.2 ketones, 80-250bg Yay!

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Christie & Maverick said:
I would think at the vet they’d be using a rapid insulin to help bring down the high BG numbers, continuing to monitor and manage electrolytes and provide fluids. Giving water frequently at home helps, but it doesn’t work as well as fluids particularly when a cat is chronically dehydrated. There is a Hill’s a/d food that you may want to see about getting, most cats find it very palatable and its texture is very fine which makes it easier to use in feeding tubes.
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She is already in Hills Prescription A/D since we took get home Wednesday with get feeding tube. Thanks
 
Bron and Sheba (GA) said:
I also think Sid would be better in the hospital on an IV drip. It is very hard to manage her at home with such high ketones and vomiting and nausea. If it is not the expense which is stopping her being in hospital, I would ask that she be managed in hospital until she is more stable. As mentioned they can bring down the BG with short acting insulin quicker than Lantus.
Also ask about ondansetron for nausea. That is a better option than cerenia for nausea, although cerenia is better for vomiting. And ondansetron can be given in conjunction with the cerenia as they work on different pathways.
Smaller more frequently meals is better too, but make sure she is getting enough calories as it is both insulin and calories that will combat ketones.
Just checking it is Hills a/d that you have been giving her via the tube.
Please keep us updated.
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So luckily she's only thrown up her meals twice. No vomit or nausea since we've cut back some of her medication(which can have these side effects as per the vet).
We gave her 2.5 units this morning to combat the HI reading on the meter.
We are hoping they will give her some short acting insulin and give us some for home.

Side note: we are currently storing her Lantus in the refrigerator as that's what the pharmacy had been doing. Is there any reason we shouldn't be doing this, for example can it effect the effectiveness of it? Thanks
 
Obsidian's Servants (Sid) said:
Side note: we are currently storing her Lantus in the refrigerator as that's what the pharmacy had been doing. Is there any reason we shouldn't be doing this, for example can it effect the effectiveness of it? Thanks
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It should always be stored in the fridge (opened and unopened). If it's an older vial/pen, it can start to lose effectiveness (so always a good idea to closely monitor BG when switching to a new vial) but they are generally good if stored properly in the fridge (and never frozen!) for multiple months after opening, and up to the expiration date unopened.
 
Obsidian's Servants (Sid) said:
She is already in Hills Prescription A/D since we took get home Wednesday with get feeding tube. Thanks
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My apologies I missed the earlier post where you noted you had this food, and wasn’t sure whether you were feeding something different in the feeding tube.

Hoping you get some good help today at the vet’s. I will perhaps offer a caution with the use of fast acting insulin at home without help from an experienced member who knows how to use it. At the vet’s they can keep a close eye on how the fast acting insulin is working and intervene quickly. Knowing when not to give it is as important to know as when you can give it. It would require frequent monitoring, every hour for several hours so you can determine onset, nadir, duration and you need to be careful with overlapping nadirs between the two insulins.
 
Just got her home.
At the vet her BG was 559 when we got there and 450 when we left. Looks like the show insulin was taking effect.

Her ketones were down to 3.

She was very dehydrated from the high BG. They gave subq fluids, taught us how to do it and sent it home with us.
They still didn't want to hospitalize her.
When we got home her BG was 526 and her ketones went down to 2.3.

We are still worried about her high BG.
But after some research about Lantus, sounds like with dose increase, it can take a few days to build up the depot and sometimes you will see an increase in BG with an increased dosage.

We have her 2.5 units and we will check her again here shortly.

No nausea or throwing up just very lethargic. But she hasn't really slept in days so she's gotta be stressed and tired.

We are on a every 2 hour feeding and so far so good.
 
Yay for small improvements, we’ll take them! Good news that you have subq fluids for home, that should help flush out the ketones more quickly, albeit I appreciate you have been dedicated to giving her water in her feeding tube. Did they mention how much subq fluids to give?

If it’s not too much trouble, when you get a chance would you mind please starting a new post and link this one? We try and keep the posts to around 50 and it will be easier to watch for the latest details for those who are trying to keep up :).

Sending continued healing vines, you are doing such an amazing job for your girl :bighug:
 
I am very glad you took her to the vet.
I can see the BG is still very high. I’m wondering if she could have dropped low somewhere along the line where you were not testing and this is a bounce. I can’t see the 450 you mentioned in the SS?
And I’m very pleased to see the reduction in ketones and that you are giving 2 hourly snacks via the tube.
I’m also pleased you are giving sub Qfluids. How much?
I’m sure Sid is exhausted after all that activity…you too. Take care.:bighug:
 
Bron and Sheba (GA) said:
I am very glad you took her to the vet.
I can see the BG is still very high. I’m wondering if she could have dropped low somewhere along the line where you were not testing and this is a bounce. I can’t see the 450 you mentioned in the SS?
And I’m very pleased to see the reduction in ketones and that you are giving 2 hourly snacks via the tube.
I’m also pleased you are giving sub Qfluids. How much?
I’m sure Sid is exhausted after all that activity…you too. Take care.:bighug:
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They gave her 150ml and said they would tell us if we need to give her more.

She's doing so much better this morning, she's talking and wants attention. She actually ate all of her 10am feeding on her own.

Her BG is in the 300s and her ketones went slightly up over night
 
I’m glad she is eating better.
What were the ketones this morning and overnight? Would you mind continuing to put the ketone results to the remarks column of the spreadsheet please so we can see easily? Thanks.
I see you have gone up to 2.5 units of insulin. I would not increase further until the depot has had a chance to catch up.
WHAT IS A DEPOT INSULIN
 
I will update her ketones on the SS.

So I just checked her ketones and they were 5.3.
At 11:30am they were 3.7.
5:30 pm yesterday they were 2.3.

Her current BG is 324.

She has an appointment tomorrow to get her feeding tube checked. I'll have them run her numbers again while we are there.

She's still been acting better. Eating some of her food on her own.

Yeah definitely will not increase her dosage anymore till we get this increase storer in the depot.
 
I’m glad she is feeling better. And eating some food on her own. That’s an improvement. Thr ketones are certainly fluctuating. Are you giving any subQ fluids at home now?
 
For some reason I can't edit my spreadsheet anymore from Google drive. I will get her numbers updated as soon as I get that figured out.

Her BG was 133 this morning and the vet advised us to only give her 1 unit. This evening it's 362 so they had us give her 2.5 units again.

They instructed: If her blood glucose is between 100-250 give 1U, if >250 give the 2.5U, if <100 no insulin, just food. If less than 60 and lethargic, give karyo syrup and see vet.

Do we agree?

Also ketones are 1.2.
 
Obsidian's Servants (Sid) said:
For some reason I can't edit my spreadsheet anymore from Google drive. I will get her numbers updated as soon as I get that figured out.

Her BG was 133 this morning and the vet advised us to only give her 1 unit. This evening it's 362 so they had us give her 2.5 units again.

They instructed: If her blood glucose is between 100-250 give 1U, if >250 give the 2.5U, if <100 no insulin, just food. If less than 60 and lethargic, give karyo syrup and see vet.

Do we agree?

Also ketones are 1.2.
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I’ll ask @Bandit's Mom to have a look at your SS.
I think it would be better if you followed our TR dosing method. Lantus does not like the dose to be chopped and changed much as it messes with the depot. I’ll link the TR dosing method below.
great to see the ketones down.
 
LANTUS DOSING METHODS
There are two dosing methods here. Tight regulation and start low go slow. TR is better for you with ketones in the picture. You have to test at least 4 times a day and not be feeding dry food. Have a look and see what you think.
 
Just to add to what Bron already said, Lantus dosing is based on how low a dose takes the cat. The preshot can often have no bearing on how low the numbers can go in that cycle. We have seen cats start in the 300s or 400s and drop to the 40s and also seen cycles start in the 50s and zoom up to 400! If you take a look at other spreadsheets, you will get a sense of what I mean.

With TR you can also get Sid to a good dose sooner.

Obsidian's Servants (Sid) said:
For some reason I can't edit my spreadsheet anymore from Google drive. I will get her numbers updated as soon as I get that figured out.
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This is a bug in the Google Sheets app. It doesn't happen if you update the SS on a laptop/desktop - only on the app, and the error goes away on its own. Someone posted that reinstalling the app helps. You could try that.
 
Thank you for all the info.
I've updated the SS on my laptop, still can't get it figured out on my mobile. Hopefully it will fix itself.

Now the vet is having us only give her 1 unit, no matter what her high number is.
As Sid has gotten down to 53 one morning, which we ended up not dosing her that morning. I agree that we are chasing the jumps a few cycles behind.
She was 547 this morning, I plan on upper to dose to 1.5 in the PM as she is showing ketones again but less than last night, which were 7.1 and this morning down to 4.2.

Hoping this will help with the high numbers and ketones showing up.

Overall she's doing quite well, she is eating all of her meals on her own.
She's on about 220 calories a day of only A/D wet food.
We are only using the feeding tube for her meds, supplements and extra water.

She seems back to her normal self, enjoying life, wasn't sure she was going to make it this point.
 
I am concerned you are dropping the dose to 1 unit with all those ketones in the picture. There has been a lot of chopping and changing of the dose so it is hard to see which is the best dose. But dropping it back to 1 unit is not the answer in my opinion.
I would continue to try and increase the amount of calories Sid is getting.
With the dose….the depot from the 2.5 units was influencing the 1 unit doses.
 
Bron and Sheba (GA) said:
I am concerned you are dropping the dose to 1 unit with all those ketones in the picture. There has been a lot of chopping and changing of the dose so it is hard to see which is the best dose. But dropping it back to 1 unit is not the answer in my opinion.
I would continue to try and increase the amount of calories Sid is getting.
With the dose….the depot from the 2.5 units was influencing the 1 unit doses.
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@Obsidian's Servants (Sid)
 
Diane Tyler's Mom said:
@Obsidian's Servants (Sid)
Have you chosen which dosing method you want to follow yet?

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

@Obsidian's Servants (Sid)
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I'm having a hard time with her dosage. The internist gave us strict instructions to keep her at 1 unit unless she drops too low. We are have a meeting with her on Tuesday and am suppose to do a curve already, but we're been having to change her dosage so much, it's not going to be accurate. Also she said we can feed her as much as she will eat (since she's majorly under weight, her goal weight was 12 and now she's 9). And she's showing ketones. It's just hard, so much conflicting info from all the vets.
 
Hydration can make a big difference too. Does Sid seem dehydrated? That was a constant battle when we were fighting ketones and subQ fluids were key. I know you said the vet sent you home with some but then you were advised against administering fluids due to Sid’s heart murmur. I think I’d ask about that again given the increasing ketones. Fluids can also help bring BG down a bit in many cats. Fluids can be tricky with heart issues but they gave 150ml then sent you home, I think? So maybe there’s a balance in there somewhere…
 
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Bron and Sheba (GA) said:
I am concerned you are dropping the dose to 1 unit with all those ketones in the picture. There has been a lot of chopping and changing of the dose so it is hard to see which is the best dose. But dropping it back to 1 unit is not the answer in my opinion.
I would continue to try and increase the amount of calories Sid is getting.
With the dose….the depot from the 2.5 units was influencing the 1 unit doses.
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We've been feeding her as much as she wants to eat
JL and Chip said:
Hydration can make a big difference too. Does Sid seem dehydrated? That was a constant battle when we were fighting ketones and subQ fluids were key. I know you said the vet sent you home with some but then you were advised against administering fluids due to Sid’s heart murmur. I think I’d ask about that again given the increasing ketones. Fluids can also help bring BG down a bit in many cats. Fluids can be tricky with heart issues but they gave 150ml then sent you home, I think? So maybe there’s a balance in there somewhere…
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She doesn't seem dehydrated, we are giving pretty of water with her meds thru her tube. The Urgent care gave us the subq without knowledge of her heart murmur. The internist now is worried about using anymore with get murmur.

Her ketones were down to 1.6 this morning. We are doing a curve today and the numbers look good. We are doing side by side with the AlphaTrac.
 
I'm glad you upped the insulin dose to 1.25 units. In addition to the curve, it's very important to try to get at least two tests per cycle. That means trying to get at least a "before bed" test each night. Many cats drop lower at night, and that before bed test can give us a clue if that's happening. As mentioned above, here we decide what the Lantus dose should be based on how low that dose takes the cat. It's a good sign that ketones are coming down and below 2.6.

At some point, the heart murmur should be investigated further by a cardiologist/echocardiogram. It is possible for cats to have a benign tumour that comes with age. If that were to be the case, fluids would be OK.
 
I agree with what others have noted, including the need for a bit more testing.

Dehydration isn't so much the issue with ketones. Fluid helps to dilute the ketones that are floating around. It's one of the reasons that when a cat is being treated for DKA that they are put on IV fluids.
 
Wendy&Neko said:
I'm glad you upped the insulin dose to 1.25 units. In addition to the curve, it's very important to try to get at least two tests per cycle. That means trying to get at least a "before bed" test each night.
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When you say before bed, we dose her usually at 8pm, are you wanting like a 9 or 10 o'clock?
[/QUOTE]At some point, the heart murmur should be investigated further by a cardiologist/echocardiogram. It is possible for cats to have a benign tumour that comes with age. If that were to be the case, fluids would be OK.[/QUOTE]
We are already working on scheduling her a echocardiogram. Thanks
 
Sienne and Gabby (GA) said:
I agree with what others have noted, including the need for a bit more testing.

Dehydration isn't so much the issue with ketones. Fluid helps to dilute the ketones that are floating around. It's one of the reasons that when a cat is being treated for DKA that they are put on IV fluids.
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They didn't want to give her an IV last visit due to her being anemic, and didn't want to dilute her blood any further.
 
Can you re-test? That 528 is completely out of line with the preceding numbers. It may have been a bad test or a bad strip.

Given Sid water in her food shouldn't have the same effect as IV fluids.
 
A before bed test is ideally around 2 or more hours after the shot. Lantus takes a couple hours to onset (or start to take effect).

Has anyone described what a bounce is to you? The following description could explain higher numbers.
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

For another example, look at the PM cycle on 8/15 and the nice low blues, followed by a whopper of an AMPS the next morning.
 
Wendy&Neko said:
A before bed test is ideally around 2 or more hours after the shot. Lantus takes a couple hours to onset (or start to take effect).

Has anyone described what a bounce is to you? The following description could explain higher numbers.
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

For another example, look at the PM cycle on 8/15 and the nice low blues, followed by a whopper of an AMPS the next morning.
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Thank you I'll wait til at least 1030pm and test her again. Yeah we've heard of the bounce but not fully educated on it. That's what looks like is happening.
 
Sienne and Gabby (GA) said:
Can you re-test? That 528 is completely out of line with the preceding numbers. It may have been a bad test or a bad strip.

Given Sid water in her food shouldn't have the same effect as IV fluids.
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We are testing side by side with the AlphaTrac and it was reading the same jump. We just tested her again 2 hours later and the numbers are the same, just a touch lower actually.
 
Here is an explanation on bouncing. I’m glad the ketones are coming down. You’re doing a great job.
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Hey everyone!

I just wanted to give a quick update.

Sid is doing great! She's gaining weight, has tons of energy and is having a great life.

All of her liver and kidney numbers are back to normal.
Her heart murmur is harmless.

Thank you for all the support.
And a word of advice, get pet insurance. It actually saved our pet's life.

I'll update her spreadsheet soon.
 
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