Ketone After Taking Senvelgo

[Jan Chung]

Hi Admin and all members!

Max’s Recent Health Updates:
Diet: Raw meat diet since 2019.
Diagnosis: Diabetic since August 2022.
Weight: 4.83 kg 22/09 5.0 kg 26/09
Medications:
Gabapentin 50mg twice a day
Hypokal 78mg once a day
Lantus insulin increased from 3.35 units to 6 units within a month in September.
Max, now 18 years old, is struggling to chew meat, so we blend his food with about 20 ml of water and feed him via syringe. He gets 50g of raw meat per meal, 4 times a day (at 1000, 1600, 2200, and 0400, every 6 hours).
Spread sheet ( updated on 26/09 at 1803 HK time https://docs.google.com/spreadsheets/d/1jIYq5qZQtnyaH3xn63wPnljYRVmYYuGvC4k35sTpx3M/edit
I don’t know how to post the pictures of Max’s blood test result please refer to the post on Facebook
https://www.facebook.com/share/p/6w..._share_include_copy=1&fb_entity_type=newsfeed
Max seems to be experiencing insulin resistance recently, so I took him to the vet. Both the vet and I suspect Acromegaly. Blood tests were sent off, and we're awaiting results in two weeks. In the meantime, the vet suggested starting Senvago, which we initiated on 22/09 at 2040 (Hong Kong time). His last Lantus shot was at 0400 on 22/09, and the vet advised skipping the 1600 shot that day to start Senvelgo at 2040.

The vet also insisted on installing the Freestyle Libre 2 sensor and advised checking Max’s ketones using a blood ketone meter every 6-8 hours. I’ve had poor experiences with Freestyle Libre in the past and don’t trust it, but the vet refused to administer Senvago without using the sensor. Blood tests at the clinic showed no ketones present.

Max has now been off insulin for more than 18 hours. However, something unexpected happened. The vet instructed giving him 1 unit of Lantus at 1440 on 23/09. I later discovered Max had 2 mmol/L of ketones at 1500. Because I don’t trust the Freestyle Libre, my maid and I consistently monitor his glucose levels with a blood glucose meter, especially before meals.

On the night of 23/09, we stopped Senvago and returned to administering 3 units of Lantus at 2200.

Meal times and glucose/ketone levels:
24/09 - 0400:

Glucose: 9 mmol/L
Ketones: 2.7 mmol/L
50 ml subcutaneous water, 50g raw meat.
24/09 - 1000:

Glucose: 7.7 mmol/L
Ketones: 2.8 mmol/L
I was supposed to give 3 units of Lantus as his glucose was under 10 mmol/L, but I waited until 1100, when it rose to 13.2 mmol/L, and then administered 3 units.
24/09 - 1600:

Glucose: 7.5 mmol/L
Ketones: 3.3 mmol/L
50 ml subcutaneous water, 50g raw meat.
Max's appetite has decreased, which may be due to the ketones or the frequent blood tests. We fed him via syringe, and though he finished his meal, he’s been moaning.
The vet has now recommended increasing Max’s insulin dosage to 4 units for the next shot that I did at 1910 tonight. That is 8 hours after the last shot.

I feel upset and guilty for trying Senvago instead of a different approach. I’m so regret that I made the decision.
I had wanted to try a combination of short- and long-acting insulin. I’m also very frustrated with the Libre sensor, which shows significant glucose differences compared to the blood glucose meter. Despite lowering the insulin dose to 3 units, the glucose levels have been manageable.

I will continue monitoring his ketones every 6 hours. I understand the fastest way to reduce ketones would be hospitalization, but I’ve already spent over USD $1200, and ketone strips cost $70 for just 10 strips. The vet is confident that Max’s ketones will drop within 24-48 hours. They mentioned hospitalization may be necessary if his glucose reaches 10 or higher.

Questions:
1)Any suggestions for managing Max’s condition under these circumstances?
2)Can someone assist with adjusting his insulin dosage?
3)Any experience with long and short acting insulin injection can share with me?
4)From your experience, what should I do next?

 

[Jan Chung]

 

[Jan Chung]

Updated News on 26/09/24 at 1842 Hong Kong Time.
My fault! I was driving when my maid called 3 times and I told her to give Max 5 unit at 1900 last night but NOT what the vet and I supposed to plan for 4.5 unit by mistake.
that's why Max's glucose level at 0400 in this morning. Luckily that Max is fine and finished 60g of raw meat.
Good news is Max's Ketone is dropping now from 3.3 to 2.6 today. will check his glucose and ketone in 10 mins.

 

[CORKY]

Updated News on 26/09/24 at 1842 Hong Kong Time.
My fault! I was driving when my maid called 3 times and I told her to give Max 5 unit at 1900 last night but NOT what the vet and I supposed to plan for 4.5 unit by mistake.
that's why Max's glucose level at 0400 in this morning. Luckily that Max is fine and finished 60g of raw meat.
Good news is Max's Ketone is dropping now from 3.3 to 2.6 today. will check his glucose and ketone in 10 mins.

Welcome Jan Chung, you have very good instincts on not trusting the Libre, they are very unreliable, fall off or stop working way before the 14 days, great you are home testing, you can use a human monitor with strips, no need for a PET METER, it is important Max eats foods between 0-10% carbs to keep his glucose numbers leveled below there are to links we need you to review so we can help you on this journey, thank you for all the information you send us as well, I tagged an expert on the insulin you are giving Max as well, We are here for you!
https://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

@Suzanne & Darcy

 

[Jan Chung]

Thanks for the info. I had read it before and I’m feeding Max raw meat diet.
I had updated the spread sheet and Max’s glucose levels is much better than before.
@admin #admin or anyone who can give me some advice on this case?
As I mentioned I made the mistake and told my maid to give Max 5 unit last night and caused his glucose level dropped to 1.8 at PMPS +9 and luckily that he looks normal and it the meal time and he had good appetite and finished all of the food.
AMPS today 26/09 glucose level was 10.6 for safety reason I just gave Max 4 unit and PMPS glucose level was 13.5, 4 unit again.
Am I correct? Can someone guide me on this process?
The vet said Max has extremely insulin dependent/ insulin resistance because he just read the freestyle sensor’s number for reference that is totally inaccurate and big difference between the glucose meter. ( 4-12.4 difference!!!!!)
It’s really dangerous if the owners just read those number and give their cats the injection!
I had explained to the vet and then he said “If he acts normal at 1.8 he has a very dysregulated system!” Is that true?
This is not the first time that his glucose level was dropped to 1.8-3.0 at the mid night 30 mins before the meal time (04:00) And he is fine, not sign and symptoms of Hypoglycemia. I remember it does happened not more than 5 time since in 2022 August.
Is that common for the sugar cats? It does happen on my friend’s sugar cat few times and she is fine too.

Welcome Jan Chung, you have very good instincts on not trusting the Libre, they are very unreliable, fall off or stop working way before the 14 days, great you are home testing, you can use a human monitor with strips, no need for a PET METER, it is important Max eats foods between 0-10% carbs to keep his glucose numbers leveled below there are to links we need you to review so we can help you on this journey, thank you for all the information you send us as well, I tagged an expert on the insulin you are giving Max as well, We are here for you!
https://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

@Suzanne & Darcy

 

[CORKY]

Thanks for the info. I had read it before and I’m feeding Max raw meat diet.
I had updated the spread sheet and Max’s glucose levels is much better than before.
@admin #admin or anyone who can give me some advice on this case?
As I mentioned I made the mistake and told my maid to give Max 5 unit last night and caused his glucose level dropped to 1.8 at PMPS +9 and luckily that he looks normal and it the meal time and he had good appetite and finished all of the food.
AMPS today 26/09 glucose level was 10.6 for safety reason I just gave Max 4 unit and PMPS glucose level was 13.5, 4 unit again.
Am I correct? Can someone guide me on this process?
The vet said Max has extremely insulin dependent/ insulin resistance because he just read the freestyle sensor’s number for reference that is totally inaccurate and big difference between the glucose meter. ( 4-12.4 difference!!!!!)
It’s really dangerous if the owners just read those number and give their cats the injection!
I had explained to the vet and then he said “If he acts normal at 1.8 he has a very dysregulated system!” Is that true?
This is not the first time that his glucose level was dropped to 1.8-3.0 at the mid night 30 mins before the meal time (04:00) And he is fine, not sign and symptoms of Hypoglycemia. I remember it does happened not more than 5 time since in 2022 August.
Is that common for the sugar cats? It does happen on my friend’s sugar cat few times and she is fine too.

it is very unfortunate that the Freen Style does read low number lower than they really are, and the High BG number will only reach to 350, then automatically will read HI, and you are correct it is dangerous, however, insulin is not increased, decreased or not given according to the glucose level reading, the shots need to be consistent, and same dose, otherwise the system or diabetes will not be regulated either, the dose take a couple of cycles to regulate, example if you look at Corky's spreadsheet you will see that I shoot on low numbers twice a day, then again I am a compulsive tester, when he is in the green numbers, they are the best numbers to be in, the pancreas begin to heal on these numbers, but it took me a bit of a time to feel comfortable about these cycles, also since for now you are giving high doses, at random times it is important that you test before shooting, the norm is Test, Feed, Shoot, but a few insulins have a different protocol;, so I did tag the insulin expert for you, You need to have what is called a HYPO KIT, this includes KARO Syrup/Honey, medium carb food 12-15 % carbs and High carb food 15-20 % high carbs, in case and only then, of a very low glucose 50 or under, all your questions will be answered, give a bit of time for the person I tagged to answer you I will also tag another expert
@Bron and Sheba (GA)
@Suzanne & Darcy

 

[Diane Tyler's Mom GA]

@Jan Chung
This is where you can set up what we call your signature, it's at the end of everyone's post in gray letters. Just tap on your name up top then tap on signature and add this information.

Do you see mine about Tyler , it's in gray letters at the end of my post

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Bexacat or Senvelgo (if applicable) and dates
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

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Also please add you are from Hong Kong
Then put the link for your spreadsheet under your signature

 

[Diane Tyler's Mom GA]

Hi Admin and all members!

Max’s Recent Health Updates:
Diet: Raw meat diet since 2019.
Diagnosis: Diabetic since August 2022.
Weight: 4.83 kg 22/09 5.0 kg 26/09
Medications:
Gabapentin 50mg twice a day
Hypokal 78mg once a day
Lantus insulin increased from 3.35 units to 6 units within a month in September.
Max, now 18 years old, is struggling to chew meat, so we blend his food with about 20 ml of water and feed him via syringe. He gets 50g of raw meat per meal, 4 times a day (at 1000, 1600, 2200, and 0400, every 6 hours).
Spread sheet ( updated on 26/09 at 1803 HK time https://docs.google.com/spreadsheets/d/1jIYq5qZQtnyaH3xn63wPnljYRVmYYuGvC4k35sTpx3M/edit
I don’t know how to post the pictures of Max’s blood test result please refer to the post on Facebook
https://www.facebook.com/share/p/6w..._share_include_copy=1&fb_entity_type=newsfeed
Max seems to be experiencing insulin resistance recently, so I took him to the vet. Both the vet and I suspect Acromegaly. Blood tests were sent off, and we're awaiting results in two weeks. In the meantime, the vet suggested starting Senvago, which we initiated on 22/09 at 2040 (Hong Kong time). His last Lantus shot was at 0400 on 22/09, and the vet advised skipping the 1600 shot that day to start Senvelgo at 2040.

The vet also insisted on installing the Freestyle Libre 2 sensor and advised checking Max’s ketones using a blood ketone meter every 6-8 hours. I’ve had poor experiences with Freestyle Libre in the past and don’t trust it, but the vet refused to administer Senvago without using the sensor. Blood tests at the clinic showed no ketones present.

Max has now been off insulin for more than 18 hours. However, something unexpected happened. The vet instructed giving him 1 unit of Lantus at 1440 on 23/09. I later discovered Max had 2 mmol/L of ketones at 1500. Because I don’t trust the Freestyle Libre, my maid and I consistently monitor his glucose levels with a blood glucose meter, especially before meals.

On the night of 23/09, we stopped Senvago and returned to administering 3 units of Lantus at 2200.

Meal times and glucose/ketone levels:
24/09 - 0400:

Glucose: 9 mmol/L
Ketones: 2.7 mmol/L
50 ml subcutaneous water, 50g raw meat.
24/09 - 1000:

Glucose: 7.7 mmol/L
Ketones: 2.8 mmol/L
I was supposed to give 3 units of Lantus as his glucose was under 10 mmol/L, but I waited until 1100, when it rose to 13.2 mmol/L, and then administered 3 units.
24/09 - 1600:

Glucose: 7.5 mmol/L
Ketones: 3.3 mmol/L
50 ml subcutaneous water, 50g raw meat.
Max's appetite has decreased, which may be due to the ketones or the frequent blood tests. We fed him via syringe, and though he finished his meal, he’s been moaning.
The vet has now recommended increasing Max’s insulin dosage to 4 units for the next shot that I did at 1910 tonight. That is 8 hours after the last shot.

I feel upset and guilty for trying Senvago instead of a different approach. I’m so regret that I made the decision.
I had wanted to try a combination of short- and long-acting insulin. I’m also very frustrated with the Libre sensor, which shows significant glucose differences compared to the blood glucose meter. Despite lowering the insulin dose to 3 units, the glucose levels have been manageable.

I will continue monitoring his ketones every 6 hours. I understand the fastest way to reduce ketones would be hospitalization, but I’ve already spent over USD $1200, and ketone strips cost $70 for just 10 strips. The vet is confident that Max’s ketones will drop within 24-48 hours. They mentioned hospitalization may be necessary if his glucose reaches 10 or higher.

Questions:
1)Any suggestions for managing Max’s condition under these circumstances?
2)Can someone assist with adjusting his insulin dosage?
3)Any experience with long and short acting insulin injection can share with me?
4)From your experience, what should I do next?

@Wendy&Neko
@Bron and Sheba (GA)
@Bandit's Mom

She has also posted more information after her introduction post
He put his spreadsheet link in his introduction post

 

[Chris & China (GA)]

Since you've just started getting back in the habit of testing regularly, it's hard to know what dose he should be on. Can you tell us how increases were done? Like did you increase from 1U to 2U to 3U...etc. or what?

When were you giving the Senvelgo (and thank goodness that you realized that was the wrong way to go!)

It's possible that you bypassed what would have been a good dose for Max, so I wouldn't take your vet telling you he was insulin resistance too seriously. Too much insulin can look like not enough because the body will "fight back" if the glucose levels drop too low or too fast. The liver will release stored sugars and hormones to bring the BG back up quickly. We have seen cats that were in the 400's at Pre-shot, drop to the 40's at nadir and be back in the 400's by the next shot time. If all you see are the 400's, you might think he needed more insulin when in fact, he needed less!.

 

[Wendy&Neko]

I would take what your vet is saying about insulin resistance very seriously. One in four diabetic cats has acromegaly and it's a possible condition that's too often ignored. Good on your vet for thinking about testing, but not good on the Senvelgo experiment.

Too much insulin does not look like too little if you've been monitoring and increasing by reasonable amounts. Wanted to get that out there, especially on this forum.

More later.

 

[Chris & China (GA)]

Good on your vet for thinking about testing,

Agreed but what caught my eye was "Lantus insulin increased from 3.35 units to 6 units within a month in September." which is why I was thinking that it may not be acro, but increasing too much, too quickly.

Of course, it's good that the vet suggested testing (and wish more of them would consider it if dosing has been increased correctly and the numbers aren't responding) but just wanted to let her know it may not be acro.

@Jan Chung I know you're asleep now so don't expect an answer until later, but do you know if your vet also tested for IAA (Insulin Auto Antibodies)?

 

[Jan Chung]

@Chris & China (GA) I’m agreed with you! I think it is because I increased the insulin to quick and too much!
I had asked the vet and he replied,
‘I am speaking to some Australian IM and DM specialists to see if your idea of basal + peak insulin has merit. Since obviously SGLT2’s are out of the question in this case.
regarding the IAA it is not a routinely-performed test in cats, it is not recommended by the ISFM Guidelines, I have not ever seen or heard of a case where that was the cause. acro on the other hand is reported to occur in up to 20% of all DM cases. the IAI test would be extremely expensive, and not available in HK. ‘
We still waiting for the IGF-1 test result and the vet will start his holiday until mid of October. I can contact him if there is any emergency happening, I hope I don’t have to msg him.
I used the same method, increased the insulin 0.25-0.5 every time and saved Max’s life in January this year when the vet told me that he will not able to survive within a week and discharged from hospital and recommend Palliative Care at home.
May be I’m too aggressive to increase the amount of insulin this time and he doesn’t need too much insulin.
I’m giving Max 4 unit at his moment and I’m looking for someone who can have a look of his spread sheet then give me some advice about how much insulin I should give him. I used to test Max’s glucose level at least 4 times a day so I will fill in the numbers on the spread sheet later for your reference. Many thanks.

 

[Diane Tyler's Mom GA]

@Jan Chung
We need you to set up your signature and put your spreadsheet link under your signature so members can help you
Members aren't going to look up top where you have your spreadsheet
This is where you can set up what we call your signature, it's at the end of everyone's post in gray letters. Just tap on your name up top then tap on signature and add this information.

Do you see mine about Tyler , it's in gray letters at the end of my post

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Bexacat or Senvelgo (if applicable) and dates
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Also please add you are from Hong Kong
Then put the link for your spreadsheet under your signature

 

[Jan Chung]

@Jan Chung
We need you to set up your signature and put your spreadsheet link under your signature so members can help you
Members aren't going to look up top where you have your spreadsheet
This is where you can set up what we call your signature, it's at the end of everyone's post in gray letters. Just tap on your name up top then tap on signature and add this information.

Do you see mine about Tyler , it's in gray letters at the end of my post

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Bexacat or Senvelgo (if applicable) and dates
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Also please add you are from Hong Kong
Then put the link for your spreadsheet under your signature

Dear @Diane Tyler's Mom GA , I had click into my name and I don’t know where I can add the info. Maybe I’m using my mobile, let me turn on the laptop and the a look thanks .

 

[Diane Tyler's Mom GA]

Your name will be all the way up top where that pic of the cat is with a vial of insulin
@Jan Chung

 

[Bron and Sheba (GA)]

This is not the first time that his glucose level was dropped to 1.8-3.0 at the mid night 30 mins before the meal time (04:00) And he is fine, not sign and symptoms of Hypoglycemia. I remember it does happened not more than 5 time since in 2022 August.
Is that common for the sugar cats? It does happen on my friend’s sugar cat few times and she is fine too.

Was the 1.8 (32) on the libre or the hand held meter? If on the libre, did you double check it with the hand held meter?

If the dose is too high, the BGs will drop low. Some cats show hypo symptoms earlier than others. I remember my Sheba dropping to I think it was 23 (1.2) and the only symptom she had was she was starving hungry. But we don’t want them to drop to those levels, it is unsafe.

 

[Chris & China (GA)]

I had explained to the vet and then he said “If he acts normal at 1.8 he has a very dysregulated system!” Is that true?

No and I think it's very irresponsible for a vet to imply that a blood glucose that low isn't a problem. There's no set number, but the brain uses a lot of glucose and when the BG is that low, brain cells can be dying. Luckily?, there are billions so losing a million here or there may not cause so much damage that you'd notice, but that doesn't mean it's something that shouldn't be concerned about.

I have not ever seen or heard of a case where that was the cause. acro on the other hand is reported to occur in up to 20% of all DM cases.

We've seen cats with acromegaly, cats with IAA and cats with both but I understand that the IAA test may not be available everywhere or could be cost-prohibitive. There is more information on IAA about half way down on this page from the Acromegaly/IAA forum.

It's also possible he's getting too much insulin, as well as the possibility that he's just a high dose cat! Some cats have no other diagnosis but for whatever reason, they just require more insulin than most.

For now, I'd suggest staying at 4U and continue gathering testing data. Since Max is a long-term diabetic (diagnosed over a year), if he drops below 2.2, you immediately reduce the dose by 0.25

 

[Jan Chung]

Dear @Diane Tyler's Mom GA , I had click into my name and I don’t know where I can add the info. Maybe I’m using my mobile, let me turn on the laptop and the a look thanks .

Done please check thanks

 

[Chris & China (GA)]

Done please check thanks

Looks fine!

 

[Jan Chung]

Was the 1.8 (32) on the libre or the hand held meter? If on the libre, did you double check it with the hand held meter?

If the dose is too high, the BGs will drop low. Some cats show hypo symptoms earlier than others. I remember my Sheba dropping to I think it was 23 (1.2) and the only symptom she had was she was starving hungry. But we don’t want them to drop to those levels, it is unsafe.

All the numbers on the spread sheet are tested by the blood glucose meter. I had never trusted the Freestyle Sensor and I tried more than 12 of them, only ONE is last for 14 days and it was the beginning I can’t remember I did compare with the blood glucose meter not! Other than that all last for 3-10 days and big difference between the blood glucose meter and the sensor! From 2-12.5!!!!!! I took many pictures and showed to the vet however he always said I’m the only owner who complained the sensor is error or inaccurate. He insisted to install this sensor for monitoring the glucose level in the first 2 weeks when taking Senvelgo. It last for 3 days only , “please check again 10 mins later “ keep showing on the screen until now…
I just checked his glucose, it’s jumped up again to 22.4 and Kentone is 2.0 it was 1.0 seven hours ago !

 

[Jan Chung]

No and I think it's very irresponsible for a vet to imply that a blood glucose that low isn't a problem. There's no set number, but the brain uses a lot of glucose and when the BG is that low, brain cells can be dying. Luckily?, there are billions so losing a million here or there may not cause so much damage that you'd notice, but that doesn't mean it's something that shouldn't be concerned about.



We've seen cats with acromegaly, cats with IAA and cats with both but I understand that the IAA test may not be available everywhere or could be cost-prohibitive. There is more information on IAA about half way down on this page from the Acromegaly/IAA forum.

It's also possible he's getting too much insulin, as well as the possibility that he's just a high dose cat! Some cats have no other diagnosis but for whatever reason, they just require more insulin than most.

For now, I'd suggest staying at 4U and continue gathering testing data. Since Max is a long-term diabetic (diagnosed over a year), if he drops below 2.2, you immediately reduce the dose by 0.25

Just checked his glucose level it’s jumping up to 22.4 and ketone is jumping to 2.0! It was 1.0 seven hours ago! What’s happening with Max? Just contacted the vet and waiting for the reply.

 

[Bron and Sheba (GA)]

You can help combat ketones by feeding more food and giving more fluids. I would offer an extra snack during both cycles around +3.
Would he eat the food if you added a teaspoon of warm water to each snack and meal?

 

[Bron and Sheba (GA)]

Just checked his glucose level it’s jumping up to 22.4 and ketone is jumping to 2.0! It was 1.0 seven hours ago! What’s happening with Max? Just contacted the vet and waiting for the reply.

He could be bouncing from the string of greens yesterday and the 1.8 the day before . If he is acting OK and eating well, I would not be concerned about the ketones level of 2 but I would feed extra food and give extra fluids as i mentioned above.
I see you give some sub Q fluids. How much do you give a day?

 

[Jan Chung]

You can help combat ketones by feeding more food and giving more fluids. I would offer an extra snack during both cycles around +3.
Would he eat the food if you added a teaspoon of warm water to each snack and meal?

Max is eating raw meat and he is struggling to chew meat so I blended 20-30 ml of water to blend it and feeding by the syringe. 4 meals a day for every 6 hours.

 

[Jan Chung]

He could be bouncing from the string of greens yesterday and the 1.8 the day before . If he is acting OK and eating well, I would not be concerned about the ketones level of 2 but I would feed extra food and give extra fluids as i mentioned above.
I see you give some sub Q fluids. How much do you give a day?

Yes I can see the numbers today is increased. APMS was 18.7 and 7 hours after the injection was jumped to 22.4. According to his weight (4.83kg on 22/9) the ver suggested that give him 50ml of sub cut water 3 times a day ( 24 hours)
Hence we had changed from Senvelgo to Lantus and we gave him the injection less than 12 hours ONCE, the normal injection time is changed from meal time(1000 /2200 ) to 3 hours before the meal times. We fed him 20-30 ml of blended meat. After the injection then waited for 2 hours to the next meal time.
I fed him 15g extra meat today ( 65g total) for breakfast at 1000, 3 hours after the injection.
Normally he had around 50g of raw meat blended with around 20-30 ml of water for every 6 hour.

 

[Jan Chung]

The vet said Max is Severe insulin resistance and need to increase again! I don’t know what’s need to increase again? does he means the insulin? ( the vet is not local, he is Australian.) If yes this will be what you guys mentioned, it’s such a cycle, numbers up, increase the insulin then uncontrollable……

 

[Bron and Sheba (GA)]

According to his weight (4.83kg on 22/9) the ver suggested that give him 50ml of sub cut water 3 times a day ( 24 hours)

Do you make sure that all the sub Q fluid that was given the time before was absorbed completely before you give the next lot?
150 ml every day is quite a lot. Do you give it 3 times a day, every day?

Can I just clarify something. Do you test him, then feed him then give the dose of insulin...one after the other?

What do you mean when you say
'Hence we had changed from Senvelgo to Lantus and we gave him the injection less than 12 hours ONCE, the normal injection time is changed from meal time(1000 /2200 ) to 3 hours before the meal times. We fed him 20-30 ml of blended meat. After the injection then waited for 2 hours to the next meal time.'
When you say injection, are you referring to the insulin or the sub Q fluids?

The vet said Max is Severe insulin resistance and need to increase again! I don’t know what’s need to increase again? does he means the insulin? ( the vet is not local, he is Australian.) If yes this will be what you guys mentioned, it’s such a cycle, numbers up, increase the insulin then uncontrollable……

Please do not increase the dose again at the moment. The 4 units is taking him down to 4.5
The dose of lantus is based on how low the dose takes the cat, not the preshot BG.
I am questioning how much your vet knows about feline diabetes.

 

[Bron and Sheba (GA)]

You say the vet is Australian...is he working in HK?
I am Australian and live in Australia. I still don't think your vet knows much about feline diabetes.

 

[Jan Chung]

You say the vet is Australian...is he working in HK?
I am Australian and live in Australia. I still don't think your vet knows much about feline diabetes.

Yes he is working in HK! Sigh… I think 99% of the vet in HK they don’t know much about Felien diabetics and they are very conservative.

 

[Bron and Sheba (GA)]

Yes he is working in HK! Sigh… I think 99% of the vet in HK they don’t know much about Felien diabetics and they are very conservative.

We can help you here.
Keep testing for ketones every day at the moment and offer more food if you can. We will help you with dosing.

 

[Jan Chung]

We can help you here.
Keep testing for ketones every day at the moment and offer more food if you can. We will help you with dosing.

Thanks. I had some blood glucose record as I gave him test at least 4 times a day all the time since he was diagnosis in 2022. I wanted to fill in the numbers in September for you guys reference, however I don’t know how to fill in the number as insulin was given every 8-10 hours. and not on sharp hours.

 

[Bron and Sheba (GA)]

How often are you giving the insulin now?
Insulin given to cats should be given every 12 hours only.
How long did you give the insulin every 8 to 10 hours?

 

[Jan Chung]

How often are you giving the insulin now?
Insulin given to cats should be given every 12 hours only.
How long did you give the insulin every 8 to 10 hours?

4 unit, twice a day for every 12 hours now.
Max’s glucose level was uncontrolled with DKA and stay in hospital for few days in January this year. Before he discharged from the hospital, they removed the insulin tube and changed to Lantus and the vet found that his glucose level was jumped up again. He said it seems uncontrollable and he will not able to survive with a week. So I took Max back home and prepared for palliative care.
I have no choice but not gave up on Max and tried this method and saved his life!
Started from 2 unit that suggested from the vet ( it was NOT enough obviously) then I started increased the amount to 3 2.5-2.75-3-3.25-3.5 and Max is saved.
Then back to every 12 hours a day when getting stable.
I found Max’s glucose numbers were getting higher and I decided to try again on 06 Sept. from 3.75 to 6 unit.
5.5 unit every 8 hours on 18/09, then increased to 5.75 on 20/09 for every 12 hours. 6 unit on 20/09 every 12 hours until on 22/09 AMPS 6 unit. we visited the vet on the same day and he asked me to skipped one shot on PMPS and started to take 3ml Senvelgo 16 hours after the last shot.
I found Ketone 2.0 on the next day ( 18 hours after the first dose) the vet asked me to give him 1 unit of Lantus and I gave him 3 unit once on that day .
Please read the spread sheet for your reference. Thanks.

 

[Jan Chung]

Dear all,
@Chris & China (GA) @Bron and Sheba (GA)
Please check the spread sheet
https://docs.google.com/spreadsheets/d/1jIYq5qZQtnyaH3xn63wPnljYRVmYYuGvC4k35sTpx3M/edit
Just tested the Glucose level was 16.6 and Ketone is increased to 2.2
4 unit insulin PMPS
Question:
Max had finished all meals and even increased the food from total 200g to 240-250g per day. 50ml x 2 sub cut water is given. why the ketone is increased in his body?
Any owner had tried Senvelgo before and had the similar experience?
Thank you.

 

[Bron and Sheba (GA)]

First of all, the vet should never have given you the senvelgo to give to Max with a history of DKA and with already having been treated with insulin.
And it sounds as if the vets pretty much gave up on Max when they changed over to Lantus after the DKA. Lantus takes from to 5 to 7 days to fill the depot for the full effect of the dose to be felt so it is no wonder his BGs rose again. So you did save his life.
I’m sorry to say I really don’t think your vet knows anything about feline diabetes.

But now it would be better if you continued to give the insulin every 12 hours with guidance from us.

I think Max could be bouncing from the run of greens yesterday and these high BGs are temporary. Keep giving as much food as he will tolerate and I would give 50 mls sub fluids twice a day.
I am going to ask a couple of other experienced people to have a look when they wake up. I will be going to bed in a couple of hours here in Australia. Keep up the good work you are doing. Max is lucky to have you.

 

[Jan Chung]

First of all, the vet should never have given you the senvelgo to give to Max with a history of DKA and with already having been treated with insulin.
And it sounds as if the vets pretty much gave up on Max when they changed over to Lantus after the DKA. Lantus takes from to 5 to 7 days to fill the depot for the full effect of the dose to be felt so it is no wonder his BGs rose again. So you did save his life.
I’m sorry to say I really don’t think your vet knows anything about feline diabetes.

But now it would be better if you continued to give the insulin every 12 hours with guidance from us.

I think Max could be bouncing from the run of greens yesterday and these high BGs are temporary. Keep giving as much food as he will tolerate and I would give 50 mls sub fluids twice a day.
I am going to ask a couple of other experienced people to have a look when they wake up. I will be going to bed in a couple of hours here in Australia. Keep up the good work you are doing. Max is lucky to have you.

 

[Bron and Sheba (GA)]

Jan could you put ‘DKA January’ in the signature please?

 

[Jan Chung]

Thanks for the prompt reply! yes I agreed with you! I found that most of the vet they are “ by the book” by the theory” and I didn’t inform him until I saved Max and he was stable.
Regarding the Senvelgo! He convinced me try and I was not interested in it. he sent me the document and report and I read that it’s not suitable for any cats who had started taking insulin. Around a month later he explained to me that that was in the beginning when they got FDA approved they haven’t give any cats who had/ taking insulin test. When they got the EU license they did. That’s why it can be used on the cats who had started insulin treatment.
We visit the vet on 22/09 and I told him that I would like to know more about short + long acting insulin treatment but he said Max may have acromeagly and insulin resistance.
Only this oral solution can be helped.
I’m so regret that I made such a big wrong decision and caused Max in pain.

The vet said it’s not medically possible, The ketones indicate insulin resistance. But the glucose levels are looks good, much bette than before. I don’t get it !

 

[Jan Chung]

Jan could you put ‘DKA January’ in the signature please?

I tried but don’t have enough space !

 

[Jan Chung]

Dear all,

May I know if there are any warnings or guidelines provided by the drug manufacturer ( Senvelgo) ? Has any research been conducted on it, or is the information based solely on owners' experiences? As this drug is quite new in Hong Kong, we have very limited information about it.
Thank you.

 

[Bron and Sheba (GA)]

I tried but don’t have enough space !

I’ll ask @Bandit's Mom if she can help you with fitting it in

 

[Jan Chung]

I’ll ask @Bandit's Mom if she can help you with fitting it in

Huge thanks for your help

 

[Bron and Sheba (GA)]

Dear all,

May I know if there are any warnings or guidelines provided by the drug manufacturer ( Senvelgo) ? Has any research been conducted on it, or is the information based solely on owners' experiences? As this drug is quite new in Hong Kong, we have very limited information about it.
Thank you.

Here is some information we have here about the oral insulin drugs.
NEW TREATMENTS FOR FELINE DIABETES

 

[Bron and Sheba (GA)]

The vet said it’s not medically possible, The ketones indicate insulin resistance. But the glucose levels are looks good, much bette than before. I don’t get it !

What did he say was not medically possible?
Ketones do not indicate insulin resistance. They indicate that there is not enough insulin and/or not enough food for the diabetic cat.
And in Max’s case the oral diabetic drug somehow triggered ketones which has been documented in some cats who take the oral insulin drugs.….But don’t blame yourself. You were doing what you thought was best. The vet needs to do a lot more reading on the subject before prescribing it to any other cats.
I don’t think he needs a short acting insulin and a long acting insulin with the BG numbers he is getting at the moment. That is a very specialised area which I doubt your vet would know how to go about it. Why don’t we try and help you first and see how that goes?.
We need to keep an eye on the ketones so if you could test every day that would be very helpful. And keep up with lots of food and the fluids.

 

[Jan Chung]

Here is some information we have here about the oral insulin drugs.
NEW TREATMENTS FOR FELINE DIABETES

I haven’t finished the reading yet, may I know that if you heard/read any most updated report that when they applied/Got the EU license, they did some tests for the cats who is having/had insulin and proved that it does help.
Coz th vet told met that not worried about what I read (“they are NOT indicated for cats that have already been treated with insulin. ”)
I had never read this before:
“Cats who are 13 or older and, especially if not overweight prior to diagnosis, are more likely to be insulin dependent or have other medical problems. They are likely not good candidates”

I adopted Max in 2017 and vets all said he is around 18 years old now! he shouldn’t take the Senvelgo!!!!!!!

 

[Sienne and Gabby (GA)]

Jan -

I would really want to see the published research out of the EU regarding Senvelgo. I read all of the available studies before we posted the information on the newer insulin treatments. I did not see any published information out of the EU. There may have been some pre-publication information circulating among vets but unless it's in a peer reviewed journal, especially with a new drug, my position would be to ask the vet to not experiment on my cat. My understanding is that in the US, the manufacturer's package insert still says that Senvelgo or any of the SGLT-2 inhibitors should not be used if the cat has been insulin dependent. I think the package insert in the EU differs. However, I would want to see the data that supports the decision in the EU.

I'm not sure where you're located. As others noted, we've certainly seen cats with either IAA or acro or both. I suspect that IAA often gets missed in that it is a self-limiting condition. In other words, you hit a point with the insulin dose and all of a sudden insulin requirements drop to a lower level. I'm honestly not sure how well informed your vet is. There are certainly vets out there who are great at managing everything except feline diabetes!

When a cat's blood glucose drops into a lower range, especially if a cat isn't used to being in lower numbers, there's a tendency for the liver and pancreas to release a stored form of glucose along with counterrgulatory hormones. These cause blood glucose numbers to spike upward. It can take up to 3 days for what we call a "bounce" to clear and numbers to get back to where they more typically fall. It's not advisable to increase the dose until the bounce clears. If you do increase the dose, you're basing your decision on a reading that is reflective of the bounce vs where the numbers actually are and it could lead to overdosing your cat.

 

[Jan Chung]

Jan -

I would really want to see the published research out of the EU regarding Senvelgo. I read all of the available studies before we posted the information on the newer insulin treatments. I did not see any published information out of the EU. There may have been some pre-publication information circulating among vets but unless it's in a peer reviewed journal, especially with a new drug, my position would be to ask the vet to not experiment on my cat. My understanding is that in the US, the manufacturer's package insert still says that Senvelgo or any of the SGLT-2 inhibitors should not be used if the cat has been insulin dependent. I think the package insert in the EU differs. However, I would want to see the data that supports the decision in the EU.

I'm not sure where you're located. As others noted, we've certainly seen cats with either IAA or acro or both. I suspect that IAA often gets missed in that it is a self-limiting condition. In other words, you hit a point with the insulin dose and all of a sudden insulin requirements drop to a lower level. I'm honestly not sure how well informed your vet is. There are certainly vets out there who are great at managing everything except feline diabetes!

When a cat's blood glucose drops into a lower range, especially if a cat isn't used to being in lower numbers, there's a tendency for the liver and pancreas to release a stored form of glucose along with counterrgulatory hormones. These cause blood glucose numbers to spike upward. It can take up to 3 days for what we call a "bounce" to clear and numbers to get back to where they more typically fall. It's not advisable to increase the dose until the bounce clears. If you do increase the dose, you're basing your decision on a reading that is reflective of the bounce vs where the numbers actually are and it could lead to overdosing your cat.

I had never read the data that supports the decision in the EU either. When I questioned the vet he replied by msg only. I will definitely send it out if I find any or the vet will send me one.
I’m living in Hong Kong, we are waiting for the IGF-1 result that the vet sent to USA and takes 2 weeks. He has updated me that he probably will receive the result earlier.

 

[Diane Tyler's Mom GA]

I can tag a member that used to be here that lives in Hong Kong maybe he will see that I tagged him and can tell you what vet he used


@PH&MonkeyPenPenFaFaTiger

 

[Diane Tyler's Mom GA]

Do you make sure that all the sub Q fluid that was given the time before was absorbed completely before you give the next lot?
150 ml every day is quite a lot. Do you give it 3 times a day, every day?

@Bron and Sheba (GA)
Hi Bron , I see that she said above

According to his weight (4.83kg on 22/9) the vet suggested that give him 50ml of sub cut water 3 times a day ( 24 hours)

Her post #25

Bron did you not mean to type 150 ml every day ?
So I'm assuming she's giving 50 ml of sub fluids 3 times a day ?

@Bron and Sheba (GA)

 

[Diane Tyler's Mom GA]

I tried but don’t have enough space !

Hi Jan you said you can't fit in your signature DKA January maybe you get delete Blind 2023 , I assume Max is blind If it still won't work try just putting
DKA Jan

Just tap on your name up top then tap on signature delete Blind 2023 and try adding DKA Jan there
Let me know if it works
@Jan Chung