New Member_MAF & Buster_Hello/Help_Post-DKA

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Madm4444

Madm4444

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I am so happy to have found you. Our journey has been fraught as of late so I haven't had time to do a formal spreadsheet, signature, etc. (I'm overwhelmed) but we need help. I have been intermittently compiling a background in the hope that you can help us.

Immediate crisis in BOLD below.

Buster (9 yo male orange tabby - adopted Feb 2019). Big eater. Gentle giant. Can be pet & held for very brief time but no cuddling or lap sits. Easily overstimulated by touch (previous life?). Sweet boy.

3/28/24. Annual physical. Weight down to 15lbs 3oz (highest = 16lbs). CardioBNP down to 52. Heart murmur unchanged. No intervention needed. Bg = 128 (IDEXX). All good but still needs to lose more weight.

Diet (at that time): 3 types of dry mixed together (indoor, uti, hairball) + prescription dental dry + UTI wet. Treats (greenies, Churu, Bravo freeze-dried meat, CatManDoo freeze-dried chicken sprinkles) - every day, several times a day. Same diet for years. No medications. Also, now struggling with constipation. Given a gel product at annual physical for bolus use then small amt for daily maintenance. The only change to diet.

5/23/24. Insane increase of water consumption & urination. Dx = sudden-onset DM. In vet's office, Bg = 483 (meter AT2) Bg = 508 (IDEXX); Wt = 15lbs.

Prescribed: 1u PZI; 2x/day; 12 hrs apart. Only 2 meals per day; Hills m/d only. All dry gone. Period. All treats gone. Period. We were devastated but followed the rules (very hard on Buster & us).

5/30/24. 1 week follow-up at vet. bg (+5) = 205 (AT2). We are all convinced it is the food & weight. Hoping if we keep everything tight, no insulin will be necessary.

Weekly checks thru June/July showed 160-174 (@ vet - all AT2; +5).

9/24/24 check @ vet. Bg = 122 (AT2). Wt = 14lbs 2oz. Down to 0.5 unit PZI.

10/25/24 vet check & dental. Bg = 138 (AT +5). Wt = 13lbs 15oz. We can take off insulin.

11/7/24. 2 weeks OTJ. Next check at vet. He was very scared after being left there last time & dental surgery. Very vocal on the drive. Bg = 161 (AT2). Same time of day.

11/18/24. Increased water & urination starts again. Lethargic. Vet office. Wt = 13lbs. 7oz. Bg = 509 (AT2). Given 1u PZI in office. Told to give 0.5u at dinner (6p). Back to former regimen: 1u PZI, 2x/day.

11/21/24. Won't eat. Can't give insulin. Lethargic. Call vet. Said possible DKA & to take to ER ASAP. We were at ER for 8 hours while they did a barage of tests including abdominal ultrasound, echo, x-rays, etc. Discovered liver tumor. Possible cause. Also pancreatitis. Scheduled surgery for 12/11. Bg = 500s; ketones = 1.6. Not DKA. Give fluids, anti-nausea. Home with maropitant (cerenia) & mirtazapine transdermal. Continue PZI, 1u. Wt = 12lbs 8oz.

11/23/24. Follow up with Internal Medicine (IM). Low potassium. Give potassium gluconate gel for home.

11/24-29/24. Lack of appetite but eating with extra prompting. Constipated & vomiting from pushing. In pain from constipation. Back to ER. Admitted. Impacted stool. 1 day in ICU to resolve. IV Humulin R. 4 days with IM to regulate bg with long-acting insulin. Discharged 11/29/24. Vetsulin, 4.5u. Added ondansetron to home meds. Moved liver surgery up to 12/4. [We did not know they would change the insulin. We were not happy.]

11/30-12/3/24. Home. Bg range = 300s to 500s using AlphaTrak3 (AT3) but we were taking at all different intervals (+11, +5, etc.). Didn't know about curves, nadir, anything.

12/4-7/24 . Liver surgery. Full abdominal incision. IV Humulin R until in post-op & transferred to IM for recovery & resuming Vetsulin. Decreased to 4u. Discharged. Added gabapentin, Miralax to home meds.

12/11/24. He was doing great considering it was major surgery. We did not do much testing during this time due to his recovery. Follow-up with IM to check post-op recovery & do glucose curve. Recovery going well. Curve: 850a-450p. 363, 327, 277, 267, 366. Had learned from FDMB that Vetsulin wasn't ideal so asked about switching back to PZI. Was told that it would be a setback & starting over. We did not want that so stayed the course. 4u Vetsulin. Liver biopsy = benign.

12/15/24. Everything was going well until it wasn't. Full crash. Wouldn't eat. Walked away from all food including treats & tuna. Lethargic. Not well. Similar to previous. Bg = 483 (AT3). Took to ER. Ketones = 3.6. Admitted for full DKA. Bloodwork also showed full panc episode. Bacteria in urine. We were so scared this was it.

12/15-16/24. Hospital. With ER / Critical Care depts to address DKA, panc. IV Humulin R. Antibiotics. Anti-nauseas. Pain meds. Everything.

12/17/24. Still in hospital. Transferred to IM dept for continued recovery & again to reintroduce insulin (Libre3). At this time, we said we wanted to go back to PZI. The dr said Buster would be in the hospital longer. We understood but at least it would be a medically supervised transition with the Libre3. He started with 4u (like the Vetsulin). 8am/8pm dosing. Libre reader. Reading taken every hour.

12/17/24. 4u PZI. Reader = HI. All day.

12/18/24. 4u PZI. Reader = HI. All day.

12/19/24. 5u PZI. Reader = HI. All day.

12/20/24. 7u PZI. Reader = HI until AM +5 to +8: high 300s then back to HI thru midnight (PM +4).

12/21/24. Significant drop to mid-100s to 200s throughout overnight hours prompted change to 6u at 8am. High 200s PMPS changed dose to 6.5u for 8p dose.

12/22/24 High 200s/low 300s overnight so kept at 6.5u at 8a.
We were picking him up at 2p. He was on antinauseas, antibiotic, gaba, miralax. As the tech was teaching me to use Libre, he dropped to 67 with low glucose alarm. No symptoms of hypo but she was clearly panicked & ran to get him food (FF & baby food). He ate it all & seemed fine. His numbers came up quickly on the drive home.

12/22-present. I have attached 2 sets of Libre graphs. 1 is clean. 1 has all my annotations, including doses, failing sensors, fur shot, etc. I know it's a lot but I'm hoping it will shed some light on what's happening b/c we can't figure it out.

After reviewing Libre data, IM dr said to increase to 7u PZI. We increased on January 4th 6am, nothing is working. Libre has been reading HI all day for 3 days with no drop below 350s.

1/5/25 Libre = HI; AMPS 560 (AT3) ketones 1.1 (NovaMax). But behavior, eating all fine for most of day. Increase in water, urination, & lethargy around +2-4 in both AM & PM

1/6/25. Libre = HI; AMPS 377 ketones 0.6. Same as above. But actually more active, engaged in the day.

1/7/25. Libre = HI; AMPS 494 ketones 0.6. This morning he is lethargic, drinking.

HELP! Should we be going to the ER right now?

We are only feeding 2x per day since December 30th b/c we can't get a handle on his bg. He is starving by the time he can eat. Yelling for it 1-2 hours before it's time. I long for the day when we have control, understanding where his values go with which foods so we can give him some healthy treats during the day. He misses his midday treats & I miss our time together when I gave them to him. It's tough when you are only seen as the 'shot-giver' & 'poker.'

I do not know where to go from here. I am trying to grasp the concept of bouncing. I am trying to keep ketones at bay with extra food in am/pm but am hesitant about feeding during the day b/c we don't understand his curve & are concerned about high bg from food all day. We can't seem to get any consecutive days where something doesn't go wrong (Libre fails, etc.).

Current diet (545-6a/545-6p):
1.5 cans FF pate (75% seafood; 25% chopped grill). [We did not want to introduce fish but it is what he ate ferociously in the hospital & eating is the linchpin so that's what we're doing right now.];
1 chicken churu tube (treat for brushing & teeth maintenance)

Current meds:
7 units PZI;
2mg ondansetron @am feeding;
12mg maropitant @ noon;
mirtazapine transdermal @pm feeding

Buster has been through so much in the past 2 months. For the nearly 6 years we've had him (he will be 10 yo on 1/15), he has had his annual physical & a couple of colds. And now this...

We don't know if this is a bounce or if we still don't have the right dose. I know the vet will just say to increase but I would feel more comfortable if I heard that from the people here who have the knowledge & experience. I'm worried that this long at these numbers is doing permanent damage (if it hasn't already). Any help would be greatly appreciated.

Questions:

Are cats typically miserable during a bounce?

How long should a dose be held until a response? Even if bg is high (no ketones) & water/urination increases & there is lethargy?

Should you feed mini-meals during a bounce? Or always feed in-between since he had DKA?

Are lower values considered a 'response' even if it is only a short time?

What is a 'breakthrough dose'?

Is it possible to be 'overdosing' on the insulin? Is there a way to get back to normal dosing (1-3 units)?

Should he be tested for IGF-1 & IAA?

Is this the wrong insulin?

Are there feline diabetes specialists?
 

Attachments

Last question first... I don't know of a subspecialty in feline diabetes. Diabetes is an endocrine disorder and endocrinology is a subspecialty of internal medicine. There may be IM vets who has a particular interest in feline diabetes but it will be hard to find someone. You may do better with a "cat only" practice. There are two cat specialty practices that I know of in Columbus. ''

Cats can be miserable during a bounce. The rapid, wide swing in blood glucose levels doesn't feel great.

How long you hold a dose depends on the dosing method you're using. Given your cat's recent history of DKA, we'd lean toward a more aggressive approach to dosing. There are yellow sticky notes at the top of the Prozinc forum. I'd encourage you to look those over, especially the note on dosing methods. Doses are increased or decreased based on what the blood glucose numbers look like. Again, based on the dosing method, a higher than desirable dose may be held for more or less time. There are 2 dosing methods with Prozinc -- Start Low Go Slow (SLGS) and the Modified Prozinc Method (MPM). The latter is the more aggressive approach to dosing.

We recommend feeding several small meals during each cycle. Generally, you want to not feed past nadir and you do not want to give food in the 2 hour period prior to shot time. (The only exception being if numbers are in a too low range.) It doesn't matter if your cat is bouncing. Especially in a cat with DKA, calories are important and more is better.

Most cats do not have an immediate and sustained response to insulin. Their numbers are up and down. It takes a while for their system to once again recognize what a normal blood glucose level is. It can take months for a cat to get regulated. It helps to remember that blood glucose is lower toward the middle of the cycle and then rises as the effect of the insulin starts to wear off. Thus, there's variability.

A "breakthrough" dose is when you see a sustained (lots of days) of normal range numbers. Whatever that dose is, your cat's pancreas likes it!

There is no such thing as a "normal" dose of insulin. What is normal for your cat may not be normal for another cat. Whatever dose it takes to get your cat into good numbers is the insulin dose that is good for your cat.

If your cat is consistently needing more that 5.5 - 6.0u of insulin then we'd recommend testing for acromegaly and insulin resistance.

Prozinc is a good insulin. It may not be the right insulin for your cat, though. The other option is glargine.

A few other issues... It will help us if you set up a spreadsheet and your signature. The information is in this post on helping us to help you. The spreadsheet will allow you to track Buster's progress. It will also allow us to follow along and make suggestions. Most of us will not make recommendations without seeing how your cat is responding to insulin. Your signature provides basic information about your kitty so we don't pester you by asking the same questions repeatedly.

DKA is a big issue and we are aggressive about it's management. You have undoubtedly spent a fortune on hospital bills. We'd like to help you keep Buster healthy and safe. Ketones develop due to an infection or inflammation + not enough calories + not enough insulin. This is a post about ketones and DKA.

Borrowing from one of the members here (@Bron and Sheba (GA)), these are recommendations regarding managing DKA:

  • you need to feed one and a half times as many calories as Buster normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If Buster won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,
  • Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
  • Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
  • Give antinausea medication if needed such as ondansetron or cerenia. A lot of post DKA kitties are nauseated
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Buster will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids
  • Set up a spreadsheet and test the BG frequently
  • Post daily with updates and ask for help as often as needed.
Click to expand...
Please let us know how we can help.
 
Thank you for your reply.
The Libre showed a reduction today from HI to 364 (+6) but only for a short time. Is that nadir given AMPS was 494?

Based on our info, does this pattern seem like a bounce from the Jan 3rd numbers or something different?

He is sleeping a lot today. Not sure if he doesn't feel well or b/c it's cold.

Since we aren't getting useful information with the Libre right now, what should be the minimum amount of testing we should do with AlphaTrak to determine if dose should change? [Please note that he requires 2 people for this task & is quite skittish after all the poking at the hospital.]

The last dose with an actual drop was 6.5u. Should we go back to that or are we asking for DKA trouble?
Or should we go up to 7.5u & hope for a response?

Sorry if I'm all over the place. As like many others, I'm not sleeping, eating, breathing very well these days/weeks...
 
Hi and welcome to the forum. My goodness you have all been through so much. You have come to the right place.:bighug:
If you could get the spreadsheet set up we will be able to help you a lot more. It is hard to help with dosing if we can’t see any data. I know you have given us data, and thank you, but it is so much better to see and assess in a spreadsheet:)
If you need help with the spreadsheet please let us know and we can ask @Bandit's Mom to help you.

Please feed him more than twice a day. He needs multiple snacks apart from the 2 main meals. This is very important he gets lots of food.
A snack is a teaspoon it two of normal low carb food.
Add a teaspoon of warm water to each snack. I’m sure he will feel better with more food aboard and be more settled.
Please follow all the suggestions Sienne gave you in point form.

Keep testing every day for ketones. It is very important we know how many ketones there are each day.
I would not reduce the dose of insulin unless the BG drops under 68 on the AT3.
Keep asking questions and post every day or more if necessary. I know this is a terrible time for you and we will help you as much as we can. Hang in there.:bighug:
 
Thank you @Bron and Sheba (GA) and @Sienne and Gabby (GA) for getting me through a tough night. I fed him a bit more & it definitely made a difference.

The IM vet reviewed the data. Based on the complete lack of movement for 3+ days at 7u & his clinical signs, she recommended 8u for last night's dose. As I am home with him all day, she felt that I could monitor him appropriately.

As much as that number scared me, I re-reviewed the PZI dosing methods @Sienne and Gabby (GA) referenced that said high dose kitties may need to move a whole unit. I also needed to reset my mindset that he is unique & needs what he needs, no matter where he was before (ECID). Much has happened & the only goal is to get him regulated & feeling better.

I gave the 8uS last night & we finally saw a response on the Libre around +6! This morning, AMPS 327 but I wasn't able to get ketones. The NovaMax Plus needs so much blood & we just couldn't get enough before he said 'no more!' Clinical signs are good which gives me a bit of relief.
8uS this morning. We shall see how the day goes...

I finally got my signature done. Now for the spreadsheet! I'm not sure which spreadsheet to use since we previously used AT3 then got Libre3 but still use AT3 for checks.
 
Madm4444 said:
Thank you @Bron and Sheba (GA) and @Sienne and Gabby (GA) for getting me through a tough night. I fed him a bit more & it definitely made a difference.

The IM vet reviewed the data. Based on the complete lack of movement for 3+ days at 7u & his clinical signs, she recommended 8u for last night's dose. As I am home with him all day, she felt that I could monitor him appropriately.

As much as that number scared me, I re-reviewed the PZI dosing methods @Sienne and Gabby (GA) referenced that said high dose kitties may need to move a whole unit. I also needed to reset my mindset that he is unique & needs what he needs, no matter where he was before (ECID). Much has happened & the only goal is to get him regulated & feeling better.

I gave the 8uS last night & we finally saw a response on the Libre around +6! This morning, AMPS 327 but I wasn't able to get ketones. The NovaMax Plus needs so much blood & we just couldn't get enough before he said 'no more!' Clinical signs are good which gives me a bit of relief.
8uS this morning. We shall see how the day goes...

I finally got my signature done. Now for the spreadsheet! I'm not sure which spreadsheet to use since we previously used AT3 then got Libre3 but still use AT3 for checks.
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I have just finished reading through your odyssey with your dear Buster. My cat also had a DKA. He had hepatic lipidosis due to not eating for days while he was in DKA (despite my alarms about it every single day.). He had an abdominal ultrasound and found irregularities in his liver. We decided to do an ultrasound guided fine needle aspiration of several suspicious places on his liver, which were benign. He had a feeding tube placed, which saved his life and allowed us to take him home after one week in the ER. I understand what you’re going through. My heart goes out to you!

I would love to take a look at any spreadsheet data you can provide and collect. If he has a Libre sensor, you should be able to fill in quite a lot of data. I would use the regular spreadsheet and put in the Libre data — then you can do spot checks when needed with the AT and just mark them with AT or an asterisk. I have people who have done this. Keep testing for ketones as best you can. I also bought a Nova Max Plus after my boy had DKA. You may need a slightly larger lancet if you’re having trouble getting enough blood.
 
It has taken a while but I finally completed Buster's spreadsheet with all the Libre data from the hospital and home.
We are now at 8u. We have tried to hold the dose long enough to know whether to increase (under vet advice). Unfortunately, we have had fur shots and terrible timing with sensors, etc. And when we are trying to be patient and his bg is so high, he is miserable, clearly not feeling well with significant increases in water consumption and urination (obvious clinical signs). Given his propensity for DKA, we are afraid to leave him in this state too long. I feel like we've missed his ideal dose several times and are on a terrible cycle. We are awaiting IGF-1 and IAA test results (prbly another week). We think that this may be the wrong insulin but want to get test results before making any decisions. I would appreciate any feedback.

@Sienne and Gabby (GA)
@Bron and Sheba (GA)
@Suzanne & Darcy
 
Just stopping by to give you a little support. My girl was positive for both IAA and IGF-1. We just had another one of our members send in blood for IGF-1 and IAA testing to MSU, and the results came back fairly quickly, both results back in 8 days.

Great job on the spreadsheet.

How is his activity level and appetite now?
 
Libre Bg @ 315 then 343 then 325 @330p. Similar late onset as previous days but still high & doesn't appear to be dropping much today. He gets his cerenia in a bacon pill wrap at 12p followed by CatManDoo chicken sprinkles in warm water. I know the wrap is all carbs & not good but it's the only way we can get it in him. Not sure how much that is impacting the response. He ate the same way on the previous 2 days. I just don't know what to make of the lack of curve. Too much insulin? Not enough? Too much food? Not enough?

His appetite is quite good but he is on Mirtazapine, cerenia & ondansetron so it's prbly artificial. But we can't take the chance that he won't eat while we try to figure this out so we really don't want to rock the boat there.

As far as activity, he's never been very active but when he is in HI mode, he's just blah. Unless he thinks he might get food, then he perks up. I guess that is a good sign. It's strange b/c there have been some days that his numbers were quite high but he was in good form.

At this stage, I can almost tell where his numbers are based on how he looks/feels. I'm hyper-focused on his ketones since the DKA. They have been ticking up these last few days. At 1.2 on NovaMax this morning. I know the literature says 2-2.5 is the tipping point but should I be concerned with the increase? He's blah but not 'DKA-blah' (if that makes sense).
 
Are you mixing water into his food? He needs as much water as he'll drink. Water can help flush out ketones. Tagging @Suzanne & Darcy to see if she has any thoughts about dose with increasing ketones.

I know what you mean about guessing how high they are by how they feel. Neko's eyes got glazed at high and she didn't do much. She started to play in the low 300's. I was so happy when that number moved down a lot!
 
Hi! Thanks for tagging me Wendy. I would love to help. You have been through sooooo much with your baby. Clearly, you love him a lot. I have to go out now to feed my feral cats before the sun goes down, but I will be back! I have been reading through your thread. It’s a lot to take in so forgive me if I ask you questions that you have already answered. See you now have a spreadsheet so I will be better able to help you. See you in a bit.
 
Madm4444 said:
It has taken a while but I finally completed Buster's spreadsheet with all the Libre data from the hospital and home.
We are now at 8u. We have tried to hold the dose long enough to know whether to increase (under vet advice). Unfortunately, we have had fur shots and terrible timing with sensors, etc. And when we are trying to be patient and his bg is so high, he is miserable, clearly not feeling well with significant increases in water consumption and urination (obvious clinical signs). Given his propensity for DKA, we are afraid to leave him in this state too long. I feel like we've missed his ideal dose several times and are on a terrible cycle. We are awaiting IGF-1 and IAA test results (prbly another week). We think that this may be the wrong insulin but want to get test results before making any decisions. I would appreciate any feedback.

@Sienne and Gabby (GA)
@Bron and Sheba (GA)
@Suzanne & Darcy
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Yes. If his test results come back positive, I would definitely switch to Lantus. It’s too bad Levemir isn’t being sold anymore because that would be the best insulin, but Lantus/glargine is very good. Back later
 
It’s confusing because your Buster has had a better response to insulin on lower doses, but right now, if he were my cat and as long as I were keeping close tabs on him (as you already are), I would increase to 9 units due to his ketones. Keep up the regular feeding throughout the cycle and keep him hydrated as much as you can with the extra water added to his food. With my boy, who had acromegaly, I often would see a dose seem to work well and then go “stale” after a short while. I had to keep chasing the better numbers with dose increases.
 
Wendy&Neko said:
Are you mixing water into his food? He needs as much water as he'll drink. Water can help flush out ketones. Tagging @Suzanne & Darcy to see if she has any thoughts about dose with increasing ketones.

I know what you mean about guessing how high they are by how they feel. Neko's eyes got glazed at high and she didn't do much. She started to play in the low 300's. I was so happy when that number moved down a lot!
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Yes, I always add at least 1-2 tsp warm water with FF. The water is also why I give the rehydrated chicken sprinkles (freeze-dried chicken) as a treat. It's basically a few tbsp of warm water with chicken pieces.
 
Suzanne & Darcy said:
Is this all Libre data? I can’t tell the difference between Libre data and AT data.
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I hope everything went well with the kitties!

I have identified when the AlphaTrak was used in the Remarks section. AT2 was used by my primary vet. AT3 used by me. Libre was used in the hospital and then by us when we got him home. Since most of the recent pre-shot readings have been HI on the Libre, we have also been taking AMPS/PMPS AT3 readings (along with ketones AMPS).

However, I have new reason to be freaked out. For the first time, his numbers are NOT going up - even after feeding (see spreadsheet). The PMPS was 203 on the Libre. Although lower than we have seen, we stayed consistent with dose b/c it always tends to skyrocket after eating. Also, we seem to get in trouble each time we mess with it. But now, I'm nervous. I was worried that he might be lethargic but then he played laser dot without any problems. I know that hypoglycemia is much lower numbers but these are low for him. Should I feed him something high-carb or wait to see if it goes up? He's sleeping now but the Libre is still sitting in 218 looking flat. My heart is racing...
 
I see he's drifting up now. There's been a few times this last while where his numbers have drifted down all the cycle, then he went up the cycle after. Looks like another one of those cycles today, but just down a bit lower at PMPS than the previous days. I think you are OK sticking with his regular low carb food at this point.
 
Wendy&Neko said:
I see he's drifting up now. There's been a few times this last while where his numbers have drifted down all the cycle, then he went up the cycle after. Looks like another one of those cycles today, but just down a bit lower at PMPS than the previous days. I think you are OK sticking with his regular low carb food at this point.
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Thanks, Wendy.
He has settled in to sleep. Bg 222. We haven't given him anything to eat since dinner (6 hrs ago). Do you think some low carb food (with water) is needed now or should we let him be?
 
I still think it looks like you need to go ahead and do the increase. You have some yellows, but nothing that is anywhere near dangerous and nothing you cannot handle if you need to steer numbers with food as long as you are available to monitor.
 
Suzanne & Darcy said:
I still think it looks like you need to go ahead and do the increase. You have some yellows, but nothing that is anywhere near dangerous and nothing you cannot handle if you need to steer numbers with food as long as you are available to monitor.
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Based on the latest spreadsheet, do you still think 9.0 or should we try 8.5?

I'm so upset with myself that I ran out of ketone strips since he's prone to DKA.

Quite honestly, between the supplies, meds & food (that he will eat) and monitoring/recording every pee, poop, gait/movement/activity, sleep amount/position, facial expression, brightness, etc., I'm pretty overwhelmed.

I desperately want him to feel better (esp. less water & peeing) & just don't know how to get there without him suffering in the 'HIs' every day while we figure it out.

I don't know how to feed him often enough to keep the ketones at bay and still see if the current insulin dose is working. Is it even possible?
 
Hi there. I am so sorry that you are struggling like this. I get it! You must be so worn out. I know what it’s like to give insulin and feel like it’s not doing anything. I looked at the spreadsheet data. I see you have a few blues. I still think you should try 9 units because you need to think of the increase in terms of a percentage of the dose. At 8 units, a ten percent dose increase would be 8.8 units. So that’s very close to 9 units. You could skinny up the 9 unit dose if you want to. With ketones in the picture, we tend to be a little more aggressive with dose increases. Even if there are no ketones in the picture, with cats who are insulin resistant, we need to really move on dose increases and not hold the doses for too long.
 
If you want to try 8.5 units, that’s okay too, but I would not hold the doses more than 6 cycles total if ketones are present— unless his numbers come down, of course. At least you did see a little blue on this current dose, but you have room to increase. Do whatever you are comfortable with.
 
Madm4444 said:
I don't know how to feed him often enough to keep the ketones at bay and still see if the current insulin dose is working. Is it even possible?
Click to expand...
Specifically related to this question…. Do you mean that you think feeding him a lot of food is raising his numbers so that you cannot tell if a dose is working? I would not stress over this because you are now feeding Fancy Feast pates, correct? They’re low carb and will not be raising his BG a whole lot. The feeding is most important. If you don’t want to feed late in the cycle, that’s okay, but keep up the calories over the course of the day and night.
 
Suzanne & Darcy said:
What did you decide to do tonight? I checked his SS and don’t see anything. Hope all is well.
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Hi. Thanks for checking on us. We're doing okay.
We decided to go with 8.5 last night.
I haven't uploaded the libre data yet. I use the reader, not the app. It's a bit of a process. The graph on the reader is small & hard to see but it looks like he went down to high 200s last night.
His AMPS was 384 (w/ AT3) this morning which was the best in a few days. We went with 8.5 again. We will see how today goes...
 
Suzanne & Darcy said:
Specifically related to this question…. Do you mean that you think feeding him a lot of food is raising his numbers so that you cannot tell if a dose is working? I would not stress over this because you are now feeding Fancy Feast pates, correct? They’re low carb and will not be raising his BG a whole lot. The feeding is most important. If you don’t want to feed late in the cycle, that’s okay, but keep up the calories over the course of the day and night.
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Yes, that was my exact question. And, yes, FF pates. Thank you. :)
 
Madm4444 said:
Hi. Thanks for checking on us. We're doing okay.
We decided to go with 8.5 last night.
I haven't uploaded the libre data yet. I use the reader, not the app. It's a bit of a process. The graph on the reader is small & hard to see but it looks like he went down to high 200s last night.
His AMPS was 384 (w/ AT3) this morning which was the best in a few days. We went with 8.5 again. We will see how today goes...
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Good. I like seeing a pink AMPS a little better than a red one. A yellow from last night (although I can’t see it on the SS) is good. Let’s work on getting those ketones down. When will your ketone strips be delivered? Let’s just hold the 8.5 dose for a few days then (6 cycles) and see how it goes.
 
Suzanne & Darcy said:
Good. I like seeing a pink AMPS a little better than a red one. A yellow from last night (although I can’t see it on the SS) is good. Let’s work on getting those ketones down. When will your ketone strips be delivered? Let’s just hold the 8.5 dose for a few days then (6 cycles) and see how it goes.
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Yes, 6 cycles is the plan.

The strips won't be here until some time tomorrow. I expedited shipping but got tripped up with the Monday holiday. Ugh.

Regarding ketones, is ANY a bad sign? Or are there ranges of significance?
 
So the ketone readings that you have gotten recently are not too bad. He’s even been below 1 a lot of the time so that is wonderful. Just keep doing what you are doing. With my cat, Darcy, his ketones started to go down even before his BG numbers came down very much. The difference was that he was getting more insulin (even though I was not seeing the lower numbers yet… I had to keep chasing the dose and making increases.) Even when his ketones were quite high, he never had another DKA, but I monitored him so closely. At the first sign of anything amiss (usually appetite loss and vomiting in our case) he was at the vet for bloodwork and usually antibiotics because his white count started climbing. Just keep watching for any signs of illness and keep testing. I am not worried with numbers 1 and below as long as he’s eating well with normal behavior.
 
Suzanne & Darcy said:
So the ketone readings that you have gotten recently are not too bad. He’s even been below 1 a lot of the time so that is wonderful. Just keep doing what you are doing. With my cat, Darcy, his ketones started to go down even before his BG numbers came down very much. The difference was that he was getting more insulin (even though I was not seeing the lower numbers yet… I had to keep chasing the dose and making increases.) Even when his ketones were quite high, he never had another DKA, but I monitored him so closely. At the first sign of anything amiss (usually appetite loss and vomiting in our case) he was at the vet for bloodwork and usually antibiotics because his white count started climbing. Just keep watching for any signs of illness and keep testing. I am not worried with numbers 1 and below as long as he’s eating well with normal behavior.
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The Libre showed no movement all day. We gave 8.5 last night to try a full cycle. No movement all night.
There was a lot of urine output yesterday. We're so concerned about how all the time waiting is affecting his kidneys.
We increased to 9 this morning.
 
Madm4444 said:
The Libre showed no movement all day. We gave 8.5 last night to try a full cycle. No movement all night.
There was a lot of urine output yesterday. We're so concerned about how all the time waiting is affecting his kidneys.
We increased to 9 this morning.
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I’m very glad you did. You’re correct that these high numbers are very hard on her kidneys. Lets keep moving forward with increases as needed because you are fully capable of handling any unexpected low numbers with the close monitoring that you do.
 
Suzanne & Darcy said:
I’m very glad you did. You’re correct that these high numbers are very hard on her kidneys. Lets keep moving forward with increases as needed because you are fully capable of handling any unexpected low numbers with the close monitoring that you do.
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Yesterday was quite the day.
No movement all day after 9 units.
At least now we know why: positive IGF-1 (>1200) and IAA (73?).
I have been looking at acro threads and have so many questions. :nailbiting:

But first, late last night the Libre kept going down. At 84, I wasn't comfortable so gave him some baby food mixed with FF pate. Took a little while but it started coming up. I'm not sure if that was the right thing to do but I panic when he drops that low after being high (PMPS 334).
AMPS 272 this morning. Hovering in the mid 350s now (+6).

I will plug the Libre numbers in the spreadsheet later this afternoon.

I guess I'll be moving over to the acro forum. Any insight into this next part of our journey from you (or anybody you might tag on our behalf) would be much appreciated.

Thank you again for helping us through all this!
 
Yes. Make a post on the Acro forum for advice about how to handle it. My boy was also an Acromegaly kitty. He did very well on Cabergoline and his dose came way down. I wanted to do the Stereotactic Radiation therapy (SRT,) but it was 2020 and COVID and I couldn’t get any response from North Carolina State University to my request for an appointment. He was up over 40 units at one point. Your cat will probably never need that much, I hope. Wendy will talk to you about treatment options. Hugs.
 
Suzanne & Darcy said:
Yes. Make a post on the Acro forum for advice about how to handle it. My boy was also an Acromegaly kitty. He did very well on Cabergoline and his dose came way down. I wanted to do the Stereotactic Radiation therapy (SRT,) but it was 2020 and COVID and I couldn’t get any response from North Carolina State University to my request for an appointment. He was up over 40 units at one point. Your cat will probably never need that much, I hope. Wendy will talk to you about treatment options. Hugs.
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Thank you!
At this stage, SRT is the way we want to go but I have a lot to learn.
In the meantime, as we try to find the right dose for now, if we have another low bg night like last night, is a small meal the right call?
 
Madm4444 said:
Thank you!
At this stage, SRT is the way we want to go but I have a lot to learn.
In the meantime, as we try to find the right dose for now, if we have another low bg night like last night, is a small meal the right call?
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Do you mean those 99 BGs from last night? Those were awesome! Love to see this! You can give a small amount of low carb food if you’re worried with a number like that (teaspoon or two). Those weren’t really early in the cycle so there’s less to worry about.
 
Wendy's Neko had SRT. Cabergoline wasn't available at the time.

I don't know how active the aero forum is. Typically, Lantus cats were switched over to Levemir due to Lantus stinging from its acidic nature. However, Levemir is no longer available in the US. I think people were posting in the Lantus forum.
 
Madm4444 said:
At this stage, SRT is the way we want to go but I have a lot to learn.
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If you post in the acro forum, we can help you with acro and IAA specific questions. Dosing questions tend to go into the insulin specific forums. Let us know what you want to know about SRT. I can point you to some other posts with lots of details on it.

Love those little greens for a couple nights ago!
 
Sienne and Gabby (GA) said:
Wendy's Neko had SRT. Cabergoline wasn't available at the time.

I don't know how active the aero forum is. Typically, Lantus cats were switched over to Levemir due to Lantus stinging from its acidic nature. However, Levemir is no longer available in the US. I think people were posting in the Lantus forum.
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Yes. I posted in the Lantus/Levemir forum on a daily basis, but if it was an acromegaly specific topic, I would post over on the Acro forum — especially questions about treatment, test results, Cabergoline, etc.
 
Suzanne & Darcy said:
Yes. I posted in the Lantus/Levemir forum on a daily basis, but if it was an acromegaly specific topic, I would post over on the Acro forum — especially questions about treatment, test results, Cabergoline, etc.
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Hi. Not sure where to post this (here, acro, prozinc?). Pls let me know where to go.

We started 10u today. Libre has stayed high and flat]. Could you pls check his spreadsheet & let me know your thoughts? Based on the past & the acro, how long should we be holding the dose?
Also, I think he may have some neuropathy. I've seen references to Zobaline. Is that the go-to treatment?
 
Yes. Zobaline is excellent. I used it. If you want, you can purchase Methylcobalamin and Folate separately and it will be a little less expensive. Can you give Buster a pill? If so, they’re quite small pills. I just gave them to Darcy straight, but he was so easy. I will look at your spreadsheet.
 
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I would have gone straight from 9 to 10 units. He’s at a high enough dose now that you can dispense with half unit doses for the time being. Later if you are fine tuning the dose maybe you will do that. I wouldn’t mess around with fat or skinny doses right now either. He needs more insulin based on his spreadsheet number. Since you were at 9.5 units for more than 6 cycles, how about just doing the increase to 10.5 units now? I would hold it for 6 cycles and unless you see blue numbers, increase again.
 
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