When somewhat new to FD, I used R as a bolus to BCP PZI basal to get Max's numbers down to a range that the PZI could be effective. Ketones were not an issue with Max.
On New Year's Eve 2008, I treated a friend's cat that had been hospitalized for a week with DKA. The day after Romeo came home from the ER ketone free and with a $5K bill, he went lethargic again and was running HI. We had no urine to test for ketones, no way to test blood ketones, and Romeo's beans were not able to afford another DKA bill. Their choices were (a) PTS and (b) me and my bag of fluids, bottle of R, and test strips. They chose me. It took about 10 hours of testing every 30 minutes, injecting R every couple of hours, and giving SubQ fluids until the HI broke and Romeo could be effectively treated with a basal insulin. We opted not to use the Vetsulin the vet had sent him home with and put him on my cat's Levemir. Romeo came quickly back to health.
When Stefani brought foster
Ahi home from the shelter he was in very lousy shape and running HI. I suggested she try R to bring him down. It worked for Ahi.
I think there is a place for using a small amount of R in Yoda's current situation. I agree with Vicky's cautions about a low dose to start (I would recommend .25U of less) and not using it with any regularity. I also agree with Nancy's caution about the timing of the nadirs. The first time I gave Max R, I didn't understand that point and made the mistake of timing the basal and bolus so that the nadirs might have coincided. The few times I used R after that, I always shot it at the same time I shot the PZI so that the R was clearing Max's system as the PZI was starting onset.
One thing with Max that is not the same with Yoda is that Max got a huge food spike in the morning. This was 5 years ago when conventional wisdom was BID feeding. Max would hog out on breakfast. Over time, I learned I could flatten Max's curve with small, frequent meals. You already are doing frequent feedings.
I understand the concerns of those who have been through DKA that immediate treatment by a vet is needed. However, I'm not sure they are fully aware of how Yoda came into your care and the limited resources that are available to treat him. And you make a very good point that he is not appearing to be affected by the ketones that are presenting in the blood tests you are doing.
I have never tested blood for ketones, and I don't know how reliable those tests are. I think most here are accustomed to urine testing. If the question were one of whether Yoda should be seen and treated immediately by an ER vet, I come back to my story of Romeo. There are sadly just some situations in which that is not a viable option, and this is one. But then, I also don't see the need, given the very apt care you are giving him with the resources you have available and him having no symptoms of a ketonic state.
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