911 cat numbers low

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Mimis mom, Oct 12, 2019.

  1. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
    My cat is a newly diagnosed diabetic. She’s been treated with Vetsulin for the last 5 weeks until last week, she didn’t eat much of her morning meal and nothing for dinner. I brought her into the emergency vet in the middle of the night and they confirmed that she was DKA.
    She was admitted, at first very difficult to stabilize (enough that the first two days they weren’t sure she would make it)
    The third day she made a complete turn around and was able to come home after the 6th day in ICU.
    since she’s been home she’s been acting like herself, but yesterday I decided to do a test at what I believe was her nadar and it read 39. She was acting normal though.
    I waited an hour and tested again and it was 115.
    Then right before her meal and next dose of Lantus it was 335. (Now this is on a freestyle meter not an alphatrak)
    Today I tested her right before her nighttime meal and it was 34.. I waited a minute and tested again and it was 43.
    She’s acting completely fine- grooming herself, inquisitive in what’s going on around her and seemingly very hungry for her night meal. I decided just to be safe to bring her to the ER vet again just to be sure and to also test their meter against mine. Theirs read 74 and mine read 34...
    They fed her some food that I brought and it went up to 91.
    No Lantus tonight and down to one unit tomorrow from 2.

    what's going On with my cat? How is she so off and reading very low but doesn’t have any hypo symptoms!?
    Thanks everyone!
  2. Tucker

    Tucker Member

    May 22, 2018
    I'm not experienced enough to help but I'm pulling for you. I've asked Bron to come online with help, she's amazing.
    Krystina & Nelli likes this.
  3. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Feb 21, 2015
    Looking now ....brb
  4. Idjit's mom

    Idjit's mom Well-Known Member

    Apr 3, 2018
    Rosa, so very sorry to hear of kitty's troubles. Can you get the signature and spreadsheet set up soon with her information? I know that Bron will be able to advise right away, but having the info available in the near future will be very helpful to advisers.

    If you need help with the spreadsheet set up, please let us know. There are members who can assist or set it up for you.

    Best wishes for kitty's recovery.
  5. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Feb 21, 2015
    Hi amd welcome to the forum.
    I'm sorry your kitty has had DKA but you have been doing the right things.

    So just to get this correct.
    You were using Vetsulin and now you are using Lantus. Is this correct?
    And the vet has advised to go from 2 units to 1 unit?

    It is great you are testing the blood glucose levels. Well done!, this will keep your kitty safe
    If your kitty has had DKA the most important things she needs right now is FOOD and insulin and fluids.

    Is your kitty eating well at the moment?
    Are you feeding a low carb wet diet?
    At the moment the main thing is she is eating.
    It is really important that she eats frequently during the day and night as food is like a medicine for DKA kitties.
    And it is really important that she gets the insulin as well.
    The recipe for DKA is not enough insulin, not enough food and an infection or inflammation present somewhere in the body.
    Do you know if she was treated for an infection?

    If you see low numbers again under 50, give some honey or high carb food.
    Do you have some high carb food at home to feed if the numbers go low?
    Kitties can drop quite low and not show any symptoms until they are dangerously low. That's why it is so important to test the BG levels.

    Sorry for all these questions but to help you we need to know the situation.

    So at the moment what you need to be doing is
    • Give plenty of food. Feed small frequent meals. And feed before giving the insulin
    • Test before every insulin shot and inbetween the shots to see how low the insulin is taking your kitty
    • If the blood glucose is under 200, stall don't feed and post and ask for help about shooting . It is important you give the insulin but not if the BG is too low. We can help there.
    • Set up a spreadsheet and enter your data. This is extremely helpful for us to help you.
    Keep asking questions..we are very happy to help.
  6. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Feb 21, 2015
    And I meant to mention
    Are you testing for ketones in the urine!
    It is really important after DKA to monitor ketones in the urine.
    If any ketones are forming we need to catch it early before it progresses to DKA agsin.
    To do this you need to buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine specimen your kitty and dip the test strip in. Check the result against the colours on the side of the bottle exactly 15 seconds after dipping it in the urine.
    Anything above a race needs vet attention.
    The best ways to stop ketones forming is to make sure kitty eats, give the insulin and give extra fluids.
    You can put extra fluids in the food if kitty will accept it.
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Feb 28, 2012
    Are you using syringes with half unit markings to give insulin? If not, you need to get some. We make smaller changes than 1 unit, hence the need for half unit markings. In a kitty with recent DKA, you don’t want to reduce the insulin dose by too large an amount. Your cat - name? - needs less than two units but maybe more than 1.
  8. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
    Her name is Mimi and they gave me a Lantus pen...
  9. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
    Hi! How do I collect urine from her and how often should I be checking?
  10. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
  11. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
    They said feed only twice a day... I don’t know how I can feed small frequent every day because I’m at work. What about freeze dried raw? I have those as a snack, I give her in the middle of the night when she’s hungry.
  12. Sue and Luci

    Sue and Luci Well-Known Member

    Nov 3, 2017
    One thing that I've found very helpful is an automatic feeder. I don't know if you have other cats or not, but this has been a lifesaver for me. https://www.amazon.com/PetSafe-5-Me...70963270&sprefix=Pet Safe auto,aps,173&sr=8-4

    I can set it up with low carb food to dispense every two hours - it'll last for 8 hours...if you need to get some low carb dry to put in for the late part of the day you can order Young Again Zero or Dr. Elsey's. Both are very low carb dry foods, however I prefer to freeze some of the Fancy Feast wet pate's in an ice cube tray and put those in the slots for later in the day. By the time it spins, those have thawed.
    Bron and Sheba (GA) likes this.
  13. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Feb 21, 2015
    You can pop a small bowl or a large ladle(spoon) under her as she squats to get a specimen.
    You really need to be testing daily for ketones at the moment after DKA.

    It is better for Mimi if you give several smaller meals during the day and night. Feed before the shot and then maybe at +2 and +5 Both cycles.
    A timed feeder is very useful.
    Freeze dried is ok and you can also freeze the canned food and it will thaw during the day.

    you need to buy some 1/2 unit syringes and then you can use the cartridge that is in the Lantus pen and draw out the dose. Lantus pens only allow you to go up and down in 1 unit increments which is too much.
    We recommend going up and down in 1/4 unit increments.
    The syringes you need are U- 100 insulin syringes 0.3 ml, 30 or 31 gauge, 6mm or 8 mm with 1/2 unit markings..
    Walmart ReliOn brand has them for $13 a box of 100.
    Itis important you get the correct syringes. If you are unsure post and ask for more help.

    It's a lot to take in in the beginning Rosa but you have come to the best place for Mimi.
    Ask lots of questions. We are happy to help.
    How is she today?
    Sue and Luci likes this.
  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Dec 28, 2009
    Sorry about hammering you with all of our questions! Aside from offering a warm welcome, whenever a cat that has recently recovered from DKA joins the Board, we react quickly.

    Just to add to the questions, I'm guessing you may be using the Lantus pen to dispense insulin. Please ask your vet for a prescription for syringes. (Not all states require an Rx for syringes.) You will need U100, 3/10cc insulin syringes rather than the pen needles. The pen will not allow you to fine tune a dose -- it only dispenses in whole unit amounts and you will be changing doses in 0.25u amounts (which is why you want syringes that are in half unit increments). (You also can't use your Vetsulin syringes since they are U40 -- they are calibrated for an insulin with a different concentration than Lantus.) There is a great section on syringes in the Insulin Care sticky.

    Just in case your vet didn't mention it, you should not roll or shake Lantus. It is in solution versus in suspension which is different than most other insulin.

    It is critically important that you don't disregard the numbers on the meter just because your kitty looks fine and is acting normally. Numbers in the 30s require an immediate intervention with high carb food or adding a bit of syrup (corn syrup/Karo, honey, etc.) to her food. It also requires that you test every 15 - 20 min to insure that your cat isn't sitting in low numbers for overly long or numbers don't continue to drop. Numbers that low could potentially cause organ damage if they don't come up quickly. I'm linking a post on handling low numbers.

    With Lantus, the initial dose is based on your cat's weight as well as what your dose of Vetsulin was. However, with DKA, it's important to make sure Mimi is getting enough insulin to keep the ketones from recurring. With a post-DKA kitty, the information on dosing methods isn't always followed exactly as written since DKA trumps everything. Ketones develop when a cat has an infection/inflammation, isn't consuming enough calories, and there's not enough insulin on board. It can be tricky trying to keep the insulin dose high enough but not so high that numbers are dropping like what you've been seeing. They do this in the ICU by keeping your cat on a IV of dextrose and using a short acting insulin to manage the BG numbers. Often when you get your cat home, it's hard for the vet to know exactly what the dose of insulin needs to be since Mimi was being given a different insulin while in the hospital and because. you have no history with her having been prescribed Lantus. The dose was your vet's best estimate. In addition, while it takes approximately a week for the Lantus depot to stabilize, some cats have a marked response to a new insulin. This response may also contribute to what you're seeing with Mimi's numbers.

    Sorry if you're already familiar with all of this information and if I've been a bit redundant. Like Wendy, I'm wary of your cutting the dose in half. I'd be more inclined to to suggest a dose of 1.5u providing you an get syringes.

    And, of course, welcome to the Board.

    Suzanne Burton likes this.
  15. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
    Thank you so much for your reply!!!! I worked today and didn’t get a chance to get to the pharmacy, but yes I agree cutting it in half just because it’s a pen and there are no half’s seems not productive..
    I just tested her blood sugar (she’s about 2 hour away from her next dose) and it’s 240 with the one unit of Lantus.
    Do vets not know a lot about dosing a diabetes? they told me to feed her only twice a day no more than that but everyone has been saying smaller meals throughout the day: Just smaller meals for a while or forever? Maybe I can arrange something. How often is frequent small meals? Can 3 times in a day be good enough or like every couple of hours. I feed them raw and canned so I can’t get an automatic feeder- or do they make that for canned?
    I have another cat and I don’t know if it’s good for him to eat more than twice a day or is it ok for him ( or better)
    Thanks again!
  16. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
    I was also reading Lantus is a once a day dosing (at least for humans...)
  17. Idjit's mom

    Idjit's mom Well-Known Member

    Apr 3, 2018
    Hi Rosa, I'm so glad you were able to come back and read the information that others have provided. It's difficult at first to get a handle on all the things you will learn. But, be patient with yourself and keep posting and asking questions.
    The sad truth is that vets only get 5 hours of diabetes education in school and that covers all types of animals. Once they've graduated and are in practice, they don't have time to stay up to date on the latest treatments for every disease in every type of animal they see. That's why message boards like this are so valuable. Not only do the people here have the time to research for new treatments, they have the day in/day out experience in their own cats so they know what works....and what doesn't!

    Many of us feed 3 to 4 times a day. An unregulated diabetic cat isn't able to fully utilize the food they eat and that means they usually very hungry. I give Idjit 3 main meals, sometimes he gets a mid-morning snack of a few small pieces of cooked chicken meat or some thawed homecooked chicken broth, and he gets a small snack of canned food at our bedtime. I intend to keep him on this feeding schedule for the rest of his life, he is more content and doesn't do the scarf and barf routine anymore like he used to. Offering the small, more frequent meals takes the places of the dry food that he grazed on previously. Keeps him filled up and happy. Plus, recovering from DKA, your cat needs to be eating.
    Yes, the timed feeder we have (a two dish model) has a little ice pack that you put under the dishes so the food stays fresh and cool. I wouldn't recommend leaving raw food out over 1/2 hour (I feed raw & supplement too for the 3 main meals), but I have left canned food in the feeder many times. PetSafe and CatMate have different models you can research. As others mentioned, freezing the canned food in ice cube trays and leaving them out to thaw would work until/if you get timed feeders.
    Many members have switched all the kitties in the household to the low carb diet, more frequent meals with success. It won't hurt either cat.

    It sounds like you have a busy life, and dealing with this new diagnosis, DKA and learning about it is going to take more time. However, you are already doing well, Lantus is a good insulin for cats..and it is recommended to dose twice a day for cats. Their metabolism is faster than humans and they need a consistent dose every 12 hours. You are testing, and that's a great help. This is a link to the Lantus Insulin Support Group HERE. When time allows, read through the yellow tagged stickies at the top of that forum.

    As soon as you can, set up the signature and the spreadsheet. If you need help with the spreadsheet, someone can set it up for you. Let us know. Recording that insulin and testing information so that advising members can read it is going to help you very much.

    Go back through the information and questions above. No one wants to overwhelm you or confuse you, we just care very much about the sugar cats and want to help. In addition, we recognize that DKA is very serious business and we want to help ensure that your cat does not experience this again. :cat::bighug:
  18. Mimis mom

    Mimis mom Well-Known Member

    Oct 12, 2019
    Thank you guys so much for all of this amazing information.
  19. Bellasmom

    Bellasmom Well-Known Member

    Feb 12, 2018
    Looks like everyone answered your questions so I will just welcome you to L&L land, these people are wonderful and someone is around all the time

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