Carmen wrote " Just worried as he's been DKA twice and seems prone to ketones -- none tonight, but it's scary seeing him back at the water bowl all the time. In case the link to my spread sheet doesnt work -- this morning before his injection he was 19.4 (349), this evening B4 injection he was 20.9 (376), about 2,20 later he's dropped to 15.4 (277) so ive lifted all the food and wont let him eat anything else tonight as i doubt it's going to drop super low now."
Hi Carmen and welcome, to you and to your baby Mithras.
I was asked to pop in and have a look at your thread and spreadsheet, having also been a caninsulin user and long time member of the board here.
You have been given excellent support already.
I see you have had ketones and DKA, so scary, I can perfectly understand the concerns you are having and glad you found us.
When you next post, could you also add- 'DKA history' to your heading? You will get more eyes who have been there to offer their support as well.
Way to go on testing at home. It makes all this so much easier.
I do not see anything that looks like rebound here and I am concerned that you are seeing those higher 300s again while giving the 3 units BID.
I would certainly consider moving to 3.5 units and let your vet know what you are seeing as the preshots rise at 3 units.
There are a few doses between 3 units and 4 units , 3.25, 3.5, 3.75 etc. that may see the levels better without a scary level at peak like at the 4 unit mark.
4 units was giving him much time in healthy numbers but that lower day you had of 57 I know can be worrying when away from home with this fast acting insulin so need to find a comfortable dose for you and that works for him.
Ketones develop from
A:lack of insulin getting where it needs (not just high blood glucose levels)
B: lack of calories being utilized by the cats body
c: and often some form of infection.
Therefore trying to find the balance of a dose that keeps those levels down is key without going too low.
**********Please do not with hold food at this time of managing this. He needs those calories.
Adjust the insulin to deal with the food need be, but he needs that food right now.
A few questions for you....
Has he had any other medical issues like the need for a dental, or a possible urinary infection brewing?
How old is he?
How did you realize he had something wrong?
Forgive me if you given all this history before.
The amount of hunger and thirst worries me as well.
An unregulated cat will not be utilizing its food and calories well, so getting a lot of food in, that has the calories he needs right now is another important piece in keeping the ketone monster at bay.
Keeping hydrated is also important. You can check his hydration levels by pulling up the scruff of his neck, like a tent, and letting it go. It should snap back into place quickly. If it does not, this could be an indication he is becoming dehydrated and needs to be addressed with your vet. My cats hate me doing this, but I try to make it pleasant as I check them and then rub them with a kitty massage on their shoulders
What are you feeding at present? How often and how much?
Honestly in my opinion, I would pretty much be feeding on demand until things level out and you are well and truly clear of ketones.
There are some tips to get this insulin to work better for you. I know you folks in the UK have a tough time convincing the vets to change it up. Here is a link with some helpful ideas about food timing, dose changes etc to help caninsulin work most effectively.
viewtopic.php?f=19&t=302
Caninsulin is actually giving you guys quite a shallow curve..meaning that the preshots are not screaming high in the 400s and your nadir is not dropping a long way down from there. This is a good thing. It makes me feel personally, you are very close to the dose you need right now.
I would really consider that change up to 3.5 before the preshot levels rise up anymore.
Nadir/peak is often abut 4-6 hours after the insulin has been given as you were seeing at the vets office.
As his pancreas hangs in lower levels under say 220 and has a chance to heal, you may need to adjust the dose downwards, but always be mindful that ketones are in his history and please always let the board know when asking for advice, what you guys have gone through. We support you differently with DKA history than the basic 'start low and go slow method'.
I usually suggest a "do not shoot" number of about 180 for a new member with caninsulin. Therefore if you have a lower than usual prehsot and it is under 180, wait to give insulin, or reduce the dose.
However, I would discuss this with your vet as well and get his input about what is comfortable for you. I would think a little lower "do not shoot " level may be necessary for you guys like 160, or even 140, but you would want to reduce the dose first.
Just a heads up there.
The insulin goes in, lowers the blood glucose, peaks, then runs out and the levels go back up. This pendulum swing is what we deal with every 12 hours and try create as gentle a swing as possible. How you get there is the finetuning you are doing now. It does get easier..promise
Please keep asking questions, read through the faqs and return to them and....
**** test before every single preshot, within thirty minutes of food and injection, and spot checkas you can- along with your vigilant daily ketone testing.
You have been through hell , DKA is so awful, and still have your baby with you, which is a huge testament to both you and your vet.
Now lets help you understand all this so you can have your kitty back to a thriving happy member of your family.
Do you have any questions from all that?
Does this make sense?
Kimmee
Can you measure out half way in between and give 3.5u? A 57 isn't too low, but it is a number to keep a check on. Usually when raising and lowering doses, we advocate not doing it anymore than 0.5u at a time, and many do it in 0.25u increments. Most cats can have dramatically different numbers with such small changes, so changing 1u at a time can cause you to miss the optimal dose.
