Intro + Newly Diagnosed Diabetic - STALLING and need help!

Hello!

I have a newly diagnosed kitty, Pearl. Pearl is 15yo with a history of some other health issues - asthma with chronic pneumonia, chronic IBD, and chronic pancreatitis. She also has a heart valve thing which the cardiologist is not concerned about. Pearl is Siamese.

Pearl was diagnosed with diabetes 12/21 with blood sugar of 500 and lots of glucose in urine. She was not keto acidotic, but presented with significant dehydration, pretty low potassium, not eating or drinking, and stumbling. She was hospitalized after diagnosis on 12/21. She was on IV insulin until 12/23 at night.

She was switched 12/23 8pm to Lantus, 1 unit. I picked her up from the hospital this morning (Christmas). Hospital had a tough time establishing her starting dose, since her sugars don't shoot up between 8am and 8pm dose (they DO shoot up so far during the night).

Which brings me to now! And HELP! Her blood sugar right now is 197 (using ReliOn Premier meter). I was told don't shoot her unless the blood sugar is 200 (20 minutes ago it was 196). Am I in the safe zone to go ahead and administer the insulin?

THANK YOU!

 

Can you test 2hr post-shot, and (if necessary) even later throughout the night? Do you have plenty of supplies (test strips, high-carb food, honey/karo syrup) in case she goes low tonight?

If so, you could try shooting the 197-- it's really not different from 200, when you take meter variance into account. But if you are more comfortable skipping tonight's shot and shooting tomorrow morning, when (perhaps) you are better able to monitor the whole cycle, I think that would be fine, too.

Congrats on home-testing so early in this whole process! That will help get you and Pearl on-track in no time!

 

HI Nan!

Yes I can test 2 hours post-shot and throughout the night (how many hours in between).

So! I really effed up. I fed her, then got the insulin ready. (I am experienced giivng sub q fluids and B12 shots, so I know what it feels like when the needle goes into the skin). I never felt that with the insulin needle. When I pulled the needle away from her fur, that damn needle was BENT at 90 DEGREES!! And my fingers smelled like insulin!! I couldn't find any wet fur, but 1Unit is sooo teeny would I even feel wet it if all went on my fingers? I do not have confidence that it went into her, she didn't even flinch, and I kept pushing the syringe against her, and she made no move like nothing was going on.

So now I REALLY do not know what to do! With insulin, she usually goes up to 400 in the middle of the night. I am scared about her going too high (she was diagnosed at 500 with stumbling and a bunch of other symptoms).

Advice PLEASE!

 

Well, it might have been a "fur shot" with the insulin smell and bent needle , but no matter what, do not shoot again. You don't know how much insulin actually got in, and you don't want to over-dose here.

I wouldn't worry too much about high numbers in the short term-- it's really over long periods of time that they cause damage. So, what I'd do is just test at +2 as planned, and see where she is then .

 

Ok, thank you so much Nan! When I test at +2, what happens if she is really high? Do I reshoot, or just call it a night and try again in the morning? And, lol, "fur shot" that is new for me!

 

Nope! You are done with insulin for the night.

 

Ok! Got it, and thank you so very much for your help! Meowy Christmas!!

 

Hi Margaret, glad to see you and Pearl made it over from the FB page! And welcome!

 

Same Welcome!

 

Hey Margaret!! So glad to have you and Pearl over here!

I know you're a little intimidated by the message board, but don't worry! None of us bite and we keep our claws nice and trim!

Here's some reading for you that will help us to help you! Remember, I'm happy to help you with getting things set up so don't over-think it.

You can do this!!

 

Hi Margaret,

Welcome to yourself and Pearl.

Although Pearl wasn't considered to be in diabetic ketoacidosis at diagnosis, do you know whether she did test positive for ketones at that time, or at any stage while she was in the hospital?


Mogs
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Hi Mogs!

Pearl's urine was checked for ketones about an hour before hospitalization (when she was diagnosed at our vet). No ketones then. Once she got to hospital, they put her on an IV drip for fluids and electrolytes and started her on IV insulin. When I asked the vet the next day about watching for ketones, he said since her sugars were coming down (went from 500 to 200) in a day, that there wasn't a worry for ketones any longer. Is this right??

So they didn't test her any further for ketones. Do I need to be watching for this/doing something about this?

Thank you!
Margaret

 

Hi Margaret,

Strictly speaking, no it isn't right. While it is more likely that a cat in ketosis or DKA will be in high numbers at the time, it is possible for cats to start generating ketones when they're not in high numbers (e.g. if infection present, appetite is poor, insulin doses are skipped).

It's a sensible general safety precaution to regularly check kitties for ketones, especially in the early days while you're 'learning your cat'. Ketone monitoring is also advisable when a kitty's poorly regulated, when there's suspicion of infection/inflammation/other systemic stressor, or when they're not getting enough food and/or insulin for whatever reason.

Further reading and tips:

Ketones and DKA

Tips for collecting urine samples

Some cats appear to be more prone to throwing ketones than others. We normally ask new members about whether their cat has any history of ketosis or DKA because, given the cat likely is more vulnerable to throwing ketones again, it's important safety information for members to be made aware of when they're helping with dosing decisions (particularly when it comes to potentially skipping doses).


Mogs
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