? Sebastian PMPS 42 +1 87 +2 123 +4 57 +5 135 +7 94 +8 78 +9 60 +10 68 +11 69 Ketones +9 0.8. 7u

Justin & Sebastian

Justin & Sebastian

Member Since 2019
Yesterday

AMPS is 94. I need to go read the low numbers post but I'm assuming I need to lower the dosage and monitor closer. However I'm having trouble getting him to eat. He goes and sniffs at it but doesn't want to eat.
 
Okay he's eating a bit of the beef baby food, and now a bit of the Dr Elsey. Also I know 94 isn't really low, it's just low for him, much lower than I was expecting.
 
Which method are you following? SLGS or TR? When you get a low number or one lower than you are expecting, double check it. Then you can stall (don’t give any food) and recheck in 15-20 min to see if the number is rising on its own.
 
Which method are you following? SLGS or TR? When you get a low number or one lower than you are expecting, double check it. Then you can stall (don’t give any food) and recheck in 15-20 min to see if the number is rising on its own.
 
Chubba (GA) said:
Which method are you following? SLGS or TR? When you get a low number or one lower than you are expecting, double check it. Then you can stall (don’t give any food) and recheck in 15-20 min to see if the number is rising on its own.
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Honestly I've read both and I don't really see what the difference is other than how frequently you adjust. I was told that since he's not on a wet food diet we're doing SLGS. We've been on the current dose for 11 cycles. I see on the guide it says if it's below 90 don't give insulin. I did two checks, one was 94 the other was 88. So it sounds like I shouldn't give insulin and test again in a bit. He's already, although not much and he's acting like he's nauseous and I think he might throw up.
 
I did not shoot this morning. Per the SLGS it says to not shoot if they're below 90 and that's where he was. +1 is 78. Blood ketones is 0.3. He didn't really eat much for breakfast but he didn't throw up. Looked like he was going to vomit for a bit, he was drooling and keep moving over to the carpet like he was going to but the Cerenia must have kicked in.
 
Sorry my internet wasn’t working. I didn’t even thing my last post went through. I’m not familiar with DKA, but I think you don’t want to skip shots with that in the picture. I’ll tag @Wendy&Neko and maybe she can offer some better advice.
 
Justin --

I want to offer a suggestion. You have a kitty that is prone to ketones developing. In this situation, ketones trump literally everything else since this can develop into a legitimate emergency in a heartbeat. The best way to keep ketones at bay is to get as much insulin and food into your cat as possible. In Sebastian's case, this means not skipping shots. Also, if you are giving Cerenia, give the pill about 30 min before a meal -- give it a chance to work before you offer food. Did your vet give you an appetite stimulant (e.g., mirtazepine or cyproheptadine)?

If numbers are dropping, I'd encourage you to intervene with food. You do not want Sebastian to earn dose reductions right now. Prop up his numbers with food as best you can. He may end up getting a dose reduction but do your best to prevent it.

With a ketone prone cat, the guidelines for a dosing method may not applying every situation.
 
Since this is the lowest number you have shot, make sure you start by grabbing a +1 and a +2 and +3.

The Carbs in the gravy can wear off and it's not uncommon to see numbers drop when that happens. It can take up to two hours for the carbs to wear off , but sometimes sooner.
First of all see what he is at at +1.

BTW whatever the shot time was that now becomes your new shot time, and +1 will be one hour after you shot.
To reflect accurately what has gone on this morning
The 78 would go in the amps column, so you would put 94@+12 78@+13,
Did you get another test after the 78? or did you shoot straight after that?
If the 78 was your amps then right amps@+13 if it was later amps@+13.5 (or whatever it was)
 
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I'm not really following. There's no +12 or +13 columns.
78 was before he ate. 94 was about an hour later, after he ate but before I dosed him.
 
Good Morning Justin. Good job shooting this morning. As it's been said, with a kitty and ketones and a recent DKA, skipping is not a good choice. The recipe for another DKA episode is + Not enough insulin + in appetence + a systemic stress or infection ( ie pancreatitis )

It is scary when they won't eat in cases like this. Have you seen the list of things to try when kitty goes off their feed?

Jill's List
-making a buffet to give him choices
sprinkle food with :
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- heating food
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo chicken treats -- crumble into dust over food
- poor a little water from tuna in water over food ( I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats-- check labels)
-powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.
other ideas of foods to offer your kitty to stim appy:
- trader joe tuna for cats
-baby food -- beechnut turkey and broth or chicken and broth. they have no onions or other additives. some babyfoods have onions . please read labels if you can't find beechnut.
- kentucky fried chicken
- deli turkey /chicken
- plain cooked ( boiled or baked ) chicken breast
-canned chicken for people (watch the label that their are no onions)
- chicken broth -- low sodium

Cats that are not eating much for a few days are at risk for hepatic lipidosis
Last resort to eat give Medium or the high carb, wet food

sometimes in order to get a cat to eat you even have to resort to dry it is more important that they eat. there are a couple low carb / grain free brands -- EVO and wellness core. Dr. Elsey's * I have added Young Again Zero Carb
 
Yeah, i tried most of those things. Warmed the food, used forti flora. Put out a bunch of different foods (Wellness Core Turkey & Duck, chicken baby food, turkey baby food, beef baby food, and Dr Elseys) and he didn't really want any of it. Just sniffed at it, ate maybe 2-3 kibbles of Dr Elsey and that's it. I finally put out some of the FF Gravy and he licked up the gravy but didn't eat as much as I'd like so I finally blended some up and syringe fed him, which he had no problem with and has kept down.
 
Justin & Sebastian said:
I'm not really following. There's no +12 or +13 columns.
78 was before he ate. 94 was about an hour later, after he ate but before I dosed him.
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No there isn't.
Sorry I didn't make it clear.
You put all that info in the amps column and then you will have to colour it green manually.

Have a look on Georges ss for an example, look on the 2015 tab date 15/12/2015, you see I stalled that morning and the info all went into that one column. You may need to make sure that you select text wrapping on that cell so that you can see the numbers and info.
 
Looks like you earned these today shooting a green number.

E3B0C9F7-9520-4C53-8068-289398CD7ED6.gif


You will need to really stay on top of the testing today. Is your vet open today? I’m asking because you might want to get a prescription for ondansetron 4 mg which is a human drug and you’ll have to take to the pharmacy. I’d ask for just ten with refills because it’s expensive and you’ll give 1/4 twice a day although you can dose three times a day if needed. It’s for nausea and it has been my experience that it works better than cerenia although using them in combo is perfect as they address nausea from different modalities.

If your vet is not familiar with it, as mine wasn’t, have her look it up in Merck’s. It is a great thing to have in your toolbox. If he’s not nauseous, he will eat better and if he’s drooling, he’s nauseous.

The other thing is to be careful when you give fluids. We’ve found in “some” cats, giving fluid can drop the BG. It doesn’t happen to them all and never happened to my Gracie but we’ve had enough around here that it’s smart to be cautious when thrnBG is running low until you know if it has that effect on him.
 
Justin & Sebastian said:
Okay I gotcha. Just did his +1 and it's 189
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That's good. Well he's gone up not surprising as the shot will more than likely not have onset and he's had some HC.
No food now and grab that +2.
See if we can see when he onsets, he may be starting a bounce, since he probably hasn't seen any green in quite a while, but you never know.

When I saw that green this morning, I thought 'hmm that 110, doesn't look so out of place now';)
 
Marje and Gracie said:
You will need to really stay on top of the testing today. Is your vet open today? I’m asking because you might want to get a prescription for ondansetron 4 mg which is a human drug and you’ll have to take to the pharmacy.
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Yeah, I'll be testing every hour, maybe every half if he gets low again. Vet is open today, just called them and they're prepping an ondansetron (that's a mouthful to pronounce) rx for him right now.
 
Marje and Gracie said:
Is your vet open today? I’m asking because you might want to get a prescription for ondansetron 4 mg which is a human drug and you’ll have to take to the pharmacy. I’d ask for just ten with refills because it’s expensive and you’ll give 1/4 twice a day although you can dose three times a day if needed. It’s for nausea and it has been my experience that it works better than cerenia although using them in combo is perfect as they address nausea from different modalities.
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It's been 4 years, but back then I found my local grocery store pharmacy sold Ondansetron for $3.00 a pill and Costco sold them for $0.30 a pill, so I've always found it pays to shop around. You don't need a Costco membership to use their pharmacy. Just saying.
 
Justin & Sebastian said:
Yeah, I'll be testing every hour, maybe every half if he gets low again. Vet is open today, just called them and they're prepping an ondansetron (that's a mouthful to pronounce) rx for him right now.
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It’s also known as zofran :) You also want to give it 30-45 mins before he eats; when you give the cerenia, you can also give the zofran but the latter can be dosed more often and that’s a good thing!
 
Justin, when you have a chance or some time, can you add his ketone numbers to the remarks column in your spreadsheet and maybe how much he ate and how he's feeling. Those extra remarks may help you in the future to look back on in a similar situation, and will help others to help you.

I would get another test before running out to the vet and/or then the pharmacy to make sure he is in safe numbers.

I'm glad he took the syringe feeding well. That's good.
 
Dyana said:
I have to leave for the afternoon (I'm going to my first animal CPR class :cat:).
Please get another ketone test this afternoon, and keep trying to get food into him throughout the day. Best Of Luck.
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Yeah I'll be ketone testing him around +6. I was told to hold off on food until we get another reading so we can measure the onset. +3 is coming up, so I'm assuming I should try to feed him after I get that reading?

Sienne and Gabby (GA) said:
If you haven’t been to the vet, an appetite stimulant might also be a good idea. Both mirtazepine and cyproheptadine are human drugs but the vet may stock these.
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Don't think we're going to get to the vet today since they closed at noon and I caught them pretty late with the zofran request. They're open again tomorrow at noon so I'll get to them first thing to get the zofran and some stimulant.
 
Justin & Sebastian said:
so I'm assuming I should try to feed him after I get that reading?
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Yes, get that +3 and then see if he will eat..
But although I suggested holding off feeding, if you had had to go out feeding, to er on the side of caution would have been the correct thing to do.

It looks like he is bouncing, the +3 should confirm that. Unfortunately that means we won't be able to see where he onsets.

Here's an explanation of Bouncing taken from the new to the group sticky
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
In Sebastian's case, if we assume the 110 the other day was good, it looks like it took 3 cycles for him to clear the bounce. He hit the 110, his numbers went up, then they came down this morning. So I would be looking for signs of him clearing the bounce at around 3 cycles. Of course he could clear quicker, or longer, he is a cat after all. And with the HC dry out of the equation now, what we are seeing may be a drop in his insulin requirement due to the reduction of carbohydrate in his food. The disruption of the depot with the 5u dose may have also impacted the numbers as the depot settles.

If his numbers are up then I would try and get him to eat the low carb food, hopefully he'll fo for it.
 
That 256 is slightly down on the +2, but given meter variance, I would say flattish.

From what you've said on the condo, the last food was at amps and that was gravy lovers? Is that correct?
If that's the case the effect of the carb in the gravy lovers will have subsided and the BG is not being influenced by that anymore.
 
Gill & George said:
From what you've said on the condo, the last food was at amps and that was gravy lovers? Is that correct?
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Correct. I just now fed him half a can of Wellness Core wet food. I put out a few different things and he just sniffed at them and didn't eat so I finally just blended it up and syringe fed it.

Also, I caught him in the bathroom and was able to get a keto stick under him. Negative on ketones, but more interestingly, only trace on the glucose. I'm not sure what that means. The vet told me there should always be glucose in the urine for a diabetic, however with us trying to actually reach regulation and those low numbers, I would maybe suspect that to be expected?

I'm still going to do a blood ketone reading on him in a couple hours so we get an current reading since I know the urine is delayed
 
Also wanted to add I got some weight readings on him. I weighed him first thing this morning and he was 10lbs 11ozs. I weighed him again at around 1 which is when I normally do it and he's at 11lbs 4oz. He did get 200ml of sub-q about 4 hours ago so not sure how much that's factoring in.
 
Justin & Sebastian said:
I put out a few different things and he just sniffed at them and didn't eat so
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I had luck with parmesan grated on top, it seemed to encourage George to eat when he was feeling crummy with his bad teeth.
Justin & Sebastian said:
Also, I caught him in the bathroom and was able to get a keto stick under him. Negative on ketones, but more interestingly, only trace on the glucose. I'm not sure what that means. The vet told me there should always be glucose in the urine for a diabetic, however with us trying to actually reach regulation and those low numbers, I would maybe suspect that to be expected?
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There's something we refer to as the 'Renal Threshold' that's the BG point at which glucose stops spilling out into the urine, it varies from cat to cat, for George he stopped having glucose in his urine when he was below 200 BG. So a cat can be diabetic, but if he is regulated and spending most of its time below the renal threshold, then you won't see glucose in the urine. So George, is below the renal threshold at the moment, since he's mostly in the green, but he is still diabetic, just well regulated with his insulin dose.
Justin & Sebastian said:
Also wanted to add I got some weight readings on him. I weighed him first thing this morning and he was 10lbs 11ozs. I weighed him again at around 1 which is when I normally do it and he's at 11lbs 4oz. He did get 200ml of sub-q about 4 hours ago so not sure how much that's factoring in.
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well 200ml of water is 200g / 7 ounces, so yes I imagine as it absorbs and before it flushes out of his system it could account for the weight difference.
 
+4 is 211, so it's coming down. Think I should get a +5 or can I give him a break and let him rest a bit and check back at +6 for a BG and ketone reading?
 
Justin & Sebastian said:
+4 is 211, so it's coming down. Think I should get a +5 or can I give him a break and let him rest a bit and check back at +6 for a BG and ketone reading?
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I would perhaps try and get him to eat a little more now and then check at +6. It looks like you have a bit of margin there to give him a little break, but no later than +6.
With the numbers dropping this is looking less like a bounce.
 
Gill & George said:
Has he been keeping his food down?
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Yup, hasn't even been acting like he wants to vomit like he was doing earlier. Been taking the syringe pretty well too, once I get him "primed" he'll start licking it off the plate and the end of the tube. Not going to give him any more now and hope he'll want to eat on his own for dinner time.

Going to give him the Cerenia an hour before food tomorrow. I feel like the half hour wasn't quite enough. It kept the food down but he definitely felt nauseous.
 
Justin & Sebastian said:
Negative on ketones, but more interestingly, only trace on the glucose. I'm not sure what that means. The vet told me there should always be glucose in the urine for a diabetic, however with us trying to actually reach regulation and those low numbers, I would maybe suspect that to be expected?
I'm still going to do a blood ketone reading on him in a couple hours so we get an current reading since I know the urine is delayed
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It’s good to keep an eye on the blood ketones because you are right; it’s real time and the urine is delayed.

So your vet is incorrect about diabetics always having glucose in their urine. They only dump glucose in the urine when they go above the “renal threshold”. For cats, that can be anywhere between 200-250 on an AT meter. It varies by cat and there have been some cats here that hit renal threshold about 150 on a human meter. You can estimate his renal threshold, if you want, by getting urine glucose test strips (you can actually buy combo ketone/glucose urine test strips) and testing his numbers at lower levels to see when he starts getting glucose in them. It helps if the kitty has been in low blue or green for a cycle or so. Gracie never had glucose in her urine until she hit about 200 on a human meter.

I’m glad he’s keeping food down and eating from a syringe.

You are currently two hours past his normal shot time of 7:30 now. If he starts heading up, be sure you get a +10.5 test and if he’s high yellow or above, you can shoot at +11. That will get you a little closer to your normal shot time. We only shoot that much early if the BG is fairly high and they aren’t going to be clearing a bounce because shooting early “can” act as a dose increase. But if he’s high and headed up, why wait to give him insulin?
 
Justin & Sebastian said:
Yup, hasn't even been acting like he wants to vomit like he was doing earlier. Been taking the syringe pretty well too, once I get him "primed" he'll start licking it off the plate and the end of the tube.
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That's good. Do you think you've managed to get a normal amount of food into him?

I'm not sure about doubling the time for the nausea meds, having never had to use them on George. I don't know if the wear off quickly......

He may not be done dropping so far, I'd probably suggest getting another test in 2 hours, to see if he is still dropping.
If he's started to come up significantyl then you could give yourselves both a break, until +11. (the +11 can be useful if you are faced with a lower than usual PMPS, it tells you in what direction the numbers are heading, if the PS is lower tan +11 then it's a heads up, it can be your first sign that the next cycle is going to be active and will need close monitoring


If he's still dropping, then continue monitoring the cycle until you see him rising. If you need to feed him after +6 to bolster his numbers, just remember no food after +10.

It wouldn't surprise me if you see him continue to drop for a little longer.

Just want to give you the heads up I'll be heading to bed soon, its 10pm here.
 
Marje and Gracie said:
You can estimate his renal threshold, if you want, by getting urine glucose test strips (you can actually buy combo ketone/glucose urine test strips)
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Yeah that's what I've been using, the Keto-Disatix that have the combo. We picked them up after the p'titis attack in November and I've been using them on him almost daily. Today was the first time I've seen the glucose not maxed out.

Marje and Gracie said:
You are currently two hours past his normal shot time of 7:30 now. If he starts heading up, be sure you get a +10.5 test and if he’s high yellow or above, you can shoot at +11.
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Sounds good. Per Gill's advice I'll test again at +8 and see how we're looking.

Gill & George said:
That's good. Do you think you've managed to get a normal amount of food into him?
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For sure. He's had 3/4 can of wet food plus a bit of the FF gravy. The 3/4 can wet is on par with what he would normally eat in a 12 hour period, maybe even a bit more.

Gill & George said:
Just want to give you the heads up I'll be heading to bed soon, its 10pm here.
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Have a good night and thanks for all the help. I'm pretty sure he'd have wound up in the hospital without everyone's advice on meds and food and dosing and such so we're just really, really grateful for everything.
 
Look at all those pretty new colours on Sebastian’s spreadsheet. :cool: I was always pleased when Neko’s urinalysis came back with negative glucose. My vet got used to it too, though the lab always commented to it.

At Sebastian’s weight, you can give a dose of more than 1/4 4 mg pill of ondansetron. Dosing can be 0.5 mg/kg two times a day to start and can go to double that. He is a little over 5 kg. I would start with the lower dose, and increase to half a pill if needed. BTW, Zofran is the brand name and often considerably more expensive than the generic ondansetron. In Canada the pricing is gold plated. :rolleyes:
 
88 is safe, but you could try giving him a couple of teaspoons of LC food, just to see if he'll hold steady.

I would probably test again in 30 Min.
 
The idea of giving him a little food now, is that we find that a couple of teaspoons of LC as they first drop into green can help level their bg out. It's best to get ahead of the numbers than to let them overtake you.
He's drones 90pts in 2 hours (45per hour), he's sped up a bit.
 
Gill & George said:
The idea of giving him a little food now, is that we find that a couple of teaspoons of LC as they first drop into green can help level their bg out. It's best to get ahead of the numbers than to let them overtake you.
He's drones 90pts in 2 hours (45per hour), he's sped up a bit.
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Gotcha. Still trying to figure out that balance between staying ahead of it and overreacting. It's only a couple minutes til the .5 now but I'll keep that in mind for next time.
 
+9 is 65. So what's my gameplan here over the next few hours? How frequently should I test? We're waiting for his numbers to start rising again, correct? And I'll want to stall dinner by up to 1/2 hour if they haven't yet? Will I be reducing the dosage? If I do stall and they haven't started to rise after 1/2 hour, I'll be giving HC Gravy, right? And then continuing to monitor for a few hours until that wears off and we see it rising, similar to what I did this morning?
 
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