Stalling ... +11.5 is 223/12.4.

[Alana & Fatty]

Who is this cat?!?!?

He's hungry, and I have more papers to grade, so he will eat and I will retest in a couple hours. He also hung out in the blues for 3hr straight (that I know of -- maybe longer) today. This is total madness.

 

[Shelley & Jess]

Maybe next time try stalling for 20 to 30 minutes without food, re-test BG, see if the number is rising and then decide if it's safe to shoot, if still on the low side do another stall without food. You can stall for up to an hour with Prozinc and still stay on the same dosing schedule for the next shot (if number is high enough to shoot)

He's not going to faint away withholding food for 30 minutes to see if he's on the rise - even though he may act like it!

With ketones in the picture we gotta get you used to shooting lower numbers, 223 isn't low, lower than you're used to, but not low.

I also think you should increase to 1.25U. You've held the 1.0U/1.1U dose long enough. We usually 'fatten' up a dose when kitty is close to being near a good dose - Sir Fats isn't there yet and he hasn't shown any real difference at nadir with 1U and 1.1U.

 

[Shelley & Jess]

PS, the dates on your spreadsheet are a little messed up, when you get a chance can you fix that up please.

 

[Alana & Fatty]

Hi Shelley!

He's not going to faint away withholding food for 30 minutes to see if he's on the rise - even though he may act like it!

I just confronted him about this and he insists he will, in fact, faint! Hahaha. Thank you for this. Seems he is perhaps on a bounce from yesterday's blues (maybe) but hopefully will come down today ... AMPS is in the (high) teens again.

With ketones in the picture we gotta get you used to shooting lower numbers

Can I ask you ... and I swear I'm not trying to be pedantic or difficult here, so I hope I don't come across that way. A few members have mentioned "ketones in the picture," and a few have said that since he was below 0.6mmol/L (upper limit of normal), they don't "count." My keto pee diastix don't pick up anything under 0.5mmol/L (his maximum blood reading), which is the ketone testing method our normal vet advocates for. And I don't mean ... "well, since the urine sticks read negative, the ketones aren't there" ... I'm just wondering, does this 0.5mmol/L reading "count" as Fats having a history of ketones? I appreciate everyone's feedback and the studies they sent me. Just don't know how to categorize Sir Fats with this under-normal-limits but still detectable-in-blood ketone reading, and I'm asking because a "history of ketones" seem to be an important thing to know about.

I also think you should increase to 1.25U

Last night I realized the 1.1U I said I have been giving the last 2 days is really about 1.2 (updated on my SS). It's a skinny 1.25. I am using U40 syringes with only full and half unit markings so this is just a smidge under what I think 1.25 would be (I can align the plunger consistently at about 1.2 and 1.25 though). I am still going slowly as he seems to go all over the place with larger (even 0.25U) dose changes, but today will be day 3/6 cycles of 1.2U. I saw your message after he got his shot this morning but will bump him up, thank you. When Fats was in remission, anything above 6 mmol/L at nadir seemed outrageously high to me ... and I think I only saw that once or twice in a few years of weekly spot checks. I don't know when I became so afraid of single digit numbers! Snap out of it, Alana!

PS, the dates on your spreadsheet are a little messed up

Fixed!

Thank you for reading my novel!

 

[Shelley & Jess]

Hi Alana!

I just confronted him about this and he insists he will, in fact, faint! Hahaha.

Can I ask you ... and I swear I'm not trying to be pedantic or difficult here, so I hope I don't come across that way. A few members have mentioned "ketones in the picture," and a few have said that since he was below 0.6mmol/L (upper limit of normal), they don't "count." My keto pee diastix don't pick up anything under 0.5mmol/L (his maximum blood reading), which is the ketone testing method our normal vet advocates for. And I don't mean ... "well, since the urine sticks read negative, the ketones aren't there" ... I'm just wondering, does this 0.5mmol/L reading "count" as Fats having a history of ketones? I appreciate everyone's feedback and the studies they sent me. Just don't know how to categorize Sir Fats with this under-normal-limits but still detectable-in-blood ketone reading, and I'm asking because a "history of ketones" seem to be an important thing to know about.

I'm looking at it along the same lines as @Deb & Wink mentioned in your previous thread: Dosing advice for Sir Fats the sugary ...

A bit concerned because the ketones had risen the other day, but were back down today.
Not enough insulin + not enough food + an infection/inflammation can lead to ketone production. Doesn't have to be all 3 factors either.

Oh gosh, you're not being difficult at all - I mentioned it as a general safety precaution because ketones can progress quickly given the 'right' conditions - one possible factor being not enough insulin.

With ketones in the picture we gotta get you used to shooting lower numbers, 223 isn't low, lower than you're used to, but not low.

What BG number do you feel comfortable with giving a full dose of insulin right now?

 

[Alana & Fatty]

What BG number do you feel comfortable with giving a full dose of insulin right now?

Maybe ... 16 mmol/L, 290 ish? I know that seems high, but I'm also noticing that his nadirs (while still in the high blues) have been about half his PS numbers the last couple days, so that seems like a big drop to me (about 10 mmol/L or 180). I read on the PZ sticky to chill a bit if the drops were 50% or so, so that was my approach. Last night when he was at 12 ish/220 ish, I wasn't sure if he would drop 10 mmol/L like he did from AMPS to nadir, so I didn't feel comfortable shooting at that number. I am still learning what his lil bod is going to do so I'm probably being way more cautious than more experienced people would be. Fats has been diabetic for a long time but it's just within the last six weeks ish that I've had such a hard time figuring him out -- I'm basically a newb!

That meme is basically my life

 

[Liz & Minnie]

I'm asking because a "history of ketones" seem to be an important thing to know about

Hi! Minnie has been in the hospital 3 times for DKA so I am now petrified of ketones, though I only just started with blood ketone readings. 'Fortunately' I can smell the ketones on her breath which alerted me at her diagnosis and with the last hospitalization, I could smell it before it showed up on the pee sticks.


Some of the first (and easily implemented!) advice I got here was to switch from 2 meals a day to multiple smaller meals and be sure to add water to the food to help keep ketones at bay. Minnie's on Lantus, so I don't know how much of this applies for you but water...who doesn't need more water?!

You've been at this a lot longer longer than I have, so maybe you already know and do this

Ketones start to form when there is not enough insulin and not enough food and the body starts to use fat instead of carbs (glucose) for its energy and the byproduct of this is ketones ...

I would give three snacks during each cycle at the moment to get enough food into her. Food is like a medicine when it comes to ketones and DKA.
So that is 6 extra snacks a day as well as the preshot meals. Is that manageable? Don’t feed for the 2 hours before the preshot BG as you don’t want it to be food influenced. Keeping the snacks for during about the first 6-7 hours of the cycles is best if you can do that.

 

[Alana & Fatty]

Hi Liz!

Thanks for your advice -- I've heard about the "ketone smell" but as I've never smelled it (thank the kitty gods and knock on wood and salt over the shoulder and whatever else works), I freaked myself out last weekend being like: Is THIS the smell? It wasn't the smell. Does it really smell like apples or nail polish remover?

The multiple small meals things mixed with water is sound advice! We do that already, not as a ketone thing, but because Fats also has kidney disease and he prefers to eat mini meals throughout the day and night (7 times usually), and yes, the extra water is definitely good for him! It's helpful to know this is also good for keeping ketones away, so thank you. Fatty's appetite is really good at this point in time (again, thank all the kitty gods and woods and salts), and I hope that continues. The vet said if he was eating well and drinking well (he doesn't drink water, but he gets 100ml subqs and a bit more than that in his soupy food), he would be in good shape. Sounds similar to the advice you got, so that's reassuring.

Sounds like you are taking very careful and loving care of Minnie -- she is lucky to have you. Hopefully 3 times is enough and she is now "over" her DKA scares!

 

[Deb & Wink]

By the time you can smell the ketones on the breath of your cat, it's likely your cat is already in DKA.
So don't wait for that sign to happen. Be proactive is what I'm saying.

Yes, ketones can smell like nail polish remover (acetone) to some people. I think it smells fruity, like overripe or browning (rotten to my way of thinking) bananas. Sort of a sickly sweet smell. (Had a significant other human, that had that ketone sickly sweet smell a number of times).

 

[Liz & Minnie]

Hi Liz!

Thanks for your advice -- I've heard about the "ketone smell" but as I've never smelled it (thank the kitty gods and knock on wood and salt over the shoulder and whatever else works), I freaked myself out last weekend being like: Is THIS the smell? It wasn't the smell. Does it really smell like apples or nail polish remover?

Nail polish remover! Somewhere in the back of my brain I knew about the smell before I knew anything about diabetes, so when she first stopped eating and I took her to hospital the Dx didn't surprise me at all. I could smell it around her head though when I'm getting worried I get right in her face to smell her breath. I can't remember where I read it but I think there are 3 different types of ketones and only one of them has the smell (?)

I've only recently discovered that 1) not every cat smells of it and 2) not every person is able to smell it. Maybe a new career path, cat-breath sniffer?

 

[Deb & Wink]

I've only recently discovered that 1) not every cat smells of it and 2) not every person is able to smell it. Maybe a new career path, cat-breath sniffer?

 

[Alana & Fatty]

So don't wait for that sign to happen. Be proactive is what I'm saying.

Absolutely yes -- I'd much rather check blood ketones and know if things are going in that direction than wait to smell it. Actually, I'd much rather us not get to that point at all, but still. I'm pleased/relieved his BGs seem to be moving in the right direction, though of course there is still more work to do! The receptionist at the vet clinic yesterday said I could just check his BG 2x a day (I had asked about getting something for his poor pokey ears) ... I was like ... but he isn't regulated! I need to know!

Maybe a new career path, cat-breath sniffer?

I feel like there is a customer base just waiting for you to fill this role. Perhaps you might find some takers on this forum! Fats probably thinks I'm a total freak -- last weekend I was trying to smell his breath, and since mid Jan I have been putting my face onto his little belly and asking his organs and electrolytes and stuff to do specific things since he had his first panc flare and was dealing with increased kidney values, though he is doing so much better now. I think I'll keep talking to his organs -- can't hurt. The things we do for love!