1/1/15 Webster

Hi everyone.

No post today, just trying to enjoy my new year after a hectic 6 weeks.

Webster's numbers have been in the 300's even after clearing his bounce.

While I didn't want to increase his dose so soon, after seeing these high numbers and seeing a ketone reading of 0.7 today, I wanted to go ahead and get him started on a little more insulin to lower these numbers and drive the ketones away.

Moving forward, I'm going to monitor him closely for the next 6 cycles and hopefully we will see some numbers 80 - 200 in the coming days. If we can get him in this range without going hypo, I plan to leave him there for at least a week or more to give him a chance to stabilize.

 

Hi Mike,

I don't see where you're thinking that Webster cleared the bounce yet from the 30's night before last. It hasn't even been 2 full days yet and a bounce can last 3 days. Sometimes even when the bounces have begun to lessen, if a cat gets into really low numbers like the low 30's, that can cause a dramatic, full 3 days bounce.

Ah, maybe you are thinking the 244 was a clearing of the bounce? I'm guessing that's it. When cats are in a bounce the numbers can bobble around from high to med high and back again - i think everything points to him still being in a bounce at this point.

If I were you, I'd drop back to 1.0u and give him another day to clear the bounce, in other words i'd stick with the 1.0u until Saturday morning to give him a chance to see what he gets to post-bounce. If you stick with the 1.25 that got him to 33, when the bounce clears he may end up right back there again.

Does that make sense? Bounces are the hardest thing - i wasn't kidding when I wrote the post on them and said that it took me 6 months of people pointing them out to me before i could finally "read" bounces. They're tricky.

 

Thanks for stopping by Julie.

What are your thoughts on his numbers and dosing from PM 12/18 to AM 12/22?

While this was 2 weeks ago, he seemed to handle the 1.25u dose fairly well, staying above 100?

 

Diabetic cats change - in some ways 2 weeks ago might as well be 2 years. Whenever there is a cat going down the dosing scale, i think it indicates that the pancreas is kicking in and supplementing what is being injected. He gave you a 33 at 1.25u which is a definitive indicator that 1.25u is too much for his body now. It's a constant dance of responding to his changing needs.

If he were my cat, i'd feel completely comfortable going to 1.0u and seeing what he gets to when he clears this very dramatic black numbered bounce! He does have some flair, doesn't he?!

 

Here's the part of the guidelines that apply to Webster's drop to 33:

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.

• If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.

• If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.

 

I see what you are saying about diabetic cats changing.

Right now I feel as if I'm stuck between a rock and a hard place.

If I wait too long to decide on a dose increase, I risk fast development of ketones and potential for him to go back into DKA.

If I increase too fast, I risk hypo.

Neither I want to see. DKA is scary as is Hypo... At this point I'm just not sure which one I'm most fearful of.

 

Maybe this reminder will help. Hypoglycemia kills quickly; hyperglycemia kills slowly.
I'd rather be dealing with high numbers, adding in a short acting insulin if ketones start showing, then come home to a cat in a hypo, because I've got time to deal with it.

 

as far as ketones go, remember you need the equation "not enough insulin + not enough food + infection/inflammation" to produce ketones.

I just think it's important not to increase the dose during a bounce, especially after a cat's gotten into the 30's. I'd be worried about what's going to happen when he clears the bounce. If you are really worried about the ketones and feel you need to increase, i'd go to a dose less than the 1.25u.

It may be that the teeth are the sticking point in the ketones equation and until his dental gets done, this is going to be the merry go round that you are stuck on. Personally, I'd go ahead and get it done. I don't see any value in delaying it, unless it's a $$ issue. But if you can get it done, i think sooner is better than later, and likely it's going to have a positive impact on the way he wants to flirt with ketones. For an ordinary diabetic, dentals can be done by most vets. If a cat has a special circumstance (like punkin had acro and its accompanying problems) then a veterinary dentist may be justified. For Webster, I'd just get it done.

 

Thanks Julie.

I am concerned about ketones and I am also equally concerned about hypo. As I have been told, ketones can develop very quickly. I've been told that Webster can reach dangerous ketone levels within a couple of days.

As for the dental, I really do want to get this done. However, the thought of him not eating after the procedure really concerns me. Money is not really the issue, it's simply the confidence that it's the best decision at this time. The last thing that I want to see is him not eating and in desperate need of insulin.

I'm still not clear when it comes to the formation of ketones. In order for ketones to develop, are the presence of inflammation and or infection absolutely certain?

 

I see what you are saying. I'm still not comfortable working with a short acting insulin and its just one more thing to learn. Learning all of this information and applying it on such short notice really has me stressed out.

 

Most cats do eat after a dental procedure. The last time Gabby had a dental with several extractions, I put down a plate of baby food (easy on the mouth) and she shoved Gizmo out of his bowl and ate his dinner.

While anesthesia can slow the gut, it also acts as an appetite stimulant.

 

Mike, I can't promise how Webster will react, but I want to tell you that I've been through four dentals on cats, including one on Wally, which included an extraction. None of them had any trouble eating after. I was told to give Wally canned food for three days, but he insisted on kibble immediately. (To my shame, he was a kibble eater.) When DK had his dental last spring, I stopped giving the pain meds early, because he was not in any pain. I realize that you can't know if he needs a dental until you see the vet, but it sounds like it's worth checking out. Living on the edge of disaster at both ends, isn't something you can keep up forever. Also, you can always say no, if after talking to the vet, you feel like it's not a good idea.

 

yes. that's my understanding.

punkin with all his acro problems, had 2 dentals. he was absolutely fine afterwards. He had teeth extracted in both of them. He also had a surgery because he had a weird growth in his mouth that was interfering with his ability to chew and he had no trouble afterwards. He had 4 days of anesthesias for the acro SRT treatment.

the biggest problem he had was diarrhea from the antibiotics. i would give fortiflora from the first day of antibiotics if Webster needs ABs.

In weighing out the situation, I wouldn't hesitate to have the dental done. I think you've got a good chances of tremendous benefit and a smaller chance of risks.

 

Just my 2 cents...

Cobb had a dental in May. He had 4 extractions. He ate immediately when I offered him food afterwards. He was gentle with eating initially, but his appetite never suffered.

 

Hi there

I can't recall a case that did not involve all three elements.

I'm not at all sure what it is you are seeking, what sign or signal will quell your concerns and/or fears.
No one, not even a vet or veterinary dental specialist, can tell you with 100% certainty how it will play out for Webster.
What we can do is point out potential pitfalls. Likewise should there be any post dental weirdness there is no better place to be than here. Plenty of first hand experience, guidance and support.

I think that doing your research, hearing other CG experiences and speaking to your vet is the way to go.
Know that after all that - what it comes down to is a leap of faith.

 

I think there is a mixup here of ketones vs DKA. So let's back up a minute.

Ketones form when there is not enough insulin to metabolize the sugar and so the body burns fat for energy. Then ketones develop. There does not have to be any infection/inflammation present for ketones to develop.

The recipe for DKA is not enough insulin + not enough food/water + infection. So the ketones develop first because there is not enough insulin and then the ball "can" start rolling if there is also infection present and the kitty is not eating. If he's showing some ketones but he's eating, then the concern about DKA is less but we certainly want to be sure you and your vet address the ketones.

I agree with Julie that he was still in a bounce from that 33 and it looks like he's clearing it tonight. I would also decrease the dose back to 1u tomorrow and try to be patient.

And Happy New Year!!

 

thanks for correcting that for me, marje.

It does look like Webster's on his way to clearing that bounce.

 

You're welcome!! It's easy to get them confused and I'm sure I've done it in the past as well.

 

Hum.. Thanks for pointing this out. Well I suppose there was a mix up here or lack of understanding.

I was under the impression that ketones were caused by a lack of insulin, lack of food, + infection/inflammation and that DKA occurred when ketone levels reached a certain threshold

So if there are elevated ketones levels but infection or inflammation is not present then DKA is unlikely to occur?

I am of course not satisfied that he's not at risk for developing DKA as we are still not certain if an infection or inflammation is present.

Obviously the next logical step is to get a dental exam and I understand this and have been told this many times. I do want to have have a dental completed. I suppose that I'm just feeling as if he's already frail and am afraid to proceed.

As for the vet addressing the ketones, a couple weeks ago I had a lengthy 45 minute conversation with my vet who brushed off his ketone reading of 3.4 as a concern but said that it was simply "a part diabetes" and hesitantly sold me a bag of ringer solution, line set, etc and said that flushing out ketones was "not standard procedure when it comes to treating diabetes" and that the levels would come down on their own once his insulin deficiency was corrected.

I was obviously frustrated when he told me this but his ketone levels did come down once his BGs started to come down.

 

I wanted to reply to everyone on here individually but it's late and I am wore out. I did read all comments and appreciate everyone who stopped by.

As for returning his dose back to 1u, I will do so in the morning. After seeing him sitting still in the 300's all day today, I was under the impression that his bounce had cleared and that 1u was not enough. Thanks for talking some sense into me.

Tonight I had to fight his drop with an additional 4 oz of MC/HC food.

I sure that I ultimately overfed him and sent his BGs to the moon but I saw him headed down the same road as the previous days and didn't want to wait until he was in the 50's before reacting aggressively.

Thanks for all of the encouragement as far as getting Webster's dental. I can assure you all that this days is coming soon.

 

Mike

Just wanted to let you know we all support you and think you are really doing a great job. I can hear the stress in your condos and it worries me for you. We all know you are doing the very best for Webster and you are worried about him.

Insofar as the ketones and DKA, when the body starts producing ketones because there is not enough insulin and fats are being used for energy, then the cat can become dehydrated from the diabetes and the ketones. The blood pH can change, electrolytes become imbalanced. Then it is a short step to DKA if infection is present and the kitty is not eating and stays dehydrated.

Try to get some rest......

 

Thank you Marje.

 

For some lucky ones this dance is easy. For the rest of us it is nervous time until our kitties settle down. You are doing a wonderful job with Webster. I promise it will get easier. I just can't tell you when.