7/28 Henry WC. AMPS 301 ket: 4.3 +4 397 +7 346 ket: 4.1 +9 400+

John & Henry

John & Henry

Member Since 2022
previous: https://felinediabetes.com/FDMB/threads/7-20-henry-wc-amps-400-3-261-6-145-9-122-pmps-400.266096/

Sorry I haven't posted in a week. Life has been busy. Henry has generally been OK. There will be nights where he'll act sick, stop eating and get the subQ electrolyte fluids and be better the next day. Well, last night when he started doing this I checked his ketones and they were at 2.7, which was a little worrisome since I'd only seen them that high one other time since he's been home, but last time they got that high the subQ fluids worked and within about 24 hours he was back down to 0.3. Well this morning I was more than a little disappointed that they're now at 4.6. The vet finally sent the budesonide into the compounder yesterday and I picked it up. I didn't give it yesterday because of the high BG and ketones, I was waiting for them to come down a bit before giving the first dose, which still hasn't happened. I feel like his high ketones may be due to not absorbing the food because of the IBD. Should I start the budesonide anyway? I'm wondering if he may have been doing better earlier on because he was getting the novel proteins? I switch back to the FF a week or two ago because he likes them better/eats more, but maybe that was a bad idea? I'm updating my SS with all the libre data right now. He's had some pretty low BG numbers and also periods of very high BG, so it's so hard to assess.
 
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I emailed the vet to ask about giving the budesonide with BG and ketones this high. I also panicked and gave him a dose of regular insulin 2 hours before I was supposed to. I think I'm going to give some fluids shortly. I also asked the vet if I'm able to give the subq fluids more than once per day, but I've yet to hear back. Does anyone know if that's ok? Here's what's in the electrolyte solution (Isolyte S):

isolyte-s-vs-lactated-ringers-solution.jpg

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edit: He's still acting sick today, but he has eaten about 1 and a half cans of FF. I think I'm going to go buy some more novel proteins.
 

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Hi John,
Henry is bouncing from the run of greens and the green preshot on 26/7.
I am concerned about the 4.6 ketones. Have you checked the urine ketones to see what that says? I would do that.
You may need to get his bloods checked by the vet to see that are still ok and not heading towards DKA again.

If you think he was doing better on the novel proteins I would go back to those.
How is his appetite at the moment? Is he lethargic? Drinking a lot?

You need to be guided by the vet as to how often you give the subQ fluids. Some people do give them twice a day but it is usually splitting what would be given once a day. I would definitely ask the vet what to do with the subQ fluids if you want to increase them

I have no experience with using budesonide so can’t comment on that sorry.
I will tag @Wendy&Neko
 
I don't see a problem with starting budesonide right away. Neko had a lot going on when she started hers (new heart failure and small cell lymphoma diagnoses), on top of existing kidney issues). I absolutely agree with Bron on getting a vet consult on giving fluids. You don't want to overwhelm Henry's body or heart. Neko's heart failure was caused by fluids.

Also, try the novel proteins again. My IBD kitty enjoys the non novel protein foods too, until they hit her tummy. You can also get freeze dried treats in novel proteins. I find that makes things interesting again as toppers.
 
So I just got off the phone with the vet, and she wanted me to give him another dose of regular insulin right now (double his previous dose), so I've given him that and I'll be monitoring closely. The other stuff she said are in my replies to Bron and Wendy below.

Bron and Sheba (GA) said:
Hi John,
Henry is bouncing from the run of greens and the green preshot on 26/7.
I am concerned about the 4.6 ketones. Have you checked the urine ketones to see what that says? I would do that.
You may need to get his bloods checked by the vet to see that are still ok and not heading towards DKA again.

If you think he was doing better on the novel proteins I would go back to those.
How is his appetite at the moment? Is he lethargic? Drinking a lot?

You need to be guided by the vet as to how often you give the subQ fluids. Some people do give them twice a day but it is usually splitting what would be given once a day. I would definitely ask the vet what to do with the subQ fluids if you want to increase them

I have no experience with using budesonide so can’t comment on that sorry.
I will tag @Wendy&Neko
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Opps, I just realized the ketones were actually 4.3 (which is pretty much as bad). I just re-checked them @ AMPS +7 and they've came down a little (4.1). I'll try to catch him in his box with some ketostix. I just talked to the vet and asked about his bloods which were just run on 7/22 and she said it looked good, that potassium was normal, liver enzymes had improved, pretty much everything looked good besides his red blood cells were a bit low. She didn't mention pH and I forgot to ask, I'm not sure if they checked that or not. I just purchased a bunch more of the novel proteins. He ate a little over half of a 3oz can of some venison. He drank a TON last night, his whole 300ml drinking dish was dry this morning after refilling it just before bed and he may have even drank more out of the dogs bowl. Today he's drank some but not more than about 30-50ml. I wouldn't say he's lethargic, but he's doing what he does when he's sick and what he's done before going DKA which is pacing around the house from room to room as if he's looking for something. So the vet just called me back and said he can have up to 100ml of the fluids per day, I asked if they should be split and give 50ml twice a day and she thought it would be better to give them all at once, which seems strange. It seems like it would be better to break them up and he's usually ready to get off my lap by the time I've given 60ml, so yeah... I might just split them up anyway, I don't see how it could hurt.

Wendy&Neko said:
I don't see a problem with starting budesonide right away. Neko had a lot going on when she started hers (new heart failure and small cell lymphoma diagnoses), on top of existing kidney issues). I absolutely agree with Bron on getting a vet consult on giving fluids. You don't want to overwhelm Henry's body or heart. Neko's heart failure was caused by fluids.

Also, try the novel proteins again. My IBD kitty enjoys the non novel protein foods too, until they hit her tummy. You can also get freeze dried treats in novel proteins. I find that makes things interesting again as toppers.
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Yep, I just gave him his first serving back on the novel proteins. He eats them, just not as vigorously and completely as the FF. He likes a good variety which I got him this time instead of mostly just ziwi peak, so hopefully that'll help appetize him. Vet said 100ml of fluids (instead of 60ml) per day is fine. She said to hold off on the budesonide for tonight and touch base with her tomorrow.

Thank you for your replies Bron & Wendy. It's much appreciated.
 
John & Henry said:
I emailed the vet to ask about giving the budesonide with BG and ketones this high. I also panicked and gave him a dose of regular insulin 2 hours before I was supposed to. I think I'm going to give some fluids shortly. I also asked the vet if I'm able to give the subq fluids more than once per day, but I've yet to hear back. Does anyone know if that's ok? Here's what's in the electrolyte solution (Isolyte S):

edit: He's still acting sick today, but he has eaten about 1 and a half cans of FF. I think I'm going to go buy some more novel proteins.
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Real fast: definitely okay to split sub-q and sometimes is better/easier on the cat. I have done this many times myself. But it's a split of the daily amount of sub-q and not a doubling of the total daily amount of sub-q. So don't increase the amount of sub-q without consulting vet.

I am very worried about those ketones.
 
I just wanted to absolutely verify that I am not saying that I ever doubled the amount of fluid that my cats have received. I did not. I split the total daily amount into two parts. I also had a cat who had a pleural effusion due to excess fluids that her heart (which was compromised) could handle. This was under vet advice. :-(
 
And John, I'm so concerned about not only Henry but about you. I read that you're having some difficulties yourself. You will both be in my thoughts and prayers. You have been fighting so hard for Henry. I love that. I hope things will go better for you all the way around. Hang in there. You have loads of people here who care and are rooting for you and Henry. How are the enzymes going? The budesonide could really be a game-changer for Henry. I would start as soon as possible - provided your vet agrees tomorrow. I have had cats who did a major 360 turnaround once starting steroid therapy.

Henry is so high the last few days. I wonder what's up there?
 
John & Henry said:
So I just got off the phone with the vet, and she wanted me to give him another dose of regular insulin right now (double his previous dose), so I've given him that and I'll be monitoring closely.
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I assume this is “regular” with a capital r, as in R insulin? (meaning another 0.5u R on top of the 0.25u you already gave a couple of hours ago?) Rather than 3.5u Lantus. Glad you’ll be monitoring closely.
 
Suzanne & Darcy said:
I just wanted to absolutely verify that I am not saying that I ever doubled the amount of fluid that my cats have received. I did not. I split the total daily amount into two parts. I also had a cat who had a pleural effusion due to excess fluids that her heart (which was compromised) could handle. This was under vet advice. :-(
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Yep, I got that. She said I could go from 60ml per day to 100ml. I'm going to split that into two different 50ml doses.

Suzanne & Darcy said:
And John, I'm so concerned about not only Henry but about you. I read that you're having some difficulties yourself. You will both be in my thoughts and prayers. You have been fighting so hard for Henry. I love that. I hope things will go better for you all the way around. Hang in there. You have loads of people here who care and are rooting for you and Henry. How are the enzymes going? The budesonide could really be a game-changer for Henry. I would start as soon as possible - provided your vet agrees tomorrow. I have had cats who did a major 360 turnaround once starting steroid therapy.

Henry is so high the last few days. I wonder what's up there?
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Awww, Thank you Suzanne, I'm doing better now other than being a little more busy than usual. I had some pretty big health problems going on the last time I posted, but that situation has improved some now. I appreciate the concern and the prayers and all the support Henry and I get on here. You guys are all amazing :bighug::bighug::bighug:.

Hopefully 100ml won't be too much. I see CKD kitties get much more than that. He's been getting a full strength dose of enzymes in every meal. 75% of the time it's mixed in the food and I give him pills out of convenience for both of us the other 25%. I've come to the realization that letting the enzymes sit in the food to "incubate" for 20 minutes probably isn't a requirement. I read on one of the EPI sites that's done not to activate them, but rather to make sure they don't burn the mouth. I obviously don't want to burn his mouth either, but whenever I open a can he goes crazy and waiting 20 minutes it's tough because sometimes by the time I actually give it to him the "thrill" of getting the food has subsided and he's sometimes less enthused to eat it. Once he's not sick and packs on some weight I can go back to waiting 20 minutes, but it doesn't seem to bother him at all, so for now I'm going to forgo the wait. Hopefully the ketones come down tonight and he can get on the budesonide tomorrow. Yeah, I wish I knew why he was so high. I guess it's from all those greens 5 cycles ago. Hopefully they'll be breaking soon.

JL and Chip said:
I assume this is “regular” with a capital r, as in R insulin? (meaning another 0.5u R on top of the 0.25u you already gave a couple of hours ago?) Rather than 3.5u Lantus. Glad you’ll be monitoring closely.
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That's right JL. 0.5uR not Lantus. Unfortunately I'm not sure if I got a fur shot or his BG is just determined to be high no matter what, because it didn't come down a bit, in fact it went even higher :( I'm monitoring closely tho.
 
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Wanted to add that I just found a puddle on the bathroom floor. Not sure when he left it since it wasn't in an obvious place, but a ketone check on it says it's between "light" and "medium". Peeing outside of his box is another thing he's been doing when he's sick. Also, there was no stools in his box today, but I'm not sure if the dog may have been visiting the "kitty buffet" or not. We caught her doing it last night for the first time in awhile, so I've blocked off access to the dog. Let's hope he's not having constipation problems now on top of everything else.
 
Hey John. I've been following you for a while. I'm one of the ones that was worried about you. I'm glad your own health issues are better now.
That 53 on the libre on 07/24 worries me as the last time he had a 55 on the libre he was 37 on the nova. I would test on the nova when he gets those very low numbers on the libre just to be sure. And again 15 minutes later until he was over 70? on the nova without the influence of a food spike.
I pray the budesonide helps him do a major turnaround, like Suzanne has seen.

Okay, back to bed
mail
for me
 
Dyana said:
Hey John. I've been following you for a while. I'm one of the ones that was worried about you. I'm glad your own health issues are better now.
That 53 on the libre on 07/24 worries me as the last time he had a 55 on the libre he was 37 on the nova. I would test on the nova when he gets those very low numbers on the libre just to be sure. And again 15 minutes later until he was over 70? on the nova without the influence of a food spike.
I pray the budesonide helps him do a major turnaround, like Suzanne has seen.

Okay, back to bed
mail
for me
Click to expand...

Thank you for the thoughts and kind words Dyana. Yes, I always assume the libre is going to be much lower than the nova that I almost don't even bother checking with the nova and immediately feed him some HC. Especially when it's in the hypo range when I compare the number from the libre to the nova meter I can guess what it's going to be within 2 or 3 points every time. I don't know if all my libres have all been from the same lot because I've been picking them up at the same pharmacy or the placement of the libre but it's incredible how closely all 3 libre sensors have off by. It's harder to accurately guess in the upper numbers because there's more variation but the libre is almost always quite a bit higher. It's probably best that I check it anyway so we can know how low it's actually going for the sake of the TR protocol. The vet today said that she would like to raise his Lantus dose but she didn't like all those low numbers he's been seeing. As of today she has live access to all the data from the libre, so we'll see how that goes...
 
Bron and Sheba (GA) said:
How are things going John?
I see you have given R twice during this cycle.
Have you got any more tests in since the +9.?
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Well, better I'd say after just checking his ketones. Ketones are down to 1.7, BG has finally came down after the R dose at PMPS. The two R doses in the last cycle did just about nothing, which is strange because I was trying really really hard not to get a fur shot, so I'm not sure why it's doing basically nothing sometimes. After giving the shot I've started smelling the injection area for insulin and I haven't detected any, so I'm not sure whats going on with him.

He's been eating consistently although not eating as much as he normally does. I think I'll give him the other 50ml of fluids before I go to bed. The libre alarm has always alerted me when he's going towards hypo -- I got it set at 75 (which always happens when I'm sleeping without fail) so I'll be keeping tabs on him during this fall.
 
John & Henry said:
The two R doses in the last cycle did just about nothing, which is strange because I was trying really really hard not to get a fur shot, so I'm not sure why it's doing basically nothing sometimes.
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I never figured it out. This happens some times with R. Sometimes just .. nothing! I'm sooo glad those ketones were down. I'm hoping you and Henry have a better day today!

I worry, too, about the 100 mL being too much - so I am glad that you are splitting it up between two sessions. It's just that, at his weight, I question it. But I'm not the vet here and hopefully she's checked his heart out. I know she's trying to balance so many conditions and not overdo or underdo anything. It is soooo hard. I'm glad that Henry has you because you will watch for any signs of overhydration.
 
So just checking in quick with an update. Ketones were down to 0.3 about 13 hours ago. BG stayed in the 200s most of the night then shot up this morning. Currently at 366 on the libre and rising. Hit as low as 250 in the last 12 hours. He's acting good and begging for lots of food but not always liking what he gets but does eat most of it eventually. I'll continue to monitor closely and update SS tomorrow.
 
Ugh, just woke up and his meows sounded weak and frail like I've never heard before. Ketones are back up to 4.4! How does this happen so quickly! Only ate half his food. Turned his nose up at a different flavor. Warming his subq fluids right now :(
 
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