In danger of DKA

Hello again. It's been a while, we've run into a serious problem. I've been using a ReliOn meter and running in 100's and 200's. Giz wasn't acting like he felt well so we went to the vet and he was 350+ and had >1000 mg/dL glucose in urine. Now he has a Freestyle Libre sensor on and is running up and down like crazy. I'm kind of looking for support.

 

Hi and welcome Gizzy and Mom
How can we help you.?
You mention in danger of DKA in the subject line?
Does Gizzy have ketones? Is he at home or in hospital?
Do you have a spreadsheet?

 

You can enter the BGs from the libre onto the SS.Just note on the remarks column that the BGs are from the Libre.
I would continue to test daily for ketones in the urine and note the result in the remarks column of the SS.
As you able to put the SS into your signature? We can easily access it there. I’ll ask @bandits mom to have a look at the SS as I don’t think it is one of ours.

It is really important when ketones have been present that you don’t skip any doses of insulin and that the dose is adequate.
I would like to see the BGs from today’s readings first but it looks to me as if he could do with an increase. I would save the fattening the dose for when your kitty is in green numbers and you are fine tuning the dose.

Also with ketones in the picture you need to be making sure Gizzy is getting plenty to eat.
Ketones form when there is not enough food for the body to use as fuel and it starts to use the fat and the byproduct of that is ketones.
So offer snacks every couple of hours throughout the day and evening, except for the 2 hours preshot, as well as the main meals.

 

The vet (not my regular) increased him to 1U starting last nights shot. I'll put the ss in the signature then update it with todays #s.

 

Hi Bron, the tag didn't come through (there's an apostrophe after t - Bandit's). I am able to see the SS. Are you having trouble with viewing it on your tablet?

 

Hi. In looking at your ss you have been taking reductions when not once has Gizzy dropped under 100. Please look at our dosing methods. With TR reductions are taken if your cat drops under 50 and with SLGS if under 90.
Did he have ketones recently and has he ever been DKA?

 

Yes I can see the SS. CG is going to put it into the signature and update.

 

He's never had DKA and as far as I know never had ketones. Unfortunately I was following the guidance of another group on FB and I'm very concerned about other cats being cared for with their guidance. They were having me decrease his dose trying to get a lower nadir and this is where I ended up with him.

 

Didnt you say he was showing ketones yesterday?
That group is known for reducing the dose and causing problems

 

Oh, sorry, he never had ketones until this situation. Yes, he did yesterday.

 

@tiffmaxee CG mentions ketones in her first answer to me . It is squashed up in with my quote

 

I have seen them say to reduce the dose several times when it was inappropriate and unfortunately you are not the first person we have had arrive here as a result of this. The only way you will get a lower nadir and get regulated is to find the correct dose. If you are going up in 1/4 unit increments and are testing frequently, it is completely safe to continue increasing in the same manner until you get the result you are looking for. There is no reason to reduce the dose, unless the kitty has dropped low.
If the dose is reduced for any reason (other than earning a reduction), or the dose is skipped, it is important to be testing for ketones.

 

I'm really confused as to whether to follow the vet or what I've learned over the years. She wants me to stay at 1U for the full 14 days of Freestyle. Does that make sense? Also only feeding at shot time.

 

Would subq fluids help clear this faster?

 

As far as feeding goes.......only feeding at shot time is old thinking. Gizzy needs his preshot meals twice a day and then at least a couple of snacks during each cycle. What have you been doing over the years?
As for the dose of 1 unit.....we would have suggested going up to 0.75 units. But as you have already given 2 doses of the 1 init, I would stick with that and check the testing frequently. While you have the libre on you might as make full use of it.
As for staying on the 1 unit for 14 days......well that depends on the BGs. If he earns a reduction, you would reduce the dose.
Would you like to have a look at our two dosing methods? They are both excellent. you certainly test enough to do the tight regulation method as long as you don’t feed dry food.it will depend on which method you chose as to what BG you reduce at.
Link to methods https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Does Gizzy normally have subQ fluids?
Is he at all dehydrated?

 

He's never needed subq before. His energy seems to be back to normal and gums aren't sticky so I'd say he isn't dehydrated. I can add some water to his food. We don't feed him dry food so I could probably do TR but it scares me to go that low. I'd feel more comfortable at this point to do slgs. He's lost 2 lbs in 2 months so I'm going to start giving him extra food during the day. He's always had treats throughout the day, about 1/4 can of FF each time I test him. Would you suggest his FF or boiled chicken or tuna?

 

Adding some warm water to the food is a good idea. If he doesn’t have any ketones and doesn’t seem dehydrated I would not give the subQ fluids atm. But if ketones reappear I would look at them again.
You can start off with the SLGS if you like. With that method you can only increase once a week whereas you can increase every 3 days if needed with TR.
But start with SLGS and see how you go . You can change over any time as long as there is no dry food. Can you put SLGS in your signature please so we can see, thanks. We always look at the signature and the SS when we help you.
Tuna is not a great food for cats...although I know they love it. I would keep that for when you really need him to eat.
The boiled chicken is fine .....as long as it isn’t too much. The only reason I say that is because it is not a complete meal nutritionally. If it is only about 10% of what he eats overall that is fine but if it is much more it will throw out the balance of the calcium/ phosphorus etc.
I think I would stay with the FF and add in some chicken on top of that.
Is FF his main type of food?

 

He only eats FF chicken feast.

 

A lot of people use boiled chicken as treats for when they are testing. They cut the food up into treat sized pieces, freeze it and feed them as a treat when testing.
Other things you could give are chicken hearts, or freeze dried foods that are now available.
I feed my cats a home made raw diet and when I gave them some freeze dried food to try, they didn’t recognise it as food and started to play with it.

 

LOL silly kitties.

 

Let me add my 2 cents.

• Adding water to Gizzy's food is a good idea regardless of ketones. With ketones it's an even better idea. It helps to dilute the ketones. It is also good for your cat's kidney health.
• Did your vet give Gizzy a thorough check-up? Any infection or inflammation can both cause an increase in BG and cause ketones to develop. (Ketones occur due to not enough insulin, not enough calories, and an infection/inflammation.) One common issue in cats is they have a dental inflammation caused by tartar.
  • It looked like Gizzy's numbers were higher starting with your using the AT2. It may be coincidence or it may be that your Relion meter was off or it may signal an infection/inflammation.
• Make sure Gizzyy is eating. As I noted above, not enough calories can contribute to ketones developing.
• Gizzy needs more insulin. I would not hold the dose for 2 weeks especially if you're having to deal with ketones.

I am not a fan of some of the other diabetes groups. Frankly, I think their guidance is poor and we've seen a number of disasters. Some of the moderators of the other groups used to be here and we did a great deal of intervention based on their advice. A few left in a huff to set up these other groups. There's at least one group that supposedly follows Elizabeth Hodgekins, DVM's brand of tight regulation that eschews giving a cat high carb food if numbers are low. There have been tragedies. We are not perfect here. But, we have enough members who will pick up on misinformation. We do not ban members for challenging a moderator or raising questions. That's not the case in other groups You are wise to raise questions about the quality of the information you received.

 

Thank you for responding. This was not my regular vet and no, she didn't do any bloodwork. I questioned her on that and she said this is a lack of regulation issue. I'm pretty sure she's right about that but would have preferred confirmation of no infection. His reading 30 minutes ago, at shot time on the Libre was "high". Still no ketones on urine strip. I'm kinda mad that I paid $100 for her to interpret the info from freestyle but I'm not following her instructions because I disagree with them. He needs to eat during the day. When would you increase his dose?

 

My sensor is dead! UGH Monitor with AT2 every 2 hours??

 

If you were planning on doing a curve today, then yes, you'd need to test every 2 hours, but I don't see any reason why you really need to do a curve. Just grab some tests at different points in the cycle.

One of the bad things about the Libre is it's unreliability. It seems either cats get them off long before the 14 days or they just stop working for whatever reason and you have to buy a new one if you want to continue using it.

Glad to see you here from that other group. The only group on Facebook that's associated with the FDMB is the Feline Diabetes group. The one you were in gives a lot of very questionable advice in my opinion too. We don't give much in the way of dose advice unless it's an emergency. We encourage everybody to join here and post here so they get the benefit of the most experienced people.

 

I'm having a difficult time deciding whether to do a post over there about what happened. I hate to stir things up but I'm concerned about what they're doing. I don't feel like I need a curve at this point but it would be helpful to have some people's thoughts on increasing his insulin.

 

If I'm reading your spreadsheet correctly, Gizzy has been at the current dose for 4 cycles, correct? I would hold the dose tonight. Even with TR, increasing after 4 cycles is aggressive. My only concern would be if ketones developed. If that's the case, we get aggressive.

Is Gizzy doing OK? Are behaviors normal? No lethargy, hiding, eating OK?

 

If you're doing SLGS, you hold the same dose for 7 days (14 cycles) and then do an official curve....but you test enough now to choose Tight Regulation if you want to. On SLGS, reductions in dose are earned if he drops below 90 on any type of meter.

On TR, you can increase the dose as often as every 6 cycles if you're not getting the results you want. Dose reductions are earned if the cat drops below 68 on a pet meter, 50 on a human meter

If you're going to continue doing SLGS, you just went up to 1U four cycles ago so you'd hold the 1U dose.

 

We increased to 1U Thursday evening. Eating great, not hiding - sleeping on the kitchen counter, lethargy is hard to tell because he's a pretty laid back kitty - he's definitely not as lethargic as he was on Thursday when I took him to the vet. I checked his urine this am for ketones and it was neg. Do you know anything about the 'freestyle? Can I take it off at home?

 

Got it. I'm more comfortable on SLGS. Is there a benefit for Giz to do TR?

 

The main benefit is being able to increase the dose as often as every 6 cycles.

On SLGS, you hold the dose for the full 14 cycles even if he's running higher than you want him to (which may contribute to the development of ketones)

The sooner you can get Giz into normal numbers, the better his chances of remission.

You can always try TR and if you decide it's not for you, go back to SLGS

 

Thank you. I guess I'll try TR even though it makes me nervous.

 

I don't know anything about the Libre. Sorry.

 

The point is moot anyway. It's off.

 

He was diagnosed at 2 years old, there won't be remission for him.