? Trace Ketones

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by JanetNJ, Aug 12, 2018 at 5:50 AM.

  1. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    i think it's safe to say that my vets two week experiment with vetsulin at a lower level has failed. We are at day 12 of this 14 day disaster. I had my highest ever reading this morning at 546 and this made me nervous so I used the blood ketone meter And got a reading of 0.8. That's considered a trace right? Ugh in so so frustrated with this.

    CC is eating and drinking fine thankfully.

    I texted the vet this morning to beg her to let me switch insulins. This is ridiculous!!!!!! :( I am so worried. Haven't heard from her yet. I just don't understand her reluctance.

    CC ate 3 Oz of food and I put at least a can worth of water in it (a bit at a time) and she drank all that. So she's eating and drinking good. Not acting strange. I tested her at 6:15 am eastern time... How often should I test the ketones? Every 3 hours?


    @Kris & Teasel
     
    Last edited: Aug 12, 2018 at 6:49 AM
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, that's still trace ketones, Janet. I don't think you need to test for ketones every 3 hours - maybe later afternoon or even around 6:15 PM if she's acting fine. Keep adding as much water as she'll tolerate and watch her clinical signs.

    Anyone looking at your SS without knowing your vet's instructions would say the dose is too low. Does your vet have any experience prescribing any insulin other than Vetsulin? That might be why she's reluctant.

    If CC ends up needing a significantly higher dose to get her into good numbers you might reconsider Lantus or Levemir. They're U100 so you get more doses out of a vial. ProZinc is very expensive when you go through it quickly. Yes, there's less time flexibility with the Ls but it's not impossible to work around.
     
  3. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    From THIS info thread:
    When do ketones show up on a blood ketone meter such as the Nova Max Plus or Precision Xtra Blood & Ketone meters?

    The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
     
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  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Thanks, Sharon. I should have said that 0.8 was negative for ketones. :confused: Too early for me ... sorry, Janet.

    Using a blood ketone meter is tricky because we have no clear gradations of numbers that correlate to negative, trace, small, etc. Basically, anything up to 2.4 -2.55 is negative, it's trace around that boundary and then above 4 it's DKA. I have a blood ketone meter (Freestyle Precision) and used it several times when Teasel was very sick in June/July and found it useful only because I didn't have to stalk him to the litter box. However, interpreting the numbers is confusing - anything above 4 is BAD. Anything up to 2.55, say, is OK. The urine strips are easier to deal with if you can get a sample easily.
     
  5. JanetNJ

    JanetNJ Well-Known Member

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    Ok well that makes me panic less. Last time I used the meter it said LO meaning it didn't detect any ketones at all. To answer your previous question she said her perfered insulin is lantus, then ProZinc. A different vet at the clinic prescribed the vetsulin. She was hesitant to switch because cc did well on it in the past. Well that's great but for the past 6 months or so she HASN'T done all that great on it. That's why we did this two week compromise. I KNOW it's not enough insulin. I'm doing what I have to do to get my way. (Sigh)
     
  6. JanetNJ

    JanetNJ Well-Known Member

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    I've read that ty. Still makes me nervous to see any show up since the last time I tested (about a week ago) the meter found nothing.
     
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  7. JanetNJ

    JanetNJ Well-Known Member

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    Lantus is so hard for me though because my schedule is not super predictable. In the summer in all over the place, so I'm not good about 12 hours apart exactly. and the rest of the year in not home to monitor most of the day to get her low enough. Ugh
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Now I understand. There are many kitties that have been put on a different insulin because one either didn't agree with them or stopped working as well. Give a depot insulin some thought, Janet. I know you're set on ProZinc but maybe have a discussion with your vet about why she likes Lantus. It certainly has become the insulin of choice for cats but it's always your call.
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Valid concerns. ProZinc, though, only allows about an hour's dosing time flexibility. Unfortunately. it's only through trying Lantus that you'll learn how CC responds, whether she dives, etc. Generally there's more of an issue with that in kitties on Vetsulin. I'm not trying to twist your arm - I know how hard it is to think about an insulin change. I agonized for a long time before I switched Teasel form ProZinc to Lantus.
     
  10. JanetNJ

    JanetNJ Well-Known Member

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    I'll take anything else at this point.
     
  11. JanetNJ

    JanetNJ Well-Known Member

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    Down to 243 mid cycle... Still too high but at least not SCARY high. :/
     
  12. JanetNJ

    JanetNJ Well-Known Member

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    Ok vet finally got in touch with me and said ok to switching to ProZinc or Lantus. She won't be in the office until Tuesday which is fine because I'm out most of the day tomorrow. Now I will have to really decide which insulin I want to try first. On one hand in more familiar with how ProZinc works and like it's time flexibility. On the other hand I know lantus had a good reputation for working well and most do good on it over time. Although I'm totally clueless how to dose it and a little nervous since I am not home to test frequently once school starts. I suppose I could try ProZinc a few months and if it doesn't work out try lantus.

    I wonder in general if one is generally tolerated better at higher doses than the other.
     
  13. Kris & Teasel

    Kris & Teasel Well-Known Member

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    How long do you have before going back to work? You wouldn't need much time to get familiar with ProZinc because it's similar in action to Lantus. One of the bonuses of Lantus, though, is that there are very clear sets of guidelines on how to dose. I suggest you go read the yellow stickies on SLGS (Start Low Go Slow) and TR (Tight Regulation) on the L forum. You're so used to making your own dosing decisions with Vetsulin that you might like having set guidelines to follow. That forum s huge and has a lot of very experienced people to help.

    Re high doses: I don't know of many higher dose kitties on ProZinc - likely a cost factor. There are quite a few on Lantus and there are many that started on it and were switched to Levemir because it doesn't sting the way a big dose of Lantus does in some kitties.
     
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  14. JanetNJ

    JanetNJ Well-Known Member

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    I go back Sept 4th.
     
  15. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Hi Janet - I saw your post about Insuilinx. Thanks for posting that comparison by the way.

    Then I looked at CC's spreadsheet and saw that BLACK! Holy smokes. :eek:
    Come over to the Lantus and Levemir subforum. You don't have to test all the nadirs. Just do 12 hour curves on the weekend to get good doses setup. And test some evening early nadirs.

    I have a great cat-only vet. But I no longer ask for diabetes advice. However, I do keep her totally informed. And I get most of my supplies from the web

    Leo was on Prozinc for one vial in 2016. It worked good for him. But it was expensive and had to be refrigerated in shipment. Too much hassle. Plus I wanted a depot insulin to level out the edges (a bit). So now he lives on Levemir.
     
  16. JanetNJ

    JanetNJ Well-Known Member

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    I don't know if my vet has ever used levemir... Not sure if she would prescribe it.
     
  17. JanetNJ

    JanetNJ Well-Known Member

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    ty for your input.
    So why did you ultimately go with levemir over lantus?
     
  18. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Another question... Given my cat is on 3.5-4 units, and really needs 5, what dose of the new insulin would I start with?
     
  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If it's ProZinc, you could start around the same dose, maybe a tiny bit lower for a couple of cycles for your own peace of mind. When I switched Teasel from ProZinc to Lantus in early 2017 I dropped his dose by 0.5 u for a couple of cycles but raised it back up soon after. Post on the ProZinc forum. If you try Lantus, ask on that forum for guidance. Its action is different and it takes several cycles for the depot to build (the higher the dose, the larger the depot) so you see what a dose can do. The L folks would likely suggest a small reduction because some kitties have a vigorous response to a new insulin. In general, Levemir doses are slightly smaller than Lantus doses to achieve the same effect.
     
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  20. JeffJ

    JeffJ Well-Known Member

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    It was 2 years ago when Leo switched to levemir. I don't remember why I switched. But since then I interacted with people here on it. After the first Walgreens purchase, I got the rest of the levemir off the web, at substantially lower prices.

    Ultimately you are the "decider". I didn't cut my vet 100% out of the loop. But now I fully manage all aspects of Leo's diabetes. You have the same potential.
     
  21. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I've been managing it on my own for two years but this insulin is no longer working. Before my vet would let me change insulin I had to agree to do it her way. Well her way sucked and she's higher than ever. So now I get to decide which insulin and I'm having trouble deciding.
     
  22. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No decision on insulin is irreversible, Janet. ProZinc would be familiar and you could try one vial. If you go to Lantus you'll be learning a new way of dosing. You could try buying just one pen (or its cartridge) from a reputable seller on the Supply Closet forum for not a huge outlay of cash. It's only 3 mL (300 units total) so you wouldn't be out the $$$ for a 10 mL vial if you decide you don't like it for CC.
     
    Last edited: Aug 13, 2018 at 2:56 PM
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  23. JeffJ

    JeffJ Well-Known Member

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    I get my Levemir from Alan Hamman on Supply Closet. 100% reputable. Timely delivery, and generally a real nice guy. I researched why I made the decision (in this post)
    - Leo didn't like the high cost and special ordering of prozinc
    - he didn't like the fat U40 needles either

    C.C. is your kitteh. You can do whatever you want. I think your deep experience on the forum indicates you can switch to whatever insulin you want. Kris is right that Levemir is different. But it is still just insulin. And a lot of people use it.
     
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  24. Amanda and a Loudogg

    Amanda and a Loudogg Member

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    Jun 16, 2017
    Hiya Janet!
    I feel like it's been so long, but I don't get to "see" you as often now that I switched over to Basaglar (glargine, similar to Lantus). I just wanted to put my two cents in since I was almost in the exact same situation with Lou as you are with CC. I had no desire to move to a depot insulin from Vetsulin for the same reasons as you. I wanted to go to Prozinc since it's similar in action (I work doubles occasionally, and I thought I couldn't manage a 12-hour insulin). The vet offered to switch him to Lantus, and I didn't argue (which is surprising). She gave me the prescription for glargine and then I agonized whether I should use Basaglar (which is $40 or so cheaper than Lantus, but similar in action. They're both glargine.) or Lantus, or if I should just call her back and go with Levemir. I wanted to go with Levemir because I had heard Lantus can sting at higher doses and Lou's doses had been increasing. I've heard in general Levemir is better for cats, but Lantus (glargine) also has a great track record, so I don't know if it matters so much which one to go with.

    I finally decided to just go with the Basaglar to utilize the cost savings. I figured if he didn't react well we'd switch to Levemir in 6 months. While he bounced around like it was going out of style for the first 2 months, he's finally getting the hang of things, even starting to earn reductions. Obviously Lou has a different situation in that he's an IAA kitty, but I thought I'd share our story. Previously I was the only one who tested and gave Lou his insulin. We started out on the Start Low Go Slow protocol and I had my DH Caleb get comfortable testing BGs. We have opposite schedules, so now we realized we could handle TR protocol with both of us testing at different times of the day. I still handle the majority of insulin dosing and testing, but it's been such a weight off having Caleb's help. I love being able to have him in those lower numbers.

    I know it isn't much, but I hope it may help make your decision a bit easier. It does suck learning a new insulin, but the L&L board is so busy it's usually pretty easy to get help. My only regret so far is that I wish I would have done it sooner. :(
     
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  25. JanetNJ

    JanetNJ Well-Known Member

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    ty for takimg the time to share your experience and thoughts.
    If I could test during the day the decision would be easy. I'm uncomfortable with lows of lantus tr when i won't be home in a few weeks. Ugh I just don't know what to do. My vet said she's ok with either, although she's not going to do levemir.... I think she doesn't have too much experience with it and that's fine in not going to press the issue on that one at this time.

    I feel like with the right dose vetsulin was getting her down but just not lasting long enough. So I'm inclined to give ProZinc a chance since it works similar bit is supposed to last longer. In the other hand ProZinc is more expensive pet unit. And on another hand out know lantus had a good reputation... I really just find it so hard to wrap my head around. But I do realize there is a lot of support here. Scheduling is an issue sometimes too.... Being exactly 12 hours is tricky for me. My head is ping ponging. Lol.
     
  26. JeffJ

    JeffJ Well-Known Member

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    I'm a rule breaker. And I don't set my alarm. Leo sometimes gets AM levemir doses up to an hour late. (Don't tell Wendy).:D:rolleyes:
     
  27. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Unless I happened to be up early, I routinely administered Levemir on a +13/+11 (or later) shot schedule because I'm not an early morning person... shhhhhhhhhhhhhhh. :cool:
     
  28. JeffJ

    JeffJ Well-Known Member

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    OMG - now we are both in big trouble!!!:eek::eek::eek:
     
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  29. JanetNJ

    JanetNJ Well-Known Member

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    Rebels. Lol
     
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  30. JanetNJ

    JanetNJ Well-Known Member

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    My vet thought ProZinc was worth a try. I have been anxious about switching to lantus and my partners vote was for giving ProZinc a try. Wrist case we give it a few months and see what happens. If not enough progress I can always go to lantus. I realize ProZinc is more expensive... We aren't hurting financially thank God, so we decided not to let the cost be a factor. I ordered it from chewy so we will see how fast it comes. They are usually quick with shipping.

    I feel relieved that whether it's ultimately the insulin that is best or not we at least made a decision. I've been going nuts for three days waffling back and forth. CC hit a personal high reading tonight so something had to happen. Can't keep on like this. Good news is the ketone meter couldn't detect anything this afternoon.

    My vet charged us a huge amount for Gabapentin compared to online. I tried to order it through valleyvet.com who had the best price, but as I checked out they said they were prohibited from shipping to nj. :/. Seriously? So I tried 1800 pet meds and that order seemed to go through although much pricier. Still a lot cheaper than my vet thoug.
     
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  31. JeffJ

    JeffJ Well-Known Member

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    I bet a lot of forum members are getting meds from online sources. Especially for common refills.

    Let's see how it goes with Prozinc. The only time I ordered it, it was thru my vet. What a hassle. I hope your Chewy order goes thru fine. Too bad C.C. hit such a high number. It will just get better from here.
     
  32. JanetNJ

    JanetNJ Well-Known Member

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    Ty. She did great on it the first time around. Went into remission in just four months. This time around its been a year.... Started off well but then totally went off the rails.
     
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  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm sure you're relieved at making this decision, Janet. You're right - you can always try Lantus later on. :)
     
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