? 02/22 - Sarafina - AMPS 324 +4 360 - Ketone levels

[CrispyCod]

Morning,

Sarafina switched from Prozinc to Glargine 11 cycles ago, currently on 4 units through a u100 syringe. Previously she was on 10 units of Prozinc through a u40 syringe. Vet advised to 'start again' when switching, which I am aware is not what is suggested here. Vet also originally advised to increase her dosing of prozinc every 24hrs by one unit, and we seemed to get a 'runaway', with increasing swings and peaks. Hence the decision to switch. Since switching, although values are not where we want them to be, she does seem to be more stable and Peaks have dropped a lot, daily average is coming down, but the Nadir is not coming down very quickly, if at all.

Since the change of Insulin we have seen a couple of things...
1) for one day, she went off her food and water, but is now eating normally, (not 'starving' or off her food)
Chars seemed to improve and a lot flatter
2) Ketone levels have gone from nothing to between 1.5 and 4m/mol.
3) She seems somewhat dehydrated - we are adding water to her food and mixing bone broth powder with warm water, to encourage her to drink more
4) She is slightly less active, but still goes out, purrs, wants her belly rubbed etc

Attached some additional data as well.

My questions:
Having only completed 5 cycles at 4 units, should we switch to 5 earlier, should we go even higher to 6, or do we be patient?
Should we get her into the vets? dont want to stress her out and push levels higher, but....DKA...

My thoughts were, we we moved too quickly on the Prozinc increases, and had gone past the right dosing, also the switch and the drop in dose caused some problems, but overall results seem better.

Essentially do we persist and follow the plan, or do we react?

Hopefully some guidance or shared experiences will help us decide the best way forward.

thanks everyone.

 

[Tim & Pookey]

Morning!

Here’s your previous post if folks want to go back and read: New Member

I see Wendy was talking about people usually using the same dose when making that insulin transition. But that makes sense about moving too fast previously… I wonder now what your options are for the dose with ketones increasing, can/should you go faster again? I don’t know.

@Wendy&Neko @Sienne and Gabby (GA)

 

[CrispyCod]

Thanks Tim, Forgot to add and just to be clear we have decided on TR protocol, such that we can respond quicker. I have also read on here that kitties can become 'used' to the higher levels so need a larger dose to 'break' it. I suppose I could wait one more cycle see if the last increase has settled, as per the protocol, or increase to 5, very tempted to go to 6 to get a response, but dont know what would happen to the curves as it would likely affect the depot, also dont know if that would also cause a over reaction, but, I feel I need to do something because of the Ketones...

So much great information and support here, but still dont know! Getting more worried by the hour.

Chart attached is midnight to midnight Insulin dose is 12 hrs 6am 6pm, so the drops dont appear to line up with AMPS/PMPS +6

 

[Wendy&Neko]

) Ketone levels have gone from nothing to between 1.5 and 4m/mol.

That's a red flag to me. Anything 2.4 and above is a risk of DKA. The fact that she went off her food for a day even more so. More information here: Ketones, Ketoacidosis and Diabetic Cats: A Primer on Ketones. Sarafina's dose is way too low. You've gone from 10 units of insulin to 4 units. I would, at a minimum, go up to 6 units. Note for any lurkers, this is a recommendation for Chris and Sarafina only, the switch to Lantus was at too low a dose and ketones are showing up.

 

[CrispyCod]

Hi Wendy,

I wasn't sure, gave her dose 30 minutes ago at 5, which I flip flopped around for hours. The protocol suggested going up in .5's but also as you rightly say we came down from 10.

last couple of nights the nadir has shifted along by quite a few hours as well as an aside, which has made it look flat for most of today.

With only 30 minutes passed, is giving that extra 1 unit going to be a problem? Are there negatives to doing that this close?

 

[Sienne and Gabby (GA)]

I think it was fine to give the remaining insulin given how little time had elapsed. Just be careful this evening. The danger might be that you could have a nadir that's a bit off but I think it's unlikely if it was truly only 30 min for the additional insulin.

 

[CrispyCod]

Thankyou both, extra dose given within 30 minutes. Quick drop to 306, now bouncing around the 324 mark. She is very active, wants her food at feeding time, but eats it slowly and left a little, has been out stalking etc, and came running across the garden when I called her in which seems positive.

What could the behaviour of her curve be with the potential for’ NDW’ and the larger bump, obviously we can’t predict, but generally what kind of impact does it have? I have read the sticky on the TR protocol, but any other insights welcome.

Weird thing at the moment is that whatever the dose (or insulin used for that matter) BG seems to hit a wall at around 324. Has she become accustomed to that number as her normal, maybe? Every time we seem to increase her dose, we get a small impact, then settles back at the same range.

Will put a new post tomorrow evening, just to update, fingers crossed! My hope at this point is just to get her under the renal threshold, then I know we are on the right path and can fine tune from there…

Thanks again, support here is so helpful, in more ways than one!