Just a confirmation that we all really need to always test for ketones!

Discussion in 'Feline Health - (The Main Forum)' started by monty_dweezil (GA), Feb 15, 2018.

  1. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Our Dweezil last year while we were away, got DKA and almost died. Thankfully he was a resilient boy and the vets were able to save him.

    We had already been testing him for years using Ketodiastix but at the cattery while we're away his stress level seems to rise (though he seems ok, loves the lady and eats well) so he always needs a much higher dose of Lantus than he gets at home. Which we now know.

    Anyway, last November and again 3 days ago, at home, I managed to get a pee sample at a random time and thank GOD I did, as both times there were ketones.

    The first time it was 1am and the ketones were "small" on the strip. I freaked out, remembering the other 2 times. I then acted, gave him an extra 1.5 units of lantus (8 hours after his previous shot and 4 hours before his next one), wet food with mixed with water and encouraged him to drink water. I then prayed he would live through the night. The 24 hour emergency vet is...not so good.

    In the morning at 5am my partner does the feeding and insulin and I said you MUST GET A PEE. YOU MUST. Usually this is easy but some mornings Dweezy just seems not to do one until later.

    It was down to trace levels. THANJ GOD, I said! He then had his regular insulin and breakfast, seemed happy and not lethargic like the night before and ate well, and although at 11am his next pee still was trace (at which point I called our vet for help), by his 5pm pee, NO KETONES AT ALL, WOO HOO!

    So THIS time was different. I woke up in the late morning and just knew he felt weird. Quiet. I got a pee after encouraging him to go to the litter box at 11am, and it was trace ketones. DAMMIT. I wasn't sure what to do. He had had 1.5 units of lantus 5 hours earlier but his AM doses often don't seem to work as well as the PM ones. So I gave another one unit and watery food.

    He seemed to get more lethargic and I just knew this was not going to improve at home this time, so to the vet we went.

    His ketones were now 2 or "small / medium" so he got subcutaneous fluids with us there, as well as an intra-muscular one unit of lantus.

    After an hour, we left and he was much more his old self. He had dinner. We went out for a quick dinner (this was Valentine's Day OF COURSE) and when we returned he was our sprightly, excited Dweezil again. SO relieved.

    Also, that night his 1am pee...NO ketones at all and still none since.

    So after all of that blather, my point is, if your cat is in high numbers like s
    unfortunately Dweezil often is, people will say it's ok to test for ketones every 24 hours.

    NO. I had tested at 1am the night before and there were none. But by 11am the next morning, they were there.

    Please test whenever you can! Catching it early can and probably will save your furbaby's life.
     
  2. Sylvie

    Sylvie Member

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    Sep 26, 2017
    i was going to say holy caca do you ever sleep after looking at his spreadsheet! pretty cool, i didn't realize an implanted monitor was actually an option for cats. how long do they last?

    my cats numbers are under 200 all the time now but, even so i still check for ketones every 5 days or so. didn't realize when his numbers were higher in beginning, i should of been checking more often like you mentioned. good advice for others with high sugar kitties!
     
  3. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Dec 9, 2017
  4. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    Jul 19, 2011
    Whoa - using Lantus in this way is extremely dangerous. The condo you linked used a completely different insulin with a different action. Lantus, being a depot insulin, built that depot a LOT by using Lantus to do this. This can be a huge issue for several days. PLEASE PLEASE do not do this again. If you need to use a bolus, there are experienced people here that can help you safely do it and with the right insulin.

    Ketones - good catch. Yes it's critical to check ketones often. Dakota went down that road a couple of years ago but using fluids and treating the other things causing them, we stayed away from DKA.

    @Wendy&Neko
    @Phoebes

    I know there are others but that's the 2 I can remember right now...they'll know more too.

    .
     
  5. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I echo Lyresa, please never again give more Lantus to help battle ketones. A better approach is to get to a good dose of Lantus. I am glad you increased, but am worried that you seem to be shooting different doses all the time. Please take. Look at the two dosing methods described in the Lantus and Levemir forum, pick one and dose accordingly. If you need to give a little higher carb food so you can maintain him at 2.0 units, so be it. I would also post in the Lantus forum for advice. Lots of ketone experience there, but not me personally.
     
  6. Fly

    Fly New Member

    Joined:
    Jan 27, 2018
    Good catch. @monty_dweezil I am located in the Redlands qld so same time zone as you and have used lantus to largely control my boys numbers and this has included varying his dose over time to allow for other meds changing his BG recently due to other illnesses.

    We see the affect of lantus a few days later. While this page is great with specific doseing advice, if you want someone local to connect with on FBook and have someone local to talk too before you make changes and talk to about sugar cats in general. Maybe together we can get the numbers a bit more consistant.

    Just if you are interested.
     
  7. Tracey&Jones

    Tracey&Jones Well-Known Member

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    Dec 12, 2016
    @Sandy and Black Kitty

    I know she has helped a few people here get over the DKA hump and guide with food and dosing.
     
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  8. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Jul 18, 2011
    Lantus is a long lasting, depot insulin. If you don't know what that means, please read this sticky. If you give Lantus more often than every twelve hours, you face multiple nadirs and a distinct possibility of a hypo from overdosing your cat. You will also confuse the heck out of the depot, which always results in wonky numbers.

    Lantus works best with consistent dosing. You have been changing your dose way too frequently and the depot can't keep up. It looks like Dweezil needs more insulin. Please pick a dose and stick to it, either 6-10 cycles or one week, depending on if you're doing TR or SLGS. Getting Dweezil into consistently better numbers will go a long way towards lowering the risk of ketones.

    How is Dweezil eating? Remember, the recipe for ketones is: Not enough calories + not enough insulin + inflammation or infection. Any signs of illness, injury or infection?

    It's never a bad idea to check for ketones. They can happen even if the BG is not sky high, if the other factors are present. DKA is scary, life-threatening and expensive. Been there, done that. Never want to do it again. I'm sure you don't, either.
     
  9. rawia

    rawia Member

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    Aug 24, 2017
    What is the best trick to test your cat, how can i collect a pee sample!! I can not make her to pee on the strip for sure and i always want to test but have no idea how to do it??
     
  10. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    Here are some Urine Testing Tips
     
  11. Sylvie

    Sylvie Member

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    Sep 26, 2017
    i keep a strip ready near box on days i am going to test and when i see my cat go to litter box, i quietly walk up to it and grab strip and than i wait until he starts peeing a little before i quickly sneak strip into his urine stream. doesn't require but, a second or two to get strip wet so cat doesn't even notice..
     
  12. StephG

    StephG Well-Known Member

    Joined:
    Sep 8, 2016
    I use the plastic wrap trick. My cat has become an expert at digging it out of his way or covering it with litter. Funny part is, if it's not in there- he doesn't did too pee. Jumps in, pees then jumps right out. He is seriously offended if I try to put our in his stream. I swear he sits lower to prevent it.
    I read another trick to put wrapping paper or plastic grocery bags near the box so you can hear them getting in it. I tried this but my civvie thinks it's a fantastic place to pee if I leave it on the floor, even for ten minutes.
    There's another member on here that has had 3 bouts of DKA and one of those times the cat was only in the 200s...
    Good job catching the Ketones early!
     
  13. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    AHHH, I didn't quite realise the risks of using Lantus as a bolus to try to help reverse the ketones. I do know how it works, but just felt I had to do something.

    At the vet, Dweezil's intra-muscular injection was Lantus but he said it would work fast and wear off in 1-2 hours. By the time his monitor activated to get readings an hour later, there was no evidence of any real lowering and he was only a few points lower than he had been at the vet.

    What confuses me is...

    When he gets a lower dose in the AM, his numbers tend to get more in the yellows. When he gets 2 units in the AM, he stays mostly in the pinks and reds.

    Last night's numbers were a bit better. Got down to the yellows again.

    Also what confuses me is, we try to hold a dose but his AM nadir is sometimes SO late. He'll be high pinks all day and then at 12 hours suddenly start to drop. How much and for how long, we never know. He has sometimes had his AM dose (5.30am) nadir at 9pm and sometimes gone down too low to shoot (greens). So this really messes up the PM routine and thus the following AM routine, and so on.

    Neither of the 2 ketone events and extra insulin given resulted in any real lowering of his numbers.

    I feel in my bones that 1.7 units both AM and PM is right, if we can just HOLD those doses without him ending up green too late to shoot.

    I don't honestly know if he needs more or less insulin. I read that very high flat curves for a while and then a hypo drop followed by seemingly insulin resistance can signify an overdose. This has basically been his pattern for ages I think.

    I don't know if he has a naturally late nadir or if his AM insulin dose is too high which causes the really late nadir. Because it doesn't happen (much) in his PM dose. Which is a lower dosage.

    I want an uncomplicated insulin that I can see what each dose does!!!!!

    Thank you so much Fly for your lovely offer!!!
     
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  14. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    Are you following SLGS?
    Have you thought about doing TR?
    You can shoot greens on TR protocol. It takes a lot of monitoring but with the implant it might be easier.
    On TR with a lot of data, I've shot a full dose as low as mid 50s. I have a high dose cat so he can't skip shots. I have dosed lower than his usual on green preshots too but with the data I have, I know he goes up quick after eating and he loves to bounce!
    *Note* do NOT copy my dosing.
     
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  15. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    Wouldn't that be great??

    Unfortunately, insulin is a hormone and as anybody who's ever had a teenage girl knows, hormones can be very unpredictable!

    One minute screaming at the top of their lungs how much you're ruining their lives and the next minute laughing hysterically over the phone with their friends

    Add to that the variation in absorption, the fact that kitty might eat more (or less) that cycle, how much exercise they get makes a difference and then there's that "I'm a cat and I dare you to figure me out" principle!!
     
  16. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    Goodness. You know, with Dwee, I don't want to do TR because he can only wear these monitors for a maximum of 2 weeks at a time and sometimes they only work for between 5-10 days and then you have to give him a break, as where the monitor has come off is a patch of partially bald / partially sore skin and he can't wear a heap of monitors one after the other (if only). There is only one really good place on his back that works the best.

    Once there's no monitor, we have nothing but pee, water, appetite, weight and behaviour to try and see what he's doing. He has NEVER let us prick his ear.

    So no TR for me. No way.

    Oh, and he only eats Fancy Feast classics and the Weruva Cats in the Kitchen cans (not pouches and not BFF) with carbs less than 6%.
     
  17. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    Chris and China, SOOO TRUE!!!
     
  18. Squalliesmom

    Squalliesmom Well-Known Member

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    Jun 26, 2015
    Have you ever tried his paw pad for testing? If you do try it, I heartily recommend making a "kitty burrito" before you prick his foot. I tried to prick Squallie's foot once and he explodedin about 15 different directions at once, lol.
     
  19. Fly

    Fly New Member

    Joined:
    Jan 27, 2018
    My cat Squeak has had flat curves and also long curves so I needed to skip and than he would go high into yellows. I started to shoot partial doses when he was lower but arent as experienced as the above people (and diabetes is a 2nd priority with his health so happy to sit around blue).

    I found when I reduced the dose his curves weren't as long. Have you thought about maybe starting at 1.5 or 1.75 and staying at that dose for a min of 5days?

    Also how many times a day do you feed?

    I feel Lantus is actually an easy insulin as it doesnt seem as scary with curves as no depot.

    Once you start to see the difference the shots from 2 days ago make on the BG today, it will start to seem clearer.

    Cherie
     
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  20. Fly

    Fly New Member

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    Jan 27, 2018
    Also, I'm not sure what numbers your vet said to aim for but if BG are around 10 (yellows) you can still shoot a full dose. I've had a few vets say 10 is great, others agree with the majority of the research and say 10 is too high. Even around 8.3 you can normally safely shoot a full dose (even much lower). Shooting around these numbers is still a long way off hypo but will help reduce the highs that follow over the next 1 to 2 days.

    Keeping the dose consistant (unless you get a green number) will help you see the impact a dose changes makes easier. This is important to know how he reacts.

    Just a few ideas, it does sound like you have read a lot though which is great.
     
  21. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Jul 18, 2011
    You really need to shoot the same dose AM and PM. Shooting different doses will prevent the depot from filling, and you won't get a clear picture of what the insulin is doing. The higher numbers are not caused by shooting 2 units. Those pinks and reds are bounces from the yellows. When the BG gets to a lower point than the body is used to, the body reacts as though there is a hypo, and glucogens are released to bring the BG up. As the cat experiences more and more lower numbers, the body adjusts to them and stops reacting so much. You are not doing Dweezil any favors by shooting a lower dose at night. Please try shooting 2 units AM and PM consistently for at least 6 cycles and see how Dweezil does.
     
  22. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    What I also don't understand is how the same dose can be suitable for a high pink or red BG number AND a blue number! I've found when we tried to do that in the past, he would literally plummet in 1-2 hours into hypo.

    Also we never know what to do when, at PM dose time, he is going straight down for the first time all day. Then I stall and 20 minutes later he's gone down even more. Then I stall again and he's dropped even more. Like from pinks to low blues. So I eventually have to feed, lest I be mauled by starving felines, and even then the BG goes down. By now it's 2 hours late and still dropping. Finally at 4 hours past PM dose time, he starts rising. But now it's too late. I've tried giving a small dose then to try to prevent a huge skyrocketing number, but it doesn't do anything.

    Dwee has had 4 hospital-required hypos in just over 3 years. First one was whilst on 4 units. The week before he seemed to be doing really well on 4 but then a sudden hypo. Then after a few months on 3 units, another hypo. Then we reduced to 2-ish units. He didn't do as well then so after months our vet urged us back up to 3 units again. I was against it and said I bet he goes hypo in a week. It happened after just 3 days.

    Back down to 2 units. Was doing well on 1.8 units AM and PM for 5 months at the beginning of 2016 and actually put on good weight for the first time since diagnosis (weirdly, although this was great, he seemed very nervous all the time, fought with his brother Monty, and was very territorial), and we thought YAY, we've found the right dose FINALLY! But then...hypo. Sigh. So since then we're too scared to go above 2 units

    Nothing ever changes with his food. He always eats really well. I just don't understand.

    When he was very first diagnosed in late 2014, he was started on 2 units of lantus. After a week, a curve at the vet was attempted. Nope. He had a "psychotic episode" and no one could get near him. They even had him sent home to be put in a big wire cage in case he attacked Monty. He was fine once he left the vet. But no curve was obtained, ever.

    They lowered his dose to 1 unit though, based on the 2 tests they managed to get.

    Soon after though, he went back up to 2, then 3, then 4 and so on.

    HA!!!! A burrito Dweezil! If Dwee is even partially restrained or held, he will MAUL! He is a beautiful boy and loving and affectionate, but does NOT allow restraint. He also doesn't like his paws being touched.
     
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  23. Fly

    Fly New Member

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    Jan 27, 2018
    What numbers do you call a hypo?

    If his numbers are under 3 (light gteen) it's not always a crisis hypo. If it's his nadir at say 3 and he starts heading up that is great and it means you could look at reducing the dose by .25.

    It really sounds like he may be doing better than you think and it's his bouncing due to too much insulin that makes it looks bad. Id really suggest pick a dose and do it consistantly for say 5 days. That will allow you to find a new norm and his body time to adjust. Even 1.75 if he has had a hypo off 2 before.

    I'm happy to connect on fb if you are nervous and just want someone to chat with about your concerns as they arise (on the same time zone). And if you keep the spreadsheet up to date, the amazing people on here can give dosing advice when and if needed.


    Re testing. I'm lucky my Squeak is the best patient but my non diabetic I've tried to test a few times and it is a nightmare (he doesnt go to the vet if I can help it as he has been known to bite them) but as he watches Squeak get tested daily and comes closer and closer while I'm testing, he isnt seeming as scared of the prick. I hope he never gets diabetes though cause I'll need to wear arm length gloves and a face mask. Haha

    Cherie
     
    Last edited: Feb 16, 2018
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  24. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    I've found in the past, 2 units in the PM made him go down to bright greens and feeding medium carb food every 30 minutes for 3 hours was needed to keep him above hypo.

    Also, even when he doesn't go into the yellows at night, he still won't go down from pinks and reds in the day on 2 units. On 1.5 units he will.

    But I really don't know. Like tonight I gave him his normal 1.5 units that normally would have him going to yellow at least, but instead tonight he's just gone up from pink to red. After a day of pinks and reds.
     
  25. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    A hypo when we didn't have a monitor on and didn't know his number, was him twitching and acting odd, not eating, vomiting, and he tested at the vet as being 20 and 40 (1-something and 2 something).

    With the monitor, he's gone LO, which means under 40 (2.2) but he showed no symptoms and we were able to eventually get him up with food.

    Sometimes even after only 1.5 units at night he's gone from red to LO in 2 hours, though that is rare. Other times, it has taken AGES for the insulin to kick in and he'll be yellow for hours with some random blues, and then suddenly go down to 3 right before his AM shot is due and will stay at 3 for 3-4 hours after his shot was due. How can we deal with this!?

    We NEVER know when his nadir is, or what it will be. Sometimes it's 3-5 hours. Usually between 12-16 hours.
     
    Last edited: Feb 16, 2018
  26. Fly

    Fly New Member

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    Jan 27, 2018
    Lantus doesnt work that quick so I think what you are seeing is the result of a dose 24hrs or even 48hrs before. Lantus can have a nadir at 14hrs after the shot so you need to look at the prior shots not the ine you just had.

    If you have given 1.5 tonight. Do you feel comfortable to stick with 1.5 morning and night (except for any hypos) for several days to see?
     
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  27. Fly

    Fly New Member

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    Jan 27, 2018
    This in itself makes it look like 2.0 is too much. However as lantus is a depot and the effect builds up over a few days its hard to comfirm as the depot isnt being kept consistent with different morning and night shots.

    I tried different shots early on as my boy wouldn't eat enough in the morning and it didnt work. As soon as i put more effort into getting him to eat and kept a consistant dose he leveled out and we got flat curves which are great.
     
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  28. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    I would second the suggestion of trying to stick with 1.5 for a few days. The high numbers and « near hypos » you mention are probably him bouncing from too high a dose. The it’s like trying to steer straight when you have a trailer and it starts swaying. You overcompensate and make the swaying worse. You see a high number so give more insulin but that high number is in fact due to a previous low number due to too much insulin already, so it makes it worse. You see a lower number so you give less, but that lower number can be due to less bouncing because of a previous lower dose, and by lowering more you end up having not enough and then seeing high numbers.

    That’s why it’s super important to stick to the same dose long enough. Adjusting dosage with Lantus is like steering an ocean liner. You don’t see the results of the move you make today until a few days down the road.

    This is because of the depot. There’s a sticky somewhere that explains it but I’m on my phone and need to get back to work so can’t dig it out right now.
     
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  29. cmb

    cmb Member

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    Dec 29, 2017
    what kind of monitor is this and does the vet need to implant it?
     
  30. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    It's a stick on Freestyle Libre patch sensor. I WISH it was an implant! Then it could stay there forever!

    We actually have tried 1.5 units AM and PM for several weeks in between monitors and some with monitors, and after a while it just seems to not work. In November for instance when I found those 1am ketones, he had been on 1.5 units consistently and had been eating a heap but still got ketones, and also was losing weight. So it obviously wasn't enough. Infection was ruled out too.

    But then he also has gone hypo on that dose, so how does that make sense?
     
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  31. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Dec 9, 2017
    That's because his insulin needs vary. Insulin is rarely a "set it forever and forget it" thing. That's why we keep on monitoring and that we have guidelines (even a protocol, TR) for adjusting the insulin dose.

    So maybe he's fine on 1.5 for a while, but then he needs a little more, and needs to go to 1.75 for a while... and then comes back down... and who knows, maybe yet down.

    It's why it's called the sugar dance!
     
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  32. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    Damn that hateful dance! I suck at dancing! lol

    It's hard to do the dance without the monitor!
     
  33. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    My cat is on a high dose, but you can see that his needs have gone up then down and then up again. We rarely decrease dose based on preshot. Only when we can't monitor or were terrified.
    If 1.5 is too little and 1.75 is to much, could you try a fat 1.5? I measure fat doses with the top of the plunger barely touching the bottom of the half unit mark. Skinny doses I put the bottom edge of the part of the plunger (that you line up the dose with) right on top of the mark of the syringe. Hopefully that isn't too confusing.
    Even on the high dose my cat is on, sometimes a drop makes a big difference so I know the frustration of a surprise heavy action cycle.
     
  34. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    Nothing wrong with that decision. Best to keep him safe and know his and your limitations. :cat:
     
  35. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Dec 9, 2017
    Sounds like SLGS is a safer bet, indeed, if there are periods where you can't monitor! Do you more or less know when the monitor is going to come off?
     
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  36. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    Yes, it sadly tends to come off after about 10 days, so probably around next Saturday.

    If you have a look at my SS for today, for once during the day he went into some yellows earlier in the day and did NOT go down later in the day. Which I thought was good. But then as soon as I gave him his PM dose, it's as if I injected glucose by the way he responded!!!

    What on earth has happened?!
     
  37. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Dec 9, 2017
    It looks like a bounce from the yellows. He’s not used to those values so he produced glucose to try and keep himself in “better” (according to his out of whack metabolism) values.
    Are you going to be giving 1.5 in the morning now too? It’s really tricky to try and interpret what is going on with a different dose AM and PM.
    Is his food intake similar for the AM and PM cycles?
     
  38. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Dec 9, 2017
    To help with the readability of the SS I would put in all dates, just write “no monitor” in those where you can’t measure, and write down the doses you’re injecting.
     
  39. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    Ok, I will.

    Overnight he was HI all night until finally he came down to 26 (475) at 4am.

    After his AM shot (of 2 units. I know, I know. It's not ideal. Our vet is adamant that 1.5 is not enough despite the past evidence that it produces better numbers - more yellows than pinks / reds - but I also understand where he's coming from as whenever we stick to 1.5 for more than a week, he seems to get completely out of control and has now ended up with ketones twice), he went down to 22-ish 400 by 5 hours later and then around 15 (280) at the 10 hour mark. Now at his PM preshot time he's back up to 400 again.

    The thing also is...ok, so 1.5 does seem to work better, at least in the day, and for a week or so, but it's still not blues or greens. I actually don't even WANT greens. They scare me too much as he always seems to go too low once he goes near them.

    So if 1.5 units isn't enough to get blues, but 1.7-1.8 and 2 units is (apparently) too high so gives pinks and reds, what does WOULD give blues!?
     
  40. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    Also, regarding the bouncing from the yellows, if you look at 9 February, that day he got 1.5 in the morning, had mostly yellows, and then got 1 unit in the evening as I was nervous he might keep dropping later, and he stayed in the yellows all night. On those smaller doses.

    I thought...surely this proves 2 units is too much then!!!

    Then the next day his monitor fell off, and then 4 days later he had ketones.

    What?!

    AND after that good day of yellows he didn't bounce that night! So why bounce last night with just a few hours of yellow?
     
  41. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    Try looking at your spreadsheets by groups of 3 days, not cycle by cycle. That’s why dose-hopping makes it really hard to understand what is going on. Too many variables.

    Have you tried 1.75?
     
  42. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Actually, I think that may be "the" dose but complications like monitors coming off early, hypos, prolonged bouncing, and issues with getting that exact dose on syringes with 1 unit increments...it's been hard to tell.

    We tried using the 0.5 mark syringes but they blur before my eyes SO badly I literally cannot even see! I even tried using those jeweler magnifying glasses. Still blurred. My eyes aren't the best.
     
  43. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Looking at the last 3 days, I can see the first day of the 3 he had some yellows, but since then, all pinks and reds. Why...
     
  44. Fly

    Fly New Member

    Joined:
    Jan 27, 2018
    What do you feed him and is ut a similar amount morning and night? Free feed, and chance of getting non low carb foods?

    I strongly suggest same dose morning and night. I've seen 5 vets around Brisbane since my boy has been diagnosed and all have different views on doses and what to aim for. Also, correct me if I'm wrong but doesnt the high and low increase chance of ketones. A day in yellows before back to reds wont really reduce the risk much.
     
  45. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Really? My vet said that ketones tend to come after a few days of not dropping down at all, so I had been assuming going from reds / pinks to yellows would keep him at least partly safe for a little while.

    He always eats the same food AM and PM. His routine is almost identical AM and PM.

    5.30am - AM dose with breakfast
    Also tends to do his morning pee

    5.30am - 7am - hangs out in lounge room

    7am - into the bedroom for some rest after my partner goes to work and I sleep late. There is a bit of food always available but he seems not to notice

    10am - we get up and get ready for the day

    10.30am - a small snack mixed with a bit of water, usually the same as breakfast

    10.30am - noon - hangs out in lounge room

    Noon - 2pm - relaxes in bedroom while I go out

    2pm - 5pm - hangs out in lounge room. Again, there is food around and sometimes he nibbles but mostly not a lot.

    5pm - he follows me around while I measure all 10 water bowls, jugs and glasses around the house. Usually he will do a pre-dinner pee here too.

    5.30pm - PM dose with dinner, same as breakfast (same meaning Fancy Feast Classics under 5% carb)

    6pm - 7.30pm - hangs out in bedroom while we go out for dinner

    7.30pm - 1am - relaxes in lounge room until we go to bed. He sleeps with us.

    Between 9pm - 10pm is a small snack, the same as the morning one.

    So. Pretty much the same routine and food for both AM and PM.

    Oh, and he goes in the bedroom while no one is around because (a) we don't want to risk the cats fighting (90% of the time they're good), (b) it's air conditioned in there when it's hot, and (c) he likes it. lol.
     
  46. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    While it IS true that we usually see ketones in higher numbers, they can be produced even if the cat is in normal numbers (although it's more rare)

    Dropping from red/pink to yellow is going in the right direction and will help ....it just won't negate the possibility completely and as long as he's already shown that he's prone to developing ketones, it's best to keep a close eye on them
     
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  47. Fly

    Fly New Member

    Joined:
    Jan 27, 2018
    What Chris said matches what my vets have said. Also that its not always but is commonly found in unregulated diabetes.
    Do you measure the water to see how much he has drunk? If so, wow. With 2 cats I ruled that out instantly and time wise was happy too. Lol Good on you.

    With food, if there is no chance of getting non low carb. Have u tried restricting food 2hrs before each shot/meal? Yes small portions are good but if he eats a little without you noticing and you are going off that BG, it can make a little difference. Even if low carb. I know its not much, just trying to think of something that could help explain some of the regualr non consistent readings and hypos.
     
    Last edited: Feb 21, 2018
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  48. Fly

    Fly New Member

    Joined:
    Jan 27, 2018
    I also felt that I was getting slightly lower BGs on the FF chicken and giblet than the other fish low carbs. Maybe try 1 flavour for 3 days and see if it make a differrence.
    I almost gave in tonight and gave mine dry food. His diabetes is not our first priority and i just wanted him to eat...raw chicken saved the day...just. lol Until tomorrow.
     
  49. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Yes! I've noticed the FF chicken one is lower too. I think. From the food spreadsheet I think it had 2% as opposed to 5 or 6% like say, the turkey. My babies won't eat the giblets. Or any beef ones. Or liver. lol.

    Only chicken, turkey, tuna, salmon, seafood medley, cod sole & shrimp, whitefish and tuna, and savoury salmon. All Classics.

    We actually do find that he doesn't tend to eat much, if anything, in the few hours before breakfast or dinner. He just has his small low carb snacks mixed with water at those 2 times in the day / night.

    And YES, measuring the water is SO time consuming! There are currently 3 water sources in the lounge area, 1 in the hall, 2 in the laundry, 1 in the bathroom, and 3 in the ensuite. Dweezil is the only one who drinks from the ensuite. We can see who drinks from the lounge room as it's in our line of sight from the couch. Monty drinks a bit from the laundry, hall and bathroom but Dweezil does not.

    Either way, if the water goes from say 400ml to 700ml, it's likely to be Dweezil and it's not a good sign.
     
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  50. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Sigh. Well, the monitor stopped working the morning of us having to take the boys to the cattery, and then the next afternoon when we picked them up, within 30 minutes of getting home at 6pm, he did a pee and there were ketones (1.5% or "small") so off we went to the emergency vet, where we waited around until 9pm and then he stayed overnight. His ph was 7.23 which isn't TOO bad for DKA, but still bad.

    Better now after several hours of fluids and some IV insulin, Dweezy is coming home tonight. His glucose is still 17. Lowest the IV got down to was 15. Seems even when they give the injection it doesn't do much!
     
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  51. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    The next time you have a working monitor, I'd strongly suggest you be more aggressive on your dosing.

    There's no reason to hold the dose more than 3 days if it's not getting him down where he needs to be.

    Also, you should give the same dose both AM and PM....changing the dose screws with the depot and you're not going to get the best results.
     
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  52. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Yes, we are going to be trying some different things. This, what we've been doing, is just not working.

    The vet at the emergency hospital this morning gave 1.5 units and then 1.5 units before we came and got him at 6pm. He is right now at 234, down from what he was then.

    The reason we hold a dose and don't know what to really do, is because there is partial insulin resistence going on and WHEN the 1.5 unit dose (for instance) works, it works ok / sometimes not so good / sometimes he goes towards hypo and is steered by food (when the monitor is on). But it just doesn't always work. So to increase a dose, it scares me as WHEN 1.5 works, what would 2 or 2.5 do?

    There were still ketones in his pee right after he got home, but we called the hospital vet and asked and he said it was his first pee since last night so there would still be residual ketones. They also let him go home a day early as he HATES being in the hospital SO much it hinders his treatment. His ph was back to normal and so were all other values, and his ketones were apparently all flushed out.

    He ate well when he got home and has had quite a bit of water.

    So far he is ok, but I just continually live in fear of either hypo or keto. I seriously have PTSD from this, I really do.
     
  53. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    It must be such a stressful situation! :bighug:

    As Chris suggests, I would definitely try and make the most of it when the monitor is on, and be more agressive with dosing during those days. Fingers crossed!
     
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  54. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    Thank you! It is a NIGHTMARE of chronic stress. HE isn't stressful, but IT is. I love him. I hate IT.

    Tonight for instance, unlike last night with his good PM numbers, straight after his dose he went HI on the monitor. NO effect and again, like I injected pure glucose, not insulin. It is bizarre. Even a fur shot does not do this.

    I have since given him another 1 unit 4 hours after his initial PM dose to try to get SOME downward movement, as tomorrow we are switching him to Vetsulin / Caninsulin just to try SOMETHING since it has been 3 years of unregulation on Lantus and it's just not working anymore.

    So tomorrow he can't have his AM Lantus as then it will overlap with the Vetsulin later, so giving this 1 unit booster now may help and won't hurt tomorrow. I can't stand the risk of being HI all night AND most of the day tomorrow.
     
  55. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    Are you sure it can't be a monitor malfunction?
     
  56. monty_dweezil (GA)

    monty_dweezil (GA) Member

    Joined:
    Dec 15, 2014
    No, this has happened randomly before and it shows in his behaviour. Much thirst and quieter than usual.

    Even despite that extra 1 unit, he was still HI until 1am and then he went down slightly to 468 (26). At 5am he was 450 (25) and threw up. He was NOT himself.

    We got a pee sample and it had trace ketones. He only JUST recovered from the last DKA crisis!

    Back to the vet. Poor Dweezy was lethargic and breathing VERY fast. We went over to the emergency centre where we were the other night and to the specialist section, where they put him on fluids and also did an ultrasound as our vet thought he felt a mass that when palpated, Dweezil cried. The ultrasound revealed no mass thankfully, but his colon and stomach are inflamed, his kidneys are "showing his age" (9), his lymph nodes are enlarged and for some reason, despite being given 2 lots of long acting injectable antibiotics over the past 2 weeks, he has a mild fever.

    Latest update is he ate well today, is off the rapid IV insulin and his glucose is 368 (still seems high to me), free of ketones and they are now starting the caninsulin but need to look into these other things and see how his night goes and how tomorrow goes in terms of a curve.

    I thought we may have to say goodbye to him this morning. He was all sedated. Many tears.
     
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