? 4/9/18 Ravan/amps464/+2 294/+4 347/pmps289/+2 314/+5.5 201/+7 424

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Hi Kris & Teasel,
I just increased 2 days ago. I've got 4 more days to go before another increase, Right?

I've been testing a lot. At what point do i need to do a curve? I thought I had already done one?
 
@JoyBee
Hi,
it was quite a drop - Red AMPS to Yellow...
Please take another test, at maybe +4 if possible.
When the +2 result is that much lower than the PS the entire cycle could be very active.
Ducia always bounces after large drops - don't get discouraged if Ravan does it , too, it's common in cats.
If it is going to be his pattern - to drop a lot at +2 you can try splitting his preshot meal in to 2 portions and feed one at preshot and than an hour later at +1. It could possible make the lowering not too drop-y.
 
@Tanya & Ducia,
I haven't left the house since the increase 3 days ago. I'll test again at +4

He went from 258 to 169 when i 1st increased, but then continued UP to 472!

It's been 9 weeks & I still don't know when he might go up or down. I look at his SS & don't see a reliable pattern?

I'm very frustrated! Afraid to leave the house for an hour or two.
 
JoyBee said:
I'm very frustrated! Afraid to leave the house for an hour or two.
Click to expand...
take the +2 test and if it close to the +2 you are ok.
JoyBee said:
It's been 9 weeks & I still don't know when he might go up or down. I look at his SS & don't see a reliable pattern?
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Until you figured his individual patterns I think it is good idea to keep testing at +2 - very often it tells you that the day ahead will bring lower numbers.
I cannot see any particular pattern in his SS that you can rely on yet.
I personally would be inclined to check out if that +2 lower =active cycle and would keep testing.

But it is me... @Wendy&Neko Wendy, as a test-a-holic I might be giving Angela bad advise and make her test unreasonably often. How often would you test Ravan ? I am afraid that with Trace ketones in the picture a dose increase is due quite soon and that might compel me to advise testing more... Can you help here, please? Being housebound needlessly must feel awful...
 
@Tanya and Ducia

It's not "Angela" it's "JoyBee" (just so there's no confusion)

If I test at +4 & it's going UP would it be safe to go out for 2 hours ?

Also I just increased 3 days ago. Don't I need to wait a week till I do a curve before I increase?
 
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JoyBee said:
+4 bg 347!! This is driving me crazy! Very Upsetting it's not going down!
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as a bouncer's mom I know well how frustrating Pinks are..Hang in there.
The good news is that you have time until preshot or very late in cycle. Have some good time for yourself.
I would not expect any drama today.
 
Hi JoyBee,

First, you are testing frequently enough (recently) that you don’t need “a curve” you have the data you need to make dosing decisions from the spot checks you are doing every day. A curve is for people that must limit their testing and don’t have a good idea of how low their cat is going on a dose.

You are early on in this journey and this is where you will need the most patience, you have not yet arrived at a proper working dose of insulin. It looks like Ravan needs more insulin. You can’t focus on one cycle or wonder why every little thing is happening or not happening how you want it to. Insulin is a hormone, not a drug and just like the hormones you may be more familiar with, unpredictable is part of the package. :p

With SLGS, even more patience is needed as the dose increases are further apart than TR. You will get there, eventually, but it will take time. :)
 
Tanya and Ducia. (thank you)

I'm very worried about the trace ketones starting to show up!

I can see Ravan doesn't feel good.He back to drinking a lot of water. (I literally get sick to my stomach when my animals are unwell.)

I'm still not sure if it's OK to keep giving him Ringers? It did seem to make him feel better.
 
Stacy and Asia,
Thank you for the advice. It's just so frustrating to get a number in the blue & then go back up! I get sick to my stomach everytime I see his numbers go up.

He sleeps nearly all the time & started drinking a lot water again . I get depressed! Crying everytime I look at him. I know it's not good but I can't seem to get a handle on all this.
 
JoyBee said:
I'm very worried about the trace ketones starting to show up!
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It is worrying. But if it is not higher than the Trace amounts it is not an emergency. Keep doing what you were doing and I think you might want to increase a little earlier then per SLGL.
the SQF: it is very good flashing the ketones out. Be careful with amount and frequency.
 
JoyBee said:
Stacy and Asia,
Thank you for the advice. It's just so frustrating to get a number in the blue & then go back up! I get sick to my stomach everytime I see his numbers go up.

He sleeps nearly all the time & started drinking a lot water again . I get depressed! Crying everytime I look at him. I know it's not good but I can't seem to get a handle on all this.
Click to expand...

It’s great that you are on top of the ketone testing, and while trace amounts isn’t an emergency, it’s a sign to be vigilant. I would be concerned as well, not panicked, but concerned. Is there something preventing you from doing TR (like any dry food in the picture)? With TR you will have much more flexibility to get these numbers down, faster, as you can increase every 6-10 cycles instead of every week and you take reductions below 50 instead of below 90. With any ketones showing up, you want to make sure he is getting enough food, enough insulin, staying hydrated and does not have any medical problems/infection going on. Does he have any symptoms of common things like UTI, teeth infection, pancreastitis? When was his last vet visit with blood work and a urinalysis?

How much are you feeding him? Are you limiting his intake or allowing him to eat more? I would let him eat more for now, being unregulated, he can’t make proper use of his food. Has he lost any weight since diagnosis or very recently?
 
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I agree with Stacy that you're able to test enough to use the TR protocol with Ravan. You'll be able to change the dose more frequently and get him into better numbers sooner. I'd definitely go that route if you're getting "trace" ketones and are worried about the high BGs. It WILL require you to be braver in dosing and accepting lower BGs than you're accustomed to.
 
One's he's hit the low and headed back up on any given cycle, put away the test kit. Go out of the house. Do something for you. :bighug:
 
Wendy&Neko,
Thank you for the advice. I'm so stressed even when i go out I keep looking at the clock Thinking i better get home.

I lost 3 of Ravan's litter mates in less than 2 yrs (last year was the 3rd one) Every time i look at Ravan & his sister Peggy Sue I think I'm going to lose them too.

I get too emotional now after trying to save the last 3.
 
@Stacy & Asia, Kris & Teasel

I read over the TR method & do Not think I could handle it. When Ravan goes down to the blues I'm Happy! Lower & I'm sick thinking about Hypo.

I lost 3 of Ravan's litter mates in less than 2 years. Nearly lost my mind trying to save each one.

I'm still grieving over them & now Ravan & Peggy Sue are both sick. It's really too much stress!

I need to clarify something else. I DO Not want to test as much as I have been. It's causing Ravan to shy away from me & I just realized today how much it's costing me to buy the strips.

About $20 a week ($80 a month!) I'm putting everything on a credit card. My income is so low I do not need to file income tax! When it comes to my Kitties I don't think about how much it's costing.

There comes a time when I need to be realistic & slow down money wise.

I became vegetarian 20 yrs ago so I could feed my Obligate Carnivores meat. If I lose my home trying to help my cat I don't know where I'd Go?
 
JoyBee said:
@Stacy & Asia, Kris & Teasel

I read over the TR method & do Not think I could handle it. When Ravan goes down to the blues I'm Happy! Lower & I'm sick thinking about Hypo.

I lost 3 of Ravan's litter mates in less than 2 years. Nearly lost my mind trying to save each one.

I'm still grieving over them & now Ravan & Peggy Sue are both sick. It's really too much stress!

I need to clarify something else. I DO Not want to test as much as I have been. It's causing Ravan to shy away from me & I just realized today how much it's costing me to buy the strips.

About $20 a week ($80 a month!) I'm putting everything on a credit card. My income is so low I do not need to file income tax! When it comes to my Kitties I don't think about how much it's costing.

There comes a time when I need to be realistic & slow down money wise.

I became vegetarian 20 yrs ago so I could feed my Obligate Carnivores meat. If I lose my home trying to help my cat I don't know where I'd Go?
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We all struggle with getting upset and worried when they are too high and scared when they are too low. All I can tell you is that it does get easier with time. You will learn how Ravan responds to insulin and you won’t be afraid of below 100 numbers eventually.

I think it’s great that you test frequently, it will help you help Ravan by keeping him safe and being able to adjust his dose to what he needs. Have you tried giving Ravan a treat when you test him? A low carb treat might help him make a positive association with testing, many cats ask for tests because they know they get rewarded! :rolleyes:

You’re right, testing strips (and insulin) are very expensive. There is a non profit called Diabetic Cats in Need that may be able to help you with testing supplies. You can look them up on the web and see if you qualify. A cat being hospitalized for DKA is very, very expensive (and scary), it’s great that you’re testing BGs and for ketones, keep it up. Does he have any signs of infection? The recipe for DKA is not enough food + not enough insulin and infection/major stress. Make sure he’s eating plenty and add some water to his food to keep him hydrated. I would increase his insulin to 1.5 tonight or tomorrow if you can. It is not per SLGS guidelines right now, but with trace ketones, I think you should do all you can to get them back to negative and keep them there. He’s likely losing some weight if he has ketones, feed him more than you usually feed him.

I’m sorry for the loss of your kitties. :( You’re doing great with Ravan, keep it up and hopefully he will be on his way to regulation soon and feeling so much better. :bighug:
 
@Stacy & Asia

Thank you for your words of encouragement & all the advice. I will check out "Diabetic Cats in Need"

I spoke to my Vet yesterday. He again reviewed Ravan's Blood work & said there are no signs of infection.

I told him about the trace ketones. He said giving Ravan ringers a few times a week would help with that. I told him I recently increased his insulin & he advised I go slow & give it time to work.

Ravan eats when ever he asks for food. I was told earlier to let him eat. I've been delaying his food for at least 2 hrs before his shot & giving him a tabls of raw chicken after.

It's great having all of you there to help & give advice but it can get very confusing.

I was told before to be patient & give the Lantus a week to work,before increasing the dose. I finally feel comfortable doing that.

Now you're advising me not to wait & increase again. My head is spinning with all the different opinions!

2:30 am his bg was 201 I was sure it was going to drop a lot. By 4am it was 424! ( he only had the raw chicken?) The big increase was NOT expected.
 
@Judy and Boomer

Thanks for the hugs! And encouragement. I can always use that!

Last night my phone & computer went out. ( I don't own a Cell phone) Ravan's pmps was 289 I was anticipating a big drop. I had all my Hypo stuff out & without the computer to reach anyone it was really scary.

But of course by 4am he was back to 424.

I can see that if i don't calm down I'll drive Ravan & myself nuts!
 
JoyBee said:
It's great having all of you there to help & give advice but it can get very confusing.
Click to expand...
JoyBee said:
I was told before to be patient & give the Lantus a week to work,before increasing the dose. I finally feel comfortable doing that.
Click to expand...
JoyBee said:
Now you're advising me not to wait & increase again. My head is spinning with all the different opinions!
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It is rather different methods we are talking about, not different opinions.
Because you choose SLGL you are to hold the dose for 14 cycles. SLGL allows you to increase after 14 cycles when nadirs are higher then 150.

However, Ravan BG are high and he throws Traces of ketones. He might need an increase sooner than full week but it is how you do it with TR, not SLGL. Increasing per TR every3 days/ 6 -8 cycles but testing as little as for SLGL and waiting longer before increase is mixing two different dosing approaches and it is not safe.

The recent advises given re: dose increase are motivated (on my part at least) by his consistently High BG AND ketones.
The BG needs to be pushed down. That will require same testing routine you have now; testing not as frequent may not only be dangerous with frequent increases but also not as effective in dose assessment.

Does it make any sense?
 
JoyBee said:
@Judy and Boomer

Thanks for the hugs! And encouragement. I can always use that!

Last night my phone & computer went out. ( I don't own a Cell phone) Ravan's pmps was 289 I was anticipating a big drop. I had all my Hypo stuff out & without the computer to reach anyone it was really scary.

But of course by 4am he was back to 424.

I can see that if i don't calm down I'll drive Ravan & myself nuts!
Click to expand...

It's good that you have your Hypo kit ready! I recently gave my DH hell because the bottle of corn syrup had been shoved back to the middle of the cupboard and (since I'm very short) I had to get a chair in order to find it. Not something I want to be doing if Boomer is in a hypo or near-hypo situation. I reminded him that it must stay in front at all times!

Try not to panic when Ravan gives you a number that is lower than usual. You will learn his cycles, how he responds to insulin, how he responds to food. But it takes time. Unfortunately there is a long learning curve to feline diabetes (which is why most vets don't know squat about it). And sometimes cats have a mind of their own.:rolleyes: And you will find that a lower PS number doesn't necessarily mean that all of the numbers in that cycle will be lower. Shooting a lower PS number actually helps to keep the numbers flatter. I shoot numbers in the 60s but I am following TR and, more importantly, I have 4 years experience. :bighug::bighug::bighug::bighug:
 
Tanya and Ducia said:
However, Ravan BG are high and he throws Traces of ketones. He might need an increase sooner than full week but it is how you do it with TR, not SLGL. Increasing per TR every3 days/ 6 -8 cycles but testing as little as for SLGL and waiting longer before increase is mixing two different dosing approaches and it is not safe
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My suggestion to increase was not based on SLGS, TR or a mixing of the two. My suggestion to increase was based on the fact that ketones are in the picture, which means some rules get pushed to the side TR or SLGS. You are testing enough, the lowest this dose got Ravan was 169 which is still plenty of room for an increase and that was 6 cycles ago. There’s too much pink, yellow and red on this SS and trace ketones.

It’s your decision, of course, but I wanted to clarify I was not making the suggestion re: any method or protocol we use, but because ketones are an exception to them. You hold the syringe and it’s your cat. I would encourage you to test for ketones more than once day as long as you are seeing trace. They can go from trace to large in 12 hours. If you would like to one example of that you can look at @Sandy and Black Kitty ’s SS.
 
@Tanya and Ducia,

I'm sorry but I think i'm in info overload.

You said BG's are high & there are trace ketones,might need an increase sooner than a week. but then you said , mixing 2 different dosing approaches is not safe.
Are you telling me to go ahead & increase his dose today? Or is it unsafe & I should wait till the week is up?

Stacy & Asia and Kris & Teasel agree I should modify SLGS method & increase insulin dose sooner. Is this OK? Tanya and Ducia stated mixing 2 different dosing approaches is UNSAFE!

This is confusing advice.

I increased the dose from 1 unit to 1.25 on 4/6 PM it's only been 4 cycles as of now.( this morning was his 8th shot.)
 
Hi there :cool:
JoyBee said:
I'm very worried about the trace ketones starting to show up!
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Good job monitoring for ketones.
JoyBee said:
I can see Ravan doesn't feel good.He back to drinking a lot of water.
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Important observations. Remember to note of them on the ss
JoyBee said:
He again reviewed Ravan's Blood work & said there are no signs of infection.
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Not all infection/inflammation shows up in general bloodwork.
JoyBee said:
I told him about the trace ketones. He said giving Ravan ringers a few times a week would help with that.
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Proper hydration is very important.

The recipe that opens the door to ketone formation is-
Not enough calories + not enough insulin + infection/inflammation or other systemic stress.

You see the way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown it’s own fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.

When ketone formation is detected, it is a call to action. Anything above trace warrants a call to the vet.

My BK was hospitalized twice for DKA. It nearly took his life.

Please continue to monitor his urine several times per day even if you see one negative reading. The picture can change quickly. BK once went from negative to large in 24hours (see 6/22 and 6/23/2008, PM+1).

Important signs to watch for:

  • Drinking excessive amounts of water OR no water
  • Excessive urination
  • Diminished activity
  • Not eating for over 12 hours
  • Vomiting
  • Lethargy and depression
  • Weakness
  • Breathing very fast
  • Dehydration
  • Ketone odor on breath (smells like nail-polish remover or fruit)

Stacy & Asia said:
My suggestion to increase was not based on SLGS, TR or a mixing of the two. My suggestion to increase was based on the fact that ketones are in the picture, which means some rules get pushed to the side TR or SLGS
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I agree. First order of business is closing the door to ketone development.
 
I know you're worried about increasing Ravan's dose because of a fear of him going hypo, JoyBee. The presence of trace ketones is a bigger concern. Here's why: if they build to high levels - and they can very quickly - Ravan will need intensive and expensive vet care. If you raise his dose there's a chance he might present you with a green number (even a lime green!) that scares you BUT you have people here to guide you through that and it would likely take only a bit of steering with snacks and maybe some carbs to pull him up. It would be a transient and far less dangerous situation for his health than developing DKA.

The SLGS guidelines are just that - guidelines. When all is going well, follow them to the letter to slowly get Ravan into better numbers. When a concerning factor like trace ketones arises, you must address it. It trumps following the rules of SLGS because a significant health issue is at stake.

No one is trying to confuse you by giving conflicting advice. People have made you aware of the relative importance of SLGS rules versus trace ketones versus lower numbers. The possibility of lower numbers is the least of your concerns right now.

ETA: I know you want to test less but that works well under normal conditions when SLGS is the system you're following. Any time an issue arises you might need to poke more often until you get past it.
 
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JoyBee said:
You said BG's are high & there are trace ketones,might need an increase sooner than a week. but then you said , mixing 2 different dosing approaches is not safe.
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SLGL is slow dose increase. You can hold the dose longer. This gentle method allows you to test less than the TR.
TR allows faster increases but to stay safe you need to test as you do now.
You also posted that you'd like to cut on testing times.
I cannot tell you go ahead and increase when I know you may not be able to test enough to stay safe.

Here is where I saw the mix of two methods: you want to increase per TR but to test as little as SLGL, it is unsafe IMO.

Here is from the TR Sticky: "Every protocol or method has safeguards built into it's guidelines. It can become problematic or even dangerous to combine guidelines or suggestions from different protocols/methods."

JoyBee said:
Stacy & Asia and Kris & Teasel agree I should modify SLGS method & increase insulin dose sooner. Is this OK? Tanya and Ducia stated mixing 2 different dosing approaches is UNSAFE!

This is confusing advice.
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I apologize for confusing you.

My bad - I did not think of modifying SLGL due to temp ketone presence.
I thought you 'd rather need to switch to the TR entirely which you said you didn't want.

Temporary modification sounds like very good solution of which, again, I didn't think, sorry.
Stacy and Kris gave you better advise.
@Kris & Teasel
@Stacy & Asia
@JoyBee
 
Tanya and Ducia said:
SLGL is slow dose increase. You can hold the dose longer. This gentle method allows you to test less than the TR.
TR allows faster increases but to stay safe you need to test as you do now.
You also posted that you'd like to cut on testing times.
I cannot tell you go ahead and increase when I know you may not be able to test enough to stay safe.

Here is where I saw the mix of two methods: you want to increase per TR but to test as little as SLGL, it is unsafe IMO.

Here is from the TR Sticky: "Every protocol or method has safeguards built into it's guidelines. It can become problematic or even dangerous to combine guidelines or suggestions from different protocols/methods."


I apologize for confusing you.

My bad - I did not think of modifying SLGL due to temp ketone presence.
I thought you 'd rather need to switch to the TR entirely which you said you didn't want.

Temporary modification sounds like very good solution of which, again, I didn't think, sorry.
Stacy and Kris gave you better advise.
@Kris & Teasel
@Stacy & Asia
@JoyBee
Click to expand...
Hi Tanya, You did nothing wrong. I agree that mixing the methods under normal circumstances isn't a good idea. It's the trace ketones that are concerning and I think that needs to be addressed with a dose increase sooner than later. :)
 
@Hello Sandy and Black Kitty,
He's drinking more water but not excessively, He urinates usually 2 X a day.(I have 3 cats, but Ravan leaves large puddles in the litter.)

You suggest I check his Ketones 2 X a day? I can only check if I'm aware he's going downstairs to his litter box. I am trying to pay close attention but I don't always catch him when he goes.

I stay home for days at a time so I'll be here for him but if he urinates at night when i'm sleeping (a few Hrs.) I can't do anything about that.

No vomiting,he eats very well, A can or more of FFeast classic Chicken everyday .Plus several other foods,some raw chicken, a shrimp or two. Raw liver a few times a week.I just tried Freeze dried Primal Chicken. (not too interested but ate a little.)

His breathing is normal. He doesn't appear to be lethargic or depressed. We spend time outside most days & he even rolls around with his catnip & Peggy Sue.

He'll be 16 soon, so yes his activity is diminished (so is MINE!)

I am very aware that the ketones can cause major trouble. I watch him for any signs of a problem developing.

So far his ketones seem to fluctuate usually neg. but i have seen some that look like a trace, nothing higher.

I was giving Ringers 2 X a day but recently he began getting up at 50cc instead of waiting(as he usually does) for the full 100cc.

After talking with the vet i decided to give ringers a few times a week instead of every day.

Bottom line, I increased his dose from 1 unit to 1.25 4 cycles ago I'm following the SLGS method

Do you advise I need to increase his dose TODAY to 1.5 units? Because of the trace ketones?
 
@Kris and Teasel
Ravan has had 4 cycles on the 1.25 increase. Are you advising I tweak the Insulin dose just to get him out of trace ketones? Or are you advising I do a Full increase to 1.50 units? His increase was just a few days ago.

He went to 169bg when I first increased his dose to 1.25 that was only 4 cycles ago. His bg went up,and I was told it was a bounce & some cats are prone to bouncing when the dose is increased.
 
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@Judy and Boomer,
I'd appreciate your opinion.

Ravan has had mostly neg ketones but a few Trace readings. Do I stay with the 1.25 increase I did 4 days ago (on SLGS) or

do I increase the dose Today, (because of the trace ketones) to 1.5 units,instead of waiting till the week is up?

Or can I just tweak the dosage one time to see if it will get his bg lower?

What are your thoughts on this?
 
For others following, today's post on Ravan is here. http://www.felinediabetes.com/FDMB/threads/4-10-18-ravan-amps400.193950/

Joybee, yes, I would go ahead in increase as I said on today's post. This is his fourth day, not fourth cycle on this dose, so the depot is built and we know this dose is too little insulin. You increased by too little an amount last time, you are seeing trace ketones and you do a great job testing. All reasons to increase tonight to 1.5 units.
 
@Wendy and Neko.

You said the last time I didn't increase enough? I increased to .25 after I had been gradually tweaking the dose.

I thought it was ok to increase very gradually on SLGS? I thought it might prevent a big bounce?

Isn't 2 shots AM & PM one cycle? He's had 8 shots of 1.25 units Isn't that 4 cycles?

So much to remember!
 
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