? 7/1 Post DKA Millie PMPS 660, +8.5 719!!!!

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Sylvia & Millie

Sylvia & Millie

Member Since 2017
My post DKA ketone prone Millie is the highest she has ever been at +8 719!!!! Doesn't seem like she ate much over night. Just hand fed her a few syringes of food. She then went to her bowl and licked a little more. Tried testing for ketones, it appeared negative. The blood ketone monitor and strips I spent $130 on doesn't work and I can't return it so I have to use the urine strips. Right now she seems fine, just avoiding me. I will give her sub-Qs later in the morning once my husband is awake & can help me.

Insulin shot due in 3 hours. Should I be getting a prescription for a short acting insulin for times like this?

http://www.felinediabetes.com/FDMB/...-508-going-higher-dosing-input-needed.179766/
 
With a short acting insulin, you need to consider how you are testing. You will have to test more -- especially at night. Curves need to be run every hour for the first 4 hours if you give Humulin R every time you change a dose.

Short acting insulin, in the absence of testing aggressively, can be lethal. The insulin is in and out of the cat's system in roughly 4 hours so you not only have an insulin that is harsh and can cause numbers to plummet, but you have 2 nadirs for each cycle when you use R -- the nadir from the R and the nadir from Lantus.

While the numbers are high, I strongly suspect what you are seeing is bouncing. Without any routine tests at night, you have no idea how low Millie is dropping during the PM cycle and if what you're seeing is a bounce back into high numbers as a result of the earlier drop. Millie may still be bouncing from the 131 during the AM cycle on 6/28. Bounces can take 6 cycles to clear.

Also, if you are following TR, you need to both be getting at least one test during the PM cycle and you need to be evaluating and raising the dose every 6 cycles/3 days if nadirs are over 200. You've been at this dose for 13 cycles.
 
Hey there Sylvia. What is going on with the blood ketone meter? Have you tried putting in a new battery? I use the Precision Xtra Meter and I remember that it takes a few more seconds for the number to register ( unlike the blood glucose meter)

It looks like these higher numbers could be a bounce from lower numbers in the previous cycle. As Sienne said, some more tests through the cycle at nadir for each cycle will give you a better picture as to what is happening. Since she is coming down into yellows and blues I don't think a short acting insulin is needed now and as Sienne said, extreme care and someone to guide you using it is necessary.

Some cats don't feel good when they are that high and won't eat as much. Do your best to get more test in today .
 
This looks like bouncing to me. Those extra tests would be helpful. I don't have any experience with a blood ketone meter but if it was mine, I'd be Googling like crazy to learn about its quirks, issues, etc.
 
Sienne and Gabby (GA) said:
With a short acting insulin, you need to consider how you are testing. You will have to test more -- especially at night. Curves need to be run every hour for the first 4 hours if you give Humulin R every time you change a dose.

Short acting insulin, in the absence of testing aggressively, can be lethal. The insulin is in and out of the cat's system in roughly 4 hours so you not only have an insulin that is harsh and can cause numbers to plummet, but you have 2 nadirs for each cycle when you use R -- the nadir from the R and the nadir from Lantus.

While the numbers are high, I strongly suspect what you are seeing is bouncing. Without any routine tests at night, you have no idea how low Millie is dropping during the PM cycle and if what you're seeing is a bounce back into high numbers as a result of the earlier drop. Millie may still be bouncing from the 131 during the AM cycle on 6/28. Bounces can take 6 cycles to clear.

Also, if you are following TR, you need to both be getting at least one test during the PM cycle and you need to be evaluating and raising the dose every 6 cycles/3 days if nadirs are over 200. You've been at this dose for 13 cycles.
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I just got out of the hospital myself yesterday afternoon. I was going to post the other day was unable to.

I was trying to get more night time tests, my medication doesn't always allow for that. I test whenever I am able.

Should I consider another dose increase?
 
Sylvia & Millie said:
I just got out of the hospital myself yesterday afternoon. I was going to post the other day was unable to.

I was trying to get more night time tests, my medication doesn't always allow for that. I test whenever I am able.

Should I consider another dose increase?
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Have you gotten an AMBG's yet?
 
Bobbie And Bubba said:
Hey there Sylvia. What is going on with the blood ketone meter? Have you tried putting in a new battery? I use the Precision Xtra Meter and I remember that it takes a few more seconds for the number to register ( unlike the blood glucose meter)

It looks like these higher numbers could be a bounce from lower numbers in the previous cycle. As Sienne said, some more tests through the cycle at nadir for each cycle will give you a better picture as to what is happening. Since she is coming down into yellows and blues I don't think a short acting insulin is needed now and as Sienne said, extreme care and someone to guide you using it is necessary.

Some cats don't feel good when they are that high and won't eat as much. Do your best to get more test in today .
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Got home yesterday after a two day stay in the hospital. I can test Millie today. If she is not going too low during her nadirs, should I be considering another increase?

The meter just keeps reading error and saying that the BG is too low. I understand that the BG has to be high for it to give a ketone reading so I don't know if it's that (we've tried it at least a dozen times, each time getting lots of blood for the strip).

I was wondering about the short acting insulin in times when she does not come down. Her AMPS BG was 722. Should I continue hand feeding? She was VERY difficult to test this morning even with both of us holding her.
 
Sylvia & Millie said:
Got home yesterday after a two day stay in the hospital. I can test Millie today. If she is not going too low during her nadirs, should I be considering another increase?

The meter just keeps reading error and saying that the BG is too low. I understand that the BG has to be high for it to give a ketone reading so I don't know if it's that (we've tried it at least a dozen times, each time getting lots of blood for the strip).

I was wondering about the short acting insulin in times when she does not come down. Her AMPS BG was 722. Should I continue hand feeding? She was VERY difficult to test this morning even with both of us holding her.
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I think an increase is a good idea to 2.75. Got to get these high numbers down and do what ever you need to do to get food into her. Remember that the recipe for DKA is not enough insulin, in appetence and infection or system stress. How she ever had pancreatitis? Any other symptoms from her? Vomiting, diarrhea?
 
Bobbie And Bubba said:
I think an increase is a good idea to 2.75. Got to get these high numbers down and do what ever you need to do to get food into her. Remember that the recipe for DKA is not enough insulin, in appetence and infection or system stress. How she ever had pancreatitis? Any other symptoms from her? Vomiting, diarrhea?
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I will increase to 2.75 at the next dose. I will also continue to hand feed. Last night one stool was a little soft. She also threw up a little bile this morning, I thought it might be because she had an empty stomach. She had one bout of pancreatitis.
 
Sylvia & Millie said:
I will increase to 2.75 at the next dose. I will also continue to hand feed. Last night one stool was a little soft. She also threw up a little bile this morning, I thought it might be because she had an empty stomach. She had one bout of pancreatitis.
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I would just keep an eye on her today for the vomiting and diarrhea as it seems something is off with her.
 
Sylvia & Millie said:
The meter just keeps reading error and saying that the BG is too low. I understand that the BG has to be high for it to give a ketone reading so I don't know if it's that (we've tried it at least a dozen times, each time getting lots of blood for the strip).
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What ketone meter are you using and what error message are you getting?
If you are using a Nova Max with the ketone test strip, here is what it says on page 34 of the owner's manual regarding what a LO test result means:
upload_2017-7-1_10-55-54.png
 
Dyana said:
What ketone meter are you using and what error message are you getting?
If you are using a Nova Max with the ketone test strip, here is what it says on page 34 of the owner's manual regarding what a LO test result means:
View attachment 29478
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We are using the PrecisionXtra. What comes up is "error"....then I think some symbol (can't remember right now). When we looked it up in the manual it said the bg was too low. Haven't used in a few days. I can try later today and note what comes up on the meter. I also wondered if the strips are defective.
 
Sylvia & Millie said:
We are using the PrecisionXtra. What comes up is "error"....then I think some symbol (can't remember right now). When we looked it up in the manual it said the bg was too low. Haven't used in a few days. I can try later today and note what comes up on the meter. I also wondered if the strips are defective.
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With the Nova Max there are different test strips for the glucose and for the ketones. Is it the same with the Precision Xtra, or does one strip do both tests at the same time?
 
Dyana said:
With the Nova Max there are different test strips for the glucose and for the ketones. Is it the same with the Precision Xtra, or does one strip do both tests at the same time?
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Hi Dyana, with the Precision there are separate strips for the ketone meter.
 
@Dyana - I don't think you can use the same strip to test ketones vs BG. The reagent on the strips is different.

Sylvia - if you can grab a test before you fall asleep at night, that may be just fine. If you wake up during the night, you can also get a test. TR is an aggressive approach to dosing and is probably a good method to use with a post-DKA kitty. Because dosing is based on the nadir, it's important to do as best you can to get at least one test, in addition to your pre-shot test, during both the AM and PM cycle.
 
Dyana said:
With the Nova Max there are different test strips for the glucose and for the ketones. Is it the same with the Precision Xtra, or does one strip do both tests at the same time?
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Sorry for the delay, we took Millie to the vet.

One strip does both for the Precision Xtra.
 
Sienne and Gabby (GA) said:
@Dyana - I don't think you can use the same strip to test ketones vs BG. The reagent on the strips is different.

Sylvia - if you can grab a test before you fall asleep at night, that may be just fine. If you wake up during the night, you can also get a test. TR is an aggressive approach to dosing and is probably a good method to use with a post-DKA kitty. Because dosing is based on the nadir, it's important to do as best you can to get at least one test, in addition to your pre-shot test, during both the AM and PM cycle.
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Yes, Sienna, that's what I've been trying to do. If I wake enough to test her, I try to grab her if she lets me and test. It's a bit tough between my night time meds that knock me out and Millie being difficult to test alone. My husband is not going to get up at 4 or 5am to help me test her.

I switched to the TR because others said it would be better for post DKA kitty. Thanks for your advice.

We took her to the vet this afternoon, hence the delay in reply. The vet gave her an antibiotic, appetite stimulant, B12 & fluids. I tested her, her +6 was 505 so it came down. I also syringe fed her.
 
Sylvia & Millie said:
Yes, Sienna, that's what I've been trying to do. If I wake enough to test her, I try to grab her if she lets me and test. It's a bit tough between my night time meds that knock me out and Millie being difficult to test alone. My husband is not going to get up at 4 or 5am to help me test her.

I switched to the TR because others said it would be better for post DKA kitty. Thanks for your advice.

We took her to the vet this afternoon, hence the delay in reply. The vet gave her an antibiotic, appetite stimulant, B12 & fluids. I tested her, her +6 was 505 so it came down. I also syringe fed her.
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Does she show any signs of nausea like licking her lips?
 
Kris & Teasel said:
Let us know how she's doing when you have time. :bighug:
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Millie's +6 was 505 so it came down a bit. The vet gave her fluids, antibiotics, B12 & an appetite stimulant. I also fed her. She is now sitting in front of the ac since it is very hot & humid. She is on the bed which is a good sign because she refuses to get on the bed if she does not feel well.
 
Sylvia & Millie said:
Sorry for the delay, we took Millie to the vet.

One strip does both for the Precision Xtra.
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That is interesting because I use the Precision Xtra and the ketone strips are very pricy. Double check on that as if you are using a blood glucose strip in the ketone meter that could be why you are getting an error message.

What did the vet say about Millie?
 
Bobbie And Bubba said:
That is interesting because I use the Precision Xtra and the ketone strips are very pricy. Double check on that as if you are using a blood glucose strip in the ketone meter that could be why you are getting an error message.

What did the vet say about Millie?
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Yes, they are ketone strips and yes, VERY pricey ($130 for 50).

The vet didn't really say anything. She thought it was a good idea to do 'preventative' stuff, which she did.
 
Bobbie And Bubba said:
That sounds like Ketone strips, LOL

I get 40 for $90 at Universal Pharmacy in CA. It takes about 10-14 days for them to arrive. 1-866-456-2456
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Okay, my mistake. We made sure that the meter was for blood glucose AND ketones. I checked after Bobbie asked and he's right, the strips are BG and NOT blood ketone strips!!! The pharmacist charged me $100 instead of his usual $130 but they are no good anyway. I am going to call him now.

Millie's +9 was 370, yay!!!!! Came down quite a bit. I don't know if I'll ever get used to those high numbers, especially when they go even higher. Very frightening. She is also eating on her own now.

Thank you all for your advice and encouragement.
 
Oh, so glad that you double checked the strips and I am sure that your Pharmacist will make good for the mistake. Makes sense now that you were getting an error message. After you get some from the pharmacy to replace the BG strips, check out Universal. It's a nice savings.

I am so glad that her numbers came down and she is eating on her own. A big relief. Get a +2 test in the PMBG cycle to see how active it will be and if uneventful try and get one before you go to bed and if you're like me and have to get up to go to the bathroom ( showing my age) grab a test then.
 
Bobbie And Bubba said:
Oh, so glad that you double checked the strips and I am sure that your Pharmacist will make good for the mistake. Makes sense now that you were getting an error message. After you get some from the pharmacy to replace the BG strips, check out Universal. It's a nice savings.

I am so glad that her numbers came down and she is eating on her own. A big relief. Get a +2 test in the PMBG cycle to see how active it will be and if uneventful try and get one before you go to bed and if you're like me and have to get up to go to the bathroom ( showing my age) grab a test then.
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SO glad you said something, thanks for that. The pharmacist and I worked so hard to make sure we got the right meter, that I assumed we had the right strips! Tried calling, they are closed until after the holiday so I'll call then.

I'll test before bed (which is her +2/2.5). She usually stays high initially but it won't hurt. I'll test if I wake in at 4 or 5. I really need to rest, still recovering and tomorrow is a very busy day.
 
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