Question about pre-dose glucose levels

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Voula

Voula

Member Since 2014
Hi everyone. Yesterday Lucy's glucose level at +12 was lower than her level at +10 so I waited till her blood glucose went up before giving her the insulin dose. In relaxed lantus which is the forum I used to post in the advice was not to dose under 150 unless you had enough data to support doing so. What happens if the AMPS or the PMPS is lower than previous readings since the last insulin dose but is still over 150. Do you dose? Or do you wait for the blood glucose to be rising from the last reading before dosing? Usually the AMPS or PMPS is higher than readings since the last dose so I have not had this question. Thank you.
My last post was here: http://www.felinediabetes.com/FDMB/...s-271-3-208-6-174-9-185-advice-needed.130630/
 
You're going to be switching to TR though aren't you?

What we generally tell people is that until you get enough data, your "no shot" limit is 150, but that doesn't necessarily mean you don't shoot...it's just the point where if you aren't "data ready", it's best to make sure you have someone with experience willing to watch over you the first few times.

As you get more data, that "no shot" limit goes lower and lower until you're to the point where you'll shoot anything above about 50

Last night, although it looked like you had a dropping number, when you figure in the meter variance, Lucy was really pretty flat, not continuing to drop.

Since each shot doesn't "kick in" for a couple hours (called onset) it's almost always going to be perfectly safe to shoot a lower PS number, feed and just test as much as necessary. We'll usually tell you to get a +1 and +2 when you shoot a lower PS number and just go from there....doing whatever you need to do to keep Lucy in safe numbers
 
Hi Voula!!

I haven't had a chance to post to you yet so I'm glad I have the opportunity now!

There are "generally" two reasons why a kitty is lower at +12 than +10. One, which is what Miss Lucy was doing today, is a bounce clearing cycle. In a bounce clearing cycle, the number often starts high and then decreases during the day until the lowest number is late in the cycle and often at +12. You don't usually see a mid cycle nadir in a bounce clearing cycle. We call the number you get at +12 from this type of cycle a "dropping number".

The other primary reason is a "second dip" that lantus (and levemir) get. A second dip is where kitty nadirs somewhere around mid-cycle, comes up, and then dips back down at the end of the cycle. Lower BGs for this cycle are just referred to as a "second dip".

Shooting them.....
The general advice in the Lantus/Levemir forum is that if a new member without much data gets a 150 or below at PS, they post and ask for help. Shooting lower and lower benefits Lucy although we typically do not shoot below 50. If you get lower than a 150 and post, we can walk you through the options of shooting on time, stalling, shooting a reduced dose, or skipping. We like to help you learn to gradually shoot lower and lower and if we suggest that you do, we stay with you through the cycle....even if it's late at night.

One thing that is helpful for all is we usually do one condo per cat per day. The number of members in the forum would make it easier for a condo to get lost if we all posted multiple condos. If you have questions, you can just bring our attention to the subject line.

We're glad you and Lucy found FDMB. Let us know how we can help. :)

eta: saw Chris's post and just want to clarify. We don't have a "no shot" number in the L/L forum. We have a "150 post and ask for help" number.
 
Thank you Chris. Yes I have thought we should give TR a go but I feel anxious about it which I guess is normal too. I think maybe TR will give us a better chance at remission though I could be wrong about that I don't know. I am home a lot and I can test so it is worth a go. I guess because I have only dosed once between 150 and 200 that I felt really anxious last night and wanted to see a rising number before dosing. I know it will all get easier with time :)
 
Hi Marje. Thank you so much for all the explanations and it is reassuring to have people willing to stay with me like Serryn did last night. It is a matter of getting braver on my part and trusting the advice of others too. I have a fear of hypoglycemia and that is holding us back a bit. Our vet is keen for me to dose at lower levels too. Does posting one condo a day mean posting a new thread or topic? Thank you again I really appreciate your assistance.
 
Posting one condo a day means one thread a day with all of your questions, comments, concerns, etc in it. For example, you have a condo for today; it's not a problem that you posted this question separately but normally, you could have posted it there with a subject line to catch our eye. It's only so we don't "lose" people as their condos fall to the second page.

I remember when we were new, I swore I'd never shoot below 150. But it wasn't long before I was shooting 50s. We keep it safe and hang with you so you don't have to worry so much. Also....remember that with low numbers, you are in control because you can test and then you can react to the lower numbers.:)

We were all where you are and we're happy to help you....and then one day you can help someone! In one month, you'll read your early posts and be amazed at how much you know and how far you've come :cat::cat:
 
Marje and Gracie said:
Posting one condo a day means one thread a day with all of your questions, comments, concerns, etc in it. For example, you have a condo for today; it's not a problem that you posted this question separately but normally, you could have posted it there with a subject line to catch our eye. It's only so we don't "lose" people as their condos fall to the second page.

I remember when we were new, I swore I'd never shoot below 150. But it wasn't long before I was shooting 50s. We keep it safe and hang with you so you don't have to worry so much. Also....remember that with low numbers, you are in control because you can test and then you can react to the lower numbers.:)

We were all where you are and we're happy to help you....and then one day you can help someone! In one month, you'll read your early posts and be amazed at how much you know and how far you've come :cat::cat:
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Thank you for explaining about the condos :) I so appreciate your understanding and kindness and the sharing of your own initial anxieties too. I look forward to my increased confidence.
 
You're very welcome. It's a learning curve and you can't know the condition and posting and reading SSs, etc all at once.

Have a good night!
 
The only thing I'd add to Marje's explanation is that part of the learning curve with shooting lower numbers is to build the caregiver's confidence. Everyone chews on their fingernails with shooting progressively lower numbers -- especially the first few times. Those of us who have been doing this for a while remember what seeing that first low pre-shot number was like and how nerve wracking that cycle was. Like Marje said, in the beginning everyone is apprehensive and then once you get the hang of it and have confidence in your ability to steer the numbers with food, you get annoyed when you don't see low pre-shot numbers!

The one thing that I encourage people to do is to start thinking about where your comfort level is. The next time you see a lower pre-shot number, how low do you think you'd be comfortable shooting? I'd still suggest you post and ask for help so there will be someone to walk you through the process but a little bit of mental preparation also helps. If you happen to notice someone who is in a similar situation before Lucy, you might want to read along with that condo so you'll see first hand how the process works.
 
Thank you Sienne. That is all very good advice and again it is good to know that others have felt the same about dosing at lower glucose levels but that with time and experience comes confidence. I have been reading other discussions to see how others handle similar situations and that is very helpful too.
 
If you are home and able to test more it is definitely worth the effort. The data will give you knowledge and courage will soon follow.
You can read about becoming data ready here. Lots of good information to help you prepare for shooting lower and lower PSs.
 
Hi Voula!
Voula said:
What happens if the AMPS or the PMPS is lower than previous readings since the last insulin dose but is still over 150. Do you dose? Or do you wait for the blood glucose to be rising from the last reading before dosing?
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This is where "know thy cat" comes into play. Since it was the first time you've seen Lucy's BGs continue to go down even after +12, you did just fine skipping. You can look at it as collecting data on what happens if you don't give a shot. Next time it happens, you can decide whether to give a shot (maybe with a reduced dose) and collect data on how that affects the cycle.

Going forward, if you're tentative about jumping immediately into shooting 150 pre-shots, is to work your way down to it first, as Sienne mentioned. Right now for example, your no shot/stall number is 200. Move it down to 190. Then, after you've given a few shots with a 190 range pre-shot, move it down to 180, and so on and so forth. And, of course, you can do the same for shooting lower than 150. The other thing you can do that might help decrease the anxiety is give a reduced dose at those lower pre-shots the first couple of times until you feel more comfortable trying out the full dose. Even now, I'll sometimes give reduced doses on low numbers if I'm not going to be around to monitor. Take your time and ease into it as fast or as slowly as you need to.
 
Sandy and Black Kitty said:
If you are home and able to test more it is definitely worth the effort. The data will give you knowledge and courage will soon follow.
You can read about becoming data ready here. Lots of good information to help you prepare for shooting lower and lower PSs.
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Thank you Sandy and I read the information you posted. I am keen to get Lucy's diabetes regulated as the vet thinks she needs a dental cleaning and possibly one tooth out too. The vet said we have to get Lucy's glucose levels down first so that is why I have to get courageous and not fear dosing at lower levels too.
 
KPassa said:
Hi Voula!


This is where "know thy cat" comes into play. Since it was the first time you've seen Lucy's BGs continue to go down even after +12, you did just fine skipping. You can look at it as collecting data on what happens if you don't give a shot. Next time it happens, you can decide whether to give a shot (maybe with a reduced dose) and collect data on how that affects the cycle.

Going forward, if you're tentative about jumping immediately into shooting 150 pre-shots, is to work your way down to it first, as Sienne mentioned. Right now for example, your no shot/stall number is 200. Move it down to 190. Then, after you've given a few shots with a 190 range pre-shot, move it down to 180, and so on and so forth. And, of course, you can do the same for shooting lower than 150. The other thing you can do that might help decrease the anxiety is give a reduced dose at those lower pre-shots the first couple of times until you feel more comfortable trying out the full dose. Even now, I'll sometimes give reduced doses on low numbers if I'm not going to be around to monitor. Take your time and ease into it as fast or as slowly as you need to.
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Hi Kay. I am going to save your post as it is so good and what I need right now. I am saving others' posts too on this topic. I think you helped me with my anxiety about blood glucose testing too so thank you again. I think it was your kitty who was difficult to test too. I will refer to what you and everyone said and I will also post when we have lower pre-dose levels too and get support and advice about what to do. I feel so much better after all the wonderful replies so thank you from me and Lucy too.
 
A note: many cats do better if the dental is done before getting "stabilized" on insulin. In fact, the dental contributes to regulation as dental infection and pain elevate the glucose levels.
 
BJM said:
A note: many cats do better if the dental is done before getting "stabilized" on insulin. In fact, the dental contributes to regulation as dental infection and pain elevate the glucose levels.
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That is interesting BJM. Why do vets say to get cats stabilised first before dental work is done? Is there an added anesthetic risk or risk of ketoacidosis if a dental is done with uncontrolled diabetes? When Lucy had sedation for a blood test she developed ketones after the sedation so I worry if she has the dental done now with uncontrolled diabetes she might develop ketones again and maybe have problems from it. I do certainly understand that dental infection and pain can elevate blood glucose though Lucy seems to be eating well but I have noticed she eats more on one side. However she also has had vestibular syndrome and has residual vertigo at times and she sometimes tilts her head to the side a bit. The other worry is that after the sedation Lucy's vertigo flared up and she couldn't walk for one day until the sedation fully wore off. So I have a lot of worries about the dental work and though I know that resolving dental issues helps diabetes I also worry about ketones developing and causing issues. So from that point of view I wonder if it would be better to get some regulation of the diabetes before having dental work with an anesthetic. Because of Lucy's issues we are going to go to the vet teaching hospital and I have been thinking we should probably make an appointment for a consultation even if Lucy's diabetes is not regulated to see if the dental vet and the anesthetist vet think the dental should and could be done before we get regulation of Lucy's diabetes. Thank you.
 
BJM said:
In fact, the dental contributes to regulation as dental infection and pain elevate the glucose levels.
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BJM is absolutely right! If a cat needs a dental it can be very difficult to get the cat regulated. Just depends on the cat, but we've had many cats that got better cycles (fewer zig-zags from high high to low low) after the dental was done and infection or inflammation was cleared up.

One trick you can do to save posts that are helpful to you is to copy the URL (the website address) and paste it in the comments section of that day's row in your spreadsheet. Because it is a google doc it will become a hot link and you'll be able to click on it to come back to the thread (condo) that you linked.

just seeing your last post. Would you add in your signature line or very obviously (maybe colored & bolded) in the spreadsheet about the past history of ketones, please? that is very important information. If she is ketone-prone, it becomes even more important for her blood sugar to get under control and for any infection to be addressed. Eating on one side can mean that she has a problem in her teeth on the other side.

Are you checking her daily for ketones?

A good vet doesn't need the cat to be tightly regulated before doing a dental. Punkin had 2 dentals and maybe 7 anesthesias - and he had acromegaly and was never tightly regulated. You don't want her sky-high, but it's a balancing act and the positives of getting the dental done may outweigh the risks of the procedure itself.
 
You want to be sure no immediate crisis is present, you may want some reduction in glucose values, but perfect control takes a long time and meanwhile, the dental problem is feeding the fire.
 
julie & punkin (ga) said:
BJM is absolutely right! If a cat needs a dental it can be very difficult to get the cat regulated. Just depends on the cat, but we've had many cats that got better cycles (fewer zig-zags from high high to low low) after the dental was done and infection or inflammation was cleared up.

One trick you can do to save posts that are helpful to you is to copy the URL (the website address) and paste it in the comments section of that day's row in your spreadsheet. Because it is a google doc it will become a hot link and you'll be able to click on it to come back to the thread (condo) that you linked.

just seeing your last post. Would you add in your signature line or very obviously (maybe colored & bolded) in the spreadsheet about the past history of ketones, please? that is very important information. If she is ketone-prone, it becomes even more important for her blood sugar to get under control and for any infection to be addressed. Eating on one side can mean that she has a problem in her teeth on the other side.

Are you checking her daily for ketones?

A good vet doesn't need the cat to be tightly regulated before doing a dental. Punkin had 2 dentals and maybe 7 anesthesias - and he had acromegaly and was never tightly regulated. You don't want her sky-high, but it's a balancing act and the positives of getting the dental done may outweigh the risks of the procedure itself.
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Thank you Julie. That is a good tip for saving posts. Lucy has only had ketones once and that was after the sedation. I test her urine daily for ketones sometimes several times a day. After the comments you and BJM made I will speak to the vet about getting the referral to the dental vet sooner and keep working on lowering Lucy's glucose levels too. I don't like that Lucy may have pain and am keen for her dental issues to be addressed soon but had been worried about doing a dental with unregulated diabetes.
 
BJM said:
You want to be sure no immediate crisis is present, you may want some reduction in glucose values, but perfect control takes a long time and meanwhile, the dental problem is feeding the fire.
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Thank you BJM. I will speak to the vet in coming days about a referral to the dental vet.
 
Voula....I noticed you're also posting on the Diabetic Cat Care forum

As you've probably noticed, we have a slightly different protocol from theirs. It's going to be in Lucy's best interest if you decide which one you're going to follow since otherwise you're going to keep getting conflicting information on how best to treat Lucy.

They use a sliding scale with Lantus. The Roomp/Rand Tight Regulation protocol we use uses consistent dosing unless the cat earns a reduction. Lantus works best when it's given consistently.

I know it sounds somehow "right" to dose like humans deal with their own diabetes, but cats aren't people....and in people, they often use both bolus (one that works quickly) and basil insulins at the same time (like Humulin R or N plus Lantus or Levemir)

Just something to consider. I looked at both places when we were first diagnosed too, but felt this forum's peer review system was using the best advice of the most people with real life experience, whereas on that forum, they have specific "dosing advisers"

They do have success stories, but so do we, so I can't tell you which one will work best for Lucy...just that it's going to be confusing for you if you try to work both of them
 
Hi Chris. I posted one week ago on the other forum because it was at a time when I needed a quick reply about a low pre-dose glucose level and no one had answered on the board here and a friend from DCC suggested I ask on DCC what to do. I am not following the Hodgkins protocol though I am open to it. I joined both boards some time ago to try and decide which protocol to follow but have chosen to give the Rand protocol a go as that is what our vet wants to do too. The administrator of DCC is a lovely woman who has been very kind and welcoming and knows I am following the Rand protocol not the DCC protocol and I do post on DCC in support of others at times but don't give advice because like here on FDMB I have developed friendships with people on DCC. But they all know I am following the FDMB protocol and are supportive of my choice. I agree it would be confusing to be getting advice from both boards and I am not doing that in terms of swinging between two different treatment approaches as you can see from our spreadsheet I am giving regular twelve hour doses and not using a sliding scale and increasing and decreasing doses according to the advice of our vet with opinions from people here on FDMB taken into account in my decisions. I have chosen the FDMB protocol because it has formal evidence behind it and because our vet likes it too. I understand the difference between the two protocols and am not confusing myself with contradicting opinions. I understand what you are saying though and thank you.
 
Good to hear Voula!!

I was just worried for Lucy. I know several people on DCC too and have nothing particular against their way of doing things....it's a decision we each had to make for our own kitties

Great that you're sticking with us :D
 
Voula, back when we were actively dancing our sugar dance (2008-2009) I ran into that 'catch 22' of the vet not wanting to do a dental until BK was regulated.
Regulated? BK - a cat who did not see green for 6 months and didn't taste HC for a year in spite of using a basal and bolus insulin whose combined doses reached 45u per day?

About that time I found a small lump on the back of his neck which his vet removed and biopsied and thankfully it was benign.
however while he was under the vet took the opportunity to take a look in his mouth. She saw remains of a broken tooth and easily removed it.
She also saw his teeth and gums were in a state that was far beyond her ability and referred us to a veterinary dental specialist.

Take a stroll through BKs ss, noting theses events and changes to BGs and doses that followed.
10/23/2008 - lump and tooth fragment removed
12/08/2008 - first major dental - 8 extractions.
05/29/2009 - second major dental (can't recall how many more extractions - maybe 4?)
10/23/2009 - 21 months after dx the last cat anyone thought would go OTJ did just that.

Bad teeth and gums where his Achilles heel. His is a striking example of the effect healthy teeth and gums can have on BG.
 
Chris & China said:
Good to hear Voula!!

I was just worried for Lucy. I know several people on DCC too and have nothing particular against their way of doing things....it's a decision we each had to make for our own kitties

Great that you're sticking with us :D
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Thank you so much Chris. Yes I have met great people on both boards and I don't want the people who were so kind and supportive on DCC to feel I have abandoned them because I have chosen to do the Rand protocol so I will keep in touch with them and maybe ask the occasional question but I have decided we are doing the Rand tight regulation though it is nerve wracking I feel the consistency of dosing at evenly spaced intervals will suit Lucy and me too. I have a chronic illness and suffer a lot from fatigue and so I think the ten hourly intervals of DCC would not suit me though I know even with the Rand protocol there will be times you might delay a dose and so have to change your dosing schedule like I did the other night as I was anxious. I realised later after I posted to FDMB and got no replies about the low pre-dose level of 3.2/58 last week that I posted at the time of the change to the new FDMB board so my post and questions remained on the old board unseen. :) So thankfully some people on DCC were able to assist by advising me not to dose as Lucy's glucose levels were falling that morning and I have no experience with dosing at that level or maybe even enough data to do so. So anyway thank you again and I appreciate your care and support too.
 
Sandy and Black Kitty said:
Voula, back when we were actively dancing our sugar dance (2008-2009) I ran into that 'catch 22' of the vet not wanting to do a dental until BK was regulated.
Regulated? BK - a cat who did not see green for 6 months and didn't taste HC for a year in spite of using a basal and bolus insulin whose combined doses reached 45u per day?

About that time I found a small lump on the back of his neck which his vet removed and biopsied and thankfully it was benign.
however while he was under the vet took the opportunity to take a look in his mouth. She saw remains of a broken tooth and easily removed it.
She also saw his teeth and gums were in a state that was far beyond her ability and referred us to a veterinary dental specialist.

Take a stroll through BKs ss, noting theses events and changes to BGs and doses that followed.
10/23/2008 - lump and tooth fragment removed
12/08/2008 - first major dental - 8 extractions.
05/29/2009 - second major dental (can't recall how many more extractions - maybe 4?)
10/23/2009 - 21 months after dx the last cat anyone thought would go OTJ did just that.

Bad teeth and gums where his Achilles heel. His is a striking example of the effect healthy teeth and gums can have on BG.
Click to expand...
Thank you so much Sandy. I will definitely look at your spreadsheet and talk more with our vet too. The vet thinks it is not urgent to have the dental done but not to leave it too long but it worries me in case Lucy has pain and at the very least I will get a referral to see the dental vet and get an opinion on what needs doing and when we should do it. Because of Lucy's difficulty in recovering from anesthesia due to her vestibular syndrome issues we are going to have a vet anesthetist do the anesthetic like last time when Lucy needed to have a CT scan when we were trying to find out what was causing her vertigo issues. I will look at your spreadsheet now.
 
Sandy and Black Kitty said:
Voula, back when we were actively dancing our sugar dance (2008-2009) I ran into that 'catch 22' of the vet not wanting to do a dental until BK was regulated.
Regulated? BK - a cat who did not see green for 6 months and didn't taste HC for a year in spite of using a basal and bolus insulin whose combined doses reached 45u per day?

About that time I found a small lump on the back of his neck which his vet removed and biopsied and thankfully it was benign.
however while he was under the vet took the opportunity to take a look in his mouth. She saw remains of a broken tooth and easily removed it.
She also saw his teeth and gums were in a state that was far beyond her ability and referred us to a veterinary dental specialist.

Take a stroll through BKs ss, noting theses events and changes to BGs and doses that followed.
10/23/2008 - lump and tooth fragment removed
12/08/2008 - first major dental - 8 extractions.
05/29/2009 - second major dental (can't recall how many more extractions - maybe 4?)
10/23/2009 - 21 months after dx the last cat anyone thought would go OTJ did just that.

Bad teeth and gums where his Achilles heel. His is a striking example of the effect healthy teeth and gums can have on BG.
Click to expand...
Hi again Sandy. That is amazing the difference the dental work made to Black Kitty's glucose levels and the vet did say that dental issues affect glucose levels and when I next speak to her I will tell her about Black Kitty and the positive effect of having the dental work done. Thank you again.
 
If you want to see another example of what a dental can do for a diabetic kitty check out Vyktor's spreadsheet pre and post dental - on 24/02/2012. I think low BG and anaesthetic don't mix well - I recall the vet was ready to postpone when he saw the low numbers we'd had on the morning before but as I expected at that time Vyktor bounced. Vet wasn't as concerned about the high on the day (Vyktor had also had DKA).
 
Thank you Serryn. That is very impressive and I will make a note of Vyktor's success for my talk with our vet. What are the concerns of having dental work done in cats with diabetes? I can see that low BG could be a concern with anesthetic. Is high BG a concern in terms of ketoacidosis?
 
Is high BG a concern in terms of ketoacidosis?
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I don't know but I wouldn't have thought so - in terms of an anaesthetic causing it to happen - DKA happens when the BG is too high for too long so I don't see how an operation could cause it. In fact, I would think that if there is an infection in the mouth not having it treated, and therefore not being able to regulate the cat, would be more likely to cause DKA. I'm just hypothesising here I don't know for sure.

I think one of the problems with high BG and an operation is the potential for dehydration but I would expect you can get around that with fluids.

Ask your vet what they think the issues might be - I would be interested to hear.
 
I will ask the vet and let you know. When Lucy had sedation a few months ago for a blood test she developed ketones in her urine on the day after her sedation and I wondered if that was because she hadn't eaten breakfast the day before and then after the sedation she didn't eat as much as usual though the ketones went away quite quickly once she recovered from the sedation and was eating again. I have never found ketones in her urine before that or since and I check her urine every day sometimes several times each day so that is one reason I worry about the anesthetic and having the dental work done though it needs to be done.
 
I wonder if the ketones and anesthesia happening at the same time was a coincidence. I know some cats have a ketone incident and never have them again. Typically anesthesia lowers blood sugar, which is why it's advised to skip giving insulin, or give a greatly reduced dose, on the day of a dental.

Hopefully your vet can provide more insight as to her concerns. I know we'd all like to hear them!

~Suzanne
 
Hi Suzanne. It is possible the ketones weren't related to the sedation. I will let you know what the vet said about her concerns after our next appointment. Thank you for your reply too.
 
It's rare to hear about ketones developing as a result of a dental. I might guess that if ketones were brewing -- which is possible since we typically do a urine test and that isn't "to the minute' the way blood testing for ketones would be -- reducing or skipping a dose of insulin prior to a procedure and not feeding that morning, might contribute to ketones appearing. Anesthesia typically lowers BG, though, but maybe not enough. It's good you're aware of Lucy's pattern in this regard.

I'd offer a cautionary note about the DCC board's use of the Hodgkin's protocol with Lantus. That protocol was developed for the old form of ProZinc.I believe it was effective with that insulin and that insulin only. With someone adapting the ProZinc approach to Lantus, it was not done with any research to support doing so. Hodgkins may publish but she is not a researcher and she has been paid by the cat food companies and doesn't always declare her affiliations. The dosing protocol coupled with the notion of not giving HC food if a cat is in low numbers has been involved in the deaths of several cats. It's not an approach I can support no matter how lovely the people on the board are. Your experience with the moderator is different than many of what many of us experienced when we would post there with a differing opinion. We were unceremoniously thrown off the board because we offered a different point of view and provided the research to support our statements. Just my 2 cents.
 
If and only if her mouth is not painful, you might start working with her to get her to accept tooth brushing. If, upon attempting to touch her mouth, she is in obvious pain, you have to wait until after getting a dental done to work on home dental care.
The reason is that you do not want to associate pain with tooth brushing.
 
Sienne and Gabby said:
It's rare to hear about ketones developing as a result of a dental. I might guess that if ketones were brewing -- which is possible since we typically do a urine test and that isn't "to the minute' the way blood testing for ketones would be -- reducing or skipping a dose of insulin prior to a procedure and not feeding that morning, might contribute to ketones appearing. Anesthesia typically lowers BG, though, but maybe not enough. It's good you're aware of Lucy's pattern in this regard.

I'd offer a cautionary note about the DCC board's use of the Hodgkin's protocol with Lantus. That protocol was developed for the old form of ProZinc.I believe it was effective with that insulin and that insulin only. With someone adapting the ProZinc approach to Lantus, it was not done with any research to support doing so. Hodgkins may publish but she is not a researcher and she has been paid by the cat food companies and doesn't always declare her affiliations. The dosing protocol coupled with the notion of not giving HC food if a cat is in low numbers has been involved in the deaths of several cats. It's not an approach I can support no matter how lovely the people on the board are. Your experience with the moderator is different than many of what many of us experienced when we would post there with a differing opinion. We were unceremoniously thrown off the board because we offered a different point of view and provided the research to support our statements. Just my 2 cents.
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Hi Sienne. You have stated the reasons why I chose the Rand protocol because the Hodgkins protocol has no studies supporting its use with lantus plus I cannot agree with the concept of not giving high carb food or honey or other form of glucose when a cat is hypoglycemic and I also do not agree that a cat cannot have a hypoglycemic episode if fed low carb food. I think that is denying the facts that too much insulin will give any cat hypoglycemia so the lack of acknowledgment of this fact troubled me and in discussion with our vet we chose the Rand protocol which has research to back it up. Not to say that treatments without research supporting them don't work but I cannot choose a protocol without research over a protocol which has research behind it. Thank you for your opinion of the possible reasons for development of ketones. The vet at the time did not think it was related to sedation and not eating but to the diabetes and so we promptly started insulin once the blood test and the urine tests confirmed diabetes. Thank you again.
 
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BJM said:
If and only if her mouth is not painful, you might start working with her to get her to accept tooth brushing. If, upon attempting to touch her mouth, she is in obvious pain, you have to wait until after getting a dental done to work on home dental care.
The reason is that you do not want to associate pain with tooth brushing.
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Thank you BJM. I used to brush Lucy's and Rosie's teeth for many years from when they were kittens and both loved it as they loved to chew on their tooth brushes and it was so cute the way they would come running for their tooth brushing. In recent years I got out of the habit of brushing the girls' teeth and I don't really know why I did. Maybe life got busier but I should have kept it up. So Lucy won't have any issue with brushing her teeth as she likes it. I bought a new tooth brush but worried maybe Lucy had pain so I haven't used it. Maybe I will try and see how she reacts to it.
 
The "recipe" for ketone development is "not enough insulin + not enough food + infection or inflammation." So it's not just high numbers alone - cats can have high blood sugar without developing ketones. All of those factors together are needed - a cat can even develop ketones in blue or green numbers, although that is pretty uncommon. You have to have all 3 factors present for ketones to develop - at least that is my understanding.

I'm glad you're checking ketones daily. That's something that is helpful if it is in the spreadsheet - some people start a column just for that, some write it in the comments section.

You're doing a super job with that - some people really have a hard time getting ketone checks.
 
julie & punkin (ga) said:
The "recipe" for ketone development is "not enough insulin + not enough food + infection or inflammation." So it's not just high numbers alone - cats can have high blood sugar without developing ketones. All of those factors together are needed - a cat can even develop ketones in blue or green numbers, although that is pretty uncommon. You have to have all 3 factors present for ketones to develop - at least that is my understanding.

I'm glad you're checking ketones daily. That's something that is helpful if it is in the spreadsheet - some people start a column just for that, some write it in the comments section.

You're doing a super job with that - some people really have a hard time getting ketone checks.
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Thank you Julie. Checking Lucy's urine is easy as I put minimal amounts of litter in the tray and then use a syringe to syringe urine out of the tray and then test it. Lucy is also great if I put a small plastic container under her just after she starts urinating so urine tests are the easiest part of managing diabetes. That is good to know about the factors in ketone development so we had two of them which were insufficient insulin as we had not started treatment yet as well as not enough food. Possibly some gum inflammation was present too.
 
As long as you are getting urine almost immediately after your kitty uses the box, your method should be fine. If the urine is not immediately excreted, I'm not sure how valid the test will be.

Have you thought of getting a blood ketone meter? Novamax has an offer for a free meter. The strips are expensive but hopefully, you'd only need to do a blood ketone test for confirmation.
 
Hi Sienne. I usually use a fresh urine sample to check for ketones. One of the glucometers I have does test for ketones. I will buy some strips for it. Thank you.
 
Actually, ketones develop when the kitty cannot use sugar for energy and starts using fat. They can't use sugar for energy because the pancreas isn't doing it's job and the insulin dose isn't allowin genough sugar to be properly metabolized for energy. The recipe for DKA is not enough insulin + not enough food/water + infection. Ketones can develop but not cause DKA but as soon as you see even a trace of ketones, you need to call the vet and be proactive in making sure she is eating/drinking, and the insulin dose is correct as well as trying to find the source of the infection. The interesting thing is that we have seen some cats develop ketones when they had normal numbers. It's not common but it can occur.

I'm very glad you understand the difference between Dr. Hodgkins approach for treating FDs with Prozinc and the TR protocol researched by Roomp/Rand.
 
Thank you Marje. I bought some ketone test strips for our glucometer in case I find ketones in the urine testing. I didn't know that ketones can develop with normal blood glucose levels so good to know that even though as you said it is not common. Yes I do understand the general differences between the two protocols though I am learning more all the time.
Marje and Gracie said:
Actually, ketones develop when the kitty cannot use sugar for energy and starts using fat. They can't use sugar for energy because the pancreas isn't doing it's job and the insulin dose isn't allowin genough sugar to be properly metabolized for energy. The recipe for DKA is not enough insulin + not enough food/water + infection. Ketones can develop but not cause DKA but as soon as you see even a trace of ketones, you need to call the vet and be proactive in making sure she is eating/drinking, and the insulin dose is correct as well as trying to find the source of the infection. The interesting thing is that we have seen some cats develop ketones when they had normal numbers. It's not common but it can occur.

I'm very glad you understand the difference between Dr. Hodgkins approach for treating FDs with Prozinc and the TR protocol researched by Roomp/Rand.
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