the dose. How long has she been back on Lantus? Is the depot still building? All questions an up to date spreadsheet could answer.
     
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Are you testing for ketones at home? You should be doing this daily if not more often. Please put the results of the ketones tests in the spreadsheet. Presence of ketones increases the urgency.
     
  8. Jaysonguy

    Jaysonguy Member

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    Feb 16, 2017
    I don't, I have multiple diabetics with one tester and haven't been keeping up to date on the SS.

    She was rock solid before this. I'd shoot her at 70 and know exactly where she'd be at +2.

    We have an awful virus going through the house as well that hit many of the cats, I think that contributed to it all.
     
  9. Jaysonguy

    Jaysonguy Member

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    Feb 16, 2017
    Pretty much I have the very vague hospital testing and then what I'm doing at home.

    I do know that they took her off the Lantus and then started her again on Monday 10/14. Before that, they were doing the short acting.

    We just were able to find strips at the store so I'm going to do that right now and see if I can get some urine to test.
     
  10. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Call the vet and get any blood test results/doses they have. It might help us paint a picture of how she was doing on R with what doses while there. How long was she off of Lantus? I am trying to understand where the Lantus depot is. If she just started back Monday, the depot is still building.

    How is her appetite now? Is she eating on her own at all? Did the vet say anything about an upper respiratory infection? How is she now in regards to that? Anything mentioned about needing antibiotics? Any infection or inflammation needs to be dealt with. Did she come home with any medications? Wondering if she needs anti nausea meds too.
     
  11. Jaysonguy

    Jaysonguy Member

    Joined:
    Feb 16, 2017
    Calling the hospital, got it.
    Yes, she started back Sunday evening into Monday.
    She has zero want to eat, she's very weak but if I syringe some food into her mouth she'll swallow it.
    No upper respiratory infection
    She was on IV antibiotics in the hospital but didn't send anything home.
    She came home with mirataz and cerenia
    We're also doing CBD for inflammation and anxiety.
     
  12. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Any luck on a ketones test yet? Glad to see she's coming down some just on the Lantus. Be interesting to see what her dosing was that got her down to the 200's on the 14th.

    Out of curiosity, and in case we need you to try R, what time zone are you in and what time is shot time?
     
  13. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    There was an infection...Here are the labs from the ER
    upload_2020-9-16_19-46-30.png
    upload_2020-9-16_19-48-15.png
    upload_2020-9-16_20-8-34.png upload_2020-9-16_19-49-49.png
    9/11
    upload_2020-9-16_19-51-6.png
    9/12
    upload_2020-9-16_19-52-29.png
     

    Attached Files:

    Last edited: Sep 16, 2020 at 8:08 PM
  14. Jaysonguy

    Jaysonguy Member

    Joined:
    Feb 16, 2017
    No, she hasn't urinated yet.

    From Monday night to this morning she's been peeing a lot but she's stopped.

    I called the doctor and she said do 30ml SubQ fluids but at the same time she's only got a murmur that's a little above a 1 so I was thinking to do more.

    She's incredibly weak and I think part of it is that we have to continuously bother her to care for her. She seems almost too weak to eat.

    It's like she's in shock trying to get over the car ride. When she first came out of the hospital she was zoned out but able to stand and clean herself. After the ride home, she's just laying on her side not reacting to anything.

    We're going to syringe some food if she doesn't eat right now, I'll test before and then shoot when done. I planned on doing fluids at 11, in two hours.
     
  15. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    @Wendy&Neko Shot time is 9:30 Eastern time so about 15 minutes
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Cape has been coming down all day, be interesting to see what PMPS is.
     
    Chris & China (GA) likes this.
  17. Jaysonguy

    Jaysonguy Member

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    Feb 16, 2017
    She's 347 after getting a non-diabetic friendly dose of cerenia and now she's lapping at some gravy food, this is the first time she's eating anything since she got home.

    I don't know if I syringe her slide and serve tonight or if I shoot her 1 unit, she falls more and hopefully gets hungry overnight.
     
  18. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    The cerenia has been compounded into chicken and marshmallow flavor and he thinks there's sugar in the liquid.

    @Wendy&Neko He's in the bedroom with Cape on litterbox watch. What do you think he should shoot tonight? 2? 1? something in between?
     
  19. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Please keep the spreadsheet up to date - it's the first thing I look at. I don't think she's sliding any more, this is up from +8. If you can monitor, I'd go for 2 units.
     
    Sue and Luci likes this.
  20. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    He said she's starting to spit food out when he tries to syringe feed so he was concerned about doing 2U again so he shot 1.5

    He has 3 other cats to test and shoot so asked me to report back.
     

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