4/3 Barsa AMPS 10.4 (187), ketones and Levemir starting dose issues

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Vintry, Mar 27, 2015.

  1. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Cross-post from the main forum: http://www.felinediabetes.com/FDMB/threads/levemir-dose-increase-very-underweight-cat-please-advice.135234/.

    Guys, I am posting here as well in case I can get more replies here. My cat has very high BG, she's very underweight but still eating. I'm scared I can lose her. Please read this + original post and advice if you can, it's urgent. I switched her from Caninsulin (3 units) to Levemir (1 unit) 2 days ago, even though my vet said I should start with 2 units. Now I see that I was wrong and the dose should be higher. Is it true that it's not possible to increase it to 2 units after 3 days because it has to be done in increments (0.25 or 0.5)? If true then it will take me 6 days to get to 2 units and then I still don;t know if that dose will be enough.. I wish I could give her 2 units asap :(
     
    Last edited by a moderator: Mar 31, 2015
    Reason for edit: Removed 911 prefix as Barsa has been taken to her vet.
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Hello and Welcome to this forum. My Neko started on Caninsulin (it didn't work for her) and now we are on Levemir. I much happier with it and hope you will like it too.

    Take the time to read the starred Sticky Notes on the top of this forum, if you haven't already. Levemir is a depot insulin, so you have to wait for the depot to build before evaluating how it's doing. That means patience and waiting - both hard to do. It's too early to tell if the dose you started with was too low.

    There are two ways that people here use to determine dosing, either the Tight Regulation Protocol or Start Low, Go Slow Method. Read them both and decide what you'd like to use, then put a note in your signature. It helps us help you and means we don't have to keep asking questions about how you are deciding dosing. You test enough for the Tight Regulation Protocol. It is the more aggressive but is a safe method for increasing doses. According to TR, you have to hold the initial dose for 5-7 days. Increases after than are .25u if you are seeing nadirs below 300 (16.6). We don't like to suggest going any faster, for the safety of your cat. Safety is our number one rule here.

    If you are worried about weight, have you thought about feeding her some higher calorie food? If you told us where you live, we might be able to suggest some foods to try.
     
  3. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    You sound a bit panicky, and I'm wondering if she needs another vet visit. Having blood sugar in the 200's (we use US numbers on this forum, and that's equivalent to the yellows you're getting) isn't a crisis situation. But if she's weak and not eating, that is. Just looking at her blood sugar it doesn't look like she's in trouble, but you are there with her, and you know her, and if she's doing poorly I'd take her to the vet again. Her blood sugar isn't high enough on its own to be causing weight loss, I don't think.

    Below is the info on starting out on Lev and on increasing if you're following the Tight Reg Protocol. I think because of your situation and concern about the high blood sugar, and because you do test enough to keep her safe using Tight Reg, i'd go that direction rather than the Start Low Go Slow. Wendy's right about normally holding the initial dose for 5-7 days, but there is an option that I've bolded, of increasing after 3 days if the blood sugar tests tell you that this dose is definitely not enough because the cat is staying flat and high. Usually we'd call over 300 (pink numbers) as flat and high. You're getting yellow numbers.

    You're right that there is a dosing formula for those following Tight Reg that provides a ballpark starting dose, and that the dose on the previous insulin is also taken into account. Could you possibly add in just the data from the last week on Caninsulin so we can see it in context on the spreadsheet? Did you think 3u on Caninsulin was the right dose? This actually doesn't look too bad for a start on a depot insulin. Since she's getting into yellow numbers on just the 1u, 2u might be too much. There's nothing in her spreadsheet that would make me think you should make a large dose increase, certainly not an entire unit. It's hard to say, but it's safer to start with a lower dose and increase methodically so you don't overshoot the right dose. As you have seen, too much insulin can cause high numbers that look a lot like too little insulin.

    You can't hurry building the depot that comes along with Lantus and Levemir. Take a look at this sticky, especially the first link that is called "Lantus and Levemir: What's the Difference?" - reading that will help you greatly in understanding why you don't make dose changes too quickly. I think I would give it 3 days (6 cycles) on this dose, then increase by 0.25u if she still isn't getting anything less than yellow. That probably sounds like it wouldn't do anything, but 0.25u can make a big difference. Then I would re-evaluate every 3 days after that and increase until you're getting nadirs in green numbers. When we see kitties that have passed the first week on insulin who are staying in pink numbers or higher, sometimes we'll suggest they "fast-track" meaning increasing every 4 shots. But Barsa is definitely not high enough for that.

    And welcome to LL! Keep asking questions and we'll do our best to help you help Barsa. It would be great if you could post regularly so we can keep an eye on what she's doing on the dose and give you feedback if you need it. I'm glad Wendy suggested that you take a look at both dosing methods - we need to know what direction you want to go before we give dosing advice. The info below only goes with Tight Reg, so if you want to go with SLGS, this doesn't apply.


    REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

    • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
      Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
      More monitoring may be needed.
    • It will be necessary to test kitty's blood glucose levels multiple times per day.
    • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
    • Feed a high quality low carb canned or raw food diet.
    • Feed small meals throughout the day. Some kitties adapt well to free feeding.
    Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
    (Revised 10/28/2013)

    "General" Guidelines:
    • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
    • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
    • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
     
  4. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    I am in the UK so I buy the food available here from Zooplus and HappyKittyCompany. Brands - Bozita, Thrive Complete, Catz Finefoods, Almo Nature. The aim at the moment (if that is correct) is to feed wet canned low-carb (under 7%) food that is high in protein (16-18%). One thing I'm not sure about is how much boiled chicken breast to feed? 100g chicken breast is not the same as 100g canned food..

    Protocols..I think I can follow the Tight Regulation one. I'm already drawing the curve on the paper to try and figure out how it all works. But so far, after 5 cycles, the nadirs are 12--14 (220-250).
     
  5. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    If Barsa is very underweight, you want to feed enough to let her regain her weight.

    There's no restriction on how much boiled chicken breast to give her - I gave it to punkin as pokey treats and it didn't raise his blood sugar. You want most of her food to be canned so it has the taurine and vitamins that are added, but you can give chicken in addition to that.
     
  6. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    I am panicking because this high BG is wearing her out. I know it could be worse, numbers could be red. BUT this has been going on for a couple of months now. Somogii effect - BG high high high into 20s on 4 units of Caninsulin (I started feeding her less food then to stop it going up). Then when I realised what is happening and lowered the dose (50% - 2units) she had to cope again with this adjustment for 3 days and that's when she lost even more weight. THEN I went back to the original 'good' dose - 3units and...nothing. Caninsulin stopped working. So you see all that was going on for a couple of months, that's why I'm worried. How much poor baby can take (( but she is a strong girl, I have faith.

    I am going to copy all the data I have from my little book to spreadsheet, this shouldn't take too long.
     
  7. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    I've updated the spreadsheet. 16.6 (299) this morning, 16.3 (293) after 6 hours. Is this normal? I might be expecting too much after Caninsulin. Levmir as far as I know is very gentle, is that why I don't see any BG drops? I have U100 syringes now (with half-unit measurements), been using a FlexPen for the past 2 days. Even with these syringes 0.25 is very difficult to draw! Don't know how you do it. So tempted to increase to 1.5
     
  8. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    This might be it:

    "Diabetes is never 100% predictable, but by getting a few spot checks every evening, you will have a good idea of how low each dose is taking your cat and whether an increase or decrease is appropriate. By contrast, basing your dosing on the results of a single curve can leave you guessing – kitty was high all day on the curve, but is he really high all the time, or did you just happen to choose a day when he was bouncing to do your curve? To me, getting some midcycle tests in 8 or 9 cycles out of every 14 seems safer than relying on curves in only 1 or 2 cycles."

    BUT my cat is not in that 'good' range yet to have a bounce, it's pretty much the same, persisting yellow numbers. This is already cycle 6.
     
  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I'm not sure what's going on with your spreadsheet. The data isn't transferring over to the US tab.

    The first thing to realize is that Lev (and Lantus) are both depot-types of insulin. This is in part, what makes them far more gentle than Caninsulin. It also means that it takes several days (5 - 7) for that depot to form so that you're able to see the benefit of this kind of insulin. Given that you've dropped the dose with starting Lev coupled with the depot not yet being in place, Barsa's numbers are not bad at all.
     
    Bron and Sheba likes this.
  10. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    It might help you to look at some other spreadsheets. While the goal is to get everything under 120, it doesn't happen instantly.

    My point is that while she isn't regulated yet, she will get there. You really can't rush this process and it's better not to increase too quickly or by too large of an increment or you may overshoot the right dose and cause her to have high numbers from being overdosed. And you won't even know you've done that until she crashes into low numbers from it.

    Just hang in there and be methodical. Most new people ask for help before increasing until they get the hang of it. Switching from another insulin is probably the hardest because you have to change your way of looking at the blood sugar numbers that you get. You can't see a high number at pre shot and increase the dose like you can with other insulins. With lantus and Levemir, you look at how low the cat is getting on a particular dose and evaluate the dose based upon that low number. It's a different way of dosing and thinking of how you manage her diabetes, but I think when you get used to it you'll like it.
     
  11. Jmeli

    Jmeli Member

    Joined:
    Dec 3, 2014
    I cant give you any advice but look at Roohs spreadsheet. We started posting here regularly mid January and the awesome help we got from Julie, Wendy, Sienne & others got us to where we are today. They really know what they are talking about. It took about 1 month on Lantus to find his right dose but I think it would have happened sooner if I had been here sooner listening to these ladies and following the protocol they use.

    I also thought Rooh was having symogi swings and he was severely underweight. I free fed wet food and had to encourage him to eat often and used as many kitten foods as I could find that were low carb to increase his calories. He could only eat small meals because he would get sick. I added Dr. Goodpet digestive enzymes to all his meals and still do. He was also put on methylcobalamin (b12) and with his vets blessing we used dandelion for his upset stomach. Oh I dont know if it made a difference but I also added LEF Cat mix to his regimen initially to give him extra vitamins.

    Hang in there. ((hugs))
     
  12. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    Rooh's spreadsheet is actually a perfect one to look at. Notice how many high numbers he had in the first weeks, and how he didn't get a green number until he got up to 4.0u about 6 weeks into the spreadsheet.

    Then as you continue scrolling down you can see the transition to an all-green tightly controlled spreadsheet. It's a happy sight.
     
  13. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Thank you. You explain it all so well. I need to get the emotional element out of my thinking and do the right thing. Basically, what I understood is that patience is key and 0.50 increment after only 3 days wouldn't be wise because of depot, right? Ideally I need to go up from 1 unit to 1.25 after 5-7 days. Because my Barsa is tiny-tiny now (legs' muscles all gone, God knows how she still climbs over the fence!) I am going to increase to 1.25unit after 3 days - that will be tonight. Waiting for your approval now wise ladies.

    I did look at a number of spreadsheets: Neko, Rooh, Gabby - all very good examples. Numbers looking so good, nothing like Caninsulin swings. You are right, my Barsa's BG not that bad I guess, numbers are just high because she's not regulated yet.

    Jmeli, does Rooh have pancreatitis? My cat had her bloodwork done to check for underlying deceases and nothing came up. Nevertheless she has some kind of digestive tract problems every now and then. I see that in her stools, it's not exactly diarrhea, more like a puree consistency, not solid. What helps your cat might also be good for mine so I appreciate your tips. Also, in case you find it useful, on another thread of this forum BaileyUK (she's amazing!) recommended organic aloe vera juice, her kitty has pancreatitis and it's good for stomach.

    "The aloe vera juice I give Bailey is PUKKA ORGANIC ALOE VERA JUICE. I did a lot of research to make sure it was safe,so this is what I found out,it MUST be made from only the inner leaf gel (the outer rind is toxic for cats) it must be free from synthetic preservatives and MUST NOT contain potassium sorbate or sodium benzoate.I buy it at a local health shop,if you cannot find it locally google and there are on line places to do mail order. I give Bailey 1 teaspoon twice daily,it has worked for Bailes,I had him at the vet this morning and he agreed his stomach feels less swollen,he has been on it now for over three months."

    Hanging in there as instructed! :)
     
  14. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    I do think she's overall high enough that you could increase to 1.25u tonight if you want to.

    Let's see if others have a different opinion about it, though.

    With Neko & Gabby, did you look at their early spreadsheets as well? Often people see the most recent tab and both Wendy & Sienne have been doing this for years. Their kitties were hard to get regulated in the beginning but they just plowed on through til they had success.

    Neko also has both acromegaly and insulin autoantibodies, 2 conditions that cause a need for a high dose, which also makes things difficult to regulate.
     
  15. Jmeli

    Jmeli Member

    Joined:
    Dec 3, 2014
    He was not diagnosed with pancreatitis but he also had stomach issues and probably had a mild case of it. He pretty much stopped eating before dx. We did not do the FPLI test but did bloodwork and his liver ezymes were very high. He lost 20% of his body weight in about a month and he really wasnt to bad overweight to begin with.. I tried aloe vera in the past with another cat that had IBD and didnt see it help her. I totally believe in Aloe, but ECID. So far what I have been doing for Rooh is working so Im not going to rock the boat. Thinking back, I do think the LEF vitamin mix does help because it has egg yolk lecithin in it and that also helps with hairball digestion and all the vitamins and amino acids, he needed them. I would make a slurry of the powder with water and syringe it in his mouth. Now i still add it to his food a few times a week. (fyi -it must be refrigerated)

    Is Barsa an outdoor cat? you mention she goes over the fence. Sorry i have not had time to read all your posts.
     
  16. Jmeli

    Jmeli Member

    Joined:
    Dec 3, 2014
    Looking back at Roohs medical notes he probably did have pancreatitis. He was on secnidazole 1 month prior to FD dx for Giardia. There is an article that Metronidazole and similar drugs are suspected to be able to cause pancreatitis and in turn a bad pancrease can lead to diabetes. I suspect in Roohs case, this may be what happened.

    Edit - The article stated Secnidazole was suspected to cause pancreatitis, not Metronidazole.
     
    Last edited: Mar 28, 2015
  17. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    She's an indoor cat but if everything is ok and nothing is bothering her (like upset stomach), even with high sugar she goes outside to roam, in and out, in and out. Last week she was feeling so bad that she just stayed home all the time. As soon as she feels slightly better (like today) I have to let her out or she will annoy me until I do.

    Digestive enzymes, do they have side effects? And methylcobalamin, it's just vitamin B12, right? I want something safe. Do you get it as injection at vet's?
     
  18. Jmeli

    Jmeli Member

    Joined:
    Dec 3, 2014
    Digestive enzymes are completely safe and many cats need them added to their food to help digest. Plant based ones are best. I used Dr. Goodpet brand. There is a big difference between digestive enzymes and "pancreatic" enzymes so make sure you get the right thing. B12 can be in tablet form or injectable gotten at the vets. I give Rooh Natural Factors methylcobalamin tablets and dissolve it in water and add to his food or syringe feed. I think some other people here use Zobaline, another brand. About 6 weeks ago he started having neuropathy and I started it then, at 3mg a day, it took 4 weeks, but he is getting better and now i only give it a few times a week. Here is a article that talks about neuropathy and B12.

    When Barso goes out roaming do you think she might be getting into high carb food at neighbors houses?
     
  19. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    I was worried about that too at first but no, seems unlikely. Her frequent trips into neighbours' gardens don;t affect the glucose levels. I tested
     
  20. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    She just vomited, an hour before food, it's unusual for her although she also vomited a day ago. Both times early in the morning, that's about 8 hours after food. How can I tell if cat is nauseous? What are the signs? And I am not sure what to do now. I have to feed and shoot in half an hour. What if she doesn't want to eat? What do you do in these situations? With Levemir I have to be on time.

    I don't know..is it ok to keep posting here or do I need to make a new thread if I have a question? Don't want to litter the forum.

    Edited: just measured, AMPS - 16.9 (304). She just might eat, what's best to feed after vomiting? Options I have: boiled chicken, canned (low-carb) food, liquid food (Liquivite)
     
    Last edited: Mar 29, 2015
  21. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    What does the vomit look like. Is it clear and foamy, or hairball, or food? Clear and foamy can be from a bit of an acid tummy. Some cats if they go long times between food will do that kind of vomit. When did she last eat?

    Normally we start one new thread a day.
     
  22. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    No hairball, it was food and a lot of liquid. She just ate some chicken (about 30g) so I gave her a shot. But for future reference, if she refuses to eat and it's time for a shot, what to do?
     
  23. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Some cats scarf and barf, so spreading food out to smaller mini meals can help. With Levemir, you can delay the shot up to 1/2 an hour and still shoot on time the next cycle. If she won't eat, try a buffet of different foods. Here is a post of different ways to try to stimulate kitty's appetite. And with Levemir you still have a few hours before onset, so you do have time to get food into her. If she's just eaten plain chicken so far today, I'd try to get her to eat some of her regular low carb food. You do want some carbs on board when the insulin onsets.
     
  24. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    I am new to the forum so can't give you advice but I can tell you what happened with my cat.
    Sheba, was in red numbers for months. This was before I joined the forum. I thought it was Somogyi effect and reduced the insulin. All it did was make her pee more so I went back to the original amount. She was weak in the legs from the high blood sugars and Methyl B 12 tablets helped but mostly she got better from that when her blood sugars came back to the normal range. I used Zobaline

    She had sloppy poops for months, in fact that is what put her out of remission back onto insulin. I tried everything and had tests done to no avail. Finally I changed foods and realised she was allergic to the food she was eating.
    You could try plain boiled pumpkin mashed to firm up the poop. I give it to Sheba as roughage now.It is good for both constipation and diarrhoea. Start with half a teaspoon twice a day and adjust as you see fit. You should see results fairly quickly.

    She was often also very tired and lethargic and i finally realised this was due to her being dehydrated. She had to have subQ fluids at the vet a few times but then I started to give her extra fluids in her food and she has been fine since then. It can be hard to keep them hydrated when they have higher blood sugars but warm water in the food helps. Make it soupy if your cat will eat it.

    The best thing I ever did for Sheba was join this forum. They have sorted us both out and Sheba's blood sugars are so much better. She was a terrible bouncer ( and still can be at times) but I have been taught how to control the drop and stop bounces.
    I agree with Julie when she said the blood sugar on its own was not high enough to be making your cat ill.
    I had Sheba in much higher numbers for months and while she did loose weight, she held her own. Take her to the vet if you are worried. Otherwise make sure she is eating and drinking well.

    We were all where you are feeling at the moment at some point in our diabetic journey so we all understand the overwhelming feelings you have at the moment :bighug::bighug:

    Listen to what these wonderful people here tell you what to do. You can trust them to do the very best for your kitty and I promise you they will get you both sorted out.:)..
     
    Last edited: Mar 29, 2015
    Anne & Zener GA likes this.
  25. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Thank you for that information
     
  26. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
  27. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    No!
    Don't use pie filling as it will have other things in it including sugar!
    Either make your own from raw pumpkin ( easy) or buy canned PLAIN pumpkin with nothing added at all
    It is available but not sure what it is called in the UK. I am in Australia.
     
    Last edited: Mar 29, 2015
  28. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    You can freeze the pumpkin into ice cube trays and take out as you need it
     
  29. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Another alternative that some cats prefer is babyfood squash - again, just squash and water.
     
  30. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    BD dropped from AMPS 16.9 to 14.9 after 4 hours. Barsa keeps drinking water, a lot. Tested for ketones - very high - deep pink number, says 8mmol under it (80mg, 0.8, +++). Is this now an emergency? Do I need to take her to vet or is it possible this number will drop, she didn't have ketones at all 2-3 days ago.
     
  31. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    I would advise you to call your vet if your cat has ketones. I would do so without delay if that is the case. I am not a very experienced member of the board and hopefully others who are more experienced will give their opinion. I remember when we had ketones before starting insulin the vet was very anxious to start insulin without delay so I think you should call your vet and tell them about the ketones. All the best and sending you a hug too.
     
  32. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    I agree with @Voula, ketones mean calling your vet and taking her in immediately. They can be very serious and need to be handled at the vet.
     
    Voula likes this.
  33. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    I definitely will do and take her to vet if needed as soon as possible. It's sunday today tho, everything is closed. She's drinking and drinking but I don't see her pee much. I know about ketoacidosis, that it's very dangerous. Is there anybody else here whose cat had ketones? What did you do? So many problems at the same time: she's 3.2kg, in yellow-pink numbers, vomited today and now ketones. The only positive is that she's eating for now, but then again I dont know how tonight will go.
     
    Bron and Sheba likes this.
  34. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    Is there an emergency vet clinic nearby that you can call for advice as to what to do?
     
  35. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    I think vets are obliged to provide either after hours service or else to provide an answering service that gives you the number of an after hours vet to call if needed.
     
  36. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    Noodle had to be treated at the vet for ketones--she had DKA when she was DXed with diabetes, they need fluids and close monitoring. Ketones turn to DKA VERY quickly, my vet has only had one patient with ketones that had not yet developed into DKA. I don't have much other advice except trying an emergency clinic.

    I cross posted in Main Health to get you some more advice in the meantime. Please call an after hours/emergency clinic ASAP, ketones are not something you want to try to treat at home.
     
    Last edited: Mar 29, 2015
    Jill & Alex (GA) likes this.
  37. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi,
    I am not very experienced either but I agree with the others you need to get to a vet as soon as possible.
    You need to try and get your cat to eat, drink and make sure you have given the insulin which is due.
    Ketones happen when there is not enough food and insulin and probably an infection
    So you need to
    • Get to the vet ASAP
    • Give plenty of fluids
    • Give food
    • Give insulin due
    Bron
     
    Jill & Alex (GA) likes this.
  38. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Gabby had ketones when first diagnosed and I've been here for 5+ years so I know ketones. What people have been suggesting is on target. Ketone levels that are above trace are an emergency. I would do one thing first. Test yourself. If the ketone strips are old or contaminated, you could have a false reading so one quick way to know is for you to test yourself.

    If the strips are reading accurately, it's in your cat's best interest to get to an emergency vet clinic. There is likely an infection going on that is contributing to ketones developing. An infection, not enough calories, and not enough insulin contribute to ketones. Fluid (either in food but sometimes administered subcutaneously) also helps to flush ketones.
     
    Jill & Alex (GA) likes this.
  39. milfordcollector

    milfordcollector Member

    Joined:
    Nov 15, 2012
    Hello! My Sabrina had DKA 2xs in the past 6 months.......please get him to the vet as soon as possible...they will use a fast acting insulin to get the #s down, sub q fluid support, and 24hr monitoring until the kitty stabalizes. The ketones can climb very quickly & kill as soon as a few hours....sorry to be so blunt, but this is a true er situation. Sending healing vines & prayers your way.... Cindy & Sabrina
     
    Jill & Alex (GA) likes this.
  40. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    I live in the uk and if you phone your normal vet office the answer phone message will tell you where the emergency vet they are linked to is. I agree with the others it is the best place for her at the moment.

    Where in the uk are you?
     
    Jill & Alex (GA) likes this.
  41. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    I agree with the others, if there is an emergency vet available, take her in. Give her the full dose of insulin, even if she's not eating a lot and let her eat anything she will (even dry, carbs are ok with ketones). Usually cats with ketones will be really dehydrated, so add extra water in her food.

    If you have to wait until tomorrow, don't hold insulin, mix honey in the food if you have to to keep BS up, but don't skip the insulin. Ketones happen for a few reasons, lack of insulin, lack of food (starvation), or infection combined with the other 2.

    It sounds like you've been giving insulin for a while and not had a weight gain? To me, I'd ask the vet if there isn't something else contributing to the low weight (parasites, IBD, hyperthyroid, etc.). If her body is starving for a reason other than the diabetes, she will always be at risk for DKA and there may be other ways to treat it. There are some prescription high-calorie, easily digestible foods that may help her as well.

    DKA is rough, my cat max was very sick with it when he was first diagnosed. The longer you wait, the more expensive it is to treat as well, so it's best to just get in ASAP.
     
    Jill & Alex (GA) likes this.
  42. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    Please let us know how Sheba is doing when you get back from the vet's. Healing thoughts coming your way.:bighug:
     
  43. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Thank you all. I am in London. Followed your advice and took her to emergency vet clinic, cost a fortune just to get her in for appointment because it's sunday. Anyways, vet said I can leave her overnight for 24h intravenous fluids (+ short-acting insulin) or have subcutaneous fluids to get her through tonight. I've opted for latter. So Barsa got some fluids in her now and I was also given a 500ml packet of fluids which I am to take with me tomorrow when I go to my usual vet.

    The doctor said that cats who have ketoacidosis stop eating and mine is still eating so it could be worse. That still doesn't give me a piece of mind but what can I do. Got home, checked her pmps bg - 14.1 (much better), gave her food - thank God she ate it, syringe-feed her water - 8ml every hour.

    Anybody here in the UK can recommend a good high-calorie low-carb food?
     
  44. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Please keep testing for ketones.

    Did the vet take blood? Did they say anything about electrolytes being off?
     
  45. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    @Elizabeth and Bertie
    @BaileyUK @Critter Mom

    Do any of you guys know a good low carb high calorie food

    Elizabeth recently drew up a draft food chart for uk members

    https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml#

    Go to the uk food draft b ie click on the top right tab.

    When my cat was poorly but before he got diabetes I used this food which you mix with water and then syringe feed but this is not low carb.

    http://www.vetuk.co.uk/royal-canin-...n-convalescence-support-instant-sachets-p-254
     
  46. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Iryna,

    So sorry to hear that you and Barsa are going through this.

    The easiest/quickest higher calorie food you can get will probably be the Gourmet Gold pate's, as they are available from supermarkets.

    Online, probably the highest calorie foods are those made by Forthglade (available from Fetch.co.uk and some other online stores).
    Other high calorie options are Nature's Menu kitten food (various independent pet stores and online); and Ropocat Sensitive Gold from the Happy Kitty Company (the venison version is popular with my lot).

    In addition to the main food, you might also think about getting some Liquivite: This is a liquid cat food (a bit like thick chicken soup). Many cats find it very palatable, and it has the advantage of helping to keep cats hydrated. Again, it's available from a few places online.

    Keeping fingers and paws crossed for beautiful Barsa,

    Hugs,

    Eliz x
     
    Last edited: Mar 30, 2015
  47. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    At this point, due to ketones and weight, I wouldn't worry as much about carbs. Focus more on what she will eat, and what has the calories. A medium carb wet food is ok and will provide a better substrate for the insulin than low carb. Many of the low carb food also have lower calories, so the cat has to eat more volume which might be an issue if she is trying to gain weight. You can continue to adjust insulin to account for the extra carbs. Also, continue to increase the insulin as long as sugars remain high. You can increase by 0.5U after 6 cycles due to the development of ketones. Make sure you are monitoring BS closely.

    300 calories a day is an average intake for a cat. A smaller cat like yours might need less to maintain weight, but 300 will help her gain. 300ml of water is average intake for a healthy normal weight cat. Diabetics, especially with ketones need more. This includes the fluids in food.

    Low potassium is common in cats with ketones. Also, it's possible there is an infection underlying, GI issue, other issue causing low weight. Ask your vet about these when you go tomorrow.
     
    Last edited: Mar 29, 2015
    Jill & Alex (GA) likes this.
  48. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    No, he just injected fluids. I'm just praying tonight will be a better night for her and that she doesn't vomit again in the morning, dreading it. In the morning, if all is well I will feed her, shoot insulin and take her to vet with that fluids bag. Maybe I'll have to leave her there for 24h, maybe less.. I just don't know what my vet will say. Anything specific I should ask him for? What about these electrolytes?
     
  49. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    Has she had any food tonight? As Wendy said I feed remi small meals and often so I feed at least four times in the evening and again the morning rather than just two big meals. If she is throwing up on an empty tummy then try feeding later into the evening. Remi last feed is about 1 or 2 am and is then fed again at 6 am. I also give him 1/8 Zantac twice a day as this helps with stomach acid but that was with agreement from the vet.

    Have you tested for ketones again since you got home?

    Re the vet I would ask for a full blood panel
     
  50. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    Do you leave the wet food down overnight. At the moment you really want her to eat quite a lot to get the calories into her.
     
    Jill & Alex (GA) likes this.
  51. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Thank you Elizabeth, that's a good list of foods. Will try to get hold of them. Liquivite is already in the ration but she won't eat a lot of it.
     
  52. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Philka, you reckon I should leave the food out even if her insulin dose is too low? Next time I can increase it is on tues the soonest I think.. At the moment I am trying to split the feed in 2-3 times but I do it in the first 3 hours after the shot (old Caninsulin habit) Yes, she ate today. Hope all that food will stay in! And hope she doesnt get diarrhea! These are my main worries when it comes to food. Also if I feed too much and/or at any time during the day, will it make glucose go up too much?
     
    Last edited: Mar 29, 2015
  53. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    When you have ketones present it's critically important to get enough insulin in her, even if it means you have to give her high carb food. The presence of ketones isn't directly related to the blood sugar #, except that it's clear when you have a really high BG that there isn't enough insulin. The development of ketones means not enough insulin. Ketones can develop even at lower numbers.

    Let me get some other experienced people's opinion. I'm thinking since she was on a higher dose of insulin before that perhaps it would be ok to go ahead and increase with her next shot. But hang on and i'll ask for some other input.
     
    Jill & Alex (GA) likes this.
  54. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    You could just try splitting the meals into smaller doses so her tummy doesn't get too empty. I fed the small meals in the first part of the cycle when the insulin was still falling and then would stop after about +5 or +6. That way the time between the meals was never more than about 6hours and so it would help to prevent build up of stomach acid. But until blood Glucose is regulated she may need more food than normal to help her maintain weight as the food isn't being converted by the body into the energy that it should.

    Many people free feed and just remove the food 2 hours before the next shot is due.
     
  55. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Yes, she was on 2, then 3 units of Caninsulin. Either 2 or 3 was the correct dose. Somogii effect was caused by overdose, 4 and 5 units definitely tooo much. But now in hindsight..could 3 units have been too much too? Vet prescribed 2 units Levemir BUT he's never dealt with this insulin, not even familiar with it. I was so surprised when I asked for it and got it. I thought he'll prescribe PZI. SO, I started on 1 unit to be on the safe side. And the rest you know :(
     
  56. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    I'd think it'd be ok to increase to 2U as their vet had recommended initially so long as the BS is watched closely (every 4 hours or so) and the cat is eating. You can always mix honey into the food or feed dry food for extra carbs to handle the increased insulin, if she's eating.

    Levemir works very differently than caninsulin, and development of ketones usually means not enough insulin. Sometimes, when increasing a dose there are some inbetween BS numbers that are higher, then you get to a good dose and get mostly blue numbers. Maybe 4-5 wasn't enough instead of too much, or she had started to get an infection and that's where the high # came from.
     
  57. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    I'd be reluctant to add dry food to the picture unless she refuses to eat other canned foods. You just want to keep her eating at this point.
     
    Meya14 likes this.
  58. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Up from 1.25 to 2 units? If I did this in the very beginning when switching then maybe that would be ok.. But now I don't know if I can jump like that. All the comments at the top of this thread actually discouraged me from doing that. Managing diabetes is so not easy. I will soon dream colourful BG numbers in my sleep.
     
  59. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    How long do you have til her next shot is due?
     
  60. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I agree with Meya14 about increasing the dose to 2u BID "IF" you think you can get as much food into Barsa as necessary to keep the blood sugar from plummeting. Like she said, you can always add karo, honey, sugar water, etc. to food or feed dry food if you have to to handle the extra insulin.

    If you're reluctant or don't think you can monitor closely and feed throughout the cycle, I would suggest increasing the dose to 1.5 unit. In other words, know and understand that increasing the dose requires careful monitoring.

    At this point, given the circumstances, I'd feed whatever she'll eat. More insulin, food, and fluids will be of great help...


    The guidelines you were quoted above are for treating under normal circumstances. When a cat is throwing large ketones, guidelines and protocols get thrown out the window. They don't matter at this point. Forget about "protocols" for now.

    Barsa needs more insulin to stop ketones from developing.
     
  61. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    You are testing, so you 'll see if and when you need to back off the dose as you continue monitoring. Levemir is slow to build up in the system, so even with giving a bit of a boost with a bigger dose increase now, your testing will let you know if you need to adjust in time to do so,
     
    Jill & Alex (GA) likes this.
  62. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Look at her numbers friends, I just tested her. 13.9 (250). I will test for ketones in the morning, in 6 hours and if they're still there then....increase the dose I guess. But it already looks like something is happening, right?? If only these stupid ketones were gone :(
     
  63. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Keep going with the hydration and food. If you are in the US, it is possible to pick up a shorter acting supplemental insulin such as R (regular) and very, very cautiously add tiny amounts of that to help get the glucose down.
    Did the vet check the potassium level when you were there?
     
  64. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    No he didn't do any tests. And he would only give my cat short-acting insulin if I left her in the clinic overnight, which I didn't do. It's an emergency clinic so this vet doesn;t know anything about my cat and wouldnt trust me with his insulin. Why is potassium level important? And electrolytes? Im going to Barsa's doctor tomorrow, maybe I can see if there's any info from last week's blood test.

    I need to get some sleep now, so worn out and emotionally drained. My family too, everyone is worried sick.

    Good night ladies. What would I do without you all.
     
    Last edited: Mar 29, 2015
  65. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Unless something unusual happens (like a drop into low-normal numbers) between now and the next shot, I believe the dose can be increased to at least 1.5u BID... if she's no longer throwing ketones. IMO, the Levemir starting dose was too low.

    If you're seeing anything but trace ketones, I would increase to 2u BID and monitor closely.
    As BJM said, keep going with fluids and food. If I were in your shoes, I would also try to test for ketones twice a day.

    BTW, ketones are not dependent on BG numbers. We've seen more than one ketone prone cat develop ketones when their blood sugar registers in the 100s.

    Just my thoughts...
     
  66. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    They should run labs. An electrolyte imbalance, particularly phosphorus level, is the result of the ketoacidosis. The electrolytes are typically a part of a blood panel.

    Now is not the time to tell someone to use R without any prior discussion or preparation. She's in the UK.

    Please understand that ketones can develop regardless of whether numbers are high. Barsa's numbers would not cause me, at least, to be on the lookout for ketones. You did great with testing to see if they were present.

    I would encourage you to follow Jill's advice regarding dose. She's one of the people who has the most experience with Lantus and Lev.
     
    Jill & Alex (GA) likes this.
  67. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Re Liquivite food, it has a high fat content but because it's so watery it is NOT calorie dense. If hydration is the main issue then it might be a good option but if your kitty isn't eating much volume of food then your cat might not be able to eat enough of the Liquivite to get the necessary calories.
     
    Jill & Alex (GA) likes this.
  68. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Potassium is just one part of the chemical messaging system in the body, and is affected by insulin use. That is part of what makes diabetic ketoacidosis difficult to manage. As you give more insulin, the electrolytes change in concentration, sometimes dangerously.
     
    Voula and Jill & Alex (GA) like this.
  69. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Thank you! Good to know.

    I can appreciate your feelings. Many of us have been there, including myself. However, if at all possible, try to feed and syringe some water every few hours if you can. It could make a difference...
    :bighug::bighug::bighug:
     
    Critter Mom likes this.
  70. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    I just sent you a private message that should be in your inbox. I can fix your US spreadsheet for you which will help us with giving suggestions in the future.
     
  71. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Marje and Gracie, yes! That would be very good, thank you. I've done it, you can edit it now.

    The news are not good. She vomited again. Almost same as yesterday, only yesterday an hour before morning feed, today 2 hours before.
     
  72. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Some cats do better with lower fat content when dealing with pancreatitis.
     
  73. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    I'm glad Jill weighed in on the dose, and I hope you can both get some rest and help her keep some food down this morning.

    Sending "feel better" vines to Barsa.
     
  74. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    More vomiting and not eating, hardly even walking. Running to vet
     
    Chris & China likes this.
  75. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Taking her to the vet is best. Glad you're on your way.
    Update when you get a chance. I'm off to bed, but others will be logging on soon.

    Sending positive thoughts and healing vines...

    :bighug::bighug::bighug:
     
  76. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    Sending healing prayers for your Barsa and a hug for you too.
     
  77. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Oh, (((Iryna)))...
    Am praying that all will be well.

    Eliz
     
  78. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    She's in vet's hands now, I had to syringe-feed my baby on the way because I gave her an increased dose of 1.5 but she didn't want to eat anything. Vet is going to run a blood test and give her fluids as well as monitor her blood glucose. We both tested it there, me as usual with my human glucometer (freestyle) and he used his Alphatrek (for cats). Mine showed 11.4, his - 19.
     
  79. Vyktors Mum

    Vyktors Mum Well-Known Member

    Joined:
    Nov 15, 2011
    :bighug::bighug::bighug:
     
    Last edited: Mar 30, 2015
  80. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    I am so pleased to hear Barsa is in good hands at the vets and it sounds as if you have a good vet who knows what he is doing. That is so important! You must be feeling exhausted and worried :bighug::bighug:but Barsa is in the best possible place. You did a great job keeping her going until you could get to your vet. Well done.
    Try and get some rest if you can so that when Barsa is well enough to come home, you will be rested and fresh to continue looking after her.
    Please keep us all up to date with how she is going if you can. Am sending healing vines for dear Barsa.:bighug::bighug:
    Bron
     
  81. BaileyUK

    BaileyUK Member

    Joined:
    Oct 8, 2013
    So sorry to hear that your baby is not well.
    When things settle down if you would like to try the aloe vera juice the best one to try in the UK is called
    Pukka Organic Juice,readily available on UK Internet,or I buy it at my local health store.
    Best of luck. Diane
     
  82. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Please keep us posted as you learn more.
     
  83. Jmeli

    Jmeli Member

    Joined:
    Dec 3, 2014
    Vintry maybe the liver shake would help Barsa with her appetite when she comes home. I gave it to Rooh once when he wasn't eating and it helped him. Sending healing vines for you and Barsa.
     
  84. suki & crystal (GA)

    suki & crystal (GA) Well-Known Member

    Joined:
    May 4, 2014
    Hi Vintry, haven't posted on your condo before but have been watching developments over the weekend. Just wanted to send healing vines to Barsa, and hugs to you too, you certainly are having a tough time at the moment. Take care.

    Suki
     
  85. Vicki

    Vicki Member

    Joined:
    Mar 9, 2015
    Liz and I are sending those healing vines and energy to you and Barsa. And prayers! Hoping all is well soon. :bighug:
     
  86. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Thinking about you and Barsa...
    How are things going?
    :bighug:
     
  87. Tiger(GA) and Ruth

    Tiger(GA) and Ruth Well-Known Member

    Joined:
    Apr 15, 2014
    :bighug::bighug: Barsa has been in our thoughts and prayers!
     
  88. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Good morning everybody,

    Here's a big update on what's been happening. Yesterday was a busy day. I've run out of glucose test strips, went to a couple of shops to find the right food for Barsa (low-carb, high-calorie) and then finally pick her up from vet's. 3 days felt like a week. I have read every single reply here (sorry if unanswered sometimes!) and want to thank you all for your advice, kind words and prayers. I feel like we are all family here and probably nobody else can understand what it feels like better than you. Thank you so much for being there for me and Barsa in hard time! She is home now, All ketones flushed out, NO traces at all. She is wobbly when walking, less than 3kg but tail is up and appetite is Very good :) I still cannot relax but the worst is behind. I hope that this thread will help someone else in the similar situation. It certainly did help me. I've learned a lot and hope you did too.

    So I took her to vet on Mon first thing in the morning. They were still closed so I waited half an hour outside, syringe-fed her liquid food and tested glucose every hour. Glucose dropped to 4.4 that day because she's had very little food. My doctor put her on the drip, and did glucose curve. He of course didn't like the fact I didn't follow his instruction to start with 2 units Levemir but said that 1.5 is the correct dose (I said to him it's not exactly easy to tell because she's had little food, that's why it fell to 4.4). Anyways, for now Barsa remains on 1.5 units. She stayed on the drip until 6 oclock (they close at 6.30), then they transferred her to another clinic that stays open overnight where they continued giving her fluids. Then back to my vet in the morning, again on the drip. So no less than 20hours of fluids. The tests they've run - full profile, electrolyte profile, urinalysis. There were no underlying conditions or complications (halellujah), but as expected - low potassium and phosphorus. These numbers have gone up now, I took home Kaminox supplement (to give 2ml twice a day), it's mainly potassium, also vitamin B complex (B1,B2,B3,B5,B6,B12), iron and amino acid blend.

    I've updated the spreadsheet. A bit of a mess with insulin injections. While Barsa was in overnight clinic, she only received nurse care, which means no vet involvement so no unsulin injection in the morning. They fed her there, then around 9 transferred her back to my vet, he fed her there again and only then gave her insulin. So 4 hours late, BG was 13 (234) pre-shot. And in the evening when I took her home - 17.5 (315) before food. So I will wait and see how soon it will stabilise, 3-5 days..?

    Conclusion. If I didn't take her to vet on that day, she'd probably die. If you see any ketones - run to vet. And I did because so many of you urged me to do so and explained why. So she's alive and better thanks to all of you here (BIG HUGS). Just like that you can save a cat over the internet :)
     
  89. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    That is wonderful news and healing prayers for Barsa to continue to improve and a big hug to you too.
     
  90. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    That is indeed wonderful news to hear Barsa is home and free of ketones. Sending healing vines to Barsa
     
    Last edited: Apr 1, 2015
  91. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    What great news!

    A word of caution, though. Ketones can be unpredictable and can develop even when a kitty is in good numbers. You did great and were checking for ketones and caught them before the situation turned dire. Please continue to check Barsa for ketones whenever you can and try doubly hard if anything seems "off" (e.g., Barsa is lethargic, refusing food).

    In the meantime, food is essential. Add as much water to food as Barsa can tolerate. We'll keep an eye on the insulin dose.
     
  92. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Woo-hoo! Wonderful news! Happy to hear Barsa is doing so much better! Thank you for updating.

    I just want to second Sienne's comments. Don't let your guard down. As you've experienced, things can turn quickly.
     
  93. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Yes, I've been giving her that potassium supplement today and syringe-feeding water again. She's eating very well but glucose numbers are still not in the blue and it will take time to gain weight. Tested for ketones again - traces. I don't know if this is the remainder that should soon get flushed out or is this new ones again..any ideas? What's confusing is this. Ketones appear first in blood and then couple of days later in urine. Vet tested blood and urine yesterday, told me no more ketones, and that potassium is still low so I am to give it as supplement. But if I see traces in urine today, shouldn't they have been in blood yesterday? I have an appointment with him tomorrow (checkup), will see what he says about these traces and also ask again about insulin dose.
     
  94. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    I'm so glad you've made it through the crisis and she's back home and doing ok. I don't know how long it is between when they show up in blood until they also register in urine.

    There is a blood ketone meter available in the US. I don't know if it's available in the UK or not, but if youwant to explore that possibility it's called the Novamax and it tests both glucose and ketones in the same strip.

    Keep up the food and water, keep testing for ketones.
     
  95. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
  96. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    I've had to cancel the appointment. Emailed the doctor this morning asking about ketones. He replied saying they're in urine because BG is high. If Barsa is being, lethargic, quiet and not eating then we should have her back on fluids. For now, she seems fine so no fluids. And increase insulin to 1.75 or 2 units to get sugar under control. So I'm dreading these 4 days of Easter holidays when everything will be closed. Novamax or Ketostix strips..either way if ketones are there then I cannot do anything about them :( But if the future is bright then yeah, we should all have them in arsenal to catch the problem early.

    let's wait and see, maybe it will all be ok and the nasties won't come back.
     
  97. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    Did the vet give you a high calorie food to feed her? There is one called IAMs Max cal (and a few other brands of critical care foods) that would be helpful until she's out of the clear with all this ketone business and might help her gain some weight back. Your insulin need is going to fluctuate at first during all this, so if her sugars remain high for a few days, let your vet know and ask if he wants you to increase.
     
  98. Vintry

    Vintry Member

    Joined:
    Jan 31, 2014
    Let's see. She's eating four times a day because she has good appetite. I wanted to split it into 3 meals in the morning and 3 in the evening but she's not happy with very small meals.

    So, yesterday - morning - meal 1 - 100g - 6.1% carbs - 105 calories
    - meal 2 - 85g - 4.1 carbs - 66 calories
    yesterday - evening - meal 1 - 85g - 6.6% carbs - 98 calories
    - meal 2 - 40g - 4.1% carbs - 33 calories

    Total - 310g, 302 calories per da. She weighs 3.1kg

    Is that good? The food is mixed, some high in fat and some high in protein but all are under 10% carbohydrates. Some have over 100 calories per 100g.

    P.S. I think the one I just fed her is good. 85g can of Miamor pate, 98calories in it, 12% protein, 7% fat, 3.5% carbs
     
    Last edited: Apr 2, 2015
  99. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I know what you mean. I'd try to be prepared to treat at home under similar circumstances with sub-q fluids, a fast-acting insulin, oral syringes to assist feed, an appetite stimulant, meds for nauseousness, an antibiotic (if necessary) and some high calorie food like Meya14 mentioned above.

    Do you know how to administer subcutaneous fluids at home if ketones become worse? If not, I'd ask your vet to teach you. He/she can also tell you how much fluid to give if ketones are present... an amount that would be safe for Barsa. I'm not familiar enough with Barsa's medical history to suggest an amount. You'll need a bag of fluids, a line, and several needles.

    When there's a threat of ketones and kitty remains in high numbers, some of us will use a fast-acting insulin (bolus) in addition to the Levemir insulin (basal) dose to help bring numbers down. Here in the US, the fast acting insulin is called Humulin R or Novolin R, but other countries have similar choices. A discussion took place in one of suki & crystal's threads not too long ago: Advice on R. You might find it worth reading and discussing with your vet.

    Regarding fast-acting insulin available in other countries... here's an excerpt from Crystal's thread:

    "Alternatives can be found here: Activity profiles of the insulins (I used a translator I have installed on my laptop).
    Normal-Insulin (Alt-Insulin)
    - Insuman Infusat
    - Berlinsulin H Normal
    - Humaject Normal
    - Huminsulin Normal 40
    - Insulin Actrapid HM
    - Insuman RAPID
    "

    Your vet will know what's available in your country.

    You may not need any or all of this stuff, but at least you'd have something to work with if necessary.
    These are all things to discuss with your vet if you should need to treat at home over the holiday weekend.
    .


    She's tiny! I'd say 302 calories for a 3.1kg/6.8lb kitty is pretty good. When kitties are throwing ketones, it's the amount of calories consumed that becomes important. The % of carbs is less important. Whenever Alex threw ketones I'd let her eat as much as she wanted, as frequently as she wanted, and whatever she'd want to eat.



    Please post for help, advice, or suggestions as needed. Many of us can help.
     
  100. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    Hi, sorry to hear all that you have been through. Our Tess had a DKA episode last month and I know just how scary it is. One thing I would like to stress is the importance of keeping Barsa eating. If the only food she will eat is higher carb, feed that to her even if it means increasing the insulin dose. Ketones develop when the cat's body resorts to metabolizing it's own muscle because lack of insulin prevents it from using the glucose in the bloodstream. Ketones are the by-product of that muscle breakdown.

    2 weeks after the DKA I panicked when I though I smelled acetone on her breath again (a sign of ketones). The first thing the ER vet asked was if she was eating. It was just before her shot time and we hadn't tried to get her to eat. The vet produce a bowl of diced chicken and Tess went to town on it. Our Rx was to take the bowl of chicken home and don't panic unless you can't get her to eat. :cat: She is on fluid therapy at home as well (but that is also because she has kidney disease) which helps to keep the system flushed out, it isn't that hard to do. Marje did a great video on how to give fluids.

    Many of us are deeply suspicious of the "prescription" food that the vets insist on. Tess developed an addiction to one while in hospital. It is way to high in carbs, but I can mix it w/ low carb food. It keeps her eating. That is crucial, so a little Hills W/D is better than nothing!

    Since Barsa has had DKA once, she will be more prone to it. Keep her eating w/ whatever food it takes to do so, the insulin can be adjusted for the carbs in the food.
     
    Last edited: Apr 2, 2015
    Meya14 likes this.

Share This Page