? 6/21 Ketone Positive Post DKA Mill AMPS 280 +3 233; +7 153: STILL Increase dose?

[Sylvia & Millie]

Millie's number's last night: PMPS 349; +2 303; +4 300; +6 302 +8 237. Not urinating so no ketone count yet. She has been syringe feeding. I will increase amount today. Once hubby is done with handymen, we will give sud-Qs. She is back to drinking (yay, maybe we can get a ketone count soon). Seems a tiny bit better. Thanks for the words of encourage and all the help.

http://www.felinediabetes.com/FDMB/...e-need-dosing-advice.179512/#post-19864036/21

 

[Kris & Teasel]

Millie's number's last night: PMPS 349; +2 303; +4 300; +6 302 +8 237. Not urinating so no ketone count yet. She has been syringe feeding. I will increase amount today. Once hubby is done with handymen, we will give sud-Qs. She is back to drinking (yay, maybe we can get a ketone count soon). Seems a tiny bit better. Thanks for the words of encourage and all the help.

http://www.felinediabetes.com/FDMB/...e-need-dosing-advice.179512/#post-19864036/21

I've been watching from the sidelines, Sylvia, and I see that you have good help from experienced people. I'm glad Millie seems a little better. If nothing else, you'll have had a lot more testing practice. Keeping fingers crossed that things improve today.

 

[Sylvia & Millie]

SubQs and feeding, now waiting to get a ketone test done. Will also call the vet to see what she thinks (probably after the +2 reading).

Any advice as to how to proceed today greatly appreciated.

 

[Marje and Gracie]

Sylvia

I just read along yesterday but I think it's very important that you start increasing the dose per the TR protocol. It would have been a good idea to raise her dose to 2.25u today and monitor so u less you see some green numbers today, I'd increase the dose tonight as long as you can monitor.

What you are up against is that she is not getting enough insulin (and maybe has some other issue going on) but in order for us to suggest safe dose increases, there have to be more tests (I know you weren't feeling well and hope you are better). It's particularly important for a DKA prone cat.

That doesn't mean you have to test every two hours. But I would suggest the following:

• Always get a preshot test
• Always get a +2 test; if she's about the same or lower at +2 compared to PS, it's likely to be an active cycle
• If she's not dropping fast or lower, get random spot checks as you can each cycle. Try to fill in some cells of the SS each cycle with random tests

Doing the above will let you know when she needs an increase (or reduction) and when it's safe to increase the dose. If you post daily, we can help you with dosing decisions.

And as Meya said, don't be afraid of the bounces. Be respectful when they clear as that can involve an active cycle. But don't avoid necessary increases just because she said bouncing (although....you do not want to increase on a bounce clearing cycle).

 

[Sylvia & Millie]

Sylvia

I just read along yesterday but I think it's very important that you start increasing the dose per the TR protocol. It would have been a good idea to raise her dose to 2.25u today and monitor so u less you see some green numbers today, I'd increase the dose tonight as long as you can monitor.

What you are up against is that she is not getting enough insulin (and maybe has some other issue going on) but in order for us to suggest safe dose increases, there have to be more tests (I know you weren't feeling well and hope you are better). It's particularly important for a DKA prone cat.

That doesn't mean you have to test every two hours. But I would suggest the following:

• Always get a preshot test
• Always get a +2 test; if she's about the same or lower at +2 compared to PS, it's likely to be an active cycle
• If she's not dropping fast or lower, get random spot checks as you can each cycle. Try to fill in some cells of the SS each cycle with random tests

Doing the above will let you know when she needs an increase (or reduction) and when it's safe to increase the dose. If you post daily, we can help you with dosing decisions.

And as Meya said, don't be afraid of the bounces. Be respectful when they clear as that can involve an active cycle. But don't avoid necessary increases just because she said bouncing (although....you do not want to increase on a bounce clearing cycle).

Yes, I totally understand and agree. I will definitely need a little support as I increase. I may not do it tonight because I need to sleep (no sleep last night). I will increase tomorrow morning's dose and test during the day. Right now I'm trying to figure out how much & how often to feed. Also, how much fluid should I give daily until this has past?

 

[carfurby (GA)]

Sending more prayers.

 

[Marje and Gracie]

Yes, I totally understand and agree. I will definitely need a little support as I increase. I may not do it tonight because I need to sleep (no sleep last night). I will increase tomorrow morning's dose and test during the day. Right now I'm trying to figure out how much & how often to feed. Also, how much fluid should I give daily until this has past?

While it is very important that the CG be able to monitor, I also have to stress the importance of getting Millie's dose to where it needs to be as quickly and safely as possible. While I can't make any guarantees that she won't come down tonight, she has yet to drop down on the first cycle of a dose increase.

As far as how much to feed, you said she sometimes eats 2-5 oz cans and usually maintains her weight but has lots some. I wouldn't feed her any less food if it takes 2-5 oz cans to keep her weight steady. I don't remember, sorry, but has she ever been tested for hyperthyroidism?

I would try to feed her minimeals from PS to +5. You could feed 2-4 minimeals by just dividing up her food into either two portions or four. Many diabetic cats do well with three or four minimeals given at specific times to work with the insulin but Millie has been pretty high and flat, as far as we can see.

If you were able to get the tests, as I've suggested, we can see if she is diving and bouncing. In that situation, we could help you develop a feeding plan for her.

I'd be adding at least a couple tsp of water to every helping she gets and if you are just feeding two minimeals each cycle, I'd add more. You want to try and flush the ketones so, as long as she will eat her food a bit soupier, it's ok to give 2-3 tsp of water with each helping.

 

[Bobbie And Bubba]

I responded to a tag on yesterday's thread and just wanted to post it here in case you didn't see it.

Sorry, I just got the tag and looks like things are going better now. Glad you got insulin into her last night. Bubba had moderate ketones the Dec before last and pushing lots of fluids helped ( I added 1/4 of a cup to every meal) and making sure he ate offering every tasting trick in the book (His favorite when off his feed was Beech Nut baby food chicken, turkey or ham)
Keep testing for ketones as you need to stay on top of that.
ETA: I just wanted to comment on the bouncing and holding the dose. Some kitties just are bouncers and holding the dose will not combat that. The nadirs are what you want to look at for dosing not the bounce numbers. Increasing the dose safely by the TR protocol to get her in healthier numbers for longer periods of time is what will help her with staying out of ketones and the bouncing.

 

[Sylvia & Millie]

While it is very important that the CG be able to monitor, I also have to stress the importance of getting Millie's dose to where it needs to be as quickly and safely as possible. While I can't make any guarantees that she won't come down tonight, she has yet to drop down on the first cycle of a dose increase.

As far as how much to feed, you said she sometimes eats 2-5 oz cans and usually maintains her weight but has lots some. I wouldn't feed her any less food if it takes 2-5 oz cans to keep her weight steady. I don't remember, sorry, but has she ever been tested for hyperthyroidism?

I would try to feed her minimeals from PS to +5. You could feed 2-4 minimeals by just dividing up her food into either two portions or four. Many diabetic cats do well with three or four minimeals given at specific times to work with the insulin but Millie has been pretty high and flat, as far as we can see.

If you were able to get the tests, as I've suggested, we can see if she is diving and bouncing. In that situation, we could help you develop a feeding plan for her.

I'd be adding at least a couple tsp of water to every helping she gets and if you are just feeding two minimeals each cycle, I'd add more. You want to try and flush the ketones so, as long as she will eat her food a bit soupier, it's ok to give 2-3 tsp of water with each helping.

So sorry, for some reason I didn't see this. I am still syringe feeding. This afternoon is the first time she ate anything on her own and that was a piece of a very HC treat, just two nibbles. I've continued to try to entice her, but nothing. Her tummy is upset (diarrhea 2x today) so I added some organic plain pumpkin to the syringe mix. She is not drinking so I am giving a little water. Right now I am feeding whenever I can and whenever she will take it until she's back to eating on her own.

Millie had a thyroid test last year. We can redo it.

 

[Sylvia & Millie]

Millie's +7 was 156, is an increase still wanted?

 

[Nan & Amber (GA)]

That 156 isn't too low, but it is lower than she's been seeing on this dose, even after the reduced shot last night. I wonder if this is yesterday's midday shot's depot having an effect, or possibly just the effect of getting less food than usual.

I'm getting a bit concerned about her not peeing at all. Do you mean that you just haven't caught her in the act (or within a reasonable amount of time if you put down plastic), or has she really not peed in the 24hrs she's been back from the vet?

 

[Gill & George]

It might be worth getting another test in later on say a +9?? To see if she is still dropping or staying flat.
Whether or not an increase is warranted may depend on what Millie's numbers do at the end of todays cycle.
If she were to drop into green, probably best not t increase.

 

[Sylvia & Millie]

That 156 isn't too low, but it is lower than she's been seeing on this dose, even after the reduced shot last night. I wonder if this is yesterday's midday shot's depot having an effect, or possibly just the effect of getting less food than usual.

I'm getting a bit concerned about her not peeing at all. Do you mean that you just haven't caught her in the act (or within a reasonable amount of time if you put down plastic), or has she really not peed in the 24hrs she's been back from the vet?

She peed yesterday, I got a ketone test last night. I haven't caught her or seen wet litter. She was very dehydrated yesterday & was probably still somewhat today. The diarrhea may not be helping.

 

[Sylvia & Millie]

It might be worth getting another test in later on say a +9?? To see if she is still dropping or staying flat.
Whether or not an increase is warranted may depend on what Millie's numbers do at the end of todays cycle.
If she were to drop into green, probably best not t increase.

I will test her again in a bit.

 

[Sylvia & Millie]

It might be worth getting another test in later on say a +9?? To see if she is still dropping or staying flat.
Whether or not an increase is warranted may depend on what Millie's numbers do at the end of todays cycle.
If she were to drop into green, probably best not t increase.

This is confusing, I thought the increase/decrease is dependent on the nadirs?

 

[Gill & George]

This is confusing, I thought the increase/decrease is dependent on the nadirs?

It is, the nadir is simply the lowest number in the cycle(not always at +6), Millie may nadir late in today's cycle so depending what you see later on would depend on whether you take the dose up or not.

 

[Gill & George]

This is confusing, I thought the increase/decrease is dependent on the nadirs?

Also, as Marje said in her post above, you would not want to increase the dose if she was clearing a bounce this afternoon, getting the extra test and then the pmps later on will help tell us if that's what is happening.

 

[Jill & Alex (GA)]

Just want to throw another thought/consideration about dosing into the conversation...

When a cat is actively throwing more than trace ketones, it definitely means more insulin is needed. Normal dosing guidelines get thrown out the window in favor of getting more insulin into the cat.

In order to do so safely, one will have to

• monitor carefully
• AND may have to feed higher carb foods instead of the usual low carb foods

to keep kitty from bottoming out.

Under these circumstances a blood ketone meter might also prove to be very helpful.

 

[Sylvia & Millie]

Just want to throw another thought/consideration about dosing into the conversation...

When a cat is actively throwing more than trace ketones, it definitely means more insulin is needed. Normal dosing guidelines get thrown out the window in favor of getting more insulin into the cat.

In order to do so safely, one will have to

• monitor carefully
• AND may have to feed higher carb foods instead of the usual low carb foods

to keep kitty from bottoming out.

Under these circumstances a blood ketone meter might also prove to be very helpful.

What is a blood ketone meter and where do I get one? Sounds like it might be helpful.

 

[Sylvia & Millie]

You were right, her +9 is 131. Does that still indicate an increase?

 

[Jill & Alex (GA)]

What is a blood ketone meter and where do I get one?

A blood ketone meter will test both glucose and ketones in the blood.
I'm only familiar with two:

• Nova Max Plus Glucose Meter
• Precision Xtra Blood Glucose Meter

Most pharmacies should carry them, but I'd call first.

The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf

 

[Sylvia & Millie]

A blood ketone meter will test both glucose and ketones in the blood.
I'm only familiar with two:

• Nova Max Plus Glucose Meter
• Precision Xtra Blood Glucose Meter

Most pharmacies should carry them, but I'd call first.

The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf

I have no idea what the significance of 2.4 and/or 2.55 mean.

 

[Jill & Alex (GA)]

You were right, her +9 is 131. Does that still indicate an increase?

I'm not sure who you're asking, but if it's me...
I don't know. In cases like this, increasing the dose depends on whether she's still throwing more than moderate ketones, your ability to monitor, and getting her to eat higher carb foods. In other words, right now we need to know if she's still throwing ketones to know if the dose should be increased providing you can meet the criteria I just mentioned.

I have no idea what the significance of 2.4 and/or 2.55 mean.

Of course not, but you will if you use a ketone meter to check ketones in her blood. The meter will give you a numerical result. If it's less than 2.4 - 2.55 you don't have to worry.

 

[Sylvia & Millie]

I'm not sure who you're asking, but if it's me...
I don't know. In cases like this, increasing the dose depends on whether she's still throwing more than moderate ketones, your ability to monitor, and getting her to eat higher carb foods. In other words, right now we need to know if she's still throwing ketones to know if the dose should be increased providing you can meet the criteria I just mentioned.

Of course not, but you will if you use a ketone meter to check ketones in her blood. The meter will give you a numerical result. If it's less than 2.4 - 2.55 you don't have to worry.

Asking anyone who is available to answer, lol! I don't know why she hasn't urinated or maybe it's so small I haven't noticed in the box. Her tests were off for her pancreas but nothing regarding UTI. I'm calling the pharmacy to see if they have a ketone meter that I can pick up this evening and this way get some answers as to what is going on with her.

 

[Dyana]

When I was searching for a blood ketone meter, I called about 4 pharmacies and 2 of them had the meter with the glucose strips but not the ketone strips, but they said if you order them (like tonight) they could be there the next day to pick up. It would be helpful for you (now and in the future) because you can get a ketone reading anytime and the reading is for now, not hours ago as the urine ketone test results give you.

 

[Sylvia & Millie]

When I was searching for a blood ketone meter, I called about 4 pharmacies and 2 of them had the meter with the glucose strips but not the ketone strips, but they said if you order them (like tonight) they could be there the next day to pick up. It would be helpful for you (now and in the future) because you can get a ketone reading anytime and the reading is for now, not hours ago as the urine ketone test results give you.

On the phone with pharmacists now. Definite want to get one.

 

[Bobbie And Bubba]

On the phone with pharmacists now. Definite want to get one.

I have seen some meters come with a few strips to start you off. Hopefully, you'll be able to get both tonight. They are really very handy to have to give immediate results.

 

[Sylvia & Millie]

I have seen some meters come with a few strips to start you off. Hopefully, you'll be able to get both tonight. They are really very handy to have to give immediate results.

Just called a bunch of places, no one had them. Our regular pharmacist order the meter & strips for us, will pick up tomorrow. So glad to be getting it!

Going to feed Millie now......

 

[Dyana]

I'm so glad you found one. I know they often just say "No." and you have to say "Can you order it for me?" and then they say yes. Good job!
You did make sure they are ordering the blood ketone test strips, correct? Because the meters come with glucose test strips, that you already have.

 

[Sylvia & Millie]

I'm so glad you found one. I know they often just say "No." and you have to say "Can you order it for me?" and then they say yes. Good job!
You did make sure they are ordering the blood ketone test strips, correct? Because the meters come with glucose test strips, that you already have.

Yes, definitely made sure it was the ketone strips. They cost $130 for 50 strips and he's giving them to me at cost for $100.

 

[Dyana]

That's great. Your pharmacist is very nice to do that for you.
Have you had any luck in getting a urine ketone test, yet?

 

[Sylvia & Millie]

That's great. Your pharmacist is very nice to do that for you.
Have you had any luck in getting a urine ketone test, yet?

Still no urine, she must be covering it (she doesn't always). She's eating on her own, but only with 'toppers' (crushed treats & chicken).

 

[Dyana]

Still no urine, she must be covering it (she doesn't always). She's eating on her own, but only with 'toppers' (crushed treats & chicken).

That's good she's eating on her own. Sometimes with toppers is just fine, and right now eating anything is most important, along with getting her insulin and hydration.

 

[Marje and Gracie]

So sorry, for some reason I didn't see this. I am still syringe feeding. This afternoon is the first time she ate anything on her own and that was a piece of a very HC treat, just two nibbles. I've continued to try to entice her, but nothing. Her tummy is upset (diarrhea 2x today) so I added some organic plain pumpkin to the syringe mix. She is not drinking so I am giving a little water. Right now I am feeding whenever I can and whenever she will take it until she's back to eating on her own.

Millie had a thyroid test last year. We can redo it.

You might want to order some Renew Life Saccharomyces boulardii for the diarrhea or you can get Nutricology at Walmart. It can really help with diarrhea has long as her B12 isn't low.

 

[Nan & Amber (GA)]

How is Millie doing?