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

OK then, food-wise I am doing things right then. Now insulin.

If I do it properly then I have a day to go (tomorrow) until next dose increase. Then it's going to be full 3 days - 6 cycles. Could you please have a look at my spreadsheet and let me know what you think is an optimal choice. Option 1) Increase the dose to 1.75 or 2 units tomorrow morning or Option 2) Increase the dose on Sat morning (that is after 3 days on 1.5unit).

30th and 31st are messed up days. 3oth - 1.5unit but no food. 31st - 1.5unit injection 4 hours late.

 

I think that you could probably increase bu 0.25 the dose tomorrow as long as you watch carefully even though it hasn't been a full 6 good cycles. Ketones indicate there isn't enough insulin. Then hold for the 6 cycles.

Has your cat always been small or did the cat loose a lot of weight. Sometimes, the ketones can come from the muscle breakdown that occurs in hyperthyroidism as well. Has she been tested?

 

Yes, she's had tests. Everything else is in order. Barsa was 4.5kg pre-diabetes. She could never regain it. The most she weighed with diabetes was 4.2kg.

 

I agree.

Is there any chance of getting another ketone test done before the next shot? The reason I'm asking is I would probably increase the dose to 2u at the next shot if Barsa is throwing above "trace" or "5" ketones on a dip stick AND you're able to monitor carefully. I tend to be aggressive with ketones when kitty can be monitored closely. This advice is given with the assumption that you won't see Barsa drop any lower than mid-200s tonight.

If she does drop lower than mid-200s tonight, I would stick with an increase to 1.75u at the next shot time.

 

Ketones are the same 2nd day now, between peachy and pinkish number - traces to 1.5

If I increase to 1.75 and it's not enough then I will have to stay on that dose Again for minimum 3 days. If I increase to 2 units then if that is too much, I can always lower it. That is why I regretted like 100 times not starting her on 2 units as vet instructed. Plus I can test her glucose every 2 hours if I have to. Agree?

Big surprise for me, BG just went down to 13.1 two hours after food/shot. Oh how I wish it went even lower!

 

Eh... not necessarily. You "can" increase after 2 - 4 cycles, BUT we don't encourage increasing that quickly unless there's a darn good reason for doing so.

IMO, a cat throwing ketones is a good reason for increasing a dose sooner rather than holding a new dose for a full 3 days (6 cycles). When a cat is throwing ketones it means there's an inadequate supply of insulin. Period. If you want to get rid of the ketones one has to increase the dose even if it means feeding kitty high carb foods to prevent kitty from dropping dangerously low.

That's the reasoning behind my comments above: "I would probably increase the dose to 2u at the next shot if Barsa is throwing above "trace" or "5" ketones on a dip stick AND you're able to monitor carefully. I tend to be aggressive with ketones when kitty can be monitored closely. This advice is given with the assumption that you won't see Barsa drop any lower than mid-200s tonight.

If she does drop lower than mid-200s tonight, I would stick with an increase to 1.75u at the next shot time."

However, if you want to increase the dose to 2u BID, it's imperative Barsa is monitored very carefully no matter what time of day or night it is. If I were available to monitor often that's probably what I would do because ketones scare me more than low numbers, but both can kill. Besides frequent monitoring there are other responsibilities to go along with the risk. You must also be prepared to take her to an ER if it became necessary to put her on a glucose drip. I'd also have my hypo tool kit well stocked.

Just my thoughts...

 

This is the first time I've commented on your condo, but I've been watching along the whole time. Do NOT feel bad!! Ketones could have developed if you'd started at 2 units or started lower and gradually worked your way up. Ketones are usually produced when there's a mix of not enough food, not enough insulin and an infection/inflammation...and they can happen even with a cat who's in much more "normal" numbers too

It would have been dangerous to start a kitty that weighs that little on 2 units and you could have ended up with much more tragic results...there's no way any of us can see into the future ....and thinking "what if" in regards to what's already happened doesn't help anybody either.

You're getting some great advice on how to take care of your sweet kitty, so I'm not adding to it, but please don't blame yourself. You're doing the best you can now and that's the important part.

 

If she drops to 100 - 125 at nadir tonight, I think I'd give some serious thought to sticking with a 0.25u increase.

 

We are in blue numbers! Ketones this morning - traces (not pink any more!). This is without dose increase, staying on 1.5 for now

 

5.9 (106) before food. What to do? Shoot 1.5unit? I was not prepared for this. What a rollercoaster!

 

Levemir often has a really late nadir, then BS starts to go back up after the next shot time. The next shot usually doesn't start to kick in until hours later. If it were Max I'd go ahead and shoot the 1.5 (I regularly shoot below 100) and feed now. If in 2 hours his BS is not rising, then mix half a teaspoon of some honey into wet food and feed again, or feed a handful of dry food. Test about every 3-4 hours so you have an idea of her curve when shooting at lower numbers.

Levemir is easy to steer with food, and with the ketones, if the blood sugar is low, you want more carbs, not less insulin.

 

OK, done! 1.5

Meya14, thanks

 

I'm sure I've seen Mel (Mother of Muse) say that with Levemir you really need to grow balls (Big Ones); because unlike other insulins Levemir cycles can have the lowest number close to when the next shot is due...

Iryna, could you possibly add 'Levemir' - and the current dosage - to your signature, so that folks can see at a glance what insulin and dose you're using?

Sending continuing well-wishes to beautiful Barsa......

Eliz

 

Good job shooting. I'd probably get a test sooner (maybe +2) than +4 just because they can keep coming down after you shoot depending on what kind of duration she gets. Sometimes my Gracie nadirs at +15 on levemir. If Gracie is still dropping at PS, I usually get a +2 test on her. If she is going up at PS, I wait longer.