Cat recovering from DKA

New member here, and also new to having a cat with diabetes. It all started Jan 8th with a sick visit to the vet. My cat had mucus coming out of his nose and sneezing. He looked dehydrated, down, and was eating and drinking less. I was told he had a cat cold, was given antibiotics and sent on my way. Monday vet called and said bloodwork was good but his glucose was 460 so he was probably diabetic. Gave me a follow up appointment. Well Tuesday night my cat would take 3 steps and lay down and he looked even more dehydrated so I took him to ER. He was limp, eyes closed, not breathing well. They admitted him and said he was in Diabetic Ketoacidosis. Had no idea what that even meant. He spent 5 days in ER, was told second day he just wasn’t going to make it his kidney levels went from 4 to 6.9 so I made the decision to put him down. That night his blood work improved slightly so I gave him another another day, which he kept improving from there. 5,000 dollars later and a lot of emotional stress he was discharged home where I’m injecting fluids, giving meds and insulin. His numbers have gone really high and then yesterday below 50, I’m panicking. I called my regular vet he said give him a meal. Helped but then back down so I gave him more food. He is on a lifestyle libre for now and that should last about another week.
I want to do what is best for him and any info or guidance I can get is appreciated.
What food is good?
What is a good meter for home testing?
Tips on what to do or not to do when levels are too high or too low?

 

Bump

 

Took a look at the spread sheet. I don’t understand it fully gives me an idea on what I need to learn to keep track. Thanks for the tips on food and going to be getting a meter soon. The one I have now it was attached to him and I can scan with phone but it’s only good for about 8 more days

 

Hi Liza and welcome
So glad you made it over from the Facebook page
I’ll just read through your post and then be right back!

 

How is Sandy today?
Just confirming he is on Glargine 1 unit twice a day...that’s what you said on the fb page.

What food are you feeding him at the moment and how is his appetite?
Are you doing subQfluids at the moment?
When a cat has had DKA and recovering at home there are some important things you need to be doing to stop ketones from coming back.
The recipe for DKA is not enough insulin, not enough food and an infection or an inflammation in the body. So we have to make sure that he is getting enough insulin, getting enough food and the infection or inflammation is being treated.
The plan is:

• Sandy will need 1 1/2 times as many calories as he normally eats at the moment. This is because food helps the ketones from reforming. He will need his meals before his insulin shot and then he will need snacks through out the day and evening/night. I would offer a snack every 2 hours except for the two hours before the reshot blood glucose test. This is because we don’t want the preshot number to be food influenced.
• Don’t skip insulin doses. Always test before every insulin dose to see it is safe to give the shot. If the BG (blood glucose) is under 200, stall, don’t feed and test again in 20 minutes to see if it is rising. And post and ask for help.
• Test the urine for ketones at least once a day, more often if any ketones appear. Did you manage to get the bottle of Ketostix I mentioned on fb and test for ketones yet?
• Give extra fluids in the food if he will accept it. If he is having sub Q fluids he will not need as much oral fluids.
• If he is nauseated and doesn’t want to eat, make sure you have some anti nausea medication such as cerenia or ondansetron at home.

If you could set up a spreadsheet and enter any data you have, that would be very helpful and then we can help you with the dose of insulin.
Here is a link to how to set up the SS and the signature which will appear at the bottom of all your posts and will tell us about Sandy.
If you have any trouble with setting up the SS I will ask @Bandit's Mom to help you.
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

You can buy a ReliOn Prime or Premier meter from Walmart for a very reasonable price and the test strips are not expensive. You will also need to get the test strips and some cotton balls to put behind the ear to support it while you test.

At the moment it is really important that Sandy eats. The best food is low carb food canned food ....Link below... that is 10% or less carbs. But at the moment what ever he will eat is OK as he must eat. You will also need to have some higher carb food as well for if he drops low.
So buy some around 15% (medium carb) and some around 22% (high carb) to have for when he drops low. Look for the carbs amounts column.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

If you are not sure of anything please ask questions. I know this is all very new for you and mush be overwhelming. But I am so glad Sandy is improving after being so ill.
Bron

 

If Sandy dropped below 50 you will need to reduce the dose of insulin.
Can you confirm he has been having 1 unit of glargine (Lantus) please so that we can give you the new dose.
Do you have syringes that have 1/2 unit markings in them? If not, you will need to go out and buy them. You should be able to get them at Walmart or pharmacies.
Ask for the U-100 3/10 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings on them. Thee are several brands to choose from.

After dropping below 50, Sandy is then going up into high numbers as he is bouncing from the low number. This is a normal response so don’t be alarmed. By feeding regularly during the cycles that will help Sandy from dropping so low. But we also need to adjust the dose.
We don’t want him dropping below 50 because that is too low.

 

Hi Liza,

The guide for creating a spreadsheet was revised recently but the link in the "How you can help us to help you" document hasn't been updated yet. Here's the link you'll need:

How to Create a Spreadsheet

(@Bron and Sheba (GA) - I've put in a request to Marje asking her to update the link in the new member guide.)


Mogs
.

 

Thanks Mogs!

 

Hi, thank you for the info,
After days in end not sleeping I crashed last night. Still woke up with alarms for Sandy’s readings and food/insulin times. He has his own room so he can recover and I’m right there with him.

He is in fact at 1 Unit of glargine. He is also on
-Clavacillin 62.5mg every 12 hrs
-Cerenia 16 mg 1/2 tab every 24 hrs
-100 mLs Subcutaneous fluids
I’m feeding fancy feast poultry & beef 2x’s a day
When his glucose dropped I gave him another meal.
His numbers are all over the place, started really high, 2 days ago actually good for most of the day, now he’s all over the place again with 2 really low drops under 50.

Follow up today with vet, more blood work to check his kidney values, and I asked that he check his pancreas as well. Will hopefully get results back tomorrow.
Dropped insulin to 1/2 Unit
As far as Sandy’s mood...he is ok, sweet, purring, gaining weight back, big appetite sometimes and other times only eating a little. Peeing a lot at 1 time, averaging 2-3 pees a day, and has had 2 poops since Monday.
Will see if I can figure out the chart...this is all new to me so bare with me, and thanks for your help in advance.

 

Hi Liza,
Good to hear from you.
Are you feeding Sandy several snacks doing the day and evening. It is really important he is eating 1 1/2 times as many calories as he would normally eat.

Are you testing the urine for ketones every day? This is really important as we need to know that ketones are not coming back.

If you were giving 1 unit of Glargine before he dropped under 50, you need to change the dose to 0.75 units, not 1/2 unit (0.5unit).

If you are having trouble setting up the spreadsheet I will ask @Bandit's Mom to help you. If you can then put in the data you have collected so far that will be helpful.

 

Hi Bron,
I haven’t been feeding him any snacks other than when his BG is down I give him an extra meal. But I’m going to take your advice because he is not eating enough calories in the two meal a day that the vet told me to do.

I have not done testing for ketones as I had no idea how to collect his urine, but I just looked up some videos and showing I have to get a special litter for it. Could you let me know what you think is the easiest way? They did do a pee test yesterday at the checkup but they didn’t let me know what they were testing for, I’m going to call today and find out results and if they tested for ketones.

Regarding the unit of insulin, last night I gave the .5 when I gave him his 2nd meal at 8:30pm. I tested his BG before he ate and it was too high to read. At midnight down to 288, 6:30am 154. His next meal is at 8:30 I will test before to see where he is at.
I’m having a little bit of a hard time figuring out the spreadsheet, I see it on the google app, but can’t find it when I go into my drive, but I’m not very good at this stuff so I think just have to figure out how to add in on here once I complete it.
But do you still think I should go with the .75 with the numbers he showed from his last dose? Or should I stick to the .5?
Also I’m feeding him fancy feast classic pate which is what I saw a lot of people use with their diabetic cats.
Do you think this is a good choice?
Any suggestions for snacks throughout the day?
My goal is to get him into remission, I know it will take some time, but trying to figure out what is the best diet for that to happen. I’m not going to concentrate on that right now because the short term goal is to get him to eat.

 

Hi again,
Just realized you added a link regarding food earlier, thank you I will check it out!

 

Hi Liza,
Regarding the collecting the urine to test for ketones which is really important at this stage.....you can try putting a little plastic container or a large spoon under his butt as he pees. Or you could put the test strip directly under his butt and catch the stream of urine.
You need to read the test strip exactly 15 seconds after you dip it into the urine against the colours on the side of the bottle. The colour will keep changing after the 15 seconds and will then not be accurate.
Yes that would be a good idea to ask the vet if the test they did was a ketone test.
The strips you need to buy are Ketostix from a pharmacy or Walmart.

Regarding the food......the snacks you feed should be the low carb food you are feeding for the main meals. Fancy feast pates are fine.
Feed him well before the insulin dose then I would give a small snack every two hours except for the two hours before the preshot as we don’t want the BGs to be food influenced. Also feed him the snacks after the pm dose as well. These Snacks are really important as he needs all that extra food I mentioned. Food is like a medicine in cats recovering from DKA.

Regarding the spreadsheet. I am going to ask @Bandit's Mom if she can help you set it up. She is very good at doing it.

Regarding the insulin...it is very hard to give dosing advice without a SS to see the data, so I think it would be a good idea to stick with the 0.5 units at the moment, especially if he is dropping to 154. He is having big drops in BG which can trigger bounces back up high again so give those snacks I mentioned and the food should hopefully help slow down the big drops.
Try hard to get the ketones tests please as that will help tell us if the insulin dose is enough. We don’t want to see even a trace of ketones in the urine if we can help it. It is the insulin and the food that will stop the ketones from reforming.

Your first goal should be to get him recovered from the DKA. Your second goal should be regulation and your third goal can be remission . It is good to have goals.
Keep asking questions and posting each day and letting us know how he is and what the BGs are doing. Once the SS is up and running please keep it updated as we check it. Thanks

 

This is a handy resource:

Tips for collecting urine samples


Mogs
.

 

Thank you so much!

 

Ok and thank you for this. I feel very lost and confused most of the time so all this really helps. I did get the strips you mentioned from what you had said on fb page. Brought them home and was thinking how in the heck am I supposed to collect his pee? ☹️
I will definitely be giving him snacks every couple of hours. I’ll keep the insulin at .5 for now and see how it goes.
And now that you mention the insulin after eating. So the vet told me to give it to him as he’s eating. Understand this a little more now. I’m thinking his drop might have been so to him just not eating much when I give him the shot. Like I said sometimes he eats a lot and then not so much at the feeding times I’m giving the shot.
How long after he eats do you think I should give him the insulin? Also what if his BG is 150 or under when it’s time for the shot? Should I still give it or should I skip until next dose?

 

• 
  
• 
  
• when you get a chance ,It would be helpful if you can set up your signature so we don't have to ask you the same questions over again. Members will look at this first . Members would have to look up your previous posts to see what insulin you are using
• It appears after each post in gray, look at mine,

• On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
• • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add any other text, such as
  • Caregiver & kitty's name (optional)
  • DX: Date
  • Name of Insulin
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.


tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people
You can also add where you live in your profile, not your signature

This is at the bottom of every ones post in grey

 

Ok thank you for explaining it. I’m really having a hard time with figuring it out. I really don’t fully understand the spread sheet and what’s on there means.
I’ve got it downloaded to my google app, not even sure how I did it so now I just have to figure out how to insert the numbers and get it on here

 

Another helpful resource:

How to use the spreadsheet


Mogs
.

 

Hi Liza,

I am not experienced as the other members here but I will do my best to help you out.

The first thing I want to say is just breathe!!! I know it's a lot easier said than done especially considering the scary circumstances that you went through, but I have to say that a lot of the comfort of knowledge about how to do things certainly comes with experience. If one thing doesn't work, try something different! I also had a lot of trouble thinking of how to collect my fur baby's pee, but I know with her schedule she always goes after her nightly feeding at around 11pm and made sure to catch her pee then. I guess she had to go so bad she didn't mind me lifting the lid and sticking the strip right underneath.

I also use Glargine for my kitty and I shoot her after she eats, 1) because she gets cranky if I try to inject her before food and 2) if there's ever a problem with her not eating I don't panic after. Sometimes she just gets picky and likes to eat throughout the day. This is just a personal preference.

For people newer to insulin and don't have quite an idea of how insulin affects their cat at certain doses, as mentioned earlier the rule of thumb is to not shoot below 200. If the number is before 200, you "stall", ie you don't give food and retest within an hour to see if the numbers come up by themselves. If they don't, you have options from there. Post and ask. It really is a balancing game because too high a BG and you risk keytones, too low and you risk a hypo episode. Unfortunately this is just part of the process for many people until you find out what works best for your cat. That's why it's so important to keep the spreadsheet up to date so members can have an idea of how to help you better, more datapoints allow for more knowledge about how to move forward when stuff like this does happen. You will see it time and time again on this forum, that every kitty is different.

As for meters I personally use Alphatrak 2. It's stupidly expensive, but I find it helpful to have on hand if her BG goes too high or too low. There have been MANY members here with success with regular human meters. If you have the mental capacity to read up on human meters and pick one you like, do that. If not, stick to what you have currently. Throughout this entire process, it's important to be kind to yourself.

I know this is all very new and very overwhelming.... Try to take it step by step. There is a LOT of knowledge to learn and get used to throughout this process, it doesn't happen overnight.

 

Hi Liza
What type is meter did you get? I mentioned the ReliOn meter which is a human meter and is very suitable for cats.
Some people are using the alphatrak pet meter which is a lot more expensive to run. We do not recommend you use that as our dosing methods are based on the human meter. We can’t give you exact equivalent numbers on the alphatrak meter as none have been properly documented so I would encourage you to get the ReliOn meter.

 

Thank you for this. I had a shutdown today. I couldn’t even freak out I have been so tired from not sleeping that I had no energy left.
He is currently on lifestyle libre and it was great to just scan the sensor. Well 2 days early it’s telling me that I need to change it, it was supposed to be a 14 day. So being new to all of this it caught me off guard, I just got sad as I haven’t learned to prick ears when it happened and I was just hoping he’d be ok. 1 hour later my mom calls me, she is 74, tells me she has covid. Another hit. But I bounced back quick because that’s what I do under pressure so I went to get a meter at cvs and some supplies for my mom since she is going to be under quarantine. On top now I have to get tested for covid because I just saw her last week, I feel good so I hope I am good.
My poor boy Sandy is bearing with me I swear he just looks at me and is thinking “mom can you just stop with the meds and the poking me” . He is on fluids at home, 3 more days, and the dang needle is 18gage and so long. I struggle with him and he sounds like he’s growling at me.
He threw up today for the first time since he’s been home and I’m worried hoping it’s nothing serious. good news is I got a meter, one that I grabbed quick at CVS because I’m looking to get the Relion one but they were out at the Walmart that’s close to me. I successfully got blood from the ear but it took 3 tries and he was pretty mad at me.
I have yet to figure out the spread sheet and borrowing a laptop tomorrow because I just can’t figure it out on my phone.

 

I went to Walmart but they were out of the Relion one and told me they would have more soon. I had to opt out for a cvs brand one. But successfully got blood from ear after 3 tries.
Wanted to let you know I successfully tested his irons and no signs of ketones. Held it right under him as he peed just like you suggested.
I had a tough day today, the lifestyle libre stopped working 2 days early and the app said I needed a new sensor. My 74 yr old mother found out she has covid so now it’s another worry for me. I just saw her last week but I’m always careful with everyone including her so I wear my mask and sanitize so I’m hoping I don’t have it. I feel good, no symptoms, but regardless getting tested Monday.
Sandy is getting pretty mad with the pokes, he knows what’s coming and he gets anxious and irritated. So I’m sad. But he’s only got 3 more days of the fluids.
I wanted to ask how many times should I prick his ear to test BG? And before meals? And after meals? Some hours after meals? I hope it’s not too much because it’s making anxious myself.
Last I’m borrowing a laptop tomorrow to try and figure out the spreadsheet. I can’t for the life of me figure it out on my phone.

 

Sorry meant to say tested urine not irons, spellcheck mistake

 

I'm so sorry to hear that Liza, I will keep you and your mom in my thoughts. Hope you and your mom will pull through ok.

Don't be discouraged! It takes a while for cats to become used to their new regimen, they're probably thinking "why is my human poking me so much?" My furbaby took a while to get used to it, and used to throw tantrums all the time. It was especially awful when we were giving her meds after a suspected liver infection. She HATED the big blue pill. She would throw things off shelves in protest, and even a couple of months after her diagnosis refused to eat much for two days because she was so upset... But after we laid out 6 different cans of food on 6 different plates for her I think she got the hint that we're only doing this because we care about her. Sandy will get used to it in time. Even our furbaby didn't take to pricking her ears well, there was one time where no matter what we did we could NOT draw anything after 10+ attempts. She was very cranky after that. Now I can poke her while she lies down after her foody time and she barely flinches, and giving her the insulin shot just gets us a soft huff instead of hissing. At one point she learned to go for the face....

In any case, keep an eye on your Sandy. Fingers crossed everyone pulls through from this mess and you can look back on this time and not feel so anxious.

And don't forget to get your spreadsheet situated when you have the time and the energy!

Wishing you all the best.

 

Hi Liza. I’m so sorry your Mom has covid. I send my best wishes to her.
Great you got a human meter. You need to test before every insulin dose to see it is save to give the insulin. If you are unsure if it is safe to give, stall, don’t feed and test again in 20 minutes to see if the BG has risen. Post and ask for help.

You also need to test during the cycle, especially the first half to see how low the insulin is taking the BG. Are you giving a treat each time you test?

I’m going to ask @Bandit's Mom if she will help you with the spreadsheet. She will contact you and please send her a private message.

Great there are no ketones! Keep testing each day please... really important!

How is his appetite. Is he eating plenty?

 

Bron, I'm really really sorry. This is the 4th time you have tagged me in this condo and I'm not sure how I've missed it. I have just sent Liza a PM for the details I need to set-up the spreadsheet.
A thousand apologies!

 

@Bandit's Mom sometimes the tags don’t work.

 

Hi Bron, I called and asked vet for another lifestyle libre, he called it in to my pharmacy and I picked up and successfully put it on Sandy. So I’m back to scanning, hopefully for another 14 days this time. He was in high numbers again today, 250 to 500, and thats as high as the libre goes. I drew blood from the ear and he is at 538 on the human meter now at 12am. His meal and insulin were at 9:30pm. Still has his appetite and I’ve been feeding small meals every two to 3 hours so he gets calories. He did throw up yesterday but today he was fine. I tested the urine again tonight and no ketones.
Thank you for your support and bearing with me, both Sandy and I are a work in progress.
I received the message with the spread sheet. I never do anything on computers like copy and transfer stuff so even that’s just all new to me. But I know I’ll figure it out

 

Hi Liza, I can see your SS! Great!
I’m very pleased to hear he is eating for you and you are giving snacks every few hours
And fantastic there were no ketones in the urine. Keep testing every day please and if you could put the result into the SS in the remarks column that would be very helpful...thanks!
Are you able to put some of the BG data in the SS so we can see please.?

Can you tell me how much insulin you are giving him at the moment please.

How is your Mom doing?

 

Bron I have set up the SS and Signature, but I don't know which insulin Sandy is on. Is it Lantus?

 

Thanks for setting the SS up!
Yes Sandy is on Lantus.

 

Thanks, Bron. SS and Signature updated!

 

Hi Bron, Bandit’s mom helped me!

Bandit’s mom helped me!
My mother is ok, she ran a fever last night but that’s her only symptom so far.
I’m giving Sandy .5 of glargine. I’m not sure what’s going on no because his numbers are really high again since yesterday. He threw up Saturday and then again today after his breakfast this am. He was taking anti nausea medicine but he finished it on Friday, not sure if that’s why he’s throwing up now. The laps in numbers in the SS is because I had to get another lifestyle libre because the other one stopped working so I didn’t get any numbers during that time. Back to scanning now. But am worried about him throwing up and I gave him the insulin. Gave him a few pieces of cooked chicken and he held it down but it was small amount

 

Hi Liza,
I think Sandy needs more cerenia or you could also ask for ondansetron which is another antinausea medication which works on a different pathway and can be given at the same time as cerenia.
You really need him to be eating well at the moment so make sure you get the cerenia today.
I don’t like seeing those black BGs. Have you been giving 0.5 units every 12 hours? Nothing is entered into the SS..
Have you been taking the BG before every shot? It is very important that you do to ensure it is safe to give the insulin.
You enter the preshot numbers under the AMPS and PMPS column.
Then next to that column is the units column (U) where you put the number of units of insulin you give.

How does he seem? Is he alert and interested in the food?

 

Hi Bron,
I got more cerenia yesterday so he is back in that. I’m going back and for the from the lifestyle app to put in the numbers and I missed putting those in, but have gone back and did it. Now that I cae the SS here it will be easier to update it daily instead of trying to put in days worth of numbers. I have been giving Sandy .5 Glargine every 12 hours. Last night his numbers started dropping and just this am it’s 101, so I’m not sure what to do but I’m worried if I give insulin his number will drop really low so I’m holding off. Should I skip this dose completely?
And Sandy is alert, even being playful with those high numbers so I’ve just been watching him closely. Urine is still negative for ketones, got the hang of testing that now thank goodness

 

Hi Liza,
Can you add the 101 to your spreadsheet?
I would test him again to see if his BG has gone up. Has Sandy eaten yet? If so, is he keeping his food down? It is not recommended to skip a dose of insulin for a cat who recently had DKA. Lets see what others have to say, but maybe depending upon his numbers, you could give him at least half a dose. Do you have high carb food or syrup to help steer his numbers, for just in case?

 

Hi Dyana,
Just added it and I just took it again (1hour has passed) and it’s 106. Sandy did eat, he’s not having a lot in a sitting when it’s time for his shot, so I’ve been giving him food about every 3 hours when he’s awake just to get calories into him. He is holding his food down now, although I think it’s because he’s back in cerenia. I do not have high carb food as I thought this was not good, but this is all new to me. I did get some syrup to have on hand in case his numbers drop again. When they dropped before (2 times) he was able to have a meal and his numbers went up.

 

Hi Liza,
Sorry I wasn’t online to answer your question. I’m glad Dyana could help. I live in Australia so my hours are quite different to yours.
What did you end up doing? there are no units written in the SS for the last two cycles?

As Dyana said it is not good to skip insulin after DKA. If this happens again change your subject line and ask for help.

I’m glad he is responding to the cerenia.

Yes you need some higher carb foods for if he drops lower. The FF gravy lovers are high carb and you can look on the link I will post for more options.

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

After hearing it’s not good to skip a dose and looking it up I decide to give him 1/2 dose, so .25, his number went up to 187 then started dropping and all day so far it has pretty much been in normal range. He’s only eating small amounts every 2-3 hours. But has kept food down. One thing I noticed is that when he eats bigger meals is when he tends to throw up. His BG right now is 75, I gave him a snack I’ll watch how his number goes next couple of hours. One thing I’m worried about is his super high numbers couple days in a row, then normal numbers like today. I’ve been writing a lot down but think I’m going to start putting down the flavor of food he is eating. I got the variety fancy feast classic pate and not sure if this is why his numbers are changing so much depending on the flavor he eats.

 

Test him again in an hour after the last test to see he’s not dropping down further. I’m glad you gave him a snack.
I’ll write more but wanted to tell you this first..I’ll be back soon.

 

Well done giving the 1/2 dose.
Did you give the 0.25 units for the am or the pm dose or both.
At the moment your SS is saying you gave the 0.25 units at the am dose.
Is that just an error?

Don’t be concerned about the high black numbers. Sandy was bouncing from the lower blue numbers he had the days before that. bou ding is quite normal especially in newly diagnosed cats. Bouncing happens when the cat drops too low, too fast or drops in lower numbers that he is not used to having any more...these numbers can be blue or yellow numbers if he is used to being in higher than that numbers. When all that happens, his body thinks it has to save itself and it dumps stored glucose and regulatory hormones into his system which shoots up the BGs.
Bouncing can last for up to 6 cycles and there is nothing you can do about it. Just wait it out.
When they come off the bounce, they will come back down to more normal numbers that they were having before the bounce. Sometimes when they are coming off the bounce they can drop quite quickly down to lower blue or green numbers.

If you get a green number like you did this morning 86 at +5, always test again in an hour to see the number is not dropping further.
And always give a snack.

 

Ok I will and thank you for all your help

 

Ok thank you for explaining that, I’m just so confused I get so happy when he gets into normal numbers and then he shoots back up. I still have days prior to put in just hard going back and forth from the app to the chart but I wanted to show what’s been going on past few days. The .25 was his morning dose. It was delayed because I didn’t know what to do. So now I’ll give him the next dose 12 hours from then. If his numbers are still low do you think I should do the .25 again?

 

Ok I understand now about the dose and when.
So you need to adjust the SS to show that. At the moment it looks like you gave the am dose on time and then skipped the pm dose.

So this is what you need to do:
What was the BG when you tested at AMPS? 101?
What was the BG and the time when you tested and decided to give the 0.25 units of insulin?135?
In the AMPS column you need to stack all that information because the new AMPS time is when you gave the dose of 0.25.
So it will look something like this......101@+12; 135@+? (This is your new AMPS)
Then the BGs you did afterwards are from that time, not the original AMPS.
So if all those BGs you have taken since you gave the insulin today are before the pm dose, they need to go into the am cycle.
In the appropriate spot.
Does that make sense?

I’m going to ask @Bandit's Mom to contact you to have a look and help you if needed, she will be online a bit later. Bit in the meantime if you could RY and fix it, that would be great.

 

Ok yeah I messed up then, I think I get it now. Will fix my numbers. And sorry thanks for bearing with me. I have my numbers flipped between am and pm

 

You didn’t mess it up....it’s just a matter of knowing how it works when the shot is delayed.

 

Hey Liza
I just saw on the Facebook page that you said Sandy had dropped down under 50 a couple of times.
Is that correct? I can’t see that on his SS.
If he dropped under 50 he needs to have the dose reduced.
Can you can confirm please?

 

Yes he dropped low couple of times, I just have to put the test of the previous days in. But I wrote it all down from the lifestyle app now so I have to redo it now, on the app it goes from bottom to top if that makes any sense and this is the reason I was having a hard time figuring out how to transfer it over. Once I’m done hopefully it will make sense

 

Ok I can see lots more tests have been put into the SS, thank you.
Try and keep it updated is you can, especially with any low numbers, as we look at the SS before we help you.
I can see you dropped from 1 unit to 0.5 units when Sandy dropped to 48 a week ago so no need to reduce again. normally we reduce by 0.25 units not 0.5 units but leave it at 0.5 units now as he has been on it for a week and doing well.
I see he is bouncing a bit today from the lovely green numbers yesterday.
Thank you for putting the ketone results into the SS. ...that very helpful and it’s great they are negative!
You are doing a really good job helping him recover from the DKA.
Is he still eating well?

 

Ok figured it out I had all my numbers backwards between am and pm. Also though the +#’s were times, not hours from when shot given. The lifestyle libre only goes up to 500, I did test with meter couple of those times and numbers were about 540sh. Left it in the chart as 500 since that’s what the libre said. I have about 10 days left for the libre so I have to get better at getting blood from ear,

Thank you Bron, I’m really trying. He ate about 3 very small meals today, he looks good has gained weight back but I’m sure the fluids I was injecting helped. Last night was the last day so hoping he starts eating better and drinking more on his own. Now that I have the numbers in and understand the SS sheet I’ll make sure to keep up with it. And yes yesterday his numbers were so good, today higher but better than the really high yet numbers the other day. Hopefully his body starts adjusting well and he gets good numbers more consistently

 

Can you get him to eat more than 3 small meals a day? That isn’t really enough for a cat recovering from DKA.
Do you think he could still be nauseated and that is why he is not eating a lot?
Are you still giving him any cerenia or ondansetron for nausea?

 

He ended up eating 5 meals by the time the day was over. He’s yea he’s back on cerenia. I gave him a meal at 3am because his BG dropped and ate again around 7am. Still small amount. when I gave him his night shot his B

He ended up eating 5 meals by the time the day was over. He’s yes he’s back on cerenia. I gave him a meal at 3am because his BG dropped and ate again around 7am. Still small amount.
When I gave him his night shot his BG was 2

He ended up eating 5 meals by the time the day was over. And yes he’s back on cerenia. I gave him a meal at 3am because his BG dropped and ate again around 7am. Still small amount.
When I gave him his night shot his BG was 238, gave him regular .5 dose. Seeing he dropped to 50’s do you think the .5 might be too high now? Or is there such a thing as it dropping at night? My fear is this will happen and I’ll be sleeping when it drops. I only caught it last night because I had set my alarm. Fed him and went back to sleep, when I checked again at the next wake up alarm he was 64 so I fed him. Should I leave food out for him at night just in case?

 

Hi Liza
Have you decided to do right regulation , TR, or Start LowGo Slow, SLGS method?
If you do TR you won’t reduce the dose unless Sandy drops under 50. I think TR is much better for post DKA. As long as you are not feeding dry food, you can do TR. and you are testing enough for that.

Cats often drop lower at night and it’s a good idea to get up and test. He dropped at +3 last night to 59 so it was the correct thing to do to feed him. And you tested again to see he hadn’t dropped lower so that is good.
I see you dropped down to 0.25 units at AMPS. If you are doing TR you need to stay at 0.5 units.
Leaving food out at night is a very good idea but testing is also very important.

I think it would be a good idea for you to start posting in the Lantus page where there are more people to help you as I live in Australia and an not always online when you need help.
On the Lantus page you post daily and link your previous post so we can look back at your threads.
To post you put the date, name of cat and AMPS. So 1/30 Sandy AMPS xxx
Link to Lantus page
https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

link to dosing methods
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

 

Hi Bron, he went lower than 59 but I hadn’t scanned during the lower drop I noticed it in the daily graph that the libre app provides. I fed him this morning but he didn’t eat much so I was afraid of giving the .5 because I didn’t know how he was going to eat after shot so I did 1/2 dose .25.
His numbers have been really good today, he’s had a few small meals and has stayed low. Do you think I should continue with the .25? Instead of the .5?
And I’ll definitely try and post on there if I can figure it out, this page is kind of confusing to me to navigate.
I have lost faith in the vet I have. I was supposed to hear back from him today and nothing. And the only info I got from him was if Sandy is under 90 to skip the dose completely. And that’s not what everyone else it telling me.
I appreciate you helping me, with your advice and others on here and help from the Facebook page Sandy is doing better and his numbers are improving slowly but surely.

 

Do you know how low he went when he dropped lower than 59?
If it was under 50 you would reduce the dose to 0.25 which you did this morning

Have you decided if you will follow TR or the SLGS method yet?

You need to be aware that a lot of people who post onthe Facebook page do not have experience with DKA and with the best of intentions may not always give the best advice, so before following that advice, please check over here with us to see if it is OK.

 

I can only see the graph and see it went under 50. I don’t know what the TR or SLGS method is really.
And yes I’m honestly just following advise on this forum. the FB page is good to see what people are doing that works for them, but following your advice on here has improved Sandy’s numbers so I’m more comfortable filling the advice from people on this forum if I need to make changes. I took a picture of the graph from the app but it’s not letting me upload on here.

 

Ok. Stick to the 0.25 units then.
Looks like he bounced a bit from the green numbers yesterday but is coming down again so keep testing as he may drop lower.
Keep feeding often
Here is the link to the two dosing methods.
Click on this linkhttps://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Don’t forget to start posting on the Lantus page I gave you

 

He dropped again. I tested him

 

Liza, did you feed him some high carb food and test again?
Have you tested for ketones today?
Is he eating well today?

 

I did check for ketones, that is negative.
He just got done eating regular food that is higher in carbs but still he only ate a little not even an ounce.

 

Really good no ketones
Do you think he is eatong as much as he has been this last week?
I am wondering if he dropped lower because he's no eating enough?

Do you have any highercarb food if you need it? And some Karo or honey?
Can you test again now to see if he's rising and not dropping further please?

 

I tested again when he started to eat and he was at 83 down from the hundred. I just tested again and he is at 90 so going back up.
The only difference in eating is that last week I gave him variety of food I picked up just so he would eat, this past week he’s been eating the fancy feast pate mostly and some chicken treats. But he’s been in that for at least 1 week now and his numbers were really high a few days ago, and now for past 3 days way lower and more time in normal. But then he has those drops.
I do have some high carb food on hand, it’s dry food but I added water to it so he gets liquid too just because I’m not injecting fluids anymore. I also have honey and corn syrup on hand. When he drops he’s able to eat so I give him food.

 

Lisa,can you stall,don't feed and test again in20 minutesto see if he is rising.?
When did he last eat?

 

Because Sandy has so recently had DKA we don't want him to go off insulin too soon.
I have spoken to some other experienced people and we were wondering if you would be able to test religiously at +2 every cycle to catch any drops in the BG. You would also need to test after that as well but the +2 is important to catch the drops.

We would also like you to feed higher low carb food than you are feeding at the moment to try and stop the drops.
Do you have any low carb food that is around the 8% carbs?
Here is a list to look at
Click this linkhttps://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Also if you see a low number on the libre freestyle, always test it yourself to see if it is correct as it is not reliable at low numbers.

I will wait to hear back from you Liza. Thanks.

 

It’s 1am here at the moment so I’m going to go see if I can find any on the list at CVS pharmacy that’s open 24/7 and also another convenient store that’s open. I just tested him again and he is at 129 now. 45 minutes have passed since I was supposed to give insulin, how long is it ok to delay? I’ve read 2 hours. So I’m thinking wait for his number to go up some more if that’s ok? Or should I give the .25 now you think at 129?
And I just want to confirm?
Higher carb? Or lower carb?
you put higher low carb so I don’t know if typo?
I’ll be up all night and I will scan him every hour in case he drops. Seems I have bad luck when I scan every 2 to 3 hours there’s a drop that happened that I missed.

 

You need to buy some higher low carb about 8% carbs to feed instead of the lower carb food you have been feeding during the cycle. The idea is to try and keep him on 0.25 units but he will need to be given this 8% carb food to keep the BGs up a but higher.
You will need to test every +2 and then after than depending on the BGs. Wecan help you but you must do it religiously to keep Sandy safe. Can yo do that, do you think?

You also need to buy some medium carb canned food about 15% carbs for when he drops lower.
Dryfood is no good. Please don't use that.

You also need to buy some high carb food around 20-22% carbs for when he drops lower.

How far out can you be with your shooting schedule?
How long since he's eaten?
What food do you have inthe house at the moment?
I will wait for your reply

 

He just ate again, I gave him some Blue Buffalo canned
Other foods I have on hand are
Sheba white fish &tuna cuts
Rachel Ray ocean fish & flaked tuna
While hearted grain free chicken recipe pate in gravy

 

Haveyou taken another BG to see where it is?
If you can test the +2 this cycle and can monitor the BG after that I would give the 0.25 units...as long as the BG hasn't dropped again.
You can always give honey or Karo if the BG drops during the cycle
Areyou going to go out and buy some higher carb food now?

Will you please post all the BGs you get this cycle so we can see what is happening.
I will be able to be with you for a few hours. Then I will get someone else to watch you

 

BG right now is 145. And yes I’ll be up scanning to see where he is at throughout the night. And yes I’m getting ready to go out and see what they have. It’s only 10 minutes away so I won’t be gone too long.
And again thank you for walking me through this

 

Ok. Did you give the 0.25 units.?
Before you go out I would go through the list and write down some of the 8% (approximately) carb, and medium carb and high carb cans of food before you go as it can get really confusing with a huge list to choose from
There are FF medium and high carb foods to choose from. Gravy lovers are usually high carb.
And there should be some around 8% as well or maybe some in another brand.
Let me know how you go!

 

Fancy Feast Gravy Lovers beef variety is 20% carbs. The other flavours of FF Gravy Lovers are 15%.


Mogs
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Thanks Mogs.

 

I was lucky enough to find Pate Indoor Chicken & Pate Ocean Fish & Tuna which are 8% on the list.
And some FF that are on the list I believe at 15% I have to double check. man’s also found some feiaki

I lucky enough to find Pate Indoor Chicken & Pate Ocean Fish & Tuna which are 8% on the list.
And some FF that are on the list I believe at 15% I have to double check. man’s alsot found some Friskies that were about the same %
I gave the .25 he was at 165.
I’ll check at +2 and so on and probably more tonight. I’ll keep updated the SS

 

Well done!

 

Liza I can see a +1 173 and a +2 178.
So not much of a food bump. This could mean he will have an active cycle and may drop some, so keep testing.
Did you give any food at + 1 or + 2. If not I would give him a snack of the new 8%food you got tonight.

 

Hi Liza, have you read the post I wrote just before this.? It would be really helpful if you could either “like “ the post so I know you have seen it, or write something so I know you have seen it.
Have you given Sandy any food after the +2?
It is very important he has some food then to stop him dropping when the insulin onset starts.

Also just a reminder that because you gave the insulin 2 hours later, you will have to work you way back to your schedule by 1/4 hour per cycle or 1/2 hour per day.

 

Liza, have you taken any more BGs after +2?
It is really important you keep monitoring him and feeding him some snacks of the higher carb 8% food we discussed earlier.

 

I’m really sorry Bron, I went to sleep at 5am when my husband got up. I woke up with alarms still to scan and my husband made sure he ate. He was picky about the food but still ate some. He stayed steady above 200 and he is at 222 at the moment.

 

Hi Liza,
I am very glad to hear that Sandy is OK.
I know you are exhausted having been through a roller coaster with Sandy over the last 2 weeks. I do understand completely how you feel.
But I really need you to stay in touch with me if I am going to be able to help you. Just post and say I am going to sleep but will wake up and test in an hour and I've just tested him and his BG is XX and I fed him. Then I know he is OK and you have seen my latest post.
Otherwise I don't know what is happening and its very stressful for the adviser, especially when we had put a new plan in place to keep him on 0.25 units and feed some higher carb food. This is not a criticism at all, just a reminder that you need to stay in touch. I can see your reply as soon as you post it.

So he bounced a bit last night from the 47 yesterday morning but looks as if he is coming down again.
Are you still feeding the 8%carbs to him?
Have you tested for ketones today?

Liza, do you think you could write in the remarks column the food and % of carbs you are feeding him please as that would be very helpful. eg fed 2 teaspoons 8% carb at +3

 

I completely understand, I know it’s not criticism your just worried and I can’t thank you enough. Wish I had posted I was going to sleep when the sun came out, I just passed out soon as I saw my husband got up and said he’d take over. I also keep getting signed out of the page when I go to another app. I keep bouncing between here and the libre app when this is going on.
I got some Mirataz for Sandy to see if it helps increase his appetite, started it this afternoon.
do you think that is a good medicine that can help?
He didn’t have much of the Blue Buffalo that has 8%, total of maybe 2 tablespoons, I will add on comments section. When he lost interest in that I tried another flavor but he wasn’t interested. Needed him to eat so I tried the Friskies chicken and gravy bits and he’s had another 3-4 tablespoons of that, but that’s higher than 9%. Still his number is only going up a little after food then comes back down. He’s never been a picky eater so I’m wondering if his stomach is just adjusting after going through DKA. Or if there is something else going on?

I know it’s not a good idea to stop insulin because of the recent DKA, but with these lower numbers do you think his body might be doing what’s correct on it’s own? Or should I drop the dose even more?
I’m just really afraid he’s going to drop under 50 again and I’m going to miss it in a matter of couple of hours like last time.
thankfully I’ve got the libre and can scan often but when I change to pricking ears I don’t want to be pricking his ear 10-12 times a day or more.

 

I have posted on your other post on the Lantus page. I’m glad you have started a post there.
We can continue talking over there as two posts going is confusing.

re the Mirataz. That is an appetite stimulant and is fine to give. But you must make sure Sandy is not nauseated first before giving it.
Is he still having cerenia? If he has been eating well with the cerenia and you are no longer giving it, he could still be nauseated. DKA kitties can take some time to get rid of the nausea so don’t be alarmed. Just continue the cerenia. It is very common for post DKA kitties to be nauseated.

If he won’t eat the 8% food then give another higher carb food. Try and stick around the 10% if you can. Most important thing is he does eat. That trumps everything.

Yes I think his body is healing itself and maybe his pancreas is starting to produce some insulin. But if we stop the insulin too soon, the ketones could come back and we certainly don’t want that.

Dont worry about having to prick the ears10 or more times a day. It won’t hurt him. Plenty of us do it.
Remember if you see a lower number, you can feed him to bring the numbers back up. If it is a number under 50 on the Libre, check it on the human meter first to see it is correct then give some honey to bring the number up.

Always post and ask for help if you are unsure. We don’t mind how many questions you ask
And change the subject line of your thread if you have a question so that we are alerted.

 

Hi Liza,

By way of general information, for some cats there can be some lingering nausea for quite some time following an episode of DKA. I see from your earlier posts that you have Cerenia for Sandy. If that's not working well enough then, as Bron recommended above, ondansetron is a good anti-nausea med.


Mogs
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@Bron and Sheba (GA) - Snap!


Mogs
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Ok and that makes sense, he is still on Cerenia, he has still thrown up a few times past couple of weeks but I notice it’s when he does eat a larger amount of food, within minutes of finishing he throws it up. I’ll wait 20-30 minutes and usually he will eat again but it will be smaller amount.
I officially hate diabetes, hate seeing him going through this and not be able to fix him ASAP ☹️

 

Smaller meals more often are better anyway.
Keep the cerenia going for now.

 

Hi Liza,

Ah, the ol' scarf 'n' barf! When that happens it's typically regurgitation rather than vomiting proper so the anti-nausea meds might not help so much with it.

Maybe try feeding Sandy a small amount of the main feed (a couple of teaspoons), wait about 5 minutes or so, then give him more. Sometimes getting that small bit of food into the tum for a few minutes helps settle it (and might take a little of the edge off the urge to scarf). Alternatively, try spreading the food out thinly on a dinner plate to slow him down a bit.

BTW, is Sandy pooping regularly?

I agree with Bron's suggestion about how smaller, more frequent feeds can help kitties with GI issues eat better and more comfortably (based on practical experience with my own cats).

If only love was medicine, Liza, then Sandy would be all better in a heartbeat.




Mogs
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He’s always been a slow eater but he’s never been picky.
Now he’s being picky with food so I’m having to try different foods/flavors. But I can tell his tummy is upset because he will pause in the middle. He’s only eating a tablespoon at a time and 2 at most.
His kidney levels were normal Jan 8th before he got sick, during his ER stay the level went up to 6.9. Checkup on Jan 22 it was 3.5. I was told normal is 2 but better if it’s 1.5.
I’m not sure what all of it means but could the throwing up be because of his kidney levels being high.
He would throw up sometimes before he got sick but it wold happen if he would overeat or with certain flavors of food so I thought might of been a good allergy at the time

 

Which kidney level is this, Liza?


Mogs
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I didn’t know there are different ones. They just told me his kidney levels got high during DKA. Because it was a cute they said his kidneys may continue to heal and get into a lower number but probably not back to normal

 

Lots of things can go completely out of whack during a DKA episode.

To answer your earlier question and by way of a general guide, yes, it is possible for elevated kidney values to cause nausea and eating issues. The three main blood serum values looked at for kidney issues are:

- Blood urea nitrogen (BUN)
- Creatinine
- Phosphorus

Tanya's Site has the following helpful page:

Nausea, vomiting and inappetence - symptoms and treatments

CKD kitties with nausea problems are also often prescribed Cerenia and/or ondansetron so whether Sandy's queasies are a hangover from the DKA or down to the kidneys still being 'under repair' the treatments are similar. My civvie, Lúnasa, is IRIS stage III and she gets ondansetron as a daily maintenance med.

Lovely pic of your boy, Eliza.


Mogs
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Ok I’m going to ask at his next checkup what level they are talking about.
When he came home from his ER stay he was on Cerenia, told give it to him 4 more days. So I finished it and sure enough he threw up the next night after not taking it. Got some more for him I have another 4 days worth.
Is that something he can be on for a little while? Because I’m going to grab some more just wondering how long he can be on it for.
And thank you I took that pic couple days ago he is looking like his old self again, he was in such terrible shape when he went through DKA. I’m amazed at how he’s recovering at least from just looking at him. I know internally it will take a little longer.

 

It's a good idea to always ask for copies of all lab test results for your own records. If you look in Sandy's spreadsheet, at the bottom you'll see a LABS tab. You can record results there. Some members here are very good at interpreting labs and you could always ask them to have a look at Sandy's results if you wish.

I don't know about the Cerenia, Liza. It's only available for cats as an injection in the UK so Saoirse only ever had the occasional dose of it. Other members should be able to tell you more.

Ondansetron can definitely be given long term. Saoirse was on it for a couple of years and Lúnasa has been on it for months and will continue to take it. If your vet were willing to prescribe ondansetron but doesn't carry it in stock, it can be obtained from human pharmacies with a written veterinary Rx.

Our furry ones are truly remarkable and very resilient little creatures. (((Sandy))) I'm glad to hear how much better Sandy's doing. DKA is really rough.


Mogs
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Ok I got his records of care and bloodwork emailed to me. I definitely can’t interpret them. Will try and figure out how to add on here
Thank you

 

You should be fine to give the cerenia to Sandy as it is only going to be a short term thing. You might like to ask your vet for some ondansetron for the nausea as well. It often works when cerenia doesn’t and it can be given at the same time as the cerenia as it works on a different pathway in the body.
I’ll tag @tiffmaxee to comment on the cerenia as well as I think she gave it to her kitty Max.

 

If you go to Sandy's spreadsheet and look at the bottom of the screen you'll see a tab with "LABS" on it. If you click on that it will open up the sheet where you can enter his test results from the email.


Mogs
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PS: It's better than uploading a file because once they're in the spreadsheet the test results will be available any time, rather than just being in the one thread. That'll make it easier for members to help you. Also, as you add successive sets of test results, you'll be able to track how Sandy's doing based on any changes in the results.


Mogs
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Cerenia can be given for as long as nausea and/or vomiting is an issue. You want to keep giving it for several days after symptoms are gone and then slowly taper off. If symptoms reappear you start again I’m going to read the rest of the condo and will be back.

 

What dose of cerenia are you giving and how much dues ge weigh? Some vets don’t give a high enough dose. It works better as a sub-q injection but it stings. Another medication to ask your vet about is ondansetron. For some cats it helps more. For now make sure he gets cerenia every 24 hours. I think I responded to you last night on Lantus but can’t remember what you posted.