5/17 Jack AMPS=354...going up and not down on dose increase

Jack & Mopem'sMom

Jack & Mopem'sMom

Member Since 2020
Good morning,
I am confused that Jack's numbers are going up instead of down on the new dose of glargine. Based on the 200's we were getting with the 3 units, shouldn't he be showing some 200's with 3.5? I got up at his + 6 PM last night, expecting a 200 something and he was actually the highest he was all day at 379. :( I know we are supposed to hold the dose for 7 days, but I'm concerned with the constant blood ketones of 0.5- 0.7 I have not been able to get any fluids into him the past few days because he has become harder to handle and it seems no one I know can come help me hold him anymore. He hates the vet and the ride there, so it's stressful on him to take him there for fluids; but maybe I should? I'm not sure which is the best course of action. Maybe I'm just impatient, it's only been one day on the new dose. Any advice on fluids, dose increase timing, and/or insight into his rising numbers is greatly appreciated. Thanks !

Yesterday:https://www.felinediabetes.com/FDMB/threads/5-16-jack-331-amps-0-6-ketones-dose-increase.263346/
 
Hi Christine, Jack's numbers have been flat and high for the last few days. When looking at numbers you have to consider a meter variance of 15-20%. So 300 is more or less the same as say 270 or 330.

Like @Wendy&Neko pointed out, he was switched at too low a dose from Prozinc. Maybe you can increase sooner than 7 days - as a special situation - given that he should have been started on a higher dose of Semglee and his history of ketones - assuming you can get at least one mid-cycle test in each cycle. Maybe a dose increase every 3 days till you start seeing nadirs below 200? Let's see what Wendy advises when she gets online.

How is the transition from dry to wet food going? Not only will wet food increase his hydration, you can also then follow TR rather SLGS which allows for faster dose changes.

Sorry to hear you are having difficulty giving fluids. Are you warming the fluids? Do you give Ringer's Lactate or Normal Saline? The latter is supposed to sting. Maybe something here can help:
https://www.felinecrf.org/subcutaneous_fluids_tips.htm#cat_preparation
 
Bandit's Mom said:
Hi Christine, Jack's numbers have been flat and high for the last few days. When looking at numbers you have to consider a meter variance of 15-20%. So 300 is more or less the same as say 270 or 330.

Like @Wendy&Neko pointed out, he was switched at too low a dose from Prozinc. Maybe you can increase sooner than 7 days - as a special situation - given that he should have been started on a higher dose of Semglee and his history of ketones - assuming you can get at least one mid-cycle test in each cycle. Maybe a dose increase every 3 days till you start seeing nadirs below 200? Let's see what Wendy advises when she gets online.

How is the transition from dry to wet food going? Not only will wet food increase his hydration, you can also then follow TR rather SLGS which allows for faster dose changes.

Sorry to hear you are having difficulty giving fluids. Are you warming the fluids? Do you give Ringer's Lactate or Normal Saline? The latter is supposed to sting. Maybe something here can help:
https://www.felinecrf.org/subcutaneous_fluids_tips.htm#cat_preparation
Click to expand...

Interesting on the meter variance...I have never heard that before, thanks for the information...although I think it makes it confusing and harder to stabilize if the meter reading varies that much from the actual blood level. The transition to wet is abysmal. He is basically free eating the YA and Dr Elsey's kibble with the occasional dish pick up from me mid-day, but that is not consistent due to my ever changing at home/in office/at customer site work schedule. I am warming the fluids, it is sodium chloride per the vet who said something about the Lactated Ringers being bad for him with the diabetes. I can't remember what she said. Thanks for the fluids link...the acupressure part looks interesting and something I will try. He was being bribed with tuna or chicken water (some warm water and a piece or two of tuna or chicken) but that trick wore off fast. I appreciate your advice and input. I'm hoping his numbers come down today; I do see there is less fluctuation in numbers, his curve seems to be flattening, so maybe that part just happens first? Or maybe I got excited at seeing the 200's the other day and that was just a day he ate less. He is being impossible about eating the proper way. Anyway, thanks again!
 
Jack & Mopem'sMom said:
The transition to wet is abysmal. He is basically free eating the YA and Dr Elsey's kibble with the occasional dish pick up from me mid-day, but that is not consistent due to my ever changing at home/in office/at customer site work schedule.
Click to expand...
The transition to wet food can take more effort with some cats who are kibble addicts. I don't know if anyone has shared this before:
http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf


Jack & Mopem'sMom said:
I am warming the fluids, it is sodium chloride per the vet who said something about the Lactated Ringers being bad for him with the diabetes. I can't remember what she said. Thanks for the fluids link...the acupressure part looks interesting and something I will try. He was being bribed with tuna or chicken water (some warm water and a piece or two of tuna or chicken) but that trick wore off fast.
Click to expand...
Why does he get fluids? Does he have kidney issues? Even with CKD, you do not give fluids till the creatinine crosses a certain level.
 
Bandit's Mom said:
The transition to wet food can take more effort with some cats who are kibble addicts. I don't know if anyone has shared this before:
http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf
Yes I have read this several times, Jack is not cooperative, and will starve himself instead of eating wet food. I can't give insulin if he doesn't eat. I'm going to try to pick his dry bowl up more often, but there are a few other cats in the house that will binge eat and puke if I pick it up for too long. Jack won't eat in a room by himself, either.


Why does he get fluids? Does he have kidney issues? Even with CKD, you do not give fluids till the creatinine crosses a certain level.
Click to expand...
He is getting fluids for the ketones. Vet said 150-200 mls a day. I'm lucky if I get 50 into him lately, and there has been none the past few days.
 
UGHH and now at +8 AM he is 436. I know he didn't get anything...he's been sleeping on the couch most of the day. I thought it was a good shot this morning; I always check to make sure teh syringe is empty and his fur is dry. I'm losing my mind. :banghead:
 
There is a phenomenon we call New Dose Wonkiness that sometimes appears in the first few cycles after an increase, that causes temporary higher numbers. Details in this post: New Dose Wonkiness (NDW) and failed reductions It should be done by this cycle and hopefully you'll see some action tonight. Let's wait until a couple cycles before we just talk about the next increase, unless of course his ketones start going higher.

This is my favourite video on giving fluids: How to Give Subcutaneous Fluids (Video)
 
Wendy&Neko said:
There is a phenomenon we call New Dose Wonkiness that sometimes appears in the first few cycles after an increase, that causes temporary higher numbers. Details in this post: New Dose Wonkiness (NDW) and failed reductions It should be done by this cycle and hopefully you'll see some action tonight. Let's wait until a couple cycles before we just talk about the next increase, unless of course his ketones start going higher.

This is my favourite video on giving fluids: How to Give Subcutaneous Fluids (Video)
Click to expand...
THANK YOU :bighug:
 
Jack & Mopem'sMom said:
He is getting fluids for the ketones. Vet said 150-200 mls a day. I'm lucky if I get 50 into him lately, and there has been none the past few days.
Click to expand...
That seems like a lot of fluids. What is his weight? Could you ask the vet why you need to give Normal Saline (NS) and not Ringers Lactate (LRS)? And also confirm whether that amount of fluids is still required every day?
You could also try the syringe method of giving fluids rather than the IV set. It goes much faster.

Do you have his latest labs from the last time they were done?
 
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Bandit's Mom said:
That seems like a lot of fluids. What is his weight? Could you ask the vet why you need to give Normal Saline (NS) and not Ringers Lactate (LRS)? And also confirm whether that amount of fluids is still required every day?
You could also try the syringe method of giving fluids rather than the IV set. It goes much faster.

Do you have his latest labs from the last time they were done?
Click to expand...
Jack is about 15 - 17 pounds. He was 17 pounds in Jan when he was diagnosed, he has lost some weight but is still a big boy. I don't have a copy of his bloodwork, I can email the vet and ask for a copy, but from what I remember, he was all fine except for the blood glucose. I cna also ask for more info on why saline and not the lactated ringers. She said as long as he was showing more than 0.2 ketones he should have fluids. He hasn't had that much fluid since I stopped getting help. He averages 50mls every few days. This morning he is now 1.0 on ketones so I will have to do try to get fluids into him again since it's my understanding that fluids and lowering BG is the only thing that brings them down?
 
I just googled it. Please ask your vet about this.

Some research suggests that lactated Ringer's may be preferred over normal saline for replacing lost fluid in trauma patients. Also, normal saline has a higher chloride content. This can sometimes cause renal vasoconstriction, affecting blood flow to the kidneys.
 
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