GA DKA feedback/guidance (Final update: RIP Mimi)

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memopad85

memopad85

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Some of you may remember me, my niece's cat, Mimi, was diagnosed with diabetes in the beginning of this month; I did start a thread in the old forum and got a lot of great advice. Due to time constraints and other things going on in my life, I had no time to make out a profile and spreadsheet for Mimi until today; I posted the links in my signature. As you can see in the spreadsheet, her numbers seem to be all over the place since we began giving her Prozinc and monitoring her BG. Its only been about 2.5 weeks, and we don't give her any insulin if her BG is less than 200. I am wondering if her erratic numbers is due to the fact that she is new to insulin? Or maybe need to adjust her insulin dosage? Any advice will be greatly appreciated.

And for those of you who remember my thread from the old forum, if you recall, she wasn't eating or drinking water in the beginning, but after a week of giving her the appetite stimulant, she began eating and drinking on her own; now she eats what we give her and is back to her normal self for the most part.
 
Hopefully someone else will chime in soon but I would suggest 2 things when looking at her profile and spreadsheet.

1) the dry food: their are only a few that are diabetic friendly and even then it is not recommended. High carb food can cause high numbers even if its only a couple pieces of kibble. Recommended diabetic friendly dry is Young Again zero carb, Stella & chewys freeze dried, EVO cat & kitten, and Epigen.

2) I would lower the dosage so you have 2 shootable numbers. That seems to be a problem right now. No dose a lot of times because she's too low then she'll shoot up, some of those numbers are probably due to bouncing as well. I would suggest maybe sticking with .5 units for a few cycles to see how that looks, even if she' really high come time for shot. Better to be too high for the moment than too low.
 
Hi there. Its been a week since I changed Mimi's dosage to 0.5 units of Prozinc and quit giving her dry food. Her BG numbers look better than before, but still goes a little high at times. If anyone can take a look at Mimi's SS and give me some feesback, I would greatly appreciate it. Thank you.
 
Cutting the dry food really helped; look at the color shift from red pre-shots to magenta, then to yellows and blues.

There are 2 possibilities:

1) he might be higher because he is getting insulin he doesn't need, so his body is compensating by releasing some stored glycogen which converts to glucose. I say this based on how he responded when he was up in the 400s at pre-shot and then dropped like a rock with the insulin. If you're OK with it, you might see what happens with no insulin for 1 cycle and monitor how he responds to food. If he drops about 2 hours after food, you'll know the pancreas is starting to kick back in. Its an experiment.

2) or he might need a slight dose increase or to develop a sliding scale so you can shoot based on his new patterns; that'll take a little time to develop.
 
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You collect data starting from the dry food removal, as responses with the dry may be different.
You get nadir tests when you can to see how much drop you get from the pre-shot and dose.
By observation of these, you will see that at higher pre-shots, it may be safe to give a slightly higher dose and at lower ones, a lower dose.
You make another sheet and group together the similar pre-shots and doses, and start experimenting to see what works most optimally for your cat (Note: each cat is different, so the sliding scale for one may not work for another!)

If the glucose goes up mid-cycle when you do give insulin, that's another clue it may not be needed, or it could be reduced. I just have a feeling she's darn close to getting off.

Are you using U-40 syringes? You can do smaller doses (0.2 unit increments) with a U-100 syringe and conversion table, if you're interested.
 
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Thanks for the info. I am using U-40 syringes and am interested in using U-100 syringes for smaller dosages.
 
U-100 means 100 units per mL
U-40 means 40 units per mL, ie, it is 40% of the concentration of a u-100 insulin.
When you use a U-100 syringe to measure a U-40 insulin, the markings need to be adjusted by 40% or 0.4, to calculate the U-40 dose.
Short version: each 0.5 unit marking on a U-100 syringe measures 0.2 units of U-40 insulin.
0.4 * 0.5 = 0.2 units of U-40
0.4 * 1.0 = 0.4 units of U-40
0.4 * 1.5 = 0.6 units of U-40
0.4 * 2.0 = 0.8 units of U-40
0.4 * 2.5 = 1.0 units of U-40
and so on.
 
You've been giving 0.5 units.
Depending on how the no insulin cycle pans out, you can try 0.2 or 0.4 units if he's over 150 mg/dL on a human glucometer.
 
Sorry for the delayed update. I was planning on doing the cycle with no insulin this past Monday (1/5), but Mimi sneaked into the kitchen in the morning and ate dry food, so her BG was over 500. I waited till Wednesday (1/7) to do the no insulin cycle. It seems she did okay, as shown on the SS. We feed her a 1/4 can of Friskies Classic Pate 3 times a day, morning, mid-day and evening. Take a look and let me know your opinion is. Also, I'm not giving her any insulin today to see if her BG numbers remain the same as yesterday.
 
Wow! That's quite a reaction to dry food. Now you know she will always need to eat low carb.

I think she still needs a little insulin. To be regulated, she needs to be in the mid 200s at preshot and in double digits at nadir (but above 50). remission numbers are between 40-120 on no insulin. I'd try .25 if you can eyeball it on your U40 syringes or .2 on the U100s.
 
Her numbers looked good today with no insulin, around the same range as yesterday. Tomorrow I'll start giving .25 of insulin and go from there.
 
Welcome back!

I was using the U-100 syringes for smaller doses for Hank which worked out very well.

I also switched Hank to 9 Lives wet food for lower carbs. I feed him flavors between 2-5% carbs according to the food chart on catinfo.org.

Of course, you should always transition food switching slowly for less stomach issues.

It's worked well for Hank.

Just a thought.

Keep tracking. You're doing great!

Kimmie
 
Thanks for the help. We didn't have to worry about switching her food, we were already feeding her Friskies Classic Pate before she was diagnosed with diabetes. We just quit giving her dry food and now feed her 3 times a day (1/4 canned wet food). I have another concern. Yesterday (1/9) we started Mimi on 0.25 of insulin and her BG numbers have been good, but since yesterday, we've been having to force feed her again, all 3 meals yesterday and this morning. She's not eating or drinking on her own and isn't acting like herself; she just mopes around all day and looks drowsy (the same way she was right after being diagnosed for diabetes and being treated for DKA). Not sure what this could be since she was doing so well and eating on her own, now all of a sudden going in the opposite direction. Anyone have any ideas of what is going on with her?
 
Are you testing for ketones? If not, I'd go out and get some ketone strips and test her. Cats do not always have to have high Bg numbers to have ketones.

The other possibility is that she is dropping lower at some time other than the standard nadir time. I'd get some numbers before and after that window. If she is on a roller coaster from yellows to greens, that may make her feel off. But I would test for keyones asap.
 
When lethargic, check glucose and ketones. Either may be associated with lethargy.
And it could be something else, too, so if neither of those seem like a problem, a vet visit is in order. I'm thinking you mau need to fatten that quarter unit dose a hair.
 
I'm not checking ketones, I'm gonna have to go buy some strips. BJM, what do you mean fatten that quarter unit dose a hair?
 
To fatten a dose, you increase it a smidgen, but not up to 0.5 units.
To skinny a dose, you do the opposite.
 
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I did get strips, but so far have been unsuccessful in getting her urine. Besides that problem, she is eating on her own a little bit more; she eats some meals on her own, but other times only eats some and is forced fed the rest.
 
Oliver would never let us watch him pee. We'd put him in a room with a clean litter box filled with aquarium gravel. He'd just have to christen the clean box and we'd get our smaple without it soaking into the litter. I think there are special litters that test for ketones also, but have never tried them.

I'm glad she is eating better and feeling better. Her numbers look good. I'd be sure to monitor when you shot into a 170 or below. And be sure it is a rising number, not still falling.
 
My niece was finally able to catch Mimi urinating in the box, but by the time she got to her, she wasn't able to get enough urine on the strip; she missed the most important one, keatones. Some of the results were not normal, Mimi's protein was 30+ and specific gravity was 1,030. Everything else looked good, with the exception of Ket, Bil and Glu since she was unable to get enough urine. Should I be worried about the protein and specific gravity numbers? By the way, the multistix 10 sg strip was used.
 
Terrific on no ketones. I wouldn't worry about the other stuff.
 
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Mimi is back to just looking tired and sleeping a lot. Her ketones were negative last time it was checked and her BS numbers are good. We have been having to force feed her the last couple days. Any ideas of what is going on?
 
i don't know, but do you have any of the appetite stimulant she used before? Did you ever get an indication from the vet about her decrease in appetite? Any suggestion of pancreatitis?

Here is some info in it to see if the symptoms sound familiar:

http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

I do think it would be wise to get a curve to see if the +6 is her lowest point or if she is lower before or after that. If she is dropping low at some point, that could make her feel crummy.
 
The appetite stimulant was given to her just once in the beginning when she was newly diagnosed with diabetes. The vet said she wasnt eating because she was in DKA, so her body was in a manner of speaking, in shock. The vet only gave one weeks worth of the appetite stimulant. Besides the not eating, she does look lethargic and when I pull her skin, slightly dehydrated. She did throw up once a few nights ago, but hasn't since.
 
when did you last check for ketones? If not today,I think I would get a current test, just to be sure that isn't the problem. If you are concerned and she is not acting normally, maybe a vet visit?
 
Last ketones check was last Friday, Jan 16. I haven't been able to catch her urinate since then. I am going to take her to the vet, but her vet is closed on Wednesday and I work all day tomorrow; trying to find a coworker to cover part of my shift. If not, then I will take her to the vet for sure on Friday. I am concerned, but she still jumps from the bed to her cat post and vice versa and she isn't throwing up.
 
If she is acting better toward the end of the cycle and worse during the cycle, I'd definitely get some numbers and see if she is dropping at some point.
 
I took Mimi to the vet yesterday and they kept her overnight. I called this morning and over the phone told me she isn't doing any better. The vet said its DKA (BS was 298) and not pancreasitis, her enzmymes are fine. The vet said depending on how far I'm willing to go, either put her down or recommend a specialist. I'll be going later to go pick her up. Not sure what to do, I'll get a copy of her results and post later on.
 
You can do fluids at home, but managing the electrolyte disturbances from DKA are tricky.
 
I posted the lab results for Mimi; for the blood work, there is one test pending, and for the urinalysis, its still pending as well. I went to the vet already to speak with them in person and said that its DKA and that her liver and kidneys are not working right. He recommended keeping her for the day to give her more fluids and see what happens, but he couldn't guarantee anything. The options were: give her more fluids and hope for the best, take Mimi to a specialist and see what they recommend, or to put her to sleep. Mimi is going to stay for the day for more fluids and I'll be picking her up later on in the afternoon; after that I don't know what to do.

Financially speaking, I won't be able to afford to take her to a specialist (and its not guaranteed if the specialist can do anything); so far since Mimi first being diagnosed with diabetes this past December, I've spent close to $2000 already. Morally speaking, it feels wrong to decide her fate based on money and its my niece's cat, and its hard to see her hurt and cry; she was crying her eyes out when we got home from the vet. Also, its morally wrong to see a cat have to suffer like that, and if more fluids throughout the day doesn't work, then I think the best option would be to put her to sleep, even though it will make my niece very sad (she's had Mimi since she was kitten and she's her very first cat).

BJM, you said that fluids can be given at home, but its tricky with electrolyte disturbances from DKA. Do you have experience in this or have any literature? What are the success rates? If anyone else has any thoughts or recommendations, I would greatly appreciate it.
 
I attended most of the diabetes sessions at the Midwest Veterinary Conference last winter, including a discussion of what is needed to intervene with DKA. The complexity is why many cats remain at the vet for several days, or are euthanized due to the cost.

Here, when we have someone who has had a cat that went through that, or one that is showing more than trace ketones in the urine, we encourage fairly intensive monitoring, pushing fluids, syringe feeding if the cat won't eat, and in some cases, the use of Regular (R) insulin. It can be very intense nursing and there are no guarantees of success. There are supportive things which can be done for the liver and kidneys.

If you can post the lab results, we may be able to get feedback from folks who have dealt with this before.

Please go up to your first post in this thread, and on the right hand side find the little down arrow. Please click on that and change your title to DKA feedback/guidance, or something similar, so folks notice the topic.

I put a post over in Lantus to get you more feedback and thoughts.
 
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I am so sorry to hear she is in DKA again. Hard, hard choices. You know how much you can afford in time, energy and money. And no, you don't want it to be so difficult for everyone that her quality of life is no longer there. Having said that, we definitely have cats surviving DKA, usually requiring stays in the ER or lots of supplemental support at home.

Only you know what is right for you and for her. And whatever choice you and your niece make will be the right one, because you will make it out of love.
 
Ok. I see them.

bilirubin is increased
glucose is increased
potassium is decreased
sodium is decreased
Na/K ratio is increased
Chloride is decreased
Cholesterol is increased
Triglyceride is increased
Neutrophils increased
Lymphocytes decreased
 
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Here's a stab at it:

When there isn't enough insulin, fat is broken down for energy. This may increase the cholesterol and triglyceride values. Also, the fat goes to the liver for processing, which can cause it to swell. This may make the bilirubin increase.

When the glucose is elevated above about 240 mg/dL, the kidneys start dumping the water with the glucose into the urine. The animal can become dehydrated, plus the increased urination may excrete a lot of the minerals. This may explain why the potassium (K), sodium (NA) and Chloride (Cl) values are off.

The values for neutrophils and lymphocytes indicate infection.
 
We picked up Mimi from the vet already, she doesn't look any better, we'll be taking her back in the morning for a re-check and possibly another day for fluids. The urinalysis results are back and posted on the spreadsheets under the labs tab; her ketones are 3+(high). We'll see how she does over night and tomorrow after getting more fluids. She does have an IV in place, so I'm going to ask the vet when we bring her back home tomorrow if they can keep it in (I work in a hospital, so I have access to fluids) so I can give her fluids at home.
 
Ketones are a by-product of fat breakdown. You want to encourage fluid consumption.
 
Quick question: Mimi's BG was 105, most likely because she didn't eat much during the day at the vet; the vet said they did feed her a little bit of food. Should I give her a small dose of insulin? We did force feed her dinner.
 
Until and unless she is testing over 150 mg/dL on a human glucometer, I would not give insulin unless you can stay up, monitor her, and intervene if her numbers start dropping low.
 
Last night she just wanted to be left alone, and she did urinate A LOT in the litter box. This morning she didn't look any better, and she was hiding underneath the bed. Her BG was at 157; we had to force feed her and she still looks dyhydrated, had to force her to drink water again. Going to take her to the vet in a few hours for a recheck.
 
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