NEW MEMBERS - Ketone dancer kitty, dosing advice?

[Niko's Mom]

Hi all,

We recently had our lovely 2.5 year old Niko diagnosed with diabetes after a round of steroid shots. Niko has otherwise been a healthy cat but had steroids for his allergies and itching.

We have been having a whirlwind with his diagnosis. Originally, we tried a diet change because Niko's numbers were between 220-280. He has had on and off ketones throughout - I am able to smell them and also we are using urine sticks every day to test.

A week ago, he had rising ketones (up to small in urine) but was presenting fine - eating, drinking, playing, not lethargic, normal stools. We took him to the ER because of a risk of DKA. He was at 6.9 blood ketones but was otherwise completely normal. The vets were stumped but sent us home with subq fluids and we started on Lantus that day.

We started him at 0.5units and it cleared his ketones up within 12 hours.

Now, a week later, he is back at small amounts of ketones in his urine (I don't have a ketone blood meter but I can assume he is probably back to 6.9-7 in his blood, based on how much is spilling into his urine). He has that acetone breath as well, like last time.

I took Niko to a regular vet yesterday out of fear of DKA. He seemed fine, they have sent off his blood and urine for cultures -- I also asked to run a fPL test to see if it's pancreatitis.

I guess I am trying to see if anyone has had similar experiences. Niko does not have any symptoms despite rising ketones - he is urinating and has normal stool, drinking a lot, we have upped the carbs in his food to hopefully drive down the ketones, added water etc. Playful and alert.

I have upped his dose now to 0.75units. Note, he doesn't seem to go over 350 in his BG levels, so I am wary of upping the dose too much in case he goes hypo. The vets are making me feel crazy for being concerned because he isn't presenting clinically.

Has anyone every had a cat that runs extremely high in ketones but show no physical symptoms? I was told maybe it's a UTI or pancreatitis, or even EPI (Endocrine Pancreas Inefficiency). Once again, no symptoms from Niko to support these diagnoses.

I saw a story posted by @Lisa & Oberon about Oberon having high ketones but presenting fine.

I'm a little bit at my wit's end because I'm super worried about Niko and feel like he might turn at any time.

Thanks.

 

[CORKY]

Hi all,

We recently had our lovely 2.5 year old Niko diagnosed with diabetes after a round of steroid shots. Niko has otherwise been a healthy cat but had steroids for his allergies and itching.

We have been having a whirlwind with his diagnosis. Originally, we tried a diet change because Niko's numbers were between 220-280. He has had on and off ketones throughout - I am able to smell them and also we are using urine sticks every day to test.

A week ago, he had rising ketones (up to small in urine) but was presenting fine - eating, drinking, playing, not lethargic, normal stools. We took him to the ER because of a risk of DKA. He was at 6.9 blood ketones but was otherwise completely normal. The vets were stumped but sent us home with subq fluids and we started on Lantus that day.

We started him at 0.5units and it cleared his ketones up within 12 hours.

Now, a week later, he is back at small amounts of ketones in his urine (I don't have a ketone blood meter but I can assume he is probably back to 6.9-7 in his blood, based on how much is spilling into his urine). He has that acetone breath as well, like last time.

I took Niko to a regular vet yesterday out of fear of DKA. He seemed fine, they have sent off his blood and urine for cultures -- I also asked to run a fPL test to see if it's pancreatitis.

I guess I am trying to see if anyone has had similar experiences. Niko does not have any symptoms despite rising ketones - he is urinating and has normal stool, drinking a lot, we have upped the carbs in his food to hopefully drive down the ketones, added water etc. Playful and alert.

I have upped his dose now to 0.75units. Note, he doesn't seem to go over 350 in his BG levels, so I am wary of upping the dose too much in case he goes hypo. The vets are making me feel crazy for being concerned because he isn't presenting clinically.

Has anyone every had a cat that runs extremely high in ketones but show no physical symptoms? I was told maybe it's a UTI or pancreatitis, or even EPI (Endocrine Pancreas Inefficiency). Once again, no symptoms from Niko to support these diagnoses.

I saw a story posted by @Lisa & Oberon about Oberon having high ketones but presenting fine.

I'm a little bit at my wit's end because I'm super worried about Niko and feel like he might turn at any time.

Thanks.

@Sienne and Gabby (GA)

 

[Diane Tyler's Mom GA]

Hi all,

We recently had our lovely 2.5 year old Niko diagnosed with diabetes after a round of steroid shots. Niko has otherwise been a healthy cat but had steroids for his allergies and itching.

We have been having a whirlwind with his diagnosis. Originally, we tried a diet change because Niko's numbers were between 220-280. He has had on and off ketones throughout - I am able to smell them and also we are using urine sticks every day to test.

A week ago, he had rising ketones (up to small in urine) but was presenting fine - eating, drinking, playing, not lethargic, normal stools. We took him to the ER because of a risk of DKA. He was at 6.9 blood ketones but was otherwise completely normal. The vets were stumped but sent us home with subq fluids and we started on Lantus that day.

We started him at 0.5units and it cleared his ketones up within 12 hours.

Now, a week later, he is back at small amounts of ketones in his urine (I don't have a ketone blood meter but I can assume he is probably back to 6.9-7 in his blood, based on how much is spilling into his urine). He has that acetone breath as well, like last time.

I took Niko to a regular vet yesterday out of fear of DKA. He seemed fine, they have sent off his blood and urine for cultures -- I also asked to run a fPL test to see if it's pancreatitis.

I guess I am trying to see if anyone has had similar experiences. Niko does not have any symptoms despite rising ketones - he is urinating and has normal stool, drinking a lot, we have upped the carbs in his food to hopefully drive down the ketones, added water etc. Playful and alert.

I have upped his dose now to 0.75units. Note, he doesn't seem to go over 350 in his BG levels, so I am wary of upping the dose too much in case he goes hypo. The vets are making me feel crazy for being concerned because he isn't presenting clinically.

Has anyone every had a cat that runs extremely high in ketones but show no physical symptoms? I was told maybe it's a UTI or pancreatitis, or even EPI (Endocrine Pancreas Inefficiency). Once again, no symptoms from Niko to support these diagnoses.

I saw a story posted by @Lisa & Oberon about Oberon having high ketones but presenting fine.

I'm a little bit at my wit's end because I'm super worried about Niko and feel like he might turn at any time.

Thanks.

@Bron and Sheba (GA)
@Wendy&Neko
@Bandit's Mom
@Sienne and Gabby (GA)
@Chris & China (GA)

Can you please look at her Spreadsheet
Besides reading her introduction post could you please read her post #7

She's from the Feline Diabetes Facebook Group
In post 7 she is wondering if she should switch to TR because of the high ketones

 

[Diane Tyler's Mom GA]

@ana_stark
Can you set up what we call our signature it's information we need about Niko
Tap on your name up top then tap on signature
Please set up your signature

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Bexacat or Senvelgo (if applicable) and dates
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Thank you!

You will see it at the end of everyone's post in gray letters

Can you set up our spreadsheet where we enter our cats BG numbers This link will tell you how to set it up and how to use it
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

 

[Niko's Mom]

@ana_stark
Can you set up what we call our signature it's information we need about Niko
Tap on your name up top then tap on signature
Please set up your signature

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Bexacat or Senvelgo (if applicable) and dates
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Thank you!

You will see it at the end of everyone's post in gray letters

Can you set up our spreadsheet where we enter our cats BG numbers This link will tell you how to set it up and how to use it
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

I've updated my signature, it should show up now. I have a pre-existing spreadsheet for Niko which I have included in the signature. it should be viewable. Thank you.

 

[Diane Tyler's Mom GA]

I've updated my signature, it should show up now. I have a pre-existing spreadsheet for Niko which I have included in the signature. it should be viewable. Thank you.

Hi Ana signature looks great , I don't think this is our spreadsheet though. Take a look at mine Tyler's. Even though he passed 4 months ago you can see what it looks like. He was in remission for 3 years and 4 months , passed away from cancer
You can tap on my tabs from 2021 and the rest

Your spreadsheet is hard to look at ,do you think you can create ours
@ana_stark

We like to use US numbers since most of our members are from the US

Ana one other thing there are 2 dosing methods for Lantus one is called SLGS and the other TR
Both will tell you when an increase or decrease is needed.
Here is the link so you can read about them and add it to your signature for now and then when you create our spreadsheet
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Niko's Mom]

Hi Ana signature looks great , I don't think this is our spreadsheet though. Take a look at mine Tyler's. Even though he passed 4 months ago you can see what it looks like. He was in remission for 3 years and 4 months , passed away from cancer
You can tap on my tabs from 2021 and the rest

Your spreadsheet is hard to look at ,do you think you can create ours
@ana_stark

We like to use US numbers since most of our members are from the US

Ana one other thing there are 2 dosing methods for Lantus one is called SLGS and the other TR
Both will tell you when an increase or decrease is needed.
Here is the link so you can read about them and add it to your signature for now and then when you create our spreadsheet
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

thanks so much for your help. ive created the new spreadsheet using the template provided, it is now in my signature. I took a read through the SLGS/TR information and it looks like, based on my time in the Feline Diabetes Facebook group, I adopted the SLGS approach. But now, given his rising ketones, I wonder if I should do TR with him - more aggressive increases? Your insight would be beneficial.

Thanks so much.

 

[Diane Tyler's Mom GA]

thanks so much for your help. ive created the new spreadsheet using the template provided, it is now in my signature. I took a read through the SLGS/TR information and it looks like, based on my time in the Feline Diabetes Facebook group, I adopted the SLGS approach. But now, given his rising ketones, I wonder if I should do TR with him - more aggressive increases? Your insight would be beneficial.

Thanks so much.

Looks great, Ana I really am not experienced enough to give dosing advice but to me I think TR would be a good choice , let's see what the members I tagged have to say ok
@ana_stark

 

[Diane Tyler's Mom GA]

Ana was there a reason you weren't giving any insulin on Dec 27 thru Jan 5 th
@ana_stark
Just figured it out you tried the diet change first
Anyway you can get a few more tests in during the day and night. I assume you work , if you do can you get one when you get home . At night try and get a +4 and +6
Mix up the testing times up when you can

 

[Niko's Mom]

Ana was there a reason you weren't giving any insulin on Dec 27 thru Jan 5 th
@ana_stark
Just figured it out you tried the diet change first

yes, diet change first. recommended by our vet because his numbers were so low they didn't think he needed insulin. low and behold, he starts pushing out ketones.

he's still at a 'small' in his urine right now but eating, playing, acting fine. just like when we were at the ER vet last week, which prompted us to start insulin.

 

[Diane Tyler's Mom GA]

yes, diet change first. recommended by our vet because his numbers were so low they didn't think he needed insulin. low and behold, he starts pushing out ketones.

he's still at a 'small' in his urine right now but eating, playing, acting fine. just like when we were at the ER vet last week, which prompted us to start insulin.

Ok I understand
Anyway you can get a few more tests in during the day and night. I assume you work , if you do can you get one when you get home . At night try and get a +4 and +6
Mix up the testing times up when you can

 

[Niko's Mom]

Ok I understand
Anyway you can get a few more tests in during the day and night. I assume you work , if you do can you get one when you get home . At night try and get a +4 and +6
Mix up the testing times up when you can

ok, i wont be able to tonight as i'm doing a double shift but ill get some tomorrow as im home all day. will aim to get a +4 and +6, which is probably close to his nadir.

thank you. he just showed up as trace in his urine, so looks like something is happening (positively).

 

[Diane Tyler's Mom GA]

ok, i wont be able to tonight as i'm doing a double shift but ill get some tomorrow as im home all day. will aim to get a +4 and +6, which is probably close to his nadir.

thank you. he just showed up as trace in his urine, so looks like something is happening (positively).

Ok you're doing a great job Ana

 

[Diane Tyler's Mom GA]

@ana_stark
Do me a favor in your title I want you to put NEW MEMBERS in front of Kitty with high ketones .
To do this tap on the word Thread Tools to the right then tap on Edit Title and add that then tap save
Was that trace of ketones just now, if so add it in the remarks section on the SS
Just wondering are you from Canada

 

[Niko's Mom]

@ana_stark
Do me a favor in your title I want you to put NEW MEMBERS in front of Kitty with high ketones .
To do this tap on the word Thread Tools to the right then tap on Edit Title and add that then tap save
Was that trace of ketones just now, if so add it in the remarks section on the SS
Just wondering are you from Canada

Thank you for your help and kind words. Added his ketone trace to today’s date remarks section and changes the title of this thread.
Yes, I’m from BC, Canada!

 

[Bron and Sheba (GA)]

Hi and welcome Ana and Niko to the forum.
It’s great you are so well organised with the spreadsheet, signature, hometesting and test ongoing ketones. Well done!
It looks as if you are doing everything right.
How much food are you feeding Niko.? With ketones in the picture you need to be feeding more food than you normally do. Up to 1 and 1/2 times as many calories. . Offer the 2 main meals and then lots of snacks during the day and evening. The snacks are normal low carb food…a teaspoon or two of food. And if Niko will allow you to, I would add a teaspoon of warm water to each snack.
It is food and insulin which will combat the ketones. And fluids.

Are you able to get any more tests in during the cycles? Lantus dosing is based on the nadir not the preshot, so you can see why we need to see those BGs taken during the cycles. And don’t forget the pm cycles as well, they are just as important. Keep asking questions and posting every day. We are happy to answer any questions and will help you get Niko back to good health.

 

[Niko's Mom]

Hi and welcome Ana and Niko to the forum.
It’s great you are so well organised with the spreadsheet, signature, hometesting and test ongoing ketones. Well done!
It looks as if you are doing everything right.
How much food are you feeding Niko.? With ketones in the picture you need to be feeding more food than you normally do. Up to 1 and 1/2 times as much. Offer the 2 main meals and then lots of snacks during the day and evening. The snacks are normal low carb food…a teaspoon or two of food. And if Niko will allow you to, I would add a teaspoon of warm water to each snack.
It is food and insulin which will combat the ketones. And fluids.

Are you able to get any more tests in during the cycles? Lantus dosing is based on the nadir not the preshot, so you can see why we need to see those BGs taken during the cycles. And don’t forget the pm cycles as well, they are just as important. Keep asking questions and posting every day. We are happy to answer any questions and will help you get Niko back to good health.

hi thank you for your reply! I’ve been feeding him like crazy for the last couple days. He is eating lots. I’ve been mixing some higher carb FF pates and gravies with his low carb tiki mousse pouches, adding water. I’ve also added Boulardii probiotics, some nutri-lys powder. I’ve been giving him extra treats and some kibble to increase his appetite.

I will do my best to get some more cycle data, especially tomorrow as I am home. I guess I’m just trying to understand if .75 is too low of a dose for him since his ketones keep spiking. I know it’s hard to tell since we haven’t been able to get constant nadirs but I’m just worried.

he’s a special case in that he can dance with ketones of up to 7 and not display any DKA or worrisome symptoms. This is causing me a lot of confusion.

his urine and blood have been sent off to a lab for culture. We also asked for a fPL test. I’m just wondering if it’s an infection brewing or that the ketones are because his dose is so low.

 

[Bron and Sheba (GA)]

will do my best to get some more cycle data, especially tomorrow as I am home. I guess I’m just trying to understand if .75 is too low of a dose for him since his ketones keep spiking. I know it’s hard to tell since we haven’t been able to get constant nadirs but I’m just worried.

Lantus is a depot insulin and it takes 3 days for each dose increase to take full effect. So it will take 3 days for us to see what the 0.75 dose will do. It is probable it won’t be enough insulin but you can’t rush with increases. With ketones the picture we can be a bit more aggressive but please try and get at least one test in during every cycle.

Other things to watch for with ketones in the picture, which can indicate if we need to be concerned are lethargy, loss of appetite, vomiting, diarrhoea, excessive drinking. These are all red flags which will alert you that he would need to see a vet.

I think it is a good idea to check for pancreatitis, or any other infection. That would need to be addressed asap if something was found.

In the meantime, keep up the extra food, fluids and test daily for ketones.

 

[Niko's Mom]

Lantus is a depot insulin and it takes 3 days for each dose increase to take full effect. So it will take 3 days for us to see what the 0.75 dose will do. It is probable it won’t be enough insulin but you can’t rush with increases. With ketones the picture we can be a bit more aggressive but please try and get at least one test in during every cycle.

Other things to watch for with ketones in the picture, which can indicate if we need to be concerned are lethargy, loss of appetite, vomiting, diarrhoea, excessive drinking. These are all red flags which will alert you that he would need to see a vet.

I think it is a good idea to check for pancreatitis, or any other infection. That would need to be addressed asap if something was found.

In the meantime, keep up the extra food, fluids and test daily for ketones.

thanks so much for this. I’ll keep up what I’ve been doing.

couple questions:

if his pre shot BG drops to below 200 (after re-testing etc) do I still administer the full .75?

once I’ve gotten some data for the 3 days from now, where can I post to get my dosage evaluated to see if we will need to increase it?

 

[Diane Tyler's Mom GA]

@Bron and Sheba (GA)

Bron and Sheba (GA) said: ↑
Lantus is a depot insulin and it takes 3 days for each dose increase to take full effect. So it will take 3 days for us to see what the 0.75 dose will do. It is probable it won’t be enough insulin but you can’t rush with increases. With ketones the picture we can be a bit more aggressive but please try and get at least one test in during every cycle.

Other things to watch for with ketones in the picture, which can indicate if we need to be concerned are lethargy, loss of appetite, vomiting, diarrhoea, excessive drinking. These are all red flags which will alert you that he would need to see a vet.

I think it is a good idea to check for pancreatitis, or any other infection. That would need to be addressed asap if something was found.

In the meantime, keep up the extra food, fluids and test daily for ketones.


ANA said
thanks so much for this. I’ll keep up what I’ve been doing.

couple questions:

if his pre shot BG drops to below 200 (after re-testing etc) do I still administer the full .75?

once I’ve gotten some data for the 3 days from now, where can I post to get my dosage evaluated to see if we will need to increase it?

 

[Diane Tyler's Mom GA]

I’ve been giving him extra treats and some kibble to increase his appetite.

@ana_stark

Hi Ana , you had mentioned you were thinking about switching to TR, since you are feeding to any kibble at all you can only follow SLGS .

If you can get rid of the kibble you can then think about following TR

 

[Niko's Mom]

@ana_stark

Hi Ana , you had mentioned you were thinking about switching to TR, since you are feeding to any kibble at all you can only follow SLGS .

If you can get rid of the kibble you can then think about following TR

Even if the kibble is below 10% carbs? That might be tough, he seems to really be enticed by it, he’s a little bit of a kibble addict.

 

[Bron and Sheba (GA)]

his pre shot BG drops to below 200 (after re-testing etc) do I still administer the full .75?

Post here and ask for advice. And change the subject line to reflect your question. Say something like. Preshot BG xxx stalling. Please help.

once I’ve gotten some data for the 3 days from now, where can I post to get my dosage evaluated to see if we will need to increase it?

Post here for dosing advice

Even if the kibble is below 10% carbs? That might be tough, he seems to really be enticed by it, he’s a little bit of a kibble addict.

Just keep feeding him what he’ll eat for now. We can sort that all out later when the ketones are a distant memory

 

[Diane Tyler's Mom GA]

@Bron and Sheba (GA)
Bron I'm so sorry to tag you again but Ana was thinking about switching to TR maybe , but Niko does eat kibble. I told her she would have to follow SLGS .

Her post above your last reply to her she said
Quote
Even if the kibble is below 10% carbs? That might be tough, he seems to really be enticed by it, he’s a little bit of a kibble addict.


So Bron she has to follow SLGS correct
Sorry just saw you answered her about this

 

[Bron and Sheba (GA)]

So Bron she has to follow SLGS correct

Yes. Thanks Diane.
Ana will have to follow SLGS because she is using dry food BUT because there is a history of ketones and he has traces at the moment we are a bit more aggressive with dosing. I want Ana to feed Niki whatever he will eat at the moment as eating a lot of food to combat ketones is more important than what type of food Ana feeds.
So she can put SKGS into the signature and SS but we will be taking ketones into account when we consider the dose.
For lurkers, this is not something for you to consider or do. This is only for Niko because we are trying to get rid of the ketones.

 

[Wendy&Neko]

You want to increase his calories, not his carbs, to combat the ketones. But like Bron said, what ever he'll eat is the best thing for him.

Oberon was the one kitty that came to mind that was showing higher level of ketones but still acting normally. Oberon was diagnosed with a secondary endocrine condition (insulin auto antibodies), that may or may not have been a factor. Lisa did eventually get rid of the ketones when she got to a higher dose.

 

[Diane Tyler's Mom GA]

Yes. Thanks Diane.
Ana will have to follow SLGS because she is using dry food BUT because there is a history of ketones and he has traces at the moment we are a bit more aggressive with dosing. I want Ana to feed Niki whatever he will eat at the moment as eating a lot of food to combat ketones is more important than what type of food Ana feeds.
So she can put SKGS into the signature and SS but we will be taking ketones into account when we consider the dose.
For lurkers, this is not something for you to consider or do. This is only for Niko because we are trying to get rid of the ketones.

Thank you Bron
@Bron and Sheba (GA)

 

[Niko's Mom]

@Bron and Sheba (GA) @Diane Tyler's Mom GA @Wendy&Neko thank you everyone for your insight. It looks like Niko has flushed some of the ketones out, he's registering as a bare trace this PM, but I still smell some on his breath. Normal otherwise, eating lots.

Can someone take a look at his sheet? We have bumped him up to 0.75 and did a couple mid cycle tests today but it's like he didn't even have a nadir. I am thinking 0.75 might just be too low for him. Very confused about his numbers.

 

[Diane Tyler's Mom GA]

I did see your tag Ana but I am not experienced enough to give dosing advice, let's see what Bron says
@Bron and Sheba (GA)
I see Bron said in her post #18 above

Lantus is a depot insulin and it takes 3 days for each dose increase to take full effect. So it will take 3 days for us to see what the 0.75 dose will do. It is probable it won’t be enough insulin but you can’t rush with increases. With ketones the picture we can be a bit more aggressive but please try and get at least one test in during every cycle.


Let's see what she says
@Bron and Sheba (GA)

 

[Wendy&Neko]

Lantus is a depot style insulin. Each shot, some goes into the blood stream and some not which is released later into the blood stream. Basically this means you have to be at a dose for a minimum amount of time to build this depot. Before then, you may not see what the dose is capable of doing. If you are following SLGS for dosing, you hold each dose for 7 days before deciding if you need to increase. If there are ketones in the picture, we might shorten this time, but it's still too early to see how this dose is doing.

One more thing that will be very helpful is to get a test in the night cycle, perhaps just before you go to bed. Many cats go lower at night. We determine the dose based on how low the dose takes the cat, hence the importance of those night time tests.

 

[Bron and Sheba (GA)]

I see Wendy has answered your question. I’m glad the ketones are almost gone. Keep up the extra food, daily testing of ketones and trying to get extra tests done

 

[Niko's Mom]

Lantus is a depot style insulin. Each shot, some goes into the blood stream and some not which is released later into the blood stream. Basically this means you have to be at a dose for a minimum amount of time to build this depot. Before then, you may not see what the dose is capable of doing. If you are following SLGS for dosing, you hold each dose for 7 days before deciding if you need to increase. If there are ketones in the picture, we might shorten this time, but it's still too early to see how this dose is doing.

One more thing that will be very helpful is to get a test in the night cycle, perhaps just before you go to bed. Many cats go lower at night. We determine the dose based on how low the dose takes the cat, hence the importance of those night time tests.

thank you. he is coming up on 6 cycles of the 0.75 tonight. the ketones have returned back to trace today and i have a feeling they'll climb. just feels like he is dancing with them. we will be a bit more patient but just based on his numbers, i feel like the 0.75 is barely affecting him, vs. when we started on january 6th, he seemed to be responding to it. it's like we're not even giving him insulin.

his bloodwork returned. he is negative for pancreatitis and the vet said his other values are normal/not concerning. waiting on urinalysis now. not sure what's going on with this little guy.

appreciate all of your help, s well as @Bron and Sheba (GA) and @Diane Tyler's Mom GA - you folks have been a tremendous help, so thank you once again.

he's just a peculiar case so that's why i keep having all these questions! not sure how he's going to do tonight in terms of ketones, i'll hold off on the temptation to bump it to 1 unit. will try to get some more mid cycle numbers/night mid cycle.

 

[Wendy&Neko]

Good luck with that before bed test. Even one 2-3 hours after the shot will tell us if we are missing lows at night. If he drops a lot from PMPS at that time, you might need to do a mid cycle test.

 

[Bron and Sheba (GA)]

We are happy to keep answering any questions

 

[Niko's Mom]

@Bron and Sheba (GA) @Wendy&Neko hi both. is it possible for you folks to do a quick review of niko's sheet? he keeps bouncing like crazy. we just started day 5 of the 1.00 unit dose. he seems to get ketones when he is above 200 for too long... we have seen some nice blue dips into below 200, which is when his ketones clear. then he bounces right back up to 200-300 and the ketones develop within HOURS. it's like we get a nice blue, think we are on the right track... then bam, a random pink. is the dose too high? should we hold it for another 3-4 days and see? it's driving me crazy!

 

[Wendy&Neko]

he keeps bouncing like crazy

Completely normal, and annoying to us. It's the most common common new people have. You want him to see those lower numbers he's not used to yet. The side effect is the bounce. The only way to stop them bouncing is for them to spend more time in normal blood sugar numbers. It helped me to think of bounces as the results of the insulin taking my cat lower than she was used to - meaning that it was working.

The dose is not too high. If it was, you'd see a number under 90 (when following SLGS). In fact, if his numbers stay the same for a couple more days (not below 150), he'll need another increase. The fact you are seeing ketones is a clue he probably needs more insulin.

 

[Niko's Mom]

Completely normal, and annoying to us. It's the most common common new people have. You want him to see those lower numbers he's not used to yet. The side effect is the bounce. The only way to stop them bouncing is for them to spend more time in normal blood sugar numbers. It helped me to think of bounces as the results of the insulin taking my cat lower than she was used to - meaning that it was working.

The dose is not too high. If it was, you'd see a number under 90 (when following SLGS). In fact, if his numbers stay the same for a couple more days (not below 150), he'll need another increase. The fact you are seeing ketones is a clue he probably needs more insulin.

Thanks for your reply. AAAGH!! I love the safety and stability of Lantus but as an analyst by trade, I rely on numbers for results.
So hard for me to see his beautiful yellows before we even had him on insulin now be tarnished by pinks…. But I need to remember we are also seeing more blues.

I am planning to keep this dose for an extra 5 days to really give 10 days for the depot to settle. After that, can I post here again to have you review if we need an increase?

Niko is a weird guy! We took him for lab work last week, he was sitting at a 9 (!!!) in his blood ketones and a 220 BG…. Any time he is above 200 for too long, he develops ketones.

they found nothing wrong with any of his other values. No kidney issues, no UTI, no infection, no pancreatitis. Beautiful BUN values.

I’m thinking we need to donate his body to science when he passes (which hopefully won’t be a while, he’s so young and we are trying so hard to regulate him).

thanks for your words of encouragement.

 

[Wendy&Neko]

There are down sides to holding a dose too long too. Kitties get used to higher numbers and it can cause a form of glucose toxicity. Which may mean an even higher dose to get over it. Upper blues are good, just greedy for better for Niko.

 

[Niko's Mom]

There are down sides to holding a dose too long too. Kitties get used to higher numbers and it can cause a form of glucose toxicity. Which may mean an even higher dose to get over it. Upper blues are good, just greedy for better for Niko.

Okay, that makes sense too.. so should I give it 2-3 more days and come back to review if we need to up the dosage?
I found that with our 0.50 unit, he got used to it so fast and just stayed at a flat yellow curve. Then the .75 broke him into the blues again, but he kept bouncing… now with the 1.00, longer time in the blues but even higher bounces….

 

[Wendy&Neko]

Yes, 2-3 days should be good. The annoying thing about insulin is that it's a hormone, not a drug. You go up in dose and what you see doesn't always make sense. Lower nadirs is good though, as well as longer times in blue.

 

[Niko's Mom]

@Wendy&Neko @Bron and Sheba (GA) hello! dosage review from Niko and myself again. we just completed day 8 of the 1.00 dose yesterday. Niko is very bouncy and it discourages me in his dosage. Every time we have a nice blue run, he bounces right back... we started today with a 1.00 'fat' dose (so 1.00 + an extra drop) because I'm afraid a +0.25 increase might make him jump even more... thinking a smaller increase over time is safer. What do you think? Should we see what the 1.00 'fat' does for 3 days and then go up to 1.25? Or maybe something as simple as a 1.15? I have calipers so I can calculate those dosages. I'd love to see him spend more time in the optimal range but he is SO RESISTANT! I hope his pancreas calms down eventually, it hates being healthy. We have completed eliminated dry food as well now so maybe we will see a difference.

 

[Wendy&Neko]

Please go up to the full 1.25 units. Try not to worry too much about the bounciness. It is completely normal (but annoying to us). It is only by seeing more numbers in normal blood sugar range that Niko's body will become used to those numbers and stop bouncing as much. SLGS says to increase by 0.25 units if nadirs (plural) are 150 and above, which they are. You can't get a cat used to just a little bit lower numbers, then a little bit lower again. Just rip off that bandaid!

 

[Niko's Mom]

Please go up to the full 1.25 units. Try not to worry too much about the bounciness. It is completely normal (but annoying to us). It is only by seeing more numbers in normal blood sugar range that Niko's body will become used to those numbers and stop bouncing as much. SLGS says to increase by 0.25 units if nadirs (plural) are 150 and above, which they are. You can't get a cat used to just a little bit lower numbers, then a little bit lower again. Just rip off that bandaid!

Totally understand you! I just need to bite the bullet here. We will get him on the 1.25u.

just a question — is it bad on his kidneys/organs to have these bounces? I’m assuming it’s worse if he stays high/elevated all the time but trying to understand the long term effects.

thank you!

 

[Wendy&Neko]

According to Neko's internal medicine vet (she did have bad kidneys), he said prolonged time in higher numbers due to too low a dose is worse than spikes up, as long as he's seeing some good numbers regularly.

 

[Niko's Mom]

@Wendy&Neko @Bron and Sheba (GA) hi both. day 7 of the 1.25 u. we had a nice couple blue runs and hit his lowest (103) and also his highest (432).

it seems the pattern he has with dose adjustments is incessant bouncing for 3-4 days, with nice blues and then high pinks/reds. then he levels out to his stubborn yellows by day 6/7. is this normal with lantus? a rather 'flat' curve?

what do you think? bump up to 1.5 tomorrow?

 

[Wendy&Neko]

You might want to start posting on the Lantus/Lev/Biosimilars forum. That'll get you quicker answers on dosing questions.

The first few days after an increase, you are waiting for the depot to fill, so you might not see what that dose can do until 5-6 cycles in after an increase. We also have a phenomenon we call New Dose Wonkiness (NDW), that can cause temporary increase in numbers in the first few cycles. Yes, bouncing is normal for newly diagnosed kitties, and even some not so new. He will get flatter when he gets to a more fitting dose. I think you could increase tomorrow, unless he goes lower tonight.

 

[Niko's Mom]

You might want to start posting on the Lantus/Lev/Biosimilars forum. That'll get you quicker answers on dosing questions.

The first few days after an increase, you are waiting for the depot to fill, so you might not see what that dose can do until 5-6 cycles in after an increase. We also have a phenomenon we call New Dose Wonkiness (NDW), that can cause temporary increase in numbers in the first few cycles. Yes, bouncing is normal for newly diagnosed kitties, and even some not so new. He will get flatter when he gets to a more fitting dose. I think you could increase tomorrow, unless he goes lower tonight.

Will definitely post on the Lantus forum for his next dose review, thanks! And yes, Niko definitely has the NDW. I just find it weird that when he has the NDW, he gets beautiful blue runs and then when he stabilizes on a dose, he goes back to rather flat yellows. I guess that means he's saying it's not enough?

We will increase to 1.50 tomorrow. Doing a curve today but he isn't dipping so far, just running a slightly inclined yellow trail.