Post Ketoacidosis ( BG levels increasing after insulin shot)

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Gabriel16, Jan 18, 2022.

  1. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi everyone,
    My cat was in ketoacidosis two weeks ago and we started treatment with insulin as recommended by the vet.
    The dosage we give him is twice a day, two IU of Lantus insulin.
    At the morning usualy the response is good and the sugar levels drop to some normal level, it starts rising again close to 12 hours after the first insulin shot.
    The second insulin shot with 2 IU, we give him 12 hours after the first one, but this seems to have no effect. Instead of decreasing the blood sugar level starts increasing dramatically over 33 mmol/L.
    Any advice is much appreciated.
     
  2. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.


    Are you home testing?
    I'm going to tag a few members concerning ketoacidosis
    @Bron and Sheba (GA)

    @Wendy&Neko

    @Sienne and Gabby (GA)
     
  3. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi and welcome to the forum Gabriel and kitty.
    I am not sure what the vet told you about caring for your kitty at home after having had DKA but there are a few things that you need to do that are really important.
    DKA happens when there is not enough insulin, not enough food and an infection or inflammation present.
    How is your kitty’s appetite? Are you feeding a low carb diets. do you have a hypo kit set up?
    For post DKA kitties it is important that you:-
    • Make sure you are feeding one and a half times as many calories to your kitty as he would normally eat. This is important because food helps keep ketones away. Offer a snack every couple of hours except for the two hours preshot when you are hometesting the BGs.
    • Do not skip any insulin doses. If the blood glucose (BG) is too low, stall, dont feed and test again in 20 minutes to see if the BG is rising…and post and ask for help.
    • Test daily for ketones using a bottle of Ketostix from Walmart or a pharmacy. Follow the directions on the bottle. You will need to collect a sample of urine from your kitty.
    • Give extra fluids…try adding a teaspoon of warm water to all the cats snacks
    • Highly recommend you start home testing the BGs so that you know what the BG is before you give the dose of insulin….if you are not already doing so.
    • If your kitty had an infection make sure the antibiotics are finished.
    • Post daily for help and advice
    What could be happening is your kitty could be bouncing during the pm cycle from lower BGs during the am cycle. Bouncing is normal and can happen when the BG drops too low, too fast or lower than the kitty is used to lately. The body then panics and dumps stored regulatory hormones and glucose into the system which sends the BG up high. Bounces can last from 1 to 6 cycles and there is nothing you can do but wait them out.

    If you could set up your spreadsheet so that we could see your Data, we will be able to help you a lot more. Information about how to set it up in the link Diane gave you. Lantus is a good insulin for cats.
     
    Wendy&Neko likes this.
  4. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
  5. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    I updated the signature with basic information.
    Will update with spreadsheet in few minutes.

    Yes we are doing home testing, usually every time before each insulin shot, and 2,4,6 hours after the shot.
    We have a kit ready in case of hypoglycemia, which happened twice since we started with the insulin, at the beggining.
     
  6. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    We are feeding him with this food the past 5 days: https://www.farmina.com/uk/cat-food/farmina-vet-life-feline/84-diabetic-feline.html as recommended by the vet.
    He was not eating at all, the first few days, but his appetite is back to normal now and he eats his meals regularly. He has some snacks also twice a day usually after the insulin shots.
    His weight at this moment is 3kg.
    We try to provide fresh drinking water on multiple spots in the home, during the whole day. Usually when his BG is high, he drinks a lot of water and when it is on some normal levels less.
     
  7. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Gabriel,
    We don’t recommend feeding a dry food diet as they are almost all high in carbs which we do not want with diabetic cats. We recommend feeding a wet diet with
    Carbs 10% or under. Most people here feed foods around 4 to 7% carbs. The food you have linked is most likely highe carbs as it has corn gluten for its second ingredient and then oats, spelt and pea fibre.
    Here is a link to a food chart written by a very well known vet who posts here Lisa Pierson FOOD CHART
    Look for foods under 10%.
    Are you feeding Bombay one and a half times as many calories as he would normally eat? This is really important in the weeks following DKA as food helps prevent ketones forming again. I would suggest offering more than one snack a cycle.
    Have you managed to get any Ketostix yet to test the urine for ketones?
    Would you like some help in setting up the spreadsheet? @Bandit's Mom is a whizz at setting them up in a couple of minutes!

    Great you have set up the signature..thanks! I can see you are using a solostar pen? Are you using syringes to withdraw the insulin or just using the syringe.
    As you increase or decrease the dose (in 1/4 unit increments) you will need to be using syringes. The syringes you will need are the
    U100 3/10ml 30 or 31 gauge 6 or 8 mm insulin syringes. There are several brands available depending in which country you live in.
     
    Bandit's Mom likes this.
  8. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi,
    Here is the spreadsheet I managed to create.
    https://docs.google.com/spreadsheet...wp0azdpVhwmIlL8VRKbDBQ6-rhs/edit?usp=drivesdk

    I know there are some inconsistencies in the hours when BG was measured, not every two hours, but we are trying to keep it as regular in the past few days.

    Regarding the food, unfortunatelly this is the only food for diabetic cats that we have on the market in my country. If you have any other suggestion, please share with me.
    In the first few days after he started eating by himself, we were feeding him nearly twice the amount than before. Now he is eating three meals per day from the dry food, in quantities the vet recommended and some snacks in between as I mentioned.

    For now we are just using the SoloStar pen, giving him 2 IU, but I can get syringes to adjust the dose.
     
  9. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Also can you please share some info how to extract the insulin from the pen ? if that is possible.
    Thank you for the help
     
  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Keep the insulin in the fridge and it will last much longer.. at least 6 months. Put the cartridge into a glass (supported ) into the main part of the fridge, not the door.

    upload_2022-1-19_20-10-20.jpeg
     
    Diane Tyler's Mom likes this.
  11. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Tnx, but the pen has options to choose 1,2 or more IUs to insert at a time. It can't be adjusted by 0.4 or less.
    Any advice for this ?
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    With a pen you can only give insulin in 1, 2, 3, 4 etc units. They are really meant for humans.
    You need to buy the insulin syringes I mentioned above and then you can give much smaller doses. You insert the needle of the syringe into the insulin reservoir as shown above and draw out the insulin. Does that answer your question?
     
    Diane Tyler's Mom likes this.
  13. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    yes
    Thank you a lot for the advice
    I will try that
     
    Bron and Sheba (GA) likes this.
  14. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Hi. Is your cat's name Gabriel? If so, can we have a name to call you?

    Has he always weighed 3kg? What do you think his ideal weight would be?

    When you have time, read the yellow Stickys at the top of the Lantus forum. It's a lot of information, I know. We usually have to read them more than once or twice to start to absorb some or most of it.

    As you'll read in the Stickys, Lantus likes consistency and is best given every 12 hours, and dosing changes are based on the nadir (the lowest numbers) in the cycle. Some kitties bounce a lot after getting a low number (or a lower number than they are used to, or the number drops too fast), and bounces can last up to 6 cycles (3 days). You'll just have to wait them out and hold the same dose (consistency) until the bounce clears. Are you testing for ketones daily?

    He's getting some pretty good numbers in between the bounces.
    Are you using a human glucometer or one made for pets?
    Please ask for advice the next time you see lower numbers.

    When you tested the 2.6 on 1/17/2022, we probably would have advised you to feed him some extra carb food and to reduce the dose by 0.25 units (and asked you to do another test in a half hour), but with him being so recently DKA, he needs the insulin and going down a whole unit from 2 units down to only 1 unit may not have been advised. Hopefully, you'll get some syringes with half unit marks on them very soon and can then do smaller 1/4 unit adjustments to the dose.

    A word of caution; Please do not ever give a 2nd shot in between the doses. This will cause overlapping nadirs, and with his already sometimes lower numbers can cause a lot of trouble and be very dangerous. I don't know what time it is in your country, but I would be getting extra tests in today, and tonight.
    upload_2022-1-19_7-2-23.png
    Best of luck to you. We are here to help. :bighug:
     
    Diane Tyler's Mom likes this.
  15. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi this is not the spreadsheet we use, please take a look at mine at the end of my post it says Tyler's spreadsheet, he's in remission, take a look at other members
    Can you let us know what country you are from?
    Please take a look at the Food Chart Bron and Sheba gave you, or let us know where you live and we can suggest wet low carb foods.
    Please add what meter you are using human or pet meter and add it to your signature
    Tagging @Bandit's Mom to help set up your spreadsheet
    She will send you a private message look for it up top where it says inbox
    Thanks Bhooma
     
    Last edited: Jan 19, 2022
  16. Bandit's Mom

    Bandit's Mom Well-Known Member

    Joined:
    Oct 18, 2019
    Since you have linked a Farmina.Uk website, I assume you are in the UK? The Farmina diabetic cat is, in fact not suitable for disbetics since it is too high in carbs - it is lower in carbs than other cats foods but still too high for a diabetic cat. You want to feed foods that are less than 10% in carbs - preferably less than 5%

    Here is a list of low carb foods available in the UK:
    https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

    And some information for UK caregivers:
    https://www.felinediabetes.com/FDMB...-vit-b12-and-other-need-to-know-stuff.137376/

    Here is information/instructions on how to set-up and enter data into the spreadsheet:
    https://www.felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/

    I will be happy to set-up a spreadsheet as per our format for you to enter data into. Will only take me a minute.
     
  17. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi Dyana,
    Thank you for your explanation, it really means a lot and I will follow all your advices.
    My name is actually Toshe and my cat name is Gabriel.
    We are from North Macedonia (Europe).
    Everything I have done so far, is always with first consulting with the vet, but from your reply I understand now what is happening.

    About the weight, I can say 4-4.5kg, would be ideal, at least when he was at good health that was his weight.
    We are using human glucometer, because that is the only option we have in my country.
    For measuring ketones I will go to the pharmacy first thing tommorow and start measuring.
    Thank you one more time for the help.
     
  18. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi,
    I have updated the signature with the glucometer we are using and my name also. My cat name is Gabriel.
    I am actually from North Macedonia(Eastern Europe).
    We have food options to choose from, but this was the food recommended by the vet. I will take a look at the spreadsheet you sent me and try to provide one of those if available.
    If you can provide me appropriate spreadsheet it will mean a lot.

    Thanks for your help and I will do regular updates of the status.
     
  19. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Thank you Bhooma @Bandit's Mom
     
  20. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    This is too high in carbs , take a look at the food link Bhooma sent you try and stay around 5% carbs or under, limit any ones with fish to maybe once a week
    Like bandits mom said if you have trouble setting up the SS just ask and Bhooma will set it up for you. Most of us use a human meter ,that's what our numbers are based
     
  21. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Yes, I am currently looking into foods on the spreadsheet and some of them are available here.
    Will change the diet for sure, and create the correct spreadsheet.

    Thank you one more time for your support.
     
    Diane Tyler's Mom likes this.
  22. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    but you will have to transition slowly so as not to upset the tummy and to watch the BGs taking away the dry food can drop the BG by 100 points so please be sure to keep testing his BG
    Look at this link
    TRANSITIONING FROM DRY TO WET FOOD

    Also pick up some high carb wet food

    UK'ers wanting a higher carb food in gravy for their hypo kit may want to consider getting a couple of cans of Gourmet Gold: 'Chicken & Liver in gravy', 'Salmon & Chicken chunks in gravy', or 'Beef chunks in gravy'.
    These foods contain cereals, and, according to the carb calculation based on the label info ('typical analysis' percentages) have around 25% calories from carbs. (But don't rely on the label info alone. What really matters is the effect of the food on your cat; and 'Every Cat Is Different'.)

    When trying to raise low numbers, it is the gravy that is particularly useful. A couple of teaspoonfuls at a time can help to raise blood glucose without filling up the cat's tummy too much (just in case you need to feed more later.)
     
    Last edited: Jan 19, 2022
  23. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi,
    Can you tell me if this seems like a good option based on the ingredients ?
    https://www.samsfield.com/beef-and-beetroot-for-sterilized-cats

    Thank you in advance
     
  24. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I don't think so since it contains pea starch, don't know how many carbs are in this
    I'll tag Bhooma to see what she thinks @Bandit's Mom
    Did you look at the food list for the UK? They list the amount of carbs
    Also did you find any of the syringes with half unit markings
    The syringes you will need are the
    U100 3/10ml 30 or 31 gauge 6 or 8 mm insulin syringes. There are several brands available depending in which country you live in.
    @Bandit's Mom
    Thanks Bhooma
     
    Last edited: Jan 19, 2022
  25. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Yes I found syringes also some of the foods from the list, actually I already have it.
    Just wanted to ask about this brand cause it is available here and has highest percent of actual meat 85 percent I think.
    Tnx
     
  26. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Glad you found the syringes
     
  27. Bandit's Mom

    Bandit's Mom Well-Known Member

    Joined:
    Oct 18, 2019
    Hi Toshe, I can set up your spreadsheet for you. Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.

    For some reason, I am unable to open the link. But any food with grains, fruits and vegetables is most likely unsuitable since they contain carbs.
     
    Diane Tyler's Mom likes this.
  28. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi everyone,
    I have updated the sheet with the data so far. The past few days seem strange to me, his BG levels go really high, somethimg that was not happening previously.
    NOTE** my glucometer measures levela up to 33. I have marked that data with 33 but it may be higher.

    Any advice what exactly is happening or how to proceed ?
     
  29. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    You haven’t chosen a dosing method for Gabriel but because he is post DKA, TR would be the better choice. Have a look at the two dosing methods in this link
    DOSING METHODS. If you are happy with TR, can you put it in your signature and the SS at the top please so we can see.

    Looking at the SS, when you got the 47 on the 1/17, that is a reduction in dose down to 1.75 units. When you get a low number like that, you need to feed some high carb food to bring the Bg up over 50. You also need to test again 20 to 30 minutes later to check that it hasn’t dropped further.
    Do you have a hypo kit set up? HYPO KIT

    I would say that Gabriel is most likely bouncing from the 47 three days ago. Bouncing can happen when the cat drops too low, too fast or lower than they have been used to lately. The body panics and dumps regulatory hormones and stored glucose into the system and the BG goes up high. Bounces can last from 1to 6 cycles and there is nothing you can do but wait them out.

    How often are you giving snacks during the cycles as well as the pre shot meals?
    Are you test daily for ketones in the urine? This is really important. Results can be put in the remarks column of the SS please
    Watch to see if Gabriel comes off the bounce during the next cycle. If the BGs trend down monitor more closely as they can drop quite fast and quite low. Keep the SS updated so we can see and post and ask for help if needed. If you need help change the subject line to reflect the problem to alert us.
     
    Diane Tyler's Mom likes this.
  30. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi thanks for the response.
    I have updated the signature and SS with TR dosing method.
    Yes I have HYPO KIT.
    Still haven't measured ketones, but will start from today for sure.
    The last 3 days his BG is almost constantly high. We are keeping for now the 2 IU on 12 hours dosage, but especially after the PM shot, which we usually apply around 7PM, there seems to be no effect from the shot. The BG keeps increasing.

    For now he is eating only canned food, I willl start giving him some raw meat, and replace some of the meals with it. Usually I give him snacks, when trying to measure BG, cause it is very hard otherwise to keeps him in one place and take blood sample.

    Any other advice is much appreciated. I will continue updating the SS with latest data.
     
  31. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Great…..can you put the results in the remarks column of the SS please?
     
  32. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Did he get an extra 1 unit on the 19th? He could be bouncing from that too.
    As I said earlier, please do not ever give a second shot in between the 2 doses.
    upload_2022-1-21_5-43-7.png
    Just a thought. I am not seeing the 12:00:15am test on 01/19 on your new spreadsheet.
    Hopefully you'll see some better numbers tonight or tomorrow morning.
     
  33. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Yes, I missed the 12:15 AM test.
    Just added it to the new SS.
    That was the last time we gave him extra unit, after your advice we are not doing that anymore.
     
  34. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Hi,
    The 6 cycles period with high BGs was finished, or so we thought. After 3 days constantly high BG, over 33 mmol/L, it started decreasing, lowest nadir was 6.8mmol/L two days ago.
    But for some reason since yesterday we have the same issue, after insulin shot the BG increases. I started wondering if maybe I am keeping the Insulin pen wrong or not doing the shot properly, but it makes no sense. The insulin pen is refrigirated, before usage we do the safety test, everything that is recommended on the Lantus usage manual.
    I have updated the SS, any help or suggestion what might be happening will help me a lot.

    Also I have ordered the ketostix, because for some reason only one pharmacy has them in my town and they were out of stock. I should have them probably today or tommorow.
     
  35. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    It looks like your kitty is bouncing from the fast drop down to 122 at +3 from 351 on 1/22.
    You mention you have found the syringes….did you buy them and ar you using them yet?
    Are you continuing to feed all the extra snacks as we suggested?
    Please let us know when the Ketostix arrive and you have tested the urine for ketones
     
  36. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Yes I have the syringes. Should I decrease the dose ?
    I am giving him extra snacks during the day, usually when measuring the BG level, cause it's hard to keep him in one place to take the blood sample.
     
  37. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    No I would not decease the dose unless the BG drops under 50. At the moment he is bouncing.
    Are you using the syringes now to give the insulin?

    That is good you are giving him extra snacks
     
  38. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    No I am still using just the Lantus SoloStar pen.
     
  39. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I would swap over to the syringes if I were you. You waste insulin every time you have to prime the pen.
    If you are unsure about measuring the correct dose with the syringe, take a photo of the dose you draw up and copy and paste it here for us to check first time.
     
  40. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    Dyana likes this.
  41. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    That’s great the ketones were negative. Would you be able to put the result in the remarks column of the SS please?
    If you can grab a urine sample and test daily for ketones at the moment, that would be very helpful thanks.
     
  42. Gabriel16

    Gabriel16 New Member

    Joined:
    Jan 14, 2022
    yes sure
    Thank you
     
    Bron and Sheba (GA) likes this.

Share This Page