4/3 Barsa AMPS 10.4 (187), ketones and Levemir starting dose issues

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Thank you Elizabeth, that's a good list of foods. Will try to get hold of them. Liquivite is already in the ration but she won't eat a lot of it.
 
Philka, you reckon I should leave the food out even if her insulin dose is too low? Next time I can increase it is on tues the soonest I think.. At the moment I am trying to split the feed in 2-3 times but I do it in the first 3 hours after the shot (old Caninsulin habit) Yes, she ate today. Hope all that food will stay in! And hope she doesnt get diarrhea! These are my main worries when it comes to food. Also if I feed too much and/or at any time during the day, will it make glucose go up too much?
 
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When you have ketones present it's critically important to get enough insulin in her, even if it means you have to give her high carb food. The presence of ketones isn't directly related to the blood sugar #, except that it's clear when you have a really high BG that there isn't enough insulin. The development of ketones means not enough insulin. Ketones can develop even at lower numbers.

Let me get some other experienced people's opinion. I'm thinking since she was on a higher dose of insulin before that perhaps it would be ok to go ahead and increase with her next shot. But hang on and i'll ask for some other input.
 
You could just try splitting the meals into smaller doses so her tummy doesn't get too empty. I fed the small meals in the first part of the cycle when the insulin was still falling and then would stop after about +5 or +6. That way the time between the meals was never more than about 6hours and so it would help to prevent build up of stomach acid. But until blood Glucose is regulated she may need more food than normal to help her maintain weight as the food isn't being converted by the body into the energy that it should.

Many people free feed and just remove the food 2 hours before the next shot is due.
 
Yes, she was on 2, then 3 units of Caninsulin. Either 2 or 3 was the correct dose. Somogii effect was caused by overdose, 4 and 5 units definitely tooo much. But now in hindsight..could 3 units have been too much too? Vet prescribed 2 units Levemir BUT he's never dealt with this insulin, not even familiar with it. I was so surprised when I asked for it and got it. I thought he'll prescribe PZI. SO, I started on 1 unit to be on the safe side. And the rest you know :(
 
I'd think it'd be ok to increase to 2U as their vet had recommended initially so long as the BS is watched closely (every 4 hours or so) and the cat is eating. You can always mix honey into the food or feed dry food for extra carbs to handle the increased insulin, if she's eating.

Levemir works very differently than caninsulin, and development of ketones usually means not enough insulin. Sometimes, when increasing a dose there are some inbetween BS numbers that are higher, then you get to a good dose and get mostly blue numbers. Maybe 4-5 wasn't enough instead of too much, or she had started to get an infection and that's where the high # came from.
 
Up from 1.25 to 2 units? If I did this in the very beginning when switching then maybe that would be ok.. But now I don't know if I can jump like that. All the comments at the top of this thread actually discouraged me from doing that. Managing diabetes is so not easy. I will soon dream colourful BG numbers in my sleep.
 
Meya14 said:
I'd think it'd be ok to increase to 2U as their vet had recommended initially so long as the BS is watched closely (every 4 hours or so) and the cat is eating. You can always mix honey into the food or feed dry food for extra carbs to handle the increased insulin, if she's eating.
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I agree with Meya14 about increasing the dose to 2u BID "IF" you think you can get as much food into Barsa as necessary to keep the blood sugar from plummeting. Like she said, you can always add karo, honey, sugar water, etc. to food or feed dry food if you have to to handle the extra insulin.

If you're reluctant or don't think you can monitor closely and feed throughout the cycle, I would suggest increasing the dose to 1.5 unit. In other words, know and understand that increasing the dose requires careful monitoring.

At this point, given the circumstances, I'd feed whatever she'll eat. More insulin, food, and fluids will be of great help...


Vintry said:
Up from 1.25 to 2 units? If I did this in the very beginning when switching then maybe that would be ok.. But now I don't know if I can jump like that. All the comments at the top of this thread actually discouraged me from doing that. Managing diabetes is so not easy. I will soon dream colourful BG numbers in my sleep.
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The guidelines you were quoted above are for treating under normal circumstances. When a cat is throwing large ketones, guidelines and protocols get thrown out the window. They don't matter at this point. Forget about "protocols" for now.

Barsa needs more insulin to stop ketones from developing.
 
You are testing, so you 'll see if and when you need to back off the dose as you continue monitoring. Levemir is slow to build up in the system, so even with giving a bit of a boost with a bigger dose increase now, your testing will let you know if you need to adjust in time to do so,
 
Look at her numbers friends, I just tested her. 13.9 (250). I will test for ketones in the morning, in 6 hours and if they're still there then....increase the dose I guess. But it already looks like something is happening, right?? If only these stupid ketones were gone :(
 
Keep going with the hydration and food. If you are in the US, it is possible to pick up a shorter acting supplemental insulin such as R (regular) and very, very cautiously add tiny amounts of that to help get the glucose down.
Did the vet check the potassium level when you were there?
 
No he didn't do any tests. And he would only give my cat short-acting insulin if I left her in the clinic overnight, which I didn't do. It's an emergency clinic so this vet doesn;t know anything about my cat and wouldnt trust me with his insulin. Why is potassium level important? And electrolytes? Im going to Barsa's doctor tomorrow, maybe I can see if there's any info from last week's blood test.

I need to get some sleep now, so worn out and emotionally drained. My family too, everyone is worried sick.

Good night ladies. What would I do without you all.
 
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Vintry said:
Look at her numbers friends, I just tested her. 13.9 (250). I will test for ketones in the morning, in 6 hours and if they're still there then....increase the dose I guess. But it already looks like something is happening, right?? If only these stupid ketones were gone :(
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Unless something unusual happens (like a drop into low-normal numbers) between now and the next shot, I believe the dose can be increased to at least 1.5u BID... if she's no longer throwing ketones. IMO, the Levemir starting dose was too low.

If you're seeing anything but trace ketones, I would increase to 2u BID and monitor closely.
As BJM said, keep going with fluids and food. If I were in your shoes, I would also try to test for ketones twice a day.

BTW, ketones are not dependent on BG numbers. We've seen more than one ketone prone cat develop ketones when their blood sugar registers in the 100s.

Just my thoughts...
 
They should run labs. An electrolyte imbalance, particularly phosphorus level, is the result of the ketoacidosis. The electrolytes are typically a part of a blood panel.

Now is not the time to tell someone to use R without any prior discussion or preparation. She's in the UK.

Please understand that ketones can develop regardless of whether numbers are high. Barsa's numbers would not cause me, at least, to be on the lookout for ketones. You did great with testing to see if they were present.

I would encourage you to follow Jill's advice regarding dose. She's one of the people who has the most experience with Lantus and Lev.
 
Re Liquivite food, it has a high fat content but because it's so watery it is NOT calorie dense. If hydration is the main issue then it might be a good option but if your kitty isn't eating much volume of food then your cat might not be able to eat enough of the Liquivite to get the necessary calories.
 
Potassium is just one part of the chemical messaging system in the body, and is affected by insulin use. That is part of what makes diabetic ketoacidosis difficult to manage. As you give more insulin, the electrolytes change in concentration, sometimes dangerously.
 
Critter Mom said:
Re Liquivite food, it has a high fat content but because it's so watery it is NOT calorie dense. If hydration is the main issue then it might be a good option but if your kitty isn't eating much volume of food and needs more calories then I'd suggest looking at a different food.
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Thank you! Good to know.

Vintry said:
I need to get some sleep now, so worn out and emotionally drained. My family too, everyone is worried sick.
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I can appreciate your feelings. Many of us have been there, including myself. However, if at all possible, try to feed and syringe some water every few hours if you can. It could make a difference...
:bighug::bighug::bighug:
 
I just sent you a private message that should be in your inbox. I can fix your US spreadsheet for you which will help us with giving suggestions in the future.
 
Marje and Gracie, yes! That would be very good, thank you. I've done it, you can edit it now.

The news are not good. She vomited again. Almost same as yesterday, only yesterday an hour before morning feed, today 2 hours before.
 
I'm glad Jill weighed in on the dose, and I hope you can both get some rest and help her keep some food down this morning.

Sending "feel better" vines to Barsa.
 
Vintry said:
More vomiting and not eating, hardly even walking. Running to vet
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Taking her to the vet is best. Glad you're on your way.
Update when you get a chance. I'm off to bed, but others will be logging on soon.

Sending positive thoughts and healing vines...

:bighug::bighug::bighug:
 
She's in vet's hands now, I had to syringe-feed my baby on the way because I gave her an increased dose of 1.5 but she didn't want to eat anything. Vet is going to run a blood test and give her fluids as well as monitor her blood glucose. We both tested it there, me as usual with my human glucometer (freestyle) and he used his Alphatrek (for cats). Mine showed 11.4, his - 19.
 
I am so pleased to hear Barsa is in good hands at the vets and it sounds as if you have a good vet who knows what he is doing. That is so important! You must be feeling exhausted and worried :bighug::bighug:but Barsa is in the best possible place. You did a great job keeping her going until you could get to your vet. Well done.
Try and get some rest if you can so that when Barsa is well enough to come home, you will be rested and fresh to continue looking after her.
Please keep us all up to date with how she is going if you can. Am sending healing vines for dear Barsa.:bighug::bighug:
Bron
 
So sorry to hear that your baby is not well.
When things settle down if you would like to try the aloe vera juice the best one to try in the UK is called
Pukka Organic Juice,readily available on UK Internet,or I buy it at my local health store.
Best of luck. Diane
 
Vintry maybe the liver shake would help Barsa with her appetite when she comes home. I gave it to Rooh once when he wasn't eating and it helped him. Sending healing vines for you and Barsa.
 
Hi Vintry, haven't posted on your condo before but have been watching developments over the weekend. Just wanted to send healing vines to Barsa, and hugs to you too, you certainly are having a tough time at the moment. Take care.

Suki
 
Liz and I are sending those healing vines and energy to you and Barsa. And prayers! Hoping all is well soon. :bighug:
 
Good morning everybody,

Here's a big update on what's been happening. Yesterday was a busy day. I've run out of glucose test strips, went to a couple of shops to find the right food for Barsa (low-carb, high-calorie) and then finally pick her up from vet's. 3 days felt like a week. I have read every single reply here (sorry if unanswered sometimes!) and want to thank you all for your advice, kind words and prayers. I feel like we are all family here and probably nobody else can understand what it feels like better than you. Thank you so much for being there for me and Barsa in hard time! She is home now, All ketones flushed out, NO traces at all. She is wobbly when walking, less than 3kg but tail is up and appetite is Very good :) I still cannot relax but the worst is behind. I hope that this thread will help someone else in the similar situation. It certainly did help me. I've learned a lot and hope you did too.

So I took her to vet on Mon first thing in the morning. They were still closed so I waited half an hour outside, syringe-fed her liquid food and tested glucose every hour. Glucose dropped to 4.4 that day because she's had very little food. My doctor put her on the drip, and did glucose curve. He of course didn't like the fact I didn't follow his instruction to start with 2 units Levemir but said that 1.5 is the correct dose (I said to him it's not exactly easy to tell because she's had little food, that's why it fell to 4.4). Anyways, for now Barsa remains on 1.5 units. She stayed on the drip until 6 oclock (they close at 6.30), then they transferred her to another clinic that stays open overnight where they continued giving her fluids. Then back to my vet in the morning, again on the drip. So no less than 20hours of fluids. The tests they've run - full profile, electrolyte profile, urinalysis. There were no underlying conditions or complications (halellujah), but as expected - low potassium and phosphorus. These numbers have gone up now, I took home Kaminox supplement (to give 2ml twice a day), it's mainly potassium, also vitamin B complex (B1,B2,B3,B5,B6,B12), iron and amino acid blend.

I've updated the spreadsheet. A bit of a mess with insulin injections. While Barsa was in overnight clinic, she only received nurse care, which means no vet involvement so no unsulin injection in the morning. They fed her there, then around 9 transferred her back to my vet, he fed her there again and only then gave her insulin. So 4 hours late, BG was 13 (234) pre-shot. And in the evening when I took her home - 17.5 (315) before food. So I will wait and see how soon it will stabilise, 3-5 days..?

Conclusion. If I didn't take her to vet on that day, she'd probably die. If you see any ketones - run to vet. And I did because so many of you urged me to do so and explained why. So she's alive and better thanks to all of you here (BIG HUGS). Just like that you can save a cat over the internet :)
 
That is wonderful news and healing prayers for Barsa to continue to improve and a big hug to you too.
 
What great news!

A word of caution, though. Ketones can be unpredictable and can develop even when a kitty is in good numbers. You did great and were checking for ketones and caught them before the situation turned dire. Please continue to check Barsa for ketones whenever you can and try doubly hard if anything seems "off" (e.g., Barsa is lethargic, refusing food).

In the meantime, food is essential. Add as much water to food as Barsa can tolerate. We'll keep an eye on the insulin dose.
 
Woo-hoo! Wonderful news! Happy to hear Barsa is doing so much better! Thank you for updating.

Sienne and Gabby said:
A word of caution, though. Ketones can be unpredictable and can develop even when a kitty is in good numbers. You did great and were checking for ketones and caught them before the situation turned dire. Please continue to check Barsa for ketones whenever you can and try doubly hard if anything seems "off" (e.g., Barsa is lethargic, refusing food).

In the meantime, food is essential. Add as much water to food as Barsa can tolerate. We'll keep an eye on the insulin dose.
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I just want to second Sienne's comments. Don't let your guard down. As you've experienced, things can turn quickly.
 
Yes, I've been giving her that potassium supplement today and syringe-feeding water again. She's eating very well but glucose numbers are still not in the blue and it will take time to gain weight. Tested for ketones again - traces. I don't know if this is the remainder that should soon get flushed out or is this new ones again..any ideas? What's confusing is this. Ketones appear first in blood and then couple of days later in urine. Vet tested blood and urine yesterday, told me no more ketones, and that potassium is still low so I am to give it as supplement. But if I see traces in urine today, shouldn't they have been in blood yesterday? I have an appointment with him tomorrow (checkup), will see what he says about these traces and also ask again about insulin dose.
 
I'm so glad you've made it through the crisis and she's back home and doing ok. I don't know how long it is between when they show up in blood until they also register in urine.

There is a blood ketone meter available in the US. I don't know if it's available in the UK or not, but if youwant to explore that possibility it's called the Novamax and it tests both glucose and ketones in the same strip.

Keep up the food and water, keep testing for ketones.
 
I've had to cancel the appointment. Emailed the doctor this morning asking about ketones. He replied saying they're in urine because BG is high. If Barsa is being, lethargic, quiet and not eating then we should have her back on fluids. For now, she seems fine so no fluids. And increase insulin to 1.75 or 2 units to get sugar under control. So I'm dreading these 4 days of Easter holidays when everything will be closed. Novamax or Ketostix strips..either way if ketones are there then I cannot do anything about them :( But if the future is bright then yeah, we should all have them in arsenal to catch the problem early.

let's wait and see, maybe it will all be ok and the nasties won't come back.
 
Did the vet give you a high calorie food to feed her? There is one called IAMs Max cal (and a few other brands of critical care foods) that would be helpful until she's out of the clear with all this ketone business and might help her gain some weight back. Your insulin need is going to fluctuate at first during all this, so if her sugars remain high for a few days, let your vet know and ask if he wants you to increase.
 
Let's see. She's eating four times a day because she has good appetite. I wanted to split it into 3 meals in the morning and 3 in the evening but she's not happy with very small meals.

So, yesterday - morning - meal 1 - 100g - 6.1% carbs - 105 calories
- meal 2 - 85g - 4.1 carbs - 66 calories
yesterday - evening - meal 1 - 85g - 6.6% carbs - 98 calories
- meal 2 - 40g - 4.1% carbs - 33 calories

Total - 310g, 302 calories per da. She weighs 3.1kg

Is that good? The food is mixed, some high in fat and some high in protein but all are under 10% carbohydrates. Some have over 100 calories per 100g.

P.S. I think the one I just fed her is good. 85g can of Miamor pate, 98calories in it, 12% protein, 7% fat, 3.5% carbs
 
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Vintry said:
So I'm dreading these 4 days of Easter holidays when everything will be closed.
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I know what you mean. I'd try to be prepared to treat at home under similar circumstances with sub-q fluids, a fast-acting insulin, oral syringes to assist feed, an appetite stimulant, meds for nauseousness, an antibiotic (if necessary) and some high calorie food like Meya14 mentioned above.

Do you know how to administer subcutaneous fluids at home if ketones become worse? If not, I'd ask your vet to teach you. He/she can also tell you how much fluid to give if ketones are present... an amount that would be safe for Barsa. I'm not familiar enough with Barsa's medical history to suggest an amount. You'll need a bag of fluids, a line, and several needles.

When there's a threat of ketones and kitty remains in high numbers, some of us will use a fast-acting insulin (bolus) in addition to the Levemir insulin (basal) dose to help bring numbers down. Here in the US, the fast acting insulin is called Humulin R or Novolin R, but other countries have similar choices. A discussion took place in one of suki & crystal's threads not too long ago: Advice on R. You might find it worth reading and discussing with your vet.

Regarding fast-acting insulin available in other countries... here's an excerpt from Crystal's thread:

"Alternatives can be found here: Activity profiles of the insulins (I used a translator I have installed on my laptop).
Normal-Insulin (Alt-Insulin)
- Insuman Infusat
- Berlinsulin H Normal
- Humaject Normal
- Huminsulin Normal 40
- Insulin Actrapid HM
- Insuman RAPID"

Your vet will know what's available in your country.

You may not need any or all of this stuff, but at least you'd have something to work with if necessary.
These are all things to discuss with your vet if you should need to treat at home over the holiday weekend..


Vintry said:
Total - 310g, 302 calories per da. She weighs 3.1kg
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She's tiny! I'd say 302 calories for a 3.1kg/6.8lb kitty is pretty good. When kitties are throwing ketones, it's the amount of calories consumed that becomes important. The % of carbs is less important. Whenever Alex threw ketones I'd let her eat as much as she wanted, as frequently as she wanted, and whatever she'd want to eat.



Please post for help, advice, or suggestions as needed. Many of us can help.
 
Hi, sorry to hear all that you have been through. Our Tess had a DKA episode last month and I know just how scary it is. One thing I would like to stress is the importance of keeping Barsa eating. If the only food she will eat is higher carb, feed that to her even if it means increasing the insulin dose. Ketones develop when the cat's body resorts to metabolizing it's own muscle because lack of insulin prevents it from using the glucose in the bloodstream. Ketones are the by-product of that muscle breakdown.

2 weeks after the DKA I panicked when I though I smelled acetone on her breath again (a sign of ketones). The first thing the ER vet asked was if she was eating. It was just before her shot time and we hadn't tried to get her to eat. The vet produce a bowl of diced chicken and Tess went to town on it. Our Rx was to take the bowl of chicken home and don't panic unless you can't get her to eat. :cat: She is on fluid therapy at home as well (but that is also because she has kidney disease) which helps to keep the system flushed out, it isn't that hard to do. Marje did a great video on how to give fluids.

Many of us are deeply suspicious of the "prescription" food that the vets insist on. Tess developed an addiction to one while in hospital. It is way to high in carbs, but I can mix it w/ low carb food. It keeps her eating. That is crucial, so a little Hills W/D is better than nothing!

Since Barsa has had DKA once, she will be more prone to it. Keep her eating w/ whatever food it takes to do so, the insulin can be adjusted for the carbs in the food.
 
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