? 2/20 Arya - dosing advice/time? AMPS 421 +2 413, gave 2U, PMPS 319 +2 285, positive ketones test,Pos

KatieBDZ

KatieBDZ

Member Since 2020
Yesterday's post: http://www.felinediabetes.com/FDMB/...183-skipped-dose-pmps-373-post-dka-hl.225868/

Today she ate a half cup of food in the morning as well as a handful of food I left out overnight at around 2:30 am (heard her crunching in my room), tried to do a quick ketones test this morning but had to dip it in the litter right after she went (rather than in the stream, wasn't fast enough) so not fully sure on accuracy but it read as negative, gave her 2 units of insulin but I felt wetness in her fur after I did it so not sure if any went in at all - will recheck her blood glucose at +2 before work and then have a friend coming at 10 am just to look in on her, otherwise I won't be home until 5 pm.

Even though I'm not sure it went in I'm obviously not going to reshoot anything just in case but should I leave any food out for her during the day? She's post DKA/HL. Also is the 2U dosage ok? Her AMPS was pretty high so I'm thinking it isn't too much for her (she was also fine overnight although she did eat at 2:30 am)? Lastly can I change her evening shot time to be later at all or should I always want to make sure I can get a +2 in the morning and not just a +1? (I'd prefer to do 6:30 am/6:30 pm but then can only get a +1 before I have to leave for work). Thank you for any help!
 
Hi Katie
It sounds as if she is eating a bit more which is good. Yes please leave food out for her during the day. We want her to eat as much as she can.
I would keep her separate from the other cat so you know she has food while you are not there. When your friend comes maybe she could offer food as well.

That is good the ketones were negative.. keep testing at every opportunity.

If you ever do a fur shot ( the fur feels wet) DON’T EVER give another dose of insulin it is too dangerous. Even though the fur feels wet, some of the insulin could have got in.

If you can keep giving the shots at the same time for a few more days so you can get a +2 before work that would be better if you can manage it.

I don’t think the 2 units is too much for her at this point. That can be reviewed each day as we go along.
Keep doing what you are doing. You are doing a very good job looking after Arya.
Bron
 
Just read the end of your previous post and answering your question about cerenia.
A lot of cats who are recovering from DKA will be nauseated and require antinausea meds such as cerenia and ondansetron. If you think Arya could be nauseated (sniffing food and walking away, eating a small amount and walking away) I would ask your vet for some of the cerenia and ondansetron to give at home. Cats who are nauseated are reluctant to eat.
 
As a side note, if you're having to push any excess insulin out of your syringe before injection, sometimes the needle/top of the syringe gets a little wet with it and will leave the fur wet -- I've thought I gave a fur shot because of that a few times.

And as another side note since you're obviously at least gently petting post-injection (which I do too & is fine!) - make sure you're not actually rubbing the injection site after giving the shot.
 
Bron and Sheba (GA) said:
Hi Katie
It sounds as if she is eating a bit more which is good. Yes please leave food out for her during the day. We want her to eat as much as she can.
I would keep her separate from the other cat so you know she has food while you are not there. When your friend comes maybe she could offer food as well.

That is good the ketones were negative.. keep testing at every opportunity.

If you ever do a fur shot ( the fur feels wet) DON’T EVER give another dose of insulin it is too dangerous. Even though the fur feels wet, some of the insulin could have got in.

If you can keep giving the shots at the same time for a few more days so you can get a +2 before work that would be better if you can manage it.

I don’t think the 2 units is too much for her at this point. That can be reviewed each day as we go along.
Keep doing what you are doing. You are doing a very good job looking after Arya.
Bron
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Thank you for your advice/response! Her +2 was 413 before I left and I left her out a half cup of food - kept her separated from my other cat (luckily I have a finished basement that she already likes to hang out in)
 
Bron and Sheba (GA) said:
Just read the end of your previous post and answering your question about cerenia.
A lot of cats who are recovering from DKA will be nauseated and require antinausea meds such as cerenia and ondansetron. If you think Arya could be nauseated (sniffing food and walking away, eating a small amount and walking away) I would ask your vet for some of the cerenia and ondansetron to give at home. Cats who are nauseated are reluctant to eat.
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Ok I will talk to my vet and see if I can't get something after work I do think her appetite is returning though which is good! I think she's getting more comfortable/happy to be home finally :)
 
toomanycats said:
As a side note, if you're having to push any excess insulin out of your syringe before injection, sometimes the needle/top of the syringe gets a little wet with it and will leave the fur wet -- I've thought I gave a fur shot because of that a few times.

And as another side note since you're obviously at least gently petting post-injection (which I do too & is fine!) - make sure you're not actually rubbing the injection site after giving the shot.
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Oh yes I did have to push out a little excess that's a good point! I did not know you weren't supposed to touch the injection site after giving the shot - why is that? I've been just running my hand over there quickly to see if it feels wet at all to make sure it went in. Arya is also very sweet and is purring when I'm giving her the shot usually so I am giving her pets afterwards too for being such a good girl <3 while I wouldn't wish this on either of my cats I'm lucky it's her because she is so good for both shots and the glucose checks (even when I've messed up a few times and hit her vein) - my other cat would have bit my face off by now lol
 
KatieBDZ said:
Oh yes I did have to push out a little excess that's a good point! I did not know you weren't supposed to touch the injection site after giving the shot - why is that? I've been just running my hand over there quickly to see if it feels wet at all to make sure it went in. Arya is also very sweet and is purring when I'm giving her the shot usually so I am giving her pets afterwards too for being such a good girl <3 while I wouldn't wish this on either of my cats I'm lucky it's her because she is so good for both shots and the glucose checks (even when I've messed up a few times and hit her vein) - my other cat would have bit my face off by now lol
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Running your hand over her/lightly petting her fur isn't a problem. You just don't want to rub the injection site after injection because Lantus forms crystals under the skin that release the insulin slowly over time, so rubbing the site could mess w/ that process.
 
toomanycats said:
Running your hand over her/lightly petting her fur isn't a problem. You just don't want to rub the injection site after injection because Lantus forms crystals under the skin that release the insulin slowly over time, so rubbing the site could mess w/ that process.
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Ah ok got it thank you!
 
General questions - when testing the BG is it ok to always do the same ear/general spot or should you rotate? I'm much better with the right ear but I wanted to make sure that's ok for her! I've been using neosporin with pain relief and I haven't noticed any bruising or anything. Also when should you do a curve? I haven't done one yet still just trying to get her home/adjusted. Thanks!
 
KatieBDZ said:
General questions - when testing the BG is it ok to always do the same ear/general spot or should you rotate? I'm much better with the right ear but I wanted to make sure that's ok for her! I've been using neosporin with pain relief and I haven't noticed any bruising or anything. Also when should you do a curve? I haven't done one yet still just trying to get her home/adjusted. Thanks!
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In my (limited) experience, I think as long as you aren't repeatedly poking a bruise over and over, it's fine to test one ear more often than the other. But it's also good to practice on both ears, if you can.

I think it's generally advised to do a curve when you start insulin, whenever you adjust a dose... or as often as you can. I try to do a curve every weekend... either every 3 hours for 18 hours, or every 2 hours for 12 hours.
 
I tried to alternate ears with the testing, to give the other time to heal. But as long as you are checking for any bruising and avoiding those, that would work. Some people have cats with one damaged ear, and can only test on one.

As for curving, random spot checks are good for now. A curve might be good this weekend. You are trying to find the insulin onset and nadir for your cat. Note, nadir can move around a bit, and also varies by cat. "Typical" is +6, my girl on Lantus was +7-+9, except when it wasn't. Others see it much earlier. By this weekend, the depot will have had to time to start building, and you'll get a better picture of what this dose can do, though initially the depot takes 5-7 days to fully build.

The timing of and whether you even do a formal curve regularly also depends which dosing method you are following. SLGS followers do a curve once a week, while TR calls more for strategic spot checks. Doing the odd curve helps you learn the best times to test. Since Arya is recent DKA, we may be a bit more aggressive to get her to a better dose faster.
 
Wendy&Neko said:
I tried to alternate ears with the testing, to give the other time to heal. But as long as you are checking for any bruising and avoiding those, that would work. Some people have cats with one damaged ear, and can only test on one.

As for curving, random spot checks are good for now. A curve might be good this weekend. You are trying to find the insulin onset and nadir for your cat. Note, nadir can move around a bit, and also varies by cat. "Typical" is +6, my girl on Lantus was +7-+9, except when it wasn't. Others see it much earlier. By this weekend, the depot will have had to time to start building, and you'll get a better picture of what this dose can do, though initially the depot takes 5-7 days to fully build.

The timing of and whether you even do a formal curve regularly also depends which dosing method you are following. SLGS followers do a curve once a week, while TR calls more for strategic spot checks. Doing the odd curve helps you learn the best times to test. Since Arya is recent DKA, we may be a bit more aggressive to get her to a better dose faster.
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Got it thank you..tonight her PMPS was 314 she had eaten another half cup of food during the day and I was able to get her to eat about 1/3 now but that puts her total food intake at around 1 cup and 1/3 so at least 500 calories today. Is it ok that she didn't eat a lot right before the injection? By leaving her food out all day she's not really hungry at the moment. Personality wise she is better than I've seen her though she's playing and happy.
 
KatieBDZ said:
Got it thank you..tonight her PMPS was 314 she had eaten another half cup of food during the day and I was able to get her to eat about 1/3 now but that puts her total food intake at around 1 cup and 1/3 so at least 500 calories today. Is it ok that she didn't eat a lot right before the injection? By leaving her food out all day she's not really hungry at the moment. Personality wise she is better than I've seen her though she's playing and happy.
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As long as she has eaten something before the injection and you know she will eat again, it is fine that she doesn't eat everything.
You have about 2 hours before the onset of the insulin so offer her some more food around then so she has some more food aboard. Small meals often is best.
Have you managed to get anymore ketones tests done?
Good signs she is happy and playing.
 
Bron and Sheba (GA) said:
As long as she has eaten something before the injection and you know she will eat again, it is fine that she doesn't eat everything.
You have about 2 hours before the onset of the insulin so offer her some more food around then so she has some more food aboard. Small meals often is best.
Have you managed to get anymore ketones tests done?
Good signs she is happy and playing.
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Her +2 is 285 and she's eating again now - any cause for concern? Not sure I'll be able to get a +4 in. Waiting for her to pee to get another ketones test so far no luck since I've gotten home!
 
If you can get another test in this cycle that would be good as her +2 is lower than the Preshot which means it is probably going to be an active cycle. Can you set the alarm for a +5?
 
Ugh just got a ketones test in and it's darker than yesterday reading is more in the "small" range..definitely above trace..what do I do?
 
She is eating well still, drinking water, and generally acting better than she has been (alert, playful, happy)
 
Let the vet know the result as soon as you can in the morning. It’s night there at the moment right?
In the meantime try and get her to drink extra water if you can and try and get her to eat more food.
We may have to look at increasing the insulin dose next shot so if you can get a test in around +5 or 6 tonight to tell us how far she’s dropping that would be helpful.
I’m going to tag someone else for the next dose as I may be asleep (I’m in Australia)
@Wendy&Neko @Sienne and Gabby (GA)
There is more than a trace of ketones in urine at the latest test. What are your thoughts? Ayra is acting fine, eating and playing, Will you be around for the next test please In case I have gone to bed.
 
Bron and Sheba (GA) said:
Let the vet know the result as soon as you can in the morning. It’s night there at the moment right?
In the meantime try and get her to drink extra water if you can and try and get her to eat more food.
We may have to look at increasing the insulin dose next shot so if you can get a test in around +5 or 6 tonight to tell us how far she’s dropping that would be helpful.
I’m going to tag someone else for the next dose as I may be asleep (I’m in Australia)
@Wendy&Neko @Sienne and Gabby (GA)
There is more than a trace of ketones in urine at the latest test. What are your thoughts? Ayra is acting fine, eating and playing, Will you be around for the next test please In case I have gone to bed.
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Ok got it I will get a +5 and then let the vet know in the morning (it's 830 pm now) he had told me to do the 2 units for a week before making any adjustments even if she stayed a little high. Thanks for alerting others!
 
Was Arya with the ER vets when she was hospitalised or with your local vet?
I think I would just ring the ER and tell them that Arya has small ketones ( an increase) in the urine but otherwise seems ok. Do they think she should be seen by them? Tell them also that she may have had a furshot for the am dose this morning.
 
Bron and Sheba (GA) said:
Was Arya with the ER vets when she was hospitalised or with your local vet?
I think I would just ring the ER and tell them that Arya has small ketones ( an increase) in the urine but otherwise seems ok. Do they think she should be seen by them? Tell them also that she may have had a furshot for the am dose this morning.
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Just got off the phone with the ER vet they said since she is eating and drinking and her BG was 281 to just continue what I'm doing and not bring her in yet. Feeling concerned since she is drinking/urinating a lot and her breathing is a lot more rapid now ☹️
 
Bron and Sheba (GA) said:
Was Arya with the ER vets when she was hospitalised or with your local vet?
I think I would just ring the ER and tell them that Arya has small ketones ( an increase) in the urine but otherwise seems ok. Do they think she should be seen by them? Tell them also that she may have had a furshot for the am dose this morning.
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+4 is 367 :(
 
I’m glad you rang the ER.
What is her respiration rate?
Can you get another ketone urine test ?
She will drink and pee more with higher BGs
 
Also just want to check you are using insulin syringes and not the insulin pen as we will need to increase in smaller than 1 unit increments.
 
Bron and Sheba (GA) said:
I’m glad you rang the ER.
What is her respiration rate?
Can you get another ketone urine test ?
She will drink and pee more with higher BGs
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I did get another test in and it seemed darker to me - closer to moderate now - relayed this to ER vet and they said to hold off on bringing her in..respiratory rate is 30.
 
I’m concerned that the ketones are moderate, keep up the drinking and food.
Resps of 30 are Ok.

how does Ayra seem?

Test the urine each time you can please.
 
Bron and Sheba (GA) said:
I’m concerned that the ketones are moderate, keep up the drinking and food.
Resps of 30 are Ok.

how does Ayra seem?

Test the urine each time you can please.
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She's very sleepy now and lethargic but this is her usual bed time..she's used to sleeping in bed with me which is what she's doing now..very worried..should I still try to get a +5? That would be in 13 minutes
 
I think I would take her to the ER. Especially if she is lethargic and has moderate ketones. They can accelerate into DKA quickly and we don’t want that to happen. They may just need to give her some I V fluids and she needs more insulin than she is having at the moment if the ketones are increasing.
 
Bron and Sheba (GA) said:
I think I would take her to the ER. Especially if she is lethargic and has moderate ketones. They can accelerate into DKA quickly and we don’t want that to happen. They may just need to give her some I V fluids and she needs more insulin than she is having at the moment if the ketones are increasing.
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Thank you..I'm very conflicted since I called and vet said not to come..she just ate more food and drank more water and seemed awake (she jumped on her scratching post and scratched then jumped up on bed)..hate this feeling
 
My concern is that moderate ketones can multiply quickly into a worse situation.
Try ringing them again and explaining your concerns about the ketones increasing. in the meantime keep offering food and water.
Please keep me updated
I’m concerned.
 
Bron and Sheba (GA) said:
My concern is that moderate ketones can multiply quickly into a worse situation.
Try ringing them again and explaining your concerns about the ketones increasing. in the meantime keep offering food and water.
Please keep me updated
I’m concerned.
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Ok called them again they said since she is eating and drinking and otherwise ok that there's nothing to change tonight. They said that I should maybe increase insulin in the morning but otherwise stick to the plan. Also mentioned the urine strips not always being the most accurate and that they are for humans and that I shouldn't test so often because level will not change tonight/go away. Going to try to get some sleep and follow up with my regular vet in the morning..thank you for sticking with me/answering!
 
I would keep testing with the ketones strips.
I disagree with what the vets say. Ketones can change quickly.
Please keep offering her food and water.
Did they suggest a dose for the morning?
 
KatieBDZ said:
I can only do a +2 if I go into work but since I'm concerned about the ketones/a new dose I may take off or ask to work from home
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That would be really good if you could be home tomorrow to monitor and make sure she eats.

When you talk to your vet in the morning, can you ask him about giving Ayra subcutaneous fluids at home? He can show you how to do them, it’s not hard, and that would help a lot with getting fluids into her and flushing out the ketones.
I have talked to Wendy and she agrees that 2.5 units would be the best dose to give in the morning and moving forward.
 
Bron and Sheba (GA) said:
That would be really good if you could be home tomorrow to monitor and make sure she eats.

When you talk to your vet in the morning, can you ask him about giving Ayra subcutaneous fluids at home? He can show you how to do them, it’s not hard, and that would help a lot with getting fluids into her and flushing out the ketones.
I have talked to Wendy and she agrees that 2.5 units would be the best dose to give in the morning and moving forward.
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http://www.felinediabetes.com/FDMB/...5-u-positive-ketones-2-19-post-dka-hl.225971/ - new post for this morning, just wanted to update since I know you were concerned and were in the trenches with me last night <3
 
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