6/26 Henry WC. PMPS 252 +2 303

This is awesome John - the ketones staying at .3. Very good news. Just remember they do fluctuate around quite a bit during the day/night. I used to drive myself crazy with it, but finally settled down into checking once a day (most days unless they were really high - and then more) unless there were clinical signs. So happy about No R needed. Now we can see what this 1.75 will do on its own. Such a lovely cycle last time. :joyful:
 
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It’s looking like the Friskies 18% last cycle at +8 wasn’t really necessary. But that’s just Monday Morning Quarterbacking! Lol!

But seriously you are gathering really good data on Henry and how he responds to carbs, etc. I am feeling really optimistic about Henry right now!
 
Suzanne & Darcy said:
It’s looking like the Friskies 18% last cycle at +8 wasn’t really necessary. But that’s just Monday Morning Quarterbacking! Lol!

But seriously you are gathering really good data on Henry and how he responds to carbs, etc. I am feeling really optimistic about Henry right now!
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Yeah, that was my first thought when I saw the 272 as well. Just really hope we're not going into another bounce. We'll have a clue in a half hour at +2
 
Totally agree about testing ketones daily or more at this point. You can’t afford to skip a day at this point. When he’s safely staying in low ketones on a daily basis, you will know when you can gradually back off the ketone testing. It will happen…eventually. I’m really just sitting here waiting for the next test.
 
Okay, darn. A pink. Now is the time for me to say that it’s very flat with meter variance and that it’s probably that the Lantus hasn’t really onset yet, etc. We will wait for the next test. You can always reevaluate mid-cycle to see if action will be necessary. Speaking of action… Henry, give us some downward BG action.
 
It is really important that only Sandy give advice on R as she is the pro. Please listen to her only.
 
Well, not a very encouraging +2 compared to the drop at +2 last cycle. Back in the 300s :(

Sandy and Black Kitty said:
What’s the WCR so far today?

Regarding testing for ketones, at this stage my recommendation is to not let more than 24 hours pass without a test. BK once went from “trace” to “large “ in exactly 24 hours. Next stop was the emergency clinic…
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Oh yes, Henry just did one of those routines on Wednesday. His urine ketones weren't even showing (although blood ketones were 1.9), but his blood pH still managed to make it to 7.1 in 24 hours.
I recently read an academic paper on DKA in cats that said the urine ketone strips only detect one type of ketone, but there are multiple types and some cats may produce more of one than the other. The conclusion was DKA can't be ruled out by ketone strips alone. I think the blood meters detect the same type of ketone as the urine strips tho (don't quote me on that last part)

WCR is about the same as yesterday. Still laying by the front door non-stop for no known reason. Lots of eating and begging to eat despite the fact he's getting 5 cans per day and of course that requires lots of litter box visits. Overall seems in pretty good shape aside from his new found perching location.
 
Suzanne & Darcy said:
Totally agree about testing ketones daily or more at this point. You can’t afford to skip a day at this point. When he’s safely staying in low ketones on a daily basis, you will know when you can gradually back off the ketone testing. It will happen…eventually. I’m really just sitting here waiting for the next test.
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Ketones were holding steady at .3 2 hours ago at AMPS, so that's good. Down from 1.1 2 cycles ago. I've been putting the ketones in the + boxes with the BG #s when they're taken. Been taking AM & PM ones, especially when running high.
 
Suzanne & Darcy said:
Of course, John is taking R advice from Sandy and Wendy at this time. Although we know that Wendy has been out of pocket this weekend- but I mean, of course, when she returns.
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Of course Wendy too. I meant today as Wendy has other commitments. We all want to help but they are the best ones to help with R. The only other one I can think of is Marje and she’s not around right now. It’s a very tricky thing using R.
 
Suzanne & Darcy said:
Good grief, if anyone can show me a post where I have told John how much R he should give Henry then I would like to see it. I never have done so!
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Not a single person aside from Wendy has given any instructions on when or how much R to give aside from Liz who has only re-iterated to follow Wendy's dosing instructions and Wendy asked her to help me. I've been very appreciative of her assistance and keeping an eye on things.
 
Sandy and Black Kitty said:
So you now have 3 consecutive Lantus doses at 1.75 Which is great.
When using R it’s a good idea to periodically skip it (assuming there are no ketones or symptoms of DKA) so that you can evaluate the action of the Lantus dose and check nadir (they can and do move around).
Let’s see what he has in store for you this cycle.
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Yeah, not thrilled with +3 @ 337. He's back to hitting the water hard. I can almost estimate his BG just from his drinking habits alone. I'll almost guarantee ketones will be up by +6. I think the R at +6 4 cycles ago was the only thing that saved him from going into the 400s. Hopefully they won't get too bad this time. He's such an enthusiastic eater by the time he stops wanting to eat he's already in full blown DKA. The 2nd DKA he ate right up til about 6 hours before I took him to the ER. This has gotta be a bounce from getting into the greens this morning, huh?
 
His Lantus onset usually happens by now so yes I'd say bounce. The good thing is he's still relatively flat from PS.

The bounce likely due to a combination of the lower numbers that he isn't quite used to, and also the time spent in those lower numbers.
 
John & Henry said:
Ugh, looks like we're getting a repeat of 4 cycles ago. up to +372 @ +4 :(
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This is very normal, and just to set expectations will likely happen for quite awhile (as in month(s)) - a stretch in good numbers, followed by a few cycles of bouncing, back to good numbers, rinse and repeat. Over time he should bounce less often, less harshly, and clear them more quickly. Not all cats do, but those cats tend to have underlying issues making regulation a little more complicated.

I know this is much easier said than done, but please do not stress too much about the BGs themselves. Ketones are more complicated than just the BG. You are doing everything you can, his body has to do the rest...I know it sucks to have things out of your control. Speaking of which, I would ask your vet about budesonide for that inflammation. I don't like that that wasn't addressed at all.

I have two babies/toddlers, expecting another here in a few months, a temporarily disabled husband, plus a complicated cat - I perhaps know better than anyone the cumulative consequences of all the broken sleep and stress. It is not good for anyone if one day you crash and burn!
 
FrostD said:
This is very normal, and just to set expectations will likely happen for quite awhile (as in month(s)) - a stretch in good numbers, followed by a few cycles of bouncing, back to good numbers, rinse and repeat. Over time he should bounce less often, less harshly, and clear them more quickly. Not all cats do, but those cats tend to have underlying issues making regulation a little more complicated.

I know this is much easier said than done, but please do not stress too much about the BGs themselves. Ketones are more complicated than just the BG. You are doing everything you can, his body has to do the rest...I know it sucks to have things out of your control. Speaking of which, I would ask your vet about budesonide for that inflammation. I don't like that that wasn't addressed at all.

I have two babies/toddlers, expecting another here in a few months, a temporarily disabled husband, plus a complicated cat - I perhaps know better than anyone the cumulative consequences of all the broken sleep and stress. It is not good for anyone if one day you crash and burn!
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I appreciate all that. Life is no doubt tough sometimes. I will ask about the budesonide and for her to expand on those findings. Bouncing can happen for months? Ugh.. Finally got some good (albeit interrupted) sleep last night. Having insomnia problems, I'm usually not able to just lay down and take a nap, but in the last day or so I'm actually able to lay down and fall asleep within a few minutes, so has feline diabetes cured my insomnia? lol. We don't have any human children, but I'm starting to really get a good idea of what parents go through (sleep wise) with a new born.

My K9 ketone meter just went off for the first time since day before last. I've been paying particular attention to my Dog sniffing my cats head and she didn't do it at all yesterday when things were going well, but she had been doing it multiple times per day when we were in the red numbers. We'll see if she's properly calibrated in an hour and a half at +6 when i check ketones.
 
John & Henry said:
I appreciate all that. Life is no doubt tough sometimes. I will ask about the budesonide and for her to expand on those findings. Bouncing can happen for months? Ugh.. Finally got some good (albeit interrupted) sleep last night. Having insomnia problems, I'm usually not able to just lay down and take a nap, but in the last day or so I'm actually able to lay down and fall asleep within a few minutes, so has feline diabetes cured my insomnia? lol. We don't have any human children, but I'm starting to really get a good idea of what parents go through (sleep wise) with a new born.

My K9 ketone meter just went off for the first time since day before last. I've been paying particular attention to my Dog sniffing my cats head and she didn't do it at all yesterday when things were going well, but she had been doing it multiple times per day when we were in the red numbers. We'll see if she's properly calibrated in an hour and a half at +6 when i check ketones.
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You said she's GSD right? Or maybe it was another type of shepherd. I almost wonder if it's the sugar not necessarily ketones. Very curious. I have a rat terrier/beagle mix and oh my goodness the things she can smell!
 
John & Henry said:
Bouncing can happen for months?
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More like years in some cases. Some cats keep bouncing, but if you are lucky, they don't bounce as high as they used to over time. After a year, Neko mostly stopped seeing reds.

Thought about timing for giving fluids today?

Just catching up (exhausting but amazing volunteer job). I will not be staying up late today, but thought I'd pop in. Can someone remind me what type of inflammation Henry has and what the vet said about treatment? We are not vets, I think we need to keep that in mind.
 
FrostD said:
You said she's GSD right? Or maybe it was another type of shepherd. I almost wonder if it's the sugar not necessarily ketones. Very curious. I have a rat terrier/beagle mix and oh my goodness the things she can smell!
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Yep, GSD. Interesting. Yeah, it could be the sugar! Never thought about that. I gotta show her off (not sure if dog pictures are allowed, I can remove if not):
Y9fKgEJM8PCQnWPob9Ui70-qITNdTwVp6QMUPeS1KuAa3LmDAKacs8EgC5qLo-mOlAvjrASd7Dt4QP5jbu3LKyOe0NL-8HpXuwxCEIwvNNRqMv-LAIfgl5IgP07bcKHU6XQCCYrFyy1unDPMmtXnJ_yivWIyvO19Bjehc722vedyzrNGHYIbSmiDMe_7BMMqKv7gYtO51WEzYpx-MQZdCL0k7zUBz9VIXahQ7IwZN9my5YMEI6GwDKPJASJShMNjyqIDY7fWZFxqOK57kNjPGhJp9oYIpoVWaNB2OhotzTAZ4shMeD7imuXXFdrp0yhklGfwvU_KsS3R7mPifyjG-Yq56B-Oh53mP99YTApt2dGlQZM53VqqwvrwD9FYQ5QL_hfPUrM_7NOQfEtRJa_o6Hu8jGg2lJb16kNxSPd4tFTj1wjXoPN8DhBIXG_hJWrVhbl2LlktOGxJ7UEkTrVvBkDglofnhsgKpMqp2F23KswYJQz8uJjbGrqsjPEoiRhgZ4XZqwlMPLL0jKc_5FS6RAQx6Nqbgc8IVYUU1kp9OuRpUYbQAWYZ_LGtOy7ZsIrWEUYx-MXqPO4MRWFCa0bUYDUMV7gLUH350DfyJRGrKGG1VWnrEDtNS1rLrhO44-vnVIOtMMuk0zu-MCTNRscurJyzXE10dPZl9ltUq4FzfxCEpzsRdx5YpnZEXD3-RWB9qXHMO4z-SQXn-FVypTW-uLC1vE0mqPg9b9OPWUkPB16-jFAHoVuPqqIqzoPlLSLQCVg6HSdBienmgtsmpvmckZHDJt9z_WrWH_Tf=w1120-h630-no
 
Wendy&Neko said:
More like years in some cases. Some cats keep bouncing, but if you are lucky, they don't bounce as high as they used to over time. After a year, Neko mostly stopped seeing reds.

Thought about timing for giving fluids today?

Just catching up (exhausting but amazing volunteer job). I will not be staying up late today, but thought I'd pop in. Can someone remind me what type of inflammation Henry has and what the vet said about treatment? We are not vets, I think we need to keep that in mind.
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Wendy! So glad to see you. The vet has been looking for inflammation but hasn't found much. This is about the most she has said about possible causes (just got this friday):
Just to let you know, we did receive the results of the liver and splenic aspirates. His liver did have some changes that are consistent with a vacuolar hepatopathy, which is a nonspecific change in the liver cells that we often see in diabetics. There was a little bit of inflammation in his liver as well, so I do wonder if he has a chronic inflammatory condition affecting both his liver, GI tract, and pancreas, which is quite common in cats. In some cases we'll consider treating with steroid therapy or other immunosuppressives, but this is obviously less ideal in an unregulated diabetic patient as it has the potential to push them into DKA. It is also a little hard to determine on aspirates alone whether the inflammation truly is widespread or we just hit a pocket of inflammatory cells. His spleen samples did come back normal.
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@Wendy&Neko

Just to give you some quick background so you don't have to read through everything (its long, i know). Henry came back from the ER from second DKA and in less than 48 hours later had to go back after less than 24 hours in the 400s. Ketones were clear when I had came home after 2nd DKA, but after those 24 hours (well, less actually because I didn't test ketones about 8 hours before he went back) he was at 1.9 ketones. They said his blood pH was >7.35 (normal) when he left after his last 2nd DKA, but when he went back less than 48 hours later it was 7.1 ... She didn't mention what the ketone level was (I'm guessing it was well over 2.5). Her opinion was he is creating ketones very easily and instructed me to give .5uR 6 hours after the L shot if he's >300 BG. I've been following your instructions to only give .25uR if >350 @ PS & +6 or .1uR if over >300
 
Wendy&Neko said:
Can someone remind me what type of inflammation Henry has and what the vet said about treatment? We are not vets, I think we need to keep that in mind.
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I see no harm in simply asking about a steroid?

Vet had mentioned possible triaditis but wasn't sure if the inflammation was more widespread or just incidental in the liver aspirate. At this point I cannot remember if an ultrasound was done in the last two hospitalizations/why she might be thinking triaditis. She had just said she didn't want to try steroid or immunosuppressant in a diabetic cat (I see John quoted it as I'm typing this). Budesonide is primarily targeted for IBD I know.
 
Here is the first ultrasound report did when the first DKA occured. They're done 2 more since but I don't have the reports, but I don't think much has changed:

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John & Henry said:
Here is the first ultrasound report did when the first DKA occured. They're done 2 more since but I don't have the reports, but I don't think much has changed:

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I am not sure if you can tell but the image upload didn't work.

I mentioned the budesonide because if it is GI inflammation, budesonide usually does not affect BG (this might have gotten lost in all the back and forth last night/day before). The other steroids affect BG and make it more difficult to regulate, thus adding another variable to an already delicate situation.
 
FrostD said:
I am not sure if you can tell but the image upload didn't work.

I mentioned the budesonide because if it is GI inflammation, budesonide usually does not affect BG (this might have gotten lost in all the back and forth last night/day before). The other steroids affect BG and make it more difficult to regulate, thus adding another variable to an already delicate situation.
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Hmmm, no they're showing fine on my end. Even in your reply. Maybe I should do them one page at a time? & yep I got the budesonide on my list to ask about
 
Ultrasound report page 1 (let me know if the image isn't showing up this time)
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Can see it now, thanks!

I see the GI stuff noted (along with pancreas and liver). My cat has similar "working diagnosis", but I can't anesthetize him for the biopsy to confirm what it is (IBD vs lymphoma).

This vet has made a few mistakes so far, so needless to say don't jump to any decisions on treatment, meds, etc right away. Let us know what she says and we can share our various knowledge then...don't want to unnecessarily overwhelm you.
 
FrostD said:
Can see it now, thanks!

I see the GI stuff noted (along with pancreas and liver). My cat has similar "working diagnosis", but I can't anesthetize him for the biopsy to confirm what it is (IBD vs lymphoma).

This vet has made a few mistakes so far, so needless to say don't jump to any decisions on treatment, meds, etc right away. Let us know what she says and we can share our various knowledge then...don't want to unnecessarily overwhelm you.
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Indeed. Same here IBD or lymphoma. They don't want to anesthetize him until he's "stable" after the DKA. Will definitely be checking here before making any decision.

My K9 meter just went off again...
 
Sandy and Black Kitty said:
Get your R+1,2,3,4.

I’m thinking about the next cycle, which will be cycle 4 of 1.75u Lantus. The R you just shot may set up a lovely AMPS.
If he Lantus depot is satisfied and the dose starts showing some action you may be busy. Time will tell :cool:
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It's so hard to tell sometimes. 2 days ago when I gave the R at +6 it brought BG down like 100 points. Next cycle I did the same thing and it hardly moved BG at all. But yes, I'm hoping for a beautiful PMPS. I can handle busy.
 
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