I need eyes and help .....

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nancy and payne

nancy and payne

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Although I rarely post anymore I still read everything, it was just so nice to NOT have a reason to post, unlike now......

I'm not sure what to do next .....just a refresher.
Payne was Dx 3/10 and went right into DKA, then came home 10 days later and went back into DKA two days later and once more until we found the mix to stop it.

I changed her to TID and added R to the pzi and we found that and pred kept her ketones away, don't know why? Over a year ago, maybe 18 months ago we tried changing her to L but within 3 days she went back into DKA.

After 4 DKAs we had her TID with pzi 3.5u with 1uR and pred x2 daily. That stopped the DKAs and we checked urine/blood for ketones religiously. Over time I got rid of the R and tried to get rid of the pred BUT every time I did .... ketones! She never goes low and I was happy with the low 200s.

About 10 weeks ago her #s started climbing .... where we had lived in the low 200s we were in the high 300s. I had eliminated R almost a year ago and have the pred 2.5mg. every other day and she was on 3u pzi TID. whew!

I have tried adding the R back in but no matter what the dose she would bounce! We have tried everything and then started to go down in dose of insulin which scared me because she was always such a big gulper! She has not had ketones this entire time.

I finally went down to 1u TID and she is still in the high 300s with seemingly no nadir. We did a curve yesterday and her #s have been in the high 300s with no nadir, totally flat.

Today she is still in the 300s BUT is in MODERATE ketones, I would think the low doses of insulin. So the BIG question is .... what do I do now? She has been to the vet, every test run and his comment is .... "Well, her #s are high but she looks great, don't worry!" He is a great vet but Payne is so complex she puzzles him.

I have kept her out of DKA for a long time and it is the LAST place we want to go!!! The only thing that brings her ketones down is a lot of insulin and a lot of pred. What do I do? It seems as if her body needs less insulin but she needs more for the ketones.

I tried using R to bring her #s down but even a small amount made her bounce badly .... but I just gave her .5u R when I read her ketones today. ANY suggestions, thoughts, ideas, etc. would be welcome.

Nancy and Payne
(who is laying in the sun cleaning herself and looking GREAT!!)
and sorry Sue I keep a log on her now, not a SS anymore :(
 
Hi Nancy,

I'm so sorry this is happening, you have always amazed me with your superior care of Payne.

Have you sent a pm to Kim? I bet if the two of you put your heads together you could figure this out.

Scritches to Payne.

Robin
 
Wow, Nancy, you are the one I turn to for advice.....Could you give us an idea of the numbers you have been seeing for the last few days so we have some reference for what she is doing, numberwise. I am positive you will say no, but any chance the insulin is no good? Expiration date/floaties?
 
Her #s have been in the 300s for most of the past year and I figured it was the pred. BUT when I reduced the pred from 2.5mg daily .... we would start to see trace ketones. This was with a daily insulin intake of around 9u given TID daily.

Then she would nadir at about +5 and go into the mid 200s. For the past 10 weeks no nadir and she lives in the mid to high 300s. Every test has been run and my vet thinks she looks GREAT! and is astounded she is still alive, so I shouldn't worry so much about the #s.

Well we all know high #s shut down kidneys and other horrible things. On the other hand even with moderate ketones she looks good and is acting normal. I on the other hand am not :)

Any thoughts would be welcome.
Nancy
 
nancy and payne said:
Her #s have been in the 300s for most of the past year and I figured it was the pred. BUT when I reduced the pred from 2.5mg daily .... we would start to see trace ketones. This was with a daily insulin intake of around 9u given TID daily.

Then she would nadir at about +5 and go into the mid 200s. For the past 10 weeks no nadir and she lives in the mid to high 300s. Every test has been run and my vet thinks she looks GREAT! and is astounded she is still alive, so I shouldn't worry so much about the #s.

Well we all know high #s shut down kidneys and other horrible things. On the other hand even with moderate ketones she looks good and is acting normal. I on the other hand am not :)

Any thoughts would be welcome.
Nancy
Click to expand...

That's just plain ridiculous. and no moderate ketones is not something to be ignored.why is Payne on Prednisone?
 
okay I just re-read your post and from what I am seeing the reason she is on prednisone is soley to keep ketones away????not for any other reason? Seriously? Did your vet tell you to do this? The one time I gave Alex(who is VERYYYYYYYYY ketone prone) a 5mg prednisone by mistake instead of his thyroid pill he went soaring into the 500's and it took over 24 hours for him to come down. I cried the whole time. Thank goodness my vet is my ex bf or I would have gone nuts at myself.

Are you sure that's not the reason your kitty needs so much insulin?
 
She is on pred for the ketones. After the third DKA I read in some journal that pred had worked on some dogs to deter ketones and we tried it on Payne because what did we have to lose? It worked! With high doses of insulin and pred daily, no ketones and that worked for the past year until she started running really high #s and nothing helped BUT no ketones.

The weird thing was when I decreased her insulin to 1u BID her #s still stayed in the 300s but the very low 300s,
lower than she has been in 10 weeks.
 
hi nancy. marje asked for additional sets of eyes...

first off, i want to qualify my remarks by saying i have never used any of the P insulins. however, i am familiar with R, ketones, and their treatment. i do have a couple questions. please forgive me in advance if i should already know the answers. i don't get over to this forum often.

  • has payne ever been tested for a high dose condition (acromegaly, IAA)?
  • have you ever dosed in microdoses of R rather than in increments of 0.5u or more?

high, somewhat flat numbers despite higher doses of insulin could be a sign of a high dose condition.

when using R, the idea is to simply take the edge off the numbers so the basal insulin has a little lower starting point. you'd want to see a drop of only 50 - 100 points maximum from R. anything more than that usually sets up a bounce. in other words, the idea is to use the R sparingly. in some kitties, a mere 0.1u of R can drop kitty a 100 points or more. that's why i was wondering if you've ever administered less than 0.5u of R at a time.

and a shot in the dark...
has payne been tested for hyper-t? many vets miss the diagnosis if they solely rely on the results of the T-4 test. a T-4 and a Free T-4 ED is a better combo for diagnosing hyper-t.

as far as the pred goes... i've not heard of using pred to combat ketones. like caryl, i would expect pred to raise her numbers.
 
Hi Nancy -

It seems odd advising you about R, since it was you that coached me when I first started using it. Like Payne, Grayson doesn't do squat with small amts of R. No action til he gets 2-3u.

Any chance her body has built up a resistance to Pred over this time? I know in humans they don't like to use it for prolonged periods, though I know several people who have. They tend to have issues with their teeth, rectal bleeding, all kinds of things.

Is there anything else, maybe an antibiotic you could add in low doses to fight off the ketones?

Are you giving fluids?

Remind me how old she is too.
 
I don't think she has ever had a test for hyper-T .... I understand the roll of R but because she has always been a big gulper, I have needed to use .5-1u with her 3-4u pzi (TID) when we were battling ketones before but have not had to use R in over a year.

She did have an acro test last year because my vet thought her insulin dosage was high, was neg. Also Payne has never dropped a lot, ever. Even when using R 3x a day, a drop at nadir of 50 pts. was all I could ever get.

She had her first 3 DKAs at UC Davis Vet school and NO ONE could understand why the pred helped her ketones, but by the 3rd DKA EVERYONE said give her pred! ohmygod_smile

She is a very complex cat but she is a fighter and we will get past this, thanks everyone!
 
I did a re-boot with Grayson back in about March or April. Went from 6u to 3u to 2u. He did about the same on all of them - actually a little bit better. But then came another ketone scare and we climbed back up again. You said UC-D did the Acro test (I'm guessing they did IGF-1 and sent it to Michigan State). Any chance they did the IAA test (for insulin resistance). She's not as high as some of our IAA kitties, but it might be an explanation. After all this time, she could've broken through the resistance, but I would think she'd have been more flat, like Grayson was. We were excited if we saw 50 points of movement while he was "swimming in a sea of pinks". And at this point, I don't know that the test would do anything.

Anything you could try in lieu of the pred?
 
i understand.
i only asked about R doses because of your comment about small amounts of R causing her to "bounce badly".
perhaps a lesser dose of R would help pull numbers down without causing a bounce.
 
I had cut out the pred at one point, maybe 6 mos ago and we started to see trace on the urine ketone strips and have settled in at 2.5 mg. every other day and that seemed to work, no ketones as long as her insulin was at about 9u a day and yes she is a big gulper :)

Payne is 6 now, was 4 when she was Dx. She looks good and is full of energy, even with moderate ketones. Just pushed her civvie Tommy out of the chair she wanted. Her weight is almost over-weight and her eyes look good, not like she has ketones.
Nancy
 
Hi Nancy, sorry to read about Payne and the sudden change in her numbers.

A few thoughts regarding what is going on. First, she seems so similar to my Kitty, who was also dosed prozinc tid at 3 to 3.5 units. Kitty never had much of a nadir and stayed pretty flat-- in my mind, I related it to gas in a car-- the tank always stayed half full! The amount of PZI sayed pretty much the same in her body 24 hrs a day. She never really had a nadir-- because the insulin stayed constant. But, occasionally I would catch wonky continuous higher cycles for her- 300s---that would sometimes last days. So, I would start testing more.....AND, on occasion, I caught a low number that would explain the high flat cycles. I would become complacent in testing and her numbers, as long as she stayed in the low 200s. But, when I saw consecutive preshot numbers in the 300s-- I knew somethIng was wrong and would start testing. More times than not I would catch a low number-- causIng a bounce and explaining the higher numbers.

I say to stick with your normal tid dose and keep her tested. She needs more insulin to ward off the ketones-- even if I had to feed a higher carb food- I would do so to give her more insulin.

If she is hyper T- you would expect a BIG appetite and weight loss. I had Kitty checked for that also--- she was negative!

Good Luck to you.
 
The big appetite could be caused by the prednisone.....it causes people to gain weight and is often given to sick animals to improve their appetites. It also causes a false sense of well being. This is is veryyyyyy complex drug. Just saying . I really don't mean to cause any harm but I want you to know and be aware of exactly what prednisone is if you aren't already. Every time Alex gets sick with something (even when his arthritis flares up) I always hear "normally I would try pred first to get the inflammation down, but naturally not on a diabetic"..... :(

If it were me and my cat, I would try everything else first. Honestly and sincerely. Because it took me soooo long and I had sooo much trouble getting myself off prednisone. And I wouldn't make that public if I didn't care so much. :oops:
 
I truly understand the dangers of using pred .... trust me on that. I have tried reducing/ending pred using SQ fluids (50 ml x2 daily) and 9-12u of insulin but only to have the ketones start up again, EVERY TIME!

As my Grandma used to say, "Sometimes you don't get to chose the devil you dance with." My GREAT fear is DKA. We can go there so quickly and be almost dead within an instant, after we start seeing ketones. SQ fluids don't dilute them enough and R won't chase they away, what is my choice? I know the pred helps her appetite, but she has ALWAYS loved her food!

I am going back to 3u TID and a drop of R until the ketones drop. I will do SQ fluids tonight (I am in CA) But what do I do about her being in the 300s? I checked her records and she did have a hyper-T test 13 mos ago, neg. She is very complex .... four different doctors have made the say goodbye speech to us, it's not going to happen! she is a young cat with a huge will to live, I need to figure this out. Thanks everyone! ANY thoughts welcome.

Nancy and Payne (who is tired of testing and wants to be left alone!)
 
Poor Payne! :evil:

I know they don't enjoy it, but they do feel so much better when we can help them. But who can reason with a kitty? ;-)

I think your plan sounds good. Good luck to you both! Keep us posted.

Lu
 
nancy, if you will update your ss with the last couple of weeks of numbers the PZI gurus may be able to help you with dosing. as you know (generally speaking) the presence of ketones indicate an inadequate supply of insulin. under similar circumstances, in the lantus TR group we suggest increasing the dose even if it means feeding higher carb foods to prevent kitty from bottoming out.

you mentioned giving sub-q fluids hasn't been effective. if payne is throwing moderate ketones it would probably be best if she's given IV fluids by a vet.

just throwing a few thoughts out there for your consideration...
 
Nancy

Thyroid levels can change quickly. They can be normal for a long time even if a cat is exhibiting symptoms of hyper-T (and I'm not saying Payne is but some cats do). I would have my vet run not only a free and total T4 (ED) but also a free and total T3.
 
Nancy it sounds like a plan but please keep us updated. Are u 100% sure there are no other infections? Dental problems? ANYTHING that can be causing this raise in bg? If not? Have you ever considered trying levemir? A lot of high dose kitties do very well on it. Although it don't recommend it to 99% of anyone-i mean what i do- i shoot tid with levemir...
 
Thanks to everyone for your time, I appreciate it. The vet checked for infection, ran cultures, etc. neg. Teeth are fine and everything else is good but I will have the thyroid tests redone.

I'm really good at dealing with ketones but if I think I see problems, she's at the vets on a drip :)
Nancy
 
Today is a MUCH better day!
Yesterday I went back to shooting 3u TID with a drop of R and MAGIC! her ketones are dropping and so are her numbers. I gave her 50 ml SQ fluids last night and this morning but she is like, LEAVE ME ALONE!! I feel fine :)

My goal is to do away with the pred as soon as we get through this .... I want to thank everyone for there help, it is always much appreciated!
Nancy and Payne
 

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Cute picture of her! I've never seen anything but her avatar.

Glad she's feeling better. Maybe she just wanted to shake up her dose a little - and keep you dancing on your toes! :lol:

She just loves a big gulp of ProZinc, doesn't she? ;-) (although it's nothing compared to G's dose!) :shock:
 
Hi Nancy

Just checking in on you and the most beautiful Payne....love her picture. I'm glad she's doing better. How did the thyroid test pan out?
 
Nancy - How's Payne doing? RE: pred - aren't you supposed to reduce that gradually? Or can you safely cut it out cold turkey?

Hoping she's cooperating... keep us tuned in!

Lu
 
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