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Discussion in 'Feline Health - (The Main Forum)' started by Terrelle, Jul 23, 2015.

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  1. Critter Mom

    Critter Mom Well-Known Member

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    I have chronic PTSD, Robin. It banjaxes your sleeping. (*sigh*)

    Sweet dreams to you too, Robin, when it comes your time to turn in. :)

    Nite nite,


    Mogs
    .
     
  2. Robin&BB

    Robin&BB Well-Known Member

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    Oh, don't misunderstand: Didn't mean your vet, just vets in general ...
    Monitoring is important because insulin is a very potent hormone. And seeing how a cat reacts to administration of that hormone is important: the spreadsheet data can give us pretty clear indications about when to increease/decrease dose, overall health, etc. The goal is (hopefully) remission. If remission cannot be achieved, then the goal is good regulation at the smallest dose possible. So you must have adequate data to help you heal your cat. Otherwise you're, quite literally, shooting in the dark. Not at all a wise thing to do.
     
  3. Robin&BB

    Robin&BB Well-Known Member

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    (I had responded to this a few minutes ago and somehow my post inexplicably disappeared into cyberspace... Arrgh!:banghead:)
    We monitor because insulin is a very potent hormone. The data we gather from regular BG testing helps us to know how a cat's body is reacting to our administration of that hormone.

    Blood glucose monitoring tells us when it's safe to shoot insulin (AMPS/PMPS), whether or not a particular dose is achieving the desired effect (better control of glucose levels), and what happens when a dose is increased or decreased. Transitioning from higher-carb food to low-carb, for example, can result in an immediate need for a dosage decrease. But how would one know that without regular BG tests?

    Our goal for sugar kitties is to either (hopefully) get them into remission or get their blood sugar well-regulated at as small a dose as possible over time. Without regular BG testing, one is - quite literally - shooting in the dark. Not at all a wise idea!
     
    Last edited: Jul 27, 2015
    Reason for edit: typo!
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  4. Terrelle

    Terrelle Member

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    Thank you, that makes sense... Sorry if I'm being bothersome, I'm just so scared right now...

    Her levels seem much safer today, She's about at the time when she seems to start climbing and she's at 89 :) I think the .5 in the evenings seems safe,
    I wonder if I should keep her on 1iu during the day though as she seems ok... or do you guys think .5 is just safest?
     
  5. Robin&BB

    Robin&BB Well-Known Member

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    Hi, Terrelle (Funny: I had logged off, then suddenly got a feeling I should log back on again ... and saw your post) - Let's look at your SS: You shot both last night (1.0U) & tonight (0.5U) when she was at 118 BG. At +4 last night, with the higher dose, she had dropped to 188 by +4; tonight - at half the dose, mind you - she has dropped to 89 by that same time in the cycle.
    That's a nice green #, we like it, but ... since you're going to be out of town, I would think 0.5U would be more prudent a dose to have a substitute caregiver giving to Terry.

    I doubt that Terry is going to start spiking a whole bunch of high BG#s at this dose, so is unlikely her eye will be in danger of too much pressure on it. Also at the reduced 0.5U dose, there's less risk of dropping too low at a time when nobody's there to test & steer with food. Remember ... you had to steer with food just last night at 1.0U. Hypoglycemia, when severe, can be deadly. Why take that risk?

    I'd do the 0.5 - yes, it's safer.
     
  6. Robin&BB

    Robin&BB Well-Known Member

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    And I'd be checking at least a +6 tonight, too - to see how she's rising.

    Of course, you may want to check in with someone who's very experienced with Caninsulin first thing in the morning to weigh in on it.
    But as for me, I'd rather play it safe than risk a hypo when your caregiver can't be there to monitor at mid-cycles.
     
    Last edited: Jul 28, 2015
    Reason for edit: typos
  7. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Curves can give us useful information about how the cat's body is using the insulin.
    We can pick up clues about when the insulin starts working (onset); when the blood glucose is likely to be at it's lowest (insulin 'peak' or blood glucose 'nadir'); and how long the insulin lasts in the cat's system (duration). We can also get an idea of how low a cat's blood glucose will drop on a given dose.
    But these things aren't necessarily 'set in stone'.

    A curve is a 'snapshot' of what happens on a given day, and it cannot be assumed that what happened on Monday will also happen on Tuesday (although it may well be similar). That is why tests in addition to curves (or indeed instead of curves) are so important.
    Every test result we get is like a jigsaw piece in the puzzle that is feline diabetes. And the more jigsaw pieces we have the clearer the picture becomes. However, the picture we are trying to understand is not a static one: It may shift and change over time, sometimes in subtle ways, and occasionally quite dramatically.

    There are a huge number of things that can affect how a cat's body will respond to any given insulin shot. Some of those things we have some control over, and some of those things, well, we don't...

    We may be able to choose which insulin type we use. We can control how much insulin we inject into the kitty, and the timing and location of the shot. We can often (but not always) control what the kitty is eating, and when s/he eats it.
    But we can't control how the kitty responds to the insulin shot.
    For example: Maybe the kitty is off her food that day. Maybe she is constipated or has a furball. Maybe she is sick. Maybe she is using more energy than usual. Maybe her pancreas is waking up and producing more insulin (and maybe that is only being produced intermittently). Maybe her body stops producing insulin. Maybe there's a full moon that day (oh yeah, some cats have been affected by this).
    And there are a whole load of subtle factors within the cat's own body that influence how well the insulin is utilised.
    It's always seemed to me that it's a bit like monitoring weather systems. There are certainly patterns there, but the patterns can shift and change. Sometimes the weather can be predicted with accuracy. And sometimes it can't...:rolleyes:
    .
     
    Last edited: Jul 28, 2015
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  8. Robin&BB

    Robin&BB Well-Known Member

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    @Elizabeth and Bertie - Good info for Terrelle, but she's going to be out of town; what is your take on the 0.5U vs. 1.0U while she's away, as her stand-in won't be able to get any mid-cycle #s?
     
  9. Critter Mom

    Critter Mom Well-Known Member

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    Morning!

    I've been reviewing Terry's spreadsheet again, and I really think that 1 unit is too high a dose. She's getting 'tick mark' curves on it, drops at onset, jumps up after early nadir then spends second part of cycle at higher values - sometimes much higher than the pre-shot level -before falling again at the end of the cycle. Granted, there will be food influences involved but it's hard to interpret the data better without seeing the feed times/carbs alongside the BG data.

    For example, you look at the PM cycle for 26 July, the 1 unit dose dropped her BG like a rock by +3 and at +4 it was already rebounding. By +5 - within the period of Caninsulin peak activity - it has shot up 60 points higher than the pre-shot. That may be food-influenced, or it may be the liver dumping more glucose in response to the drop in the cat's blood glucose levels in the hours after the shot.

    I'm also concerned about giving Caninsulin at such low preshot numbers - even at 0.5 IU BID (or even SID).

    -----

    I'm working on the assumption that your sitter is going to home test BG at AMPS and PMPS each day but is highly unlikely to test mid-cycle (as mentioned earlier in the thread).

    With the eye issues in play, if Terry were mine I'd definitely want to consult my vet before briefing the sitter.

    Looking at blood sugar levels in isolation, if Terry were my cat I'd ask the vet if the following strategy were OK:

    1. Set a higher 'no-shoot' number for the sitter. (I'd suggest asking your vet about setting it at 200, and certainly not less than 180.) DEFINITELY keep the dose at - or below - 0.5 units Caninsulin.

    2. Ask your sitter to ring you with the preshot test result every cycle before giving the go-ahead to administer the Caninsulin. (Plus agree with her about what to do if she can't reach you.)

    3. How long is the sitter going to stay with Terry? Is there any chance of getting some +1 and +11 tests? They can be particularly helpful when mid-cycle tests aren't possible.

    4. Ask your vet about maybe only giving insulin for the daytime cycle since a lot of cats run lower at night. It could be that Terry runs lower. Looking at her data, it's the AMPS that's highest. If she does have a natural tendency to run lower at night - and the data supports that hypothesis - you could take advantage of this to keep her safer since it should theoretically allow you to skip the PM dose without her numbers going too high. She's getting a lot of bang for her buck on the daytime doses as it is, and most of the time she's in the normal range for a healthy cat, even at 0.5 units of Caninsulin. (Great that you got the data last night!)

    5. Most important of all, ask your vet how the concerns about Terry's eye health should influence her blood glucose management goals and therefore dosing strategy.

    6. Make sure your sitter has the hypo guidelines printed out and ready to hand, along with Terry's different foods and honey/karo. Make sure the sitter knows which are low, medium and high carbs.

    7. Agree a course of action with your sitter should Terry's appetite be a bit off (she might be missing you!).

    Needless to say, your sitter will have your vet's contact details and emergency number. I'd also suggest maybe quickly setting up an FDMB account for your sitter so that she can post here for help if she can't reach yourself or your vet should an emergency arise.

    -------------

    Those are things that I'd suggest you consider. If I were in a similar situation with Saoirse, I'd be looking to give the absolute minimum of insulin necessary to keep her stable and safe. That said, I am extremely cautious at the best of times, and that caution is several orders of magnitude greater when it comes to keeping my cat as safe as possible on insulin.

    As an afterthought, is your sitter able to check Terry's pee for ketones at all? Might be an idea to grab some Ketodiastix to leave with her. (Belt 'n' braces and all that jazz. ;) )
    .
     
    Last edited: Jul 28, 2015
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  10. Robin&BB

    Robin&BB Well-Known Member

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    @Elizabeth and Bertie - You are marvelous! A wonderful list of suggestions. I'm so glad you're around ... :)
     
  11. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Ha-ha! I'd love to take the credit but it wasn't me, Robin, it was Aine. :D
     
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  12. Robin&BB

    Robin&BB Well-Known Member

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    @Elizabeth and Bertie , @Critter Mom - :blackeye::banghead::oops::oops::oops: - Holy crap! Aine, sorry about that! Looks like I need more sleep. More coffee. Or both! Anyway, you are BOTH marvelous in my book! :)
     
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  13. Critter Mom

    Critter Mom Well-Known Member

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    (*polishes fingernails*)


    :p

    ETA: I forgive you, Robin! (Thousands wouldn't...)

    ;)
     
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  14. Robin&BB

    Robin&BB Well-Known Member

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    Good morning, Terrelle! Please see the post above with the list in it, from Aine/ Critter Mom, who knows how Caninsulin works. How did the +6 go last night, & what kind of # did you get this morning?
     
  15. Terrelle

    Terrelle Member

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    Jul 23, 2015
    Hi I got 113 this morning and gave her the .5 iu... I regret it it seems stupid. I'll come home and check her on my break. Again if she follows her trends I think she should be fine, my worry is just that she won't. She did eat a lot this morning. *fingers crossed she's ok and I don't ahve a panic attack about it at work :S
     
  16. Robin&BB

    Robin&BB Well-Known Member

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    And your break is at which time on the chart? +3? +4? +5?
     
  17. Robin&BB

    Robin&BB Well-Known Member

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    Never mind. I can see that it's @ +3. Try not to worry, ok? I think it'll be ok.
     
  18. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    To be honest, Robin, I think it's a tricky situation.
    I would love to be able to say that 'this' or 'that' course of action will be fine, but I just don't know.
    I've been looking after my own diabetic kitty for 8 years but I probably wouldn't be able to predict, with any real degree of accuracy, what his insulin needs will be next week. :smuggrin:

    We're all trying to come up with ideas for a plan whereby Terry can be kept safe while Terrelle is away. And by 'safe' in this case we mean, 'safe from hypoglycemia'. (But there is also the complicating issue of Terry's eye, which worsens at higher blood glucose levels (and I'm not sure we understand why that is the case...))

    From looking at the SS it's apparent that the one unit looks too much, so the .5 unit should be safer (in terms of protecting against hypoglycemia). But there is no way of knowing for sure that the .5 unit won't also be too high a dose.
    Terry's numbers seem to be improving, and if they continue along this course then she may very soon 'outgrow' the .5 unit and need a lower dose.
    Also, cats sometimes eat less when their caregivers are away. So her insulin requirement may also be less as a result.

    Based on current numbers, I'd suggest no more than .5 unit. And I would even consider reducing to around .25 to allow for the possiblity that the insulin requirements may continue to decrease.
    I would also consider pre-filling a syringe with coloured water to show the correct dosage, so the pet sitter can use that as a guide.. (Cats have occasionally been overdosed by pet sitters who misunderstood the syringe measurements.)

    There should be clear guidelines given to the sitter about the 'no-shoot' number. I'd suggest 200/11 (but again, this may or may not be OK; there are no guarantees).

    Might it be possible for the sitter to use Terrelle's log in details so that s/he can access FDMB for advice or support while Terrelle is away?

    Getting back to Terry's eye problem; this is, understandably, a big concern for Terrelle. And to be honest, it worries me too. I don't understand why it's happening or what it's significance is. But I wouldn't want it to get worse because of any suggestions that we make on this forum.

    I do agree that it would be good if Terrelle could get the vet's agreement to any proposed plan. We are not vets. We are ordinary folks looking after our own diabetic kitties the best we can, and pooling our knowledge and experience. We can offer suggestions based on that knowledge and experience, but that is all we are qualified to do...
    .
     
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  19. Terrelle

    Terrelle Member

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    Ugh I can't believe I shot her in an hour she dropped to 126. I left out some high glucose food just in case, she ate a lot of her w/d this morning so hopefully that does the trick
     
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  20. Robin&BB

    Robin&BB Well-Known Member

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    That was a pretty low # to shoot, but her dose has been reduced by 50%. I agree with Critter Mom/Aine regarding setting the pre-shot limit at 200 for your sitter while you're away, no lower.
     
  21. Terrelle

    Terrelle Member

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    Jul 23, 2015
    Are cats usually at their highest right before their insulin? My concern is she would spike too high mid cycle

    But then I really don't know anything about this :S

    I'm so scared my decisions will hurt her
     
  22. Robin&BB

    Robin&BB Well-Known Member

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    I'm going to be honest, here ... at the risk of saying something that many may not agree with. You said earlier that you do, in fact, get to see your grandfather frequently. While I realize (at age 95) this could end up being his last camping trip with your family, you have a cat at home in a rather unusual circumstance: Needing low pressure on an eyeball, and needing insulin for diabetes. If it were me, I'd do one of two things:
    1) Stay home.
    2) Have your cat stay at the vet clinic under close medical supervision.
    Sorry, but that's the best advice I can give you. And I feel for you in your predicament, I really, really do.:bighug:
     
  23. Robin&BB

    Robin&BB Well-Known Member

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    There are just a lot of variables here, you know?
     
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  24. Terrelle

    Terrelle Member

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    I would leave her with the vet but she's very high stress and I don't want to upset her even more :(
     
  25. Robin&BB

    Robin&BB Well-Known Member

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    But what would happen if she hypos mid-cycle when there's no one in your house to manage that? At least at the vet, there's the ability to monitor her closely, and act quickly if a problem arises.
     
  26. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    @Terrelle , I know that Robin has your kitty's best interests at heart when making these suggestions. And they are sound suggestions that will probably give your kitty the best chance of staying safe and well.
    Yes, I know you want to go away on this trip. It's important to you and your family. And we are trying our best to come up with suggestions that may help someone to look after Terry while you are away. But, unfortunately, we cannot give you the reassurance you need that everything will be OK.

    We can only offer suggestions. Then it is for you to weigh things up and decide on a course of action.
    (I wish we could do more.)

    What do you think is the best course of action for you?
    .
     
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  27. Robin&BB

    Robin&BB Well-Known Member

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    Beautifully put, Elizabeth. Thank you, I could not have said it better.
     
  28. Critter Mom

    Critter Mom Well-Known Member

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    I thought of that at first, Eliz, but then you might have the situation where she is asking for help here, and Terrelle's login will be in use. Should Terrelle also wish to sign on at the same time she'd be blocked, hence my earlier suggestion of setting up a separate user account for the sitter.

    I agree with you about the eye. That, a nearly normal - and possibly improving - pancreas plus the possibility of pining-related inappetence are of real concern to me here. Throw the unpredictable and potentially large drops Caninsulin is famous for and no mid-cycle testing to boot. That's a lot of risk.
     
  29. Robin&BB

    Robin&BB Well-Known Member

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    Re: Kitties not eating well when owner is away - Gee, Aine, I'd forgotten all about that aspect! Your comment jogged my memory about that sort of thing, though: Bat-Bat got her first-ever UTI in 2009 while I was across the pond, with my daughter in Berlin. DH @ home with her simply reported via Skype that she was "...somewhat off her feed." 3 wks. later I return home to a kitty with raging UTI. Vet said it was likely caused by her stressing at my absence. :)banghead: Arrrgh, pining kitties + clueless DH = ER vet visit.)
     
  30. Terrelle

    Terrelle Member

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    Jul 23, 2015
    I'm thinking that as long as my sitter doesn't shoot under 200 there should be little risk, and her numbers have been good and I am only gone for week and later in the week I may be able to get some mid day readings from my sitter.

    Sorry for all the trouble guys, I have a pretty severe anxiety disorder that makes it difficult for me to make decisions on my own :S
     
  31. Robin&BB

    Robin&BB Well-Known Member

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    No trouble at all; that's why we're all around. (Anxiety is my other middle name, btw.):bighug:
     
  32. Critter Mom

    Critter Mom Well-Known Member

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    If it's any comfort to you, I'm in exactly the same boat. I developed chronic PTSD after a car accident and it completely screwed up my ability to make decisions about anything - even something as mundane as trying to choose between two identical blocks of cheese in a supermarket. Gives a whole new level of meaning to the term 'decision paralysis'. Part of the reason why I write such lengthy posts on this board is because I can't make snap decisions and hence I explain my reasoning for people to follow. I also tend to try to thing of all contingencies. I hope I haven't overwhelmed you - my intentions are good. :oops:

    :bighug::bighug::bighug:
     
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  33. Robin&BB

    Robin&BB Well-Known Member

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    DITTO!!! Will be thinking good thoughts for both you and your kitty over this next week, Terrelle ...
     
  34. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Geez, that's a coincidence. Anxiety is my middle name too. That must almost make us family! ;)

    @Terrelle , seriously, you're not the only person here with an anxiety disorder, so please know that people do understand. You're not alone. And in fact, you're in very good company....:cat:
    .
     
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  35. Terrelle

    Terrelle Member

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    Jul 23, 2015
    Ok I just checked her and she's at 76, and usually her lowest is around +3 so I think she'll be fine, whew
     
  36. Critter Mom

    Critter Mom Well-Known Member

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    Thanks for the update. :)

    It's great that you managed to get a mid-cycle test today on the lower dose for the AM cycle. More data = a little bit less worry. ;)

    (You should have seen me when Saoirse was on Caninsulin at lower numbers - I set my alarm to go off every six minutes to make sure I checked her for any clinical signs of a hypo and my heart would be in my mouth until after +10 of every cycle. :nailbiting: )
    .
     
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  37. BJM

    BJM Well-Known Member

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    You and your sitter may find the Secondary Monitoring Tools in my signature link additional help in determining how to manage her, specifically, the amount of food and water consumed and the amount of urine and fecal output, plus dehydration checks. If the sitter can get a urine ketone and glucose check (usually within about 20-30 minutes after eating, cats eliminate), that'd be another check on the diabetes management.
     
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  38. Robin&BB

    Robin&BB Well-Known Member

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    @BJM - FYI: I think Terrelle has already left for her camping trip, but hopefully she has connectivity wherever she is and/or her friend has access to her account here @ FDMB.
     
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  39. Terrelle

    Terrelle Member

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    Jul 23, 2015
    She's been sitting around 5.7 on her own so she hasn't needed any insulin, haven't been able to update the spread sheet, but so far so good :) I think she may have gone into remission already
     
  40. Robin&BB

    Robin&BB Well-Known Member

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    Wow, that's amazing! :):):):):):)
     
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  41. Critter Mom

    Critter Mom Well-Known Member

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    Great to get an update! Wouldn't surprise me in the slightest that Terry's coasting.

    Say "Hi!" to your grandad for me. Hope ye are having a grand time. :)
     
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  42. Terrelle

    Terrelle Member

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    Thanks so much, will do :)
     
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  43. Terrelle

    Terrelle Member

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    Update ... Terry has been between 5-7 at all her readings so no need for insulin since the night I left :)

    I have a question, are ketones usually a concern if her levels are stable and normal?
     
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  44. BJM

    BJM Well-Known Member

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    Ketones form as a by-product of fat breakdown for calories. They form during lack of insulin or starvation which causes fat breakdown for calories. When deliberately trying to lose weight (slowly when for a cat), some ketones will form.
    Ketones in high levels become a problem when the body becomes too acidic. This is called diabetic ketoacidosis.
     
  45. Terrelle

    Terrelle Member

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    Jul 23, 2015
    should I worry about testing for them? She's been off insulin for almost a week but her levels are fine
     
  46. BJM

    BJM Well-Known Member

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    Breaking down fat too fast in the cat may overwhelm the liver, so if she's losing weight, check for them. Too much fat breakdown can overwhelm the liver and cause hepatic lipidosis (fatty liver) which disrupts digestion and can be fatal.
     
  47. Terrelle

    Terrelle Member

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    So far no weight loss but I'll keep an eye on it then, thanks. I think initially the vet found ketones but I think it could have been caused by her surgery
     
  48. BJM

    BJM Well-Known Member

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    She was probably fasting for surgery, right?
     
  49. Robin&BB

    Robin&BB Well-Known Member

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    Hi, Terrelle - Just a quick note to say I'm so HAPPY to hear that Terry's #s are running so well. That's marvelous!!!:joyful:
     
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  50. Terrelle

    Terrelle Member

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    Jul 23, 2015
    She was stressed so she wasn't eating much
     
  51. Critter Mom

    Critter Mom Well-Known Member

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    Great news about Terry's BG numbers! I was kinda hoping this might happen. :) Keep a close eye on her numbers over the next couple of weeks to make sure they hold in the normal range. Fourteen days of normal numbers without insulin and she will be officially considered diet-controlled (OTJ).

    Re ketones, it's no harm to do periodic checks with a urine test strip.

    Are you back from your trip now? Did you and your grandad have a good time?


    Mogs
    .
     
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