New Here - Terrified and Overwhelmed

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Sally_, Jan 11, 2020.

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  1. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Hello Everyone,

    I am new to the forum and to diabetes for a beautiful little guy name Kingy. I am terrified and panicked and am having a really tough time concentrating when I read others' posts. Please do forgive me if I have not yet commented on your posts or ask something here in this introduction that is already covered or abbreviations. I did read most of the New - Start Here section and it has helped quite a bit.

    Kingy celebrated his 16th birthday in October and is also battling a thymoma and IBD. We were very recently told that the long term use of prednisone for his thymoma has brought on diabetes. He was in diabetic ketoacedosis earlier this week with blood sugar levels in the 600's. We did an IV flush and have started the glucose curve as of Tuesday night and it has been a rollercoaster.

    We were given an aggressive dose of 1.5 units of Vetsulin twice per day but then went to 1 unit twice per day since he was hypoglycemic Wednesday then getting close to it yesterday and today. Today, he went to 71, so I thought he was hypo. Vet had told me anything under 75 and that is consistent with everything so far I have read. She instructed me to give 0.5 units twice daily. If it's helpful, I will share his readings. I have been so upset and so stressed that I have not been able to sleep so I have been monitoring every hour and a half to three hours so I have good data.

    I have sooooo many fears, yes. But I also have so many questions. Practical questions. I am also very nervous because he has so many other issues going on... he just had two pancreatitis flareups along with a respiratory infection on top of IBD and the thymoma. I feel like there really isn't much room for error. Oh, arthritis too...

    Wednesday and Thursday he did beautifully with the insulin but tonight, he was a bit lethargic and I of course have freaked out. I even called the emergency veterinary group to "consult" about whether I should take him in or not since it would already be his fourth vet visit this week and he has become tired of them after the last 18 months of cancer - but maybe it was the constipation or that I administered too strong a dose of CBD or what... luckily he is more himself again (though still no BM) so I think I was just freaking out and thinking the worst. One thing the emergency vet said was that it may have been the Somogyi effect or overhydration or the constipation. He did give me a good guideline for what I should do that calmed me down - see if he does better in an hour or two then bring him in if it's not a clear yes. Kingy perked up within 20 minutes or so.

    I am just scared and I feel like I don't know how to help him. He has lost quite a notable bit of weight and the fur on his chest, chin, cheeks, and paws already and I feel like he is so fragile and, like I said, little margin for error or a learner's curve. Most of all, I want him to feel good and loved. He's so sick and I'm sure exhausted from all the visits and medications that I am so sad that this is another one on top of it.

    I don't know where to begin but I wonder about how people handle eating with insulin... unfortunately, given so many things he has going on, he has access to food all the time. We even started syringe feeding to help him keep eating this week and he started eating on his own Wed and Thurs. Less today but still a bit. He also still has to take the prednisone because it has been very dangerous for him when we've tapered him off of it. And he has to eat with that... so I am anxious that I don't know how to juggle coordinating everything so that it can be most beneficial to him as quickly as possible - I understand this will not be a quick fix, which is one of the things that worries me.

    I am sorry, I am just struggling a lot right now. Kingy lives with my mom and her partner and they have turned to me for each of his medical needs and are also overwhelmed. I have actually been staying at his place since Tuesday so I can monitor him every few hours but the stressors have really been taking a toll on the dynamic and I am overwhelmed, scared, sad, and just a mess.

    I would love some support and some info on I'm not even sure what it is I need exactly... and I am happy to share his readings. I would just like to help my little guy through all this.

    Thank you so much <3

    Sally with Kingy
     
    Last edited: Jan 13, 2020
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  2. Bekkanblue

    Bekkanblue New Member

    Joined:
    Oct 26, 2019
    Aww Sally, it sounds like you are doing very well by Kingy! Especially with all his issues. It can take a while to get an insulin dose dialed in, but the roller coaster is tiring I agree. I'm a vet tech so I see this a lot in our ICU, and have a 14yo diabetic cat myself. It sounds like you're doing a wonderful job monitoring!! As for the eating/meals, I know some people actually feed 3-4+ times a day, smaller meals, so maybe a routine like that would work well for your guy. I'm sure others will speak up who know more than I do! I was just checking in on a slow overnight shift (half my patients are diabetic tonight!), read your post and wanted to give you a big supportive 'hug'!
     
  3. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    :)Hi Sally and Kingy and welcome. I am sorry Kingy has been so ill

    • if Kingy has had keto acidosis it is really important that you make sure that he eats plenty. Try and get him to eat 1 1/2 times as much as he normally does. Food is like a medicine following DKA. Feed small meals often as well as the meal before the insulin. Both during the day and the evening at the moment. It is more important he eats any food so if he will only eat higher carb food that is ok for the moment as the most important thing is he eats, and plenty of it
    • it is also really important to test the urine for ketones daily following DKA. You can buy a bottle of Ketostix from Walmart or a pharmacy. Collect a urine sample from Kingy and dip the test strip into the urine and test exactly 15 seconds later against the colours on the side of the bottle. Anything above a trace of ketones needs vet attention.
    • It is really important that Kingy is getting enough insulin so that ketones don’t come back. I would encourage you to home test the blood glucose levels to keep him safe and to ensure you are giving the correct amount of insulin.
    • Add some water to his meals if he will allow it to add fluids.
    If he is not eating enough food, he may be nauseated from the DKA and may require an anti nausea medication such as cerenia or ondansetron. Ask the vet for them.

    I can understand how concerned you are and feel you are struggling at the moment. It is a lot to get your head around in the beginning and with DKA on top if it, it is hard.
    We have a lot of cats come here following DKA and can help you with his recovery. If you follow what I have suggested above they are the most important things to do at the moment.

    Reading through your post I am wondering if you are already home testing the BG levels??if you are that is wonderful. We have a spreadsheet that you can enter your numbers into and that will help us help you a lot. I will put the link in at the end. If you need help with it just ask.

    Keep asking lots of questions, we are happy to help. I am in Australia and am just off to bed but will be back here tomorrow and will look in to see how you and Kingy are going. . Others may come along in the meantime.
    You are doing a great job helping your Mom with Kingy:bighug:
    It will get much easier. It is hard though with the DKA added in in the beginning. This is a very support community and we are so glad to have you as part of it :)
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
    Bron
     
    Last edited: Jan 11, 2020
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  4. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Thank you Bekkanblue and Bron.

    That is very helpful information already and the hug means a lot.

    I am home testing his BG levels, yes. A spreadsheet would be very helpful. I just sent someone out to go get the Ketostrips and some A/D food and Clinicare liquid diet. I am not trying for low carbs yet, just anything to get him eating. He was eating well Wednesday and most of Thursday but not so much since then. We have been syringe feeding to supplement but it's been most for the last day or so. I am confused about the timing of eating with insulin and I think I got it wrong, which might be part of why he went low yesterday.

    He is on Cerenia already as part of his regimen for the IBD and pancreatitis. But still struggles to eat at times when he is having a flare up or issue of some kind. That tends to be his primary symptom for any of the things going on. His other medications include prednisone, omeprazole, CBD oil, and some vitamins/supplements.

    His BG levels with the reduced (1/2 unit) dose have been high and I am scared the DKA will (or has) returned so I decided to do the 1 unit when it was time for his dose this afternoon. I made an adjustment in his routine where now he gets his medication (prednisone which will raise his BG and has to be taken with food) at the same time as his insulin. His BG was at 465 and I gave him some Clinicare then his insulin then his medications and a couple bites of food. His next BG two hours later was at 433. Still very high but I think this is the part of the action where it's going down more steeply in the next few hours if I am understanding it right. He just sought out a few bites on his own and I gave him some A/D with a little bit of pumpkin. He is still quiet and low key and I don't know which of the issues is going on or if anything is emergent right now. The letter from your kitty post helped calm me down.

    I know that the last few days, he was doing very well, but his BG was generally in the 150-250 range. And I am scared he will go into DKA again and, truthfully, he is so fragile that I am worried it would be too much on his already overloaded system.

    I was also told to do 150ml of subcutaneous fluids then yesterday to do 200ml, which I was not comfortable with at all. But I did and it was not far apart in timing when he started acting all lethargic again. One of my freak outs last night was whether I overhydrated him and put his life in jeopardy. I'm already scared for today's dose of fluids and don't know how I'm going to handle it.

    I'm still scared but I'm grateful for the information so far even. I'm very happy to have found this community and appreciate the help and support for me so I can help my little guy feel his best. He deserves that.

    Thanks,
     
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  5. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Bron, I just realized you included the spreadsheet link and am looking at the instructions now but am having a hard time getting it set up. I will keep working on it.
     
  6. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Sally I am going to tag @Marje and Gracie and see if she can set up the spreadsheet for you
     
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  7. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Marje and Gracie hi Marje do you think you can help set up the spreadsheet for Sally, she is really having a tough time with her kitty Kingy. Thanks so much
     
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  8. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Sally if you can
    Put some information in your signature, so it's there at a glance. Otherwise we have to look back through a lot of posts for some basic info. Your first name, cat's name, cat's age, Dx date (diagnosis), insulin you are using, meter you are using, any concurrent medical issues, your time zone, any medications your cat gets.
    On the left, under Settings, Click on Signature.
    This is where you will put information that helps us give you feedback.
    There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc.
     
    Last edited: Jan 11, 2020
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  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to FDMB.

    I think we've all been completely overwhelmed at the beginning of this journey. It's especially the case if your kitty has other medical issues you're juggling. The piece of good news is that it will all become routine.

    With Vetsulin, it's important that you have food on board before you give an insulin injection. Vetsulin works quickly -- it has a fast onset. If Kingy's appetite is a question mark, making sure he's eaten if a prerequisite prior to shooting. You want to feed Kingy about 30 min before shot time.

    If you've not already found it, this is our beginner's guide to Vetsulin.
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Tagging @Chris & China (GA) since Marje and Gracie are not available this week.
     
  11. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Tagging @MrWorfMen's Mom to help with dosing of vetinsulin. Linda are you able to help here please? Sally is home testing, SS not up yet but will be soon. Kingy is recovering from DKA and appetite not great yet.
     
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  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Sally with the subQ fluids if you are giving 150 ml, or 200 ml (200 ml is a lot in one go) I would make sure they are 24 hours apart. Check also that the previous subQ fluid has all been absorbed before you give more.

    If you are finding Kingy is still nauseated after having the cerenia, ask the vet for a script for ondansetron. It is a human drug but works well with cats for nausea and can be given at the same time as cerenia as they work on different pathways in the body. Ondansetron can be given 8 hourly if needed. You will need to take the script to the pharmacy to be filled.
    cats are often still nauseated when recovering from DKA and need anti nausea medication for a while until it all settles down.
    How is Kingy doing today.?

    Did the vet at the ER say there was an infection or inflammation present?
    The recipe for DKA is not enough insulin, not enough food and an infection or inflammation. So it is important that the infection/ inflammation is also treated.
     
    Last edited: Jan 11, 2020
  13. Jennifer R.

    Jennifer R. Member

    Joined:
    Dec 20, 2019
    Welcome to the Feline Diabetes board. I am a newbie, so I won't try to give any advice, just sending good vibes and hoping you find your way. There is a lot of information, here and elsewhere, and it can be overwhelming.
     
    Last edited: Jan 12, 2020
    Reason for edit: Removing impertinent question that came off as rude
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  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    @Jennifer R.
    Vetsulin is actually a better insulin for a cat with DKA as it is a faster acting one and that’s what you need for DKA. Lantus which is generally a better insulin for cats is a slower long acting insulin that needs the depot to fill before you see the full effect and that is too long a time to wait for a cat with DKA.
    Hopefully when Kingy is recovered fully from DKA he will be able to swap over to a longer acting insulin.
     
  15. Jennifer R.

    Jennifer R. Member

    Joined:
    Dec 20, 2019
    That's interesting information. Thank you for the explanation, which makes perfect sense. I hope things get better soon for Kingy. He has a lot of challenges, but it sounds like he is in good hands. The people here have a lot of experience.
     
  16. Jennifer R.

    Jennifer R. Member

    Joined:
    Dec 20, 2019
    I think we have several other people with cats with IBD.
    I have a gastrointestinal disorder myself, and many of my fellow patients(EoE) also have endocrine disorders. I treat gastrointestonal with a steroid, too, called budesonide. Hopefully they will develop new treatments for these issues.
     
    Last edited: Jan 12, 2020
    Reason for edit: Removing extraneous info
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  17. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    The package insert (http://products.sanofi.us/Lantus/Lantus.html#section-16) for Lantus includes:


    INDICATIONS AND USAGE

    LANTUS is a long-acting human insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. (1)

    Limitations of Use

    Not recommended for treating diabetic ketoacidosis. (1)
     
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  18. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    I'd be happy to set it up for you....Just send me a private message by clicking on my name and choosing "start a conversation" so I can get some information from you
     
  19. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Welcome to FDMB. I'm so sorry to hear Kingy is dealing with a number of health issues but he's obviously in good hands and we can help you get through this more critical period and beyond.

    I cannot comment on dosing without seeing the readings you've been getting. I see Chris offered to set up the spreadsheet for you so don't hesitate to take that assistance. Once the spreadsheet is set up, if you can plot in the readings you've taken so far then we can take a look and see what we can suggest.

    My one question is whether you are using the VETPEN or a vial for Kingy's insulin. If you are using the VETPEN doses can only be adjusted by 0.5u and we often recommend adjustments in 0.25u increments. You can use the VETPEN somewhat like a vial with a syringe to do finer dosing but the syringes need to have 1/2 unit markings on them. Unfortunately, if you got your supplies from the vet, they usually provide full unit marked syringes only. The syringes with half unit markings can be ordered at ADW. Alternately, you can use U100 syringes with a conversion chart but I think for now till you get settled down, the U40 with half unit markings would be a better choice.
     
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  20. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Hello Everyone,

    Thank you to each and every one of you for the support and for the very helpful info! I am so incredibly grateful and very happy to say that your advice has already been helpful to Kingy!

    Chris, thank you for the help on the spreadsheet - I just sent you a message. And thank you to Deb for tagging to make that connection. I really think the spreadsheet will be very informative.

    Diane, thank you for explaining how to set up my signature and what to include I have done that so if it's not showing up, please let me know to troubleshoot.

    Bron, I am actually very nervous about giving him that amount of fluids. He was 7.1lb on Tuesday and his body condition is quite poor and seemingly very abruptly declined. While I was waiting for the 24 hours to pass, he seemed dehydrated and I was very scared it would lead to another bout of DKA or that he was in discomfort and feeling terribly while waiting. But I was scared to do that amount. He has seemed to do well when he has had between 110 and 130ml's so today, I did about 120ml. He perked up quite a bit afterwards, brightened up, and was eating better. He did not show any signs of potential overhydration thankfully... I don't feel comfortable going to 200ml's. I asked the vet on Monday about ondanestron, before we knew he had DKA. She said that she does not know if he actually is nauseous to even be taking Cerenia. She did say his pancreatitis is worse, which is inflammation unfortunately. From what I understand, other than pain medication, his usual medication regimen is in line with the treatment for pancreatitis anyway. What I don't understand is how he would be getting it now a second time in a month if he is already being treated for it routinely. After I made some adjustments to include eating 30 minutes before his injection and giving his medication just after and then followed by a smaller bit of food, Kingy has been doing better today! He was more alert and perkier, livelier overall, and his gait and general weakness were much better. He was eating quite a bit on his own at various parts of the day! This improved even more after his subQ fluids. I was so relieved and so glad to see him enjoying parts of his day instead of just laying down and hiding, looking uncomfortable! So, thank you for breaking all of that down. We were able to use one of the Ketostix today and it gave me a great deal of peace of mind. It also gave me tools for an action plan for supporting him, which contributed to his being able to enjoy the day. That means the world to me. Thank you again.

    Sienne, thanks so much for the link and info! I'm going through the Vetsulin beginners guide and the info about having Kingy eat before the injection really helped me get a better sense on how to coordinate so he can get back on track asap. That was one of the biggest worries I had, not knowing how to best juggle making sure he eats a lot for everything he has going on and the effects of the insulin.


    Jennifer, I appreciate the warm welcome and share the same for you and your kitty as well <3 My understanding is that, since the pancreas and intestines are so near to each other in both in terms of proximity and function, inflammation in one often triggers the other.

    Linda, thank you for the welcome as well and the suggestion to plot the readings. I had not thought of that but it will be very helpful to better organize all the info to get a clearer sense of what is happening for him. I use a vial and the syringes for it do half unit marks.

    Kingy was notably doing better today. He was more alert and interactive and ate on his own a number of times, I am so proud of him! He is of course still quite fragile, but he seemed much more present, comfortable, and lively. Thank goodness. His readings were very variable with one being at 505 and the lowest so far at 134. I fed him at that number so it would not go down into the hypo ranges. Unfortunately, he remains constipated since Thursday morning. What are the guidelines for that ... in other words, I keep having to get food into him, but with feeling so full already, I am worried I am going to create another set of potential problems.

    I did not know what I needed last night when I posted, just that I needed help to help my beautiful little guy. I was so relieved and so happy to discover that implementing everyone's advice has allowed him to feel a bit more like himself. I have a lot to learn but I don't feel as helpless anymore nor terrified that anything, e even asymptomatic, can happen at any time and be a crisis to pull away from.

    I look forward to getting a spreadsheet completed once or twice a day and know it will bring in a significant benefit for him! In the meantime, I have a clearer sense of the picture which always helps to make better decisions.

    Since he had perked up quite a bit, I took a few hours off to replenish my own energy in order to get him what he needs.

    Thank you again, Everyone!
     
  21. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Sally I am so pleased to read that Kingy is feeling a bit better. That is good news.
    And excellent news there were no ketones. Getting a negative result is very reassuring.

    I can see your signature perfectly.

    I think 100 - 120 mls a day is plenty subQ.

    If the vet thinks he still has pancreatitis, he could well be nauseated so I don’t think it is unreasonable to ask for more antinausea meds.

    For constipation you could try some plain mashed pumpkin. If you use canned make sure it has nothing else added. If you cook it yourself just add water to the pumpkin, cook it, drain, mash and give a teaspoon twice a day in food. Add more if needed. Put left over pumpkin into an ice cube tray, freeze then bag and use as needed.

    please keep us updated with Kingys progress. Please give him a cuddle from me. And ask as many questions as you want. Bron.
     
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  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I too am delighted to hear that Kingy is feeling a little better and eating some on his own. Take this one day at a time and keep asking questions and soon you'll develop a routine that works for both you and Kingy. Please keep us posted.
     
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  23. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Sally it's so great to hear that Kingy is feeling better, will keep sending good vibes for him. Do you have a picture of him
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hope some of your fears have been lessened and some of your questions answered.

    Please, take care of yourself during this time. Hugs for you.:bighug::bighug::bighug: Glad to see you said you were taking some down time.

    When you feel ready to, you might want to go back through all the posts here and read things again. So much information was covered that a review would be good. Maybe even reading things twice.

    Let us know when or if you have more questions.

    I see that Kingy is actually your moms cat and you have been living at your moms temporarily. Is that correct?
     
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  25. Jennifer R.

    Jennifer R. Member

    Joined:
    Dec 20, 2019
    Glad Kingy is feeling better. That's interesting about the overlap. I hope Kingy continues to feel better.
     
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  26. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Thank you so much, Bron, Diane, Linda, Deb, and Jennifer! Chris has set up the spreadsheet for me and I will fill it in asap - a huge thanks again for that!

    I have a question in the meantime... Kingy's pre-shot today was at 546 and within 2 hours dropped to 146. Since it was going so fast, I gave him a snack and two hours later, it was was 310. Two hours after that it was 435 and the next 2 hours was 505. I am getting anxious because it is quite high and it's still in the rising stage with a few hours left to go before the next injection (at least 3 or 4 hours). I don't know what to do in the meantime... Should I give the shot early? I am not sure how to handle this part and any thoughts would be very helpful.

    You guys have already given me so much information that Kingy's significant improvement is attributable to you and that means the world to me!

    Deb, Kingy lives with my mom and her partner. He stayed with me for about 8 months a few years ago so he is "mine" in my heart but they're his pet parents. I was staying at their place for a few days after we found out he was in DKA because they didn't know how to help him and thought it was how he was always going to be and didn't want him to have a life of suffering, especially with all his other health issues. I did not know too many details, but I know of MANY cats living with diabetes having a happy, fun life filled with love. So I stayed to help get him back on track and to get the glucose curve readings. Unfortunately they drive me insane normally and the added stress made for a long week that I am sure no one benefited from. I managed to come home and get some food (I couldn't eat through most of Tuesday through yesterday) and some sleep. Kingy was doing better so it was a good opportunity to just replenish.

    Right now I am scared of this rising to 505 already when he has another few hours left till the shot and will be filling in the spreadsheet...

    Diane... thank you for asking for pics of him! He is a beautiful guy. I have updated my profile pic to one of him and will try to figure out the upload link to share a few for everyone. He is a beautiful boy inside and out. I told him he has a wonderful community helping me figure out how to help him while I gave him a cuddle from Bron.

    Back in a bit with spreadsheet data and hopefully a report of a lower BG level...

    Thank you all again!
     
    Last edited: Jan 12, 2020
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  27. Sally_

    Sally_ New Member

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    Jan 8, 2020
  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Sally
    Oh my goodness he is adorable!!
    No don’t give the insulin sooner than it is due. Kingy is probably bouncing from that fast big drop from 546 to 146 in 2 hours. Good job giving him a snack. Next time try giving him a snack at +1 to try and slow the drop.
    Bounces can last from 1 to 6 cycles and there is nothing you can do but wait them out. Bounces happen when the BG drop too fast , too low or lower numbers than kitty is used to. Then his body dumps glucose and regulatory hormones into his system to ‘save’ himself.

    Once we can see all the data on the SS we will be able to help more and suggest things.
     
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  29. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Hello Bron,

    Thank you, he is a sweetheart! Thanks for that information... is bounce the same thing as the Somogyi effect I was reading about? It makes sense... Does 1 to 6 cycles mean 1-6 of the 12 hour periods the insulin lasts or the 2 hour windows of time we test? I am working on the spreadsheet now, going through instructions on how to fill it in.

    His Ketostix today were negative too, I was very proud of him! He also walked down the stairs by himself after the 435 BG level - he hadn't done that in a few weeks!

    Thanks again,
    Sally
     
    Last edited: Jan 12, 2020
  30. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    He looks a real sweetheart! One you want to pick up and cuddle!! He looks like he likes having his photo taken! And I’m so glad his walking is improving.

    And excellent no ketones. When you get your SS up and running can you pop the results of each ketone test into the remarks column please as well.

    The Somogyi effect has never been proved in cats. It was first mentioned by a man named Somogyi in humans many years ago.
    Bouncing can last 1 to 6 12 hour cycles. Some cats are bouncier than others. A lot of cats bounce in the beginning. Some only for one cycle, others more. Some stop after a while and others bounce all the way to remission.
     
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  31. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  32. Bekkanblue

    Bekkanblue New Member

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    Oct 26, 2019
    I'm so glad Kingy is doing better, and he is totally adorable!
     
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  33. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Thank you for the links... I am trying to better understand everything he is experiencing so the more information I have, the better I can help him.

    In going through the spreadsheet, I realize my data is not as clear as I had hoped but it helps me better plan my testing so I can have productive data. I am updating it to my signature now... there were a few things that did not line up exactly with the SS so I explained them in the remarks for that day. I am happy to clarify if they do not make sense, I do apologize if that complicates things.

    His injection is coming due in the next hour so I am relieved that it will help lower his BG... being that high that can't feel great and it has me nervous that the ketones will come back. But I am going to test him, feed him, wait 300 minutes, then do the injection, feed him at +1...

    And thank you - he loves to cuddle and be held ...and yes, he does pose and enjoy being admired. Sweetest boy!
     
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  34. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Sally_ oh Sally he is such an adorable little fluff ball. He looks so regal. You are doing a wonderful job caring for him. He is such a lucky boy to have you.Looking forward to hear more about Kingy. The pics are just too cute
     
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  35. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    I think you meant 30 minutes....LOL

    On your spreadsheet, it might be clearer if you put all the text that you put in the first line (in the +1 cell) over on the far right in the "remarks"....right now we have to scroll forever to get to the first real entry.

    If you need me to, I can do it for you....just let me know.

    I'd sure like to see you using a better insulin. The Vetsulin is sure hitting him hard and fast which just sets him off on a huge bounce. With Vetsulin, we hope they'll drop about half (compared to the PS) ….so like if his PS was 300, we'd look for his nadir to be about 150'ish.

    By dropping so quickly and so much, he'll keep bouncing high again.
     
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  36. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Thank you, Bekkanblue and Diane. He is an amazing little guy, very inspirational as well - to still be a happy and sweet guy with everything he's been through, is just beautiful to me <3

    Thanks, Chris - I edited the spreadsheet to put my comment in the remarks... and I did mean 30 minutes, lol, thanks for catching that.

    I had asked about Lantus but vet brushed it off and said she likes this one and that she doesn't even carry Lantus. Larry's comment earlier mentioned that Vetsulin is fast acting and may have been better with the DKA going on. I have not asked the vet because I did not know that until I read it here and her office is closed until Monday.

    We just had the +1 snack and test but I'm getting nervous because it was a 200 point drop in the first hour and I worry that he might bounce again or go too low so I'm scared now and want to go feed him more. Am I being overly reactive or is it reasonable to be concerned about a 200 point drop in the first hour? I also did a 1/2 unit shot given the big drops today. Vet had recommended that on Friday but I told her I was not feeding him before the shots and that most of his food was during the rising part of the insulin action so I wanted to try again with the 1unit making the adjustments for food intake. Her response was to ask what his BG was at +4.

    Kingy is enjoying his night, he was sitting on his dad's lap, one of his favorite things to do, and popping in and out of his heated condo to play with his fountain and drink more water. I am very proud of him.

    We have been giving him a lot of pumpkin (along with coconut oil and olive oil mixed in with his food) but still no BM and I'm getting more concerned about it but also concerned about him continuing to eat with that going on. I have mentioned it to the vet but she still has not responded about it.

    Bron, the info on Somogyi vs. bounce was very helpful, thank you again. I also scrolled up to review some earlier information and, now that I am calmer, I realized you mentioned that you are in Australia. I hope you and your loved ones are safe with the wildfires.

    One other question about the spreadsheet... if I have a test at a half hour point, for example +1.5, is it best to log it under +1 or +2?

    Another question I have may not be as urgent right now, but I wondered how I would safely go about changing the timing of his insulin doses. When we heard about the DKA last week, I left work and canceled out the rest of the week to stay with him and get him back on track. I go back to work tomorrow evening and, at the moment, his doses are at 2pm and 2am. I don't mind the late night, but I will be at work for the few hours after the AMPS and will not be able to test. When I asked the vet, she said I don't have to monitor him and that 99% of her diabetic patients don't even do home testing. I would like to monitor his responses, especially with his bouncing, so I would like to see if I can move his doses to be at 9am/9pm or 10am/10pm. Is there a safe way to do that without risking DKA coming back?

    Thanks so much again, everyone. I have been so grateful for the practical and emotional support here and incredibly relieved that I have some data and tools that have been helping him feel better. He is a happier boy thanks to each of you.
     
    Last edited: Jan 13, 2020
  37. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Sally
    The SS looks great and lots of information in the remarks column. Looks much better there.
    I agree with Chris that lantus is a much better insulin for Kingy once he gets past the ketones. It is a longer acting and gentler insulin and very suitable for cats. Vetsulin is really an insulin for dogs but because it is a faster acting insulin it is better for Kingy while the ketones are hanging around. I would ask your vet to swap over to Lantus but leave it a week or two.

    If you test at say +1.5 you record in the SS in the +1 column... eg 304@+1.5 and stack it under the +1 number if you have one recorded.
    If it’s +6.5 you write eg 220@+6.5 and put it in the +6 column.

    ALWAYS feed Kingy a good amount before every shot and wait 30 mins before giving the insulin. This is because Vetsulin hits hard and fast and you need food aboard to counteract the drop. It is fine to feed again at +1 or when you think he needs it but always give that good meal before the Vetsulin. 200 is a very big drop at +1 but if you are not feeding him before the shot, this is why.

    How many days since he has had his bowels opened?

    Yes thank you we are safe from the fires where I live but very saddened by all the loss of lives, property and the dreadful loss of farm animals and wild life. It is just too terrible.

    I am going to tag @MrWorfMen's Mom to answer your question about changing the times for shooting. Yes it is possible to do that but I have never used Vetsulin so I am not sure of how they do the swap over.... if it is the same as Lantus or not.
    I’m glad that sweet boy is happier. We just need a poop now Kingy!
     
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  38. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    We are very proud of you and all you are doing to help your mom's cat. Even if it does stress you out. Deep breathing exercises work for me to help with the stress.

    With Vetsulin lasting only 12 hours or so, and it looks like even less for Kingy, changing the shot time should be simpler than with Lantus users. But some questions for you, since the recent DKA makes it more complicated.

    Is Kingy past the DKA issues? Eating well? No ketones? Still on some medications? You are still checking everyday for ketones so please keep doing that.
    Are your parents home testing or are you the only one doing that right now? (They should learn if at all possible, but let's leave that for another time.)

    Possibilities for moving the shot time when you are using Vetsulin.
    1. You could skip a dose and then start up at your new preferred shot time with the next cycle. It would be like with a 'fur shot' where the insulin did not get into your cat, or you don't know how much got into your cat (Never give a second shot in the same 12 hour cycle if you thing you may have missed)
    2. Reduce the dose to 0.25 U for this AM and then pickup again with your 0.5U dose in the PM cycle.

    I have NOT used Vetsulin personally for a cat. I have used NPH insulins for 2 cats. The NPH insulins drop the BG's even faster and harsher than Vetsulin does and have an even shorter duration. For NPH type insulins, we'd have the person skip the shot if they wanted to change the shot time. No "depot" effect like there is with lantus/levimir and very little if any carryover with Vetsulin. I certainly don't see the Vetsulin lasting much past +9 on Kingy's SS.

    I'd really like for other people to weigh in on those suggestions before you do that though. Not too many people signed on right now. @Bron and Sheba (GA) has already tagged someone else for you. Bron isn't it Tuesday wee hours of the morning where you are?

    Kind of concerned myself that your Kingy has not had a bowel movement in several days. Could he be going outside of the box somewhere and your mom and partner are not finding it? May need an enema at the vet. Sometimes when a cat has not had a bowel movement, the vet sticks their finger up the cats butt and Voila!, poop comes out. Or you could try sticking your finger up Kingy's butt to feel if it's impacted and maybe get the same "instant pooping" reaction. He won't like it and it can be messy, so be forewarned.

    You can get a prescription from your vet and buy the lantus at a human pharmacy. Or order it from Canada as Chris and China will tell you. Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies Until the DKA is completely resolved, no more ketones, I think it's too soon to switch to lantus.
     
    Last edited: Jan 13, 2020
    Sally_ likes this.
  39. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Sally, your signature says you are using an Accutrak 2 meter. Did you mean the pet meter an Alphatrak 2? Your SS says Alphatrak (pet meter)
     
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  40. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Bron, I am glad to hear you are safe, though it certainly has been very devastating and I cannot imagine not feeling saddened by it.

    Thanks for clarifying about logging the half hours in the SS. I will do that moving forward since I noticed I had a lot of my tests in that range. Tonight, I fed him 30 minutes before his insulin and there was still that 200 drop in +1 so I fed him again at both +1 and +2. His +2 was another 112 decrease to be at 212 from 526 so I am a little anxious. This was with the 1/2 unit dose as well so I am glad I did not give the 1 unit dose. He was eating on his own as well both before the insulin and at +1. A good amount of food would be what a kitty normally eats in a meal? His eating has been variable but I try to replicate what would be eaten by a healthy cat during a regular mealtime. I also organized his medication to be around the same time as that PS meal so the prednisone BG effects can be counteracted (since vet said it raises BG) and it might be more glucose for the Vetsulin to work with.

    He has not given us a "royal deposit" in the litter box since Thursday morning. I noticed him straining to try on Friday morning and started him on olive and coconut oils mixed in with his food and the pumpkin on Saturday. He has not been trying to since Friday either. I mentioned it to both his vet and the emergency vet I called but his vet had not responded about the issue (she commented about something else) and the emergency vet said give it a bit more time. Today I made everyone make a big deal about it and they gave us Lactulose - but I see that that takes 48 hours AND is contraindicated for diabetic cats! So I made them bring him in and the poor guy threw up and only had a small BM. They said he should go by tomorrow. I'm still pretty upset about it.

    Deb, I keep writing the Accu Trak but it is the pet one, Alpha Trak. Sorry about that, I don't know why I keep doing that, but thank you for catching it. Yes, I am the only one doing the home testing (yup, I agree with you. Sigh) for now and your input on how to change the time has helped me figure out how to approach it. You must be very brave - I would be so terrified of an insulin that drops even faster and harder than what Kingy has right now. Vet took his urine today to make sure the DKA is gone but she never gave us any medications. I don't know if what would normally be given is what he is already on though (prednisone, omeprazole, Cerenia, subQ fluids, and some vitamins). He has been eating well in spite of the constipation (which had me worried) and his ketostix are still coming up negative.

    I did try and see if I could put my finger in there to try and help him but when I looked, I didn't think I could safely do it. And he must be very sore already from trying to strain all morning. We have been watching him almost nonstop (cats love that lol) so I doubt that he has gone outside of his box, especially since he was straining very hard today and Friday when I noticed it at all.

    I like the idea of a gentler and longer acting insulin for him - it sounds like it would be a more gradual drop but more sustained throughout the duration of the action if I am understanding that right? And keeping the ketones away is a priority right now so I will ask where I can get it for him in another week or two. Thank you both, that is very reassuring. I did not want to keep making him eat more than was comfortable today so I skipped his next insulin dose and will give when I get out of work in a few hours. I'm worried about that too but I did not want to risk a megacolon or something like that that would require a surgery or something.

    After his shot last night, he was doing great - was very active and eating a lot and drinking water and looked really comfortable. I will update with how he is doing when I go see him in a few hours. I was showing him the thread and letting him know that a lot of kind people care about him and his wellbeing <3
     
  41. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Sally
    What dose of insulin did you skip? I can’t figure it out looking at the SS.
    It isn’t a great idea to skip doses with DKA in the recent past. Are you planning to bring the dose forward to suit you better or did you just skip and are planning on staying with the same times?

    He is certainly having big drops fast, then bouncing up high. Maybe try getting some higher carb food and feeding it at shot times to see if that slows the drop. Maybe some around 10 or 12%..wet food.
    Hopefully once he gets onto Lantus the big drops will stop.

    Hopefully he will have a BM soon.
     
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  42. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'm glad to see you reduced the dose to 0.5u following that reading of 71 the other day but I would continue with the 0.5u or at most 0.75u (if you are using syringes and a vial rather than the Vetpen). The 71 was a safe reading but you don't want Kingy going any lower than that on Vetsulin because of the swift steep drops in BG it causes. Normally I would have suggested immediately reducing the dose at that point in time to 0.75u.

    Kingy is dropping early and dramatically which is setting off a lot of bouncing. I think lowering the dose might help but also a change to Lantus should make the drops a little less dramatic.
     
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  43. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Hello Bron, the skipped dose is delayed in giving. I apologize, poor choice of words on my part. I was getting worried about giving so much more food than he is recently used to eating when he hadn't had a BM over a few days and, when I heard he was going to see the vet for it, I thought to wait till after that. I was anticipating a relief for him but it did not happen that way. He got his injection 2 hours ago and I am planning his next dose 12 hours from it... unless that is ill-advised! He again had a big drop at +2, going from 534 to 200 and this was with a meal 30 minutes before and then again at +1.

    I have been giving him a mix of the Clinicare (25% carb), A/D (also 25% carb), pumpkin, and one of his favorite foods (both of which happen to be higher carb loaded) mixed with water. Perhaps it is the amount of food I am giving that needs to be adjusted? I don't mean to split hairs, just trying to make sure I am doing what will be helpful for him, but what would be an appropriate amount of food to give? I try to replicate what a healthy cat would have at a meal, which is a bit more than what he would normally eat. I also give his medication at that time to help have something for the Vetsulin to work with, especially since his prednisone will raise his BG.

    Hello Linda, thank you for the feedback. I am using a syringe, yes. I apologize, I missed that that was asked earlier. My syringe does not have a marking for .75u and I did not want to eyeball it because that small an amount, even a slight error can translate to a big impact... but I was wishing I could go to .75u. Are there syringes with that marking I could pick up at a pharmacy or somewhere that would be appropriate for insulin?

    Tonight, he is not at all happy and very uncomfortable and depressed. The vet visit was really unpleasant for him and I don't blame him. But he has been miserable since and it unfortunately did not yield a helpful outcome for him. So we will probably have to do the same tomorrow. Poor guy. I am so sad to see him so uncomfortable and unhappy and to hassle him when he is like that to make him bleed makes me sad. I know I am pricking him to help him but I guess I am just sad that he is so sick. I am staying with him tonight though to comfort him through the night after such a long day and a long week. I will probably feed him again during the hour between +2 and +3 because I am scared of the dropping action.

    Thank you again for the feedback and help. Tonight is a really hard night.
     
  44. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    When you write the insulin dose in can you put in the SS column (PMPS or AMPS) not sure which one it was for you. ... that you gave it at +14 or +16 or whatever the time was since the previous injection was given. Do you know what I mean?
    So the insulin doses after that will be 12 hours apart. Will that help you with your timing that you were wanting to move to.?

    So you are already giving him higher carb food to eat... is that all the time or just at shot time?
    Remember that with DKA in recent past he needs extra food/ extra calories.

    I’m going to ask @MrWorfMen's Mom to look in again about the dose / food/ carbs because if you are giving 25% carbs and Kingy is still having those huge drops in the first hour she may have other suggestions.

    Is the SS up to date?
     
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  45. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Yes, the spreadsheet is up to date but I will add the adjusted time that you suggested - I do know what you mean with that notation. I am about to do his +4 so that will be in there in a few minutes as well. The timing change helps, yes.

    I have been giving him 1.5 times as much food as he was eating before and he still (except today) eats on his own. The shot time meals are the carb heavy ones. Once it was explained here for me, it made sense to front load those during that time. He also gets A/D one other time in the day with my mom and we have not made an adjustment to low carb foods at all yet.
     
  46. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I think a change to low carb food and Lantus (when the time is right) will make a big difference with Kingy’s BG levels.
    He’s come a long way in just over a week since DKA. A lot of post DKA kitties are still nauseated and are having trouble eating at this stage.

    Have a look around for suitable low carb food for him to eat which will be compatible with his IBD so you have some on hand for the changeover.
     
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  47. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Thank you. There are some that he loves already and I reach for those when he is in the higher ranges. I'll start the research for what would work with IBD and low carb.

    Should I keep the higher carbs that he is currently getting PS?

    I am very proud of him, he is a warrior! He has been through a lot in the recent weeks and especially this week. I am sad to hear about a lot of the other DKA kitties still struggling though I am incredibly relieved he has been doing so well overall since. How long does it usually take for a full recovery? Can the constipation be related?
     
  48. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I would keep the higher carbs for PS at the moment and the +1. Once he moves over to Lantus you should be able to gradually change over to normal low carb.

    I doubt the constipation is related to DKA as far as I am aware. I’m sure someone will correct me if I’m wrong.

    Recovery from DKA depends on many things... the cat, how bad the DKA was, if their other blood work is stable, how much they are managing to eat on their own, any recurrence of ketones.. Some cats have to be tube fed for a week or two.

    The main issues I see for Kingy at the moment are the constipation which needs to be resolved and doing the swap over to Lantus (at a suitable time) which hopefully will help with the erratic BGLevels.

    Keep testing daily for ketones. That is really important.
    You are doing a really good job looking after Kingy. He’s lucky to have you in his corner.
     
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  49. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Thank you. I am just happy that he is here to look after and mostly doing well. And frankly, I would be lost without the guidance here so he is lucky to have this wonderful community. We are still on the BM watch - will update on that.
     
  50. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You can try the 0.10 dose and see how that works. It gets tough when they end up with pre-shots that are too low to shoot but as Bron mentioned, getting Kingy on a low carb only diet might just get you over the hump and help get number down across both cycles.
     
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  51. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    The 0.10 dose?
     
  52. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You want to draw up insulin so that the black stopper on the plunger is just below the Zero line on the syringe (the very top wider line closest to needle).
     
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  53. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Hello Sally! I just wanted to say that Kingy is beautiful, and you are taking such good care of him. Once he gets past the constipation, I think you'll see how much better he's feeling already.
     
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  54. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    That may not be applicable to all syringes. I have some syringes where with the plunger all the way depressed the end of the plunger is ~0.2 units below the zero mark and sme as high as ~0.2 units above the zero mark. I eyeball very low doses by how far the plunger is moved. The key is consistency in doses, not the absolute dose.
     
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  55. Dusty Bones

    Dusty Bones Member

    Joined:
    Oct 20, 2013
    Hi, beautiful kitty! Have you tried Miralax mixed in with his food? About 1/8 tablespoon should do the trick to get his poop moving. It's perfectly safe and used on Dusty all the time.
     
    Last edited: Jan 14, 2020
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  56. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I agree Larry but the point is to skinny up the dose she's been giving so while we won't know if it's 0.10u or 0.2u, it will be less than what has been given before. The marking on the syringes aren't consistent even in the same box sometimes so unless one uses calipers, it's tough.

    I was in a hurry last night and should have suggested drawing up what Juls perceives to be the 0.10u using coloured water in a used syringe and using it for comparison to keep the dose consistent because as you said, consistency is more important than absolute accuracy.
     
  57. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Hello Everyone,

    I wanted to share some of Kingy's triumphs and updates! Vet said that, based on his U/A from Monday, the DKA is resolved! We are so happy about that! He had another assist with the constipation today so that has improved, but is not 100% just yet. We have added Miralax and Lactulose. I was hesitant about the Lactulose because I see it is contraindicated in diabetic cats, but vet said we can correct for it as we go. Poor Kingy also has a UTI so that might be part of why he wasn't even trying for his litter box. He got a shot of Convenia for that.

    We had our first furshot today, too. So, unfortunately, my data for today is not very helpful. Now that the DKA is resolved, is it too early to ask for the Lantus or should I still wait another week or two for that? I have also started looking at some of the low carb food lists. His food before the cancer was low carb so I hope it can be an easier switch. After that, he wasn't eating much so we tried to entice him with whatever junk food he was willing to eat.

    Thank you for the kind compliment, Juls and Dusty! Miralax was added today.

    Linda, thank you for the clarification about the dosing - I will make that change with his next shot. My syringes don't have that marking so the descriptor you and Larry provided was helpful.

    I will update once that dose is due.

    Thanks again, everyone <3
     
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  58. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I am sorry Kingy has a UTI. The convenia shot is not the best antibiotic for a UTI in my opinion. An oral a/b such as clavamox would have been better. Did the vet send off the urine sample for testing to see which antibiotic it was sensitive to do you know?

    You will need to test daily for ketones still, particularly now he has a UTI and with the fur shot today. Even though the DKA has resolved Kingy can still be prone to getting ketones at the moment.
    Fur shots happen to everyone so don’t stress about it but do test for ketones.

    I have asked a couple of others people about changing over to Lantus/when is a good time and will get back to you on that. In the meantime I would speak to the vet about lantus and get it lined up.
    I’m glad the constipation is resolving.
     
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  59. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Thank you for asking, Bron. I will be sure to keep testing for ketones - that way, there is early detection while he's still at risk. Yes, the urine sample was sent for a culture but did not give any results yet. I think we go back to the vet on Friday so I will ask about the culture results and see if we can get him on a better a/b.
     
  60. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Convenia lasts for 2 weeks so the vet probably won’t give you another at this point.
    Can you ask about the Lantus as well ?
    Still loving the steep slippery slide I see.
     
  61. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    I absolutely will ask about the Lantus. Will it be an appropriate time to make the switch?

    Yes, and his slides are with being fed before and after injection as well as at hour 1... I really look forward to the Lantus soon.
     
  62. Dusty Bones

    Dusty Bones Member

    Joined:
    Oct 20, 2013
    Any luck with the poop?
     
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  63. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Hello Everyone,

    I'm sorry I have been MIA, my mother was in the hospital and I was spread really thin and an incoherent mess. She is home now, luckily. I have felt so horribly about not giving an update sooner but have good new...

    Kingy has been doing very well in a lot of ways!

    He did start giving us BM's and has been mostly regular with that, thankfully. His BG levels have also mostly been in the high 100 and low to mid 200 ranges and he hasn't needed his insulin injections. I was shocked by that! But the vet said he could be going into remission and reaffirmed not to give it to him if he's not over 300. I don't really know if I am convinced that in the same month as DKA it would possible for him to go into remission, but I am glad that he has had stable BG levels and that they are low enough that he is not at risk for ketones right now. Still, I have been checking his Ketostix and they continue to be negative daily as well as his BG levels a few times a day.

    If he really has gone into remission, I have all of you to thank. I could not have helped him in any way without every single one of you.

    However, this didn't happen before diabetic neuropathy started to set in... he was weak in the back legs but also shaking his front paws, which really bothered everyone. Vet said to try gabapentin, against my better judgment, which made him a zombie even at the lowest possible dose. We took him off that after a day and that was the day he needed insulin again. But I was reading about high doses of methyl B12 and started him on that. He seems to be responding to that but is still not really moving much and today is acting like he does when he has GI upset. It made me wonder whether B12 supplements can be an irritant to the stomach, especially with his IBD. I was also reading that topical CBD oil can help and I started that too.

    Does anyone know if oral B12 supplements can be irritating to the GI system? I've been giving high doses since it's nontoxic, but it makes me wonder if it's bothering his already sensitive stomach and intestines. Is there anything else I can do for the neuropathy in the meantime?

    Thank you all so much. I have been so grateful and touched by the kindness and helpful support from this group that it has helped me get through an insane few weeks.

    Thanks,
    Sally with Kingy
     
  64. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    What type of B-12 are you giving?

    I totally disagree with your vet. 300 is too high and as long as he's running that high, the chances of getting his neuropathy under control is pretty much nil. The most important thing to do to give him the best chance is to get his blood glucose numbers down into a more normal range.

    I'd strongly suggest you find a vet that will give you a better insulin like Lantus, Basaglar, Levemir or ProZinc. Vetsulin is more of a dog insulin. It tends to hit cats hard and fast and then wear off before the next shot it due.

    A normal cat's BG should be between 68 and about 150 (on the AlphaTrak). At those levels, not only can the pancreas possibly heal and resume working (true remission) but the nerves in his legs that are being destroyed by the high glucose levels can start to repair themselves.
     
  65. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    Hi Chris - The oral B12 is methylcobalamin and his injections are cyanocobalim. He's been on both for about a year and a half but I increased the oral ones, the methylcobalamin. I actually want to change his injection also to the methylcobalamin but it's been hard to find.

    I am glad you shared all of that information, I thought I was supposed to get him in the 150-250 range and always under 300. He has been clustering mostly around the 150 range but has not had readings over 225 in awhile, except for the day with gabapentin. Hitting him hard and fast and then wearing off was exactly what was happening for him with Vetsulin. I asked vet for Lantus twice and she said she will give us a script for it but to wait another few weeks first given how recent the DKA was. But I didn't know he was supposed to be in the 68-150 range at that time so I didn't ask her what to do in the meantime. Kingy's parents are scared to change the vet (everyone else they went to kept saying to euthanize him a few months ago when he had the pancreatitis flare up because they thought it was his cancer progression, but imaging showed otherwise) but I will keep looking and see if I can call it a "second opinion" of sorts.

    If his BG is to be in the 68-150 range, when should I be giving him insulin? I'm scared to give it when it's at 300 because of how far it dips so quickly. When he had the gabapentin, he went from 300 to 88 in two hours and that was with me feeding 30 min before, at injection, and an hour after. I guess that's where the Lantus comes into play, it works differently. I will reach out to another vet I used to work with with my cat (I lost her in April after an 18 month battle with kidney disease) tomorrow to see about Lantus and see if she is aware of the right ranges.
     
  66. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Do you have test strips to test the urine for glucose? These are different from the test strips for checking ketones. Some urine test strips check for both.

    A BG of 300 is too high not to give insulin.
    A BG in the 200's is too high not to give insulin.
    BG spilling into the urine means there is too much glucose in the blood stream and kidneys are filtering it out.

    With DKA in Kingy's past history, not giving insulin is risky. (Another DKA episode)

    You might try a very tiny dose of the Vetsulin, such as 0.1U (not 1.0U) if you are around to monitor and BG test. Until you can get a better insulin from your vet. (NOT the NPH type insulins like Novolin or Humulin, as those are awful for cats.)
    Prozinc, Lantus, Levimir are the better insulins for cats. Get the Lantus in the insulin "pen" or mini vial.

    There are regulated BG ranges and then there are normal BG ranges. Excerpt for you from this document.
    What is Regulation?
    • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
    • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
    • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
    • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
    • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
    • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
    Hope your mother is more back to being her usual self and doing better after her hospital stay. That must have been such a worry to you.
     
  67. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Info for you on smaller doses.

    Fine dose gradations:
    • 0.5U = exactly half a unit
    • 0.4U = skinny 0.5 touching the line
    • 0.3U = skinny 0.5 with daylight under the line
    • 0.2U = fat zero with daylight over the line
    • 0.1U = fat zero barely touching the line
    Pictorial guide using a U-100 syringe marked with half units:

    [​IMG]
    [​IMG]
    [​IMG]
     
  68. Sally_

    Sally_ New Member

    Joined:
    Jan 8, 2020
    It is with the deepest sadness and joyous relief that I share the passing of my precious Kingy this afternoon at 3:33 - angel numbers. His unflagging spirit and warrior strength was an inspiration and he has been a gift in the lives of all he touched. Fly whole and free, my beautiful boy! Your Queen welcomes you home!
     
  69. Kerri & Tigger

    Kerri & Tigger Member

    Joined:
    Dec 17, 2019
    What a lucky kitty to have known such loving care. Wishing you peace and precious memories.
     
  70. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Oh Sally I am so so sorry to hear about Kingy. My heart is breaking for you right now. You took so good care of him and I'm sure he knew it. I am looking at his pictures again and I am so heartbroken for you and your mom. He is no longer suffering and is probably romping around like a little kitten again. May I asked what happened
    Fly high sweet Kingy cat_wings>o
     
  71. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Many hugs, Sally.
     
  72. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    So sorry to hear about Kingy. His pictures are very handsome and reading your posts you did an awesome job of being his mom. It's never easy to see them go. Those darn little furballs weasel their way into our hearts. :bighug:
     
  73. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Lighting a ring of candles in memory of your beloved cat Kingy.

    candle.jpg
     
  74. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Sally, I am. SO sorry to read that Kingy has passed away. Such a shock to read this.
    You looked after him so well
    Fly free sweet Kingy and lamd softly at the rainbow bridge:rb_icon:cat_wings>o
     
  75. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
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