? PMPS 431, +4 478, +10 417; AMPS 424. When to give add't increase?

[Sylvia & Millie]

So Millie continues to look better after her ketone episode. I increased her dose yesterday morning to 2.25. her AM +4 was 181. Last night and today she is running high (PMPS 431, +4 478, +10 417; AMPS 424.

I tested her urine from the litter box with the strips and it was negative (I know this isn't the best way to do it but it's all I have right now). Still trying to figure out the blood ketone monitor, I've gotten nothing or error the times I've tried to use it. I will try again when I test her during today's cycle.

She is eating and drinking well and using her litter box. She's animated and cuddling so I know she's feeling better. I printed out the food chart because I want to get her some high calorie food so she can gain weight. After her two DKA episodes and this week, she can stand to gain 3-4 pounds.

Moving forward I want to be more proactive about her insulin. How long should she stay at the 2.25 if she continues with high numbers? Do I hold for several days as the TR protocol advices? I know with her history it can be a bit different and I just want a sense of what I'm doing. I expect top test her during the weekend since my husband is home.

http://www.felinediabetes.com/FDMB/...dosing-feedback-increase.179612/#post-1987541

 

[Osha]

Maybe you aren't getting a large enough drop of blood for the ketone meter. It takes a larger blood drop than the blood glucose meters.

That is wonderful that Millie is feeling better.

I don't know the answer to increasing earlier than 6 cycles. I am sure someone with more experience will come and answer that question.

 

[saltycat]

Glad that Millie is feeling better and the ketones appear to be getting flushed out. I am not experienced enough with DKA cats to offer advice. I know you don't want her to stay high too long, but this looks like a bounce from yesterdays blue. Like Amanda mentioned, 6 cycles is the normal wait time to increase with the TR protocol, but DKA and other conditions can require a modified version of the protocol based on the condition and situation. Bumping you up to the top so some eyes with experience in DKA prone/post kitties can chime in.

 

[Gill & George]

I tested her urine from the litter box with the strips and it was negative (I know this isn't the best way to do it but it's all I have right now).

That's good news. I'm sure you'll figure out the blood ketone meter soon enough. Negative on the urine strip is good. Glad she is peeing too.

I'm so glad she seems to be feeling better, we all love a cuddly cat.

As for dose increase, it will be dependent on numbers, presence/absence of ketones, appetite, other issues.

Last night looks like a bounce cycle (great job getting those tests), she was high and flat, but she has seen blue on the 2.25 and the 2.00 u dose, I'd like to see if she'll do it again, I think that I would perhaps hold for the moment, (unless she starts to through ketones in which case you might need to take action sooner) and see where this dose gets her. Watch for the bounce clearing, if you test and get a sudden drop follow up with a another test sometime later to see if you can catch her low point.



You might need to be more aggressive with the dosing because of the ketones , but before you were to do that I'd like to see what others think. With DKA in the picture, if she were still to be throwing ketones getting enough insulin into Millie, becomes more important than adhering strictly to any protocol.

I'd wait and see how the day progresses, before coming to any firm decisions. It will be interesting to see if she's going to stay high and flat or if her BG's will slide down today.

 

[Sylvia & Millie]

That's good news. I'm sure you'll figure out the blood ketone meter soon enough. Negative on the urine strip is good. Glad she is peeing too.

I'm so glad she seems to be feeling better, we all love a cuddly cat.

As for dose increase, it will be dependent on numbers, presence/absence of ketones, appetite, other issues.

Last night looks like a bounce cycle (great job getting those tests), she was high and flat, but she has seen blue on the 2.25 and the 2.00 u dose, I'd like to see if she'll do it again, I think that I would perhaps hold for the moment, (unless she starts to through ketones in which case you might need to take action sooner) and see where this dose gets her. Watch for the bounce clearing, if you test and get a sudden drop follow up with a another test sometime later to see if you can catch her low point.



You might need to be more aggressive with the dosing because of the ketones , but before you were to do that I'd like to see what others think. With DKA in the picture, if she were still to be throwing ketones getting enough insulin into Millie, becomes more important than adhering strictly to any protocol.

I'd wait and see how the day progresses, before coming to any firm decisions. It will be interesting to see if she's going to stay high and flat or if her BG's will slide down today.

I didn't do the +2 before bed last night because Millie is a grazer and was sibling for two hours! I went to bed and woke up later. I guess I missed her nadir, which isn't easy to catch anyway for several reasons. I hope to get the ketone meter reading today. It's a bit tricky since I am using the AlphaTrak for her bg and then using the other meter for her ketones. If anything when we're both home this evening it'll be easy for each of us to take/use a different meter.

I figured I'd have to take this step-by-step, especially given her recent situation, and ask as we go along.......

 

[Gill & George]

I didn't do the +2 before bed last night because Millie is a grazer and was sibling for two hours! I went to bed and woke up later. I guess I missed her nadir,

Often on a bounce cycle they stay high and flat and bobble around and don't really have a distinct 'nadir' it doesn't look like you missed any important numbers last night.

 

[Kris & Teasel]

I'm glad that Millie seems to have turned a corner with the ketones. So scary! I've been there. I can't help with dosing advice but the pros will weigh in soon.

 

[Jill & Alex (GA)]

That's good news. I'm sure you'll figure out the blood ketone meter soon enough. Negative on the urine strip is good. Glad she is peeing too.

I'm so glad she seems to be feeling better, we all love a cuddly cat.

As for dose increase, it will be dependent on numbers, presence/absence of ketones, appetite, other issues.

Last night looks like a bounce cycle (great job getting those tests), she was high and flat, but she has seen blue on the 2.25 and the 2.00 u dose, I'd like to see if she'll do it again, I think that I would perhaps hold for the moment, (unless she starts to through ketones in which case you might need to take action sooner) and see where this dose gets her. Watch for the bounce clearing, if you test and get a sudden drop follow up with a another test sometime later to see if you can catch her low point.



You might need to be more aggressive with the dosing because of the ketones , but before you were to do that I'd like to see what others think. With DKA in the picture, if she were still to be throwing ketones getting enough insulin into Millie, becomes more important than adhering strictly to any protocol.

I'd wait and see how the day progresses, before coming to any firm decisions. It will be interesting to see if she's going to stay high and flat or if her BG's will slide down today.

I like Gill's suggestions. I certainly wouldn't be in any hurry to increase the dose after only 3 cycles at 2.25u if she's negative for ketones... especially since we have no idea how low the 2u dose dropped her during the PM cycle on 06/21.

About Millie:

• How is her appetite? Is she eating her normal amount of food?
• Are you feeding LC or MC?
• Are you adding any water to her food?
• How is she acting?
• Is she pooping and peeing normally?

If she tests positive for ketones, please let us know immediately. It may be necessary to become more aggressive.


Alex was a ketone prone cat. Under similar circumstances, these are the things I would focus on everyday:

• getting her normal amount of calories into her plus half of that everyday (assist feed if necessary)
• adding as much water to her food as she would tolerate
• giving her water by syringe as often as was practical
• testing for ketones twice a day
• learning how low the current dose was taking her (testing BG frequently)
• keeping an eye on the litter box to make sure everything was ok in that department
• administering sub-q fluids if necessary

Being proactive helped keep ketones at bay with her.
Maybe it'll help Millie...
Good luck!

 

[Sylvia & Millie]

I like Gill's suggestions. I certainly wouldn't be in any hurry to increase the dose after only 3 cycles at 2.25u if she's negative for ketones... especially since we have no idea how low the 2u dose dropped her during the PM cycle on 06/21.

About Millie:

• How is her appetite? Is she eating her normal amount of food?
• Are you feeding LC or MC?
• Are you adding any water to her food?
• How is she acting?
• Is she pooping and peeing normally?

Millie's appetite is really good.
She is currently on a MC, higher calorie food (CORE Wellness Beef with very little FF Gravy Lovers or Grilled). Yes, we are adding water to her food and she is drinking regularly.
She is back to herself, social, alert, looking out the window, etc.
She is back to normal pooping and peeing.


If she tests positive for ketones, please let us know immediately. It may be necessary to become more aggressive.
Will do. 30 minutes we tested her bg, it was 286. We also tested for ketones; tried the monitor again but we still get E-3 or E7, not sure why or what that means. The monitor said the bg was too low to read. The ketone reading is based on the bg being high (or so I understand).


Alex was a ketone prone cat. Under similar circumstances, these are the things I would focus on everyday:

• getting her normal amount of calories into her plus half of that everyday (assist feed if necessary)
• adding as much water to her food as she would tolerate
• giving her water by syringe as often as was practical
• testing for ketones twice a day
• learning how low the current dose was taking her (testing BG frequently)
• keeping an eye on the litter box to make sure everything was ok in that department
• administering sub-q fluids if necessary

Being proactive helped keep ketones at bay with her.
Maybe it'll help Millie...
Good luck!

Thank you for the suggestions!