3/8 Sasha AMPS 393 ketone and R help, please

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Sasha&Tara

Member Since 2012
Hi Everyone, My 7 year old cat Sasha was diagnosed with diabetes in 5/2011. I have been giving him Lantus 2 Units twice daily. 6 AM and 6 PM are his shot times. I use a One Touch Ultra Glucometer to test his BG's.I always test preshot, and do curves during my days off of work. His normal preshot BG is usually around 350- he usually peaks between 100-200. I feed him all low carb, gluten free canned food...Merricks, Wellness and Fancy Feast Classics.

He was hospitalized February 26th because of ketones. 5 days later, my Sasha came home to me. The vet said the ketones were gone, and sent me home with Baytril antibiotics and a new bottle of Lantus.

Yesterday at 2:30 AM, his blood sugar skyrocketed. It was 485 at 12am. 412 at 2 am. I didnt know what to do. Thankfully, I found this website and the wonderful folks advised me to get ketone strips. Sasha tested positive for moderate Ketones. I do not have the money to hospitalize him again. The 5000 dollars I spent to hospitalize him last week was LITERALLY my savings. I took him to a vet that allowed me to post date a check until I get my next paycheck. He gave me SubQ fluids to take home and told me to raise his insulin to 3 units twice daily.

His ideal weight is about 12 pounds, right now he is 9 pounds.

Sasha is eating, but very HC canned food. Very thirsty and lethargic. Very hungry but will only eat HC FF with Gravy. About 4 cans in 3 hours. I gave him 100mls of the subq's at 6AM. He had another round of SubQ's at 5PM. I gave him his 3 units of Lantus at 6 PM. He was at 424 at 10:30 PM, and 443 at 12:30 AM.

I was able to get the R insulin as suggested to me. Am just waiting to hear back on what I should do with it.. I will be off of work to take care of him tomorrow. I'm going to catch a few hours sleep now but will be up early this morning. Thank you so much for reading this!!!
 
Re: 3/7 Sasha moderate ketones

Hi Tara. ...welcome to you and Sasha ...we're glad you're joining our Lantus Land family where you will find a warm group of people who are very generous with their time.

Here is your health condo: Sasha's Health Condo

I'm glad you have increased the insulin to 3u. If you can post early in the morning at +11 or do, Dyana will probably be waiting to help you. We had wanted to start the R tonight but someone would have to coach you on it and stay up a good portion of the night. It will be better if we can hopefully do it in the morning. Please be sure one of our experienced people is here to go through it with you.

Ask questions....we are here to help in any way we can.
 
Re: 3/7 Sasha moderate ketones

Hi Tara. I'm sorry I can't be of any help as I have no experience with ketones.
I just wanted to welcome you and Sasha.
This will also bump your post up.
 
Re: 3/7 Sasha moderate ketones

Good morning all, I am not quite sure how to start a new post and link this one yet. Gave Sasha some fluids around 1:30 AM, and took a nap. I'm up again. Woke up to a hungry kitty. My Sasha this morning at AMPS is 388. Next shot should be at 6 AM. I have the R...not sure what I should do...

Thank you for the warm welcomes!! Hugs
 
Re: 3/8 Sasha AMPS 388 mod ketones

Good Morning, Tara. I will be here with you until 7:00am EST.
Normally, we do not feed from 2 hours before the Lantus insulin shot until shot time. Did you feed her since +10?

When you write AMPS 388, I am thinking you already shot this morning's dose. Did you?
 
Re: 3/8 Sasha AMPS 388 mod ketones

Good morning Dyana!!! I just took his BG at 5 AM. He didnt eat before that. He did eat a can of HC FF after I took his blood. I wanted to make sure he is okay to keep food down, so far he is. I didnt give him his Lantus yet, usual time is at 6 AM, and I wasnt sure if you give Lantus and R together... this is a whole new ballgame to me...
Thanks
 
Re: 3/8 Sasha AMPS 388 mod ketones

I'm glad you're going to be home today. That's important.

Yes, we like to give the R at the same time as the Lantus, because we never want the R nadir to be at the same time as the Lantus nadir. R is fast acting: onset in about 20 to 30 minutes, nadir about +2.5 and duration about 4 to 5 hours.
Lantus doesn't normally have an onset until about +2 and nadir around +6, and duration is hopefully about 12 hours.

Please let me know if you need to explain any of this terminology.

How much HC did she eat at +11 (5:00am)? And what was the BG test?

I have to run to the shower. I'll be back in 10 minutes, and I do have to test, shoot, and feed my cat, at 6:00am, too. But I'll be here to help you.
 
Re: 3/8 Sasha AMPS 388 mod ketones

Thank you, I am starting to understand more now about the R. I took Sasha's blood on an empty stomach at 5 AM, he was at 388. Since then he had one can of HC FF with gravy and is lurking around his food dish waiting for more.

Dyana, I will be able to stay home with him as long as I need to. If I have to use my vacation days, then so be it!
 
Re: 3/8 Sasha AMPS 388 mod ketones

I was also able to get a sample of his urine just now, the color on the Keto-Diastix after 15 seconds indicates that his ketones are large.
 
Re: 3/8 Sasha AMPS 388 mod ketones

So I will give him 3 units of Lantus today? And how much R? Thank you so much, I know you have all of your own stuff to do too!!!
 
Re: 3/8 Sasha AMPS 388 mod ketones

Sorry, my cat threw up and I had to clean that up.

What is the +12 test number?
 
Re: 3/8 Sasha AMPS 388 mod ketones

Storage and handling: You want to keep the R insulin away from your Lantus insulin.

I keep my R in it's box, in the refrigerator door (it is not as sensitive to tempurature fluctuations and movement as Lantus is), and I keep my Lantus in it's box on the top shelf, but not touching the sides of the refrigerator.

When you are giving both: Get out the Lantus, measure the dose, and shoot and put the Lantus away in it's specific place in your frig, then get out the R and measure the dose, shoot, and put the R away, in it's certain place in your frig.

It is important to not make a mistake and give the wrong dose of the R, because it is so potent.
 
Re: 3/8 Sasha AMPS 388 mod ketones

He is 393 +12

Okay thats very good advice so I dont mix them up....


Geez is your cat ok?
 
Re: 3/8 Sasha AMPS 388 mod ketones

Sorry, you have to press Next Picture, until you get to Half-unit fractions: 0.4 on tip, 0.1 in syringe. Press Next Picture 10 times to get to the correct photo. I'm sorry, I'm drawing all this out, but it's important. And I will only be here another 45 minutes or so.
There are others that will be here for you after I leave.
 
Re: 3/8 Sasha AMPS 388 mod ketones

One thing good about R is that it does not have a shed. Meaning, when you give Lantus, some of it is used throughout the cycle (12 hours) and some is still left in a depot area in the fat and is still there after 12 hours, and will somewhat affect the next dose. Others can explain this better than I can.
R is in and out. You shoot it, it will do it's thing for about 4 or 5 hours and then it is gone. So, those 4 or 5 hours need to be closely monitored. Meaning, we will want you to do a test every hour, after you give the R.

Whenever, I give R, I want it to slowly drop my cat's blood sugar down by about 150 points, in that 4 to 5 hour duration.
If you give too much, the cat may dive down real fast. That's why you need to be diligent about the testing.

Please don't over fill Sasha on food, just in case, we need to intervene with some extra HC food. By the way, I am so glad she is eating :razz: ETA: We do want her to eat eat eat, but we also want to save some hunger for just in case we need her to eat.

How are you feeling?
 
Re: 3/8 Sasha AMPS 388 mod ketones

Ok, I gave him his Lantus and have the .1 in the syringe. wow this must be strong! Ok I'm giving it to him now, Dyana
 
Re: 3/8 Sasha AMPS 388 mod ketones

With such a tiny dose, I always be sure to hold the plunger in with my thumb while shooting the dose, until I take the needle out of the skin. That way you are more likely to get that little bit that is in the needle into her, rather than the vacuum affect sucking it back into the needle when you take your thumb off the plunger.
 
Re: 3/8 Sasha AMPS 388 mod ketones

Ok, I gave it to him... boy I have never measured insulin like that before. It was just a drop- I went by the picture. It felt like I didnt put anything in him because the dose was so small, but I know that I did!!! I will test him every hour now. And let him save his appetite. I thank you so much, I will keep his SS updated.


I am exhausted, lol- but that's okay. Another pot of coffee brewing and I will be good to go!

Thank you for explaining this so well. I do understand about the shed.


At what point do you think I should give him SubQ's? Last time he got them was at 2AM
 
Re: 3/8 Sasha AMPS 388 mod ketones

Now, that you have a few minutes, you can go to your first post of this condo, and Edit the subject line.
The 388 was at +11. The AMPS is the number when you gave her her insulin.
So, change it something like 3/8 Sasha AMPS 393 ketone and R help, please
 
Re: 3/8 Sasha AMPS 388 mod ketones

I don't remember you telling me, so sorry if I missed it, but how much HC did she eat when you tested her at +11?
 
Re: 3/8 Sasha AMPS 388 mod ketones

He had almost a whole can...likes to lick up the gravy and leave some of the chicken behind..
 
Okay, well what that tells me, at the moment anyway, is that the HC didn't move her numbers much, if she was 383 and +11 and then ate almost an entire can of HC, and then was 393 an hour later at +12.
That's another reason, why I want you to be extra diligent about testing today, is because she could be on her way down. We started with a very small dose of R, but like I've said before, it is very potent stuff. This small dose may not do anything, but then again it might. If she was on her way down already, and the HC just kept her up because of the food spike, then the R may show some action. Normally, we wouldn't push the use of R with a possible high carb food spike, but right now it is essential that we get rid of these ketones, so we need to get those BGs down, and keep her eating and hydrated.

I'm sorry, if I'm not making sense. Please ask questions if you don't understand something.

Anyone else that would like to chime in and give their opinions?
I'm just trying to give Tara the information I have before I have to leave for work.
 
Dyana, You are explaining perfectly and it is making a lot of sense, thank you. I will be monitering Sasha every hour.

Was just wondering if the SubQ fluids interfere with the insulin because they are both placed under the skin?

Thank you for all your help. Have a great day!
 
Hi Tara,

Welcome to baptism by fire! I'll stay with you until some more experienced people are available. How does Sasha seem to be feeling?
 
Hi Linda! lol, "baptism by fire" is exactly right!!! But everyone has been so supportive, thank you and Sasha wouldnt have made it through the past 48 hours without the angels on this site. Sasha is exhausted so he is laying down now. He is alert though, when I call his name, and his eyes are bright today. I thank you for staying with me!!! It's so comforting to know I am not alone!
 
I have no experience with R but I unfortunately do have a lot of experience with ketones. My cat Tawny was very sick 3 times in Nov & Dec 2011 & ketones were a major issue.

Here is the formula for ketones: not enough insulin + not enough calories + infection = ketones.

Does Sasha have any kind of infection?

You are absolutely doing the right thing by getting more insulin into Sasha to try and bring his #s down. The HC is spiking the #s but as Dyana said that is being taken into consideration here. One thing I do w/Tawny is add as much water to her food as she will tolerate. That helps keep her hydrated.

You want to test Sasha for ketones as much as you can today too and post those results as well. some people put saran wrap over the litter and then dip the stick in that if you can't actually catch Sasha going every time he goes. If you have more than one cat that won't work of course.

It is really important to get those ketones to clear. If Sasha goes off his food today you will need to syringe feed him to keep those calories coming. If you can get some high calorie food, like Wellness chicken or Turkey & Giblets that also helps.

I have to work today too and will be leaving in a little over an hour but I'm sure others will be here today for you.

Desi
 
~O) ~O) ~O)

just popping in to see how it's going.

Dyana has covered the bases on the R. The important thing now is to monitor every hour an see what Sasha's reaction is.

So happy to hear he is easting! How is he behaving in general?
 
Good morning, Tara. Welcome to LL!

I don't have R experience, so I will let others guide you on it.

I have not heard back from Venita. Have you heard anything from DCIN? I contacted a former caseworker with DCIN, he asked if you had followed the links to apply for help? I could not find any links like that on the DCIN blog, but it may be just me! He suggested that you email Jennifer at DCIN... here's the email address. Jennifer @DCIN.info (edited to add space...remove the space when emailing) I would email her ASAP. I will continue to try to get a response from someone at DCIN.

As far as the fluids....from what I understand, you should try to give the fluids on the opposite side from where you give the shot...so if you shoot on the right, give fluids on the left. Hopefully someone with squids experience will be more help on that....
 
You gave the R at about 6:30, right? That's a nice drop. It's going to be very important to test him every hour until at least the first 4 hours after giving the R. It was only a tiny drop you gave him, but look what it has done already!
 
Great - going in the right direction :-D

You may see effects of the increased Lantus this cycle as well.

We want Sasha to eat, however we want him to be a little hungry in case you need to guide the numbers with food.
So, rather that a whole can at once, feed him in 1/2 can increments.

I've got to get ready for work now and will check back for your +2. You have enough strips?
 
Thank you to everyone else who has posted, I just saw all of the threads now!!! I will be testing him every hour, I do have plenty of strips! I am very happy so far, his BG is coming down. Appetite is good. Sasha is very tired as he has been up all night and morning with me poking him and trying to get him better.

Laurie, I couldnt find the link to apply either..I PM'd them yesterday and left my phone number but they are probably very busy!

Desi, the vet did send me home with antibiotics. He's taking Baytril.

Thank you all again for the tips! Will keep updating his SS. I am wondering what time I should give the Subq's?

Also, how often should I be offering food? I know I dontwant to fill him up too much...
 
good morning, tara! i just wanted to pop in to wish you well. you're in very capable hands.
i have to go out of town this morning, but i'll check in with you first thing when i return sunday.
sending positive thoughts...
 
Have the fluids you administered earlier been completely absorbed? You don't want to keep giving fluids if there's still some sloshing around.
 
Sasha, I'm sorry this is the first I'm seeing this, I got the PM from Carl and the email from Cheryl this morning. Can you please email me at jennifer @dcin.info (remove the space). Thank you.
 
Good morning and welcome! Looks like you are getting some great help, but I wanted to tell you hello. You are doing great! I have never done R but have had experience with ketones and Desi gave you the formula for what causes ketones.

Ketones = not enough insulin + not enough calories + infection = ketones.

It's ok that he is eating HC canned right now. Calories are very important in the equation so feed him what he will eat. Just give it in small increments in case his BG dives and you need to bring him up, just like all the others have said. Did they test him for infection or have him on any anitbiotics?

Sorry you are going through this. This is the very best place you never wanted to be.
 
Good morning Tara,

Sorry I haven't been around the FDMB. I didn't see the PMs about your situation until now.

You can email me at Venita@dcin.info.

It sounds like folks are trying to walk you through this situation with at-home treatment. Desi is right.

not enough insulin + not enough calories + infection = ketones
Click to expand...

As you know, emergency care for a cat with ketones, and maybe DKA, is about $1000-$1200/day. DCIN can set up a chip-in for that, but our funding base is spread a bit thin right now. But send me an email and we can talk about what DCIN might be able to do.

You might want to make a plea to the Lantus Land Emergency Fund (LLEF) for some funding as well. Laurie and Mr Tinkles signature line has a link to LA-LA-LA-LANTUS & LLEF. If you can't get to that link to apply for assistance, send Laurie a private message here.

I will subscribe to this and other posts you have made about this situation so that I can follow. I will PM you my phone number.
 
Hi Venita and Jennifer! Thank you for responding to me. Will check my PM's Venita...Jennifer, I sent you an email. Thank you!
 
UPDATE: His sugar is down to 309 +3 hours! he's perking up, nuzzling me... he wanted to eat, I let him have half of a can of FF :-D Still wondering what time to give the SubQs?
 
Tara --

Fluids are not a matter of what time. It's a matter of whether the last "dose" of fluids has been absorbed. You can give too much fluid which can cause other problems.
 
great! :-D

so far this cycle-

AMPS - 393 >> 3.0u Lantus 0.1u R 3oz. FF
+2 - 324
+3 - 309 >> 1.5oz FF

what flavor FF is he eating?

I'm going to work - will try and peeks in later.

Ii don't have experience with sub-qs but I'm sure someone who does will be along.
 
Hi guys and welcome to Lantus Land! I have no experience with ketones or R insulin, but I can see you are in very capable hands right now! I'm happy to hear he's perked up some .. as I'm sure you are too! Have a great day!
 
I spoke by phone to Tara. DCIN is willing to set up a chip-in for a vet visit, but we hope that LLEF also can help. I have asked Tara to contact the LLEF people.

DCIN is sending testing equipment to Tara and Sasha, so at least that cost is out of her way. DCIN also is willing to help them with Lantus insulin when they need it.

Venita
 
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