? How to handle not feeding

[SmallestSparrow]

Methos has yet to respond to insulin the same way twice. He can have the same PS, get the same dose and have wildly different curves while eating the same food. Or the PS is wildly different, the dose the same, same results. Or the PS the same, dose different , same results etc. usually unpredictability is just a stressor but now he’s going to need to be without food tomorrow from +3 to probably +8 or 9. I’ve imagined a few ways to deal with this but none seem ideal and I wonder if I’m missing a best way. He’s needing to go without food for tests.

normally he eats a medium (40 cal) breakfast low in carbs (tiki mousse and tiki broth) except he gets a pill pocket with it. At +2.5 to +3 he gets essentially no carb 20 cal snack of tiki chicken breast shreds. At +4.5-+5 he gets lunch (50 cal tiki mousse), at +8 another 20 cal snack of Tiki chicken shreds (other meals later but that’s the time period at issue). These meals are mostly driven by him not usually eating much at once (always like that but I assume his pancreatitis isn’t helping any).

He needs to be without food definitely from +3 to +6.5 for an ACTH stim test (will be able to have small amount of freeze dried snacks but no real eating 2 hr prior/during to prevent lipemia. Once the stim test is over he has an Ultrasound on call. I may be able to let him have a tiny amount of food but not much between stim test and US. These were scheduled for different days but we pushed up the stim test because of concern over his vetoryl dose but one thought I have is pushing it back to later this week (not sure I can move the US). Even if I split them up I still face him needing to fast from +3 to +6.5 for the stim test whenever this week it happens.

I did a trial today of a huge breakfast (all the mousse he’d normally get at breakfast and lunch), a lower calories snack at +2 (just broth with shreds) and then nothing to +6.5 and he did fine. Unfortunately he got only 2U this am bc AMPS a bit low for me (especially since I was going to try not to feed him). Otoh he could also be low tomorrow. I’ve shot similar numbers with 2 and 2.5–both times went lower than he did today even with me feeding extra low carb or even medium carb food.

I’m hoping he performs similarly tomorrow; I’ve considered dealing with contingencies: if lower at +3 (his last chance to eat) give medium carb food. Or give low carb food and take greenies and pill pockets to use as treats rather than freeze dried chicken or liver. Would one be preferable over the other? Is there a better option?

of course there’s also the chance he refuses to eat altogether in the morning. Any advice is gratefully accepted

 

[Heike & BInie]

Hi Colleen,

so great you are doing these tests to keep him safe! You really think about everything. I am really not an expert in this at all but if snacks are allowed between +3 to +6.5, wouldn't make it sense to bring both with you, the freeze dried and the pill pockets and you decide after testing his bg which one to give? Curious what the experts say...

Send you a big hug and all paws and fingers are crossed, that everything goes well!

 

[SmallestSparrow]

Thanks Heike, I’m really worried I will arrive with him heading into hypo but he needs these tests. Otoh his BG and ketones have been higher so I don’t want to shoot him into red either.

The stim test was scheduled weeks ago and the US is sort of squeezed into their schedule. He’s not doing well, losing a lot of weight, poor appetite, electrolytes out of balance so he really needs the tests I just don’t want to kill him trying to get them done.

@Heike & BInie i hope both of our kitties do better soon

(My vet’s partner does the ultrasounds and he already thinks I’m crazy so I have no doubt he won’t let me be with Methos. If I remember I will ask them to give him some fluids before or after the ultrasound because he probably won’t drink while he’s there)

 

[Staci & Ivy]

Oh Colleen I’m so sorry you are going through all of this! It’s so complicated. I don’t have any good answers but wanted to wish you and Methos lots of good luck and warm wishes and hugs.
I hope you can get some good advice on how to handle.
Did your vet have any suggestions?

 

[SmallestSparrow]

Oh Colleen I’m so sorry you are going through all of this! It’s so complicated. I don’t have any good answers but wanted to wish you and Methos lots of good luck and warm wishes and hugs.
I hope you can get some good advice on how to handle.
Did your vet have any suggestions?

Thank you. I texted her three times today, first asking the question then twice more with updates on how my experiment was going. After the third she replied that she was at a funeral and could she text later (hoping this is the embarrassed emoji). She is such a saint. I need to be better.

She said I could come thirty min later if that helped (give the vetoryl 30 min after his shot so he’d be a bit further along in his cycle). I wish he was more predictable. I’m going to hope that the extra pill pocket or two with gabapentin (plus the one with vetoryl) will be a good carb load no matter what he decides to do but the 30 min window is good if I have to delay bc he’s too low to shoot at all (shouldn’t be but he’s fooled me before with an amps of 90 and the previous day amps 379). I guess (baring sage advice from an old hand) I’ll just try to get him to eat a big breakfast, and pack a bag with everything he’s eaten in the past and cross my fingers. I probably won’t get a +4 just bc I don’t want to stress him closer to his stim test (hopefully his amps is high enough that I can just get a +3 before he gets his light snack (if he will eat it) and ask the clinic to run lytes and glucose in the pre-stim blood. If at all possible I want to avoid ear sticks during the test which will last either +5 to +6 or +5 to +6.5 (I don’t remember how long they are, if it’s pre/30 min post/60 min post or pre/60 min/90 min.
Once the test is done I can stick him and if necessary maybe feed some mod carb or a high carb treat while waiting for the ultra sound.

 

[SmallestSparrow]

I keep thinking back to my previous adrenal tumor/cushing cat (before I knew) where I’d just give him a shot while he ate breakfast (no meters then) kiss him on the nose and leave for work. But he was younger and I just thought he was a fat diabetic cat. Methos is just so fragile I feel like I don’t have any room for error.
I took him to the ER yesterday because his ketones were high and I was also worried about his potassium. Two more vets (we got there at shift change) had a chance to say “wow, those are rare. I can’t believe you’ve had two”

 

[Staci & Ivy]

I keep thinking back to my previous adrenal tumor/cushing cat (before I knew) where I’d just give him a shot while he ate breakfast (no meters then) kiss him on the nose and leave for work. But he was younger and I just thought he was a fat diabetic cat. Methos is just so fragile I feel like I don’t have any room for error.
I took him to the ER yesterday because his ketones were high and I was also worried about his potassium. Two more vets (we got there at shift change) had a chance to say “wow, those are rare. I can’t believe you’ve had two”

I wonder if that’s actually true, that it’s rare (did you mean diabetic cat??)
If so I don’t think it’s so rare.

I’m hoping your great plan works well, Colleen. You’re giving him such wonderful care!!
Ivy and I are crossing everything for a very successful day tomorrow and that You and Methos come through the day just fine. We are sending you love and hugs

 

[SmallestSparrow]

I wonder if that’s actually true, that it’s rare (did you mean diabetic cat??)
If so I don’t think it’s so rare.

I’m hoping your great plan works well, Colleen. You’re giving him such wonderful care!!
Ivy and I are crossing everything for a very successful day tomorrow and that You and Methos come through the day just fine. We are sending you love and hugs

Hugs right back to you!
I meant cats with adrenal tumors are rare. So I’m told. A lot. By several vets with my first one and now with Methos. How I came to have two of them I have no idea. I suspect they aren’t quite as rare as believed but maybe cats don’t often get ultrasounds and even if they do, their adrenal glands are tiny so probably hard to see. Methos had an ultrasound a year prior for loss of appetite and licking his belly that didn’t show it. He had an US in the ER (wouldn’t eat, throwing up) and they didn’t see it but saw a (probably ) benign liver mass. So he was referred to a radiologist who saw it on his state of the art ultrasound (and confirmed the liver mass was most likely benign). It was Jan 2023 but many in my area were still in COVID procedures so the radiologist came out to the parking lot and we stood apart wearing masks. I couldn’t believe he was saying Methos had an adrenal tumor—it was like being hit by lightening a second time. When I told him my previous cat had had one also he was the first vet to say “wow. That’s unbelievable. Those are really rare”. I replied “I know” while sobbing. Now when they say it I can say “I know” while just tearing up.
Erik, my first, was treated as a poorly controlled diabetic cat for three years—he only got an ultrasound because he threw up, stopped eating, and I’d already given him insulin so we went to the er. He’d passed a stone before so I thought maybe he had another one. Now that I’ve had two I see some pattern to them.

 

[Staci & Ivy]

Hugs right back to you!
I meant cats with adrenal tumors are rare. So I’m told. A lot. By several vets with my first one and now with Methos. How I came to have two of them I have no idea. I suspect they aren’t quite as rare as believed but maybe cats don’t often get ultrasounds and even if they do, their adrenal glands are tiny so probably hard to see. Methos had an ultrasound a year prior for loss of appetite and licking his belly that didn’t show it. He had an US in the ER (wouldn’t eat, throwing up) and they didn’t see it but saw a (probably ) benign liver mass. So he was referred to a radiologist who saw it on his state of the art ultrasound (and confirmed the liver mass was most likely benign). It was Jan 2023 but many in my area were still in COVID procedures so the radiologist came out to the parking lot and we stood apart wearing masks. I couldn’t believe he was saying Methos had an adrenal tumor—it was like being hit by lightening a second time. When I told him my previous cat had had one also he was the first vet to say “wow. That’s unbelievable. Those are really rare”. I replied “I know” while sobbing. Now when they say it I can say “I know” while just tearing up.
Erik, my first, was treated as a poorly controlled diabetic cat for three years—he only got an ultrasound because he threw up, stopped eating, and I’d already given him insulin so we went to the er. He’d passed a stone before so I thought maybe he had another one. Now that I’ve had two I see some pattern to them.

Oh my, Colleen. That’s just so intense. I’m so sorry you’ve had to deal with this twice.
(Maybe in some crazy way Methos was meant to have you, with your experience and huge heart, as his Mom).

We will be thinking of you both tomorrow and sending very good wishes for good news and smooth testing.
You’re doing an amazing job with your sweet boy

 

[Wendy&Neko]

A couple things I think are going to be in your favour, numbers wise, for tomorrow. First, his dose is 2.5 units. A couple days ago you shot 2.25 and this morning 2.0 units. Both of which will drain the depot some. On 2.5 units, he wasn't going anyplace dangerous, and you've drained that depot some, making it even less likely. Next, when Methos sees blues, he tends to bounce, and that'd be even more likely on the lower dose. The million dollar question is how long he'll bounce/be in higher numbers due to the reduced doses. That PMPS says bounce for sure, just not sure how long.

Neko never got fasted for U/S. She even had a couple unscheduled ones where she'd naturally had her meals before the vet appointment. The IM vet was fine with that.

I’ve considered dealing with contingencies: if lower at +3 (his last chance to eat) give medium carb food. Or give low carb food and take greenies and pill pockets to use as treats rather than freeze dried chicken or liver. Would one be preferable over the other? Is there a better option?

Medium carb will wear off after a couple hours, the numbers bump won't be sustained. Not easy to see exactly when Methos typically has his nadir, but maybe +5-+6? It seems to vary a bit, so that's not something to be counted on. Ideally you'd like a solution that lasts until nadir. The other question is whether you are going to be the one giving snacks, or do you have to rely on a tech doing it? I also wouldn't blanket say "do something if +3 is lower" because if it's still high, say over 200, I'd worry less than if he's in the 100's.

 

[SmallestSparrow]

A couple things I think are going to be in your favour, numbers wise, for tomorrow. First, his dose is 2.5 units. A couple days ago you shot 2.25 and this morning 2.0 units. Both of which will drain the depot some. On 2.5 units, he wasn't going anyplace dangerous, and you've drained that depot some, making it even less likely. Next, when Methos sees blues, he tends to bounce, and that'd be even more likely on the lower dose. The million dollar question is how long he'll bounce/be in higher numbers due to the reduced doses. That PMPS says bounce for sure, just not sure how long.

Neko never got fasted for U/S. She even had a couple unscheduled ones where she'd naturally had her meals before the vet appointment. The IM vet was fine with that.

Medium carb will wear off after a couple hours, the numbers bump won't be sustained. Not easy to see exactly when Methos typically has his nadir, but maybe +5-+6? It seems to vary a bit, so that's not something to be counted on. Ideally you'd like a solution that lasts until nadir. The other question is whether you are going to be the one giving snacks, or do you have to rely on a tech doing it? I also wouldn't blanket say "do something if +3 is lower" because if it's still high, say over 200, I'd worry less than if he's in the 100's.

thank you so much!!

Where his nadir is is the million dollar question. On the way up it initially seemed +4 to an occasional +5. Then became +5 to 6. By the time we got to 3 it was anywhere between 4.5 and the next PS. On the way down it’s held that range. I realize his tumor knows no rhyme or reason, and my short shots don’t help but he hasn’t been eating much the last 2 weeks. Then to compound the issue he was off vetoryl and spiranolactone for 2 days and is now on a half dose of vetoryl only.

the radiologist he saw before insisted on fasting. Dr H doesn’t but commented when he did Muz last week that he’d eaten so less than ideal for test. The stim test is the bigger issue because if his nadir isn’t waiting for the next PS it will happen mid stim test. I give the treats. No one else should get their fingers near his mouth—his eyesight close is nonexistent and fingers look like chicken. His response to gabapentin is variable sometimes he’s too zonked to be interested in eating but since his vetoryl is half dose he may be ravenous. The first time we did a stim test he reached his huge polydactyl paws out quickly, grabbing my hand to bring the treat closer to his mouth (which is also big). And both look bigger bc my hand is small. There was an audible gasp from the vet and two techs in the room. But he just wanted the treat to his lips. As with everything about him these days no predicting. i know 100 isn’t dangerous to everyone else but two days ago I could only keep him above 100 with MC food (which I eventually over did just because I was trying to safely leave with him to the ER and be able to wait there without him crashing…as it was we couldn’t stay anyway). I just worry that with gabapentin on board we may be “oh it finally kicked in” when in reality his glucose is 50. Him going from mid 300s to 75 at +5 has scarred me for life! But that was higher doses and i will keep repeating that tomorrow am when im sure he will give me a hard to predict PS

Thanks so much for the reassurance. It means a lot. I’m so scared we will kill him trying to figure out how to keep him alive. I probably should have done the surgery.

 

[Heike & BInie]

Thanks Heike, I’m really worried I will arrive with him heading into hypo but he needs these tests. Otoh his BG and ketones have been higher so I don’t want to shoot him into red either.

The stim test was scheduled weeks ago and the US is sort of squeezed into their schedule. He’s not doing well, losing a lot of weight, poor appetite, electrolytes out of balance so he really needs the tests I just don’t want to kill him trying to get them done.

@Heike & BInie i hope both of our kitties do better soon

(My vet’s partner does the ultrasounds and he already thinks I’m crazy so I have no doubt he won’t let me be with Methos. If I remember I will ask them to give him some fluids before or after the ultrasound because he probably won’t drink while he’s there)

Hi Colleen,

I really hope all these tests help Methos to get better! I wonder if Methos is not safe anyway during the tests. I remember when I brought Binie to surgery, I had a bag with food and a long list what to feed at which bg level. My vet just looked at me and said: "We have glucose here in abundance. If she goes too low, we can always put her on a drip."

By the way: I am sure they think I am crazy. But I always bring them chocolate and Christmas stuff, so at least I am the nice crazy cat lady.

I keep my fingers crossed everything goes well!

 

[SmallestSparrow]

Hi Colleen,

I really hope all these tests help Methos to get better! I wonder if Methos is not safe anyway during the tests. I remember when I brought Binie to surgery, I had a bag with food and a long list what to feed at which bg level. My vet just looked at me and said: "We have glucose here in abundance. If she goes too low, we can always put her on a drip."

By the way: I am sure they think I am crazy. But I always bring them chocolate and Christmas stuff, so at least I am the nice crazy cat lady.

I keep my fingers crossed everything goes well!

Well he’s safe bc his amps was 399 and +4 high 200s so…he’s really gone downhill off vetoryl (my vet was once again right) and I hope he goes back to full dose today. And maybe increase insulin. We can discuss the sspirsnolactone. She suggested once a day. Maybe I could do that. Or half of the original dose twice a day. thanks for your good wishes. Going in now

 

[SmallestSparrow]

I’m exhausted. Thanks to everyone for their positive thoughts and encouragement. You can see from my not well documented spread sheet tha Methos started high and stayed there riiiight until the middle of the stim test. In between draws they leave us in a room with a litter box and water; the box is literally half as long as he is, I forgot to bring his as I knew this was an issue. Usually he tries to figure out if he will fit diagonally but instead he got in and fell down. Even on higher gabapentin that’s never happened. So I broke my plan of not sticking his ear mid test and while it came down a lot from 400 it didn’t explain him tipping over. I asked them to check his lytes doing the post stim draw and his potassium was low again. In only two days off vetoryl and spiranolactone. The tech gave me the result, I panicked and was crying by the time my vet came in. Meanwhile his glucose despite being given an entire pouch of low carb food continued to decrease. I didn’t want to add hypoglycemia to the hypokalemia. He got three greenies. when vet came in and calmed me down he got a potassium tablet..and more low carb food and two pill pockets for the K. Despite all that only 202 90 min later.

His US isn’t good news (not that I expected any good news) but I’m going to try not to focus on their preliminary reading; they’re sending a copy to the radiologist who’d done his first two ultrasounds to get his opinion. New goal: make to to Friday when he gets repeat lytes.

 

[Staci & Ivy]

 

[Heike & BInie]

I’m exhausted. Thanks to everyone for their positive thoughts and encouragement. You can see from my not well documented spread sheet tha Methos started high and stayed there riiiight until the middle of the stim test. In between draws they leave us in a room with a litter box and water; the box is literally half as long as he is, I forgot to bring his as I knew this was an issue. Usually he tries to figure out if he will fit diagonally but instead he got in and fell down. Even on higher gabapentin that’s never happened. So I broke my plan of not sticking his ear mid test and while it came down a lot from 400 it didn’t explain him tipping over. I asked them to check his lytes doing the post stim draw and his potassium was low again. In only two days off vetoryl and spiranolactone. The tech gave me the result, I panicked and was crying by the time my vet came in. Meanwhile his glucose despite being given an entire pouch of low carb food continued to decrease. I didn’t want to add hypoglycemia to the hypokalemia. He got three greenies. when vet came in and calmed me down he got a potassium tablet..and more low carb food and two pill pockets for the K. Despite all that only 202 90 min later.

His US isn’t good news (not that I expected any good news) but I’m going to try not to focus on their preliminary reading; they’re sending a copy to the radiologist who’d done his first two ultrasounds to get his opinion. New goal: make to to Friday when he gets repeat lytes.

Oh Colleen....I am so sorry the vet visit was so stressful, both for Methos and you. And I am sorry the results are not good. I hope the opinion of the radiologist gives more insights, how to help Methos. I send you and Methos lots of love and healing energy. He so lucky, he has a mum like you.

 

[SmallestSparrow]

After a horrible few days BG and ketone-wise, and no improvement even after restarting his vetoryl and aldactone, my vet reluctantly agreed to put him back to 3U (the number we originally thought would be his number until he had some unpredictable low numbers)—at least until Vetoryl beat his tumor back a bit. I should have known bc her last words on it was “ok but we’d gone back down to avoid really low nadirs” and I foolishly replied “I’ll handle those, if they happen—his nadirs have mostly been mid 200 or higher”…sigh, 80 last night and over 400 this am. Just something else to discuss on our appointment today

 

[Wendy&Neko]

Not sure the Vetoryl caused the 80. On the 2.5 unit dose he had seen as low as 106, which for those following SLGS means staying with that dose as the nadirs are in the desired 90-149 range. Jumping up to 3.0 units was too big a jump in insulin dose, which he told you right away. Plus, he's been sliding down to blue every 3 cycles lately, last night was the 3rd cycle since the last blue, so not the best cycle for an increase.

 

[SmallestSparrow]

Not sure the Vetoryl caused the 80. On the 2.5 unit dose he had seen as low as 106, which for those following SLGS means staying with that dose as the nadirs are in the desired 90-149 range. Jumping up to 3.0 units was too big a jump in insulin dose, which he told you right away. Plus, he's been sliding down to blue every 3 cycles lately, last night was the 3rd cycle since the last blue, so not the best cycle for an increase.

I regretted it as soon as I did it. And even more later. I asked to go back to 2.5 but was asked to stick with 3. If tonight is a repeat do you think it would be ok to go back to 2.5? I admit I wanted to go up bc while off Vetoryl and spiranolactone he developed ketones (luckily not acidotic but the ER visit was traumatic for us both).
Also it’s not clear from my comments probably but he was slightly hyperkalemic on Friday. That combined with loss of appetite and general weakness, and significant weight loss despite same intake and better BG scared me that he’d tipped from Cushing’s to addisons. So I stopped his Vetoryl and soiranolactone and was off for the weekend of yellows into pinks. Sat am was the last of Friday nights Vetoryl and spiranolactone leaving his system. So far it's looking like it won't be a wild ride, but sadly may be more ketones and a trip to a different ER in the future. When my vet texted his stim test results she included her dry humor observation "not Addisons" . my hope is if we can get his K to a level with "cushion" we can try off spironolactone entirely and if needed just use K tablets because the spironolactone (IMO, she's not convinced yet) is screwing with his kidneys

 

[SmallestSparrow]

also again not clear what I've written...no sleep and little food for three days now, but Friday he was hyperkalemic, by Tuesday's stim test he was quite hypokalemic, in clinic today his potassium was the bottom of normal (3.5--a vast improvement) but with 3U tonight it could be quite a bit lower. which makes me think again of the rant that went on in my head but not out of my lips in the early hours of Wed in the ER (I won't say more because I desperately need a place to take him in an emergency) but I wanted to say "I don't think my library is the best place to treat a ketotic hyperglycemic hypokalemic cat"...not that me saying that would have done any good. so I could use positive thoughts from all as I attempt to not kill my cat.

 

[Wendy&Neko]

If you want to follow what the vet says for dosing, that is up to you. I'm just letting you know that eventually (not tonight obviously he's bouncing) 3.0 units will take him lower than you like him to be again. Jumping around dose the last few cycles might make it take a little longer to show it.

I get the concern about K. I did a high five when my current cat's blood work came back with K over 4! Instead of the low border she'd been hanging around. Idexx here, 3.7 is the low end of normal.

Tonight is your chance to get a good sleep. Try to do so.

 

[SmallestSparrow]

If you want to follow what the vet says for dosing, that is up to you. I'm just letting you know that eventually (not tonight obviously he's bouncing) 3.0 units will take him lower than you like him to be again. Jumping around dose the last few cycles might make it take a little longer to show it.

I get the concern about K. I did a high five when my current cat's blood work came back with K over 4! Instead of the low border she'd been hanging around. Idexx here, 3.7 is the low end of normal.

Tonight is your chance to get a good sleep. Try to do so.

might mean sleep (that was my first thought, followed quickly by "I can gulp down some cereal standing at the sink while making sure the other cat getting over pancreatitis is still eating). but the night is young and he likes the medium carb food a lot.

I'm not saying I want to stay at 3 (although also I don't want more 0.9 ketones and a frustrating trip to the ER), but I know not only my vet says stay put on a dose for a week but I think also people here. not that I totally follow rules anyway but I do listen to wise experience. so I was asking would he bounce more if I go back to 2.5? I was worried about that this am when I did 2.5 and when his numbers were bad I yet once again cursed my ability to always make the wrong decision. or anything else that would go wrong if I went back to 2.5? of course this is moot if he stays 400 all night. right now I think there's going to be issues anyway until the vetoryl gets a hand on his cortisol (I'll try to attach his test results, will need to change to my phone to do that. Re K--me sitting on the floor in my library (now cat hospice ward) insulin syringe in one hand, pill pocket with 1/4 Renal plus in the other (1/4 bc I was told to stop it so it was my compromise) thinking I'd never send a human home to do this at home like this. his K was 2.8. so 3.5 is good but if I believe the ER (not totally) his K Wednesday in the early hours was 4.0.

 

[SmallestSparrow]

also, my vet does half unit changes. I've considered cheating a bit since who would know...but while I may not follow rules I never lie. it's a Catholic thing. and I especially can't lie to my vet who has done so much for my boys. so changes are half units...at least for now. otoh ive seen A LOT of variation in syringes so I suppose I could get a slight alteration in dose just by changing brands. I bought some made in the US and want to change from my current made in Korea but don't want to add more uncertainty right now.

 

[Wendy&Neko]

0.9 ketones is lower than when we'd recommend a vet visit, more on a 'keep close eye on'. See the papers attached to the bottom of this thread. Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

After I switched to Lantus, dosing was my domain. The locum vet who switched me told me to follow what FDMB said. You are right about syringe variation. Even sticking with my BDs, the syringe weren't consistent. My girl was very sensitive to small changes, even less that 0.25 units. Odd for an acro.

 

[SmallestSparrow]

You are right about syringe variation. Even sticking with my BDs, the syringe weren't consistent

BD is the brand I want to change to…but: I noticed one had the first 5 units marked at an angle. Can’t win. But I do want to change anyway. Just hoping he settles down so I can.

Thank you for the link. The problem for me is 0.9 can be DKA although less likely than a higher number. So I have a lethargic cat who’s drinking a lot, peeing a lot, not eating, barely moving, dehydrated —plus significantly hypokalemic, with BG over 400 and ketones. I won’t share the entire process leading up to this point but when I asked the vet on duty how I was supposed to tell this isn’t DKA (so I don’t come into the ER…the only thing missing is fruity breath but I have no sense of smell) she said “his blood pH would be a acidic” “what was his pH?” I asked. She replied “we didn’t test that”. They drew his blood but tested only lytes and ketones (I think she assumed those would prove what I said was wrong). Anyway, I guess if I’m concerned in the future I will drive an extra half hour to the next closest ER. Started to remind me of vets accusing me of not giving my previous cat his insulin because he wasn’t responding to their dosing as he should. Adrenal tumors being rare no point in considering that maybe the pet parent isn’t lying
The Korean made ones I’m using are better than the Chinese ones I’d had before but sometimes the plunger is crooked

 

[SmallestSparrow]

After I switched to Lantus, dosing was my domain

Feel free to give me suggestions

 

[Heike & BInie]

Hi Colleen,

sorry to read that Methos ketones went up and so happy they are in a good range again. Sounds so stressful what you have been through. I don't have good advice but I keep you and your boys in my thoughts. Hope you can get some rest today and tonight!