Help?? Anybody? Dka kitty and TR, possible bounce?

Luxe

Luxe

Member Since 2020
Hello there. My threads from yesterday
https://www.felinediabetes.com/FDMB/threads/ojs-ketones-back.239408/

https://www.felinediabetes.com/FDMB/threads/oj-hit-his-first-blue.239510/

So long story short, i have a kitty named oj who was diagnosed dka 11/9/2020. We've been having no luck regulating him and getting him to a low number. He has a bad tooth that im sure is keeping him higher because of the pain/discomfort but nobody will take the tooth out with numbers as high as his. He is currently on gabapentin for the pain but i can still see the tooth bothering him some what when he eats, and once something hits that tooth he just stops. His numbers staying so high are also keeping him drinking and peeing non stop which is keeping him dehydrated. We've been to the vet every week for subq fluids to flush ketones and rehydrate. They wont prescribe me the fluids to administer at home. Im wondering if the ketones coming back so often are false positives due to being overly concentrated from dehydration? He still acts very active when they're present and has an appetite and they go away withing 24hrs of the fluids. Yesterday he hit his first blue number and then a few hrs later was back up to 700 (using alphatrak) i was told on another thread its probably a bounce. I've updated his numbers on the spreadsheet. Was hoping to see more lows today but 400-500s which is his normal. Today is the 3rd day of 2.5units lantus twice a day. Will numbers stay a little higher after a bounce? Was the 113 just a fluke? Tomorrow should i up another half unit since his numbers are staying so high?? If anyone has any advise especially if your cat is also dka i'd love to chat. Im trying to get him low as soon as possible so someone will take out this tooth. I do have appointments set up next week at different vets so maybe i'll get different opinions as my vet doesnt seem to know much at all. When i mentioned a possible bounce today i was looked at like i had 12 heads lol
 
Sorry nobody got back to you sooner. Anytime that happens, make a new comment on your post which will bring it back to the top of the forum.

Luxe said:
Will numbers stay a little higher after a bounce?
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Bounces can take up to 6 cycles to clear.

Luxe said:
Was the 113 just a fluke?
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Next time you get a number like that that's just so different from what you'd expect, it's a good idea to retest immediately. It could have been a wonky test strip.

Stick with the 2.5 for now....and if possible, it'll help to get a couple more tests on the AM cycle and an earlier test on the PM (like +2 or +3). The more data you can get, the easier it is to figure out what might be going on.
 
Numbers wobble around during a bounce, so generally higher but not predictably higher by a certain amount.

As for that tooth, check to see if there are dental specialist vets in your area. Neko's general vet did her first dental when she was clearly in the "not regulated" category, but the next one when her heart was not 100%, I chose to go to a dental specialist. They do extra monitoring with the anaesthesia plus all they do is dentals and usually complicated kitties so they have no problem with dentals on diabetics.

Are you thinking of following TR for dosing? If so, could you add TR to your signature. We'd hold doses at least six cycles, but up to 10, with that blue and then evaluate after that. With the threat of ketones, we might suggest increasing after six of you don't see anything lower.
 
Than
Chris & China (GA) said:
Sorry nobody got back to you sooner. Anytime that happens, make a new comment on your post which will bring it back to the top of the forum.



Bounces can take up to 6 cycles to clear.



Next time you get a number like that that's just so different from what you'd expect, it's a good idea to retest immediately. It could have been a wonky test strip.

Stick with the 2.5 for now....and if possible, it'll help to get a couple more tests on the AM cycle and an earlier test on the PM (like +2 or +3). The more data you can get, the easier it is to figure out what might be going on.
Click to expand...
Thanks. Its hard for me to get more am tests. Some mornings he's up when i leave for work at 6am and i check those days, but 90% of the time he sleeps till around 10am under my parents blankets so i cant really get to him without waking them up and causing issues before i leave for work. I come home on break every day between 1030-11am for his test,feed, shoot and then im not back from work until usually the 7+ mark. Unfortunately no one else in the house is comfortable testing or shooting which i understand. But i've been trying to get what i can. On days im off the next morning i'll try and get more shots after the pm. I would think the mornings would be lower because his pmps is same between 1030-11pm and then he gets his meal and sleeps. With no food after that i would think he'd be shooting lower in the morning but 500s seem to be the number to be.
 
Wendy&Neko said:
Are you thinking of following TR for dosing? If so, could you add TR to your signature. We'd hold doses at least six cycles, but up to 10, with that blue and then evaluate after that. With the threat of ketones, we might suggest increasing after six of you don't see anything lower.
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I think i might be if thats the best way to go with numbers being so high. He seems to be throwing ketones on a weekly basis and then once he gets his subq fluids they're gone within about 24hrs. But then he dehydrates again and they come back. So im not sure if its false positives from the concentration or what. He's hungry when they're showing up and still active. I check his urine 2-3 times a day when i can catch him. Its rare that i miss a day. He's especially thirsty after his shots/food. Last night after his meal and pm shot he drank for like 10 minutes straight and then pee'd 3 times in about 45mins. He wasnt straining and each time was like a full bladders worth so im not thinking uti. I hope i can get him regulated soon so i can help curb that.
As for dental specialists there are some in neighboring states, a few hours each way so its an option but i wanted something closer to an emergency vet so God forbid anything happens i can quickly transfer him somewhere. Thats happened to friends of mine during just routine cleanings so thats weighing in the back of my mind as well
 
Occasionally you can find a dental specialist that does road trips. Might be a question to your vet. Or maybe they'll be more confident if there is a registered anestheologist vet present for the procedure. We have one here who also does road trips to clinics.
 
Wendy&Neko said:
Occasionally you can find a dental specialist that does road trips. Might be a question to your vet. Or maybe they'll be more confident if there is a registered anestheologist vet present for the procedure. We have one here who also does road trips to clinics.
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Thats awesome! Hopefully some of the vets i'll be seeing next week have something to help me. Im going to type up all his info, insulin, dosage, times, numbers, days ketones present, food, subq eeeeeverything so they have a very clear picture. It makes it so much harder with covid and not being able to be there for the actual exam. And i dont want to forget anything when they call me to go over the exam findings. I've been so scatter brained worrying about him all the time
 
It's really tough at the beginning, learning everything you can about feline diabetes, and you've got DKA/ketones, meds, how OJ responds to insulin. It will get easier over time. :bighug: It's just a steep learning curve. Lean on us.
 
Definitely feel like we got a lot at once. He's being so good about all the pricks, shots, liquid meds. I would love to get to a point where we dont have to do any of that, but i'd take like a week of even yellows at this point because it would at least make me feel like we're going in the right direction. But thank you~ super glad i have people to talk to on here who can relate
 
Going to bump up to 3 units for his morning shot today. Pretty sure the 113 was just a fluke from the other day :( He was up wandering this morning so i got an ear prick and a urine test. BG was 499 7+ ketones were negative 3rd day so far.
 
Do you know if there's an infection that's causing or contributing to the dental issue? If so, the recipe for ketones developing is an infection/inflammation + not enough calories + not enough insulin. If there's an infection or inflammation, an antibiotic would help. The insulin dose looks like it's bringing numbers as low as 113. However, without more data from the PM cycle, you don't know whether numbers are going as low or lower at night. (Many cats experience lower numbers at night.) Is there any possibility of your parents not having oj sleep with them?

What is your vet's concern with having you administer fluids at home? One alternative is to add water to os's food. The more water you can get into your cat, the better the chance of keeping the ketones at bay.

With TR, increases occur every 6 cycles/3 days. Remember, the increase to 2.5u brought numbers as low as 113. I would also not increase by 0.5u. Increases are typically made in 0.25u increments. Are you going to be home to monitor? Without PM data and to knowing what the ketone level is, I wouldn't want oj's numbers to drop low if you're not going to be home and no one else will test.
 
Sienne and Gabby (GA) said:
Do you know if there's an infection that's causing or contributing to the dental issue? If so, the recipe for ketones developing is an infection/inflammation + not enough calories + not enough insulin. If there's an infection or inflammation, an antibiotic would help. The insulin dose looks like it's bringing numbers as low as 113. However, without more data from the PM cycle, you don't know whether numbers are going as low or lower at night. (Many cats experience lower numbers at night.) Is there any possibility of your parents not having oj sleep with them?

What is your vet's concern with having you administer fluids at home? One alternative is to add water to os's food. The more water you can get into your cat, the better the chance of keeping the ketones at bay.

With TR, increases occur every 6 cycles/3 days. Remember, the increase to 2.5u brought numbers as low as 113. I would also not increase by 0.5u. Increases are typically made in 0.25u increments. Are you going to be home to monitor? Without PM data and to knowing what the ketone level is, I wouldn't want oj's numbers to drop low if you're not going to be home and no one else will test.
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Both of my parents are retired and home all day someone is always there during the days. Im not sure the 113 was actually accurate as i havent come close since. He was on clavamox for 2weeks. There wasnt a difference in the numbers. And the vet said subq fluids are short term fixes not long term fixes so its unneccesary to do them *eye roll* i have no problem doing them. I rehab reptiles and im sure its easier on a big cat vs a small lizard lol. I am going tuesday to a different vet who has some diabetes experience and im going to inquire about the freestyle libre?? That way my parents can scan him for me while im working crazy hours with the holidays and i can get an hourly breakdown of whats going on with him.
He also does drink crazy nonstop but just pees it all out immediately. I just got yesterday an electolyte drink for renal failure cats thats supposed to help with hydration. He loved the flavor and i added that to his food yesterday. With the bad tooth the water makes it a little too watery and he cant eat, just smooshes it around flat against the bowl. We quarter up a 3oz can of fancy feast and he eats it a chunk at a time.
But okay, i'll go up the .25. Thanks for the input :)
 
Thanks. I know its a little pricey but i was thinking just doing it for a couple weeks to get a better gauge of whats going on. Especially during night time hours. Im going definitely read up on it more before i decide to try it. Especially because il not sure he would try to just dig it off and then it would be pointless. Hes also so thin idk where they could apply it
 
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