3/15 Oren;amps-478- HELP-ADVICE KEYTONES+6-328;PMPS-hi;

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Megan & Oren

Megan & Oren

Member Since 2015
Yesterday: http://www.felinediabetes.com/FDMB/threads/3-14-oren-amps-346-6-374.134558/

sister leaves today; she really helped me organize my house re: all Oren's testing/supplies etc. I don't have much room and it was a bit chaotic here initially! I realized that he really only went 3.5 cycles at 2.5u before I upped him, hope that's ok? I think the advice said 4 cycles... somewhat distracted this weekend w/ sister visiting, but she is a nurse and has some background w/ diabetes counseling in the past. She too said i need to give his body time to find what works and that I have no 'responsibility' for that part. Just to do the things I can do; and let biology and his body begin to cope. This is SO hard. I feel such wild swings of optimism and then defeat. I am truly confounded as to why he has regressed so badly in his numbers, but I suppose it is his body fighting off the insulins help as a perceived danger and there just isn't yet the right amount to convince his body to stop dumping glycogen. I know, patience pants, marathon not sprint etc. etc. I'm trying hard.. Happy birthday to me.:rolleyes:
 
Actually you went 7 cycles (3.5 days) on the 2.5 dose, so I think that is perfectly fine. A cycle is one 12hr cycle so you have two 12hr cycles a day. Good luck with the dosecrease. We hope Oren sees some better number really soon.

Happy Birthday!
 
bad bad news. home from church and no pee in box, but he peed right after. Tested keytones and they're maybe between trace and small?! however, he's not lethargic, he's eating normally, no heavy breathing, no fruity smell on his breath(he has bad breath all the time), no neuropathy didn't drink much while gone but just drank some now, i put lot of water in his food this a.m, he also had a small meal at 8.30 while gone w/ lots of water.

being Sun, should I be thinking i need to call a vet if he's not displaying any symptoms other than the stick reading?
 
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Trace ketones you can do your best to manage but diligently test for ketones. It's probably not a bad thing that you inadvertently increased Oren's dose. Make sure he's eating and doesn't become lethargic. You did good by adding water to his food -- keep that up.

Also, I think you may be confusing days and cycles. I'd suggested that you increase after 4 cycles (2 days). You increased after 7 cycles. If you're following TR, then you'd increase after 6 cycles (3 days) unless there's a bounce clearing or some other reason. It's a common mistake to confuse days and cycles -- there are 2 cycles per day.
 
Since you have detected ketones, you may want to consider getting a blood ketone meter such as the Nova Max or the Precision Xtra. Urine ketones show up, om average, 5 days after ketones appear in the blood. Blood ketones show up, on average, after about 2 weeks of sustained hyperglycemia.
 
I saw in your post yesterday that he's had bad teeth and today that he always has bad breath. Mouth problems are common in diabetic cats because of the glucose floating about in their body fluids (high blood sugar = glucose in the blood). Bladder infections are fairly common too. Infections can increase blood sugar.

I'm glad he's eating well. I gave you the "recipe" for ketones yesterday - you want to stay on top of this because ketones can move from small to large in a matter of hours. If it gets beyond "trace" it becomes a very big deal. As long as it's trace, you can deal with it by making sure he has plenty of water to flush them through, plenty of food and increasing his insulin appropriately to get enough insulin into him. You might want to check the sticks on yourself and see if you get trace or nothing - that's one way to know if you're reading them right.

It sounds like his mouth could be the source of an infection. You might want to get a dental scheduled - it's not uncommon for a dental to make an enormous difference in getting a cat regulated. We've even seen cats go off of insulin after everything else has been addressed and then they got a dental done. I can't say that would happen to Oren, but my point is that dental health is incredibly important in a diabetic cat.

As long as you are testing like you are - both preshots and one midcycle in each cycle and everything is over 300, I'd be aggressive and increase by 0.5u every 4 cycles (2 days) until you're seeing some blue numbers. It's important to get his blood sugar down, especially because you've caught ketones several days now. The Tilly's Diabetes Page version of the TR protocol says:

Phase 2: Increasing the dose
Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
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The important numbers are his blood sugar, not the size of his dose. He needs what he needs and as long as you are increasing methodically and testing, you can be confident you're giving him an appropriate dose. Just stick with it.

Hang in there, Megan! He's being a tough case at the moment but you'll be able to get on top of this and have his blood sugar improve if you keep at it. We're with you and cheering you on!
 
You've gotten some good advice above. The only other thing I'd suggest is talking to the vet and see if an antibiotic might help if there is a visible mouth infection brewing. Or getting a urine sample so they can check for a UTI. Infections really mess with the blood glucose numbers.

Good luck with the increase!
 
thanks all. His breath has been consistently bad essentially since I've had him, although at the time of getting his bad canines out a few years ago, he had a cleaning and it was a bit better. Thankfully, I have a vet appointment already set tomorrow w/ a new vet; I felt I didn't have a good connection with the vet at the practice I had been going to for YEARS. My original vet had retired, and the other doctor I saw a lot had also left. The new guy left me flat, even back in Oct at Oren's annual exam, pre-diabetes diagnosis. He didn't feel like an ally at all.
An acquaintance with a diabetic cat has been very happy with this practice.

Our appt. is 5.30 tomorrow, and tomorrow mornings shot would be the 4th cycle at 3.0U. If she determines there is an infection I wonder if she would advise an increase for tomorrow night, if he gets started on an antibiotic?
 
It takes a while for antibiotics to kick in - i'm not sure how long, but maybe 2 days. As high as he is, and with ketones lurking, i'd go ahead with the dose increases. I haven't seen anyone have a crisis from the AB suddenly lowering BGs. I think you'll have time to adjust his dose if his BGs begin to respond to the antibiotic.

Good luck with the new vet! It's so important to have a vet that you can work with and who you trust. They don't have to be perfect on giving dosing advice - you can get that here almost 24/7, but you want them to work with you. You might print out the SLGS and TR protocol and take them along to talk with the vet about them. Or not . . . depending on whether you want their input on dosing.
 
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