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KarenRamboConan

KarenRamboConan

Member Since 2009
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Hi everyone -

Before I start, let me just say that Miss Grace is still OTJ, and happier and healthier than ever. Her mom always asks that I thank everyone who helped get her that way. :smile:

So now I have a new "patient". My vet called last night. 8 yr-old cat brought in for weight loss, suspected HyperT, turned out to be FD in DKA. Good appetite. Treated with R and Levemir, now ketone free and has put on a pound. YAY!

Sugars staying high - in mid 20s (400s). Is on 2.5u Lev BID. Started on 1u BID 3 weeks ago, raised slowly. Curve high and fairly flat. Shooting sliding scale. Was eating hi-carb dry, now on low carb canned - mostly (steals dry dog food).

Good news - looks better, lots of energy, eating well, ketone free, gaining weight.

I am suspicious that the high flat curve may be rebound, but cautioned against dropping dose too much because of Hx of DKA. Did suggest staying with 2u for a few days, no sliding scale, and re-curve.

I have not yet met with the mom - she does not have Internet. Don't even know the cat's name!

Just wanted to know if there's anything major I should mention, or what the thoughts are.

Thanks!
 
I think you've caught the biggies - diet change and getting away from the sliding scale.

Is she home testing? That would be the next thing I'd recommend. Unlikely to catch any fast drops or low BGs that might be causing rebound if only doing a curve at the vet.

P.S. By the way, you're an angel to be helping them out!
 
Hi,

great that your helping and that this lady is on the right wave length.
Any chance you can see her ss? check how frequently she increased the dose and by how much each time?

Big debate and general consensus here that you don't see rebound on lev/lan. Do on shorter acting insulins like vetsulin.

She's also looking for breakthrough dose and may be that just needs more insulin for now. Remember ECID.
Other thing is Acro or IAA but without seeing ss no way of teling. Also think it is very early days to be considering these as well as scaring momma bean.If you carry on increasing and still high/flat in a few more weeks then makes this more suspect.

So for now would suggest taking time on increasing dose-follow guidelines in sticky (3-5 days), keep a record of observations-anything else going on?

Good luck :mrgreen:
 
I'd see what can be done about the kitty sneaking the dog's food! That could be contributing to the elevation and causing the numbers to stay high given how long the dry stuff sticks around in the system.

Unless the dose keeps creeping up, I think it's way too early to even thing about any high dose conditions. When you say the dose was raised "slowly," do you mean in 0.25u increments? Sometimes what a vet defines as slowly is rather different than our definition or a protocol-based definition. I suspect that it's more a matter of an optimal dose has yet to be reached.
 
I met mom at lunch today. :) Kitty's name is Whiskey.

She has no computer/Internet access, so no SS, sorry! She's also 7 mons pregnant with her first baby, so this is really stressful for her, poor thing.

I mentioned acro to her vet (but not to momma!), but no other signs of that ... of course, if we don't see the BGs coming down with an increased dose, we'll look closer! Nothing else seems to be going on.

There were skipped shots with low PSs and increases shots when the next PS was high - that's not true rebound, of course, but I explained the necessity of consistent dosing, no skipped shots, etc. And I suspect that the dose was raised by 0.5u, fairly quickly (because of the DKA). Also, she was on the R until recently, too, so I suspect the body has to adjust to the slower Lev.

The dog is a grazer, and mom & dad work all day, so the food stays down. She is aware of the problem, and will try to come up with something. The good news is that when the baby is born, she'll be off for a year on mat leave, so lots of time to monitor!

I've printed off the appropriate stickies, Dr. Lisa's site, good food choices, etc. She's very proactive, and very keen to do all she can for Whiskey. :-D

I'll let you know more when I know more! :smile:
 
in keeping with the spirit of the board, i've copied and pasted my email response here:

"looks better, lots of energy, eating well, ketone free, gaining weight." this is GREAT news!

if they were using a sliding scale, it's hard to say if the kitty is rebounding even if the dose was raised slowly from 1u to 2.5u bid. is the mom using R at home? is mom testing for ketones daily? was there an infection of some sort and has it been addressed with abs?

i like your suggestion to stick with 2u for now. would love to see as much data as possible because it's more than likely that the dose will have to be raised. if the numbers remain high and flat, we usually continue onwards and upwards until we find a dose which will cause a break through. is it possible to get a ss going (sorry, karen!)?

if kitty develops even a trace of ketones, we need to know asap.

a ketone free kitty in the 200s who is eating and feeling well is a good place to be. if all goes well, it'll just be a matter of increasing the dose systematically as suggested in the tight regulation protocol.
 
Thanks everyone!

Jill:
* no infection
* did use R at home until ketones were clear
* blood ketones checked weekly at vet. Have suggested getting ketostix for home monitoring
* have warned her to call vet ASAP if trace ketones appear
* sigh .... will try to start SS for her/ you're a slave driver, Jill! :razz:
* she has agreed to stay at 2u, no matter what, so we'll be able to see what happens when she isn't skipping shots or giving more

Thanks for the feedback. I have reminded both Tammy and Dr. R that it has been less than a month since Dx and DKA, and that looking at the whole cat is as important as any other statistic. I have cautioned both that staying ketone-free, eating and happy is VERY important... our sugarcats are more than just their BGs. :smile:
 
Karen, you're awesome to be helping another kitty and bean like this. I know you learned a lot from Grace too, because she certainly was not an easy one.

It sounds to me like you're hitting all the bases for now.
 
wonderful! hope she follows your suggestion to get some ketostix. testing frequently for ketones will help.
just knew you'd love my suggestion to start a spreadsheet for Whiskey! :lol: we're so used to using them now. they make detecting patterns and spotting trends so much easier. once you have time to get one together, we'll have a better idea about dose...
 
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