? Dosage Advice

Hi!
This is the first time I'm posting here and English is my second language, so please be patient if I'm doing anything wrong.

My Maverick was diagnosed about 1 month ago. He also had DKA, Pancreatitis, possible bowl inflammation, jaundice, Anemia, and possible triaditis. He is no longer anemic, and he is just now finishing up antibiotics and antacid meds. He is eating again after being on appetite stimulants and Cerenia.

Maverick was started on 1U Lantus 2Xday but its been reduced 0.25U at a time since he went low and I were unable to shoot several times causing very high values before next cycle. He is now down to 0.25U, but I'm starting to think it may be time to increase to 0.5U? He is high every night and seems to be high every second day daytime. I am very worried the DKA will return and he has seemed to be a little more uneasy the past two days. He's seeking to be alone more (hiding under a bed), his eyes are big, and he is starting to overgrow. I'm not sure if the grooming is due to high values or stress. Maverick prefers to eat more than twice daily (he's on PPP D/M canned food now), but I do not dare to feed him mid day when his values are high. I have not been able to test ketones the last 2 days but hoping to catch him peeing today.

The vet want to do a curve tomorrow, but I already have a lot of data from the Freestyle and the Glucometer, and I feel that pricking him extra will just stress him out more than necessary, especially as his days are so different in values depending on if the previous day been on the higher or lower end.

I'll attach his spreadsheet, unfortunately, I do not have the early data recorded there. This past 4 days data I solely based on the glucometer, the rest is a mix of glucometer and Freestyle.

Do you guys have any advice on dosage? Should I increase to 0.5U or do the curve tomorrow and let the vet decide?
Any other tips and trix is also welcome as I'm very new to this and him becoming sick again is a constant worry. Thank you!

 

@Mathilda and Maverick . You are as American as you can be

Your spreadsheet is in a pdf and not visually showing for me when I click on the link.

Go to you Vet and bring your data you have with you and discuss recourse with your Vet.
First.
Then I let @Deb & Wink right in a Snow Blizzard help you when she can.

 

Welcome. There has been a lot going on with Maverick.
I'm tagging a few experienced people for you.
@tiffmaxee
@Tomlin
@Wendy&Neko
@Sienne and Gabby (GA)
@Vyktors Mum

You can test for ketones at home. Here are some links which explain DKA and how to test.

• Ketones/Diabetic Ketoacidosis (DKA): Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters
• Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones
  

 

I can see the link to your SS but it would be much easier if we could get it set up in your signature. I will ask @Bandit's Mom is she can help you with that.
It looks like Maverick could be still bouncing from the green numbers a couple of days ago. It’s the 6 th cycle now so the BGs may drop lower after the cycle. I wouldn’t increase until you see if that happens... ( as long as there are no ketones in the urine).

I can see you are trying to catch a urine to test for ketones. It’s important to test daily if you can at the stage, especially if you think he is not quite himself. That will give you an indication if the insulin dose is right or needs adjusting. I would also keep an eye out for any lethargy and lack of appetite. If you could put the result of the ketone urine tests in the remarks column of the SS that would be very helpful please.

I would let him eat multiple small meals during the cycles, just withhold the food for the 2 hours before the preshot BG so it’s not food influenced. Food is also really important in the recovery of DKA. He needs up to 1 1/2 times as many calories as normal to help prevent ketones reforming.

What type of glucose meter are you using? A pet meter or a human meter? .....ETA I can see on the SS it is a ReliOn and freestyle libre.

Does the vet want to do the curve at his surgery or for you to do it? There is no need for Maverick to go to the surgery to have it done when you home test.

 

'I can see your spreadsheet now. I’m not sure why you want to do a curve at the vet’s office. Cats often are higher there due to stress. Max always was. You can do your curves at home and give the vet your results. Have you looked at the dosing methods? What are you feeding? If any dry food you would follow SLGS but if all canned then you could do TR. My dosing advice will depend on your answer.

 

Haha thanks, I'm trying
I did not quite understand how else to post the SS, but I think I got some good guidance on that so I'll try to do it correctly so its visible for ya'll to see.
I brought it over to the vet a couple of days ago and she reviewed all his data but never got back to me and was off today. Maverick vomited just now so I have an appointment first thing in the morning and I'll discuss his response to the insulin then.

 

Thank you! Yes, and he vomited just now so I'm over the edge worried at the moment- I was able to get Cerenia in him so hoping he'll stay ok until the vet app in the morning.
I was finally able to get some pee and to me it looks like he's negative for ketones, I tested twice to be sure, but then I'm not sure how much to trust the home testing. Thank you for the links, I'll check them out!

 

I would ask your vet for an RX for ondansetron, a human drug for nausea. My cat with chronic pancreatitis did really well on it. With pancreatitis you want to feed small meals often. Don’t be afraid to feed when the BG is high. If you stick with canned food you can raise the dose to .50. Are you giving anything for pain? Buprenorphine works very well for many. Don’t waste your money having the vet do a curve. You have more than enough tests.

 

I'll try to set it up in my signature, and yes, I'll add the ketones result- thats a good idea! I was finally able to catch some pee and it looks like he is still negative, I did two to feel better, but not sure how well I can trust the home strips.

Aaah, I didn't realize it can take so many cycles for to get back to normal after the bouncing, but that makes me feel better. So, should I let him have food even when his numbers are high in the middle of the day? He has been on appetite stimulant every three days but been so obsessed with meal times I stopped those meds to see how he'll do. He will be sitting asking for food for hours but I only dared to feed him when he's been low, especially since the vets says feed only twice a day- but I know this is not good for him. I think his change of behavior- especially the over grooming is rooting in stress and the fact that he's not getting food. He also had allergies before so it may also be the ingredients in his feed that he's reacting to. What would you consider small meals? He's on PPP D/M canned food and according to the feed directions he should hav 1 1/2 can daily. This is about what he eats when he's been lower in values and I've felt comfortable feeding him 1 or 2 times more per day, but the past few days he's had somewhat less than that split over 2 feedings.

Yes, thats the meters I'm using. The Freestyle sensor has been expired a couple of days so the reading over the past few days has been done with the ReliOn, but I'm planning on putting a new sensor in tonight.

The vet said it doesn't matter if I take him in or do the curve at home. However, I was able to hand in his data after she requested the curve and has not been able to talk with the vet since. I would think a curve wouldn't be necessary with all the data already collected- I feel so bad stressing him out pricking him every 2 hours when I already do a good amount of pricking and I've noticed it has been stressing him out. What do you think? Would a official curve done at home still be helpful?

Thank you so much for helping out

 

If I end up doing a curve, I'll definitely do it at home. But do you think a curve would be helpful now, or can I just base the dosage on the data I already have? I've noticed the pricking stressed him out lately so if not needed, I'll spare him the extra stress. I have looked at them but if his high values are because bouncing I wouldn't change it, but these high values are stressing me out so I'm feeling for increase to 0.5u- but I also know that that caused him to be too low at shoot time so thats an issue. I know the vet may advice me to do 0.25 in the morning and 0.5 at night, but I also know that's not really ideal with the Lantus insulin. He is gettin gPurina Pro Plan D/M canned pate. What is TR?

 

You have more than enough data.

 

Thank you! I'll look into that drug. Is your kitty getting it on a regular basis, or is it an "as needed" drug. What would you consider small meals and often? He should be eating a total of 1.5 can/day. Will the BG not shoot really high after feeding? He's not getting anything for pain and he doesn't really seem to need it- I think the overgrowing that just recently been happening is more due to stress unfortunately. He's getting Denamarin, and we finished up Farmotidine today, will finish Doxycycline tomorrow, have Cerenia as needed (as of today, had it daily before, and Mirtazapine as needed.

 

Ok, thanks! After his last sickness a couple of years ago, we did Friskes pate for a long time, but he seemed to develop allergy to it. Is the D/M higher in carbs than the Friskes and FF or what is the reason its not as good? sorry for all the questions, I just trying to soak up all I can

 

Max got ondansetron as needed. The first sign of a pancreatitis flare for him was inappetence. Divide the food into 3-4 meals each cycle. If they eat too much at one sitting they feel yucky and don’t want to eat.

 

We like questions here so ask away! There’s nothing special about DM except the price! If Maverick reacted to Friskies it’s likely an ingredient in it, often the protein source.

Check out this food list.
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

 

Thank you! Yes, I think it was the chicken. Is the carb low enough though in the D/M- if the grooming is not due to the feed, I think I'll stick with it at least until somewhat regulated to the insulin.

 

It’s higher. According to chewy.com it’s 15.79%.

 

Ok, thank you so much!

 

Hello

One thing worth doing at some point with respect to diet, is figuring out just how many calories you are feeding your cat per day & if it is the ideal amount of calories based on if they are at a good weight or if they need to gain or maybe lose weight . This is very important because protein, fats, carbs and macronutrients (like phosphorus etc) & the amount your cat is actually eating is going to be based on the calories you are feeding vs a generalized dry matter basis provided by the company or one that you figure it out yourself (even if what is provided is the typical analysis which is the more accurate nutritional info). This is “as fed” info.

This is important because many foods that may be considered as being off the table or not ideal options based on generalized percentages alone if a cat has disease states like DM, CKD, a combination of the two, Triaditis etc may in fact be fine and/or even ideal for your cat .

The nutrients need to be determined based on a what is called a 100 kcal basis. The nutrient amounts of food will be listed as “as fed” basis. In order to determine the amount of nutrients your cat is actually eating (including carbs) you need to base it on the specific amount of calories they are getting vs as fed basis .

So, to give a real life example, I have a cat who is being watched for early renal insufficiency. I am working with a board certified nutritionist for his case (as well as for my cat with DMs case). We are working on some weight loss. If his labs had come back indicating a need to change nutrients due to his kidneys, he said we were still ok with what he was eating because of the amount of calories he is getting. If we just looked at “as fed” basis and generalized percentages & he required nutrient changes, at first look, & with only a generalized percentage, it would appear that his food needed to be changed immediately. However, that is not the case because, again, he isn’t getting the percentages of nutrients that are based from the “as fed” analysis. He is eating much less calories so the nutrients are also reduced. This would hold true with food for diabetes as well with respect to carbohydrate content.

Here is a link to learn more . It can be a little confusing at first, but like everything else, once you learn more it becomes easier .

https://vetnutrition.tufts.edu/2017/08/nutrient_converter/

Best- Amy