Recent Diagnosis - need advice, please

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lbeachstace

Member Since 2022
Buddy was diagnosed and has been on Vetsulin since 1/27/22.

He started at 2 units for only 1 1/2 days and we panicked over not knowing what to look for as a reaction, so the vet said to lower it to 1.5 ml. We gave him 1.5 ml until 2/26 and then 2 ml ever since. His BG numbers were not really improving by much.

He was also diagnosed with pancreatitis (we had the blood test done), was on zeniquin and cerenia for two weeks.

He gets SubQ fluids daily - had ketones at the beginning and then the pancreatitis diagnosis. We feel it is still benefitting him, and so does our vet.

We've been testing his BG at the +6 hour mark and it's not going in the right direction. Yesterday he was acting more like himself, today he is very lethargic. Here's a sampling:
  • 3/2 - BG 287 - 10:15 AM insulin | tested BG 4:15 PM
  • 3/3 - BG 347 - 10:45 AM insulin | tested BG 4:45 PM
  • 3/4 - BG 267 - 10:45 AM insulin | tested BG 4:45 PM
  • 3/5 - BG 399 then a couple of minutes later 335 - gave insulin 10:50 AM | tested BG 5:05 PM (tested twice because we were surprised at how much higher it was than the day before.)
  • 3/6 - BG 416 - insulin at 11:00 AM | tested BG 5:15 PM
Also, our vet has us feeding him 50% more per meal than he ate before because he's lost weight and she wants him to gain it back. Is this possibly interfering with the progress? He eats it but he's not ravenous and i usually have to move it around the bowl a few times and reintroduce it to him to get him to finish.

Vet has been very resistant about changing the insulin. We know Vetsulin is not preferred by many and after not getting the results we had hope for, we would like to consider switching also. When is the right time to know to do this?

We feel lost and defeated. We've been doing tons of reading, asking questions, contacting people we know who are vets (they are not local), had a chewy.com vet chat. Everyday is spent with us worrying about him.

Thanks - Stacey
 
Hi Stacey sorry to hear about Buddy's diagnosis. Welcome to the club, my boy Hendrick was just diagnosed on 1/5/22.

You have found your life preserver here, no more drowning! This place is a miracle. I was at my wit's end, completely lost and so worried about Hendrick. The people here have decades worth of knowledge and experience helping diabetic cats as well as other feline health issues. I am very new to all this but I have read the experts here tell people time and time again that Lantus or Prozinc are much better insulins for cats than Vetsulin, much less harsh if I remember right. As far as switching, we see it all the time here -- sometimes people switch because whatever insulin they are using doesn't seem to be working out great, even though it is a highly-recommend insulin like Lantus. It seems to be hard to predict what will work best on each kittah!

The feeding of 50% more food makes sense to me, after Hendrick's diabetic keto-acidosis episode and mild pancreatitis, we fed about 50% more calories for a few weeks as was recommended by folks here.

The experts here are very numbers driven, for the best and most complete help you'll need to setup a spreadsheet and populate it with the BG test values so people can review it and offer advice and analysis.

See this post here:

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/


Good luck with Buddy! I'll see you around the forums. :)
 
We've been testing his BG at the +6 hour mark and it's not going in the right direction. Yesterday he was acting more like himself, today he is very lethargic. Here's a sampling:
You really also need at least BGs right before shot/feeding in addition to 6 hours (+6) after shot to find out what is going one. In addition you may need BG between before shot and +6 and between +6 and shot time to really see what is going on.
 
Thanks. I will fill out the spreadsheet tonight.

May I ask what the additional testing times tell us?

We have done some other test times, periodically, but we are also trying to be fair to him and give him some peace and time to rest. The fluids alone take so much out of him :(
 
Thanks. I will fill out the spreadsheet tonight.

May I ask what the additional testing times tell us?

We have done some other test times, periodically, but we are also trying to be fair to him and give him some peace and time to rest. The fluids alone take so much out of him :(

test times tell you how Buddy is reacting to the insulin. Need to know when his body starts to react to the insulin (onset) and most importantly when he hits his nadir (point where the insulin is peaking and blood glucose is lowest)

I hated giving sub-q fluids, ugh. I sympathize 100%
 
Okay, @Hendrick's mom and dad. Thank you for explaining. We'll work on that. Also, I see you switched to a human tester - do you like it better? the cost of the strips for the alpha trak2 are crazy. and yes, the subq fluids is so completely stressful. may a tears have been shed by both of us because we just feel so bad but know it helps him.


Wondering...if we upped the dose a week ago, any idea about how long it should be that we see the effects of the insulin dose? because first we saw a drop and now they've begun to go up.
 
Okay, @Hendrick's mom and dad. Thank you for explaining. We'll work on that. Also, I see you switched to a human tester - do you like it better? the cost of the strips for the alpha trak2 are crazy. and yes, the subq fluids is so completely stressful. may a tears have been shed by both of us because we just feel so bad but know it helps him.


Wondering...if we upped the dose a week ago, any idea about how long it should be that we see the effects of the insulin dose? because first we saw a drop and now they've begun to go up.


yes we started with the Alpha Trak 2 because, of course, that is what the vet recommended. They all seem to do so.

But the experts here asked if we would be open to switching to a human meter so we did and haven't looked back. $10 for 50 strips is music to my ears. And the folks here are actually more familiar with human meter numbers anyway (Alpha Trak tends to run higher).

I have zero experience with Vetsulin, far as your 2nd question goes. @FrostD ? @Sue and Luci ? @tiffmaxee ?
 
what are you feeding btw?

if you're feeding any dry food at all, I bet switching to wet food could really help the fluid situation and maybe get him off the sub-q a lot sooner. Cats eating a canned food diet get a ton more water in their bodies without even drinking from a water dish.

we started Hendrick on a all canned or raw food diet and wow what a difference. Stella and Chewy's freeze-dried raw and FF pate and his coat is amazing, and his poop no longer stinks! I wish we did this a long time ago tbh.

{edit} nm i see hound and gatos. checking it out now havent heard of them before looks good
 
@Hendrick's mom and dad - he's been on wet food his entire life - both cats are. he can't eat crunchy, causes urinary and bowel issues.

We would like him to eat a food with more protein and very low carb. Tiki has some great ones but he's very finicky about wanting only pates. I have fed them stella and chewy before - do you add water to it? i'm afraid it may be an issue for him. :/
 
do you know if rehydrating freeze dried the same as a wet food? any issue with hendrick eating it with the water added? stella and chewy is great quality and i've never heard of primal but i will check it out also.
 
spreadsheet has been updated.

nice job, I can view it.

the recommendation is always to get a variety of test times to populate the spreadsheet so that it starts to paint a picture of how the insulin is working on Buddy and how he reacts to food/carbs. That Hound and Gatos looks pretty good from a 'calories from carbs' standpoint but I didn't do the full calc. Appears to be about 200 calories/5.5 oz can with 2% carbs. Need to know % of calories from carbs though. Should be under 5%
 
do you know if rehydrating freeze dried the same as a wet food? any issue with hendrick eating it with the water added? stella and chewy is great quality and i've never heard of primal but i will check it out also.

no I don't know if it is as much water content as actual canned food, when rehydrated

Hendrick eats the Stella and Chewy's turkey morsels and chicken morsels very well rehydrated, other flavors he doesn't like as much but loves them dry as treats like the Duck duck goose. no issues.
 
Vetsulin is not a good insulin for cats but is fine for dogs. You can switch immediately if you can get it prescribed. Most vets that work with cats a lot know this and use Lantus, Levemir or Prozinc

If your cat likes pates what about getting fancy feast? I feed the two I have now Primal or Small Batch frozen but they are not diabetic. I do believe they are under 10% so fairly low in carbs. Some make their own using EZ Complete and buy protein from the meat market.
 
the carbs are 1% but the fat is high and the protein is below 50, so we'd like to improve on that. guessing stella and chewy is zero carbs?
 
We know many of you say this about Vetsulin. Is there data that anyone has to back it up? Also data to back up the other insulins?

It may come to us needing to find a new vet. Is there anywhere on this forum that recommends local vets who have a good track record with diabetes? We've asked our vet several times about switching and she's been pretty resistant for some reason. Because we aren't feeding him any of the "prescribed" foods, she attributes a lot of what is going on with that vs the insulin, no matter how much we tell her otherwise.... :(
 
LC is 9% and under. You don’t need 1%.

if he's on a lower carb diet and we change the food to a diet with better protein BUT it's ups his carb intake - is that a problem or as long as carbs are below 9% it doesn't effect the diabetes?
 
if he's on a lower carb diet and we change the food to a diet with better protein BUT it's ups his carb intake - is that a problem or as long as carbs are below 9% it doesn't effect the diabetes?

It depends on how carb sensitive your cat is. Most of us have a food in the 1-5% range, another around 10-14% and hc for if the bg is low, 15-20%.

https://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

Scroll down to the articles on food. This sticky has so much information.
 
the cost of the strips for the alpha trak2 are crazy. a
If you live in the US you can buy The Relion Premier Classic human meter , most of us use that its 9 dollars
17.88 for 100 test strips
It needs a little more blood than the Alpha Trak but I had no problem with it when I switched from the Alpha Trak to the human meter
 
Seems like most things have been covered....

Is there any chance you can test earlier in the cycle? Nadir with Vetsulin is often around +4

The problem with Vetsulin is it is often very harsh in cats and does not usually last 12 hours (more like 8, if that), which causes two problems - (1) harsh drops that only keep them in good numbers for maybe 2-4 hours a day, and (2) their bodies react in a panic to the big drops and swings and dump stored glycogen and counter regulatory hormones into the blood stream (we call this bouncing). Those are the high numbers you are seeing for a day or so after a lower number.

If you browse some of the spreadsheets on the Vetsulin forum, you'll see big swings in nearly all the cats

The ideal situation is a flat-ish curve. Look at Mr Kitty's spreadsheet from early 2021 - you can see he did well on Vetsulin for awhile. That is not the norm.

My current poster child is Ares (@Ashleigh & Ares ): look at the big swings he had on Vetsulin, but the switch to Lantus was night and day https://docs.google.com/spreadsheet...HgirotdCzRZF8fU8GKcmLPalmuw9Z4HoFP4B2/pubhtml

There are quite a few cases like that, I'd just have to dig.

The other thing - the AAHA no longer recommends Vetsulin in cats. You can find those guidelines here page 3-4): https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

You'll see although Vetsulin is FDA approved in both cats and dogs, AAHA recommends ProZinc, Lantus, or Levemir.

Some cats also have steep drops on Prozinc, but it's nearly impossible to predict which cats. If you can afford, I'd go to Lantus or Semglee. I can tell you from what I see, his swings are too big on Vetsulin - and I don't see that changing.

What's current meal schedule?
 
Seems like most things have been covered....

Is there any chance you can test earlier in the cycle? Nadir with Vetsulin is often around +4

The problem with Vetsulin is it is often very harsh in cats and does not usually last 12 hours (more like 8, if that), which causes two problems - (1) harsh drops that only keep them in good numbers for maybe 2-4 hours a day, and (2) their bodies react in a panic to the big drops and swings and dump stored glycogen and counter regulatory hormones into the blood stream (we call this bouncing). Those are the high numbers you are seeing for a day or so after a lower number.

If you browse some of the spreadsheets on the Vetsulin forum, you'll see big swings in nearly all the cats

The ideal situation is a flat-ish curve. Look at Mr Kitty's spreadsheet from early 2021 - you can see he did well on Vetsulin for awhile. That is not the norm.

My current poster child is Ares (@Ashleigh & Ares ): look at the big swings he had on Vetsulin, but the switch to Lantus was night and day https://docs.google.com/spreadsheet...HgirotdCzRZF8fU8GKcmLPalmuw9Z4HoFP4B2/pubhtml

There are quite a few cases like that, I'd just have to dig.

The other thing - the AAHA no longer recommends Vetsulin in cats. You can find those guidelines here page 3-4): https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

You'll see although Vetsulin is FDA approved in both cats and dogs, AAHA recommends ProZinc, Lantus, or Levemir.

Some cats also have steep drops on Prozinc, but it's nearly impossible to predict which cats. If you can afford, I'd go to Lantus or Semglee. I can tell you from what I see, his swings are too big on Vetsulin - and I don't see that changing.

What's current meal schedule?


Wow, thank you!!! this is more information than we've received from any "professional" over the past several weeks. wow, just blown away how we are told +6 is the nadir. we will definitely test tomorrow at the +4.

we currently feed at 10am/10pm with vetsulin administered right after he eats - takes him 25 minutes or so to eat and then insulin is given within 5-10 minutes after that. we were told to give him snacks during the day to help with weight gain but we have not thought that was the right thing to do.

i will dig around as well. i can't say thank you enough for this message, Melissa!
 
thank you all so much for taking the time to help us out. The information on this thread is amazing.

Would it be recommended to lower his dose of vetsulin from 2 to 1.5 until we are able to switch to a different brand?

after reading all of this, i can tell you that we can visually see how this is making him bounce all over the place and it's heartbreaking. We get small samplings throughout the day of our sweet little guy but most of it is spent with him in a fog. :(
 
welcome Buddy and Ibeachstance!
Buddy is gorgeous kitty!
sorry about his DX :(

just wana say Ares was 3-4 lb underweight after diabetes, vets never recommend upping calories. Got that info here, i had to feed him ALOT more than i was! He started higher calories at less than 6.5 lb and clearly just withering away...and he is now at 9lb and has been for a month now. I think he has another lb to gain but he is taking his time. He is currently getting approx 300 cal per day.
I feed him almost every 2 hours...alot of us find that feeding smaller meals throughout day (and me night with auto feeder) gives us good results and keeps the curve flatter (on lantus.)

I will definitely recommend Lantus / Semglee. Like Melissa (FrostD) said, Ares numbers are clearly night and day.

FDMB is the place to be! advice here is decades of combined experience from ppl who HAVE GONE THRU IT with their own fur babies!

My vet was also resistant to switching, have no idea why. and he was insistent that Ares would never really get better. it was very bad and sad experience with him. Some ppl here have found awesome vets who work with them and not against them.

ok, ill leav you be looks like u have a ton to read up on. :bookworm::bookworm::bookworm::smuggrin:
 
It may come to us needing to find a new vet. Is there anywhere on this forum that recommends local vets who have a good track record with diabetes?

Not that I know of, however people do frequently post threads like "Any vet recommendations for [City/State]?"

also, as usual Melissa lands with the quality content and loads of good info and data. Such a vast repository of information in that brain of hers! Helped me a ton when I first joined. Never forget it.

dammit these newbie threads always make me emotional lol. Stupid onion factory next door...
 
Wow, thank you!!! this is more information than we've received from any "professional" over the past several weeks. wow, just blown away how we are told +6 is the nadir. we will definitely test tomorrow at the +4.

we currently feed at 10am/10pm with vetsulin administered right after he eats - takes him 25 minutes or so to eat and then insulin is given within 5-10 minutes after that. we were told to give him snacks during the day to help with weight gain but we have not thought that was the right thing to do.

i will dig around as well. i can't say thank you enough for this message, Melissa!
Always happy to help!

Yes, snacks are good. Did the vet give you calories for weight gain? What's current weight vs ideal weight?

I am hesitant to recommend any change in dose. Based on the daytime data, I don't think he's going too low (below 90). But without nighttime tests, I'm missing half the picture, as they often go lower at night. The downside to decreasing dose out of caution is risking ketones (recipe is not enough insulin + inappetence + infection/systemic stress). Are you testing for ketones? Regular human ones like Ketostix work fine. https://www.felinediabetes.com/FDMB...and-diabetic-cats-a-primer-on-ketones.239971/

Now on the flipside, if he's going too low at night that's also risky. Just not enough data for me to mentally fill in the gaps/trends.
 
welcome Buddy and Ibeachstance!
Buddy is gorgeous kitty!
sorry about his DX :(

just wana say Ares was 3-4 lb underweight after diabetes, vets never recommend upping calories. Got that info here, i had to feed him ALOT more than i was! He started higher calories at less than 6.5 lb and clearly just withering away...and he is now at 9lb and has been for a month now. I think he has another lb to gain but he is taking his time. He is currently getting approx 300 cal per day.
I feed him almost every 2 hours...alot of us find that feeding smaller meals throughout day (and me night with auto feeder) gives us good results and keeps the curve flatter (on lantus.)

I will definitely recommend Lantus / Semglee. Like Melissa (FrostD) said, Ares numbers are clearly night and day.

FDMB is the place to be! advice here is decades of combined experience from ppl who HAVE GONE THRU IT with their own fur babies!

My vet was also resistant to switching, have no idea why. and he was insistent that Ares would never really get better. it was very bad and sad experience with him. Some ppl here have found awesome vets who work with them and not against them.

ok, ill leav you be looks like u have a ton to read up on. :bookworm::bookworm::bookworm::smuggrin:

Thank you! We were looking at your chart last nite ❤️ so happy to see! it gives us hope, we will be calling our vet about giving us a script for lantus. and in the meantime, i will be reading...a lot! We are so happy we found this forum/site.
 
it is so hard when you disagree with the vet. They are supposed to be the experts, put your trust in them, your furbabie's life in their hands and yet when it comes to feline diabetes it seems like most vets are fairly clueless. If they have any experience with animal diabetes at all, it is often with dogs not cats. I applaud your assertiveness here, just telling your vet to give you a script for lantus and not taking no for an answer. Godspeed!
 
Always happy to help!

Yes, snacks are good. Did the vet give you calories for weight gain? What's current weight vs ideal weight?

I am hesitant to recommend any change in dose. Based on the daytime data, I don't think he's going too low (below 90). But without nighttime tests, I'm missing half the picture, as they often go lower at night. The downside to decreasing dose out of caution is risking ketones (recipe is not enough insulin + inappetence + infection/systemic stress). Are you testing for ketones? Regular human ones like Ketostix work fine. https://www.felinediabetes.com/FDMB...and-diabetic-cats-a-primer-on-ketones.239971/

Now on the flipside, if he's going too low at night that's also risky. Just not enough data for me to mentally fill in the gaps/trends.

No problem, Melissa. We will test at night and chart it.

The vet did not give us calories - she only wanted us to give him one of the script foods. it's very frustrating, so food is not something we have talked about much other than "feed him as much as he wants". (another reason why we'd like to switch - totally different story but we had a very bad experience years ago with a different vet that caused our cat to die. we found this vet and have liked her because our other cat had IBD)

We are currently feeding him hounds & gatos chicken and liver. he gets ¾ of a can, twice a day. we saw that stella and chewy has a pate now and it has higher protein and is very low carb, so we were thinking of getting a few cans to see if we can slowly switch him to that.

have you heard of the stella and chewy pate? https://www.stellaandchewys.com/cat-food/cage-free-chicken-pate/. we've not been able to find it on any analysis sheets but the protein is higher and the fat is lower than the hounds and gatos.

is it not recommended to switch his food now though?

yes, we test for ketones. he had them when first diagnosed and they went to negative but since upping the insulin, the range has gone up to trace and one day a little higher but has now seemed to trend down again. so we are really confused why a lot of what he does is the opposite of what is expected - could this all be because of the vetsulin and diabetes?

is it also possible that something else could be going on with him? he had a full blood panel when he was diagnosed. i will upload that data to his chart. he was diagnosed with pancreatitis and was on zeniquin for 2+ weeks - she wanted him on it for another 3 weeks but there was no real reason why and we took him off it and he's been the same. he is still getting fluids daily, as he seems very week and dehydrated still.

he's also been getting constipated, and no throwing up at all. Our vet said to give him 1/4 teaspoon of miralax in his food twice a day. we've been giving just shy of that and things seem more regular.

our vet is on vacation but left everything with the other vet, who we have not seen before. we would like to call there today and get a script for lantus and syringes, so we can start to move forward. is this what you would recommend?
 
it is so hard when you disagree with the vet. They are supposed to be the experts, put your trust in them, your furbabie's life in their hands and yet when it comes to feline diabetes it seems like most vets are fairly clueless. If they have any experience with animal diabetes at all, it is often with dogs not cats. I applaud your assertiveness here, just telling your vet to give you a script for lantus and not taking no for an answer. Godspeed!

yes, it is beyond frustrating BUT we had a vet a few years ago, who administered a shot of cortisone to our cat who had an enlarged heart (that we were unaware but she took an xray that she obviously never looked at). long, sad story but she killed our cat because of it. so we've learned to do our research and fight because our furbabies have as much protection as a lawn chair that gets stolen.....so we are their voice!
 
This may help give you an idea on the calories he needs per day: https://www.petplace.com/article/ca... RER requirements,268 calories to gain weight.

A lot of things influence ketones, especially in ketone prone cats (Hendricks being one of them). Pancreatitis is a pretty common cause, especially since it can kind of linger/summer. Eating a little less, drinking a little less, but yes the Vetsulin is definitely not helping because it doesn't keep him in good numbers long enough
 
This may help give you an idea on the calories he needs per day: https://www.petplace.com/article/cats/pet-health/how-to-calculate-your-cats-daily-calorie-intake/#:~:text=for weight gain.-,When we look at Table 1, the basic RER requirements,268 calories to gain weight.

A lot of things influence ketones, especially in ketone prone cats (Hendricks being one of them). Pancreatitis is a pretty common cause, especially since it can kind of linger/summer. Eating a little less, drinking a little less, but yes the Vetsulin is definitely not helping because it doesn't keep him in good numbers long enough

thanks, i will read thru the calorie page.

as you can see from his spreadsheet, we tested him several times today and we agree that the vetsulin is not helping -- and he's having a really bad day - he's so lethargic and weak.

i contacted my vet's office today and they are refusing to switch his insulin. the advice was to up the dose of vetsulin by .5 units. We made an appt with a different vet for thursday.

would you recommend giving him small meals throughout the day? i just weighed him and he's 10.8 lbs - so he lost a tiny bit of weight again - we are bouncing between 10.8 lbs and 11.2 lbs for a couple of weeks now.
 
Hi @lbeachstace! Looks like you're getting some great information here. If you're shopping around for low carb foods, I would consider looking at ones that are also low in phosphorus--it's better for older kitties because their kidneys start to decline. All of the freeze dried foods have bone, which means higher phosphorus levels. Bones in food are great for growing cats, but not for senior ones. That's why I've opted to make my own with EZ Complete and boneless ground meats. You can leave it raw, which is best, but you can also add EZ Complete to cooked food if raw is too much for you. I wrote a whole post about raw feeding senior kitties here: https://www.felinediabetes.com/FDMB/threads/raw-feeding-senior-kitties.248460/.

Good luck on your journey! We're here to help. :)
 
Hi @lbeachstace! Looks like you're getting some great information here. If you're shopping around for low carb foods, I would consider looking at ones that are also low in phosphorus--it's better for older kitties because their kidneys start to decline. All of the freeze dried foods have bone, which means higher phosphorus levels. Bones in food are great for growing cats, but not for senior ones. That's why I've opted to make my own with EZ Complete and boneless ground meats. You can leave it raw, which is best, but you can also add EZ Complete to cooked food if raw is too much for you. I wrote a whole post about raw feeding senior kitties here: https://www.felinediabetes.com/FDMB/threads/raw-feeding-senior-kitties.248460/.

Good luck on your journey! We're here to help. :)

thank you! i will read through it. how low should the phosphorus be?
 
thanks, i will read thru the calorie page.

as you can see from his spreadsheet, we tested him several times today and we agree that the vetsulin is not helping -- and he's having a really bad day - he's so lethargic and weak.

i contacted my vet's office today and they are refusing to switch his insulin. the advice was to up the dose of vetsulin by .5 units. We made an appt with a different vet for thursday.

would you recommend giving him small meals throughout the day? i just weighed him and he's 10.8 lbs - so he lost a tiny bit of weight again - we are bouncing between 10.8 lbs and 11.2 lbs for a couple of weeks now.
He did have a later nadir, that usually happens when they're breaking a bounce from a lower number or a big drop (low could very well be 200s, just any number he's not used to). I am wondering how low he may be going overnight, so if you can grab tests then that will help as well. You'll want that data anyway for an insulin switch.

Good luck with new vet!

He likely does need an increase, but can't say for sure without nighttime info

Yes, smaller meals are pretty much what we all do. Easier on the pancreas too. If he'll graze, you can let him do that too. Just no food 2 hrs before preshot test. We try not to feed after nadir because the insulin is wearing off, but with Vetsulin that can mean 6+ hours without food and some cats don't do well with that. So whatever you feed after nadir, try to keep it smaller (but always err on the side of weight gain, he needs what he needs)

"Lethargic and weak" always makes me uneasy. Check ketones when you can. Is he eating? In pain (meatloaf position)? Nauseous (hanging by bowls but not really eating anything)?
 
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