Update---Need More Advice! New Diagnosis, Dosing Help

Astexcat

Astexcat

Active Member
Hi all,

My heart kitty was diagnosed at the beginning of the month after a visit to the vet. Her blood test at the vet (from her leg vein) read sugars in the 600s and he had me start insulin immediately, starting with 2 units 12 hr intervals.

The vet keeps having me up her dose since the numbers are not going down. We're at 5 units, and reading here makes me think she is having some massive daily swings. As her dose has gotten higher, so have her AMPS and PMPS readings.

I'm going to make a hard effort tomorrow to get some more readings throughout the day now that she's ok with testing (the earlier no PMPS readings were on days I had no help and she wasn't ok with me testing her alone yet).

Please Help... spreadsheet below (assuming I did it correctly).
 
Hello and welcome to FDMB. Sorry you needed to find us but glad you did.

The dose of insulin has been increased far too quickly and 5u is a large dose for a cat just recently diagnosed. Dosing should be based on how low a dose is dropping BG... not on pre-shot tests alone. Pre-shot tests tell you whether it's safe to give insulin while mid cycle tests will tell you how much BG is dropping on any given dose of insulin. At this point in time with only one mid cycle test, my guess would be that you are seeing a lot of bouncing from lower numbers sometime during the cycles. A diabetic cat gets used to being in higher BG numbers and when BG drops their defences go into action to bring BG back up to what the cat now perceives to be normal levels. It's called bouncing and is a normal phenomenon.

Vetsulin normally reaches peak action between +3 and +6 hours post shot although some cats will hit their lowest point (nadir) a bit earlier or later. Testing in that time frame will provide information as to how low Smudge's BG is dropping. The day you took a mid cycle test shows a big drop of 340 points by mid cycle +6. BG may have been lower earlier or still dropping at that time. That drop could easily trigger a bounce.

Many cats go even lower at night than they do during the day so it's important to get some night time tests too. We recommend testing at +2/3 post shot and if that isn't bedtime, testing again at before bed every night to see where the cycle is heading and to keep kitty safe.

The dose of insulin needs to be reduced but before making any decision about how much to reduce, does Smudge have any history of ketones or DKA?
 
I don't think she has a history of ketones. When she was diagnosed the vet mentioned she was in ketoacidosis (when we got to the vet she started breathing fast, was suddenly uncoordinated, and was there because she hadn't eaten in 24 hrs and seemed nauseous), but then didn't do any of the treatments I've seen listed online, so I don't know how bad he thought it was. He drew blood, and all her values except the sugar were within normal ranges. Then he let her come back into the room and "calm down", and then she started breathing better and regained her coordination. I do have a tester on order because I do feel it's something I need to be watching for with her.

For a vet (and staff) that all have diabetic kitties, I'm wondering about how good of control all their cats are under. On the plus side, he did have me get a meter immediately and start testing and tell me about low carb foods. Of course, he wanted Rx, but the vet techs gave me the 10% so I could sort her existing foods by acceptable and not. Fortunately (or maybe not), she loves the Rx dry food, which I want to start phasing out but it is the only food I can leave out for munching on that the dogs can't get at, so for now it stays. Trying to swap her to the Dr. Eisley's dry, or the Young Again, but it's not as well liked.

Prior to diagnosis I'm guessing I was mostly accidentally controlling it with her mostly Raw-based diet (helpful with her IBS), and the canned foods I was giving were already mostly lower in carb. Dry food as treats only, and even it wasn't the worst levels out there (I think I calculated it at 20%).
 
That's interesting that the vet suggested Smudge was in ketoacidosis but none of her blood values were off. Perhaps the vet meant he was checking her for ketoacidosis. With Smudge seemingly improving almost immediately in the vet's office, it doesn't sound like ketoacidosis was present.

The prescription dry food is extremely high in carbs and switching to Dr. Elsey's or Young Again could make a big difference in numbers.

I would suggest you reduce the dose to 2u (especially if you are switching the dry food over to low carb) for a period of 6 cycles as long as BG at pre-shot is over 200. Re-evaluate after the 3 days. If dose needs to be increased, the increase should be 0.25u or 0.5u at most. Jumping up by 1u increments means you could have skipped over the best dose for Smudge. Get some tests in the mid cycle concentrating between +3 and +6 but any data you can get will help see what is happening between shots. Always get a test before bed every night and if BG is dropping setting an alarm to retest a little later is advised.

With those high BG right now, it's very important to be checking Smudge for ketones. I'd check her daily until the numbers start coming down.

If what you are seeing is bouncing, which I suspect it is, numbers should start coming down a bit in a few cycles.

Ideally at this point in time, you do not want Smudge's BG dropping below 90 on your pet meter. If Smudge's BG should drop below 90, she earns a dose reduction of 0.25u or 0.5u as of the next dose.

Vetsulin can drop BG very quickly and steeply so if you are switching diet, monitoring mid cycle is very important.
 
I did think it was suspicious when the vet keep increasing her dose by 1U after only two or three days. I really didn't like that logic from what I had learned from a cursory read on this forum. On the plus side, at least I have a holiday break to get a better handle on this.

Thanks for the input and I'll try dropping the dose and multiple testings. Right now her AMPS was 723 and her +3 is 423, it'll be interesting to see what her +6 reading is.
 
More Help Needed!!

I've updated the spreadsheet and 3U seems to be about as low as I can go with her insulin. I tried 2.5 and got Hi readings on the meter, and tested ketones today on the meter and it registered 3. I'm going to retest in a few hours as a double check, but am wondering at what point do I get super concerned? She is still eating/drinking and behaving normally and the post said they start showing up at 2-2.5 on the meter, so they're high but I couldn't find out where you hit rush to the emergency vet level.

Also, how long do bounces continue, or at what point do you determine that a different insulin may be worth asking about? I know my vet is going to be upset that I dropped her dose, but the effects when she was at 5 were the same/worse than at the lower dose, so I don't think it was the worst decision, but know he will question it.

Any advice appreciated....
 
If you are getting a reading of 3 for ketones on a blood sample meter, then it's time to call the vet now. Ketones can build very quickly and ketoacidosis can set in abruptly . In the meantime you need to get as much fluid as possible into Smudge to help flush those ketones out and ensure he is getting plenty of food (more than usual) and insulin. If BG continues to be as high as it is now, then an increase in insulin dose is warranted.

I would not waste time getting Smudge checked as ketoacidosis can quickly become a major health crisis and can be deadly. The earlier it's treated the more likelihood of a good outcome.
 
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