Kathy and Kitty said:How is our boy today? High numbers, but at least not "hi". It's very confusing. What are the possible explanations for ongoing ranginess like this?
(((Caryl)))
Kathy and Kitty said:What has been his food intake today? Did he eat within an hour of +3?
I know Jill thought yesterday or the day before that you could wait before increasing his dose, because he had that green so recently.
I just don't have experience with ketones, so I'll ask an ignorant question. Have you ever NOT experienced rebound after R? That's the concern with R, right?
Caryl and Alex said:gave Alex .25R at +7 because of moderate ketone level that already exists from high bg. will test in an hour. (when I gave 0.1 on fur shot day it barely did anything which is why I chose this dose) i need to try to give Alex a break from the high numbers I really did not want to have to do this. :sad:
Jill & Alex said:Caryl and Alex said:gave Alex .25R at +7 because of moderate ketone level that already exists from high bg. will test in an hour. (when I gave 0.1 on fur shot day it barely did anything which is why I chose this dose) i need to try to give Alex a break from the high numbers I really did not want to have to do this. :sad:
i'm sorry to see alex in such high numbers. glad you were able to get a blood ketone reading. am curious, why do you think a blood ketone reading of 0.7 means moderate ketones? i'm pretty sure i've given you this info before, but i may have posted it in someone else's condo. sharyn/fiona did a little bit of research. she has the following posted in her profile:
Precision Xtra Readings for Cats
**'Normal' for cats is 0.0-0.3 (Fiona's normal is 0.1, D & Shadow's normal is 0.3)
**3.0 is aproximately when ketones start showing on urine ketodiastix strips at a trace - at least that is the case for Fiona.
**As BG's go down so will ketone levels (in most cases). If I can get Fiona's BGs under 250 for even a couple of hours her ketone level will go down.
**Other than being DKA at dx, the only other time Fiona has had ketones above 1.0 was when she had some kind of infection. The first time (Aug 2008) was occult and we never figured out what it was but four rounds of different ABs finally took care of it. The second time (Dec 2008) was tooth problem even though she had an extensive dental in April '08. She had a pocket behind a canine and a broken tooth. Neither of which could be seen by the vet until she was under.
**Other cats get elevated ketones for other reasons, too high BGs for too long, etc...
Here's a post that says kinda the same thing but has some other info too: http://www.felinediabetes.com/phorum5/read.php?8,1684726
and i found this chart online:
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http://www.childrenwithdiabetes.com/d_0i_191.htm
this information leads me to believe the blood ketone reading of 0.7 is nowhere near what would show up as trace ketones when testing urine with a ketostix.
Caryl and Alex said:Jill & Alex said:Caryl and Alex said:gave Alex .25R at +7 because of moderate ketone level that already exists from high bg. will test in an hour. (when I gave 0.1 on fur shot day it barely did anything which is why I chose this dose) i need to try to give Alex a break from the high numbers I really did not want to have to do this. :sad:
i'm sorry to see alex in such high numbers. glad you were able to get a blood ketone reading. am curious, why do you think a blood ketone reading of 0.7 means moderate ketones? i'm pretty sure i've given you this info before, but i may have posted it in someone else's condo. sharyn/fiona did a little bit of research. she has the following posted in her profile:
Precision Xtra Readings for Cats
**'Normal' for cats is 0.0-0.3 (Fiona's normal is 0.1, D & Shadow's normal is 0.3)
**3.0 is aproximately when ketones start showing on urine ketodiastix strips at a trace - at least that is the case for Fiona.
**As BG's go down so will ketone levels (in most cases). If I can get Fiona's BGs under 250 for even a couple of hours her ketone level will go down.
**Other than being DKA at dx, the only other time Fiona has had ketones above 1.0 was when she had some kind of infection. The first time (Aug 2008) was occult and we never figured out what it was but four rounds of different ABs finally took care of it. The second time (Dec 2008) was tooth problem even though she had an extensive dental in April '08. She had a pocket behind a canine and a broken tooth. Neither of which could be seen by the vet until she was under.
**Other cats get elevated ketones for other reasons, too high BGs for too long, etc...
Here's a post that says kinda the same thing but has some other info too: http://www.felinediabetes.com/phorum5/read.php?8,1684726
this information leads me to believe the blood ketone reading of 0.7 is nowhere near what would show up as trace ketones when testing urine with a ketostix.
Jill & Alex said:thank you for the link. it's a good reference tool.
using your chart, a blood ketone reading of 0.6 - 1.0 would mean the same as trace to low on a urine ketone strip. that's why i didn't/don't understand where you're getting the idea that a blood ketone reading of 0.7 is the same as a "moderate" level of ketones. kwim?
Any time Paula !pjstroop said:Hi Caryl..
I wish these kitties could just give us a hint on what's up with the high numbers.. confused_cat
Just wanted to let you know that I feel for ya!
Now.. sweet Alex.. PLEASE come down from there..
I hope you find out what's up (no pun intended) with Alex's numbers soon..
Thanks for your encouragement today..
Sending low number vibes to Alex!
Kathy and Kitty said:so what I would like to know about ketones is... Assuming Alex's reading is higher than trace, and is moderate, and requires action, then going back to the original question, what action would one take? Would one give R, to bring the numbers down and attack the ketones? Or raise the lantus dose, despite the greens Alex has had at this dose?
Carolyn and Spot said:I received your PM Caryl.
I did not respond to your first PM because you made it quite clear that I had nothing to offer to you.
It is *still* my opinion that:
You should not be using R on this cat, at any time, in any amount, for any reason.
Your cat's dose is too high.
Your meter is potentially leading you astray. Your nose may be leading you astray as well.
I am very sorry if the following offends you, but I find the R use in Alex to be very unsettling. That is why I do not come by. I can not sit by and watch you do this. You chose to disregard what I said, and that's just fine. You are the one holding the syringe. However, that being your choice, I can not be a part of your treatment of him. It quite literally makes me cry.
Libby and Lucy said:I see that Alex found his way to yellow for PMPS. Good! Can you please mark the 0.25 R on your spreadsheet? It's important to know when R was given.
Hillary, I'm a novice at using R and I can't speak for Carolyn, but when I look at Alex's spreadsheet I see things like this: yesterday HI to 184 with no R (then bouncing back to 473), 392 to 59 with no R, 478 to 76 with no R, 403 to 84 with no R. All those are within the last week. To me, that says that there is no PS where it is safe to give R and keep Alex from possibly dropping into a danger zone. And with Lantus it is easy enough to bring up low numbers, but R is much more powerful so a low with R can be a lot harder to bring up. Sure, if he is in Rebound City then the R might keep him from going so high, but his bounces don't last long so you really can't be sure that he'll stay in RBC for the whole cycle. Make sense?
Hillary & Maui said:Carolyn - For my own education - would you mind explaining your reason that Caryl should not be using R on Alex. And Carolyn, if she is not to use R, then what can/should she do to help Alex?
And while I don't know about R, I do know that it is used with some cats and successfully too. So, I'm a bit confused as to why you think she should NOT use R at all.
Also - Caryl - did you see jojo's posts to you late last night in yesterday's condo. I think she asked some questions and gave you some add'l information.
Carolyn and Spot said:Caryl, I will begin by saying that the reason I did not respond to your PM is because I did not appreciate your tone and the tone that you were taking with other people who were trying to help you. If you truly want help, I will help you.
I'm sorry that people think I took a tone with them it was never meant that way. Like I said, we're all people with our own sets of problems and there were times I couldn't explain things that were private. Questions kept coming at me that I couldn't answer and that may have come off as being defensive but I never was trying to be rude. If my tone was 'offensive' I was just trying to avoid things that were painful to me at the time and maybe stop the questions.Unfortunately, it's hard to tell what's really going on without seeing a person's face.
yes, I do truly want help, thank you.
However:
R: The R must go. I will not be party to any R treatment on this cat unless we determine together that it is necessary. If I even suspect R has been used, I will cease to assist.
I can do that. I wouldn't use it behind your or anyone's back. I want to help Alex. My cats are my best friends. can there be some kind of plan in case Alex develops ketones so I don't panic?
Ketones: I want to see results with ketodiastix/ketostix. Do you test with these? I also believe the true positive meter response is 3.0, however I have more experience with ketostix/ketodiastix.
I only use the meter when i need to know in a hurry and can't get a specimen. I have ketodiastix and ketostix in the house. Everything I read says that 3.0 is trouble on the meter but next time I can I'll do a sample of both at the same time. i hope it's not too soon.
Other medications: Please list what and how much of anything he is on as well as what he was diagnosed with that resulted in their prescription. Why fluids? I see when you gave fluids he dropped like a stone. Is he dehydrated?
He is on 5 mg tapezole a day 1/2 bid... He's hyper thyroid (getting tested again this week he's acting wacky, he's always hungry and hyper and doesn't gain weight) He tested low normal in December 4.2-but I can't believe that it's the same now. He was on fluids when he had ketones, the vet told me to give him 100 ml. once. He usually does drop from fluids.Other than that he's only on Xobaline now. 3mg a day.
He has a grade 2-3 heart murmur.
a small kidney stone that may or may not be responsible for blood in urine
a slightly elevated albumin level
I don't think he's dehydrated, he does urinate a lot but I soak his food in water also.
Basal insulin: up to 5.0u for time being. While it appears he is overdosed, sometimes the fastest way out of it is to give more. First 40 something you get, reduce him back to 4.75u.
Kathy and Kitty said:(((Caryl & Alex))) Tomorrow will be better.Put on the coffee.
Carolyn and Spot said:Shake it off. Give Karo now. Follow with HC Wet. 1 TBSP
Carolyn and Spot said:Also.. do not increase him to 5.0u tomorrow, just let him ride this out. No R. You know he's gonna bounce, just ride it out. Test for ketones *in urine* around +6 past AMPS.
As far as Karo tonight.. give him about a tsp for now just to help the HC
Carolyn and Spot said:Give it now. You need him out of this range this early in cycle.
Libby and Lucy said:some HC should be ok. You want to get him up at least to 60's before bed. What + hour is it now, +3.25?
oops, carolyn and I gave different advice. I've personally never used Karo but ECID, use what works for Alex. :smile:
ok i'll test him at about 12:55Carolyn and Spot said:ok let's see where he is in 15 mins.. this should get him up a bit. we may have to HC 1 or 2 more times.
Caryl and Alex said:ok i'll test him at about 12:55Carolyn and Spot said:ok let's see where he is in 15 mins.. this should get him up a bit. we may have to HC 1 or 2 more times.
Carolyn and Spot said:ugh.
he should be much higher with karo on board. I'm heading to bed in less than 1/2 hour so let's work on a plan. You can HC him again now and do that test feed test feed thing until he's over 100, leave some more down and go to bed.. or you can stay up, let him surf, and hit him with LC, HC and/or Karo as needed. Your choice.
Carolyn and Spot said:depends on what your sleep schedule is like..If you are ok staying up for another 3 hours, just let him surf along and intervene if necessary. If you are about to fall asleep right now, HC him til he's over 100, 1tsp at a time, and leave HC out.
The Lantus has barely started working, so the very best thing to do would be to monitor and let him surf, being watchful for another drop, which should be coming.
Carolyn and Spot said:Yeah I like the get up and feed and test routine. So.. go to bed in an hour, giving him a final HC before bed and making sure he's at a safe number then get up say 3 hours later to test again? Then you can decide at that time if you need to stay up or can go btb..