Ketone After Taking Senvelgo

Can someone advise/guide me please?

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Diane Tyler's Mom GA said:
Hi Jan you said you can't fit in your signature DKA January maybe you get delete Blind 2023 , I assume Max is blind :( If it still won't work try just putting
DKA Jan

Just tap on your name up top then tap on signature delete Blind 2023 and try adding DKA Jan there
Let me know if it works
@Jan Chung[/QU

Diane Tyler's Mom GA said:
Hi Jan you said you can't fit in your signature DKA January maybe you get delete Blind 2023 , I assume Max is blind :( If it still won't work try just putting
DKA Jan

Just tap on your name up top then tap on signature delete Blind 2023 and try adding DKA Jan there
Let me know if it works
@Jan Chung
Click to expand...
Jan is customary that once you have up to 50 post you should create a new post title continuation, example
Ketone Con't 09/27 After Taking Senvelgo
this way it is easier for members to read your last concern
Click to expand...
 
I want to point out that my signature shows my Neko had both acromegaly and IAA. The IAA test is less available that the one for acromegaly, Michigan State University in the US being one place that tests it. It's lower priority than the test for acromegaly, in my opinion, looking at Max's spreadsheet. The test itself is cheap, but the shipping cost would make it more expensive. I have seen some research about IAA done in Japan, but not sure where they got the testing done.

Chris & China (GA) said:
but what caught my eye was "Lantus insulin increased from 3.35 units to 6 units within a month in September." which is why I was thinking that it may not be acro, but increasing too much, too quickly.
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But a month is plenty of time for 0.5 unit increases every 3 days to hit a dose of 6 units if nadirs are over 300, which you can do if following Tight Regulation. That's why the spreadsheet was so important. Thank you for putting it together Jan.
 
Wendy&Neko said:
I want to point out that my signature shows my Neko had both acromegaly and IAA. The IAA test is less available that the one for acromegaly, Michigan State University in the US being one place that tests it. It's lower priority than the test for acromegaly, in my opinion, looking at Max's spreadsheet. The test itself is cheap, but the shipping cost would make it more expensive. I have seen some research about IAA done in Japan, but not sure where they got the testing done.


But a month is plenty of time for 0.5 unit increases every 3 days to hit a dose of 6 units if nadirs are over 300, which you can do if following Tight Regulation. That's why the spreadsheet was so important. Thank you for putting it together Jan.
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Dear all,
I’m visiting my parents now and I can’t add more info on signature via mobile, I will make it done when I arrive home later today.
I will try my best to fill in the spread sheet in September but I need to be careful about that coz I have him 3 insulin a day and sometimes it was not in sharp.
Please read the spreadsheet I had updated the last injection/ ketone/glucose level and when I gave him 50 ml of sub cut fluid.
For the blood test of IGF-1, it costed me US$450.
 
As far as documenting the three times a day insulin, just do the best you can. If you have some doses in the middle of the 12 hour cycle, just put it in that time slot in the spreadsheet.
 
Dear all,
The vet will start his annual leave and fly out for 2 weeks. He suggested that I should contact the vet named Vanessa Barrs who is working in Ctiy U and the Jocky Club in HK
“since the ketones are not resolving I sugg you make an appt with CityU asap”
However it takes 2 weeks to get the appointment I was told.
I’m trying to make the appointment now and please if anyone of you knows any members who is form Hong Kong please contact me. It’s very difficult to find an experienced professional vet who is willing to take Max’s case. I tried very hard. Many thanks.
 
The only person I know in HK is @PH&MonkeyPenPenFaFaTiger and Diane has already tagged him
I think you are doing everything you can to combat the ketones. I see the BG is coming down again and so are the ketones. Keep giving 4 units and the sub Q fluids and lots of food.
 
Hi @Diane Tyler's Mom GA , Im in front the laptop however I found that I can't tap or change the signature, even I wanted to delete all the msg and tap again...... can someone help?

The vet sent me the document regarding oral solution compared with twice daily injection in diabetic cats. However I'm new and i don't know how to attached file here, just send to @Chris & China (GA) via facebook msg.
@Chris & China (GA) could you please post on Forum for me? Many thanks.

Good News is Max's Ketone had dropped to 0.6 right now and his Glucose level is high 20.6 mmol/L its PMPS so i gave him 4 unit.
Please advise if I need to increase the amount of insulin for the next injection time.

Thank you.
 
I’m glad the ketone level is coming down. I would stay with 4 units for now as it is bringing the BG down to green numbers.
To put something into this space you copy and paste it.
 
Hi @Diane Tyler's Mom GA , Im in front the laptop however I found that I can't tap or change the signature, even I wanted to delete all the msg and tap again...... can someone help?
Sienne and Gabby (GA) said:
Jan -

I would really want to see the published research out of the EU regarding Senvelgo. I read all of the available studies before we posted the information on the newer insulin treatments. I did not see any published information out of the EU. There may have been some pre-publication information circulating among vets but unless it's in a peer reviewed journal, especially with a new drug, my position would be to ask the vet to not experiment on my cat. My understanding is that in the US, the manufacturer's package insert still says that Senvelgo or any of the SGLT-2 inhibitors should not be used if the cat has been insulin dependent. I think the package insert in the EU differs. However, I would want to see the data that supports the decision in the EU.

I'm not sure where you're located. As others noted, we've certainly seen cats with either IAA or acro or both. I suspect that IAA often gets missed in that it is a self-limiting condition. In other words, you hit a point with the insulin dose and all of a sudden insulin requirements drop to a lower level. I'm honestly not sure how well informed your vet is. There are certainly vets out there who are great at managing everything except feline diabetes!

When a cat's blood glucose drops into a lower range, especially if a cat isn't used to being in lower numbers, there's a tendency for the liver and pancreas to release a stored form of glucose along with counterrgulatory hormones. These cause blood glucose numbers to spike upward. It can take up to 3 days for what we call a "bounce" to clear and numbers to get back to where they more typically fall. It's not advisable to increase the dose until the bounce clears. If you do increase the dose, you're basing your decision on a reading that is reflective of the bounce vs where the numbers actually are and it could lead to overdosing your cat.
Click to expand...
Bron and Sheba (GA) said:
I’m glad the ketone level is coming down. I would stay with 4 units for now as it is bringing the BG down to green numbers.
To put something into this space you copy and paste it.
Click to expand...
I tried many time but couldn’t paste it, it’s wired
 
After serval attempts, I was able to change the Signature finally !!!!!!!!!!
I was so excited that Max's Ketone had dropped to 0.6 at 1900 HK time (0232am now), however it was jumped up again 1.5 hours ago at 0100,
it was 1.2. Sigh...... the vet said it is because the amount of insulin need to be increased. his glucose level is getting higher, please see the spread sheet https://docs.google.com/spreadsheet...4k35sTpx3M/edit?gid=1247431205#gid=1247431205.
tomorrow will be the "Day 3 "after the low number on 26/09 at 0400. Can I increase the amount of insulin from 4 to 4.5 unit for the next injection? Thank you.
 
Jan Chung said:
After serval attempts, I was able to change the Signature finally !!!!!!!!!!
I was so excited that Max's Ketone had dropped to 0.6 at 1900 HK time (0232am now), however it was jumped up again 1.5 hours ago at 0100,
it was 1.2. Sigh...... the vet said it is because the amount of insulin need to be increased. his glucose level is getting higher, please see the spread sheet https://docs.google.com/spreadsheet...4k35sTpx3M/edit?gid=1247431205#gid=1247431205.
tomorrow will be the "Day 3 "after the low number on 26/09 at 0400. Can I increase the amount of insulin from 4 to 4.5 unit for the next injection? Thank you.
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I saw the spreadsheet the +9 looks awesome, you need to test for the next few hours to make sure the BG does not go under 69 if it does, remember 1tsp of food each hour at a time to regulate the BG only and only if the BG is 50 you give the honey about 1ml only, it will be a quick fix, but you can continue to regulate with food, I will tag a Lantus expert on the dose, however it takes a couple of cycles for the body to get use to the dose you do not want to increases without advise just yet, ok so hold on on that increase until you get advise:bighug::bighug::cat::cat:
@Bron and Sheba (GA)
@Suzanne & Darcy
 
CORKY said:
I saw the spreadsheet the +9 looks awesome, you need to test for the next few hours to make sure the BG does not go under 69 if it does, remember 1tsp of food each hour at a time to regulate the BG only and only if the BG is 50 you give the honey about 1ml only, it will be a quick fix, but you can continue to regulate with food, I will tag a Lantus expert on the dose, however it takes a couple of cycles for the body to get use to the dose you do not want to increases without advise just yet, ok so hold on on that increase until you get advise:bighug::bighug::cat::cat:
@Bron and Sheba (GA)
@Suzanne & Darcy
Click to expand...
Have you read today’s glucose level? All are in high members and just tested it’s 19.8 at PMPS +9
 
@Jan Chung Please start a new thread. We don't want a single thread going over 50 comments and we're at 66. Just do the same thing you did to start this one but in the Subject line, put "Ketones after Senvelgo, part 2"

Put the link to this thread into the body of the new thread so people can easily go back to see what's already been said and then say whatever you need to or ask any questions you have.

I would continue to stay on the 4U for at least one more cycle. It is getting him into blues so it's important to give him the time to see what the 4U is going to do
 
Chris & China (GA) said:
@Jan Chung Please start a new thread. We don't want a single thread going over 50 comments and we're at 66. Just do the same thing you did to start this one but in the Subject line, put "Ketones after Senvelgo, part 2"

I would continue to stay on the 4U for at least one more cycle. It is getting him into blues so it's important to give him the time to see what the 4U is going to do
Click to expand...
Thank you for responding to Jan I was worried she would increase dose on her own:bighug::bighug::cat::cat:
 
Sienne and Gabby (GA) said:
Jan -

I would really want to see the published research out of the EU regarding Senvelgo. I read all of the available studies before we posted the information on the newer insulin treatments. I did not see any published information out of the EU. There may have been some pre-publication information circulating among vets but unless it's in a peer reviewed journal, especially with a new drug, my position would be to ask the vet to not experiment on my cat. My understanding is that in the US, the manufacturer's package insert still says that Senvelgo or any of the SGLT-2 inhibitors should not be used if the cat has been insulin dependent. I think the package insert in the EU differs. However, I would want to see the data that supports the decision in the EU.
Click to expand...

Jan asked me to post this for you: https://pubmed.ncbi.nlm.nih.gov/38884190/
 
I see the article has a conflict of interest statement saying the research was funded by the company marketing Senvelgo. Hmm. :blackeye: Normally I'm a fan of Stijn Niessen.

Jan Chung said:
Have you read today’s glucose level? All are in high members and just tested it’s 19.8 at PMPS +9
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Max got to 81 (4.5) last night, and now he's bouncing. Hang onto this dose for a bit yet. Here's the definition of a bounce, it's very normal at this stage.

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Not only was the study funded by the drug company, they paid the authors. They were also comparing Senvelgo to Caninsulin. I would have thought a better comparison would have been glargine given that there are effectiveness and efficacy studies. I would have to get the journal article to see what the inclusion criteria were.
 
The authors (I recognize two names) are in UK and possible Europe. Hence probably the Caninsulin comparison.
 
Bron and Sheba (GA) said:
Do you make sure that all the sub Q fluid that was given the time before was absorbed completely before you give the next lot?
150 ml every day is quite a lot. Do you give it 3 times a day, every day?

Can I just clarify something. Do you test him, then feed him then give the dose of insulin...one after the other?

What do you mean when you say
'Hence we had changed from Senvelgo to Lantus and we gave him the injection less than 12 hours ONCE, the normal injection time is changed from meal time(1000 /2200 ) to 3 hours before the meal times. We fed him 20-30 ml of blended meat. After the injection then waited for 2 hours to the next meal time.'
When you say injection, are you referring to the insulin or the sub Q fluids?


Please do not increase the dose again at the moment. The 4 units is taking him down to 4.5
The dose of lantus is based on how low the dose takes the cat, not the preshot BG.
I am questioning how much your vet knows about feline diabetes.
Click to expand...
Hence you guys bring out the question about too much of sub cut fluid, for safety reasons I better give Max 50ml twice a day instead of 3 times a day. I supposed to give him fluid every 6-8 hours.
I did test - injection - feed coz we feed Max blended raw meat by syringe and he had good appetite and finished the meal every time. We spent times on feeding him, don’t want to delay the injection time so we fed him 10/20ml of food then insulin then continue feeding him.
We always give Max the insulin at 1000 & 2200 and the meal time is 1000/1600/2200/0400.
Hence we changed back to insulin after we found he has ketone after taking Senvelgo once.
The insulin injection time had been changed to 3 hours before meal time (2200) at 1900.
He had finished meal at 1600 so we just gave him 20 ml of blended raw meat after the insulin at 1900 then follow by the normal meal at 2200.
To avoid any mistake or missing out, we mark down on the noted book for every single injection / testing glucose and ketone levels and 50ml sub cut water.
Also we had an hour delayed for the insulin injection at AMPS today as we wanted to adjust the insulin injection time as same as the meal time at 1000 and 2200. make sure he has empty stomach when we test and give him the insulin.

I gave Max 4 unit of insulin at AMPS, the glucose numbers on yesterday were not good. Understand that I have to be patient and wait for 3 days. However the vet reminded me that insufficient insulin may cause the ketone in Max’s body that’s why I’m worrying about it and struggling for the next injection how much I should give him……
I followed your guys instructions and hope that you guys will advise me about the perfect time to adjust the insulin amount, or Max will give us surprise later today, so I don’t need to increase the amount of insulin. fingers and toes r crossed.
 
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Jan Chung said:
Hence you guys bring out the question about too much of sub cut fluid, for safety reasons I better give Max 50ml twice a day instead of 3 times a day. I supposed to give him every 6-8 hours.
I did test - injection - feed coz we feed Max blended raw meat by syringe and he had good appetite and finished the meal every time.
We always give Max the insulin at 1000 & 2200 and the meal time is 1000/1600/2200/0400.
Hence we changed back to insulin after we found he has ketone after taking Senvelgo once.
The insulin injection time had been changed to 3 hours before meal time (2200) at 1900.
He had finished meal at 1600 so we just gave him 20 ml of blended raw meat after the insulin at 1900 then follow by the normal meal at 2200.
To avoid we make any mistake or missing out, we mark down on the noted book for every single injection / testing glucose and ketone levels and 50ml sub cut water.
Also we had an hour delayed for the insulin injection at ANPS today as we wanted to adjust the insulin injection time as same as the meal time at 1000 and 2200. make sure he has empty stomach when we test and give him the insulin.
Click to expand...

@Bron and Sheba (GA)

@Jan Chung
When you are giving us times can you US times , I don't understand Hong Kong times
 
Jan Chung said:
Hence you guys bring out the question about too much of sub cut fluid, for safety reasons I better give Max 50ml twice a day instead of 3 times a day. I supposed to give him fluid every 6-8 hours.
Click to expand...
How much does Max weigh?
is all the subs fluid absorbed in to the body when you go to do the next on? What I mean is can you still feel or see the bulge?
Jan Chung said:
The insulin injection time had been changed to 3 hours before meal time (2200) at 1900.
Click to expand...
you can change the insulin dose time back to what it was if it is more convenient by changing the time1/2 hour a day. It will take several days to get to the desired time but is not hard to do.

Wendy gave you an explanation about bouncing in post 70 above and that is most likely what Max is don’t . If you look at his spreadsheet you will see he bounces up high when he gets blue or green BGs. That is because he is not used to them any more. He needs to get used to them and it will take time. keep asking questions.
 
Diane Tyler's Mom GA said:
I don't know what these mean that you put
We always give Max the insulin at 1000 & 2200 and the meal time is 1000/1600/2200/0400.
Click to expand...

That's military time. From 12:01am to 12:00pm on the AM cycle and 13:01pm to 24:00am on the PM cycle.

If she posts a time like 15:00, just subtract 12 and you get 3pm. If she posts a time like 18:00, if you subtract 12, that's 6pm.

Times in the AM are the same we are familiar with but after noon, you subtract 12 to get the PM time.

So, her meal times are 1000/1600/2200/0400, which is 10am, 4pm, 10pm, 4am
 
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Bron and Sheba (GA) said:
How much does Max weigh?
is all the subs fluid absorbed in to the body when you go to do the next on? What I mean is can you still feel or see the bulge?

you can change the insulin dose time back to what it was if it is more convenient by changing the time1/2 hour a day. It will take several days to get to the desired time but is not hard to do.

Wendy gave you an explanation about bouncing in post 70 above and that is most likely what Max is don’t . If you look at his spreadsheet you will see he bounces up high when he gets blue or green BGs. That is because he is not used to them any more. He needs to get used to them and it will take time. keep asking questions.
Click to expand...

Thank you for all the support and we are trying are best to monitoring and take care of Max.
All subs fluid absorbed for sure when we do the next on. BTW, I had gave Max 50 ml sub cut fluid at 1230 an hour ago which is Seattle time 2100/ Miami time 0000 and for safety reason we will give Max 50ml twice a day .
I had tested his ketone by blood meter it was 2.1 and glucose was 19.0 mmol/L just 22 mins ago at 1300 HK time which is Seattle time 2200 / Miami time 0100.
 
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