High Ketone levels?? Lantus dose

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syringes with 1/2 unit markings are very helpful when dosing R. If that is not the kind of syringe you already have, WalMart's brand is around $13 for a box of 100 and you'll use them for Lantus too.
 
You have to give the metoclopromide 20 minutes before her feeding to be effective not at the same time as feeding.

Also Pepcid shouldn't be given at the same time as other medications - give other medications one hour before or two hours after pepcid.

Metoclopromide is not an antinausea medication for cats. But this is the least of the worries if she is keeping food down. When she turns the corner and gets over her crisis we can address this.

Recovery has more calories than AD so stick with the recovery and follow the ways above to boost calories.
 
The first week is difficult. I had to feed Maverick around the clock for the first week. He had a PEG tube and we could tell his stomach was empty every 2.5 hours (fed every 3 hours as recommended above). It was worth the lack of sleep for the first week. He had like ten medications to fit in at different times also.
 
I don't want to get in the way as I don't know enough about DKA.

But if the concern is getting more calories fed Is there a specific reason for feeding Recovery or AD? other than calories? I've been skimming the J&B list for calories: Wellness Chicken (220) and Turkey (218) for 5.5oz cans and the Kitten formula is 121 for a 3oz can. The Turkey is very soft, I make a soup of it for Tess otherwise it just mushes in her bowl.

Blue Wilderness is even higher calorie, 132 kcal/ 3oz. can. (I checked their website.) It is more expensive, but this doesn't need to be a long term food. Wilderness is also very soft, almost a mousse, so it should be easy to thin out. You could feed the same amount and still get a lot more calories into Garland.
 
Sorry for the delay. I had a bunch of "kid" stuff and my husband was late coming home. He just walked in. So I am (finally) headed to the store.

list:
R insulin
strips (im out)
babyfood I already have
Recovery canned food I already have
pedialyte I already have
Honey I have
Syringes w the half mark I already have

Am I missing anything?

What is nutri-cal??
 
Karrie and Maverick said:
You have to give the metoclopromide 20 minutes before her feeding to be effective not at the same time as feeding.

Also Pepcid shouldn't be given at the same time as other medications - give other medications one hour before or two hours after pepcid.

Metoclopromide is not an antinausea medication for cats. But this is the least of the worries if she is keeping food down. When she turns the corner and gets over her crisis we can address this.

Recovery has more calories than AD so stick with the recovery and follow the ways above to boost calories.
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Really??? They told me to do it this way. Okay, Ill change it up. So the metoclopromide I give 20 minutes BEFORE her feed? Ive been giving it right before. If its not an anti nausea, then why am I giving it to her?

I give the pepcid in the middle of the day all by itself apart from other meds, but with food. .is that right?
 
it sounds like you are in pretty good shape once you get the strips. I should have known that a mom would have all the supplies handy already. ;-) We usually recommend a bunch of cans of high carb wet food (the kinds Jill suggested). Most of those are chunks and gravy, so the gravy might go into the tube ok if you leave out the chunks. I think mixing syrup with the food you are already syringing might work as well (or better) while you have a feeding tube, so if you can't get those foods that's fine. For some cats those are really tempting, though, so it might be worthwhile to get a can or two to see if you can tempt her to eat on her own.

Do you have time to grab another test before you go? Or do you need to wait until you get strips?
 
Nutri-cal: Nutri-Cal is a high-calorie palatable dietary supplement used for stressed or debilitated pets, pets suffering from illness, surgery or whelping, aging pets or picky eaters, who need increased caloric and nutritional intake. It's probably available at Petsmart or Petco. (You might want to call and see if it's in stock.)

Make sure the baby food you have on hand is just the plain meat and broth kind -- no veggies, onions or garlic.
 
I don't want you to miss the posts from the experts like Jill, Libby and Sienne. Print out the posts if its getting overwhelming.
Pepcid works better on an empty stomach - an hour before feeding. But I had difficulty getting all the medicines in with Maverick and had to give it with food often. The DKA is the primary crisis right now so don't worry about the antinausea medication. She may not feel the best but as long as she's keeping food down thats the important thing. Metoclopromide will work for nausea caused by stomach motility. It does help some cats stop vomiting. So don't worry about that for now just keep the status quo. Once she's through her DKA crisis I can help you address nausea if she still isn't acting 100% when ketones are back to being 0.

Remember when you give medication through the tube to disolve the meds in water first. Maverick's vet told me to predisolve meds in about 3mls of water and put that in through his tube with a syringe. But the vet didn't teach me in the beginning to do a pure water flush after the disolved meds were put in the tube. So remember when you give just medicine to also do a warm water flush after to clear the tube and push all the medicine through. I remember how overwhelmed I was so thought I'd share just in case.
 
Thanks :) I am reading everyones posts. You guys are so nice to help me and Garland

I just got back and tested her. It was 409. I didnt give her her usual shot at 7.

With the pills, I am dissolving them in 3ml of water and doing them right before the feed. so the food pushes it through. Then I flush w 6 ml water. does that sound okay?

I will have to go to petsmart tomorrow to look for the nutri-cal
 
I would see what Libby thinks about the Karo she suggested. The Petinic that you're giving contains corn syrup (same as Karo) and sucrose. It also contains a bunch of vitamins. The trade off here is that the syrup/sucrose will raise BG but it also provides calories. I don't know if you need both Karo and the Petinic but I've not had experience tube feeding. Libby and Karrie and Jill are more experienced than I am in this area.
 
Sienne and Gabby said:
I would strongly advise you to work with Libby around getting Garland on a dose of R ("Regular" insulin). As she noted, R is very, very powerful. You only need a very tiny amount -- far less than the amount of Lantus you're giving Garland.
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Sienne is correct, R is very different, very powerful. You must proceed with caution and guidance.

I was in the same position in June 2008, with the step by step guidance from the folks her in Lantus Land, I learned how to safely use R to help my kitty recover from DKA.
 
I would not give another Lantus shot until *at least* 10 hours after the last one, and that is only if her number is still high. How would you feel about trying the R now?

What you would do is give 0.1 unit of R. Here is a picture of what that looks like - it's just a drop. You might want to practice first to be sure you are actually squirting out some insulin. ;-) Then test at +1, +2, and +3 after you give it to see if it is doing anything. If she is still going down at +3, then you would get a +4 to see if she is going up yet. If she is still high at +4 after the R, post for advice. Depending on what time that is, you might want to give more R or you might want to give Lantus instead (or maybe even both).

0.1u might not do anything at all, but R is powerful so it's important to be cautious with your starting dose. Some cats are more sensitive to R than others.

What time zone are you in?
 
im central time. I will test every hour and put it on my spreadsheet. R makes me nervous nailbite_smile

I will be taking Garland to the vet in the morning to get a urinalysis so we know exactly what we are battling here. But the results take 24 hours
 
no need to be nervous. That's why we start with a tiny dose and test. That way you have complete control and can make your future decisions based on data.

I'll watch for your next number in an hour. Breathe! You're doing great.
 
433

Since its going up, i went ahead and gave her her Lantus. Its been 9 hours since the last dose. The doctor said she could have 2u 2x a day. So with this dose that makes 4u for the day, like what he said she needed. I really dont even think that will help too much. Her numbers are extremely high. and even after getting that dose earlier, never went down hardly anything.
 
Please test again in an hour to see if the R has started to work.

FYI, generally we give Lantus shots 12 hours apart. Sometimes we'll give it up to an hour earlier if the cat is very high and on the way up. Experienced users will sometimes shoot up to 2 hours early if they have data to know that is ok for their cat and if they are purposely trying to build extra overlap and bring the numbers down fast. Shooting 3 hours early is almost never done.

Lantus has a cumulative effect, each dose building upon the previous ones. Even with a normal dose change, it can take up to 6 cycles (3 days) to see the results of a dose change. It might look like the dose is doing nothing, but then BAM! Once the dose kicks in things can change suddenly.
 
question - on your spreadsheet it looks like you gave 0.1u of R at +9 after the second Lantus shot and then gave another 1.5u of Lantus an hour after that (which would be +10 after the previous Lantus shot). Your post says you gave the last 1.5u Lantus shot nine hours after the previous dose. Which is right?
 
violet, i know it's a little weird to be trusting strangers on the internet, but Libby is one of the best. She's had years of experience with feline diabetes, 24/7 and you can trust her to guide you.

She guided me when i was new and my vet had us using the wrong dosage of syringes - causing my cat to get 2.5x as much insulin as he was supposed to be getting. Really. You have a pro giving you advice.
 
now its 448

Sorry, i must not have counted the boxes right. its late...

its 10 hours since that middle of the day extra shot she had.. So shes had 1.5 lantus and 1 drop of R tonight. Numbers 409, 433, 448
 
hi violet. i'm sorry i won't be around to help tonight, but i wanted to post a recap so everyone understands how much and what kind of insulin has been administered when:

8/17
amps - 294 - (1u Lantus per vet)
+6 Lantus - 404 - (1.5u Lantus per Venita) <----------- Lantus shot clock is reset
+2 Lantus - 376
+9 Lantus - 409 - (0.1u R per Libby) <----------- R shot clock starts
+10 Lantus and +1R - 433 - (1.5u Lantus per violet?) <----------- Lantus shot clock is reset
+1 Lantus & +2 R - 448

hope this helps everyone because it's confusing! :-D
 
493 now..

Im having such a hard time getting her ear to give me blood. Usually its super easy

She looks awful tonight. Long slow breathing, not moving much... its heartbreaking :(
 
My babies get up in 5 hours. I need to get at least a couple hours sleep to be able to take care of them in the morning. I can set an alarm and do a quick test in a couple hours....
 
have you been adding sugary stuff to her food tonight, or just feeding the Recovery? I'm asking just to be sure I understand how food might be impacting her numbers. It might help if you can put a * on her spreadsheet in the hours where you have fed her. Sometimes it's easier to understand patterns when you can put a visual to them.

It has been about 2 hours since the last Lantus shot, correct? If so, we can't give more R now. To give R now would mean that onsets or nadirs of the two insulins could coincide. At about +6 or +7 after the Lantus, if she is still high you can try 0.25 units of R and again test at +1, +2, +3 after the R. Please don't give another Lantus shot until at least 12 hours after the last one. I know it doesn't look possible right now, but I'm concerned that all the extra overlap could cause her numbers to bottom out if you keep giving early shots. It has happened before.

*General* guidelines for R use, since we don't have much data on Garland's Lantus cycles yet, is to not give it between about +2 and +7. Eventually you will be able to fine-tune that, once you have learned when Garland's Lantus onset/nadir/duration are.

Please talk to your vet again tomorrow about fluids, and try to find out from them if there is anything else you can do at home.

I'm going to bed and won't be around until late afternoon tomorrow, but others are watching out for you too. Good job today! I remember how overwhelmed I was when Lucy came home after her DKA/HL hospitalization. I remember syringe feeding her in my closet because she wouldn't come out. She looked horrible. One day all of a sudden she decided she wanted to live. The turnaround was unbelievable from that point. Hang in there, ok?
 
get some rest. Like I said, if you get a +7 after the Lantus shot and she is high you can try 0.25 R if you want. Wait until +12 to give more Lantus. Post if you need help. Night!
 
Violet, while you are the vet clinic tomorrow getting the urine sample collected, please ask whether they have Clinicare.

Hope has previously recommended it for thinning the Recovery for tube feeding. It will add nutrients and calories.
 
hi. I must have been way more tired than I thought. I slept through my alarm last night. My husband (im assuming) must have heard it after a while and turned it off...

This morning: Im feeding her right now. i tested her before I started and it was 302. i havent given her any insulin yet. Im about to call the vet about what time they would like me to bring her in for her urine sample
 
Libby and Lucy said:
have you been adding sugary stuff to her food tonight, or just feeding the Recovery? I'm asking just to be sure I understand how food might be impacting her numbers. It might help if you can put a * on her spreadsheet in the hours where you have fed her. Sometimes it's easier to understand patterns when you can put a visual to them.

It has been about 2 hours since the last Lantus shot, correct? If so, we can't give more R now. To give R now would mean that onsets or nadirs of the two insulins could coincide. At about +6 or +7 after the Lantus, if she is still high you can try 0.25 units of R and again test at +1, +2, +3 after the R. Please don't give another Lantus shot until at least 12 hours after the last one. I know it doesn't look possible right now, but I'm concerned that all the extra overlap could cause her numbers to bottom out if you keep giving early shots. It has happened before.

*General* guidelines for R use, since we don't have much data on Garland's Lantus cycles yet, is to not give it between about +2 and +7. Eventually you will be able to fine-tune that, once you have learned when Garland's Lantus onset/nadir/duration are.

Please talk to your vet again tomorrow about fluids, and try to find out from them if there is anything else you can do at home.

I'm going to bed and won't be around until late afternoon tomorrow, but others are watching out for you too. Good job today! I remember how overwhelmed I was when Lucy came home after her DKA/HL hospitalization. I remember syringe feeding her in my closet because she wouldn't come out. She looked horrible. One day all of a sudden she decided she wanted to live. The turnaround was unbelievable from that point. Hang in there, ok?
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I havent added anything to her food yet. So shes still just getting the recovery.
 
Libby and Lucy said:
get some rest. Like I said, if you get a +7 after the Lantus shot and she is high you can try 0.25 R if you want. Wait until +12 to give more Lantus. Post if you need help. Night!
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She will be at the vet at +12- Im dropping her off there for a few hours to get her urinalysis done. I cant wait up there bc my daughter has a speech eval I have to be at at 10. I was thinking of doing her lantus before I go. I gave her that lantus last night at 9:30pm, its 8:30am now. Would it be okay to give her the 2u in 30 minutes?
 
can you check her BG and post it a few minutes before you shoot so we can look at it?

in general you can give a shot 30 minutes early without any problems - but with the multiple lantus shots and the R shot i don't feel like i know enough to be able to say for sure. it might depend on how high she is at that point.
 
Violet's DH will be taking Garland to the vet this morning. This is the same vet Garland has been going to. The VCA in Ft. Worth is a 24-hour facility, so it does both emergency and regular care.

I spoke to Dr. Hill, Garland's vet and the facility's medical director. They will be doing a cystocentesis to harvest Garland's urine, and send it to Antech for a full evaluation. The dark color on the KetoStix might be bilirubin from the fatty liver, and not ketones. But the Antech lab will let us know.

If Garland needs it, she also will be getting fluids. Dr. Hill agrees that infections figure into DKA, but Garland received a full-spectrum ABx when she was first hospitalized, and also received a Covenia shot partway through her time there so she should still be getting ABx coverage.

I called the vet clinic back, Violet. They will be adding 3 cans of the Clinicare to Garland's take-home package.

Violet, you are doing an awesome job caring for Garland. Truly awesome!! All of us here on the FDMB will do our best to get her through this illness--advice, financial support, emotional support, prayers and well wishes.

Should anyone else want to help with the $ for today's vet visit, please see this page of the DCIN blog. Sorry that page isn't up to date with treatment info, but caring for Garland (and others) has been more important than writing about the care. (And thank you, Rebecca and FDMB, for your donation for Garland's care.)
 
julie1220 said:
can you check her BG and post it a few minutes before you shoot so we can look at it?

in general you can give a shot 30 minutes early without any problems - but with the multiple lantus shots and the R shot i don't feel like i know enough to be able to say for sure. it might depend on how high she is at that point.
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Its 321 right now.
 
Okay, I gave her the 2u. Its only 15 minutes early. I have to get going (busy day over here) Garland will be headed to the vet now and will be there for a few hours. I will let you guys know how she is when we all get back to the house!

Thanks soo much!
 
violet826 said:
Okay, I gave her the 2u. Its only 15 minutes early. I have to get going (busy day over here) Garland will be headed to the vet now and will be there for a few hours. I will let you guys know how she is when we all get back to the house!
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Good job - keep us posted. I'm working today, however I am able to keep an eye out for you.
 
Violet: you are amazing....you are doing phenomenal and I know Garland feels your love. We say here in LL that our prayers have special magic and we are all sending them to Garland and you.
 
(((((Violet)))) our thoughts and healing prayers are with you and Garland, you will get through this!!

My Payne almost died four times and with all the help here, she is doing great!! Cats are amazing they can come back from a lot!

You are doing great! dancing_cat dancing_cat dancing_cat
 
I'm still following your story and praying for Garland and you.

What a wild ride you are having....keep hanging on; you are doing
a great job.
 
You are doing an incredible job.

I'm at the airport (I've been out of town and now heading home) so I've been following from afar. Keep taking care of yourself (and Garland). Let us know if there's more we can do to help.
 
wow although a Lantus user, I've been lured into Lantus land by Venita to see how Garland is doing.


I hope the urine analysis comes out that it is not ketones, but the bilirubin affecting the reading.

But I wonder, why don't the ER measure the blood b-ketones with the Abbott Precision Xceed/Xtra? My animal hospital have those and we only determine whether in ketoacidosis by that and by blood test for pH, oxygene, and electolytes.

This is the ER parameters they use
(I= intensive care)
I-stat EC
I-stat Sodium
I-stat Potassium
I-stat Chloride
I-stat pH (normal 7,24-7,40)
I-stat pCO2
I-stat BUN
I-stat Glucose
I-stat Hct
I-stat Hb
I-stat TCO2
I-stat HCO3
I-stat BE
I-stat Anion Gap
Temperature

When Simba came in he was hypo-sodium, hypo-chloride, hypo-potassium, hypo- I-stat HCO3, hypo I-stat Anion Gap and hyper-glucose, and the blood B-ketones (0.3-1.6) where 5.8, 5.1, 6.6, and the fPLI (for pancreatitis 2.0-6.8) was on sky high 343, and the fructosamine was at very high 700's. They were fast getting him hooked up on tube, iv and all, and 2 days later most was corrected and his blood B-ketones was down to 1.8. They gave him RC Recovery in the tube.

But he had to stay in the hospital for little over 14 days, due to the severe pancreatitis, the pancrea was enlarged and inflammed to 1.5 cm wide size (ultrasound scan), they didn't think he would make it. But I told them to keep trying.


Definitely need to get the blood glucose under control, if that is the only reason for it.


Thinking of you violet and Garland.
 
Ann & Scatcats said:
wow although a Lantus user, I've been lured into Lantus land by Venita to see how Garland is doing.


I hope the urine analysis comes out that it is not ketones, but the bilirubin affecting the reading.

But I wonder, why don't the ER measure the blood b-ketones with the Abbott Precision Xceed/Xtra? My animal hospital have those and we only determine whether in ketoacidosis by that and by blood test for pH, oxygene, and electolytes.

This is the ER parameters they use
(I= intensive care)
I-stat EC
I-stat Sodium
I-stat Potassium
I-stat Chloride
I-stat pH (normal 7,24-7,40)
I-stat pCO2
I-stat BUN
I-stat Glucose
I-stat Hct
I-stat Hb
I-stat TCO2
I-stat HCO3
I-stat BE
I-stat Anion Gap
Temperature

When Simba came in he was hypo-sodium, hypo-chloride, hypo-potassium, hypo- I-stat HCO3, hypo I-stat Anion Gap and hyper-glucose, and the blood B-ketones (0.3-1.6) where 5.8, 5.1, 6.6, and the fPLI (for pancreatitis 2.0-6.8) was on sky high 343, and the fructosamine was at very high 700's. They were fast getting him hooked up on tube, iv and all, and 2 days later most was corrected and his blood B-ketones was down to 1.8. They gave him RC Recovery in the tube.

But he had to stay in the hospital for little over 14 days, due to the severe pancreatitis, the pancrea was enlarged and inflammed to 1.5 cm wide size (ultrasound scan), they didn't think he would make it. But I told them to keep trying.


Definitely need to get the blood glucose under control, if that is the only reason for it.


Thinking of you violet and Garland.
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Wow Ann :) You totally lost me with the medical talk LOL I wish they had done another blood test though. But I guess a urine test was what they wanted? I have no idea. Im so new to all of this. Maybe Venita knows?

Poor Simba.. 14 days?? Im glad he pulled through
 
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