10/4 Oberon AMPS 385/ketones 5.6, +4 355/4.9, +9.5 353, PMPS 343/4.3 incr to 6 U, +3 354, +6 356/4.9

That's when calipers come in handy. If you have to go over 6 units, you raise in half units.. Hope Oberon decides to start working the insulin.

I wonder if there are other conditions that cause ketones. I never had to deal with them so never looked into it.
 
Olive & Paula said:
That's when calipers come in handy. If you have to go over 6 units, you raise in half units.. Hope Oberon decides to start working the insulin.

I wonder if there are other conditions that cause ketones. I never had to deal with them so never looked into it.
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Pretty sure now that what's going on here is IAA + maybe glucose toxicity keeping BG high, leading to ketone production. The anemia is still a mystery, but it's possible that if he's losing kidney function that might be affecting RBC and WBC production. I think all I can do for now is keep following TR to eventually get past the IAA, give fluids to help with ketones, and monitor in case he goes from ketosis (=just high ketones, but pH ok) to ketoacidosis (=high ketones affecting blood pH) and needs a vet visit.
 
Hey Lisa, since his nadir is higher that 300, you can increase by .50 unit putting you right on the 6 unit mark. Got to get those ketones down. I’m glad he’s still eating and you are giving fluids.
 
Olive & Paula said:
If you have to go over 6 units, you raise in half units..
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Actually, over 5 units you go to 0.5 unit increases. Given his nadirs are all over 300, plus he's over 5 units, how would you feel about going to 6 units tonight? Bit unorthodox, but with those ketones in the picture, and given how much you monitor, I think he needs the increase. Note to any lurkers, this suggestion is only for Lisa and her special situation with Oberon. Sometimes you just gotta whack the antibodies.

I have another dosing technique in my back pocket that we can try later too. More later, if he needs it.
 
Wendy&Neko said:
Actually, over 5 units you go to 0.5 unit increases. Given his nadirs are all over 300, plus he's over 5 units, how would you feel about going to 6 units tonight? Bit unorthodox, but with those ketones in the picture, and given how much you monitor, I think he needs the increase. Note to any lurkers, this suggestion is only for Lisa and her special situation with Oberon. Sometimes you just gotta whack the antibodies.

I have another dosing technique in my back pocket that we can try later too. More later, if he needs it.
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I was actually wondering if we could just go for 6 units. It seems pretty clear that we're nowhere near an effective dose for him, and I really want to beat these ketones down. (Also, not that we're there yet, but do I remember right that when you get to 10 U you start going in 1.0 increments?) If he somehow starts to come down fast, I have all the MC and HC stuff I need, and I can stay up to test and all that.
 
Lisa & Oberon said:
Yep. It's just "cleaner" and faster to set up if I'm on a line. I really should probably get around to using calipers.
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I always despised dosing on the .25 and .75 marks pre-calipers. With calipers, I measure on the side of the barrel where there are no lines and then only look at them as a sanity check, to make sure I'm not too far off the mark.
Today I found a syringe whose markings were off by almost .5u. I potentially could have given Butters almost 50% more insulin than what she is supposed to get if I wasn't using calipers. :eek: I was measuring her doses against a syringe with coloured water prior to using calipers, so I would have caught the error, but still.

I don't think you have to run out today and get them you've clearly got your hands full right now. Since Oberon is at a higher dose, the inconsistencies will be smaller as an overall percentage of his dose. But I do love dosing with them and highly recommend. I'd never go back.
Good luck with the increase and battling those ketones.
 
I've already got the calipers; I've just been so swamped with other stuff that I haven't gotten around to using them. I want to take them into my lab and get measurements on my analytical balance of the actual amount being dispensed vs. caliper distance. (Yes, I'm a geek.) Somehow haven't found time to do that. Like you said, not critical right now with doses this high, but I want to be ready if he ever gets back to lower doses.

Off and running at 6 U! Let's see what he does with it.
 
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