Just a confirmation that we all really need to always test for ketones!

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The next time you have a working monitor, I'd strongly suggest you be more aggressive on your dosing.

There's no reason to hold the dose more than 3 days if it's not getting him down where he needs to be.

Also, you should give the same dose both AM and PM....changing the dose screws with the depot and you're not going to get the best results.
 
Yes, we are going to be trying some different things. This, what we've been doing, is just not working.

The vet at the emergency hospital this morning gave 1.5 units and then 1.5 units before we came and got him at 6pm. He is right now at 234, down from what he was then.

The reason we hold a dose and don't know what to really do, is because there is partial insulin resistence going on and WHEN the 1.5 unit dose (for instance) works, it works ok / sometimes not so good / sometimes he goes towards hypo and is steered by food (when the monitor is on). But it just doesn't always work. So to increase a dose, it scares me as WHEN 1.5 works, what would 2 or 2.5 do?

There were still ketones in his pee right after he got home, but we called the hospital vet and asked and he said it was his first pee since last night so there would still be residual ketones. They also let him go home a day early as he HATES being in the hospital SO much it hinders his treatment. His ph was back to normal and so were all other values, and his ketones were apparently all flushed out.

He ate well when he got home and has had quite a bit of water.

So far he is ok, but I just continually live in fear of either hypo or keto. I seriously have PTSD from this, I really do.
 
Thank you! It is a NIGHTMARE of chronic stress. HE isn't stressful, but IT is. I love him. I hate IT.

Tonight for instance, unlike last night with his good PM numbers, straight after his dose he went HI on the monitor. NO effect and again, like I injected pure glucose, not insulin. It is bizarre. Even a fur shot does not do this.

I have since given him another 1 unit 4 hours after his initial PM dose to try to get SOME downward movement, as tomorrow we are switching him to Vetsulin / Caninsulin just to try SOMETHING since it has been 3 years of unregulation on Lantus and it's just not working anymore.

So tomorrow he can't have his AM Lantus as then it will overlap with the Vetsulin later, so giving this 1 unit booster now may help and won't hurt tomorrow. I can't stand the risk of being HI all night AND most of the day tomorrow.
 
No, this has happened randomly before and it shows in his behaviour. Much thirst and quieter than usual.

Even despite that extra 1 unit, he was still HI until 1am and then he went down slightly to 468 (26). At 5am he was 450 (25) and threw up. He was NOT himself.

We got a pee sample and it had trace ketones. He only JUST recovered from the last DKA crisis!

Back to the vet. Poor Dweezy was lethargic and breathing VERY fast. We went over to the emergency centre where we were the other night and to the specialist section, where they put him on fluids and also did an ultrasound as our vet thought he felt a mass that when palpated, Dweezil cried. The ultrasound revealed no mass thankfully, but his colon and stomach are inflamed, his kidneys are "showing his age" (9), his lymph nodes are enlarged and for some reason, despite being given 2 lots of long acting injectable antibiotics over the past 2 weeks, he has a mild fever.

Latest update is he ate well today, is off the rapid IV insulin and his glucose is 368 (still seems high to me), free of ketones and they are now starting the caninsulin but need to look into these other things and see how his night goes and how tomorrow goes in terms of a curve.

I thought we may have to say goodbye to him this morning. He was all sedated. Many tears.
 
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