? 4/24 Barsa AMPS 25.9 (466) Levemir dose question again. Less is more?

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Vintry

Vintry

Member Since 2014
Back with the old problem. I am able to keep Barsa's ketones at bay with the help of subcutaneous fluids ..well ketones are there but if they don't increase up to 8mmol then it's not the worst. Anyways, I don't know how long I can keep them away like that..

I don't know what happened but glucose numbers are higher than ever now. I thought it was turning for the better. At least at 2.5u bg was going lower after food. Now, at 3u it's in 20s (360) and flat.. I can't even get any yellows. Of course this also coincided with change of glucometer so it's hard to compare visually but if you have a look at the spreadsheet, just minus about 5-6 points to get the 'old' Freestyle meter numbers. They were way underestimated anyways so it's good that I switched.

What should I do? In the previous threads everyone advised me to keep going up but I wanted to ask again before I do. When I started Barsa on Levemir at 1u her numbers were all yellow, sometimes pink before food. Now they've gone up to reds. Why is this happening? I saw greens with each dose increase, now 3units is a much higher dose but lowers less than lower doses did. It's all so confusing! How do I know I'm not injecting a dose that's too high? Am I making it all worse by going up and up? I am very worried because in the past I did that with Caninsulin (somogii effect) but of course Levemir is a different kind of insulin. So I don't know! My family is telling me to stop increasing and stay on 3units for a week, they think the numbers will settle down. But they are Very high now. What's your take on it?
 
I can think of a couple of scenarios to answer your question.
  • The difference in numbers may be due to changing meters. Some meters are calibrated differently or the strips work on a different method of chemical sensitivity and as a result, the numbers are higher on one meter vs. the other.
  • This is a bounce. Barsa was in blue numbers on the 20th. Numbers went up after that cycle. It can take 3 days for a bounce to clear.
  • There's some sort of infection present that is elevating Barsa's numbers.
If you still have strips, you could test Barsa with both meters to see if the difference in numbers is due to changing meters.

 
With the ongoing ketones, I think I'd want to rule out the possibility of an infection as well. If there isn't any infection present then ketones are more often associated with not enough insulin than too much.

I second Sienne's suggestion of trying a reading with your old meter to see if that shows a significant difference.
 
OK, so getting a test with the old meter isn't going to happen. Do you have any control solution for the new meter so you can check that the readings on that one are accurate? Failing that, you can try testing yourself - the normal range for humans is also 120 or under - it stings a bit, but it could be worse!!
 
Hmm, it makes sense. If there was more than enough insulin then there wouldn't be ketones..

If it's an infection, then I'm a little bit stuck because my vet is not suggesting anything. It's like he cannot find anything wrong. Blood test for hyperthyroidism - negative. No temperature. Blood test for liver and kidneys - fine. I didn't tell him about loose stool problem though. Don't know what else I can ask/suggest to him.. She just seems fine otherwise. When her bg is not high then she behaves like a healthy cat.
 
Aha, there's a control solution test in existence. Didn't know about it. Every day I learn something new on this forum. I don't have that solution tho so I will definitely test myself first thing in the morning.
 
It sounds as though your vet has done all the usual tests to rule out infection causing the ketones. The loose stools could be infection related, but with Rosa she had that problem when her BG was high so I'm really not sure - if the vet thinks they've ruled out infection, then that might be a symptom rather than a cause.

The idea of reducing the dose does concern me because of the ketones - if they weren't there, then I'm sure it would be something you could try...I just wouldn't want the ketones to get all the way out of control because of a reduced dose. And the fact that they're there at all makes me think she might still need an increase in insulin rather than a decrease anyway - it's just possible she might have some sort of insulin resistance.

Control solution does exist for meters, but I never bought any...a couple of times I tested myself if I wasn't sure about the meter...seemed to be easier and quicker than waiting for a bottle of solution to show up in the mail!!
 
Yes, I noticed that too. Barsa will have loose stool and gases when bg is high. Symptom indeed. Or maybe it's just a dysbacteriosis. Don't think it's something like worms.
 
I think if it was something like worms, you'd have other symptoms going on too - and that's the sort of thing us cat servants spot fairly quickly too! These cats never make it easy on us to figure out what's going on do they?
 
Sneezing could be a virus of some sort, or a cold, especially if it's only recent. That might be worth ruling out first - if it's a cold, I'm not sure there's much you can do about it except wait for it to go away, but it might explain why you're not getting such good control of her BG at the moment.
 
Are the strips for the One Touch Ultra new? Do you have a second bottle of them you could open and try one from a new bottle? Just in case there is something wrong. I'm guessing they are ok, but that's one way of finding out. April's got a good idea of taking your own blood sugar.

We switched from the Freestyle Lite to a Relion (human) meter and the spreadsheet also went from a "not too bad' look to an "OHMYGOSH THIS IS TERRIBLE" look. Take a look at it here and notice the transition on January 21st. I had to increase by 1 unit to be getting to the same range of numbers (from 5.5 to 6.5u) as when he was being tested with teh Freestyle.

I agree with Sienne - Barsa's bouncing from hitting those blue numbers in the 100's. The last time she hit them she was high for the following 2 days before she came down on day 3 - the day before you switched meters. So these past 2 days coincide with that same time frame.

I think she will likely clear that bounce tomorrow.

If she still is having ketones, the message is clear that she needs more insulin. You might want to go ahead and increase the dose by 0.25u and just give her high carb food to compensate for the increased insulin IF it is needed. My only concern is that if you increase the dose on the same cycle that she's clearing the bounce, sometimes that can create a lot of downward momentum and the BGs can fall a bit faster and harder than otherwise. As long as you have that in your mind and can monitor, I'd go ahead and make that increase.

Having a high dose cat, one thing that was pointed out to me was that the numbers that are important are the blood sugar. Not the dose. Don't worry about the dose. You are increasing methodically and she is still needing more.
 
Have you tried putting in half a teaspoon mashed pumpkin in with the food twice a day for the loose poops. It helps form up the poops well. Use either fresh pumpkin you cook yourself with nothing else added at all, or canned pumpkin (not canned pie pumpkin as it has added sugars etc) just the plain canned pumpkin. When Sheba had chronic diarrhoea at one stage, this was very affective for her.
 
Regarding the loose stool, I am trying Fortiflora. If this won't work then pumpkin is next on the menu.

Looks like you were right. She's clearing the bounce. But what a bounce! I am going to wait and see how low she's going to go today after the bounce. Is it always going to be like this, high numbers for 2-3days? To clarify, the correct insulin dose is the one that takes the cat into good numbers After the bounce, right? Or the one that can take care of the bounce?
 
The correct insulin dose is the one that takes the cat into good numbers and a good nadir.
Insulin does not take care of the bounce......you just have to wait it out.
My cat is a huge bouncer and it is very frustrating. Nothing you can do. Oh...and buy some patient pants:joyful::joyful: I have several pairs!!!
Once Barsa drops down from the bounce you will be able to see how well the insulin works.
Also once Barsa gets used to lower numbers, she should start to bounce less and get over it sooner
 
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Usually we only do increases of 0.25 units at a time so that you don't end up skipping over the ideal dose. With ketones present, that might change though so let's see what other people think too.
 
julie & punkin (ga) said:
You might want to go ahead and increase the dose by 0.25u and just give her high carb food to compensate for the increased insulin IF it is needed. My only concern is that if you increase the dose on the same cycle that she's clearing the bounce, sometimes that can create a lot of downward momentum and the BGs can fall a bit faster and harder than otherwise. As long as you have that in your mind and can monitor, I'd go ahead and make that increase.
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I'm glad you went ahead and increased. I would hold this dose for 6 cycles, assuming no ketones, and then re-evaluate. If he's throwing ketones at the larger dose, then you may be able to increase again after 4 cycles. Keep watch on that and ask someone if you need help figuring out if that's ok.
 
Regarding infection, there are several intestinal protozoa that can cause diarrhea, which usually is watery and can smell very bad. Worms may cause diarrhea. Bacterial infections can also be a factor. These can contribute to the low weight issues and hyperglycemia/ketones, and would be another thing to investigate if she is still throwing ketones. Generally, ketones improve rapidly once the right insulin dose is reached, and usually the insulin dose to eliminate ketones is lower than the dose to get normal blood sugars. So your cat is not typical, and there might be some other factors involved.

If your vet did labs, it might be helpful to post them here if you can get a copy. Intestinal parasites may show up as elevated WBC with elevated Eosinophils on the blood tests.

If you are supplementing with potassium, this may be a source of diarrhea as well. Potassium is VERY irritating to the digestive system, and if she's over what she needs for supplementation, diarrhea would occur. Another potassium lab might be in order if you are supplementing.
 
manxcat419 said:
Do you have any control solution for the new meter so you can check that the readings on that one are accurate?
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I checked the meter with control solution before posting it to Iryna and it was reading perfectly at that point. And the test strips are new.

Iryna, you can get a vial of control solution free by contacting the Customer Care section on this page (I should have told you that before, sorry about that):
http://www.lifescan.co.uk/
They usually send them out really fast, but you may need to register on the website. (When I registered I didn't let on that Bertie was a cat. I put him down as a 'dependent' or 'child' as I recall...:rolleyes:)

Edited to add: Could it be the case that the Freestyle Lite wasn't reading correctly at higher numbers? The name of that meter 'rang a bell' with me as one of those that isn't reliable at higher numbers, so I just did a quick search and found this post from Vyktors Mum: (there may well be others): SOS
.
 
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Elizabeth and Bertie said:
I checked the meter with control solution before posting it to Iryna and it was reading perfectly at that point. And the test strips are new.
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Oh, I'm sorry Eliz - I didn't realize it was a meter that you'd sent on to Iryna. When she said it was a new one, I thought it was one she'd just bought!! If I'd known that, I'd also have known you'd have checked it before you sent it on to her.
 
manxcat419 said:
Oh, I'm sorry Eliz - I didn't realize it was a meter that you'd sent on to Iryna. When she said it was a new one, I thought it was one she'd just bought!! If I'd known that, I'd also have known you'd have checked it before you sent it on to her.
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Ha-ha! Please don't apologise, April. You raised a very valid point. :bighug:
And who knows, maybe the meter has gone wonky since....?:nailbiting:
 
FYI - I also had issues with Freestyle Lite. But that was three years ago. At that time, the butterfly strips were not showing the high numbers the same as other meters did. Here is Neko's 2012 SS, I switched to the Relion Confirm with a Bayer Contour as backup after three weeks. My vet uses the OneTouch Ultra in her office and finds it compares quite well with the lab results.

Good luck with the increase.
 
Eliz, I'd say dependant/children is correct ;)

The meter is fine I think. It reads about 5-6points lower than my old Freestyle (I was able to compare twice before I ran out of Freestyle test strips). Yesterday I was trying to find information on the comparison of meters in the UK. And look what I found about my old glucometer: https://abbottdiabetescare.co.uk/im...A1002-2014_UK_ADC_Consumer_Letter_10Feb14.pdf

One Touch Ultra that Elizabeth sent me is accurate (for a human meter) but it does require a lot of blood and I have already wasted some strips. That's the only negative. I've had a look at Accu Chek Aviva meter, that one needs less blood but I don't know if it's accurate like One Touch Ultra.

The problem with Barsa's numbers is that even on Freestyle they would still be high and flat, about 17 (306) and up (if I minus 5-6points). I keep washing out the ketones with 40ml fluids every day. It's been 4 days now but I have to stop until next week because vet told me to not use it more than 4 days in a row. But yeah, it does help. Just tested - no ketones at all.
 
17.6 (310) - after 6 hours. This is just baad. Do I wait 1 more day (to make it 4 cycles) to increase to 3.5?

Edit: That would have been about 12 (216) on freestyle meter and I'd be calmer )) But better know the truth!
 
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27.3 (491) evening pre-shot today. Weekend is coming, I don't have anymore fluids. Gave her an increased dose of 3.5units.
 
Pick up some distilled water to add to the food. There are no additional minerals in distilled water, it is straight H2O. This means it can help the kidneys process urea into urine and flush ketones, without needing to be processed itself.
 
Oh, I can't get it from normal grocery shop, they don't have it. I'll have to order it online which will take time.
 
This is going to sound weird, but try your local garage (gas station for everyone in the US who thinks I just lost my mind) for distilled water. That's the only place I ever remember seeing it on sale in the UK and I don't know if even they still sell it anymore but it's the only place I can think of where you might be able to get hold of it without having to order.

Also de-ionised water is the same as distilled so you might want to look for it under that.
 
How many ml of subq fluids were you giving daily? I haven't heard that you can only give it for 4 days straight. If you get a positive ketone test i'd restart them - or at least chat with your vet to find out exactly what the concern is on giving them longer. I'm thinking the risk of ketones may be greater than whatever the risk of continuing the fluids would be.

I think when she cleared that bounce, she may have only gotten into yellow numbers (that 229 yesterday morning). That was 5 cycles after the blue 190's.

With your new meter, the nadirs are basically over 300, so you could've increased by 0.5u.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
by the way, we ask everyone to start a new thread (condo) each day to keep them from getting so long. You can quote and answer anyone's questions on the new day's post.

thanks!
 
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