? 7/10 - Mačka AMPS 503 - Vomited food - Ketones traces - PMPS 470 +2 347 Active cycle!?

[Penelope and Mačka]

Hi dear members,

Thank you all for your words of encouragement and your kind messages. This community is incredible. Your support is helping me a lot. I hope that one day I can give back to new members in need the way you do.

Yesterday I took the chance to take a nap, and also slept more than usual at night (00:30 => 5:30 wow). Mačka was in the reds with no fluctuation in his curve, can I even say curve? it's kinda flat.

He just vomited his 7AM food, so I tested ketones and it looks like Traces
What should I do? increase insulin already today to 1.25 or 1.5? I know you warmed me, and I listened to my vet what can I do right now? Thanks

yesterday http://www.felinediabetes.com/FDMB/...3-561-6-571-8-553-12-470.216547/#post-2402937

 

[Penelope and Mačka]

I just gave him 1/4 cerenia and a spoon of a new can, that he ate no problem.

Vet says to increase to 1.5 for this shot.

 

[Penelope and Mačka]

Since I don't have any replies and the insulin shot time is over due, I'm gonna go for 1.5u.

 

[Julie and Honey]

Hi there,

Glad you were able to get some rest!

I wish I could help, but am not as knowledgable as some others on dosing questions. Tagging some people that were involved in discussion and are familiar with situation. @Bobbie And Bubba, @Bron and Sheba, @Wendy&Neko. Not sure how soon they will see this though..

As for ketone question, water is important, so adding a little to food helps, check for ketones again today if you can to make sure it is improving, that is important.

I know the other day dosing was discussed at 1.75, so does not appear 1.5 would be a problem, but not sure what others would say. The situation has changed since then.

I am hoping someone else will respond soon.

Normally 911 is reserved for a kitty in immediate danger such as in a hypo or high ketones. You may want to change that to a question mark since he has eaten now and ketones are trace.

 

[Osha]

I don't have any advice. Just sending hugs and vines!

 

[Julie and Honey]

Since I don't have any replies and the insulin shot time is over due, I'm gonna go for 1.5u.

Okay. Sorry, I was typing...

It is frustrating sometimes because people are not always on the board, you can only do the best you can with the info you have at the time. I have been in the same spot and just did what I thought was best without an answer.

The ketones definitely need to be watched.

I am sure you will get some input during the day.

 

[Penelope and Mačka]

Thank you Julie, yeah he's not doing too good. I am so scared of messing with the insulin even more, but if I give 1 then that's clearly not enough. If I followed the protocol I would give 1.25 tomorrow but I think the situation is urgent and it says that in situation of Ketones it is different. My vet said 1.5, I don't now who to trust

I am afraid of giving him but i guess i'll just do the 1.5.

 

[Penelope and Mačka]

I gave him 1.5 and in 2 hours i'll feed him again after the Cerenia kicks in.

 

[Julie and Honey]

Thank you Julie, yeah he's not doing too good. I am so scared of messing with the insulin even more, but if I give 1 then that's clearly not enough. If I repeated the protocol I would give 1.25 tomorrow but I think the situation is urgent. My vet said 1.5, I don't now who to trust

I am afraid of giving him but i guess i'll just do the 1.5

I think that is fine since he likely was reduced too much on vets advice...hey, I get it, you sometimes are in the middle. Some people here honestly have a lot more knowledge on how this stuff works than a lot of vets. Since he is very high and had trace ketones, 1.5 would seem to be okay.

 

[Penelope and Mačka]

I think that is fine since he likely was reduced too much on vets advice...hey, I get it, you sometimes are in the middle. Some people here honestly have a lot more knowledge on how this stuff works than a lot of vets. Since he is very high and had trace ketones, 1.5 would seem to be okay.

Yes, you want to trust your vet, but I'm starting to see that they are not as experienced as diabetic cat pet owners

 

[Julie and Honey]

I gave him 1.5 and in 2 hours i'll feed him again after the Cerenia kicks in.

Sounds good and try to get a little more water in him, that will help flush ketones.

 

[Penelope and Mačka]

Yes, I offer him water all the time and he drinks thankfully.

 

[Julie and Honey]

Yes, you want to trust your vet, but I'm starting to see that they are not as experienced as diabetic cat pet owners

It has been said in vet school they spend about 8 hours on diabetes info and now with newer insulins being used, many vets are just not up to speed with some of the newer stuff and different insulins need different protocols. Many vets suggest not to test the animals at all! That advice can end up killing people’s pets, and unfortunately has. We spend hundreds of hours on this stuff, so we see how it is actually affecting our kitties. It is good to work with your vet, but also good to take some of their advice with a grain of salt

 

[Julie and Honey]

I gave him 1.5 and in 2 hours i'll feed him again after the Cerenia kicks in.

So I think you shot about 45 minutes late? You will want to adjust the pm shot a little because you want to be as close to 12 hours between shots as possible. They usually say you can adjust 15 - 30 minutes to get back on track.

Easiest is to move the next couple shots up by 15 min or so and you'll be back on schedule by tomorrow. Changing time more than 30 min at one time can have an effect and is not recommended. A late shot can act like a reduction and an early shot can act like an increase.

 

[Penelope and Mačka]

I think I shot 30 minutes late (yesterday evening was at 7:35pm).
And yes, thanks for the recommendations. I usually stay on a very tight schedule.

 

[Julie and Honey]

Hang in there, you are doing a good job

 

[Penelope and Mačka]

The weird thing is, before eating, he was doing totally fine, purring, playing with the chord of my sweater, being hungry and wandering the kitchen... I wonder if it's the pancreatitis stricking again?

 

[Julie and Honey]

The weird thing is, before eating, he was doing totally fine, purring, playing with the chord of my sweater, being hungry and wandering the kitchen... I wonder if it's the pancreatitis stricking again?

Sorry, above my pay grade...wiser minds may know the answer.

I will be gone for awhile, I need to get some stuff done today, it is easy to spend all day here. I’ll check back later. Hoping I get a good report

 

[Wendy&Neko]

Any chance he did a scarf and barf? In other words, ate too fast? Those super high numbers will make him hungry.

Glad you went to 1.5 units, but he really should be at 1.75 units. With DKA in recent history, you do want to give him enough insulin. Too little insulin is one of the factors leading to DKA. Try to get another ketones test in today. Ketones can go from trace to high quickly.

 

[Penelope and Mačka]

HI @Wendy&Neko, thank you for joining the conversation.

He might have, because she was very hungry, and ate fast. And barfed it all 5 minutes after.
But I have never seen him do that. He looks a little lethargic right now, a little down, so I'm not sure. He could also have nausea from barfing, although I gave him Cerenia. I also gave him a few spoons of food here and there.

I am nervous 1.75 might be too high considering last episode. Why do you think it's the right dose? According to his spreadsheet? I will test his BG at +2, which is in 40 minutes from now. Then Ketones next time he pees.

If he had indeed more ketones, what should I do? subcutaneous fluids at the vet?

This roller coaster is really consuming.

 

[Bobbie And Bubba]

I am sorry I am just getting the tag now. I agree with with Wendy to bump up to 1.75 as we take the increases and decreases in increments of .25 of a unit.

How’s his eating since the barf earlier? I hope that it was just a scarf and barf. When that has happened with one of my boys , I wait 15 minutes and try referring in smaller amounts slowly to prevent it from happening again.

To help with keeping ketones at. At, add as much water into his meals as he will tolerate. Make it soupy. The extra water helps to flush ketones. The important thing is to make sure he is eating and getting enough insulin. The recipe for a DKA event is : Not enough insulin, a systemic stress or infection , and in appetence. So , if he stops eating and ketones start showing back up again you’ll want to call your vet.

 

[Penelope and Mačka]

My vet wants me to give Macka subcutaneous fluids (150 ml /day). I am going to do it at 2pm with the nurse.
He is wobbling and his coat looks greasy.
He ate a full can in little bits since 8am. I had him drink too.
He peed again and Ketones looked fairly negative. Not sure what the problem is, besides just high blood sugar?
If his condition worsens, I will take him to the ER tonight, please pray for us that he gets better during the day

 

[Penelope and Mačka]

Thank you @Bobbie And Bubba ,

I am concerned more than usual because he has a hard time walking straight. He's weak.
Are you saying I should give a 1.75 unit tonight ?
That would mean yesterday PM: 1 unit / This AM: 1.5 unit / tonight: 1.75? Am I understanding correctly?

 

[Bobbie And Bubba]

Is he eating for you?

Does he seem to be in pain?

 

[Penelope and Mačka]

He eats and is hungry yes. But I am only feeding him one spoon at a time. I don’t know if he is in pain. His hind legs are weak so he does not want to walk too much. But right now he is laying in his side, awake, looking at birds. His eyes are mid closed. Not crouching.

 

[Penelope and Mačka]

He is very, very tired

 

[Bobbie And Bubba]

I would increase the dose at the next cycle as long as you can monitor and have test strips and higher carb food should you need it.

Is the hind leg weakness something new? Is walking on his hind hocks? Some kitties will get neuropathy from the diabetes being uncontrolled and in higher numbers.

B12 , Zobaline will help that.

 

[Bobbie And Bubba]

The higher numbers are going to make him lethargic.

 

[Penelope and Mačka]

I started giving him Zobaline 4 days ago. I would say that it looks different from neuropathy, it's an overall weakness. He had a similar weakness when my mother brought him here and he was extremely dehydrated and ketotic.

 

[Julie and Honey]

My vet wants me to give Macka subcutaneous fluids (150 ml /day). I am going to do it at 2pm with the nurse.
He is wobbling and his coat looks greasy.
He ate a full can in little bits since 8am. I had him drink too.
He peed again and Ketones looked fairly negative. Not sure what the problem is, besides just high blood sugar?
If his condition worsens, I will take him to the ER tonight, please pray for us that he gets better during the day

Oh no! I was hoping Macka would be doing better this afternoon. Hoping the fluids will help. If he is dehydrated that can make them feel poorly and feel out of it. Greasy coat can be with high sugar, if that is the reason, should improve once sugar is better controlled. Glad the ketones are looking better. Healing thoughts for your baby

Please keep us updated if you can.

 

[Zorro's mom]

Thinking of you and Macka, Penelope.

 

[Bobbie And Bubba]

I get my my

I started giving him Zobaline 4 days ago. I would say that it looks different from neuropathy, it's an overall weakness. He had a similar weakness when my mother brought him here and he was extremely dehydrated and ketotic.

it could take a couple of weeks for the weakness to improve.

 

[Penelope and Mačka]

Macka had 100ml of fluids, 2 tiki stix to accept them.
Overall he ate today 1 can during the morning + 1/4 @2:30. He has appetite.
His BG is still in the 500s.
Now he's resting.

 

[Bron and Sheba (GA)]

Just awake and getting the tag.
I agree with Bobbie and Wendy.
I would go to 1.75 units if you can monitor the blood glucose.
With recent DKA Macka needs enough insulin, enough food, no infections or inflammations and lots of fluids.
Keep testing for ketones.

 

[Julie and Honey]

Macka had 100ml of fluids, 2 tiki stix to accept them.
Overall he ate today 1 can during the morning + 1/4 @2:30. He has appetite.
His BG is still in the 500s.
Now he's resting.

Good to hear the fluids are onboard and he has an appetite

 

[Penelope and Mačka]

@Bron and Sheba and @Bobbie And Bubba : please tell me again why you want me to go to 1.75? is it because that's where we left him before I could build up his depot? Before I increased to 2 and he got a low number? Or is there another reason?

Macka woke up from his fluid nap and walks better. He's also more alert. I tried to play with him and he was responsive. Eyes are open.

I tested the ketones again, please see the photo below, is this negative or traces?
Thanks!

 

[Julie and Honey]

@Bron and Sheba and @Bobbie And Bubba : please tell me again why you want to go to 1.75? is it because that's where we left him before I could build up his depot? Before I increased to 2 and he got a low number? Or there another reason?

Macka woke up from his fluid nap and walks better. He's also more alert. I tried to play with him and he was responsive. Eyes are open.

I tested the ketones again, please see the photo below, is this negative or traces?
Thanks!

So happy to hear the fluids seem to have helped him. They will also help keep ketones at bay.

Usually the strip is closer to the color chart, that looks light. I assume you waited 15 seconds? Oh, you know what? Since he was pumped full of fluid his urine would likely be watered down, which is fine, but maybe it might show lighter on the strip?

Seems fine to me.

 

[Bron and Sheba (GA)]

That looks like negative to me.
The reason to go to 1.75 is because Macka needs to get enough insulin so as to prevent ketones and DKA again and to treat the FD.
His BGLevel shows the dose at the moment is too low. He needs to be in lower numbers.
The 2 units was a bit too much and the 1.5 was not enough.
As long as you are testing regularly you can keep Macka safe.

 

[Wendy&Neko]

We want you to increase to a safe dose that maximizes insulin but means his sugars will not go too low. Our dosing methods have worked or hundreds of kitties, they say 1.75 units should be the dose. 2,0 units was too much.

 

[Bobbie And Bubba]

I agree with @Bron and Sheba . I am so glad that he is doing better ! The extra water/ sub q fluids will definitely help.

 

[Bobbie And Bubba]

Penelope, please try to trust us. When my Bubba was first diagnosed, my former vet did not even want to teach me how to test at home, says he, “ I’ll show you when he’s more regulated. Well...had I waited for that, he’d been dead from a hypo. You have the opposite issue right now. His numbers are much too high and he’s had a DKA event. We have to get these high numbers down!

 

[Penelope and Mačka]

Is it ok to go from 1 yesterday, to 1.5 this morning, to 1.75 tonight? From the protocol perspective?

Is 1.75 going to influence his BG of tonight’s cycle at all or will it show in 2 days? Even if it shows only in late cycles, does it still improve the kitty’s health right away? Should I worry tonight and test a lot during the night?

I am so overwhelmed and exhausted by this situation that my doctor canceled my surgery :/

 

[Julie and Honey]

@Bobbie And Bubba can you assist, saw you pop in. If you can answer I know Penelope is having a lot of anxiety. I know you guys responded, but she had a couple more questions. Thx

 

[Bobbie And Bubba]

Is it ok to go from 1 yesterday, to 1.5 this morning, to 1.75 tonight? From the protocol perspective?

Is 1.75 going to influence his BG of tonight’s cycle at all or will it show in 2 days? Even if it shows only in late cycles, does it still improve the kitty’s health right away? Should I worry tonight and test a lot during the night?

I am so overwhelmed and exhausted by this situation that my doctor canceled my surgery :/

I so understand how overwhelmed you are. Sometimes, when there is a dose increase, the numbers go up before coming down. We call that New Dose Wonkiness or NDW. But that said, still get. +2 tonight after the increase. If that number is lower than the Preshot number , then the cycle could be active and more testing necessary. If higher, then get a test in before you go to bed and call it a night and get a good night’s sleep. We so understand how sleep deprived you are. Most of us with these sugar kitties are , We will help you along the way!

 

[Julie and Honey]

Is it ok to go from 1 yesterday, to 1.5 this morning, to 1.75 tonight? From the protocol perspective?

Is 1.75 going to influence his BG of tonight’s cycle at all or will it show in 2 days? Even if it shows only in late cycles, does it still improve the kitty’s health right away? Should I worry tonight and test a lot during the night?

I am so overwhelmed and exhausted by this situation that my doctor canceled my surgery :/

Penelope, I wish I could help more. I think Macka is a special case, so the exact protocol is being adjusted and there is already data and previous ketone issue, so little different than your average kitty

 

[Julie and Honey]

@Bobbie And Bubba do you know someone available the next few hours to advise in case there are concerns before she can call it a night? I can check back, but I don’t always know what to do. Thx

 

[Bobbie And Bubba]

@Bobbie And Bubba do you know someone available the next few hours to advise in case there are concerns before she can call it a night? I can check back, but I don’t always know what to do. Thx

The best thing to do would be to change the title with a 911 if there is an emergency. That way , many eyes will go to it. But that said, I do not think his numbers will be anywhere near low tonight.

I will try and circle back in a bit to check on them.

 

[Penelope and Mačka]

I understand that if +2 is similar to PMPS then there won’t be much movement during the cycle. How weird.
In my past life, before diabetes, +2 aka 9:30pm was my bed time I will shoot 1.75 units tonight and be very careful. I’ll set up an alarm if I can’t stay awake. And if anything weird happens, I will write a 911 thread. You are all so wonderful. Thank you for your help and for caring so much even though we are strangers.

 

[Bobbie And Bubba]

I understand that if +2 is similar to PMPS then there won’t be much movement during the cycle. How weird.
In my past life, before diabetes, +2 aka 9:30pm was my bed time I will shoot 1.75 units tonight and be very careful. I’ll set up an alarm if I can’t stay awake. And if anything weird happens, I will write a 911 thread. You are all so wonderful. Thank you for your help and for caring so much even though we are strangers.

Yes, if the +2 is the same or higher , then the cycle is likely to be uneventful. If it is lower that could indicate an active cycle and then let you meter be your guide as to how frequent to test.

 

[Penelope and Mačka]

1.75 units done. I think. It's very hard to pin point the .75 on the needle! I have syringes with 0.5 increments, however the lines are so close to each other, how do you all do this without errors?