4/3 Barsa AMPS 10.4 (187), ketones and Levemir starting dose issues

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Vintry

Vintry

Member Since 2014
Cross-post from the main forum: http://www.felinediabetes.com/FDMB/threads/levemir-dose-increase-very-underweight-cat-please-advice.135234/.

Guys, I am posting here as well in case I can get more replies here. My cat has very high BG, she's very underweight but still eating. I'm scared I can lose her. Please read this + original post and advice if you can, it's urgent. I switched her from Caninsulin (3 units) to Levemir (1 unit) 2 days ago, even though my vet said I should start with 2 units. Now I see that I was wrong and the dose should be higher. Is it true that it's not possible to increase it to 2 units after 3 days because it has to be done in increments (0.25 or 0.5)? If true then it will take me 6 days to get to 2 units and then I still don;t know if that dose will be enough.. I wish I could give her 2 units asap :(
 
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Hello and Welcome to this forum. My Neko started on Caninsulin (it didn't work for her) and now we are on Levemir. I much happier with it and hope you will like it too.

Take the time to read the starred Sticky Notes on the top of this forum, if you haven't already. Levemir is a depot insulin, so you have to wait for the depot to build before evaluating how it's doing. That means patience and waiting - both hard to do. It's too early to tell if the dose you started with was too low.

There are two ways that people here use to determine dosing, either the Tight Regulation Protocol or Start Low, Go Slow Method. Read them both and decide what you'd like to use, then put a note in your signature. It helps us help you and means we don't have to keep asking questions about how you are deciding dosing. You test enough for the Tight Regulation Protocol. It is the more aggressive but is a safe method for increasing doses. According to TR, you have to hold the initial dose for 5-7 days. Increases after than are .25u if you are seeing nadirs below 300 (16.6). We don't like to suggest going any faster, for the safety of your cat. Safety is our number one rule here.

If you are worried about weight, have you thought about feeding her some higher calorie food? If you told us where you live, we might be able to suggest some foods to try.
 
You sound a bit panicky, and I'm wondering if she needs another vet visit. Having blood sugar in the 200's (we use US numbers on this forum, and that's equivalent to the yellows you're getting) isn't a crisis situation. But if she's weak and not eating, that is. Just looking at her blood sugar it doesn't look like she's in trouble, but you are there with her, and you know her, and if she's doing poorly I'd take her to the vet again. Her blood sugar isn't high enough on its own to be causing weight loss, I don't think.

Below is the info on starting out on Lev and on increasing if you're following the Tight Reg Protocol. I think because of your situation and concern about the high blood sugar, and because you do test enough to keep her safe using Tight Reg, i'd go that direction rather than the Start Low Go Slow. Wendy's right about normally holding the initial dose for 5-7 days, but there is an option that I've bolded, of increasing after 3 days if the blood sugar tests tell you that this dose is definitely not enough because the cat is staying flat and high. Usually we'd call over 300 (pink numbers) as flat and high. You're getting yellow numbers.

You're right that there is a dosing formula for those following Tight Reg that provides a ballpark starting dose, and that the dose on the previous insulin is also taken into account. Could you possibly add in just the data from the last week on Caninsulin so we can see it in context on the spreadsheet? Did you think 3u on Caninsulin was the right dose? This actually doesn't look too bad for a start on a depot insulin. Since she's getting into yellow numbers on just the 1u, 2u might be too much. There's nothing in her spreadsheet that would make me think you should make a large dose increase, certainly not an entire unit. It's hard to say, but it's safer to start with a lower dose and increase methodically so you don't overshoot the right dose. As you have seen, too much insulin can cause high numbers that look a lot like too little insulin.

You can't hurry building the depot that comes along with Lantus and Levemir. Take a look at this sticky, especially the first link that is called "Lantus and Levemir: What's the Difference?" - reading that will help you greatly in understanding why you don't make dose changes too quickly. I think I would give it 3 days (6 cycles) on this dose, then increase by 0.25u if she still isn't getting anything less than yellow. That probably sounds like it wouldn't do anything, but 0.25u can make a big difference. Then I would re-evaluate every 3 days after that and increase until you're getting nadirs in green numbers. When we see kitties that have passed the first week on insulin who are staying in pink numbers or higher, sometimes we'll suggest they "fast-track" meaning increasing every 4 shots. But Barsa is definitely not high enough for that.

And welcome to LL! Keep asking questions and we'll do our best to help you help Barsa. It would be great if you could post regularly so we can keep an eye on what she's doing on the dose and give you feedback if you need it. I'm glad Wendy suggested that you take a look at both dosing methods - we need to know what direction you want to go before we give dosing advice. The info below only goes with Tight Reg, so if you want to go with SLGS, this doesn't apply.


REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Some kitties adapt well to free feeding.
Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
(Revised 10/28/2013)

"General" Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
 
I am in the UK so I buy the food available here from Zooplus and HappyKittyCompany. Brands - Bozita, Thrive Complete, Catz Finefoods, Almo Nature. The aim at the moment (if that is correct) is to feed wet canned low-carb (under 7%) food that is high in protein (16-18%). One thing I'm not sure about is how much boiled chicken breast to feed? 100g chicken breast is not the same as 100g canned food..

Protocols..I think I can follow the Tight Regulation one. I'm already drawing the curve on the paper to try and figure out how it all works. But so far, after 5 cycles, the nadirs are 12--14 (220-250).
 
If Barsa is very underweight, you want to feed enough to let her regain her weight.

There's no restriction on how much boiled chicken breast to give her - I gave it to punkin as pokey treats and it didn't raise his blood sugar. You want most of her food to be canned so it has the taurine and vitamins that are added, but you can give chicken in addition to that.
 
I am panicking because this high BG is wearing her out. I know it could be worse, numbers could be red. BUT this has been going on for a couple of months now. Somogii effect - BG high high high into 20s on 4 units of Caninsulin (I started feeding her less food then to stop it going up). Then when I realised what is happening and lowered the dose (50% - 2units) she had to cope again with this adjustment for 3 days and that's when she lost even more weight. THEN I went back to the original 'good' dose - 3units and...nothing. Caninsulin stopped working. So you see all that was going on for a couple of months, that's why I'm worried. How much poor baby can take (( but she is a strong girl, I have faith.

I am going to copy all the data I have from my little book to spreadsheet, this shouldn't take too long.
 
I've updated the spreadsheet. 16.6 (299) this morning, 16.3 (293) after 6 hours. Is this normal? I might be expecting too much after Caninsulin. Levmir as far as I know is very gentle, is that why I don't see any BG drops? I have U100 syringes now (with half-unit measurements), been using a FlexPen for the past 2 days. Even with these syringes 0.25 is very difficult to draw! Don't know how you do it. So tempted to increase to 1.5
 
This might be it:

"Diabetes is never 100% predictable, but by getting a few spot checks every evening, you will have a good idea of how low each dose is taking your cat and whether an increase or decrease is appropriate. By contrast, basing your dosing on the results of a single curve can leave you guessing – kitty was high all day on the curve, but is he really high all the time, or did you just happen to choose a day when he was bouncing to do your curve? To me, getting some midcycle tests in 8 or 9 cycles out of every 14 seems safer than relying on curves in only 1 or 2 cycles."

BUT my cat is not in that 'good' range yet to have a bounce, it's pretty much the same, persisting yellow numbers. This is already cycle 6.
 
I'm not sure what's going on with your spreadsheet. The data isn't transferring over to the US tab.

The first thing to realize is that Lev (and Lantus) are both depot-types of insulin. This is in part, what makes them far more gentle than Caninsulin. It also means that it takes several days (5 - 7) for that depot to form so that you're able to see the benefit of this kind of insulin. Given that you've dropped the dose with starting Lev coupled with the depot not yet being in place, Barsa's numbers are not bad at all.
 
It might help you to look at some other spreadsheets. While the goal is to get everything under 120, it doesn't happen instantly.

My point is that while she isn't regulated yet, she will get there. You really can't rush this process and it's better not to increase too quickly or by too large of an increment or you may overshoot the right dose and cause her to have high numbers from being overdosed. And you won't even know you've done that until she crashes into low numbers from it.

Just hang in there and be methodical. Most new people ask for help before increasing until they get the hang of it. Switching from another insulin is probably the hardest because you have to change your way of looking at the blood sugar numbers that you get. You can't see a high number at pre shot and increase the dose like you can with other insulins. With lantus and Levemir, you look at how low the cat is getting on a particular dose and evaluate the dose based upon that low number. It's a different way of dosing and thinking of how you manage her diabetes, but I think when you get used to it you'll like it.
 
I cant give you any advice but look at Roohs spreadsheet. We started posting here regularly mid January and the awesome help we got from Julie, Wendy, Sienne & others got us to where we are today. They really know what they are talking about. It took about 1 month on Lantus to find his right dose but I think it would have happened sooner if I had been here sooner listening to these ladies and following the protocol they use.

I also thought Rooh was having symogi swings and he was severely underweight. I free fed wet food and had to encourage him to eat often and used as many kitten foods as I could find that were low carb to increase his calories. He could only eat small meals because he would get sick. I added Dr. Goodpet digestive enzymes to all his meals and still do. He was also put on methylcobalamin (b12) and with his vets blessing we used dandelion for his upset stomach. Oh I dont know if it made a difference but I also added LEF Cat mix to his regimen initially to give him extra vitamins.

Hang in there. ((hugs))
 
Rooh's spreadsheet is actually a perfect one to look at. Notice how many high numbers he had in the first weeks, and how he didn't get a green number until he got up to 4.0u about 6 weeks into the spreadsheet.

Then as you continue scrolling down you can see the transition to an all-green tightly controlled spreadsheet. It's a happy sight.
 
Thank you. You explain it all so well. I need to get the emotional element out of my thinking and do the right thing. Basically, what I understood is that patience is key and 0.50 increment after only 3 days wouldn't be wise because of depot, right? Ideally I need to go up from 1 unit to 1.25 after 5-7 days. Because my Barsa is tiny-tiny now (legs' muscles all gone, God knows how she still climbs over the fence!) I am going to increase to 1.25unit after 3 days - that will be tonight. Waiting for your approval now wise ladies.

I did look at a number of spreadsheets: Neko, Rooh, Gabby - all very good examples. Numbers looking so good, nothing like Caninsulin swings. You are right, my Barsa's BG not that bad I guess, numbers are just high because she's not regulated yet.

Jmeli, does Rooh have pancreatitis? My cat had her bloodwork done to check for underlying deceases and nothing came up. Nevertheless she has some kind of digestive tract problems every now and then. I see that in her stools, it's not exactly diarrhea, more like a puree consistency, not solid. What helps your cat might also be good for mine so I appreciate your tips. Also, in case you find it useful, on another thread of this forum BaileyUK (she's amazing!) recommended organic aloe vera juice, her kitty has pancreatitis and it's good for stomach.

"The aloe vera juice I give Bailey is PUKKA ORGANIC ALOE VERA JUICE. I did a lot of research to make sure it was safe,so this is what I found out,it MUST be made from only the inner leaf gel (the outer rind is toxic for cats) it must be free from synthetic preservatives and MUST NOT contain potassium sorbate or sodium benzoate.I buy it at a local health shop,if you cannot find it locally google and there are on line places to do mail order. I give Bailey 1 teaspoon twice daily,it has worked for Bailes,I had him at the vet this morning and he agreed his stomach feels less swollen,he has been on it now for over three months."

Hanging in there as instructed! :)
 
I do think she's overall high enough that you could increase to 1.25u tonight if you want to.

Let's see if others have a different opinion about it, though.

With Neko & Gabby, did you look at their early spreadsheets as well? Often people see the most recent tab and both Wendy & Sienne have been doing this for years. Their kitties were hard to get regulated in the beginning but they just plowed on through til they had success.

Neko also has both acromegaly and insulin autoantibodies, 2 conditions that cause a need for a high dose, which also makes things difficult to regulate.
 
Vintry said:
Jmeli, does Rooh have pancreatitis?
Click to expand...

He was not diagnosed with pancreatitis but he also had stomach issues and probably had a mild case of it. He pretty much stopped eating before dx. We did not do the FPLI test but did bloodwork and his liver ezymes were very high. He lost 20% of his body weight in about a month and he really wasnt to bad overweight to begin with.. I tried aloe vera in the past with another cat that had IBD and didnt see it help her. I totally believe in Aloe, but ECID. So far what I have been doing for Rooh is working so Im not going to rock the boat. Thinking back, I do think the LEF vitamin mix does help because it has egg yolk lecithin in it and that also helps with hairball digestion and all the vitamins and amino acids, he needed them. I would make a slurry of the powder with water and syringe it in his mouth. Now i still add it to his food a few times a week. (fyi -it must be refrigerated)

Is Barsa an outdoor cat? you mention she goes over the fence. Sorry i have not had time to read all your posts.
 
Looking back at Roohs medical notes he probably did have pancreatitis. He was on secnidazole 1 month prior to FD dx for Giardia. There is an article that Metronidazole and similar drugs are suspected to be able to cause pancreatitis and in turn a bad pancrease can lead to diabetes. I suspect in Roohs case, this may be what happened.

Edit - The article stated Secnidazole was suspected to cause pancreatitis, not Metronidazole.
 
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She's an indoor cat but if everything is ok and nothing is bothering her (like upset stomach), even with high sugar she goes outside to roam, in and out, in and out. Last week she was feeling so bad that she just stayed home all the time. As soon as she feels slightly better (like today) I have to let her out or she will annoy me until I do.

Digestive enzymes, do they have side effects? And methylcobalamin, it's just vitamin B12, right? I want something safe. Do you get it as injection at vet's?
 
Digestive enzymes are completely safe and many cats need them added to their food to help digest. Plant based ones are best. I used Dr. Goodpet brand. There is a big difference between digestive enzymes and "pancreatic" enzymes so make sure you get the right thing. B12 can be in tablet form or injectable gotten at the vets. I give Rooh Natural Factors methylcobalamin tablets and dissolve it in water and add to his food or syringe feed. I think some other people here use Zobaline, another brand. About 6 weeks ago he started having neuropathy and I started it then, at 3mg a day, it took 4 weeks, but he is getting better and now i only give it a few times a week. Here is a article that talks about neuropathy and B12.

When Barso goes out roaming do you think she might be getting into high carb food at neighbors houses?
 
I was worried about that too at first but no, seems unlikely. Her frequent trips into neighbours' gardens don;t affect the glucose levels. I tested
 
She just vomited, an hour before food, it's unusual for her although she also vomited a day ago. Both times early in the morning, that's about 8 hours after food. How can I tell if cat is nauseous? What are the signs? And I am not sure what to do now. I have to feed and shoot in half an hour. What if she doesn't want to eat? What do you do in these situations? With Levemir I have to be on time.

I don't know..is it ok to keep posting here or do I need to make a new thread if I have a question? Don't want to litter the forum.

Edited: just measured, AMPS - 16.9 (304). She just might eat, what's best to feed after vomiting? Options I have: boiled chicken, canned (low-carb) food, liquid food (Liquivite)
 
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What does the vomit look like. Is it clear and foamy, or hairball, or food? Clear and foamy can be from a bit of an acid tummy. Some cats if they go long times between food will do that kind of vomit. When did she last eat?

Normally we start one new thread a day.
 
No hairball, it was food and a lot of liquid. She just ate some chicken (about 30g) so I gave her a shot. But for future reference, if she refuses to eat and it's time for a shot, what to do?
 
Some cats scarf and barf, so spreading food out to smaller mini meals can help. With Levemir, you can delay the shot up to 1/2 an hour and still shoot on time the next cycle. If she won't eat, try a buffet of different foods. Here is a post of different ways to try to stimulate kitty's appetite. And with Levemir you still have a few hours before onset, so you do have time to get food into her. If she's just eaten plain chicken so far today, I'd try to get her to eat some of her regular low carb food. You do want some carbs on board when the insulin onsets.
 
I am new to the forum so can't give you advice but I can tell you what happened with my cat.
Sheba, was in red numbers for months. This was before I joined the forum. I thought it was Somogyi effect and reduced the insulin. All it did was make her pee more so I went back to the original amount. She was weak in the legs from the high blood sugars and Methyl B 12 tablets helped but mostly she got better from that when her blood sugars came back to the normal range. I used Zobaline

She had sloppy poops for months, in fact that is what put her out of remission back onto insulin. I tried everything and had tests done to no avail. Finally I changed foods and realised she was allergic to the food she was eating.
You could try plain boiled pumpkin mashed to firm up the poop. I give it to Sheba as roughage now.It is good for both constipation and diarrhoea. Start with half a teaspoon twice a day and adjust as you see fit. You should see results fairly quickly.

She was often also very tired and lethargic and i finally realised this was due to her being dehydrated. She had to have subQ fluids at the vet a few times but then I started to give her extra fluids in her food and she has been fine since then. It can be hard to keep them hydrated when they have higher blood sugars but warm water in the food helps. Make it soupy if your cat will eat it.

The best thing I ever did for Sheba was join this forum. They have sorted us both out and Sheba's blood sugars are so much better. She was a terrible bouncer ( and still can be at times) but I have been taught how to control the drop and stop bounces.
I agree with Julie when she said the blood sugar on its own was not high enough to be making your cat ill.
I had Sheba in much higher numbers for months and while she did loose weight, she held her own. Take her to the vet if you are worried. Otherwise make sure she is eating and drinking well.

We were all where you are feeling at the moment at some point in our diabetic journey so we all understand the overwhelming feelings you have at the moment :bighug::bighug:

Listen to what these wonderful people here tell you what to do. You can trust them to do the very best for your kitty and I promise you they will get you both sorted out.:)..
 
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No!
Don't use pie filling as it will have other things in it including sugar!
Either make your own from raw pumpkin ( easy) or buy canned PLAIN pumpkin with nothing added at all
It is available but not sure what it is called in the UK. I am in Australia.
 
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BD dropped from AMPS 16.9 to 14.9 after 4 hours. Barsa keeps drinking water, a lot. Tested for ketones - very high - deep pink number, says 8mmol under it (80mg, 0.8, +++). Is this now an emergency? Do I need to take her to vet or is it possible this number will drop, she didn't have ketones at all 2-3 days ago.
 
I would advise you to call your vet if your cat has ketones. I would do so without delay if that is the case. I am not a very experienced member of the board and hopefully others who are more experienced will give their opinion. I remember when we had ketones before starting insulin the vet was very anxious to start insulin without delay so I think you should call your vet and tell them about the ketones. All the best and sending you a hug too.
 
I definitely will do and take her to vet if needed as soon as possible. It's sunday today tho, everything is closed. She's drinking and drinking but I don't see her pee much. I know about ketoacidosis, that it's very dangerous. Is there anybody else here whose cat had ketones? What did you do? So many problems at the same time: she's 3.2kg, in yellow-pink numbers, vomited today and now ketones. The only positive is that she's eating for now, but then again I dont know how tonight will go.
 
Vintry said:
I definitely will do and take her to vet if needed as soon as possible. It's sunday today tho, everything is closed. She's drinking and drinking but I don't see her pee much. I know about ketoacidosis, that it's very dangerous. Is there anybody else here whose cat had ketones? What did you do? So many problems at the same time: she's 3.2kg, in yellow-pink numbers, vomited today and now ketones. The only positive is that she's eating for now, but then again I dont know how tonight will go.
Click to expand...
Is there an emergency vet clinic nearby that you can call for advice as to what to do?
 
I think vets are obliged to provide either after hours service or else to provide an answering service that gives you the number of an after hours vet to call if needed.
 
Noodle had to be treated at the vet for ketones--she had DKA when she was DXed with diabetes, they need fluids and close monitoring. Ketones turn to DKA VERY quickly, my vet has only had one patient with ketones that had not yet developed into DKA. I don't have much other advice except trying an emergency clinic.

I cross posted in Main Health to get you some more advice in the meantime. Please call an after hours/emergency clinic ASAP, ketones are not something you want to try to treat at home.
 
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Hi,
I am not very experienced either but I agree with the others you need to get to a vet as soon as possible.
You need to try and get your cat to eat, drink and make sure you have given the insulin which is due.
Ketones happen when there is not enough food and insulin and probably an infection
So you need to
  • Get to the vet ASAP
  • Give plenty of fluids
  • Give food
  • Give insulin due
Bron
 
Gabby had ketones when first diagnosed and I've been here for 5+ years so I know ketones. What people have been suggesting is on target. Ketone levels that are above trace are an emergency. I would do one thing first. Test yourself. If the ketone strips are old or contaminated, you could have a false reading so one quick way to know is for you to test yourself.

If the strips are reading accurately, it's in your cat's best interest to get to an emergency vet clinic. There is likely an infection going on that is contributing to ketones developing. An infection, not enough calories, and not enough insulin contribute to ketones. Fluid (either in food but sometimes administered subcutaneously) also helps to flush ketones.
 
Hello! My Sabrina had DKA 2xs in the past 6 months.......please get him to the vet as soon as possible...they will use a fast acting insulin to get the #s down, sub q fluid support, and 24hr monitoring until the kitty stabalizes. The ketones can climb very quickly & kill as soon as a few hours....sorry to be so blunt, but this is a true er situation. Sending healing vines & prayers your way.... Cindy & Sabrina
 
I live in the uk and if you phone your normal vet office the answer phone message will tell you where the emergency vet they are linked to is. I agree with the others it is the best place for her at the moment.

Where in the uk are you?
 
I agree with the others, if there is an emergency vet available, take her in. Give her the full dose of insulin, even if she's not eating a lot and let her eat anything she will (even dry, carbs are ok with ketones). Usually cats with ketones will be really dehydrated, so add extra water in her food.

If you have to wait until tomorrow, don't hold insulin, mix honey in the food if you have to to keep BS up, but don't skip the insulin. Ketones happen for a few reasons, lack of insulin, lack of food (starvation), or infection combined with the other 2.

It sounds like you've been giving insulin for a while and not had a weight gain? To me, I'd ask the vet if there isn't something else contributing to the low weight (parasites, IBD, hyperthyroid, etc.). If her body is starving for a reason other than the diabetes, she will always be at risk for DKA and there may be other ways to treat it. There are some prescription high-calorie, easily digestible foods that may help her as well.

DKA is rough, my cat max was very sick with it when he was first diagnosed. The longer you wait, the more expensive it is to treat as well, so it's best to just get in ASAP.
 
Thank you all. I am in London. Followed your advice and took her to emergency vet clinic, cost a fortune just to get her in for appointment because it's sunday. Anyways, vet said I can leave her overnight for 24h intravenous fluids (+ short-acting insulin) or have subcutaneous fluids to get her through tonight. I've opted for latter. So Barsa got some fluids in her now and I was also given a 500ml packet of fluids which I am to take with me tomorrow when I go to my usual vet.

The doctor said that cats who have ketoacidosis stop eating and mine is still eating so it could be worse. That still doesn't give me a piece of mind but what can I do. Got home, checked her pmps bg - 14.1 (much better), gave her food - thank God she ate it, syringe-feed her water - 8ml every hour.

Anybody here in the UK can recommend a good high-calorie low-carb food?
 
@Elizabeth and Bertie
@BaileyUK @Critter Mom

Do any of you guys know a good low carb high calorie food

Elizabeth recently drew up a draft food chart for uk members

https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml#

Go to the uk food draft b ie click on the top right tab.

When my cat was poorly but before he got diabetes I used this food which you mix with water and then syringe feed but this is not low carb.

http://www.vetuk.co.uk/royal-canin-...n-convalescence-support-instant-sachets-p-254
 
Hi Iryna,

So sorry to hear that you and Barsa are going through this.

Vintry said:
Anybody here in the UK can recommend a good high-calorie low-carb food?
Click to expand...
The easiest/quickest higher calorie food you can get will probably be the Gourmet Gold pate's, as they are available from supermarkets.

Online, probably the highest calorie foods are those made by Forthglade (available from Fetch.co.uk and some other online stores).
Other high calorie options are Nature's Menu kitten food (various independent pet stores and online); and Ropocat Sensitive Gold from the Happy Kitty Company (the venison version is popular with my lot).

In addition to the main food, you might also think about getting some Liquivite: This is a liquid cat food (a bit like thick chicken soup). Many cats find it very palatable, and it has the advantage of helping to keep cats hydrated. Again, it's available from a few places online.

Keeping fingers and paws crossed for beautiful Barsa,

Hugs,

Eliz x
 
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At this point, due to ketones and weight, I wouldn't worry as much about carbs. Focus more on what she will eat, and what has the calories. A medium carb wet food is ok and will provide a better substrate for the insulin than low carb. Many of the low carb food also have lower calories, so the cat has to eat more volume which might be an issue if she is trying to gain weight. You can continue to adjust insulin to account for the extra carbs. Also, continue to increase the insulin as long as sugars remain high. You can increase by 0.5U after 6 cycles due to the development of ketones. Make sure you are monitoring BS closely.

300 calories a day is an average intake for a cat. A smaller cat like yours might need less to maintain weight, but 300 will help her gain. 300ml of water is average intake for a healthy normal weight cat. Diabetics, especially with ketones need more. This includes the fluids in food.

Low potassium is common in cats with ketones. Also, it's possible there is an infection underlying, GI issue, other issue causing low weight. Ask your vet about these when you go tomorrow.
 
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No, he just injected fluids. I'm just praying tonight will be a better night for her and that she doesn't vomit again in the morning, dreading it. In the morning, if all is well I will feed her, shoot insulin and take her to vet with that fluids bag. Maybe I'll have to leave her there for 24h, maybe less.. I just don't know what my vet will say. Anything specific I should ask him for? What about these electrolytes?
 
Has she had any food tonight? As Wendy said I feed remi small meals and often so I feed at least four times in the evening and again the morning rather than just two big meals. If she is throwing up on an empty tummy then try feeding later into the evening. Remi last feed is about 1 or 2 am and is then fed again at 6 am. I also give him 1/8 Zantac twice a day as this helps with stomach acid but that was with agreement from the vet.

Have you tested for ketones again since you got home?

Re the vet I would ask for a full blood panel
 
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