8/4 Salem AMPS 496.8 +6h 234 and NEGATIVE KETONE RESULT!

Status
Not open for further replies.
P

phedre

Member Since 2012
A lower number than yesterday! I'm so happy! He's still red, but at least he's not in the black anymore.

He slept in his usual spot on the bed last night and was purring at me this morning when I woke up, so I think he's perking up a bit. He'll need some assisted feeding today but I'm ok with that. I have his food out warming up and I'm going to try and get a full can at least into him over the course of the day.

Edit: he's eating! Not as enthusiastically as I'd like, but he is eating. I put down a can of friskies and he showed no interest, so I tried the md and he started in! He's licking and taking bites. He may still need extra so I'm prepared, but I'm thrilled that he's eating some after last night's total lack of interest. He probably ate about 1/5 of a can. Not a lot, but progress is progress.

Edit 2: he just had his 8am pill and was happy to eat the treats I gave him. I'm going to keep him away from any hc food and see if he does better throughout the day. I suspect the dry is what made him so off last night. I gave him a few extra freeze dried chicken breast pieces because he was gobbling them up!
 
Re: 8/4 Salem AMPS 496.8

So glad to know that Salem is eating on his own! This is much better than to force feed him. Keep it up Salem!
 
Re: 8/4 Salem AMPS 496.8

We link our threads (we call them condos) from the previous day to the current day. This way, if you need to backtrack to find something, it saves a great deal of time. Here's your condo from yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=76324&p=825955#p825955

In yesterday's condo, Libby offered to teach you how to use an additional type of insulin, Humulin R. This takes monitoring but will help to get Salem's numbers out of these high ranges during this critical period.
Libby and Lucy said:
Insulin - Lantus is a great insulin, but it takes a while to build up in the system and it can take a while to safely work up to a dose that will do some good. A lack of sufficient insulin can allow the ketones to creep back in (or sometimes they storm back in very quickly). How much is "sufficient?" Well, each cat is different, and even the SAME cat can be different if they have an infection going on. His numbers are pretty high today. In a non ketone prone cat there isn't usually much harm in just patiently waiting for the Lantus to start working. However, with Salem having just come out of DKA, you might want to be more aggressive in trying to get the numbers down. It's hard to do that quickly with Lantus. At the vet, they most likely used a faster acting insulin, probably Humulin R. They might have used it in conjunction with Lantus, or maybe on its own. R is fast acting and is in and out of the system usually in a few hours. Humulin R can be purchased at a pharmacy without a prescription. I'm not sure about Canadian prices, but in the U.S. it is usually less than $40 for a vial that will last pretty much forever.

While bringing down numbers quickly is a good thing, you have to be careful to not let it bring him down TOO fast or TOO far. You only want to use R in small doses and with advice from someone who is experienced in helping folks use R. You would need to test quite a bit at first while you learn his response to R. You would still be giving Lantus too. The idea is to use the R to help bring the numbers down into a range in which the longer-lasting insulin (Lantus) can help hold them down. It would probably help get his numbers out of the 500s while the Lantus has a chance to build up.

If you're interested, I can help you get started. What you would want to do is give a TINY dose (we usually start with 0.1 units, just a drop of insulin) and test at +1, +2, +3, and +4 after the first shot to see what it does. For some cats that little drop of insulin does nothing, for some cats it does everything. Once we see how 0.1 unit works, then we can decide what to do from there. I'm happy to help, just say the word.
Click to expand...
Please let Libby know if you want help with this.

Have you been able to test for ketones?
 
Re: 8/4 Salem AMPS 496.8

I haven't been able to catch him in the litter box yet, but I'll keep trying.

I'm really not comfortable mixing up his insulin. His numbers are lowering, I'll do another bg soon, and make sure he's eating. His vet is very forward thinking and seems to be quite up on the latest in diabetic treatment for cats so I'm happy to keep progressing slowly. He's definitely more himself today so progress is happening.
 
Re: 8/4 Salem AMPS 496.8

The thing is Lantus takes a while to build up and be at the right dose. In some cases a week or more. With a cat with high numbers a reocurrance of a crisis and DKA is very real. You really should read Libby's reply a few times. R is a very very short acting insulin that can help bring the high numbers down to a safe level and keep DKA occurance at bay. Its used very strategically in micro doses and for a very short period. Maybe only a day or two in Salem's case. So if you got Salem's numbers into the 100s he would be much safer. Maybe your vet has experience with this and would be okay with it. I was hoping someone could explain it in a short paragraph so you could get a crash course on how you would go about it and run it by the vet.

I'm so glad you jumped in and tried assist feeding. Remember its the calories that are critical not the amount of food. A 5.5oz can of a lower calorie food isn't the same as a 5.5oz can of a higher calorie food. A cat avoiding DKA needs 1.5x's the normal calories to help recovery and to help keep DKA at bay.

Its a lot to take in. You are in the info overload stage. So take some time to reread all the posts to help take it in. I had to read them like ten times when I first joined and we weren't in a crisis. I only had a bad bully vet at the time. Wish I had your vet. Also the good thing about having experience with syringe feeding is you have this in your tool chest if you ever need it in the future.
 
Re: 8/4 Salem AMPS 496.8

It's not a matter of "mixing" insulin. The strategy is fairly common with a sick cat, a "high dose" cat, or even for humans who are on an insulin pump. It's technically called "basal/bolus" dosing. You have an insulin, like Lantus, that is the basic (or basal) insulin. It's your foundation. Because Lantus is gentle, it is not as potent as some types of insulin. By potent, what is meant is that it doesn't drive numbers down. This is one of the reasons that dosing is based on the nadir.

The second insulin is given as a "booster" or in medical jargon, a bolus. R is short-acting. It's in and out in approx. 4 hours. By using R to help lower the BG level, it's easier for the Lantus to grab on and keep the overall BG level lower for several more hours. R does drive numbers down which is why it's used in very small amounts -- it is very potent.

When Gabby was diagnosed with DKA and hospitalized, the vet was using an intermediate length insulin (Humulin N) as the basal dose and R as the bolus. By getting the numbers in a better range, it reduces the risk of ketones developing again.

If you're not able to catch Salem in the litterbox, I'd suggest one of two options. Either put fish gravel in the litterbox or cover the litter with plastic wrap so you can get a urine sample. Alternatively, take Marje up on her offer to send you a blood ketone meter.

I'm not sure you appreciate how easy it is for ketones to recur. We're hounding you because we've seen too many cats go through an episode of DKA, come home, and ketones develop again. As a result, they end up in the hospital for a second or third time.
 
Re: 8/4 Salem AMPS 496.8

Believe me I am fully aware of how serious ketones are. I just spent thousands saving my cat from them, and in tears when I found out he was ketone free. I've got him in the living room keeping an eye on him so I can catch him when he goes to the box, he hasn't yet this morning. And I will continue to stalk him.
 
Re: 8/4 Salem AMPS 496.8

Still watching for pee, nothing yet. He drank a little water, and then I captured him for more syringe feeding. He's had 2x30cc this morning so far, plus the food he's eaten on his own.

Well, maybe closer to 2x27ccs, as some ends up on his fur and the towel, but we're getting closer.

I added a few tablespoons of water to the cat food in the blender to give it a smoother consistency and get him some extra liquids. I should have 1.5 cans of Fancy Feast in him by mid afternoon, which would give him ~140 calories, not counting what he ate on his own.
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

It took me four tries, one massive wasted blood sample, and a very grumpy cat, but I got his 6h BG. It's way down to 234! I know it's still high, but seeing it drop to a safer level had me bursting into tears I'm so happy.

I'm still watching him for the bathroom, and will continue to syringe feed for the rest of the day if he isn't in the mood to eat on his own. I'm keeping away all high carb foods, which is likely what caused his spike yesterday, and feeding strictly low carb wet.
 
Re: 8/4 Salem AMPS 496.8

Sienne, you posted: " By potent, what is meant is that it doesn't drive numbers down." That's not accurate - I suspect what you meant is the opposite, that a potent insulin DOES drive the numbers down. Karrie is, I think, right to emphasize that this, especially for Phedre, is the information-overload stage.

Phedre, may I ask how you would feel about trying out the blood ketone meter Marje mentioned to you? We're sorry to keep beating you over the head with the issue of ketones, it's just that they really can be so dangerous and what we want most of all is to make sure that sweet Salem stays safe and gets healthy, ok?

Please think about the blood ketone meter, k? And, if you've got any brain capacity left, about the R-insulin as a booster, too. I know it sounds so overwhelming! Maybe get in touch with Libby (of Libby and Lucy) via PM, and she'll be able to explain some details to you about it.

We all really want to help you keep Salem safe! You're doing such a good job! Get back to any of us anytime you have more queries or thoughts, ok?

Hugs.
Jane
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

I'd be more than happy to try the ketone meter. I'm still trying to catch him using the litter box, but he hasn't gone yet. I'm sitting about 20 feet away where I can see both the box and him, so we'll see how it goes today.
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

Woohoo! Way to go, Phedre and Salem. You are both doing super. :-D :-D :-D And thank you to all the expert advice givers. You're the best.
Liz
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

phedre said:
I'd be more than happy to try the ketone meter. I'm still trying to catch him using the litter box, but he hasn't gone yet. I'm sitting about 20 feet away where I can see both the box and him, so we'll see how it goes today.
Click to expand...

:-D Ah, the joys of litterbox stalking! Hang in there, Phedre! Would you like me to get in touch with Marje and ask her to send you the blood ketone meter? And if you like, I can ask Libby to get in touch with you too, regarding the option of using R, the short-acting insulin, as a way to pitch in for Salem to keep him in better numbers, like that awesome +6 you just got? Let me know, and I'll be happy to network for you :smile:

Hugs
Jane
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

I've sent her a PM about the meter. I'm still really leery of the extra insulin. I'm going to call his vet.
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

phedre said:
I've sent her a PM about the meter. I'm still really leery of the extra insulin. I'm going to call his vet.
Click to expand...

Great, I'm glad your PM'ed Marje. And I completely understand you're wary of the extra insulin. It does sound awfully scary, doesn't it! It's great that you have a good report with your vet, Phedre. Go ahead and see what feedback you get there (and feel free to share it if you like), and then we'll see how you want to move forward. If we keep harping on about something, I promise it's not to bug you, ok? We want to make sure you're safe and comfortable, and the same for Salem!

Let me know whenever you'd like some input on R from folks here who've used it a lot (and who all were in your positiong of being worried about it at first, too), k? I'll be happy to set that up for you. Check in with you in a bit.
Jane
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

Another 30 ccs of food down. He's eating it fine, and doesn't even seem to mind it. Definitely a sleepy cat, but he's not overly high energy to begin with so he's probably just worn from all the poking and prodding, and the high BS levels.

Still stalking him to the litter box, seen him head there a few times, and when I come over, he walks away from it. I think I need to wait til he's in the box and peeing.
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

Stalking Salem to the box is a pain -- been there, done that. The ketone meter will make it lots easier!

Jane -- the context of what I was saying is that Lantus isn't a potent insulin in that it doesn't drive numbers down. R is potent.
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

Sienne and Gabby said:
Jane -- the context of what I was saying is that Lantus isn't a potent insulin in that it doesn't drive numbers down. R is potent.
Click to expand...

Umm... Yeah... And while the *context* of what you wrote is obvious to you, me, and some others, it may likely not be obvious to *everyone*, and none of us want to confuse newbies or anyone else, now, do we. That's why I corrected what you *actually* wrote. :lol: Now let's let it go. ;-)

Phedre, any litterbox luck yet? :mrgreen:
Jane
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

it's good to see a better number! Let's hope he can stay there. You're doing a great job. Try to breathe! I know it's hard. I think I mentioned in your other thread that I am now learning about a different serious illness with a different cat. I had forgotten how stressful it is to have to try to learn so much information while you're exhausted and worried. I've never been someone who is good at understanding science, and trying to understand it while under stress is even harder. It will start to make sense after a while.

I'm not going to pressure you into using R, at least not right now. If you get a positive ketone test, then I can't guarantee I won't start pushing. ;-) We have seen cats go into DKA 2-3 times in a row, and we just want to help prevent that from happening. We tend to get aggressive when we see ketones in a cat with a DKA history.

Just a thought, some cats just HAVE to go use a freshly cleaned litter box. Does Salem happen to be one of those cats? I have one cat that if I ever needed a urine sample I would just have to go scoop the litter box, and I know he would show up to use it.
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

Lucy, thanks for coming in here! We heart you :mrgreen:
Jane

ETA Libby I mean. Today's various ups and downs have obviously made me confuse cats with people :mrgreen:
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

I just stuck a ladle under my cat's ass to test his urine. And it made me HAPPY. He's NEGATIVE!
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

phedre said:
I just stuck a ladle under my cat's ass to test his urine. And it made me HAPPY. He's NEGATIVE!
Click to expand...



That's fantastic news! And kudos for the very original ladle-technique, Phedre! Keep checking tomorrow and so on, ok?
I'm so happy to read this!!

Jane
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

Hi Phedre and Salem. That is a nice +6. Keep it up Salem cat_pet_icon

My kitty had DKA and was hospitalized for 8 1/2 long days. Even though it was long ago, I still remember clearly how scary that was, and how I thought about my cat day and night.

When I was encouraged to try some R, I was scared too. Eventually, I bought some, and luckily had the guidance from certain people on this board who know how to use it. Vets are normally only available when you can reach them. The help on this board is pretty much 24/7, so there is always someone here to help guide you and support you.

Now, I use R when J.D. has been in the pinks and reds for a long time and seems to be stuck in them. I'll give him just an eansy teansy tiny bit of R (barely visible in the syringe) and it can bring his BGs down into the mid 200s to mid 100s to where the Lantus can grab hold and do it's job. I can also pitch in to help you, if you have any questions regardin R.

When I am stalking the litter box to get a ketone test, I watch J.D. go in and wait until the stream has started, and then approach him with a tiny plastic cup (like a Fancy Feast Appetizers container) and just put it under his tail as he's going.
Good luck getting that test. When I am really really wanting a ketone test, I'll put the litter box right in the living room as close to me as possible.

You're doing a great job, and I know how overwhelming all this can be.
 
Re: 8/4 Salem AMPS 496.8 +6h 234!

Jane said:
phedre said:
I just stuck a ladle under my cat's ass to test his urine. And it made me HAPPY. He's NEGATIVE!
Click to expand...



That's fantastic news! And kudos for the very original ladle-technique, Phedre! Keep checking tomorrow and so on, ok?
I'm so happy to read this!!

Jane
Click to expand...

The look on his face when I stuck the ladle between his legs was priceless.
 
YAY for No Ketones !!!
smiley-happy057.gif


Man, I bet you're realived.
 
I am VERY relieved.

He just got his 6PM shot and 30 ccs of food fed via syringe as he wasn't interested in eating on his own tonight. I could not get a blood sample, I think his ears are bothering him. I tried for about 5 minutes and he was squirming a lot so I let him off the hook since his ketones are ok and I know he's eating. He's also drinking a decent amount of water (not too much, but enough) on his own, so that's good.

Overall he's improving, but it's slow and steady. I'm ok with that, as long as he's going in the right direction.
 
I would try experimenting with leaving some food out -- even if it's a little higher in carbs -- anything that Salem might find interesting. I'm wondering if he'll start eating on his own, it may prime the pump, so to speak. I'd just leave a little bit out so he can free feed.

(Oh, and the person leaving the post is Libby, her cat is Lucy.)
 
Hang in there, Phedre! It's so great that you're starting to see improvement!! :cool:

(Oh, and yes, Lucy's person is indeed Libby, not vice versa! Libby knows I know, thank heavens! Sheesh, I *am* ready for bed!)
 
Have you been told about chicken dust? This really helped tempt Maverick when he was off his food. its the purebites chicken crumbled into a fine dust and sprinkled on his food. And only the Walmart Special Kitty Turkey and Giblet food when he was picky. Maverick got purebites chicken after every poke and needle and ended up purring through both once he caught on he got the chicken treat after. Its amazing stuff. I bought the dog sized bags - cheaper.

Also have you been told about the rice sock to warm up his ear? And milking the ear to bleed? I used one of these lights behind Maverick's ear to help show where the capillaries were - it served as a backing to make poking easier too. I can't remember if it was his left or right ear which bled easy and I had to go near his tip. I free handed the lancet for easier control.

DSCN0319.jpg


DSCN0315.jpg


oh and DANCING!!!!! I'm so happy to see negative ketones. WOOOOOOHOOOOOO

:dizcat :RAHCAT flip_cat
 
What a day you and Salem have had, Phedre! Some great victories :-D :-D

I did mail the ketone meter and I sent it the fastest way possible but the US Post Office said 6-10 days and could be longer if Customs decides to open it and no guarantees once it hits Canada. Blah blah blah....anyway...it got out today so p,ease let me know when you get it. I also saw that you have a One Touch ultra mini so I sent you two boxes of OT 28g lancets that you can use in a lancing device or freehand with. 28g is good when you are starting out.

I'm also going to ask Julie (punkin) to stop by and say hello. She's another R user...Punkin is acro and so she uses it to bring his high numbers down. It's a hard decision and scary but I can attest tithe fact that you wont be left alone. When Libby helps someone, she lets them know what to shoot when and then we all watch together.

Hugs....progress ..... :-D :-D :-D
 
Status
Not open for further replies.
Back
Top