Ketones Positive: Help

Hi, My name is Alexa and my kitty`s name is Reuben. He had a blood test yesterday that showed ketone positive at 5ml/deciliter. We are about to start insulin, and the vet says this ketone reading is so low that we can start now. Can anyone confirm this for me? Thank you

I just posted this in your thread on the Health board:

Is there any way you can locate Ketostix? These are strips that you dip into your cat's urine stream that give you a reading on urinary ketones. They should be available at a pharmacy.

Not many people use the brand of ketone meter you're using and as a result, it's hard to interpret the results you're getting. Blood ketones tend to be a "to the minute" reading and more accurate than urinary ketones as long as you know what the results mean. With the Ketostix, any reading above "trace" can be critical. I can't emphasize Deannie/Boo's point enough. If the parameters of your meter are the same as one of the other ketone meters, Reuben could be in trouble. On the Precision Xtra meter, any reading above 3 mmol/L requires veterinary treatment. Being able to have the results from the Ketostix to compare with the blood ketone reading will help you (and us) to know what the results mean.

How is Reuben acting? Is he behaving in his usual way?

Usually, ketones develop as a result of infection/illness, not enough insulin, and not eating. It sounded like Reuben's appetite is good. As others have suggested, add water to his food. This will help to flush ketones from his system.

If it's not obvious, we take ketones very seriously. The presence of ketones, if they get beyond what can be safely dealt with at home (i.e., "trace" levels), can develop into diabetic ketoacidosis (DKA) quickly. As Deannie noted, DKA effects electrolyte levels which, if seriously altered, can be life threatening.

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Just another question -- have you calibrated your meter for BOTH blood glucose and ketones? From the way the manual reads, it sounds like you need to calibrate for both. It's also not clear if the point of concern is 1.5 mmol/L or 8.0 mmol/L reading. The Ketostix will help to clarify.

Ketones show up in the blood before they appear in urine, so I'd like to think the meter is accurate. I have, however, had numbers from the meter that were really hard to accept as credible. If you're not on insulin yet, I would encourage that you proceed. Likewise, if your vet found any sort of infection, an antibiotic would be in order as well. I strongly encourage you to get the ketostix to test the urine. I've felt much more confident in the readings I've gotten from a $6 bottle of (50) test strips, than I did with the $2.36 (each) strips for my meter which reads them in the blood. Good luck!

Lu --

She's in Mexico and has had trouble finding Ketostix. The numbers from the meter are not converted to US. There's more info on the original Health thread.

Hi. I posted this on your thread on the Health forum:

In my opinion, your vet doesn't even need to know you are home testing, but you have to have a vet. Wow, you are in Mexico, ok.

Your cat needs to be checked for an infection, and may need antibiotics. Otherwise, you are continuing to risk ketones, and it is very worrisome that he has already tested positive for trace amounts. If he tests positive for more than trace, you might end up spending a lot of money to save him. In any event, if he does test positive for more than trace the vet has to treat him. You can't do it alone at home. If you can't get a urine test or you can't get the Ketosticks, and he stops eating (I don't know how long -- maybe if he hasn't eaten in 12 hours -- anyone else have an opinion?), I would take him to the vet for a ketone test if he were my cat.

You also need periodic blood tests for your cat that only a vet can do. You don't have to follow your vet's advice on raising the insulin dose, etc., but it is very encouraging that your vet started your cat out at 0.5u of Lantus. That's what would be recommended here -- that or 1.0u.

As far as raising the dose, it is not recommend here to go up by more than 0.25u per increase. At lot of vets will tell you to go up by 1.0u or even 0.5u. I wouldn't want to do that after my experience with my sugarcat. How to measure 0.25 units? You need syringes that have 1/2 unit markings on them, but it looks like you got them -- the 3/10 U-100s. You can do a search here for how to get an extra 1/4 of a unit in the syringe instead of 1/2 a unit or look through the stickies until you find that info.

If you get antibiotics give them by mouth. Do not let your vet give the cat an injection of Covenia -- a shot that lasts for up to 14 days. The "convenience" is not worth it. If the cat has a bad reaction to the antibiotic you cannot get that substance out of his system for up to 2 weeks. This is especially true with a cat that has uncontrolled diabetes. With an oral antibiotic that causes a bad reaction it should be out of his system in no less than 24 hours. Write "NO antibiotic shot; NO Convenia" all over the consent forms.

If you miss with the syringe and some of the insulin goes through the other side of the skin tent you were making to inject the insulin, please DO NOT give another injection. Please, wait the required 12 hours before you give him more insulin no matter what his BG readings are. You have no way of knowing how much insulin he got, and it is dangerous to give more insulin earlier than the 12 hour point. See "Lantus Depot" sticky above.

Hope all is well, and you can get the supplies you need for your cat.

Let me do some course correction here.

The cat is eating and drinking. That's not a problem -- other than we don't know what kind of diet he's on. Rueben's caregiver (CG) is in Mexico. Vets and resources are more limited than here. Julia provided her with an on-line link for purchasing Ketostix. The CG also noted that she is some distance from the vet. She has a blood ketone meter and can test at home. I am also reticent to suggest to anyone to not follow their vet's advice. From what the CG has posted, her vet seems pretty reasonable.

You also need periodic blood tests for your cat that only a vet can do.

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Do you mean yearly blood work? I have no idea what you're trying to convey with this statement.

As far as raising the dose, it is not recommend here to go up by more than 0.25u per increase. At lot of vets will tell you to go up by 1.0u or even 0.5u. I wouldn't want to do that after my experience with my sugarcat.

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Please refer to the dosing protocol The above statement is incorrect. If nadirs are over 300, dose increases are made in 0.5u increments. Likewise, if a cat is experiencing ketones, the dose may be raised in a larger amount or in 2 days for health reasons. When a cat is at risk for ketones developing dose and food are approached in an aggressive way in order to manage the ketones. The following is from the Tight Regulation Protocol for Lantus & Levemir:

Phase 2: Increasing the dose
Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.

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Re. Injectible antibiotics
A blanket statement about giving an antibiotic by mouth is misleading. Clindomycin can be given as an injection. It is perfectly safe for most cats. There are several cats here who have gotten an injection of Convenia. The issue with Convenia is that it is often given for infections other than those that it was designed to treat. It was developed for skin infections. Vets like it because it is a one time, 2-week long injectible antibiotic. If a cat has never had the antibiotic, there is always the risk of an allergic reaction and because it lasts for 2 weeks, that can be a problem.

welcome to the group alexa and rueben!

i see you administered 0.5u of lantus this morning. rueben's preshot number was 470. you'll want to get some spot checks at +3, +6, and +9 and then test again before you give him his evening shot (that means testing before giving shots and 3 hours, 6 hours, and 9 hours after giving the shot).


i have some concerns about starting at such a low dose of insulin since rueben is throwing ketones. here in the tight regulation group, initial starting doses are calculated using this formula: 0.25 unit x per kg of kitty's IDEAL weight unless kitty is underweight. if kitty is underweight, the following formula is used: 0.25 unit x per kg of kitty's ACTUAL weight.

how much does rueben weigh? is he overweight or underweight?

another consideration to dose is rueben's diet. what do you feed him? is he eating a wet/canned low-carb diet? add as much water as he will tolerate to wet/canned food. the extra fluids will help clear the ketones.

do you feed him any dry food?

you mentioned rueben was diagnosed with pancreatitis in december. has rueben experienced any pancreatitis flares since diagnosis? if so, what kinds of treatment has your vet recommended for pancreatitis?

please post often. the answers to the questions above as well as the data you collect from testing rueben's blood sugar and ketone levels will help us help you. it's possible his dose may have to be increased sooner than later.



PS --- you can take the 911 icon off your first post now. we like to reserve that icon for medical emergencies.

Thank you Jill

I am trying to test Reuben's glucose at the correct intervals, and I just must be going about it all wrong, because it`s just a big Fail each time!! He fights and hates it, and I`m getting more and more nervous, argh!! I think tight regulation is not going to be possible at the moment :-(

I wondered about the low dose...

Reuben is on Clavamox for chronic intestinal infection which is caused by the Pancreatitis, I assume. I give him metaclopramide to control vomiting. The vet didn`t really have any advice... when he first prescribed the metaclopramide for the vomiting, he said that the change in diet was causing it. But when time passed and he was used to the food but still vomiting, I went back to using it and he was fine.

He is eating only Dr. Pierson's recipe, and tuna for the testing and injection treat. I just bought little shrimp to replace the tuna, hopefully he will like them!

He weighs 8.8 pounds (4 kilos). Before he got sick he weighed 15.4 pounds (7 kilos), and he was overweight. I think is ideal weight is probably between 10 and 12 pounds.

He has been eating a tremendous amount lately, but today is eating less. And drinking less... I am going to give him water with big syringe now. He is really mad about the failed BG testing attempts and tenses up if I try to pick him up :-( I will be so happy when we get past this phase!

Just offering our support for Reuben :YMHUG: :YMHUG: :YMHUG: :YMHUG:

reuben'smom said:

Thank you Jill

I am trying to test Reuben's glucose at the correct intervals, and I just must be going about it all wrong, because it`s just a big Fail each time!! He fights and hates it, and I`m getting more and more nervous, argh!! I think tight regulation is not going to be possible at the moment :-(

I wondered about the low dose...

Reuben is on Clavamox for chronic intestinal infection which is caused by the Pancreatitis, I assume. I give him metaclopramide to control vomiting. The vet didn`t really have any advice... when he first prescribed the metaclopramide for the vomiting, he said that the change in diet was causing it. But when time passed and he was used to the food but still vomiting, I went back to using it and he was fine.

He is eating only Dr. Pierson's recipe, and tuna for the testing and injection treat. I just bought little shrimp to replace the tuna, hopefully he will like them!

He weighs 8.8 pounds (4 kilos). Before he got sick he weighed 15.4 pounds (7 kilos), and he was overweight. I think is ideal weight is probably between 10 and 12 pounds.

He has been eating a tremendous amount lately, but today is eating less. And drinking less... I am going to give him water with big syringe now. He is really mad about the failed BG testing attempts and tenses up if I try to pick him up :-( I will be so happy when we get past this phase!

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don't worry. testing will get easier as time goes on! start a topic on the Health forum asking for tips and tricks for hometesting. you'll get a lot of ideas. hopefully rueben will become accustomed to receiving a treat for his cooperation. approach him calmly. talk to him. explain how you're testing him for his own good... that you want to make him feel better. praise him whether testing is a success or failure. if testing fails, give him a break and then come back to it again later. don't give up. with practice, you'll get there.


since rueben is underweight, we'd use his actual weight when suggesting a starting dose which in this case is 1 unit administered every 12 hours. since you're having trouble testing him at the moment, why don't you stick with the 0.5u dose tonight unless you get another positive ketone reading before then. it'll give you a little time to practice testing his blood sugar. we can talk about increasing the dose in the morning. the thing is, when a kitty is throwing ketones we want to get as much insulin into kitty as safely as possible. i don't think you'll have the luxury of staying at the lower dose of 0.5u very long.

dr. pierson's cat food recipe is great! you'll want to make sure he eats at least his normal daily amount of food. syringing water will also help. the clavamox should help with infection.

until rueben becomes comfortable with testing, please leave food out for him at all times. most kitties will self-feed if they feel their blood sugar dropping. i don't think this will be a problem right now. it's simply a precaution.

post often. every bit of information you gather will help us help you.


i won't be online for the next couple hours, but will check back to see if you have any questions as soon as i can. there are many others here who can help you in the mean time.


hang in there, ok? there's a lot to learn, but you have all of us to help you along the way.

Sienne (and Gabby) and Jill (and Alex) know far more about diabetes (and ketones) than I do; that's for sure! Thanks you two for adding to this thread after my post.

You wrote in a different post:

have not been able to find a good vet here. The best one, who the show dog crowd love and say is a genius, thinks blood glucose testing is irrelevant. So I am on my own.

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I don't know what the vet (or you) meant by "irrelevant," but I don't want you to give up on having a vet involved in the care of a 15 year old cat that you clearly love enough to treat for diabetes, so I wrote:

You also need periodic blood tests for your cat that only a vet can do.

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I did mean that you can't find out if your cat has many other problems besides diabetes without the kind of laboratory that a vet uses to test a "blood panel." Sometimes those tests can tell you more about how you should handle the diabetes. Just knowing his BG readings and whether he has ketones is not always enough. I'd like to know if my cat had a high white blood cell count if I were in your shoes, for example. For a cat that is 15 years old, as yours is, I would want to see periodic panels (some people do them every 6 months) when a cat is this old and catch anything that might be a problem as early as possible. For instance, did your vet do any test for kidney issues? I would want that done, if I were you.

You don't have to follow your vet's advice on raising the insulin dose, etc., but it is very encouraging that your vet started your cat out at 0.5u of Lantus. That's what would be recommended here -- that or 1.0u.

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Looks like I was wrong on that 0.5u dose. As far as the vet's advice, please don't avoid going to the vet just because he thinks blood glucose testing is "irrelevant," for the reasons I stated above or because he gave the wrong dose to start with, etc. You don't "have to" follow his advice if you are not comfortable with it, but don't count the vet out entirely. When you posted for the first time, you seemed to be afraid to start giving insulin until someone here agreed it was okay despite the fact that the vet said to do it. If what the vet is telling you to do doesn't make sense to you, you "should" be able to talk to your vet about what he/she is recommending until you are comfortable -- that doesn't always happen, and if your vet isn't willing to discuss it with you, please post on here and see if you can feel comfortable with the advice you get here. Ultimately, you are going to have to do the best you can under the circumstances.

I wrote:

As far as raising the dose, it is not recommend here to go up by more than 0.25u per increase. At lot of vets will tell you to go up by 1.0u or even 0.5u. I wouldn't want to do that after my experience with my sugarcat.

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Your situation is different as Sienne pointed out. Sienne and Jill and a few others here know a lot of details, and they will (almost) always chime in if something is said that isn't quite right or is misleading in the way it was worded, thank goodness.

We are all here rooting for you. Hope your baby gets better soon, and keeps eating well.

How is Reuben now handling the food transition? A change in food can cause problems with diarrhea and vomiting but that should pass in a week or two. If the vomiting hasn't stopped, there are other medications that tend to be a bit better for controlling nausea and vomiting. Many vets, mine included, tend to like metaclopramide but, in actuality, it helps to slow down stomach action which can help with vomiting. But, as I mentioned, other meds (ondansatron and maropitant) are better for nausea or vomiting. Are you still giving Reuben the clavamox? Just so you're aware, one of the major side effects of clavamox in cats is vomiting.

Shrimp sounds like a great treat -- providing Reuben likes it. Many of us use freeze dried chicken or tuna/bonito flakes. Others will use raw or cooked chicken as a treat. Basically, anything that's low in carbohydrates and your cat enjoys can be used as a treat.

I agree with Jill -- ask in Health for tips on home testing. There are some good videos on YouTube that will show you how to test. It's how I learned. Also, warming your cat's ear can help. You cane either gently rub the edge of Reuben's ear or put some rice in a sock, put it in the microwave (make sure there's no nylon in the sock) to warm it, and use the sock to warm Reuben's ear. I use test time as a few minutes where my cat gets my undivided attention -- lots of positive reinforcement with praise, pets, chin scratches, hugs, and treats. It really does get easier. Once Reuben begins to associate testing and his shot with feeling better, it will get LOTS easier.

Try using the lancet pen. If you don't like it, you can try freehanding. Also, having lancets that are 28 or 29 gauge (the lower the number, the thicker the width of the needle) make it easier to get blood in the beginning.

One other thing that might help with the ear pokes is be sure the lancet has the beveled side UP. That ensures the sharpest point of the lancet goes in first. Also, when you poke, do so at an angle.....not straight down. Are you holding something on the other side of his ear? A lot of people use a cotton ball to put on the inside so when they poke, it goes through to the cotton ball. I found a small, round cap to an old contact lens case and we put that inside Gracie's ear to support it. Once we poke, we immediately hold the poked site with a very cold, damp baby washcloth to stem bleeding and prevent bruising. She has never had a bruise and we test often. Lastly, if you can get some Neosporin Ointment (not cream) with Pain Relief and put it on lightly after every poke....it helps. You will have to be sure and take it off before you do the next test but it will help him.

We're here to help any way we can.

Hi I put my tips ( and some you tubes) in Jills help condo but I test on Do Lous feet not sure if that something Reuben would prefer or not just a thought

Hi!
Just to add a tip about ear testing. The blood flows from the tip of the ear down, so if you put some pressure (pinch the ear) just below where you intend to prick, the blood will well up a bit at this pressure "dam" and it will be easier to get a blood drop above the "dam". Putting a little Vaseline on the ear before the test will also help the blood to bead up.

We are all here to support you. Welcome to LL.

Ella & Rusty

alexa, in addition to hometesting tips posted in this thread there are more here:
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=76856#p830758.

make sure Reuben's ear is warmed up, either with a rice sock that's been warmed in the microwave or with a pill bottle of warm water. ears grow capillaries as they are poked, so even if you're not getting blood every time, you're making it easier for later. i know it's not the best, but i did aim for and hit the vein when i felt desperate. punkin didn't suffer for it - staunch the blood after you get a test and give Ruben his treat. at least i knew what his BG was. here is a pic of "the sweet spot" for poking:





i rigged up up the flashlight in a spice bottle in the pic above because then i could see where i needed to poke. it worked great for us - i think it helped to have the hard bottle behind the ear so the ear doesn't just bend away from the lancet when we poked. we use the lancet device and it works well. just depends on what works for you.

we had to burrito wrap punkin tightly in a beach towel for about 2 weeks in order to master it. he was like a tight little shrimp with only his head sticking out. the key is to wrap those front legs in tightly so rueben can't climb out of the towel. after 2 weeks, punkin gave up fighting us and we got better at doing the whole thing. you'll get there! hang in there and be persistent. your conviction that Rueben needs the testing in order to stay alive will get you through the steep learning curve and then it is easy!

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persistence will get you there! we're all behind you and we've all been in that learning place. you can get almost 24 hr help here and usually answers within minutes, so keep checking in and let us know how you're doing and whatever you're having trouble with. it gets easier with practice!

apply a little neosporin ointment on the edge before poking. It helps the blood to bead up instead of spreading into the hair.
A little more ointment aferwards too for the pain relief.

Oh my gosh, you guys are so amazing, so many lovely and helpful posts....THANK YOU!!! I just got back from picking up the test results from the vet, who is in a suburb of my city. Terrible road conditions after the edge of Hurricane Ernesto passed by last night, but I made it there and back and now have more information to share. First of all, the blood testing he is doing it not being done at a veterinary lab. I know this sounds strange, and it`s not my favorite but that`s what we have. It is common here for the vets to send their blood work to a human lab they respect over a vet lab that they don`t. I got the impression that there isn`t one here anyway. I am new in this city and still don`t know the ropes.

I will give the most important information quickly, as I have to grind food for Reuben - I have gotten behind with all the excitement! He is eating well, yeay!

First, about the Ketones - the vet says Reuben doesn`t have any. I don`t know enough (or anything at all, really!) about this to say I truly understand, but according to him the 5.00 mg/dL reading is under the 6.00 mg/dL limit, above which means there are too many and under which is normal. He says there are always a small amount of ketones fluctuating in the body - under 6.00 mg/dL. This is what he says. I guess this is what he meant when he said yesterday 'there are too few ketones to mean there is a problem'. Like I said, I don`t understand, but he swears ketones are not a problem.

Creatine is 2.12 mg/dL with 1.80 being the upper limit - but he is not worried. Bringing the BG down will resolve it, he says.

BUN is 46.54 mg/dL - a little high he says, but again - will resolve.
Urea Serica (don`t know what this is in english yet) 99.60 - a little high, not a problem he says, and will resolve.

hemoglobin - normal

red and white blood cells fine . red is a little low (4.36 milliones/mm3 with 5.0 - 10 being the target range) due to the chronic infection but not a problem.

I had his thyroid checked and it is fine.

I will post the results correctly later when I have to time, but I wanted to give an idea...

I suspended attempts to blood test for the rest of the day, and am concentrating on re-establishing trust with Reuben. I am so wound up and upset that I feel like it is more important to calm everything down and reduce stress right now. I will pour over all your wonderful posts with advice about it, tomorrow morning with coffee and a clear head

Thank you all So Much *HUGS* from me and Reuben

Someone pointed out that we should choose just one board to communicate on, should it be the Health Board?

Which board you use may depend on the information you feel like you need or want. The Health board is where we ask new members to start. It's where you can get familiar with the way FDMB works. If you need general information (for example, how to home test, about diet) or have a feline health-related question, that board is a good resource. If you have questions that are more specific to Lantus and how to dose, this is the place to post. There is more expertise about Lantus on this board than on Health. Usually, once you have a spreadsheet up and running, are testing, and have your cat on an appropriate diet, people migrate to one of the insulin-specific boards.

Many people will post a question that involves something general or Health-related in both places. There are people here who can help with many of these types of questions. However, if we feel as though there may be more expertise on Health, we'll suggest you post there, as well.

BTW, urea serica is serum urea in English. It is probably a "urea" value on lab tests here.

Red cell counts are not usually low due to infection. A low red cell count indicates anemia. However, values can be lowered if Reuben was receiving fluids.

I'm not sure I understand what your vet means about ketones. I think you would be better off if you were able to purchase Ketostix. Having them will answer a lot of questions.

Hi. That's not a bad creatinine number, and yes, the BUN is going to get better when the dehydration gets better. If you could get an electric powered water fountain for your cat, it might help. Mine is a Petmate Fresh Flow Deluxe. It's several years old, and I hope they are still making good ones. Maybe you can order online or get someone to bring one to you from the U.S. if you can't find one in Veracruz.

If you are using Lantus as the insulin, I would recommend that you use one of the Lantus forums now unless you are posting about something that isn't diabetes related at all. It may be hard for you to know what is and isn't for a little while at least.

I used to post in both Lantus forums to cover my bases, but then you have to check both, and the people in one might not be reading what the other forum's people are saying . . . . So, you might have to post something you saw in one in the other and ask the other forum's members to comment on it. Some TR people check the questions in Relaxed and try to help if the answers are different from what they themselves would say and vice versa.

Just like anywhere you need to try to read up as much as you can so that you can ask intelligent questions, but if you can't the people on this entire board are very nice, and I don't see the kind of "stuff" I've seen on other medical message boards. People here aren't trying to be snarky, thank goodness!

Hi Alexa!

Well I will disagree with your vet that ketone reading of 5 mg/dL is "normal" but it is not too surprising in a symptomatic, untreated diabetic. If it goes higher or if it does not go down as you increase the insulin, that is definitely a bad sign. It should go down to zero as you get Reuben regulated.

i definitely understand about the blood tests. I have been very lucky that my cat is so good about them, but most folks on here had a tough time getting their cats used to testing. The good news is that they do get used to it! Scout is down to two tests per month, and even still she comes running and sits quietly on my lap when I sit down in our testing spot and shake the treat container. She starts to fuss if I don't get blood on the first or second try, but once she gets her treat, we're best buddies again. Anyway, I recommend lots of bribing with treats until he adjusts. I also agree that you need to regain his trust, but don't delay the insulin treatment! If he starts to feel better, he will hopefully associate all the poking and prodding with his feeling better.

Good luck and please keep us posted. This is a great group of people who helped me get my Scout regulated and then off the insulin within 3 months of diagnosis.

Lori

good morning! i agree with sienne. having some ketone strips on hand to check urine for ketones would be helpful.

post wherever you feel most comfortable. as sienne said, the Health board is most helpful for general feline diabetes information, but the insulin specific support groups is where you'll find the most help for lantus related questions. however, posting in the Relaxed Lantus group can be hit or miss. not many folks experienced with lantus visit the Relaxed Lantus Group on a regular basis. the Lantus TR Group is the most active on the entire board. lantus users have the most luck getting help here any time of day or night. where you post is really up to you.

good luck testing rueben's blood sugar today! hopefully some of the tips posted by others will help.

let us know how we can help...

Good Morning I just did a successful BG reading -- thanks to all of you !!-- it is was 442 half an hour before dose time. Should I increase the dose this time? I`m all shakey after the blood test, whew!! And I'm sorry... I know I'm not using correct technical language yet, and making all sorts of errors in communication, please forgive me. I feel like I really know what 'basket case' means right now! But I'm not giving up! Also, I`m still looking for ketostix here in town; I am reading that I might be able to find a strip that doctors use to test for a few different things, including ketones. Fingers crossed.

Great job! Welcome to LL. Feline diabetes is a tough disease but you're getting the best advice in the world here.
Liz

Well, I wish you had received an answer about your dose before you had to give the insulin. Please tell the forum what dose you gave, and hopefully by the time you give the next one you will have an answer.

Please watch him carefully for how well he eats today. I'm almost certain someone will answer your dose question before your next shot time, and knowing how he's eating may help that person give you advice.

You are doing a great job, getting a blood test, and please don't be disappointed that you didn't get an answer quickly enough today. Sometimes if you PM someone and say, "I just posted, would you please take a look at my post?" that person has his/her email set up to get message if a PM arrives on this board. (No one is supposed to give you advice in the PMs; only on the board. So if a responsive PM says "please, look at the new post on your thread, I answered you." -- that's why.)

I should add that if you start a new thread everyday, it helps to keep things organized and get advice.

In TR the headline for your thread is supposed to be in a particular format, and you should try to include an link to the last post (if you can, and if you can't someone usually will do it for you until you learn; I'm sorry that I don't have time to explain it now.)

The format is: Month/Day Cat's Name "AMPS" # +(plus sign) #(Number indicating how many hours passed after the shot) #(Number that indicates the BG reading at that time) etc. Does that make sense? If you look at the other headlines you will see this pattern.

You can also put Q? or just ? after the string of numbers AND/or click on the button next to the question mark at the Post icon menu above. This helps people to know you have a questions, and that you are not simply providing information about your cat.

One of the key concepts with Lantus is consistency. Lantus works best if you are consistent with regard to shot time meaning that you want to shoot as close to every 12 hours as possible. It's also important to be consistent with respect to dose. Lantus dosing is based on the nadir, or lowest point in the cycle. Thus, you don't adjust the dose based on your pre-shot number. If you every have a question about dose, it's always helpful to refer back to the Tight Regulation Protocol. Given that you've just started Lantus, the following applies:

Tight Regulation Protocol said:

"General" Guidelines:

• Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
• Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
• Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

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At this point, I'd suggest you decide if you want to shoot 0.5u or 1.0u. Do you think you'll be able to get any spot checks during the cycle? If you don't feel confident in getting even one test in addition to your pre-shot test each cycle, it is probably safer to stick with a lower dose. However, I'm not entirely confident with respect to the ketone issue. If you go back to Jill/Alex's initial post yesterday, she noted the following:

Jill & Alex said:

since rueben is underweight, we'd use his actual weight when suggesting a starting dose which in this case is 1 unit administered every 12 hours. since you're having trouble testing him at the moment, why don't you stick with the 0.5u dose tonight unless you get another positive ketone reading before then. it'll give you a little time to practice testing his blood sugar. we can talk about increasing the dose in the morning. the thing is, when a kitty is throwing ketones we want to get as much insulin into kitty as safely as possible. i don't think you'll have the luxury of staying at the lower dose of 0.5u very long.

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I've always purchased my ketostyx at Wal-Mart or Walgreens. But I expect you should be able to get them on-line at Walgreens.com. I think they were about $11/bottle of 50, but it was less chaotic than going to Wal-Mart!

As long as he's eating consistently, it may not be a problem, but certainly one I'd keep an eye on. Grayson never lost his appetite, but he did get an antibiotic AND subcutaneous fluids (SubQs) - twice daily until we "flushed" the ketones out of his system.

Good luck!
Lu-Ann