Darnell & Sprocket (GA)
Member Since 2015
Did not get fluids yet but will tonight.
He isnt newly diagnosed.
He been 2 years. 3/2015
He isnt newly diagnosed.
He been 2 years. 3/2015
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? 4/6/17, Sprocket, AMPS 320.3.5u. +4/45, 77, +5/120, +6/105,+7/139,+8.5/312, PMPS 458,advise
- Thread starter Darnell & Sprocket (GA)
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Sorry missed that, but it looks like it's just recently that you've been testing more? Some cats like to bounce and his SS doesn't look ununsual for that.
Darnell & Sprocket (GA)
Member Since 2015
Yes. I had issues with alphatrak2 meter. Could never get enough blood from him. Or it timed out without enough blood. Plus too $$$.
I got human meter, relion confirm meter and literally half amount of blood needed and price is right.
So been doing more bgs since. & now can do alone luckily. He got annoyed some earlier when his ears were clammy n slow blood. Used 3 strips on that.
He slept a few hours before.
He ate @ 1oz of wet food but hope he will take more when storm stops.
He peed n ketone negative. No vomit since this morning n no poop since then either.
@Nan & Amber @Wendy&Neko
I got human meter, relion confirm meter and literally half amount of blood needed and price is right.
So been doing more bgs since. & now can do alone luckily. He got annoyed some earlier when his ears were clammy n slow blood. Used 3 strips on that.
He slept a few hours before.
He ate @ 1oz of wet food but hope he will take more when storm stops.
He peed n ketone negative. No vomit since this morning n no poop since then either.
@Nan & Amber @Wendy&Neko
Did you shoot the 3.5 units? The spreadsheet is blank.
Darnell & Sprocket (GA)
Member Since 2015
Oh sorry. Yeah.
Thanks for updating the spreadsheet.
I hope he doesn't bounce too high for you.
Sorry, but one more question for you. I was wondering whether you've decided to follow the Tight Regulation protocol (TR) or the Start Low Go Slow method (SLGS) for dosing? People will usually put either TR or SLGS is their signature as that provides guidelines for dosing.
I hope he doesn't bounce too high for you.Sorry, but one more question for you. I was wondering whether you've decided to follow the Tight Regulation protocol (TR) or the Start Low Go Slow method (SLGS) for dosing? People will usually put either TR or SLGS is their signature as that provides guidelines for dosing.
Darnell & Sprocket (GA)
Member Since 2015
Just tested again before fluids...478@9:06pm which is +2.
@75ml fluids as we are shaky n he is not happy. A friend normally comes to help but that is usually in afternoon.
I have not read the protocol yet but from what i know so far. I would probably say slow go method since I am very terrified at this point.
@75ml fluids as we are shaky n he is not happy. A friend normally comes to help but that is usually in afternoon.
I have not read the protocol yet but from what i know so far. I would probably say slow go method since I am very terrified at this point.
The decision is your as to which dosing method you want to use. With Tight Regulation, you would hold the 3.5 unit dose because we wait for an under 40 to reduce for a longer term diabetic (diabetic over one year). With SLGS you would reduce because he went under 90 today. Keep in mind that his numbers were mostly "meh" and the word increase was being used until today on 3.5 units. TR would allow you to keep more insulin into him, a consideration with his recent DKA. With time, handling lower numbers becomes easier. As you learn how carb sensitive Sprocket is and what food you need to raise him numbers (which is why it's worth tracking how much and what food you gave), then low numbers aren't so terrifying. But everyone is terrified the first few times. 
Read the TR protocol and SLGS sticky notes. Ask questions if it will help your decision.
Read the TR protocol and SLGS sticky notes. Ask questions if it will help your decision.
Meya14
Member Since 2015
Hi there, sorry I didn't chime in sooner, long day at work.
Couple questions:
Your cat had ketones/DKA in march?
Is you cat underweight (do you see spine, hips, or ribs)? Weight loss with the DKA?
What are you feeding and how much?
Has your cat been diagnosed with pancreatitis?
Any other chronic illnesses?
Couple questions:
Your cat had ketones/DKA in march?
Is you cat underweight (do you see spine, hips, or ribs)? Weight loss with the DKA?
What are you feeding and how much?
Has your cat been diagnosed with pancreatitis?
Any other chronic illnesses?
Darnell & Sprocket (GA)
Member Since 2015
Hi. Sprocket had ketones 3 times. 3 hospital visits. March 7th-10th. Friday night home. 3 nights 4 days
Did fur shot sat pm somehow. He went back to hospital but different one on sunday afternoon. Ketones. Would not eat. 1 night. 2 days.
Went to vet office on not eating great n seeming nauseated on thurs & fri am that week. Vets changed dosing 2times.
8 days home. He ate well after adding famotidine to his medication list. Steady yet stayed in 300s or low 400s. 9th morning he would not eat. Went to vet office. Ketones again. That was thurs. Then went to ER hospital again. Waited 2.5 hrs to see doctor. Admited overnight since not eating with ketones. They gave 3.5 units for 2 doses before giving 1 unit of fast acting insulin. The he went under 100 on pet meter. Stayed there all day. Friday. He went to 56 at 6pm n they gave dextrose. He was up to 200 by 8pm.
He went home on sat night after low 400s & 4 units. 3.5 units at home after that.
Trying to not get ketones yet not go under like today.
It was terrifying.
He is 13.95 lbs. He was 18 lbs before diagnosis in 3/2015. He went to 12 lbs then went back to 16 lbs after in @ 6 months. Then slowly down to his weight now.
Now feeding under 5% ff pates. Or some young again zero or evo dry when he wont eat wet.
Freeze dried treats and pill pockets.
No pancreatitis or UTI or IBS.
Said cholangiohepatitis. On liver meds plus antibiotic. Appetite stim n famotidine.
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@Wendy&Neko . Answers your questions too
Meya14
Member Since 2015
So at 12-14 lbs would you say he is healthy looking or thin. Some cats (like maine coon) have large builds, so although 13 is a good size, it might be skinny for some?
The cholangiohepatitis was probably diagnosed due to elevated liver enzymes/bilirubin. Elevated liver labs are a common effect of dehydration/anorexia/ketones and it usually does improve or resolve when cat is recovered from dka.
As far as the food, if you could look at the amount you are feeding and calculate the calories, if the packaging gives you calorie counts. Cats need 200-300 calories per day depending on size and activity. With recurrent episodes of ketones, is it possible that your cat is not getting quite enough calories?
So, in humans, we have a term for diabetics that swing very high, and then very low, and are generally hard to control. They are called "brittle diabteics". These people tend to be either very thin and frail, poor appetite chronically, or have illnesses that either prevent them for absorbing calories or increase metabolism. In these people, the pancreas and liver have a hard time increasing blood sugar when they start to go low, because they have few fat reserves or are ill. It might seem counter-intuitive, but sometimes increasing carbs helps to even these people out. What we used to do with some of these brittle diabetics was feed low carb at shot times, and higher carb an hour or two before the peak. This allowed us to give -MORE- insulin which is what was needed to help them.
Having to give -MORE- insulin isn't always a bad thing. It helps to understand the function of insulin in the body. Insulin first and foremost is a growth hormone - it allows the body to build muscle, to utilize energy, to store fat, to have a normal metabolism. A secondary effect of insulin is to regulate blood sugar. Without enough insulin, the body begins to break stuff down - muscle, fat - and that's how DKA and other issues begin. To be able to give enough insulin to help metabolism, sometimes we need to increase food, and sometimes carbs.
It will be helpful to continue to test for ketones. Also, if you are able to weigh your cat, tracking weight is a very helpful way to gauge if food amounts are adequate.
The cholangiohepatitis was probably diagnosed due to elevated liver enzymes/bilirubin. Elevated liver labs are a common effect of dehydration/anorexia/ketones and it usually does improve or resolve when cat is recovered from dka.
As far as the food, if you could look at the amount you are feeding and calculate the calories, if the packaging gives you calorie counts. Cats need 200-300 calories per day depending on size and activity. With recurrent episodes of ketones, is it possible that your cat is not getting quite enough calories?
So, in humans, we have a term for diabetics that swing very high, and then very low, and are generally hard to control. They are called "brittle diabteics". These people tend to be either very thin and frail, poor appetite chronically, or have illnesses that either prevent them for absorbing calories or increase metabolism. In these people, the pancreas and liver have a hard time increasing blood sugar when they start to go low, because they have few fat reserves or are ill. It might seem counter-intuitive, but sometimes increasing carbs helps to even these people out. What we used to do with some of these brittle diabetics was feed low carb at shot times, and higher carb an hour or two before the peak. This allowed us to give -MORE- insulin which is what was needed to help them.
Having to give -MORE- insulin isn't always a bad thing. It helps to understand the function of insulin in the body. Insulin first and foremost is a growth hormone - it allows the body to build muscle, to utilize energy, to store fat, to have a normal metabolism. A secondary effect of insulin is to regulate blood sugar. Without enough insulin, the body begins to break stuff down - muscle, fat - and that's how DKA and other issues begin. To be able to give enough insulin to help metabolism, sometimes we need to increase food, and sometimes carbs.
It will be helpful to continue to test for ketones. Also, if you are able to weigh your cat, tracking weight is a very helpful way to gauge if food amounts are adequate.
julie & punkin (ga)
Member Since 2011
Thanks for all of that update. I'm glad Meya is chiming in - DKA is nothing to mess around with and you'd like to see it further in your rear-view window!
You did a good job handling the low numbers today! As you are seeing, as long as you are testing and have high carb supplies, you'll be able to steer Sprocket's blood sugar when he gets low. It's a good feeling when you realize that you have some control over the situation and you know what to do. Everyone overcarbs the first time - next time try that lesser amount that was suggested, say a teaspoon of just the gravy. I found that I wanted a 20% or higher carb gravy food for punkin. I don't know what the carb value was of the gravy food you gave him, but he did come up fairly easily. Next time you might hold off on the corn syrup and dry food to see if the gravy alone can do it - but no harm done. Your goal was to bring him up out of danger and you did that awesomely! Once you get the hang of the idea and see some success, like today, you can try to figure out the "right" amount for Sprocket. This is an ECID (Every Cat Is Different) thing - some cats are extremely carb sensitive and their blood sugar raises easily with a smidge of 10-15% gravy. Some need more volume or a higher carb gravy. Your goal is to get him over 50 and keep him from dropping back under 50.
I'm wondering if there were some lower numbers the night of April 3rd. Notice that Sprocket had a pmps 318 and +3 239 that evening. That's not a particularly big drop, and I wouldn't have thought much about it at that time. But hindsight can often give us an opportunity to see things more clearly.
Bounces typically last about 3 days if a cat's body is not used to getting into green numbers. Even though that's Sprocket's normal body blood sugar range, he's been high long enough that when he gets into green numbers his body perceives it as a hypo - even if it isn't. So his body releases counter-regulatory hormones and stored sugars in order to save him from the hypo - which send his blood sugar soaring. It takes about 3 days to clear out that reaction and for the blood sugar to return to normal.
The reason I'm pointing at that night is because today is the 6th day from the last green streak on his spreadsheet (4/1). Looking in between these two, my eye is going to the night of the 3rd as the possibility for Sprocket to have again briefly hit green and then gone back up by the morning of the 4th, and then remaining high for the following 3 days.
It can be helpful to see patterns like this because they help you anticipate what might happen in the future. In this case, I'd start being on watch on Saturday-Sunday to see if you can catch Sprocket doing what we call "clearing the bounce." Once you've begun to see patterns, when a kitty first bounces, you can test less at the beginning because you know he's had an event that has triggered the bounce, and you know at this point in time, his bounces are lasting close to the full 3 days. As his body spends more time in green numbers, his bounces will lessen - they won't last as long and they won't bounce as high. Some cats don't stop bouncing, just depends on the cat. But many cats do.
For now, I'd test a little less (I'd still get both preshots and one mid-cycle test minimum in every cycle) and then return to watching for the bounce to clear on Saturday. If my crystal ball were really good, I'd be especially watching for Saturday night - but that's just my guess. You'll have to watch and see.
Hope some of that helps and you can get a good night's sleep tonight!
You did a good job handling the low numbers today! As you are seeing, as long as you are testing and have high carb supplies, you'll be able to steer Sprocket's blood sugar when he gets low. It's a good feeling when you realize that you have some control over the situation and you know what to do. Everyone overcarbs the first time - next time try that lesser amount that was suggested, say a teaspoon of just the gravy. I found that I wanted a 20% or higher carb gravy food for punkin. I don't know what the carb value was of the gravy food you gave him, but he did come up fairly easily. Next time you might hold off on the corn syrup and dry food to see if the gravy alone can do it - but no harm done. Your goal was to bring him up out of danger and you did that awesomely! Once you get the hang of the idea and see some success, like today, you can try to figure out the "right" amount for Sprocket. This is an ECID (Every Cat Is Different) thing - some cats are extremely carb sensitive and their blood sugar raises easily with a smidge of 10-15% gravy. Some need more volume or a higher carb gravy. Your goal is to get him over 50 and keep him from dropping back under 50.
I'm wondering if there were some lower numbers the night of April 3rd. Notice that Sprocket had a pmps 318 and +3 239 that evening. That's not a particularly big drop, and I wouldn't have thought much about it at that time. But hindsight can often give us an opportunity to see things more clearly.
Bounces typically last about 3 days if a cat's body is not used to getting into green numbers. Even though that's Sprocket's normal body blood sugar range, he's been high long enough that when he gets into green numbers his body perceives it as a hypo - even if it isn't. So his body releases counter-regulatory hormones and stored sugars in order to save him from the hypo - which send his blood sugar soaring. It takes about 3 days to clear out that reaction and for the blood sugar to return to normal.
The reason I'm pointing at that night is because today is the 6th day from the last green streak on his spreadsheet (4/1). Looking in between these two, my eye is going to the night of the 3rd as the possibility for Sprocket to have again briefly hit green and then gone back up by the morning of the 4th, and then remaining high for the following 3 days.
It can be helpful to see patterns like this because they help you anticipate what might happen in the future. In this case, I'd start being on watch on Saturday-Sunday to see if you can catch Sprocket doing what we call "clearing the bounce." Once you've begun to see patterns, when a kitty first bounces, you can test less at the beginning because you know he's had an event that has triggered the bounce, and you know at this point in time, his bounces are lasting close to the full 3 days. As his body spends more time in green numbers, his bounces will lessen - they won't last as long and they won't bounce as high. Some cats don't stop bouncing, just depends on the cat. But many cats do.
For now, I'd test a little less (I'd still get both preshots and one mid-cycle test minimum in every cycle) and then return to watching for the bounce to clear on Saturday. If my crystal ball were really good, I'd be especially watching for Saturday night - but that's just my guess. You'll have to watch and see.
Hope some of that helps and you can get a good night's sleep tonight!
While we don't normally use the term "brittle diabetics" in cats (although I've heard some vets use it for cats that are bouncing), the philosophy of managing the curve with food to flatten the curve with the goal of getting more insulin into them is something we've done here with a lot of cats.
@Darnell & Sprocket You can read more about managing the curve with food here (scroll down to post 15). Because Sprocket has shown he can dive from high to low numbers, it might help you to understand how we manage the curve with food and the value of it.
Darnell & Sprocket (GA)
Member Since 2015
@julie & punkin (ga)
@Meya14
Wow! Alot of info. My brain is not completely understanding it right now. I will read again after i get some sleep.
Meya. He is a big boy. Big feet. Long. Idk if he is overweight or not. Some vets say over n some say under.
He has had between 350-450 calories a day. I put that in remarks section daily for awhile.
I would appreciate some more people to follow me cause I am trying hard but so stressed. I know everyone has different schedules so the more people around in a helping group would be good so I dont lose my mind currently.
I am probably already frustrating Chris & Jenna as my brain is hard to understand this stuff cause I have some medical memory issues so its more difficult to process sometimes.
So please more followers the better.
Ok. Gonna try to get some sleep.
Will be up at 6am for test, meds, feed, shoot.
Hope it works tomorrow.
Trying to see a pattern. I will try to go back on some past info. Maybe it will help.
Thank you everyone today. And future!!
@Meya14
Wow! Alot of info. My brain is not completely understanding it right now. I will read again after i get some sleep.
Meya. He is a big boy. Big feet. Long. Idk if he is overweight or not. Some vets say over n some say under.
He has had between 350-450 calories a day. I put that in remarks section daily for awhile.
I would appreciate some more people to follow me cause I am trying hard but so stressed. I know everyone has different schedules so the more people around in a helping group would be good so I dont lose my mind currently.
I am probably already frustrating Chris & Jenna as my brain is hard to understand this stuff cause I have some medical memory issues so its more difficult to process sometimes.
So please more followers the better.
Ok. Gonna try to get some sleep.
Will be up at 6am for test, meds, feed, shoot.
Hope it works tomorrow.
Trying to see a pattern. I will try to go back on some past info. Maybe it will help.
Thank you everyone today. And future!!
Darnell & Sprocket (GA)
Member Since 2015
Thanks
Please see what i just posted too.
I know I need help figuring this out.
Thanks
You're welcome. It's a steep learning curve for everyone so please just write down your questions as you read and post them here so we can answer them for you.
julie & punkin (ga)
Member Since 2011
No worries, we all remember how overwhelming it is at the beginning. We'll point out things to you that we see until you begin to see them too.
That's what we do!
Thanks for telling us you have a memory issue. You're not alone - there have been lots of people here with medical issues. Just keep asking if you don't understand - this is like a crash course in college Feline Diabetes 101. At the beginning it's overwhelming, but it won't be too long before you start to understand things. In the meantime, just hang in there and continue to ask questions. There are many experienced people here who will help you learn.
Nighty night!
That's what we do!
Thanks for telling us you have a memory issue. You're not alone - there have been lots of people here with medical issues. Just keep asking if you don't understand - this is like a crash course in college Feline Diabetes 101. At the beginning it's overwhelming, but it won't be too long before you start to understand things. In the meantime, just hang in there and continue to ask questions. There are many experienced people here who will help you learn.
Nighty night!
julie & punkin (ga)
Member Since 2011
By the way, if you can move him all to the dog Duck and Pea pill pockets, that would be better. The cat ones are not low carb and 8 each day may be enough to make a difference in his blood sugar. I'm not sure how much - it probably depends on how carb sensitive he is.
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