4/27 RK-AMPS 534 ket 0.9 +3 292 +5.25 293 PMPS HI, ket 2.1 +4.75 265 +6.5 227 +8.25 486/R +10.25 571

Yesterday’s post

Today is the fifth consecutive cycle where we’re starting in the blacks. While it’s lovely of her to be so “friendly” as to greet me with a “HI” every morning (tongue firmly planted in cheek) I much prefer a numeric value. I did experiment and give a drop of R at PM +8.5 when I caught her heading up, so I suspect that contributed to “only” being at 534 this morning.

On a positive note, ketones are down to 0.9. I’m starting to think my blood ketone meter is nothing more than a random number generator.

RK nibbled on her breakfast and her Temptations treats. Maybe today we’ll break the bounce. One can hope…

 

Fingers crossed the bounce breaks today. And good news the ketones are down to 0.9
I hope you both have a good day.

 

Interesting how fast she came down on her own today, without R. Makes it hard to tease out what the impact of R is when given at PS.

Today/tonight should tell us if the reduction failed.

 

Right. I’m looking at the numbers and it’s just not clear yet. I do believe the drop of R at last night’s PM +8 might have kept today’s AMPS tamped down slightly, but I find it hard to believe it lasted that far into the AM cycle. It reads more to me that she might have started to clear the bounce?

She’s back to HI at PMPS, ketones up just over 2. I’ll update the spreadsheet when I can get back to my computer (I’m on my cell phone right now). I didn’t syringe feed as much food during the day today so that combined with her high BG … it’s probably not surprising the ketones are up. I’ll get back to more intensive syringe feeding again tonight.

I went with 0.5u Lantus and a drop of R for tonight’s PM shot. I’m not really sure what else to do at this point. I’m not clear what one drop of R is accomplishing, if anything, or when it might be accomplishing it. If DKA weren’t in the picture, I’d just skip R entirely and ride out the high numbers with Lantus and work the dosing. As it is, I’m more inclined to add a second dose of R in the last half of the cycle, or maybe even try a bigger dose of R. But that risks inducing more bouncing, perhaps? She did show movement on N, so I expect that R should offer movement as well. Thoughts??

 

The other variable I wanted to mention … RK had an enrofloxacin injection yesterday. I’ll have to look more closely at the data, but it seems there’s a possible correlation. She seems to have lower numbers the day after… (but could be total coincidence).

I'm going to talk to the vet who prescribed it next week to see if it makes sense to continue it.

 

I'm more used to seeing Clindamycin given for mouth infections. That's what Neko's dental vet used, and my dentist (blech!). It's a really strong AB though, maybe too much for the little girl.

Given how fast she drops on her own at PS, I'm more of a fan of mid cycle R with her. It does look like it's been moving her some. I would like to see an R "curve", maybe testing at R+2 and +4. To get a better idea of onset, nadir and duration of R. I've seen exactly one person use L + N, but it was Lev, not Lantus.

If you don't see any blues tonight, how would you feel about a fat 0.5 units/skinny 0.75 units of Lantus? Normally I'd say you could go back to 0.75 units, but I suspect her carb intake is all over the place.

 

Ditto on the Clindamycin. The vet who saw her initially was, I believe, trying to get an antibiotic on board immediately due to the elevated WBC and said that Clavamox was good for dental infections. At that point RK was/had been in DKA and I didn’t really care what they sent me home with as long as it was something, so I didn’t argue (I was also relieved the vet didn’t suggest Convenia). We’ve seen a couple of different vets based on who we could get in to and who was able to hospitalize so a different vet added on the enrofloxacin. We’ve seen progress with the Clavamox but I really noticed apparent improvement with the enrofloxacin (and I’ve read using the two combined can be beneficial). And yes, I do suspect that, given how bad RK looked in the early days, clindamycin was probably considered too harsh.

Yeah, I think I’m leaning that way too, thanks for the nudge. It’s hard to see HI at PS and not want to intervene, but I’ll hold the R until mid cycle and see how that goes. It’s just those darned ketones that are driving the show. Ugh.

I have R +2/+4 data but mostly in the AM cycles when R was given at PS. I’ll try to get more data. At some point I need to figure out when to sleep. I’m tired.

I don’t mind fattening up the 0.5u, it’s probably a good idea. I question the consistency of my syringe markings so should probably look into calipers. And yes, carb content is most definitely all over the place.
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Edited to add: gave a drop of R at PM +8.25 when BG started spiking up.