? 4/3 Simon +11 356 KETONES 1.8

[Katrina & Simon]

Most recent post/history

Still asymptomatic. I am going to bring him in to the vet but I'm just worried it's going to stress him out and make things worse. I can give him gabapentin but it still spikes his numbers just being in the car. What do you all think? Is there another ketone test they can do that will show a history kind of like fructosamine for glucose?

His vet isn't really concerned about seeing him today because he's asymptomatic. What do you think?

 

[Bandit's Mom]

Do you think we absolutely need to go to the regular vet today or monitor at home?

If he's not showing any signs of being unwell, you can just monitor him at home. Just make sure he eats well and is hydrated. Watch for any of the signs of possible DKA.

Signs of Diabetic Ketoacidosis (DKA)

• Drinking excessive amounts of water OR no water
• Excessive urination
• Diminished activity
• Not eating for over 12 hours
• Vomiting
• Lethargy and depression
• Weakness
• Breathing very fast
• Dehydration
• Ketone odor on breath (smells like nail-polish remover or fruit)

I would go up to 2.5U tonight/tomorrow morning if you are following TR and if his nadirs remain over 300.

 

[Allie & Gen]

I'm no expert, but I will say that when my cat was in DKA, it was pretty unmistakable how sick he was. Simon sounds like he's managing okay for now, and I think Bhooma's advice (unsurprisingly) makes quite a bit of sense. You want to get more insulin into that boy, and TR will let you get there faster. You will need to test more for safety, though, and I know that's hard! (I can't remember if you ever mentioned whether you'd thought about a CGM - continuous glucose monitor - to help with that? It could even be helpful as a short-term thing while you're working intensively to try and bring his numbers down and really need the data.)

Hugs if you want them - it's all pretty stressful!

 

[Katrina & Simon]

If he's not showing any signs of being unwell, you can just monitor him at home. Just make sure he eats well and is hydrated. Watch for any of the signs of possible DKA.

Signs of Diabetic Ketoacidosis (DKA)

• Drinking excessive amounts of water OR no water
• Excessive urination
• Diminished activity
• Not eating for over 12 hours
• Vomiting
• Lethargy and depression
• Weakness
• Breathing very fast
• Dehydration
• Ketone odor on breath (smells like nail-polish remover or fruit)

I would go up to 2.5U tonight/tomorrow morning if you are following TR and if his nadirs remain over 300.

He's been drinking more and also peeing more but that's not necessarily new... It never significantly decreased back to normal amounts since his dx. I am watching closely for other signs and just retested him +3: 304- relion 250- true metrix. I have trust issues with the meters now, I'm going to pick up replacements today, even though I don't think they're faulty the variance is throwing me off. It has been a huge range, depending on the meter and since they're both human meters, it's puzzling.

He also just ate meal 3 of the day so total food is around 5oz so far.

 

[Katrina & Simon]

I'm no expert, but I will say that when my cat was in DKA, it was pretty unmistakable how sick he was. Simon sounds like he's managing okay for now, and I think Bhooma's advice (unsurprisingly) makes quite a bit of sense. You want to get more insulin into that boy, and TR will let you get there faster. You will need to test more for safety, though, and I know that's hard! (I can't remember if you ever mentioned whether you'd thought about a CGM - continuous glucose monitor - to help with that? It could even be helpful as a short-term thing while you're working intensively to try and bring his numbers down and really need the data.)

Hugs if you want them - it's all pretty stressful!

Thank you. I do need hugs this has been so stressful. It would be one thing if it was just my Simon boy, but my other cat, Chet, is on medication for seizures, has some odd facial lumps that the vet is stumped on what they are, cytology showed not mast cell tumor but inflamed tissue... and my horse is on very expensive medication for insulin resistance. It's a lot to juggle. I'm starting to feel very overwhelmed. I did just call the vet again to ask for the libre, I think it would help a bit, and I'll just have to figure out the associated costs. Do you put it on yourself or bring your kitty to the vet? They want me to bring him in to do it, but we're not sure the pharmacy will be able to fill it quickly/by end of day. So I'm wondering if I could put it on tomorrow?

I also asked them for subq fluids to have on hand (we'll see if they say yes). I really hope we can get him more well regulated with TR. I don't know what I'd do without this forum, put vet is great but I feel like the intricacies of diabetes is difficult for them to juggle alongside everything else they treat.

 

[Allie & Gen]

Thank you. I do need hugs this has been so stressful. It would be one thing if it was just my Simon boy, but my other cat, Chet, is on medication for seizures, has some odd facial lumps that the vet is stumped on what they are, cytology showed not mast cell tumor but inflamed tissue... and my horse is on very expensive medication for insulin resistance. It's a lot to juggle. I'm starting to feel very overwhelmed. I did just call the vet again to ask for the libre, I think it would help a bit, and I'll just have to figure out the associated costs. Do you put it on yourself or bring your kitty to the vet? They want me to bring him in to do it, but we're not sure the pharmacy will be able to fill it quickly/by end of day. So I'm wondering if I could put it on tomorrow?

I also asked them for subq fluids to have on hand (we'll see if they say yes). I really hope we can get him more well regulated with TR. I don't know what I'd do without this forum, put vet is great but I feel like the intricacies of diabetes is difficult for them to juggle alongside everything else they treat.

Hmm. Your vet would probably have figured it out already if this were it, but ... where on the face are the lumps? Is there any chance Chet could have a dental infection? My Eugenides has pretty severe dental problems (surgery has been postponed until other issues are under control enough for anesthesia), and a few months back he developed a weird lump on his cheek that turned out to be a dental abscess. (It emerged in a matter of hours, very alarming.)

My vet's office installed my cat's first Libre, but I do them myself now. We have some good information about using them over here: Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

Also, this guide that was put together by a diabetic pets Facebook group is extremely helpful: Rise 360

If you do have your vet put it on, I highly recommend that you ask them not to use surgical glue. Nearly every vet's office I've heard of does this, but it has been shown to a) irritate delicate feline skin and b) sometimes "flood" the sensor, making it less reliable. Gen and I had both experiences. If they're concerned about Simon pulling it off (which is valid), it works much better to wrap a bandage around it to hold in place ... the links above go into more detail about coverings. We also recently had a thread about that: Seeking shirt recommendation for FreeStyle Libre

I do also recommend getting your vet to prescribe you multiple sensors/an "unlimited" prescription if possible, because the applicators are unfortunately single use and if yours gets triggered without securely attaching to the cat, you suddenly have a completely useless, overpriced piece of plastic and microchip on your hands. The company will generally send you a free replacement (as long as you don't tell them it's for a cat), but that's not an instantaneous process!

If you have specific questions about Libre application, @Staci & Ivy, @Jessica & Indy and I all use them (as does @Lauren & Esse, but I haven't seen her around in awhile). Staci is particularly a pro with them!

Yeah, vets are like primary care doctors ... they have broad expertise, and sometimes with a more specialized topic like diabetes they're a bit at sea. My vet is really good, but this board has been immensely helpful to me (as has some independent research I've done lately, but not everyone wants to go digging through scientific journals, understandably)!

 

[Katrina & Simon]

Hmm. Your vet would probably have figured it out already if this were it, but ... where on the face are the lumps? Is there any chance Chet could have a dental infection? My Eugenides has pretty severe dental problems (surgery has been postponed until other issues are under control enough for anesthesia), and a few months back he developed a weird lump on his cheek that turned out to be a dental abscess. (It emerged in a matter of hours, very alarming.)

My vet's office installed my cat's first Libre, but I do them myself now. We have some good information about using them over here: Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

Also, this guide that was put together by a diabetic pets Facebook group is extremely helpful: Rise 360

If you do have your vet put it on, I highly recommend that you ask them not to use surgical glue. Nearly every vet's office I've heard of does this, but it has been shown to a) irritate delicate feline skin and b) sometimes "flood" the sensor, making it less reliable. Gen and I had both experiences. If they're concerned about Simon pulling it off (which is valid), it works much better to wrap a bandage around it to hold in place ... the links above go into more detail about coverings. We also recently had a thread about that: Seeking shirt recommendation for FreeStyle Libre

I do also recommend getting your vet to prescribe you multiple sensors/an "unlimited" prescription if possible, because the applicators are unfortunately single use and if yours gets triggered without securely attaching to the cat, you suddenly have a completely useless, overpriced piece of plastic and microchip on your hands. The company will generally send you a free replacement (as long as you don't tell them it's for a cat), but that's not an instantaneous process!

If you have specific questions about Libre application, @Staci & Ivy, @Jessica & Indy and I all use them (as does @Lauren & Esse, but I haven't seen her around in awhile). Staci is particularly a pro with them!

Yeah, vets are like primary care doctors ... they have broad expertise, and sometimes with a more specialized topic like diabetes they're a bit at sea. My vet is really good, but this board has been immensely helpful to me (as has some independent research I've done lately, but not everyone wants to go digging through scientific journals, understandably)!

Chet has lumps on his forehead in the center, two each at the base of left ear front and back, two on nose, one above right eye. They look like human zits, but it's not feline acne. It's so strange.

My vet already said she would use surgical glue...3 drops very strategically and she claims they rarely fall off when she applies them, vs a tech that applied one and it fell off the next day. I'll take a look at those links, this is super helpful. I will ask for refills! When they call back, hopefully it's soon or I'll call them again.

I actually do enjoy reading studies when I'm not in this headspace! Right now, I'm so overwhelmed with everything I can't comprehend novel info that well.

 

[Allie & Gen]

Chet has lumps on his forehead in the center, two each at the base of left ear front and back, two on nose, one above right eye. They look like human zits, but it's not feline acne. It's so strange.

My vet already said she would use surgical glue...3 drops very strategically and she claims they rarely fall off when she applies them, vs a tech that applied one and it fell off the next day. I'll take a look at those links, this is super helpful. I will ask for refills! When they call back, hopefully it's soon or I'll call them again.

I actually do enjoy reading studies when I'm not in this headspace! Right now, I'm so overwhelmed with everything I can't comprehend novel info that well.

That is strange! And unfortunately I have no insight. Poor Chet, I hope they're not bugging him. Maybe some kind of allergic reaction?

The trouble is that keeping the sensor on isn't the only issue. My first sensor, the one the vet applied, had very wonky readings and blanked out a few times, at a level that I've never experienced with home installations (without glue). And Gen's skin was angry in the area for weeks afterwards. I kept finding bits of glue still stuck to him after the fur had grown back, and he gave himself an abrasion trying to scratch the area because I guess it itched so bad. It took me several rounds of applying coconut oil and letting it sit to get the residual stuff off, and I had to treat the abrasion and put him in a shirt (with way more coverage than his usual harness) to prevent him from messing with it until it healed. My vet's office still seems very confused about the whole thing, but given the second link I included above, my cat clearly isn't the only one who has had problems with the glue and his skin.

I follow the instructions the facebook group lay out (shave, alcohol wipe, adhesive wipe, application) - plus holding the sensor down with tweezers while I remove the applicator to make sure it stays put). Then I cover the sensor with a tegaderm bandage (a big clear band-aid) and put his Kitty Holster harness on him. We've had a few removals, but generally that was either when I tried something other than the harness on him, or when I accidentally placed it too close to the leg hole.

Best of luck with it all!

I hear you; it took me months to be at the point where I started looking for papers. I will say that it has made me feel a whole lot better about everything I've been doing over those months, overall. But I don't think I could have taken it in sooner.

 

[Sienne and Gabby (GA)]

There is an excellent Facebook group that @Staci & Ivy can direct you to. Most of the members here apply the Libre themselves. It seems silly to pay a vet to do this!! From what I've seen Staci tell members, you do NOT want to use surgical glue with the CGMs. It can cause the sensor to malfunction and glue will make it challenging to replace the sensor.

I've not looked at Simon's spreadsheet in a while so forgive me if I've missed something. You noted that you're following TR. However, with TR, you evaluate the dose every 3 days/6 cycles. If your cat isn't in normal numbers, you increase the dose. It looks like you're holding the dose longer than 3 days. In addition, with TR, you really need to get at least one test during the PM cycle. Regardless of whether you're using TR or SLGS, you should do your best to get a test at pre-shot times and at least one additional test during both the AM and PM cycles. If you are worried about ketones, I'd encourage you to consider sticking closely to TR. Also, reading of 1.8 is not worrisome. If you've not seen it, this is our primer on ketones.

 

[Katrina & Simon]

There is an excellent Facebook group that @Staci & Ivy can direct you to. Most of the members here apply the Libre themselves. It seems silly to pay a vet to do this!! From what I've seen Staci tell members, you do NOT want to use surgical glue with the CGMs. It can cause the sensor to malfunction and glue will make it challenging to replace the sensor.

I've not looked at Simon's spreadsheet in a while so forgive me if I've missed something. You noted that you're following TR. However, with TR, you evaluate the dose every 3 days/6 cycles. If your cat isn't in normal numbers, you increase the dose. It looks like you're holding the dose longer than 3 days. In addition, with TR, you really need to get at least one test during the PM cycle. Regardless of whether you're using TR or SLGS, you should do your best to get a test at pre-shot times and at least one additional test during both the AM and PM cycles. If you are worried about ketones, I'd encourage you to consider sticking closely to TR. Also, reading of 1.8 is not worrisome. If you've not seen it, this is our primer on ketones.

Good eye you have I just switched that in my signature today and today is the first day we're starting with TR. I've requested to join the group and currently trying to find the required application items locally, as Amazon takes about a week since we're in a rural small town. Thank you. I just retested ketones and he's 0.7 at +5 BG 282 down from 1.8 this morning! Vet wants us to immediately bump to 2.5 which aligns with me following Bhooma's advice and TR. I've set alarms for +3+6+9 am and pm and I'm spot checking between those as well. I'm lucky my boy is so tolerant.

And yes about being silly to pay the vet to stick it on, plus the stress of a car ride is certainly not helpful for Simon.

Thank you for the primer! I had reviewed it before but when I was flustered yesterday I couldn't find it

 

[Katrina & Simon]

That is strange! And unfortunately I have no insight. Poor Chet, I hope they're not bugging him. Maybe some kind of allergic reaction?

The trouble is that keeping the sensor on isn't the only issue. My first sensor, the one the vet applied, had very wonky readings and blanked out a few times, at a level that I've never experienced with home installations (without glue). And Gen's skin was angry in the area for weeks afterwards. I kept finding bits of glue still stuck to him after the fur had grown back, and he gave himself an abrasion trying to scratch the area because I guess it itched so bad. It took me several rounds of applying coconut oil and letting it sit to get the residual stuff off, and I had to treat the abrasion and put him in a shirt (with way more coverage than his usual harness) to prevent him from messing with it until it healed. My vet's office still seems very confused about the whole thing, but given the second link I included above, my cat clearly isn't the only one who has had problems with the glue and his skin.

I follow the instructions the facebook group lay out (shave, alcohol wipe, adhesive wipe, application) - plus holding the sensor down with tweezers while I remove the applicator to make sure it stays put). Then I cover the sensor with a tegaderm bandage (a big clear band-aid) and put his Kitty Holster harness on him. We've had a few removals, but generally that was either when I tried something other than the harness on him, or when I accidentally placed it too close to the leg hole.

Best of luck with it all!

I hear you; it took me months to be at the point where I started looking for papers. I will say that it has made me feel a whole lot better about everything I've been doing over those months, overall. But I don't think I could have taken it in sooner.

They don't bother him too much, he scratched one open but it healed and is smaller... So strange. I thought maybe allergies too but they aren't hot or itchy.

I've requested to join the group, I really appreciate your support and insight. Seems like a lot of steps to get it on but the website is so helpful. And I'd like to see what kind of rollercoaster he might be on that the libre can show us...

 

[Mary & Jude]

Hi Katrina, Please do two things that will help those guiding you when they take a look at your spreadsheet: note on the spreadsheet the date you've switched to TR at the top. Just note: "TR as of (date)." Then, down in the spreadsheet, create a line with a date that says "Started TR." You can look at Jude's spreadsheet for guidance on this.

 

[Katrina & Simon]

Hi Katrina, Please do two things that will help those guiding you when they take a look at your spreadsheet: note on the spreadsheet the date you've switched to TR at the top. Just note: "TR as of (date)." Then, down in the spreadsheet, create a line with a date that says "Started TR." You can look at Jude's spreadsheet for guidance on this.

Got it, both done. I will fix the line when I can get my laptop out. Thank you.

 

[Sienne and Gabby (GA)]

I'd add to Mary's recommendation about adding the date you started TR. I'd include it in your signature, as well.

 

[Katrina & Simon]

I'm giving 2.5 IU PM, he hasn't dropped below 250 today. I see the TR protocol note to increase by 0.5 if <300 nadir but per Bhooma and my vet, it definitely seems to be the appropriate dose increase, so I'm doing it.

Ketones at 2 at PMPS BG 385. I'm super nervous about this. He has never had a dose over 2 IU for lantus. Anytime we got close to 2 he'd earn a reduction. I know things change and this has worked well for so many cats so I'm trying to rein my anxiety in and not let Simon pick it up.

I don't understand how his ketones can fluctuate so drastically in a day, I can't really afford to test ketones 2-3x/day on a regular basis, but I would like to figure out why we're on this stupid ketone rollercoaster and how to get off. Started the day at 1.8, midday 0.7, now back to 2.

 

[Bandit's Mom]

Good luck with the increase! Please get a test before bed? Some cats can react to a dose increase in the very first cycle.

I don't have experience with ketones, but I'll tag @Bron and Sheba (GA) who is our go-to person for DKA/ketone kitties. She can advice you on whether it's necessary to test for blood ketones so many times a day. I know those strips are expensive!

Hopefully getting him into better numbers quickly will also help with the ketones.

 

[Katrina & Simon]

Good luck with the increase! Please get a test before bed? Some cats can react to a dose increase in the very first cycle.

I don't have experience with ketones, but I'll tag @Bron and Sheba (GA) who is our go-to person for DKA/ketone kitties. She can advice you on whether it's necessary to test for blood ketones so many times a day. I know those strips are expensive!

Hopefully getting him into better numbers quickly will also help with the ketones.

I have alarms set for the next 3 hours and one for the middle of the night, pending the next 3 tests. While they are expensive, I can do it as needed but definitely can't do it for the foreseeable future. I appreciate your assistance so much, thank you, and for tagging Bron and Sheba.

 

[Mary & Jude]

Good luck with the increase, Katrina! As Bhooma suggests, get some tests tonight. Post here if you need help. Remember: higher carb food in small 2-3 tsp increments is the tool to bring them up if they drop into numbers lower than desirable. You don't want to overfeed and fill them up. Just a bit at a time.

 

[Bron and Sheba (GA)]

Hi Katrina
Have you increased Simon’s food intake since finding ketones in the blood?

Food is another way to combat ketones so I would add a bit more low carb food to his daily intake and see if that helps.

Are you adding extra warm water to his food? Will he tolerate that?
Asking the vet about sub Q fluids is a good idea.

I would test daily for ketones if they are under 2 and he is showing no symptoms such as lethargy, not eating, vomiting, diarrhoea. If any of these symptoms appear I would test more often, or if the ketones rise above 2

 

[Katrina & Simon]

Hi Katrina
Have you increased Simon’s food intake since finding ketones in the blood?

Food is another way to combat ketones so I would add a bit more low carb food to his daily intake and see if that helps.

Are you adding extra warm water to his food? Will he tolerate that?
Asking the vet about sub Q fluids is a good idea.

I would test daily for ketones if they are under 2 and he is showing no symptoms such as lethargy, not eating, vomiting, diarrhoea. If any of these symptoms appear I would test more often, or if the ketones rise above 2

Simon is very picky and particular about eating. Everything has to be *just* right and exactly on his terms, since I've had him for his whole 12 years of life (my friend found him starving and almost frozen outside as a tiny kitten) I usually can figure out what he's asking for. I'm feeding him as much as he will eat, as often as he wants, but withholding 2 hours prior to shot times. He's slightly underweight at 11.4 lbs, I'd like him to get back to at least 12 lbs, he was 12.5 when he was in the greens and blues, and he's never been overweight, even prior to diabetes dx.

He will only tolerate a small amount of water added to his food, like 1-2 tablespoons. I've been adding it tho! He did puke on Thursday morning, it looked like a hair ball with bile. The vet won't give us subq fluids... They said he HAS to go to ER if he wants treatment if they're not open. I don't disagree on that if he's showing symptoms, but I was just thinking it couldn't hurt to help flush his system. I guess I was wrong?

Do you think the ketone tests should coincide with AMPS and PMPS or would it be best to stagger them? How often do you test ketones if you're concerned or over 2?