New (continued) Monica & Mia

[MonicaT]

Starting a new thread following the first one found here: First thread

Latest update on Mia from yesterday and today after vet visits.

She started potassium infusions on IV on the 7th, so today was day 5 of infusions. After the first infusion we saw the number go from 2.2 to 2.4, but yesterday we didn't see any difference on the electrolyte blood tests for potassium. Yesterday we saw an improvement in blood tests with the numbers increasing from 2.4 to 2.9. Today number has gone slightly down again to 2.8.

Other blood tests we are monitoring daily are RBC, HCT and HGB have all slowly been declining. We have discussed anemia, but the vet says she can see that young red blood cells are being created so that it bone barrow is working as it should. We have tested for pancreatitis on Sunday 6th, that came back negative.

Today we also tested for FIV and FeLV, both came back negative.

Blood tests are not showing any reasons to think there is something wrong with kidneys or liver. We have checked her stool to see if there is any blood, which I cannot see there is.

I am running out of ideas and am panicking seeing these number continue to decrease and with no obvious signs to why this is happening. Any ideas, advice or similar situations will be highly appreciated

RBC - 6.86 M/uL on the 7th, 5.50 M/uL on 10th and today 4.82 M/uL
HCT - 30.8% on the 7th, 23.4% on the 10th and 20.8%
HGB - 9.6bg/dL on the 7th, 7.9 g/uL on the 10th and 6.7 g/dL

 

[JL and Chip]

Have they done a blood smear?

 

[MonicaT]

@JL and Chip not sure, what is that exactly?

 

[Bron and Sheba (GA)]

@Suzanne & Darcy do you have any ideas about these tests?

 

[MonicaT]

@Sienne and Gabby (GA) @Wendy&Neko

Started new thread here. Any of you can help with blood test results and figuring out these symptoms?

 

[Sienne and Gabby (GA)]

There's a tab on your spreadsheet for labs. Can you enter the information there? It's helpful to have the reference ranges. Overall, it looks like Mia is anemic. Did the vet suggest a consult with either an internal medicine vet or a hematologist? Cornell does offer phone consults so that may also be an option.

 

[MonicaT]

Oh ok, wasn't aware of that, I will enter the information there asap

No other specialists have been suggested by the vet, we only discussed ultrasound to look at different organs like pancreas, kidney, liver, intestines etc.

Is Cornell a company or what is it? I'm not based in the US

 

[Sienne and Gabby (GA)]

Sorry -- I thought you were in the US. I didn't read your signature carefully. Cornell is Cornell University. It's one of the leading veterinary schools in the US. This is a link to their Feline Health Center.

 

[MonicaT]

@Sienne and Gabby (GA) Oh ok, no worries

 

[Suzanne & Darcy]

@Suzanne & Darcy do you have any ideas about these tests?

Not really, I have been waiting to see the reference ranges and the results on the labs tab, but I don't see them. The anemia is alarming.

 

[Suzanne & Darcy]

Has your sweet Mia had a Convenia injection recently?

 

[MonicaT]

Not really, I have been waiting to see the reference ranges and the results on the labs tab, but I don't see them. The anemia is alarming.

@Suzanne & Darcy have started filling out the SS, but having some problems understanding which ones are which as my results are all with the short code, while most in the SS are full names.

She has not had a convenia injection as far as I know. What is it for?

 

[Suzanne & Darcy]

@Suzanne & Darcy have started filling out the SS, but having some problems understanding which ones are which as my results are all with the short code, while most in the SS are full names.

She has not had a convenia injection as far as I know. What is it for?

That is an antibiotic injection (Convenia). I just ask because it can sometimes cause hemolytic anemia.

Is there a way you can take a photo of your most recent bloodwork and copy and paste it into this thread?

 

[Suzanne & Darcy]

How is Mia today?

 

[MonicaT]

How is Mia today?

@Suzanne & Darcy

I have taken a photo of all blood test results since all this started 1st October so you can see how things have changed along the way. I added the RBC, HCT and HGB in the SS too, but the rest I am not sure where go.

 

[Suzanne & Darcy]

Her Anemia seems to be getting worse. What does the vet plan to do about it? She went to the vet today?

 

[MonicaT]

@Suzanne & Darcy Yes went with her to the vet today for the latest blood tests. Positive side was that her potassium levels are back in normal range after doing IV transfusion for some days.

However the blood cell count had gone back down again after we were happy to see it going up on Saturday. Mia received an injection of the medication Epoetin Alfa, which is to stimulate the bone marrow to produce more red blood cells.

 

[MonicaT]

Anyone has any ideas or feedback on the blood results above?

 

[MonicaT]

@Suzanne & Darcy @Bron and Sheba (GA) @Sienne and Gabby (GA) just got another low BG reading at 13.6, she is due for her insulin in 35min. Should I reduse again?

 

[MonicaT]

@Diane Tyler's Mom GA

 

[Diane Tyler's Mom GA]

just got another low BG reading at 13.6, she is due for her insulin in 35min. Should I reduse again?

@Bandit's Mom
@Wendy&Neko
@Sienne and Gabby (GA)

 

[Bron and Sheba (GA)]

I’m in Australia and was asleep when you posted.
It looks as if the swap to low carb food is lowering the BGs quite a bit.
Have you tested for ketones again? It’s important we know if there are still ketones around as the dose is reduced.
Can you get that ketone test done please, and post it in the SS remarks column and here? Thanks
With the drop to 1.6 (29) while using Caninsulin, you need to drop the dose again.
I would drop it to 1 unit. However I will tag @Suzanne & Darcy to see what she thinks about that dose as she has used Caninsulin.

 

[MonicaT]

Hi @Bron and Sheba (GA) no worries, got some help from the Facebook group in the meantime

Tested for ketones again yesterday and it was negative, using testing strips. Don't have a picture of the test though, but will write a remark in the SS.

 

[Suzanne & Darcy]

Oh my goodness. That drop to 29! Bron gave good advice to drop the dose to 1 unit. I would still monitor very closely. That is one of the problems with Caninsulin — it can drop the cat’s BG very early, hard and fast.

 

[Suzanne & Darcy]

I see that you have not reduced the dose tonight. Please do reduce the dose to 1 unit going forward and monitor closely. The low carb food has definitely had an impact. You can always go back up in dose if you need to, but we must avoid those dangerous lows. You may even need to reduce the dose further- based on test numbers of course. Do not decide the dose based upon a high preshot number or high numbers that you see. We must take into consideration the lowest point in the cycle (the nadir) to be safe.

 

[Diane Tyler's Mom GA]

@MonicaT
Hi there , did you see the posts about reducing to 1 unit See Suzanne's post above

 

[Diane Tyler's Mom GA]

Her Anemia seems to be getting worse. What does the vet plan to do about it? She went to the vet today?

@MonicaT

 

[MonicaT]

I see that you have not reduced the dose tonight. Please do reduce the dose to 1 unit going forward and monitor closely. The low carb food has definitely had an impact. You can always go back up in dose if you need to, but we must avoid those dangerous lows. You may even need to reduce the dose further- based on test numbers of course. Do not decide the dose based upon a high preshot number or high numbers that you see. We must take into consideration the lowest point in the cycle (the nadir) to be safe.

@Suzanne & Darcy I did reduce a little more, but I wasn't sure exactly how many units I lowered to so I just added the previous amount for now until I understand how to calculate the amount. On the 100U syringe I am using we started at 0.05 which is 2 units. First decreased the dose yesterday morning to what we assumed was 1.5 units, measuring til between 0.04 and 0.03 on the syringe. Today (previous dose) I lowered a little again, this time measuring to the 0.03 line on the syringe.

 

[MonicaT]

@MonicaT

@Diane Tyler's Mom GA I had replied to @Suzanne & Darcy above:

Yes went with her to the vet today for the latest blood tests. Positive side was that her potassium levels are back in normal range after doing IV transfusion for some days.

However the blood cell count had gone back down again after we were happy to see it going up on Saturday. Mia received an injection of the medication Epoetin Alfa, which is to stimulate the bone marrow to produce more red blood cells.

 

[Bron and Sheba (GA)]

@Suzanne & Darcy I did reduce a little more, but I wasn't sure exactly how many units I lowered to so I just added the previous amount for now until I understand how to calculate the amount. On the 100U syringe I am using we started at 0.05 which is 2 units. First decreased the dose yesterday morning to what we assumed was 1.5 units, measuring til between 0.04 and 0.03 on the syringe. Today (previous dose) I lowered a little again, this time measuring to the 0.03 line on the syringe.

Monica, Caninsulin is a U40 insulin so you should be using a U 40 syringe not a U100 syringe, unless you are using a conversion chart.
Did the vet mention this at all or mention a U40 syringe?
Can you show us on the U100 syringe where you are drawing up to please?

 

[JL and Chip]

Caninsulin is a U40 insulin so you should be using a U 40 syringe not a U100 syringe, unless you are using a conversion chart.
Did the vet mention this at all or mention a U40 syringe?
Can you show us on the U100 syringe where you are drawing up to please?

I’m wondering if it might be a tuberculin syringe rather than an insulin syringe. That would explain the dosing references being in ml’s rather than in units (the line markings on a tuberculin syringe are mls whereas the increments on insulin syringes are units). We’ve seen tuberculin syringes dispensed a few times over the years, mostly in European countries I believe. @MonicaT I agree with Bron that it would be helpful if you posted a photo of your current syringes so we can figure out what you have.

Caninsulin is a u-40 insulin, thus it has 40 units of insulin per ml. If you’re dosing based on ml measurements, here’s a quick list of equivalencies. Be very, very careful to get the decimal points correct when drawing insulin (we’ve seen people accidentally draw to 0.5 ml rather than 0.05 ml and massively overdose their cat).

0.012* ml (just past the 0.01 mark) = 1/2 unit
0.025 ml (just past the 0.02 mark) = 1 unit
0.031* = 1.25 units
0.037* = 1.5 units
0.044* = 1.75 units
0.05 ml = 2 units of Caninsulin
0.1 ml = 4 units
0.2 ml = 8 units
0.3 ml = 12 units
0.4 ml = 16 units
0.5 ml = 20 units
1.0 ml = 40 units

*number rounded

 

[MonicaT]

Monica, Caninsulin is a U40 insulin so you should be using a U 40 syringe not a U100 syringe, unless you are using a conversion chart.
Did the vet mention this at all or mention a U40 syringe?
Can you show us on the U100 syringe where you are drawing up to please?

@Bron and Sheba (GA) @JL and Chip

I was told on the Facebook page yesterday the same thing about using the wrong syringe, so will talk about this with the vet at my appointment later today. We have been using the 100U syringes since we started insulin as that is what the vet gave us and explained that 2units on that syringe would be at the 0.05 mark. So from the conversion chart @JL and Chip provided, we are now giving 1.25 units.

Adding images of the syringe we are using below, as well as an image showing the insulin dose

 

[Bron and Sheba (GA)]

To be honest I don’t understand those syringes at all. From what I can see, the top one of the three below the main photo doesn't look like an insulin syringe. Using other syringes than the U40 syringes risks giving the wrong dose, especially if it isn’t even an insulin syringe. You are not the first person we have had this happen to. I am glad you are going back to the vet.

If there are no longer ketones, I would suggest asking the vet to swap to Lantus insulin. Lantus insulin uses U100 insulin but there are better U100 syringes than the 100 unit ones. More about that later if you swap.

 

[JL and Chip]

So those are 1 ml tuberculin syringes, but it also looks like they have dual markings for a U-100 insulin syringe. The packaging indicates that info, plus the removable needle is also a clue that it’s a tuberculin syringe. The vet is correct about the dosage … to draw 2 units of Caninsulin, you go to the 0.05 mark on the syringe. You would not want to use the “unit” markings (10, 20, 30, etc) because those are for measuring u-100 insulin, which Caninsulin is not.

Important note: the chart I provided is applicable *only* for Caninsulin (or any other U-40 insulin). If you switch to a different insulin, such as Lantus for example, and continue to use those same syringes, you’ll need to draw to a different line. That’s because Caninsulin snd Lantus are different “strengths.”

It sounds more complicated than it is.
Just post here again if you have questions and we can confirm that you’re drawing to the correct line.

I don’t know if insulin syringes are available in Malta, but it is much easier to manage dosing if you can get some. Ideally you want to match the insulin syringe to the concentration of the insulin — so, for example, use a u-40 insulin syringe with a u-40 insulin, and use a u-100 insulin syringe with a u-100 insulin. Insulin syringes also have thinner needles, which makes the shots less noticeable to the cat. The needles on your syringe are 25 gauge. Many insulin syringes are 31 gauge, so much thinner.

 

[JL and Chip]

@MonicaT How are things going? Any updates? Status of the anemia??

Your spreadsheet shows multiple low BG numbers (including several 29s) which is concerning. With anemia in the picture, it could have been even lower than that. Were there any symptoms with the low BG?

I also see you reduced the dose down to 1u and are still getting low numbers. That’s part of the problem with Caninsulin — it can hit hard and fast. If you’re not doing it already, you might want to feed both before and in the first few hours after giving the insulin shot to try to blunt the drop. I’ll leave it to @Suzanne & Darcy or @Bron and Sheba (GA) to guide you on dosing given you’re dealing with recent DKA and Caninsulin, but typically you’d reduce dose if you see anything below 90.

Any luck getting u-40 insulin syringes? It would be much easier to measure doses in them. 1ml syringes can be very difficult to work with.

 

[Bron and Sheba (GA)]

Those BGs of 1.6 are very concerning.
Have you been checking the ketones?
How is Mia eating?
I think you need to reduce the dose of insulin down to 0.5 units, test for ketones and make sure Mia is eating well.
I am going to tag @Suzanne & Darcy te the dose. Please don’t be complacent and keep giving 1 unit. You are running the risk of Mia dropping dangerously low.

 

[Suzanne & Darcy]

I am in total agreement. Please cut your dose in half immediately. 1.6 (29) is a dangerously low number. I would be surprised if you are not seeing hypoglycemic symptoms in Mia at that number. I am seriously worried because this keeps happening. Again, your precious Mia would be much better off with an insulin that works better for cats (Lantus/glargine or ProZinc). I know it can be very overwhelming dealing with a newly diagnosed diabetic cat and dealing with vets, but you are Mia’s only advocate and, obviously, the one who loves her the most.

 

[MonicaT]

Hi @Suzanne & Darcy @Bron and Sheba (GA) @JL and Chip!

For some reason I haven't received notifications on email about your replies.

About to give her a new dose, and will be reducing again based on your recommendations. Her preshot number was 10.6 which is the lowest preshot we have had til now.

Had a vet appointment on Thursday with ultrasound and updated blood tests. Her numbers finally are going up so we were vet happy! So she got her second shot of the bone marrow stimulant, and going back again Monday to see if the numbers have continued to rise. Will discuss changing insulin then. What do I need to know in terms of switching to Lantus? Do I stick with the same dose? Every 12 hours? Could I see a spike in BG numbers because it is not as fast acting and might have to increase the dose again?

I see you have mentioned ketones, I thought ketones form when numbers are high? Can they also form when numbers are low?

Mia is eating well, she is eating approximately 160-180 grams of wet food per day, which is a good amount for her. She has never been a big eater.

 

[Suzanne & Darcy]

Great news about the bloodwork. What a relief!
In order to get notifications in your email when someone replies to your thread, touch/click on your account name MonicaT at the upper right hand corner of the screen and select preferences. You will then have an opportunity to choose your notification preferences.

 

[Bron and Sheba (GA)]

again?

I see you have mentioned ketones, I thought ketones form when numbers are high? Can they also form when numbers are low?

With a history of ketones, you always need to be vigilant. They are more likely to form if the BGs are high but if there is not enough insulin and if the cat is not eating enough they can also form, even if the BGs are lower. Always check if Mia is lethargic or unwell in any way. And I would also check as you do the swap over to the new insulin as a precaution.

 

[Suzanne & Darcy]

The insulin will still be given every 12 hours and as for the dose, we will take into consideration the current dose and how low it is taking the cat. You can start at a similar dose most likely. We can see where Mia is when you begin.

 

[MonicaT]

@

Great news about the bloodwork. What a relief!
In order to get notifications in your email when someone replies to your thread, touch/click on your account name MonicaT at the upper right hand corner of the screen and select preferences. You will then have an opportunity to choose your notification preferences.

@Suzanne & Darcy Yes we were so happy when the vet came in with the blood tests! Hopefully they have gone up even further after receiving her second dose of Epoetin Alfa on Thursday

This time I received a notification, so not sure why it works sometimes and not others.

Would you say, from Mia's history and current numbers that ProZinc vs Lantus would be just as good or is one a preferred option?

Yesterday evening I reduced the dose further to 0.075 units (0.02ml on the u100 syringe).

 

[MonicaT]

With a history of ketones, you always need to be vigilant. They are more likely to form if the BGs are high but if there is not enough insulin and if the cat is not eating enough they can also form, even if the BGs are lower. Always check if Mia is lethargic or unwell in any way. And I would also check as you do the swap over to the new insulin as a precaution.

@Bron and Sheba (GA) oh ok, didn't know that, thank you! Will definitely keep up testing for ketones regularly. Would you say 160-180 grams of wet food per day sounds ok? As mentioned, she has been a small eater her whole life and is quite a petite cat, weighs 3.8kg.

 

[JL and Chip]

Yesterday evening I reduced the dose further to 0.075 units (0.02ml on the u100 syringe).

I think you mean 0.75 units (not 0.075). The spreadsheet says 0.8u. You are correct that 0.02ml is 0.8 units of Caninsulin if using a U-100 syringe (or 1ml tuberculin syringe). Looks like you’ve got the math figured out.

I think @Bron and Sheba (GA) and @Suzanne & Darcy both suggested you go to 0.5 units. It’s easier given your insulin/syringe combo to go either 0.4u or 0.6u.

0.4 units Caninsulin —>draw to 0.01 ml on syringe
0.6 units — draw to 0.015 ml on syringe
0.8 units — draw to 0.02 ml on syringe

The recent change to a low-carb food can significantly lower BG, the lower numbers you’re seeing could, at least in part, be related to that. Please continue to keep a close eye on the BG. Going from 1u to 0.8u might not be enough of a dose decrease.

 

[Suzanne & Darcy]

@

@Suzanne & Darcy Yes we were so happy when the vet came in with the blood tests! Hopefully they have gone up even further after receiving her second dose of Epoetin Alfa on Thursday

This time I received a notification, so not sure why it works sometimes and not others.

Would you say, from Mia's history and current numbers that ProZinc vs Lantus would be just as good or is one a preferred option?

Yesterday evening I reduced the dose further to 0.075 units (0.02ml on the u100 syringe).

I would try to get the vet to prescribe Lantus if the vet is willing. If not, ProZinc will be much better than the Caninsulin.

 

[MonicaT]

Hi! @Bron and Sheba (GA) @Suzanne & Darcy @JL and Chip

So I have gotten the Lantus insulin prescription from the vet, but am told it is only available in 100unit vials. Which sounds kind of scary to me after getting used to a 40unit vial of caninsulin. How will dosing of such small doses like 0.80 units be when the strength of the new insulin is more than double?? Haven't bought it yet so still using caninsulin for now.

Also, bought new syringes today, and they look completely different to the ones I have gotten used to. So kind of nervous about that too. Can you please help with the dosing on the new syringes? Sticking to caninsulin for now, where we have reduced to 0.08 units / 0.02 on the old syringes.

 

[Suzanne & Darcy]

That’s okay about the Lantus vial. I used vials of Lantus too and not the pens that are more available now. Looks like this

 

[Suzanne & Darcy]

It will be perfectly okay. You just draw the dose out with the U-100 syringes. I hope your new syringes have half unit markings.

 

[MonicaT]

@Suzanne & Darcy

I have just spoken to another member of the forum that is also located in Malta. She uses the pen and says she extracts the insulin using syringes. She has also recommended 0.3 ml syringes to use instead of the 100u syringes in order to give more accurate/detailed doses when giving low doses like Mia is getting now. Can you confirm this is a good option?

 

[Suzanne & Darcy]

It will take about a week initially for the depot to build up in Mia — so we won’t see the full effect of the dose until about a week has passed.