My Cat Moe

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GregH

GregH

Member Since 2017
Hi Everyone.

This is my first time posting here, although i've been reading the forums and everything I can since my cat Moe started having complications with diabetes a couple of months ago.

3 years ago Moe had diabetes and we gave him insulin injections and then he went into remission after 3 months. Last November he started drinking more, acting like he wasn't feeling well, and he started picking at his food. We took him back to the vet and they started him on 2 units of Prozinc twice a day. He started responding over the next several days, gaining back weight and eating all of his food again. I took him in back in for a nadir reading and he was still higher than they wanted so they increased his dose to 3 units. I took him back in a week for a follow-up appoinmtnet and his reading was 260 at nadir and they considered raising his dose to 4 but decided against it since he was feeling well. The very next night, I found the poor guy seizuring (shaking, eyes blinking rapidly) due to hypoglycemia (I fed him honey and within 10 minutes he stopped). We took him into the Emergency Vet for the night and they stablized him. After that night we were scared to give him too much insulin, they recommended giving him 2 units going forward and I bought a glucometer and started testing him at home.

I've been testing right before I feed him, and 5 hours later, and he is all over the place. Pre-shot he'll be 400, then I give him 1.5 units and he's 60. Another time he'll be at 400, and then I give him 1.5 units and hes at 500 at nadir. Its very unpredictable. We've continued to monitor him and try to do our best to both keep the dose consistent, but also raise it gradually if he has several high numbers (500+) in a row, or give him half or skip a dose if his number is very low (<100 or mid range).

Another member I believe on this site with a pet named Gracie created a very awesome google spreadsheet which I've used the format to keep track of Moe's levels since the hypoglycemic event. I've been tracking it in that same format. It is located here.

He gained some of the weight he lost back (up to 9.8 lbs). Then a few weeks ago we tried to switch his food entirely to MD (he was half MD, half fancy feast) in an attempt to try to level out his glucose readings so we didn't have as many highs or lows. Not only did that fail, around that time he started losing weight again (down to 9.4 lbs) so we switched back. A couple of weeks have passed and he's lost another half a pound again. (he's down to 8.9lbs now!) Back in August he was 10.8 lbs! Also he's been very very hungry, constantly begging for more food, but he already gets 1.3 times the amount of food we feed his brother (Oscar), who is 13 lbs. We hate to give him more and upset his levels and feeding schedule. (Oscar will steal his food so we have to watch them eat twice a day)

Obviously I'm going to take him back to the vet, but I wanted to ask if anyone had any thoughts or suggestions?

Thanks! We love our little Moe!

Greg
 
Hi Greg, welcome to FDMB. Sorry you and Moe are having such a tough time! Unfortunately, I don't use Prozinc and am really not too familiar with dosing with it, but there are lots of good folks on here who are more knowledgeable about it , and I'm sure they will be coming around later in the day.

Moe is losing weight because a cat with uncontrolled diabetes can't properly use the calories in their food, and is, literally, starving to death. Personally, I would feed him more if he is hungry, and worry about the amount once his diabetes is better regulated. There is no reason you can't continue with the Fancy Feast, if he likes it, as long as it's the Classic pates. Most "prescription" food is no better for your kitty than the stuff off the shelves at the pet store, just a lot more expensive! He needs food that is under 10% carbs, and I'll give you a link to a great site we use to check the carb contents of many foods. As long as you keep his carbs below 10% it won't upset his blood glucose levels.

http://catinfo.org/docs/FoodChartPublic9-22-12.pdf

Diabetic kitties seem to do better if you can spread their meals out over the course of the day, rather than giving one or two bigger meals a day. My cat eats three times a day, generally, but I know a lot of people feed more frequently than that. I have three "civvies" (non-diabetic cats) as well, and they have also had to adjust to the feeding schedule I use for my sugar kitty, because it would be worse than feeding time at the zoo if everyone ate on different schedules, lol! It hasn't been a problem.

I am so pleased that you are already home testing and even using our spreadsheet! Someone with more tech savvy than I have can tell you how to link it to your profile so the link comes up automatically every time you post. This helps us to be able to better help you. We also invite members to fill out their profile with pertinent information so we aren't always asking you the same questions over again. Here's the link to information on how to set it up.

http://www.felinediabetes.com/FDMB/threads/creating-a-fdmb-profile.159626/

Hopefully someone who is familiar with Prozinc will be along in a bit to help you with dosing. You can also try posting your questions on the Prozinc board, found here.

Hope I helped you some. Good luck! :)
 
Hi Greg,

I'm sorry to hear that you're currently having difficulty with regulating Moe.

Like Lucy, I've not used Prozinc but I think part of your problem is that Moe is bouncing up into higher numbers after hitting those really low BG levels as a result of the body's defence mechanisms kicking in to raise BG levels to protect Moe from hypoglycaemia. (Bounces may sometimes take several days to clear and that can make dosing very tricky.) I know that some members here use a sliding scale for dosing Prozinc but I'm unfortunately not able to suggest anything to help because I'm not familiar with using this particular insulin.

I am tagging @Sue and Oliver (GA) to see if she can help you when she is next online. She has a great deal of knowledge about your insulin type and I hope she will be able to give you some suggestions as to what might improve Moe's regulation.


Mogs
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Hi Greg,

I use ProZinc and I have an extremely bouncy cat. Moe's SS is as colourful as Teasel's. Here's what I've learned from my guy and it might help you:
  • I have to keep dosing as even as possible with no sudden changes AM to PM and day to day. Sliding scale dosing throws him for a loop.
  • I often use tiny dose adjustments like 0.1 u because I dose with U100 syringes. They give more latitude for fractions when used with U40 ProZinc.
  • I almost always hold the same dose for at least 4 cycles unless he drops too low or stays too high.
  • He'll get "stuck" if I leave him in higher numbers longer than 6 or so cycles and it usually takes only a tiny boost in dose to shift him and get his BG moving again.
Even with all these "calming measures" my cat's SS is very busy. He's not typical for sure. I'm toying with switching to Lantus but haven't made a final decision. We started on Lantus but he bounced on that and ended up in a DKA episode. I changed to ProZinc after that. However, I wasn't doing things the FDMB way so I *might* revisit Lantus.
 
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Hi again, Greg. Just a word of warning - Kris is very experienced in using U100 syringes to dose with a U40 insulin like Prozinc, but we do not recommend this unless you do know exactly what you are doing!
 
With that amount of weight loss, I suspect in general he is not absorbing enough calories. A vet visit is very important to his health at this point.

I recommend using a spreadsheet. Even if you don't post it here, it is useful to track pre-shots and nadirs. Instructions were in a post earlier in this thread.
 
For general information you need to use a conversion chart when using U100 syringes (0.3ml size with half-unit markings) to dose a U40 insulin. I echo the caveat that you need to be very sure of what's required before attempting this technique.

Here are the links you need to get going with a spreadsheet for Moe:

FDMB spreadsheet setup instructions

Understanding the spreadsheet grid

Just give a shout out for any help you need with this.


Mogs
.
 
Thanks everyone for your response and help. Moe is actually doing worse now and his glucose readings are higher. Actually went over 600 earlier this morning but he his back down to 500 now. I can get him into the vet tomorrow morning but I want to ask is it okay to give him an extra unit now (at nadir) when he is 500 or do i have to wait until his PM shot before he eats? He's obviously not feeling well now and I hate to see him like this. Thanks!
 
Oh, no-- I'm so sorry to hear that Moe is doing worse. I can't help on the dosing question-- I know that generally it's not recommended to give extra shots, but others with more experience with Prozinc and/or dealing with very very high numbers may weigh in with an opinion here.

First, though: those extremely high numbers and Moe's general unwellness worry me. Have you been testing for ketones???? It's really really important to do so so that you can avoid a DKA episode. How does he appear unwell, i.e., is he still eating and using the litterbox, is he really lethargic, any vomiting or other symptoms?

Looking at his spreadsheet, he really is all over the place, I'm not sure how to interpret where these doses are taking him. I have heard, however, that after a severe hypo event cats often become more sensitive to insulin-- so that might explain some of the bouncing around and make it harder to identify Moe's "perfect dose".

I hope he is feeling better soon. Poor Moe :(.
 
He generally just sits around and doesn't do much when he's not feeling well. Sometimes he twitches are shakes slightly when he gets above 500. We also notice slightly lighter colored stool, but there's no other symptoms that we've seen like vomiting. The doctor hadn't mentioned testing for ketones with us. I've been taking him in every week to two weeks to the vet since November. His glucose number is moving in the right direction (although its still 400), so I'm struggling with what to do here. We may just wait for the next dose at this point, since its only 4 hours away now, and then I can hopefully get him feeling better and take him into the vet tomorrow. Thanks for your response.
 
Kudos on doing the spreadsheet. Please consider putting it in your signature. He is indeed all over the place. And that huge weight loss is bad too. I would not give him an additional dose now. His vet visit tomorrow is crucial to his health. I agree with Nan - for those high BG levels, you should be testing for ketones. Poor Moe.

Consider printing out the recent BG history for your vet. If they are experienced with diabetes, it will be helpful. If you vet is not experienced with diabetes, consider getting another vet who has that experience.
 
I took his glucose again and its on the rise again, so I went ahead and have him 1 unit a couple of hours early without any food (his normal dose is now 2 units and even then seems like its not enough sometimes). I'll give him the rest (another 1u) with his dinner meal, and possibly slightly more and monitor him closely tonight. Got him playing with ice cubes on the hardwood floor for just a few minutes, his favorite game.

I appreciate all the responses. I'll look at getting a second opinion, too, JeffJ. Our vet did mention ketoacidosis and described the symptoms, but I don't have a way to directly monitor it. I do take the spreadsheet in with me each time I go, and yes, its always all over the place. Each time we think we have it figured out we get a surprise. The vet described it as like "dancing with a partner that doesn't know what he's doing". I've seen a couple of different vets at this clinic, and the older one there helped him tremendously 3 years ago when he developed fatty liver and then went back into remission for 3 years. We did have a couple of close calls with hypoglycemia a week and a half or so ago, and then it went up and stayed up high, only coming down into the 200s over the last week. And maybe that's part of our problem of what all started this most recent problem.
 
Greg - you are probably okay with the dose addition. Please read up and be very prepared for a hypo (hypoglycemia), not just for now, but for anytime. We all need to be ready with our sugar cats. If you have any questions about it, ask us.

Kudos for putting Elmo's SS in your signature. And the ice cube game sounds like fun.
 
Yeah sorry I didn't see your instruction in time before giving him the additional unit, but my reasoning that it was really high and rising back again, and I really need it down before he eats more to avoid the 600+. I know 500 is really bad, but 600+ today was terrible, and a first time for us, so we felt like we had to do something. I know we will be overlapping these two doses so I'm trying to keep that in consideration and give him 2 units total between these 2, 2.25, or 2.5 units total if we feel like we need to adjust the whole dose up again (it has been 4 cycles now at 2 units). I just got some new U-40 syringes in yesterday that have half-unit markings so that will help.

Also, believe me, we are prepared for a hypo now, we were totally unprepared for it the night before Thanksgiving and I wasn't doing home testing at that point. He ended up spending all night in the hospital and me running around thanksgiving day morning trying to find a human glucometer (we use relion because thats what is available quickly for me then). That's when we started home testing. I don't have glucose but I have honey and that's what worked for Moe last time. I also have an AT2 with a limited amount of test strips that I use to help calibrate my relion translation or if there is a question or don't understand the relion reading. The AT2 test strips are much more difficult for me to get in a timely manner.

Thanks again for your advice. Hopefully we can get this poor guy back on track this evening and tomorrow.
 
Sounds like you have some pretty good vets there, which is great! Hopefully you can have a good discussion about the best strategy for getting Moe's numbers down. I hope that the vet will be able to nail down what is going on-- it could be that he's just a bouncy and hard-to-regulate cat, or it's possible that there are some other underlying health conditions going on that they'll be able to address.

If the verdict is just "hard to regulate", then I don't know if one of the L insulins (Lantus/Levemir) would be an option, but if it is it might be worth opening that discussion with the vet. It may not have been long enough with Prozinc to be able to say whether it is going to be the right insulin for Moe, it's an effective insulin for a lot of cats and your vet may have some good suggestions for how to manage the dosing going forward. But if Moe's experiencing an increased sensitivity to insulin amounts, an insulin dosed on a sliding scale may not be right for him and one of the "depot" insulins (L/L) might give him a smoother ride. Please note, this isn't an expert opinion by any means, I'm just kind of spitballing here and can easily make up a story in the other direction, e.g. the sliding dose gives you more of the flexibility needed for a sensitive cat. It's just something to ask your vet about if you think you might be interested in changing insulins.

As for ketones: most people here test using urine dipsticks (ketodiastix or similar) which can be purchased in (human) pharmacies. The tricky thing is always getting the sample-- some people use a long-handled spoon under their cats while peeing, others crumple up some plastic wrap in the "favorite spot" of the litter box (you only need a very little bit). Ketones are always a worry with a cat running in really high numbers, so it's a good idea to check regularly. If he ever stops eating for a period of time while running those high numbers, then it becomes imperative-- ketones can develop very quickly, and when it comes to DKA, there's a world of difference in outcomes (and $$$) between catching it early and getting to a vet and not catching it until it develops into full-blown DKA. It's really good that, right now, he's still eating and drinking and all of that-- he probably just feels yucky from the high numbers (or possibly some other health issue that is what is the underlying cause of the high numbers-- so glad you are going to the vet tomorrow!), but something to keep in mind for the future.
 
Good advice from Nan. And you are doing the right thing.

The only addition I recently made for our hypo kit - is a syringe that can be used anally. In the last 2 weeks there was a very unfortunate hypo resulting in death, on this forum. When the situation is critical, it is useful to have the ability to apply sugar/syrup directly anally. Sure, not fun, but possibly a life saver.
 
Good idea about the hypo kit, I hadn't thought of that--I had just heard about rubbing it on their gums if they are unconscious. I'm very sorry to hear about the loss due to hypo on this forum.

It's about an hour before dinner and he's starving, stumbled up trying to jump up to the counter for his food, and slipped. He's okay. but I decided to feed him early because of that. His glucose is down to 371 now. He seems to be eating his normal dinner amount so far, so if that holds I'm planning to go ahead and give him another 1.25 to 1.5 units. I haven't decided which yet, but it is clear that 2 units total hasn't been cutting it lately. As Kris & Teasel (who also uses Prozinc) mentioned on this thread, I've also noticed with Moe that sometimes just a smidge more (one-time) is enough to break the cycle of highs when he seems to be stuck.
 
GregH said:
As Kris & Teasel (who also uses Prozinc) mentioned on this thread, I've also noticed with Moe that sometimes just a smidge more (one-time) is enough to break the cycle of highs when he seems to be stuck.
Click to expand...
It's amazing how this can work so well. Some kitties can become "dose complacent".
 
Yes, the sugar up the rear trick is the very last thing to try. The sugar/syrup on the gums assumes they can swallow some of it. I hope none of us has to experience a real hypo. Scares me big time.
 
@GregH -

I note from your opening post that Moe is underweight and still losing. With the wide range in BG levels you're seeing along with the weight loss it put me in mind of these posts by member Meya14:

Meya14 said:
Too low calorie intake: You should look at a cat body chart and see where your cat falls as far as weight. Basically, if you can see the outline of the shoulder blades, your cat may be too thin. Any cat that is on the thin side and having issues with BS control or DKA should -NEVER- be restricted in the amount of food they eat. Low body weight makes "brittle diabetes" more of an issue, makes BS harder to control, and predisposes to illness. Also, not all calories are processed the same way, proteins and fats have a complex metabolism that relies on several enzymes that may not be present in certain illnesses. Carbs are a much simpler pathway, and may allow faster weight gain and glucose stabilization in skinny cats. Ultra-low carb diets in skinny cats may lead to DKA if prone.
Click to expand...

Link to original post:

http://www.felinediabetes.com/FDMB/threads/cat-not-improving.169098/#post-1836148

Meya14 said:
As far as the "insulin not working" part - When there are no fat stores left in a diabetic the liver has a very hard time compensating for insulin doses. This in humans is referred to as "brittle" diabetes. What happens is that the blood sugars go very high, then insulin is given, then you get dangerously low sugars, and back and forth. The solution is actually to increase the amount of carbs you are feeding, so that you can give larger insulin doses - this will allow her to gain weight faster and for her sugars to be less "brittle". Once she is more stable, slowly reduce the carbs in the food, and monitor weight closely. The only way she'll gain weight and be healthier is with larger insulin doses than what she's been getting and that's going to mean increasing intake.

DKA happens when the body either isn't getting enough calories (in starvation or chronic illness) or not enough insulin to allow for food to be used as energy and stored as fat. The body starts burning fat instead as an emergency fuel, but over a few days, the biproducts of this, ketones, build up in the blood and cause problems.

So, it's good that she's eating by herself and sounds like she is in good hands at the current vet. When she comes out, if it were my cat, I would aim for about 20% carb food - wet or dry (other's will disagree, I know) and increase insulin to match the intake until she gains some weight. Because she can't compensate when she goes low, you need the extra carbs from the diet to even out the blood sugar swings.
Click to expand...

Link to original post:

http://www.felinediabetes.com/FDMB/threads/vets-cant-stabilize-glucose-levels.165787/#post-1790343

[Emphasis mine]

I hope that some of the above information may help you and your vet to help Moe.


Mogs
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Greg,

I see from your earlier posts that you gave an extra dose of insulin at AM+9.

I see from the spreadsheet that Moe's headed down a good bit already in the PM cycle. Prozinc is a long-acting insulin and the overlap in doses could potentially see Moe's blood sugars dip down into dangerous numbers. I strongly recommend that you monitor through the night for any unexpected lows and also be careful tomorrow; it's only a week since Moe went very low. To be extra careful I'd also recommend you leave food out for Moe to graze on.


Mogs
.
 
Wow, that is a great 2 posts Mogs. I have read a lot, but never much about underweight cats + diabetes.

Yes, Please Greg, monitor tonight. We don't want Moe to have an untreated hypo.
 
Thanks for the info Mogs. I have had a pretty big problem for most of these 2 cats's lives. They are littermates, they are brothers, they love each other. But Oscar (his brother) will eat any extra food left out. He weighs much more than Moe does and gobbles it up like nobody's business. He is definitely a food bully, so we do have to feed these guys at intervals and watch them while they eat. We already give Moe more food than Oscar, but I'm thinking about setting up a 3rd feeding just for Moe at 10pm each night. (other 2 are around 5am and 5pm).

I'm about to do another check. Trying to not poke his ears too much as they are already sore from today. He's hanging out by the kitchen now whereas before he was trying to hide from everyone and do some hard core "I don't feel good, want to be left alone" sleeping.

By the way I gave a total of 2.5 units this evening, 2 units this morning, and 2 units (morning and evening) that last several days. I do realize its long acting, but felt I didn't have much of a choice because I don't have any short acting insulin on hand. He was still pretty uncomfortable after eating tonight which is why I gave him part of his dose early before eating. I'm going to ask the vet about short acting insulin tomorrow for situations like this.

If his numbers go down into the 100's tonight I would love to feed him more and get more weight back on him. I just hate the high BG numbers because I know it makes him feel terrible. And that's also our fear if we leave food out for him all the time if for some reason we can keep Oscar away from it.
 
Well, he's now back up to 334. I just don't understand this sometimes. This morning he was at 255 at 4:00AM. He had no food until 5:30AM when i fed him and right before he ate I checked him and he was up to 452 only an hour and a half later.
 
Totally great on the thin cat + diabetes postings.
Greg - it will be nice to hear the results of Moe's vet visit. Glad to see his BG is still safe.
 
Been super busy over the last day or so. I took Moe in yesterday and was referred to an internal medicine specialist. We're at that appointment now. We had another blood panel done yesterday and they did find a lot of ketones so he'll have to be treated for that.
 
GregH said:
Been super busy over the last day or so. I took Moe in yesterday and was referred to an internal medicine specialist. We're at that appointment now. We had another blood panel done yesterday and they did find a lot of ketones so he'll have to be treated for that.
Click to expand...
Very sorry to hear about the ketones, Greg. Thankfully Moe is in the right place to get the help he needs. He might be better on a higher carb food while being treated for the ketosis (Meya14 recommends this).

Fingers and paws crossed for a speedy recovery - and for Moe to regain some weight. (((Moe)))


Mogs
.
 
I have an update that may explain a little more about what is going on with Moe.

The internal medicine specialist said that the difficulty regulating Moe is because of something else going on, not because of the diabetes itself. She did an exam and commented that it seemed like poo or something else was in there and also that the intestines seemed "ropey". She then did an ultrasound and found thickening on the small intestine. It was 2cmx1cm as opposed to what should be .5cm, she showed me the pictures. She gave me 3 possibilities: Fungal infection, Inflammatory Bowel Disease, or Small cell lymphoma or carcinoma. Obviously we are scared for Moe.

She said she could do exploratory surgery on the thickening, or we can do a urinanalysis test first to rule out fungal infection and work our way the other direction from least invasive to most invasive. Since Moe is still eating well she told me we had time to test for fungal infection first and then we could try treating for Inflammatory Bowel Disease with steroids. I asked her what she would do if it was her pet, and she told me she would be on the fence about opening him up. We chose to test for a fungal infection first since it was least invasive. We expect the fungal infection results to be back tomorrow. It's so tough to know what decision to make.

In the meantime I'm treating him for ketones at home. She gave me an IV bag and instructions on giving him 100mL a day until further notice. She thought it was unnecessary to hospitalize him at this point for that if we can accomplish the same thing on an outpatient basis, although it will take a bit longer. We started that treatment when they were showing me how to do it about 9 hours ago in the clinic and it hasn't really had much time to take effect yet but I think I might see some marginal improvement in his shakiness reducing and in other areas. He's jumping around more than he was yesterday for sure, although when he sits down or lays down he's very careful about how he lays. Obviously something is uncomfortable.

As a side note she noted his stomach was full during the ultrasound (which was done 4 hours after eating). It is taking him much longer to digest his food which I already suspected due to his glucose spreadsheet--his stomach was full 4 hours after eating). She told me that food is usually processed through the stomach extremely quickly in cats.

So that's where we are at. It's a crap shoot at this point as to the insulin dose, and it was up to 500 again pre-shot (hopefully in large part due to the vet stress and being there for 4 hours?). I gave him a total of 2.5 units to try and get his number down.
 
That's a good update on Moe. The internist will have a lot of experience in helping determine where to go with Moe. I hope it is just an infection.

The food in the stomach for 4 hours is not good. The internist is correct that food is processed a lot quicker than that usually. I wouldn't open him up until you have explored the other stuff. That is major surgery, and hard on a cat (or human).
 
GregH said:
we could try treating for Inflammatory Bowel Disease with steroids.
Click to expand...

Steroids and diabetes aren't a good mix.....we have lots of cats here with IBD as well so before going to steroids, I'd post and ask for some advice on the other medications people here use. I know that sometimes a novel protein diet can really help....something the cat has never eaten before. Rabbit, Venison and Kangaroo are usually some that most cats have never seen before

Of course if nothing else helps, it's more important to treat the disease with steroids and just increase the insulin as much as necessary to compensate
 
The fluids have been a help, and hopefully the ketones are back down to normal. We're on day 3 of 100mL of saline each day under the skin. He had a little bit of diarrhea this evening (hasn't had that in awhile) and low preshot glucose values (95), so we had to back down the evening dose from the 2-2.5 units we have been giving him since he's been sicker.

The internal medicine specialist wants to do a followup ultrasound to see if the thickening is still there and if she can get any more answers without having to go to exploratory surgery. We did rule out the fungal infection--those tests came back negative. At this point if she can't figure out any more insight from the followup ultrasound (scheduled for tomorrow afternoon) we're debating crossing our fingers and trying to treat for IBD even though we don't know if that's what it is. She did mention there is a possibility that the steroids could make his diabetes worse, although she said it is not highly common.

Thanks to everyone with advice. This is a really tough road for us and we're always not sure if we are doing the right thing at each step of the way.
 
GregH said:
She did mention there is a possibility that the steroids could make his diabetes worse, although she said it is not highly common.
Click to expand...

It depends on the type.....one of the medications people use here a lot for IBD is officially a steroid, but it doesn't effect the blood glucose the way most of them do

I'd suggest editing your subject line or starting a new post with something like "IBD medication advice"? and see what you can find out from the wealth of knowledge the people who deal with it have
 
Yes, it is a tough road. Hang in there Greg and keep helping Moe. With luck and some good treatments he'll get better.
 
Thanks for the advice about starting a new thread. I have all updates to Moe in IBD Medication Advice. The short story is that we did the follow-up ultrasound and the internist thought the thickening as longer and flatter than it was the first go-around, which she was pleased with. At this point she doesn't want to do surgery now and try getting the inflammation down--we started Moe on steroids to help the inflammation--he's on prednisolone for right now and we are planning to switch to budesinide when it comes in next week. After fluid treatment the ketones were gone as of last Friday, but I'm struggling with his glucose levels now and she also wants to feed him more because he's hungry all the time. I've been giving him a bit more insulin to hopefully compensate for the increased intake and because his preshot levels are already high to begin with.
 
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