10/26 Noodle AMPS 296 but trace ketone, need advice badly.

Status
Not open for further replies.
C

Christianna

Member Since 2014
I could really use some dosing advice. Noodle has had 2 UTIs, diarrhea and vomiting all in the past month, which played some havoc with his BG numbers. Thankfully, all those things are cleared up now. When he was at the vet last week and the vet looked at our SS, he was puzzled that Noodle's numbers weren't much different whether he was on 2.5 or 3.5 and thought (?) maybe I was giving too much insulin. He said a high flat curve could be either too much or too little. He told me to reduce Noodle .5 with each dose and then try 2 days with no insulin, and run a curve. I had uncertainty about that but also have been puzzled about Noodle's flatness. He actually seems to feel WORSE on 3.5 than on these reduced doses BUT this morn he had TRACE ketones, a red flag. Called vet at home who said as long as he was acting fine, continue to monitor closely and call or come in tomorrow. Noodle's morn dose was to be .5 but I was uneasy so gave him 1.5 on my own. What do you think? Could you please look at my SS? I don't know whether I'm heading Noodle for disaster by following vet's advice. Thanks so much! Also, is 3 months on Lantus with minimal movement enough time to consider trying Levemir?

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Hi Christi - sorry about the trace ketones. :sad: That means you need to be more aggressive about treatment, not less. Is he still on antibiotics for infection? The formula for ketones is infection + not enough food + not enough insulin. If he's eating now, I'd go back to at least 3U. Then if you get at least a couple of tests every cycle and he stays with nadirs in the 200's, keep increasing every 6 cycle until you see blues, then you can slow the increases down a bit. We do need to see at least one second test every cycle to know what is happening with Noodle. He could be either bouncing from going low at night, or could just need more insulin. The answer to what is happening in the night time cycle will tell us whether he needs more or less insulin. Getting a test just before you go to bed will help fill in the picture. My Neko really likes to go low at night and bounce during the day. If I just looked at her daytime numbers, she'd get increases.

I don't know if you are following the TR protocol, since you mostly post in Relaxed, but if you are, the protocol has you increasing fairly regularly. If you linger too long at doses, you have to be wary of glucose toxicity developing where cats become used to higher numbers. In such cases, it can require even higher doses to break through.
Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit
Click to expand...
A favour to ask of you, I noticed in some of you comments that you had made a furshot. In the cases where you've done that, could you change the spreadsheet Unit column to include something like FS or furshot so we know he didn't actually get the dose listed.

As for Lantus, it can be a very good insulin for cats. Normally we suggest that people give it a try for at least 6 months before trying something else. You need to get Noodle into better numbers before deciding whether Lantus is working for him.
 
Re: 10/26 Noodle AMPS 296 but tr. ketone. Need advice. PMPS

Hi Wendy and Neko,
Thanks so much for answering me so quickly. Noodle has 2 days of the antibiotic left, so getting him to eat has been a challenge. Even with his getting FortiFlora, he is troubled with diarrhea on most antibiotics. I thought he was over that but just found a loose stool in his box. S-I-G-H. I wonder if diarrhea impacts BGs?
I went back and corrected the furshot to read FS. I really am not sure if I gave one. I always try to smell his fur for that "bandaid" smell and it was very faint. Noodle never had 400s or 500s till he got the UTIs and subsequent diarrhea. The vet thinks that's why they appeared suddenly but didn't last.
I haven't posted on TR for quite a while simply because I was having trouble consistently getting enough tests in. So, do I understand that besides testing before every shot, which I always do, I should also test once in midafternoon (Noodle gets his shots at 9am & 9pm) and also again about 1-3 am? Noodle doesn't ever seem to drop low (to my knowledge). That's one reason I'm confused. If I EVER saw him down in the blues, I might be able to reach some sane conclusions but I can count on the fingers of one hand how many blues he's had and we've been at it 3 months :?
Since Noodle only got 1.5U this morning, what would be a good dose to give him this evening, till we can get back on track? These ketones terrify me. He didn't have any at all for several weeks, when he was up around 3 -3.5 U so is that the minimum he needs to keep the ketones away, do you think? His infections have no doubt complicated things.
Anyway, thanks so much for dealing with my insanity today! I'm going nuts over this!

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Wendy and Neko,
Thanks too for the link to glucose toxicity. I thought I had bookmarked it before but hadn't so was glad to get the link again . Lots to digest there. confused_cat

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Hi Christi - do you think you'll be able to do any testing tonight? Going to 3U would be quite a jump, but people who go on vacation with a reduced dose often just go back to the last good dose. The concern is whether he'll respond to the increase quickly. If you can't test tonight, and I'd get test at least +2 and +4, then I'd suggest doing the increase in the morning if you are around to watch him then.

Is he getting lots of water to help flush out the ketones?

ETA: If FortiFlora isn't enough to help with the diarrhea, I've seen people use probiotics such as Renew Ultimate Critical Care. Even adding plain pumpkin or babyfood squash to food (1/2 tsp) can help.
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Hi Wendy and Neko,
I'll be able to test tonight, probably will stay up half the night to keep an eye on Noodle anyway. I'm giving him LOTS of water to be on the safe side, so his puddles are even bigger than usual. He seems very sensitive to dose increases so maybe I'll just go up .25 with each dose till we get him back where he was, unless the ketones become more of a problem, then I'll fast track him up and test more often. I did add a little pumpkin to his dinner tonight so hope it will help. Thanks so much for all the help and advice! I will look into getting some of the probiotic you mentioned since he does have IBD which flares occasionally.

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Many vines for Noodle, especially ketones-be-gone ones!
Liz
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Thanks so much, Liz :smile: We need those magic vines ;-)

Christi and Noodle
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Hi Nadine,
Thanks so much for your good wishes. I can't believe how fast Noodle got into trouble with the lower dose, and it sounds like it wasn't the answer for Tibbs either. Those ketones are so scary. You're right--we are treating the same cat. Our boys have been like twins from the beginning. Thanks for telling me about the metronidazole. I'm sure Noodle had that for his colitis but it made him loopy. I hope sweet Tibbsy is getting over his colitis and that he sees blues soon. More soon...

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

hi christi
i think noodle and tibbs are following the same rule book. i just got rid of tibbsey's trace ketones. we tried that dose reduction too because we thought too much insulin but it just gave him trace ketones too. hope noodle starts getting better numbers. i think we are treating the same cat!!! btw tibbs had metronidazole for the colitis.
good luck christi. i'll check on you later too.
hugs
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Lantus is a depot insulin which means it needs a few cycles to build the depot. It likes consistency. Going up .25U per dose may lead to some wonky numbers. It's better to pick a dose, check the nadirs and stick to that dose for 6 cycles unless he goes under 50, then increase. Good luck. Adding on more ketone-be-gone vines.
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Thanks, Wendy and Neko. When I test Noodle in a bit maybe I'll get a clue which dose to settle on. I wish I hadn't started this whole dose reduction thing in the first place. It's caused a lot of sleeplessness this weekend with the appearance of the ketones. Bad advice from the vet, I'm afraid :? Thanks for your help and for the vines too :smile:

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

((((christi)))))

how scary!

I'm with Wendy - I'd suggest you go back to 3u immediately. Your vet's advice doesn't make sense to me - a cat can go from trace ketones to large ketones in a matter of hours. More than a trace requires a vet's help to get rid of them and the cat is extremely ill. Reducing his insulin opens the door to the ketones quickly increasing. If you're having trouble getting him to eat, that's a second part of the ketones equation that Wendy gave you. You already know he's got an infection. The only thing left you can control is to get enough insulin into him. I think it's really important for you to go back to 3u, give it 4-6 cycles and decide if you should increase at that point.

In regards to your question about testing - cats don't always nadir at +6. In fact, it can move around in a cat, and a cat can be an early or late nadir. It helps more if you get a sprinkling of tests around the clock instead of just trying to get a +6. So no, I don't think you need to get up at 2am to get a test. Get one before you go to bed, compare it to the preshot, consider how many hours after the shot that test is and think "how many points per hour is he moving? How long til he reaches his nadir? Is he likely to go below 50 before that time?" Cats don't move at an even rate of points per hour, so this isn't foolproof, but that can give you an idea whether or not you still need to check him again that night.

If you're hoping for remission for Noodle, you want your goal range to be 50-120. If anything, I'd say you haven't hit the right dose for him yet and that he likely needs even more than 3.5u, but more testing will tell us if that's true or not. Sometimes people get the idea that their cat shouldn't need more than 1-2u per shot, but the truth is that cats need whatever they need. Having had a high dose cat, I'm really aware of how hard it is to keep increasing the dose, but the important number is his blood sugar, not the size of his dose. If you're getting mid-cycle tests and increasing methodically per the protocol guidelines, you can be confident he's not overdose.

hang in there - keep posting and we'll stick with you & help you help Noodle, christi.

julie
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Hi Julie and Punkin,
Wow--you've convinced me not to drag my feet. It's 3U tonight then raises in 6 cycles. I really do not understand the vet's plan so I can't explain it. All I know is we've had a terribly stressful weekend with Noodle and his ketones. In retrospect, I don't know why I wasn't smart enough to figure out that surely you DON'T lower the dose in the MIDST of an infection! I am so angry at myself! Sometimes I feel like I am fighting a losing battle. The vets in this small town really suck and I've tried them all. Now I'm driving an hour to see one that had the reputation of being diabetes-savvy and this is the advice I get. I'm just so mad at myself for even listening instead of at least posting on here first. Thanks so much for sticking with me. I feel like I'm in a swamp going down for the last time. Thanks for throwing me a life preserver.
I'm still not convinced I have ever found Noodle's true nadir but I don't believe he has ever come anywhere near 50. But I will try to get more varied tests.
Thanks again, I REALLY appreciate your help! Noodle does too--he thinks his bean is really bad for making him feel so lousy :sad:

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

(((Christi))) Don't be so hard on yourself. FD is a tough, tough disease and there is a lot of information to figure out. You are doing a great job in tough circumstances. Wendy and Julie are awesome and will help you figure out how to take care of Noodle.
Liz
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

i agree with Liz - this disease is so hard and especially when your sweet kitter gets sick with something else at the same time. You can only work with what you know.

At least here on TR, we do understand the dosing protocol and can help you figure out how to apply it to Noodle. Just plow ahead - you'll get there. :YMHUG:
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Hi Christi

Please don't beat yourself up. You were doing the best for Noodle and it's only natural to assume the vet would know.

When it comes to doing "rebound checks" (taking the dose down because you think he's overdose), it seldom works for cats whose dose has been slowly and methodically increased per the protocol or slowly in small amounts as you have done. When vets or caregivers raise the dose by 1u at a time, yes, there is concern for overdose. But not when the dose has gone up slowly in small increments.

I'd like to also suggest that the other great test to get at night besides the "before bed" test is a test as soon as you get up in the morning if it's +10 or +11. It will give you an idea if he's coming up or dropping as you head into the AMPS. I'm not suggesting you get up to get the test....it's only if you are already up.

I do agree that his dose needs to go up and I have an idea it's going to need to go up even higher before you start seeing really good numbers. One thing I learned early is not to get attached to a dose ;-)

Sending Noodle some major "no ketones" vines. :-D
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Liz,
Thank you so much for your kind words. I really feel like I derailed any progress Noodle was making and put him in danger to boot. So your encouragement is really a balm to me right now--thank you.

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Thanks so much, Julie. Like probably many people on the forum feel, Noodle's having other health problems besides diabetes really makes it hard to manage sometimes. And since the vets around here are so abysmal, and many of them uncaring (won't even return phone calls) I'm always in a low-grade panic wondering what in the world I will do if Noodle has a true emergency. That does it--I'm not doing any more dose-tweaking before posting here first. Thanks, and I mean a BIG thanks, to all of you who are here for me and my Noodle.

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

hi Christi.
you ARE doing a great job. and don't worry, these folks will help get you to the right place with Noodle. both our cats don't follow the rules but you are doing the best that you can. Noodle is very lucky to have you.!!! we will go up in dose together. and i would def take the advice of these folks here over the vet. i just don't think the vets have enough experience with FD. anyway. don't beat yourself up. YOU ARE DOING GREAT !!!!
love from both of us.
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Hi Marje and Gracie,
Thank you so much for the encouragement because right now I'm wondering how I could have taken that advice. But as you said, you'd figure the VET should know! But with all the vets I've seen, I have come to the conclusion that many of them are NOT diabetes-savvy (in my area at least.) Not a very confidence-inspiring thought :? And most of them do NOT want too many questions, much less disagreeing with their course of action!
I thought I was raising the dose pretty responsibly. In fact, I stayed at 3.5 a lot longer that I thought I should because of all Noodle's infections. Both vets said I should NOT raise the dose with the concurrent vomiting and diarrhea Noodle was having. It made sense to me at the time. But surely I shouldn't have lowered the dose either. S-h-e-e-e-s-h.
I'm always up a few hours before Noodle's morning dose so getting some +10s or +11s will not be a problem. They might be revealing.
Thanks so much for your help and for the super healing vines!

Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Oh, Nadine, you are so sweet. I really needed to hear that because I feel like a pretty bad kitty- mom right now. I know you're right--that this is the best place to be. Yep, Tibbs and Noodle will go up with their doses together and maybe November will be their month. They sure are writing a new rule book on FD aren't they? And back at you--Tibbs won the kitty-mom lottery when he got you for his bean :smile: Paws and fingers crossed for no more ketones, no more infections, and better numbers starting tomorrow!

Hugs,
Christi
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

You're doing great, Christi, so try not to look back. We all learn lessons in this dance. Gracie still teaches me a few things on a daily basis. Noodle is lucky to have such a great mom.

I'm sure the extra numbers will help us figure out a good plan for Noodle. :-D
 
Re: 10/26 Noodle AMPS 296 but trace ketone, need advice badl

Thanks so much, Marje and Gracie. Just about the time I think things are going fairly predictably, either Noodle throws me a curve or I make a blunder like I did on the dose reduction fiasco :? I appreciate your help!

Christi
 
Status
Not open for further replies.
Back
Top