? 12/29 Peter Should I increase insulin to help with Ketones?

Barbara and Peter

Barbara and Peter

Member Since 2019
Waiting for a phone call from the vet after I sent her his curve from yesterday. He is looking much better, but his numbers were high all day long. Should I increase the dose? (I did last night without posting here. I am worried about the high numbers).
 
I don't give dosing advice nor have experience with ketones but if it were me, I'd just hold your 2 units - that was already a bigger than normal increase than what we usually do here (usually, it's 0.25u increases/decreases). That's just my two cents - even with the 2 units, you should monitor closely as you're now building Peter's depot for that dose and it takes a few cycles for the depot to build.

Let me tag a few people to see if they are around - @tiffmaxee @Bron and Sheba (GA)

Here's your previous post for continuity - http://felinediabetes.com/FDMB/thre...-giving-him-sub-q-fluids.240571/#post-2708086
 
Hi Barbara, like @Bron and Sheba (GA) and @tiffmaxee explained yesterday, you do not change doses based on pre-shot numbers. Dosing is based on how low it takes the cat and Lantus being a depot insulin, it requires consistency.

Since you are willing to follow the TR dosing protocol, we can make changes to the dose as often as every 3 days, if required.

As suggested yesterday, please continue with 1.5 units twice a day for 6 cycles/3 days and we can take a call on whether the dose needs to be increased or decreased.
 
Bandit's Mom said:
Hi Barbara, like @Bron and Sheba (GA) and @tiffmaxee explained yesterday, you do not change doses based on pre-shot numbers. Dosing is based on how low it takes the cat and Lantus being a depot insulin, it requires consistency.

Since you are willing to follow the TR dosing protocol, we can make changes to the dose as often as every 3 days, if required.

As suggested yesterday, please continue with 1.5 units twice a day for 6 cycles/3 days and we can take a call on whether the dose needs to be increased or decreased.
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So in TR we do not increase the dose to knock down ketones? OK I will try to be patient. He is doing better anyways.
 
Is he eating enough? Drinking? Any reason to suspect an infection? Jumping around with the dose will causes him to bounce resulting in high bg. Lantus likes consistency.
 
It is my understanding that up to 3 is considered a trace and not cause to worry. Make sure he eats enough. When he drops into bg even in the 60’s you might want to feed some 16-20% carb food to avoid a drop under 50 and a needed decrease. We increase and decrease with TR in .25 increments unless a cat is getting a high dose over 5.0.

I would get a +2 test every cycle when possible. If that test is lower or the same as the pretest you will need to get more tests to avoid an earned decrease in insulin. Whenever you see the numbers hitting blue I would test at least every 2 hours and if green at least hourly until starting to rise.

As Bron said you can increase every three days with TR if the numbers show more insulin is needed. Does this make sense?
 
tiffmaxee said:
It is my understanding that up to 3 is considered a trace and not cause to worry. Make sure he eats enough. When he drops into bg even in the 60’s you might want to feed some 16-20% carb food to avoid a drop under 50 and a needed decrease. We increase and decrease with TR in .25 increments unless a cat is getting a high dose over 5.0.

I would get a +2 test every cycle when possible. If that test is lower or the same as the pretest you will need to get more tests to avoid an earned decrease in insulin. Whenever you see the numbers hitting blue I would test at least every 2 hours and if green at least hourly until starting to rise.

As Bron said you can increase every three days with TR if the numbers show more insulin is needed. Does this make sense?
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You mean 3 mg/dL is trace on a pee stick. That is correct but he had 15 mg/dL on a pee stick and the blood test showed 3.3 mmol/L ( I am in canada) so x 18 that for mg/dL. I am reading a sticly about that now.
 
Hi are things things this evening with Peter, Barbara?
I can’t see any BG data since the AMPS this morning and it’s late evening with you now I think?
How is Peter eating? I see you gave some subQ fluids.
 
Bron and Sheba (GA) said:
Hi are things things this evening with Peter, Barbara?
I can’t see any BG data since the AMPS this morning and it’s late evening with you now I think?
How is Peter eating? I see you gave some subQ fluids.
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He was great all day, but in the evening was not looking super good. Still eating, etc. Gave him more fluids, antinausea and potassium pill. I know I should only give his 1.5, but I cannot help thinking that a bit more insulin is going to help to lower his high numbers and knock down the ketones. Have to keep feeding his snack at night.
 
:)Hi Barbara
Did you get any tests in during the cycles today? That is the only way to tell how the insulin is working. Just because the curve yesterday had him in yellow numbers is no guarantee that he will do the same today. Only 4 days ago 1.25 units took him down to 83.

When increasing the dose of insulin it must be done safely and the only way to do that is to test before the dose and during the cycles to see how low the dose is taking your kitty. You have virtually no tests in during the pm cycles except for a couple of +1s. That is 1/2 the data missing and a lot of cats drop lower at night.

I understand you saying you want to increase the dose to get rid of ketones but it must be done safely. I would suggest getting in more tests during the cycles for both the am and pm cycles.
We are very proactive in increasing the dose when ketones are in the picture but it must be done safely and within the guidelines of TR.
 
Bron and Sheba (GA) said:
:)Hi Barbara
Did you get any tests in during the cycles today? That is the only way to tell how the insulin is working. Just because the curve yesterday had him in yellow numbers is no guarantee that he will do the same today. Only 4 days ago 1.25 units took him down to 83.

When increasing the dose of insulin it must be done safely and the only way to do that is to test before the dose and during the cycles to see how low the dose is taking your kitty. You have virtually no tests in during the pm cycles except for a couple of +1s. That is 1/2 the data missing and a lot of cats drop lower at night.

I understand you saying you want to increase the dose to get rid of ketones but it must be done safely. I would suggest getting in more tests during the cycles for both the am and pm cycles.
We are very proactive in increasing the dose when ketones are in the picture but it must be done safely and within the guidelines of TR.
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He started feeling bad in the evening. Miraculously got a vet emergency appointment at +4 today. Ketones were 'moderate' in the urine.
 
Bron and Sheba (GA) said:
How are things today Barbara with Peter?
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Hello, We had a visit at a nice new vet today. (It is a miracle we got an appointment on an urgent basis. It has been so hard to find vet openings because of COVID-19 and a couple of big clinics here were hit with cyberattacks in the fall.)

Peter perked up after eating that high carb food (and when he saw the cat carrier). The vet thought her was in a fair condition and was feeling that Peter can come home and no urgent hospitalization is necessary. Complemented our ability to monitor and administer care (pats on the back for the bean).

Waiting for a blood panel and urine test. Pancreatitis or urinary tract related infection is suspected that throws everything off, but the blood and urine test is the only way we can know.

Peter is feeling a bit better and eating more, but definitely not well. For now feeding and hydrating (subQ 100 ml/day) until we know more based on the tests. The vet's advice on insulin dosing was a scale. PS: 18 mmol and up - 2 units. 18-12mmol - 1 unit. Less than 12 mmol - 0.

Thank you for everyones' feedback and help.
 
I'm not sure the link to your SS is working, all that comes up for me is the 2021 blank SS. In any case, I'm glad you were able to get Peter into a vetty visit. The sub-q fluids should help flush out the ketones, and do try and keep adding water to his food, if he will tolerate it. Please do keep monitoring the ketones, they can quickly build up.

I would strongly suggest not to follow the vet's advice on insulin dosing, just keep dosing per the TR protocol and continue to test Peter's BG levels. IMHO it would be foolish with a cat throwing ketones to withhold insulin, and certainly if you are continuing to monitor, there is no reason to do as the vet suggested and not give any insulin if preshots are less than 12 mmol/L (216 mg/dl for our US friends). The basic recipe for diabetic ketoacidosis is insufficient supply of insulin + inappetance + infection or other systemic stress.

Barbara and Peter said:
I know I should only give his 1.5, but I cannot help thinking that a bit more insulin is going to help to lower his high numbers and knock down the ketones.
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That's not how Lantus works, it is a longer acting, depot insulin, so not good for yanking down high numbers.
 
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I completely agree with @Christie & Maverick about not following the dosing advice from the vet. Lantus does not work using a sliding scale and withholding insulin with a cat showing ketones, or having very recent ketones, is definitely not advised. You are inviting ketones to reform by skipping doses.

@Christie & Maverick you need to scroll down to the bottom of the SS to see the most recent data.

Please try and get some data during the cycles as we have no idea how the insulin is working.
Lantus is dosed on the nadir not the preshot
I am going to ask @Marje and Gracie and @Wendy&Neko to have a look at Peter.
 
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