old thread. do not reply. DKA / Low-Glucose / Lantus

Discussion in 'Feline Health - (Welcome & Main Forum)' started by SSSMom, Jul 8, 2020.

  1. SSSMom

    SSSMom Member

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    I posted this on fb group as well so sorry if you are reading twice.

    Hi, our cat was inpatent for dka and pancreatitis. She still has small ketones as of yesterday @ 6pm. She hasn't peed yet, so we'll check as soon as she does. We are awaiting her pancreas levels from bloodwork.

    We are doing subq fluids at home (100ml twice a day) and force feeding friskies pate

    Last night her glucose was 190 at 10:30pm so we shot 1u (our vet told us to shoot 3 (!!) bc we need to get the ketones down; her normal dose is 2u before she got sick).

    This morning at 8am her glucose was 43. We are force feeding now and will re-check glucose at 10am. I'm afraid we're not going to be able to give her any insulin if she has a super low number. We have a ReliOn meter from Walmart.

    Anyone with experience with DKA/pancreatitis and shooting lantus?
     
    Last edited: Jul 8, 2020
  2. Briere Fur Mom

    Briere Fur Mom Well-Known Member

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    Bump
     
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  3. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    What insulin are you using? What meter are you using? 46 is a take action number do you have honey? rub some on her gums or feed if she will take it. I'm not familiar with these particular issues but please post the answers to these questions it will help our experts help you
     
  4. Briere Fur Mom

    Briere Fur Mom Well-Known Member

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    What is a current BG#? I don't have personal experience with DKA/Pancreatitis but, getting that BG # up to an acceptable reading w/o overdoing it is the key here. Lemme post in the L&L forum to see if there's peeps that can help. I will also try to tag some peeps in hopes of getting some advice.
    @Deb & Wink
    @Wendy&Neko
    @Gill & George
     
  5. SSSMom

    SSSMom Member

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    Hi, I mentioned Lantus twice in my post/title :) I mentioned that we force fed her after that 43 #. We are force feeding her again now.
    We use a ReliOn meter.
     
  6. SSSMom

    SSSMom Member

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    Checking bg again now and giving mirtazipine and cerenia
     
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  7. SSSMom

    SSSMom Member

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    Thanks all. Appreciate any help.
     
  8. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    I'm sorry when I read that number I guess I got a little shook . I did see lol after I hit post you posted it lol I was even goig to suggest you add the 911 to your title :rolleyes:

    KEEP TESTING. Every 30 mins untill you see the number rising
     
  9. SSSMom

    SSSMom Member

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    I understand. I am trying to keep calm and was doing a great job until I read other peoples' panicked comments. lol.
    We are not going to test every 30 mins because she is so stressed from multiple nights of inpatient stays but are testing every 1.5h. and force feeding at the same time. She is at 80 just now.
     
  10. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    ok 80 is a good number! I totally understand the stress factor. just try to keep an eye on her if shes looking off TEST
     
  11. Briere Fur Mom

    Briere Fur Mom Well-Known Member

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    Ideally you would be testing more frequently. I totally understand your reasoning behind not testing. Totally agree with jt. Keep food in her, w/o making her vomit(very counterproductive). Test if she seems off. Good luck and I hope you get some more advice about the DKA/Pancreatitis.:bighug:
     
  12. Gill & George

    Gill & George Well-Known Member

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    When giving Subq this can make BG lower, perhaps that is a reason for the lower number and also if she is not getting as much food.

    Can you get of Schedule.
    With DKA it is important for her to get insulin, but shooting below 50 is not advisable.
    Have you got recent data available in a table, like the ss we use here on the forum? Could you link it to your signature so we can look at it?

    I cannot really offer much in the way of advice without seeing some data.

    Good to see her number coming up. Did you assist feed regular food or did you give some higher carb food or honey?
    Are you able to get of schedule? (shoot late)
    When did you give the subq fluids?
    When is she due her shot? 10 am? or have you already shot?
     
  13. JOJI and Kit

    JOJI and Kit Well-Known Member

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    i don't think wendy or deb are around at this time of day
    @Bron and Sheba (GA) may still be

    eta: ah, and while i was typing that gill and george posted ...
     
  14. SSSMom

    SSSMom Member

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    sorry guys, trying to work, watch/feed/test her, and watch/feed my special needs toddler. I don't have a spreadsheet. We test every other day to keep an eye on her. She's normally 250 right before shot time. I think she got into the dogs low fat high carb food right before her DKA because she was almost at 500. Please don't judge me. I am literally up to my eyeballs in stress and beings that rely on me. I have a high-needs dog as well and my husband is treating covid patients.

    We gave her her regular food (friskies pate). We have a supplement as well that is low calorie, but very high nutrient.

    We can shoot late. I did NOT shoot her with the newest 80 bg level. She is due at 10:30am for shot (i am in EST). We are going to feed again in an hour and recheck.

    I have honey. Should I give that to get her numbers up so I can shoot? I have thought about it, but I don't feel confident to do it unless someone has done this before. I bought some gravy based fancy feast and friskies yesterday, too.
     
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  15. SSSMom

    SSSMom Member

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    We gave the sub q fluids last night at 10pm and again today at 10am after force feeding. (she groomed herself after being ff last night and ff today so I am hopeful she is feeling a bit better. She looks great compared to 3 days ago. almost back to normal so i freakedddddd out when i saw the 43 #)
     
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  16. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    FEAR NOT! That is one thing we DO NOT DO, judge. Life happens and we know that. Heck if you werent concerned you wouldnt be here . We get it. ;):coffee:

    And yeah so did I. :oops: lol
     
  17. tiffmaxee

    tiffmaxee Well-Known Member

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    Hi. Sorry you are in this situation. If you feed her to get the bg up so you can shoot you would need to get more tests as the test would be good influenced. Feed small amounts hourly as too much food at one time with pancreatitis can make them feel rotten. I dealt with pancreatitis for a few years before diabetes but didn’t have DKA to deal with ever.

    Are you using a human or pet meter? That’s important to know before offering any more advice.
     
  18. SSSMom

    SSSMom Member

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    Thanks. We have a relion meter, a human meter from Walmart.
    What do you mean by need to get more tests? do you mean the pancreatitis test we had at the vet that we're waiting for results on? Thank you!
     
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  19. tiffmaxee

    tiffmaxee Well-Known Member

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    Good. That makes me feel a whole lot better. I used a Relion as well and Max got into the 30’s a few times without ever having a symptomatic hypo. No you don’t need more pancreatitis tests. Sorry for the confusion. I meant blood glucose tests. I would try to not feed and then test two hours from last feeding to get a true bg. I think you will be fine to shoot. When will that be? I dint know where you are. It’s 7:55 where I am.
     
  20. tiffmaxee

    tiffmaxee Well-Known Member

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    Oh and you do need to drop the dose by .25 with that 43.
     
    Last edited: Jul 8, 2020
  21. SSSMom

    SSSMom Member

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    Thank you! That makes me feel better. I was like, how can she look so great and be at 43!!??

    She just peed and it now says "trace" ketones, which is improved from last night's "small" ketones.

    We are in EST. 11:05 here. We'll do that and test 2h after we last fed her, so that'd be in an hour. I'll post her # here and would be curious to hear what you'd shoot. I assume it is going to be above her last read which was 80.

    Thanks again!
     
  22. Gill & George

    Gill & George Well-Known Member

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    The 43 is usually a reduction.
    But....
    Dose was 2u bid before dka hospitalisation. Vet suggested 3ubid, and kitty was given 1u.

    With dka in the very recent picture, mild ketones in urine, pancreatitis, inappetence, I don't think dropping the dose would be advisable.

    Inflammation/infection+ inappetence +,not enough insulin= DKA .


    That said I agree if you are going to be shooting lower than usual, you will need to monitor this evening to keep her safe. And perhaps you may need to feed some higher carb food just so you can get enough insulin into her.

    With so little data it is hard to give you some really sound and made to measure advice. With lantus we dose based on the nadir, and this is info we do not have. In the days to come it will most likely become necessary to increase the monitoring of your baby girl, at least until she is stabilised from the DKA episode.

    (There is no judgement in the above, I know how difficult it is to juggle multiple pets with health issues, I've only just got back from 2hr round trip to the vets, I joked that I was going to move town to be closer to them, I've been there that often)

    I haven't had a kitty with DKA, I will try and get some eyes on your post from those that have more experience with this.
     
  23. SSSMom

    SSSMom Member

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    Thank you. Your first line: do you think we should have given her 3u? My husband doesn't have experience with diabetes beyond his schooling, but he was like I do not feel comfortable shooting 3u of lantus since everything we've read said we only increase or by .25 units at a time. Just want to make sure I understand. I assumed that if we shot 3 instead of the 1 we gave, she'd be dead from hypo, but maybe I'm being crazy.

    I think we're going to the higher carb food next feeding. I was up with her all night last night watching her but did not feed her or wake her because I was so concerned that she literally had not slept in 3 days and felt comfortable with the 1u and the 190 bg she had before bed. I think tonight we'll do her 2u and feed thruout the night, maybe every 4 hours or so and test in between.
     
  24. tiffmaxee

    tiffmaxee Well-Known Member

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  25. Gill & George

    Gill & George Well-Known Member

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    It's hard to say.
    If I was looking at your kittties data and we could see that the 2u (her regular dose) was getting her into good numbers (ie her nadir was in the normal range) then I would have been concerned about shooting 3u of Lantus BID.
    The problem with lantus is that it is a depot insulin and as the depot fills you see the full effect of the dose, now if 3u is too much of a dose that can leave you fighting long numbers for hours. Not what you or anyone wants.

    However if the 2u of insulin prior to her DKA was seeing her in nadirs that were regularly out of the normal range, then 3u might not be such a bad call by your vet.

    At the vets they have been most likely using a fast acting insulin to bring her BG down and will have access to a glucose drip if they needed to bolster her BG, so his 3u may be based on what he would give her in the surgery, but may not be appropriate at home or with a depot insulin.

    We don't have the numbers for her nadirs so it's impossible to make a judgement call.

    With that 43 today I would not increase the dose for now, seeing as you are noting some improvement. ie ketones reducing and she seems a bit better.
    The 1u may have been a good call on your part given that 43.

    With DKA in the picture, usual dosing protocols go out the window, DKA is more scary than hypo. Though neither should be taken lightly.

    Sorry that's probably not much help
     
  26. tiffmaxee

    tiffmaxee Well-Known Member

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    My concern is it was mentioned testing often can be an issue and she’s only been testing every other day for that reason. @Gill & George
     
    Last edited: Jul 8, 2020
  27. tiffmaxee

    tiffmaxee Well-Known Member

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    When was she diagnosed? Did wait for three drops under 50 to reduce with Max but omly after failed reductions and I tested often. He also bounced a lot so it was safe.
     
  28. tiffmaxee

    tiffmaxee Well-Known Member

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    I’d call the vet and see what is suggested with your latest test results.
     
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  29. JanetNJ

    JanetNJ Well-Known Member

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    How much does your cat weigh?
     
  30. Gill & George

    Gill & George Well-Known Member

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    I've sent them a PM and sandy and BK, I know sienne is working long hours at present. Hopefully Marje and/or Wendy will be around soon.
    Yes I imagined that's what was worrying you. It makes me uncomfortable too.
     
  31. Gill & George

    Gill & George Well-Known Member

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    We have seen vets try and use/dose lantus like a fast acting insulin, that can be a problem
     
  32. SSSMom

    SSSMom Member

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    I see, thanks. I agree it's impossible to make a judgement call. We immediately used Novolin-N while we were waiting for an ER vet that had availability on the evening of the 3rd of July. All were full. We gave honey and himalayan sea salt for electrolytes too, before we were able to be seen. We got her bg down from almost 500 to 180 before she was admitted. We've done monthly curves on her and her numbers always seemed good with us and our vet. She was on 1u and we upped over the course of a few years to 2u. We moved last July so we have all new vet care. She was diagnosed in 2013 when she found me. She was living on the streets in Chicago during the polar vortex and her kitten collar was embedded in her neck and we befriended each other over the course of a few months and then she agreed to live with us in the house :)
     
  33. SSSMom

    SSSMom Member

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    This is exactly what I think is happening with us, hence why I decided to not listen to the vet. I feel more comfortable shooting Novolin every 4-5 hours (with monitoring every hour and force feeding), but I am refraining from doing that right now since we're seeing an improvement
     
  34. tiffmaxee

    tiffmaxee Well-Known Member

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    So can you test often IF needed? I’m actually hoping for a bounce. Max always bounced from the lows.
     
  35. SSSMom

    SSSMom Member

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    Her newest # was 93 1h after eating 1/4 can friskies slurried.
     
  36. SSSMom

    SSSMom Member

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    yes, I have been testing her every other day and doing curves monthly since 2013/2014 but I've never ever tested before every shot because it seemed unnecessary (I am seeing now that's not the case since she prob had underlying infection and declined very quickly over the course of 48h). I literally have zero minutes to myself a week. Like, I collapse in bed at the end of the day, and I thought I was doing better than most by testing every other day since I did curves so often and now I'm beating myself up because she's so sick.
     
  37. tiffmaxee

    tiffmaxee Well-Known Member

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    So my gut says shoot the 2 and test in an hour and go from there. But do the rest of you think?
     
  38. SSSMom

    SSSMom Member

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    9.5lbs as of Saturday night.
     
  39. SSSMom

    SSSMom Member

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    My gut is telling me to shoot 1 just to be cautious (still reeling from seeing that 43#)
     
  40. tiffmaxee

    tiffmaxee Well-Known Member

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    It’s okay. As long as you have plenty of test strips and hc and/or karro syrup. It must be hard with all you are juggling. I wish I had more info but we have to go with what we have. All those experienced seem to not be around. Lots of excitement on the board. I’ve got another that just tested 37.
     
    Last edited: Jul 8, 2020
  41. tiffmaxee

    tiffmaxee Well-Known Member

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    Any decision?
     
  42. SSSMom

    SSSMom Member

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    I shot 1.25 and will retest soon. Fingers crossed!
     
  43. tiffmaxee

    tiffmaxee Well-Known Member

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    Test an hour after you shoot. :bighug:
     
    Last edited: Jul 8, 2020
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  44. Olive & Paula

    Olive & Paula Well-Known Member

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    I don't have dka experience. But definitely understand having no time. Don't beat yourself up. We all do the best we can. If no other than at least a test before each shot. You want to make sure it's safe to give insulin.

    Now regarding fluids, be very cautious, that's a lot to give in 24 hrs. The fluids should be Lactated Ringers. If there are any heart conditions it must be conservative. Did I read correctly about giving sea salt? The salt will retain fluids making the heart and kidneys work harder. Would be better to add extra water to the food, make it a bit soupy, and cut the fluids to 100 ml per day.

    You are doing great. A important thing for you is to make sure you get some downtime even if it's 10 minutes here and there.
     
  45. SSSMom

    SSSMom Member

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    It seems like a lot to me, too, especially given that we are giving liquid with the food. I think we are going to cut back by about 25% tonight and then 1/2 it tomorrow like you are suggesting.
    Yes, we did give seasalt 2 times before we got into the ER vet for fluids and testing. We almost gave sugar free pedialyte (not my proudest moment, trust me). At the time, we thought it would be good to retain fluids and try to replenish electrolytes. I was purely terrorized. We're not doing it anymore.
     
  46. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    If would be of enormous help to see a spreadsheet. I find it difficult to offer suggestions about dose without benefit of some picture of what your kitty's numbers have been looking like.

    I would also not give salt to a cat that is struggling with DKA. Hydration is is a factor -- fluids help to dilute ketones. Salt acts to dehydrate your cat. Sodium is less of an issue with DKA than either potassium or phosphorus. Adding water to your cat's food will help. Food is also essential so I'm glad you were able to assist feed.

    I'd be careful with sugarfree products unless you're absolutely sure they aren't toxic tp cats.
     
  47. tiffmaxee

    tiffmaxee Well-Known Member

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    Yes no spreadsheet made thus even more scary. Once this crisis is over I hope you will set up a spreadsheet and signature.
     
  48. SSSMom

    SSSMom Member

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    Thanks all,
    Obviously I'm in crisis and don't have a spreadsheet. I realize it would be helpful to have one. Her ketones are now trace, so lucky for me, the mistakes I've made have not been fatal. I appreciate everyone jumping on here, but suggesting to me that I need a spreadsheet over and over is not helpful. At all. It is super stressful.

    I talked to another vet (a family member of mine) and she said she'd never ever shoot a cat with 3u and thinks that this was not even DKA and was misdiagnosed given the numbers I gave her from the last 4 days with the ketone levels. So, I'm going to go to get another opinion in person and have a few more panels run.

    Best of luck to you all of you!
     
  49. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m sorry we have offended you we have lots of cats here and mist follow our methods of dosing. Many cats need 3 or more units at some point. I would hope the vet you saw would have taken a blood ketone test. There is a good chance she was overdosed in addition.
     
  50. Olive & Paula

    Olive & Paula Well-Known Member

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    If you could get copies of the labs that have been done and post them here, Marje is great at interpreting them.
     
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  51. SSSMom

    SSSMom Member

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    Thanks. I am not offended. I just don't have time to defend what I've shared here on every post. It is exhausting. I am not saying I'm right--just sharing what I've done.
    Her bg went up to 135 so I think we're headed in the right direction. Our emergency vet records say that they detect the presence of ketones but was done via urinalysis. Same with our regular vet when she was inpatient there since Mon a.m. Level not stated. I am doing urine strips at home obviously.

    My family member vet thinks that a GI upset threw things off and unregulated her. And/or our insulin was too old (could be--we had a 100ml vial of lantus but kept it refrigerated and recently got a new vial when we ran out). She thinks we need a urine culture vs a urinalysis to see if there is bacteria that was too diluted for a urinalysis.
     
  52. tiffmaxee

    tiffmaxee Well-Known Member

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    :bighug:Those are good things to check. People don’t always read the whole thread when they see a 911 or frankly in a hurry. Just respond to what you find pertinent if you decide to stay on FDMB. I highly encourage you to do so as these emergencies often happen when only the ER is open and nobody wants to go there if possible. It’s true not all understand depot drugs like lantus. Anyhow I’m glad you aren’t offended. We are very data oriented. :bighug:
     
  53. tiffmaxee

    tiffmaxee Well-Known Member

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    One request. Would you please remove the 911 now and put it up again IF you need help? Thanks.
     
  54. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Sorry to just get here. I don’t have anything g to add right now. Without labs, there is no way to tell if she had DKA or just ketones. While ketones are a precursor to DKA, it is possible to catch the ketones before they get too high and DKA develops. Too bad the ER didn’t do serum levels...did they do any serum chemistries?

    Insofar as a vet advising 3u of insulin, while that might have been too much in this case, it is not u common for us to see cats actually needing 3u of insulin every 12 hours.

    Do you mean a 10 ml vial of Lantus? I’ve not seen a 100 ml vial of Lantus. We have found that with proper care, Lantus can be used to the last drop.

    You would normally see ketones developing if there was infection brewing so doing a culture and sensitivity on a sterile urine sample is a good idea.

    I am happy to do a spreadsheet for you although you will have to fill it in. If you can send me a private message, I can tell you what info I need from you to do the SS. Click on “Marje and Gracie” to the left and “start a conversation” to send me a PM.

    I’ll remove the 911 for you. If the BG drops again, you can put it back up if you need to.

    Also....I didn’t see this question answered for you but we don’t ever give HC food or honey to bring the BG up to a number we can shoot. If you need to use HC food or honey near shot time, you need to wait two hours to shoot to br sure it has worn off and you aren’t shooting a food-induced BG spike.
     
  55. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    135 GOOD number whew..;):coffee:
     
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  56. SSSMom

    SSSMom Member

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    Thanks for clarifying the honey thing. I was definitely confused because it seemed like it didn't make sense to combine with lantus, but would be good to use in an emergency.

    Yes, I added an extra zero--it is 10ml vial. It seems like a huge coincidence that we started a new vial three days before the emergency vet, but I have not experienced it going bad in the past (she's been on Lantus since early 2014 I believe). Though honestly I've dropped probably one a year because I have horrible fine motor skillls and usually have someone hanging on my leg when I'm drawing them up.

    I uploaded the labs I have here: https://drive.google.com/drive/folders/1IHtKWG40wI4TOVGy7PPeVLT-Oe64VRyP
    I don't expect that anyone has the patience, time or eye sight to read any of them but would most certainly appreciate any insight if anything jumps out. Unfortunately the print quality isn't great and I don't have a scanner so they're iPhone pics.

    I appreciate the offer to start a spreadsheet and will PM you later when I get off of work (if I ever do. lol. I am so behind since I've stopped 100 times to check on the cat)
     
  57. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Because thats how life is.:p
    common here:rolleyes:;):coffee:
     
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  58. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I can read the labs but I’ll have to do it a little later. How about I PM you what I need for the SS and then later today, at your convenience, you can send the info over to me? That will cut down on one step for you. Just look at your Inbox in the upper right corner and if you see a number by it, then you have a message or messages.
     
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  59. JanetNJ

    JanetNJ Well-Known Member

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    Ok. Be cafeful giving that much fluids. The rule of thumb is 10 ml per pound of weight. 200 ml for a few days is probably ok but I would reduce that to 50-75 twice a day after that. Otherwise you run the risk of it collecting around the heart. And always make sure the previous fluids have been absorbed before giving more.
     
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  60. JanetNJ

    JanetNJ Well-Known Member

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    I would go with your gut. Someone's after a hypo they can be sensitive to insulin.
     
  61. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Hi you are doing a great job! After we can see a SS and the labs we will be able to help more.

    :bighug::bighug::bighug:
     
  62. Olive & Paula

    Olive & Paula Well-Known Member

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    @SSSMom .

    Hope things are a bit better today.

    I'm no expert on labs, but we all look at them. Marje is the one to interpret for you. Some of us put results our ss tab labeled labs. It is pain in neck to do using a phone though.

    I will say the WBC are elevated so pretty sure there is infection somewhere. The SNAP test that was done is not the best it's just a yes or no result. It's abnormal so more than likely, pancreatitis is an issue. A lot of other results could be dehydration.

    Dka is a real possibility. So you want to keep him eating, treat infection and get insulin in him. If you have to give any food he will eat and dose insulin safely, accordingly. Keep hydrated.

    My Ollie is chronic p'titis so always dealing with it. I have all meds at home and can start treating immediately when it flares, it help keep it from becoming serious and requiring hospitalization.

    You mentioned early on about sugar free Pedialyte. Not necessarily a bad thing. I have no experience with it but I do know people who take in neonate orphaned kittens use original unflavored Pedialyte.

    Hang in, keep us posted.
     
    jt and trouble (GA) likes this.
  63. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    I see you have the link to the spreadsheet, but it says I need permission to look at it. We'll be able to help more once we can see that.

    If you haven't been over to our Health Links forum yet, there is some good information there, including a post on DKA, Ketones, and Blood Ketone Meters.
     
    jt and trouble (GA) likes this.
  64. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    I think your cat definitely has an infection and with the high kidney values, BUN and creatinine most likely a kidney infection Timon and not just a UTI. How’s it going today? I dint see the pancreatitis test but will look again. The SNAP test is accurate if it’s positive but if negative you dint know if it’s in the gray zone. It could be elevated just from the infection though. She needs a culture and sensitivity test and antibiotics.

    I found the test for pancreatitis and it’s very likely except that it could be so like I said from all the other values. The ALT is also quite high. Max had chronic pancreatitis and he often registered high when he had an episode.
     
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  65. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    I was able to access the labs.
     

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