Charlie's +11 is 308. Should I stick w 2 u r?

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EllieKozak

EllieKozak

Member Since 2014
I have tried to wean Charlie down from the r and even tho it didn't really affect his numbers it threw him into dka. He had mod ketones last night, today is still showing them but it's definitely improved and he has too except his ravenous appetite isn't back yet. He will eat but only the other cats dry food. I know he shouldn't have high carb foods but right now should I just feed him anything he will eat? He's die for lantus in 30 min. Thanks
 
Hello! no advice, but bumping this post up to the top! might try putting the ? icon in your post above^^^..hope someone answers soon.
 
I'm not an experience R user, but it does take a few cycles for the Lantus depot to build, so I'd think it would be fine to stick with the same dose, provided you can monitor tonight.
 
He has to eat. In addition to DKA, not eating could result in hepatic lipidosis, another potentially fatal and expensive to treat condition. That's the last thing he needs.

If he needs to get below the renal threshold, do what you need to do with the R. I don't think he'll go too low on you with the numbers he's been getting.
 
hi ellie!

he has to eat - so whatever it takes to keep him eating is what you should feed him. even the dry food. perhaps if you pulverized the dry and then sprinkled it on LC he might accept it. that works with some kitties.

yes, i think you are back to using the R all the time until we get his blood sugar down. I'm tempted to suggest you try 2.5u tonight. If you see this and can give it before +2, and you can monitor, i would do that.

i think you still need to be testing his ketones twice a day to prevent them from building up to moderate again.

Also, think in terms of flagging us and possibly increasing every 4 cycles. We really need to get his L dose increased so the R isn't needed all the time.

My other concern is that his blood sugar isn't really that high considering these are AT numbers. That 308 is about 229. I think considering what is going on with the infection issue is important. If the metronidazole isn't working, I'd consider if there is another option. Are you giving him probiotics? Fortiflora is the typical one that people use - it's available from vets or online. have you tried that yet?
 
Julie I just ordered the ketone kit you suggested. He's so weird about his potty habits it makes it very hard. His bg just now is 464! :( i gave him 2 u r at pmps. I'm sure it's related to the high carb food. You had suggested fortiflora. He's been on one packet per day for about a month. Forgot to mention that before. I'll try grinding some dry food up to sprinkle on the LC. Should I be concerned about the 464 or just wait for the insulin to kick in? Ketones are going down but not gone.
 
I agree with Julie. I would call the pharmacies around your house and see who has or can order that meter and strips for you. I called around myself once and Rite Aid, I think it was could get it the next day, and CVS could get it in two days.
 
You want to wait til the R you already gave has worn off - probably 4 hours, and past the expected L nadir before you give more R. You can give it at preshots and +6 for the L.

I don't think you really have an option with the 464. It might be from the high carb food, hard to say. This is one of those things you have to just be dogged about. I'd probably try to give the R around the clock right now and try to sleep around testing. Sounds like a nightmare even as i say it, but i know you want to pull him through this and get him stabilized.
 
Oops. We cross posted. I'm glad you're getting the meter, and very glad his ketones are going down.
 
It's so frustrating Bc of the inconsistencies. Hoping after his appt w the internal med specialist we have some answers. Thanks again. I'll keep checking him
 
i can imagine - while his blood sugar isn't great, it's just not that high either. i keep thinking there is more going on here, but i don't know what. maybe he's got some other infection as well. or maybe it's just his gut issues.

when is his IM specialist appt?
 
Hello! Julie suggested that I check in with you on what I've been using to treat Shadow's antibiotic related diarrhea. He has been on Clavamox on several occasions and each time we've stuck with it despite the awful diarrhea it gave him. This time it was particularly bad and he showed little response to Fortiflora and pumpkin, so I decided to try the probiotic protocol listed here: http://www.ibdkitties.net/Probiotics.html

In short, it involves giving a #3 gelcap full of Saccharomyces boulardii yeast every 2 hours for the first day (we used Jarrow brand with MOS, which is bitter), then moving to a therapeutic protocol after that point which is 1/2 of the original capsule twice per day. With Shadow, I decided to add in Nexabiotic, which is a multi-strain probiotic as well, since his stools were a bit softer on the first day we put him on the therapeutic dose. In short, his diarrhea was about 75% better within a day and almost completely normal within 3 days. The neat thing about the S. boulardii is that it's a yeast, so it's not affected by antibiotics and you can give it at the same time as the AB itself. I wait 3 hours before giving the Nexabiotic, however.

Mind you, pilling him every 2 hours was kind of a pain, but the results were entirely worth it. Next time, I'll just start the probiotics at the same time as the AB and hopefully that will keep things from from going downhill in the first place.

Please don't hesitate to ask if you have any other questions about what's been working with Shadow.

I hope Charlie is feeling much better soon!
 
Hi there :cool:

Just caught up on recent events. Glad to hear you are getting the meter that checks for ketones in the blood.

BKs first DKA hospitaliation was 05/22/2008. One month later (06/22/2008), during a 24 hour period beginning at PM+1, BKs ketone level went from negative to large.I started using R on 06/23/2008 in an attempt to beat back the ketones. In spite of those efforts he was once again hospitalized with DKA.
Avoiding a third round with DKA getting him on solid ground and keeping him there took a lot of hard work.

On BKs ss, have a good look at the period from 06/22/2008 to 07/23/2008 and you will see things I had to do to get BK far away from ketones
- R given every 6 hours around the clock
- Feeding every 4 hours around the clock
- Testing for ketones 2x or more every day
- Monitoring BGs around the clock
- All of the above details documented on the ss at the appropriate +hour (making it easy for others to quickly size up recent history)

I posted daily and kept the ss up to the minite\


Based on BKs response to insulin at that time, with the help of the wise ones, we came up with an 'R scale' to use as a guide for R doses.
Have a look at a few of BKs R scales which are located on the 3rd tab of his ss. I recommend you come up with a baseline R scale as a starting point.
Once you establish your first R scale you then work on refining it using the numbers as your guide.
julie & punkin (ga) said:
i keep thinking there is more going on here,
Click to expand...
I agree, there is infection/inflammation somewhere helping to fuel ketone development
julie & punkin (ga) said:
Also, think in terms of flagging us and possibly increasing every 4 cycles. We really need to get his L dose increased so the R isn't needed all the time.
Click to expand...
I agree to this as well. systematically Increasing the Lantus dose until you do not need R to maintain negative ketones is the goal.
 
Hi Ellie,

Julie asked me to pop in as well. I see Sandy has weighed in on the R scale and I agree. We used a good amount of R with Cobb too, although he never had ketones. He did have insulin resistance so we were fairly aggressive with his insulin doses.

I agree with Julie that you should probably be increasing every 4 cycles, and at every 6 hours will help keep the ketones at bay. It will help to lower his numbers so the Lantus can work better too.

My R scale is the 3rd page if you click on Cobb's spreadsheet. I stuck to this scale no matter where we were in the cycle (depending on his PS response). If Cobb was at 300(on a human meter), I gave 3uR. But if he was rising at +6, I might give a little more. ECID with the R so you'll have to test out how Charlie responds to larger doses of it. You'll need to be around to test when you do larger doses, but since you're at 2u already, I'd suggest you go up to 2.5u for your preshot, if he's over 300 on the AT.
 
Thank you everybody for the advice! I have a lot of reading to do! :)
He seems a little more perky today but still won't eat his regular food. I did try putting some dry food crumbs in the LC and he laughed in my face! He can be so stubborn sometimes! I'll be around all day to check him.
 
Hi Ellie,

Charlie had a decent response to the R you gave at AMPS. I might still think about upping it to 2.5u when he's above 300 and see how he does with that.

Another technique you could employ is to give him some R at +9 to bring his BG down for the preshot. For example, today you might try 1u at +9 to see how he reacts that late in the cycle. And it might keep him lower for the preshot and Lantus on set. I noticed Cobb would have a different response, depending on where I shot the R in the cycle.

~Suzanne
 
hi ellie!

i woke up this morning thinking about your little guy. Checked his ss just now and see mod ketones again yesterday. I think you should increase his L tonight by 0.5u to 5.0u. Let's see how he does today and reassess before you shoot tonight.

It's going to be very helpful for those of us trying to help you if you open a new condo (thread) every day - morning is best if possible. It's also helpful if you edit the subject line of the first post throughout the day as you get new BG tests in. He needs to be kept in front of all of our noses so that he's getting as much attention as he needs to pull through this crisis.

The first post should include a "WCR" - a whole cat report. That tells us a huge amount. It would include how he's behaving - is he playing, purring and preening? is he pooping & peeing normally?

Also, keep up with the things Sandy has mentioned:
On BKs ss, have a good look at the period from 06/22/2008 to 07/23/2008 and you will see things I had to do to get BK far away from ketones
- R given every 6 hours around the clock
- Feeding every 4 hours around the clock
- Testing for ketones 2x or more every day
- Monitoring BGs around the clock
- All of the above details documented on the ss at the appropriate +hour (making it easy for others to quickly size up recent history)

I posted daily and kept the ss up to the minite\
Click to expand...

Has he been checked for pancreatitis? I'm wondering if that is playing a part here. I don't remember off-hand if you've mentioned this and I don't have time to go back and look right now. Here's the Primer on Pancreatitis.

Don't worry about replying to this thread - when you see it, go ahead and reply to people on a new one for Monday. Thanks! Hope he's eating ok this morning. Your comments & feedback throughout the day really helps as well.
 
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