? pmps 322 +5 327 TR increase going nowhere BKetones 1.1, high??

Sybil and Zoe

Sybil and Zoe

Member Since 2018
I have been increasing every 3 days except last round I went 4 days. Still not seeing a crack in the pattern. This morning I think I gave a fur shot as I felt wetness even though I felt sure the needle was all the way in the skin tent. It may be why this pm her numbers are steady in the 300's though if fur shot I would expected a higher number. She is just so stubborn with her BG. This pm I found her ketone level (blood) was 1.1 and they had been lower before. I dont know much about the ketones and I have a meter for myself is the only reason I kave readings. I was a little surprised to see the 1.1 since the only other two levels were under 1.0. No change in her eating pattern (still asking for food constantly) Is this high?
 
Good sign she is eating and BG is not sky high. Can you get more water in her? Add some extra water to food.

I don’t know about blood ketone numbers for cats, most of us just use the urine strips.

We just had a discussion with another member on ketones.
 
Julie and Honey said:
Good sign she is eating and BG is not sky high. Can you get more water in her? Add some extra water to food.

I don’t know about blood ketone numbers for cats, most of us just use the urine strips.

We just had a discussion with another member on ketones.
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She is drinking plenty of water, and urinating alot. I cant say if it is more than usual--seems to be more water. I am thinking about puting a camera in the room with the cat box so I can keep track of how often she is in there. I am going to stay up and try to do one more BG at the +6 mark. I have trouble staying up to get more in the later hours, but her curves are pretty stable. I am trying to cut back on testing since nothing much happening except when I adjust dose. I feel like I need to go up .5 instead of .25 because it always looks the same. The last check was in the yellow but I wonder about blood samples. The yellow was from hitting the sweet spot and getting a lot of blood. Most times it is just a tiny drop and occ I squeeze a little to encourage blood expression.
 
Christie & Maverick said:
1.1 reading is fine, but you may want to monitor over the next few days just to make sure the reading isn't increasing. In recent published studies for cats, ketones begin to show up at 2.4. The studies are found here...can't seem to just attach the PDFs :rolleyes:

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/
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Thanks. I looked at that article when I was serching for acceptable Blood ketone levels. I am fading fast and hope I can make it to 12:30 am for the last check. Thanks for everyones reply!
 
Zoe might have some glucose toxicity. http://www.felinediabetes.com/FDMB/...-what-is-it-what-should-i-do-about-it.144381/

You'll just have to keep giving insulin/increasing until you break the toxicity. I know it can be worrying to continue to give more and more insulin but remember: you are testing frequently, you are increasing carefully, and however much insulin Zoe needs she will need. Don't think too much about the value of the dose, but pay attention to the results. Right now, Zoe is telling she needs more insulin.
 
Keep an eye on those ketones. You can add a tablespoon of water to each meal, 2 tblsp if Zoe will allow it. It will help hydration and keeping kidneys flushed. Do not hold the insulin dose long before increasing. Try to keep it to the 3 days (6 cycles) then increase. As Crista said Zoe needs more.
 
Crista & Ming said:
Zoe might have some glucose toxicity. http://www.felinediabetes.com/FDMB/...-what-is-it-what-should-i-do-about-it.144381/

You'll just have to keep giving insulin/increasing until you break the toxicity. I know it can be worrying to continue to give more and more insulin but remember: you are testing frequently, you are increasing carefully, and however much insulin Zoe needs she will need. Don't think too much about the value of the dose, but pay attention to the results. Right now, Zoe is telling she needs more insulin.
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I agree! I think she was started off too low to begin with, @ 1 u Lantus, when she had been as high as 5.5 u on the Vetsulin prior to the switch--though at time of switch she was back down to 3 u. The Vet was new to ordering Lantus too, and I was so afraid of her dropping too low on the new juice. (lol that never happened!)

I was reading the TR again and it says to increase by .5 if nadirs are >300 and hers generally are. So this morning I gave her 4.5. I know it was sooner than 6 cycles since last adjustment, but I wanted to do it while I am home and she is drinking and peeing a lot. By waiting 3 days I would not be home on Monday to check more than the first hour or two after shot. I have been trying to give it in her side instead of scruff and I pinch up the skin(tent) and I think I gave a fur shot yesterday morning. BGs didnt budge much all day. I felt a little dampness this morning :banghead: and was afraid I did it again but maybe just a little dribbled out of the site or was on syringe because of adjusting the overdrawn amount out of the pen. The good thing is +3 was 299 down from amps of 314, so maybe it did go in. I am not a newbie to injections being a "longtime" RN, lol, so that makes it doubble-y frustrating because I check to make sure the needle went in to the hub. (Maybe it pokes through the tent? I hope not). Is this correct or do people go straight into the side? My needles are the 31 g 5/16". Humans have a lot of sub q tissue in the stomach area but not these little fur babies so I am a little wary of a straight in shot.
 
As one of the most experienced and long-term members here, I’d like to toss in my two cents worth.

First, I’d take the dose back down to 4.25u and allow her to have six cycles at that dose. Doses should only be raised when you know how low the dose it taking her and when a fur shot is not potentially in the mix. If after six consecutive cycles in which you have enough data and you see no or only one yellow nadir, increase by 0.5u. Rushing doses doesn’t help her. I understand you are concerned about work on Monday but it’s doubtful you would have seen an enormous drop into green on the first day of a dose increase.

Second, while her dose on Vetsulin did get high, you weren’t testing enough to know how low it was taking her. I’ve seen cats go from 300 to 40 and back to 300 and if the CG did not have the midcycle test, it would have looked like the cat was just high. With very few midcycle tests on Vestulin, we don’t know whether you missed a good dose. And Vetsulin is a much harsher insulin than Lantus and had more potential to drop her suddenly.

My gut tells me she will likely need more insulin but my knowledge and experience require I advise that you shouldn’t chase numbers. The TR protocol was designed to be a bit more aggressive so by increasing her after only two shots at 4.25u, one of which you thought might be a fur shot, you are pushing outside the safety mechanisms designed within the TR protocol.

Please continue to test her ketones daily and stick with the TR protocol and not a rendition of it. She’s not to the point where you need to think about custom dosing.
 
Marje and Gracie said:
As one of the most experienced and long-term members here, I’d like to toss in my two cents worth.

First, I’d take the dose back down to 4.25u and allow her to have six cycles at that dose. Doses should only be raised when you know how low the dose it taking her and when a fur shot is not potentially in the mix. If after six consecutive cycles in which you have enough data and you see no or only one yellow nadir, increase by 0.5u.
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Ok, I will take her back down. I am not sure she has actually gotten 4.5 since this morning I feel like some leaked out onto her fur.
 
Sybil and Zoe said:
Ok, I will take her back down. I am not sure she has actually gotten 4.5 since this morning I feel like some leaked out onto her fur.
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Excellent. Thank you!

And...it probably goes without saying but just in case there are readers who don’t understand, if after six consecutive cycles at any dose, if she has yellow nadirs, the increase is only by 0.25u.

And...I did see you asked about the method of shooting. Perhaps my post on Testing and Shooting Tips might help. You are correct that cats are different than people when it comes to subq injections. I have seen other members have issues with shooting a bit too shallow and once they figured out how to do it, numbers improved. I don’t know that’s happening with Zoe but a refresher might help.:)
 
I'm one of the other more experienced people here and I'd echo what Marje suggested. We all understand how hard it is to see our kitty in high numbers. Rushing the dose with a long acting insulin can be hugely problematic. The concern with increasing the dose too soon relates to how the insulin depot works and frequent dose changes does not allow the depot to stabilize.

 
I looked at the testing and shooting post and feel like the roll might be more appropriate. I have been tenting the skin. Rolling allows for better view or the injection site. Thanks.
 
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