1/21/10 - Bashful - PMPS 437, +1 394 - KETONES??

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Theresa&Bashful

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Good morning everyone...

Unfortunately, a pretty high number this morning. We'll see how he does tonight. I'll be around to do some spot checks and also test for ketones again. He seems happy and eating well. Still drinking a bit extra of water (not hugging the dish, but a bit more than he was when he was off the insulin), but I imagine that's par for the course when he's got these high numbers.

Question: If he hasn't brought his numbers down more by this weekend, would it then be the time to up the dosage to 1.5 u?

Theresa & Bash

Yesterday's Condo: viewtopic.php?f=9&t=3363
 
Re: 1/21/10 - Bashful - AMPS 418 - +1 366

I do think there's an increase in Bashful's near future. If there's any way you can get more spot checks in, it would be really helpful. What Bashful's numbers at nadir are will dictate the amount of the dose increase. So, if you can get mid-cycle checks whenever possible, thay will fill in your SS. I know we carp on this and having to do things like work really makes it tough, but whatever you can do to get in a few more spot checks will really help.
 
Re: 1/21/10 - Bashful - AMPS 418 - +1 366

Unfortunately, no way to do them during the work day because of my long commute. I'll be getting some tonight. But +6 in the evening is almost 1 a.m. my time (and I'm up at 6:30 a.m. to start the testing/dosing process)...I don't think I've gotten more than 4-5 hours of sleep in the last week because of all this and I'm starting to seriously hit the wall, but I'll do what I can. The weekends are when I can really get more numbers and also when I'll feel the most comfortable increasing the dose because I can be around to test.
 
Re: 1/21/10 - Bashful - AMPS 418 - +1 366

oh gosh look who it is! hi Theresa! sure i remember you from your PZI days and into remission, sorry to see you back on insulin (not sorry to see you!). did you find cause for why he came out of remission? thyroid was checked? teeth are all good? (when was last dental?) was he sick, or off at all, not eating well, or anything suggesting a CP flare?
well good luck on your lantus journey. (i'll check on ya in a few days, i'm not well and can't be here everyday anymore). it is VERY different than PZI and you'll have to drop a lot of the old thoughts about how to manage his diabetes. i remember he was very sensitive and would drop off the smallest doses of insulin and you never shot under 200, right? that last thing is what i wanted to talk about..see with lantus he WILL get lower PS's, it is in the nature of the long lasting insulin to do so. normal and expected. the problem is for you that you'll have to get used to shooting the lower PS. nailbite_smile see you are building up all this overlap (the shed) and you can't wait until back over 200 and drain out shed to shoot cause then you 'll spend the next 3 days refilling it. PS's don't matter much with lantus, it is all about the nadirs. and this insulin gives a flatter curve than PZI ever can so there is often no difference hardly at all between PS and nadir. flat flat flat is the goal. no you are certainly not expected to shoot the first lower PS you get, people will hold you hand and guide you through when to shoot, but after doing that (stalling) a few times and seeing how it doesn't work and looking around at the other SS's here (like for example go look at paula/pepper's SS right now) and seeing what kind of PS's they are shooting and the flat curve they get, you'll get braver. lantus is such a great insulin for cats, best chance at getting back to falls if that is in cards at all will be using lantus and hanging out in LL. good luck!
~jojo
 
Re: 1/21/10 - Bashful - AMPS 418 - +1 366

Help! Okay, scared and frustrated. His PMPS was 437 - even higher than this morning,

PMPS 437
+1 - 394
+2.25- 362
+3 - 365
+4 - 314

I tested for ketones with the strips...I THINK it was somewhere between negative and trace. I did it five times, but it wasn't really clear...seemed like a hint of pink in the center. Now I'm freaking about DKA of course.

At what point is it an emergency and needs to go to the vet? Do I just check it again tomorrow night? If we can get his numbers down will the trace automatically go away?

I don't know what to do at this point. Do I just keep testing? Do I up the dose in the a.m. to 1.5? (and I still haven't been able to find the .50 unit needles yet). If I up the dose tomorrow am there's no way I can come home to check nadir. I'm not as freaked out about hypo now that know this insulin is more mellow than PZI was. I could drop him off at vet to do something if need be, I'm just somewhat concerned about spending thousands of dollars here.

I don't have a copy of the paperwork from the tests yet (I haven't had time to stop and pick up). The blood tests were all negative, other than off pancreas levels (I'm sorry I don't know numbers), and they said that that was not unusual with the higher bgs. I don't believe they did a urine test. They tested for ketones at that time and it was negative.

WCR: He seems to be feeling fine. Drinking, good appetite, going to the bathroom fine, purring and walking normal - he doesn't really "play" anymore, but doesn't seem lethargic...just wants lovies and wants out of my bedroom..LOL

Advice?? Please please? (p.s. I'm trying to remember to breathe..lol)

Freaked out Mamma Bean
 
Hi Theresa. I wish I knew more about ketones... but at the level you mentioned, between negative and a trace, I wouldn't panic just yet. It is something to watch though. Make sure Bashful gets plenty of water, and mix it in with the food (if you don't already).

Yes, I'd say that Bashful will need more insulin and soon. You've been on this dose for 8 cycles and because of the blue on the 17th and the unknown nadir numbers... the usual recommendation is to wait for 10 cycles. Work makes it tough for you, I understand. But the trace ketones are another issue... I would ask again in the morning if you might increase the dose a little early. I honestly don't know what to say.

I'll try to see if anyone else is awake, but you may not hear anything until the morning. At least Bashful did come down about 75 points from PMPS.

Hang in there!
 
Re: 1/21/10 - Bashful - AMPS 418 - +1 366

Theresa&Bashful said:
I tested for ketones with the strips...I THINK it was somewhere between negative and trace. I did it five times, but it wasn't really clear...seemed like a hint of pink in the center. Now I'm freaking about DKA of course.
Click to expand...

I've had tests like that myself. From what I have heard from people on here, if it is trace you will *know* it. It is apparently a pearly pink and quite distinguishable from negative. But I've been there...have been scared like that. Just get another ketone test in as soon as you can. I would try for before tomorrow night if possible.

At what point is it an emergency and needs to go to the vet? Do I just check it again tomorrow night? If we can get his numbers down will the trace automatically go away?
Click to expand...

Anything above trace should have a vet visit. Ketones are formed when there is a lack of sufficient insulin, so increasing the dose can help keep them at bay. It is not the numbers per se - cats here have had ketones in the 100's - it is that not enough insulin is present.

I would up his dose to 1.25u in the AM, given his numbers (he's had yellow and blue, so that moves him to the 0.25u increase group). Test as often as you can at night because you can get tests during the day (you are doing great with that, thank you!). Plus you have the weekends, and luckily one is almost here. :smile:

ETA: We do want you to be comfortable with whatever you do, though, so if the thought of increasing right now does not sit well with you please do not feel pressured into it. If you get another ketone test that is clearly negative, the the need to increase before 7 days is not as dire. Have to keep testing them, though, as often as you can.

Have you wet a strip with water to for comparison?
 
Just a thought... Use the ketone strips and test yourself. Presuming you don't have ketones, it will give you a chance to see what a negative reading looks like.
 
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