4/20 RK - AMPS 522 +1 475 +2 421 +3 402 +4 301 +5 222 +9 188 PMPS 550 +3 362 +5.25 435 (ket 4.9-0.1)

How much ondansetron you giving her? She's such an itty bitty thing. Piling on more healing vines and good wishes for your little fighter.

Spreadsheet?
 
Wendy&Neko said:
How much ondansetron you giving her? She's such an itty bitty thing. Piling on more healing vines and good wishes for your little fighter.

Spreadsheet?
Click to expand...
2 mg every 8-12 hours. Spreadsheet is under Tubby’s link until I revamp my signature. I used your suggestion and added a tab to his sheet for now.
 
Hmm, the spreadsheet looks like a drop of R was a lot for her. After two hours she was down 100 points, but we don't want to see a drop any larger than that over the duration of R. Looks like she did 200 points. Maybe she needs to be front loaded with a few more carbs if you give R? R can sometimes cause later nadirs too. She does love the bounce!

PS: Don't forget to update the spreadsheet too.

Ondansetron can be given up to 4 times a day if needed.
 
Evening update:
  • PMPS is back up into the blacks again.
  • She didn’t eat much at PMPS but had nibbled both dry and canned food at some point during the day. I’ve been supplementing with syringe feeding canned and recovery food periodically. She only wants the higher carb so I’m sure that’s not helping her BG either..
  • Attitude is “tired” but able to ambulate; she is still weak and she feels “spiney.”
  • Bloodwork from yesterday was better, although potassium is still low and liver values are still elevated.
  • Antibiotics (Clavamox) are ongoing for at least another week. She also received enrofloxacin.
  • I’m giving subQ fluids once or twice a day, totaling around 150 ml.
  • Ondansetron is on board; added Cerenia earlier today.
  • Blood ketones are bouncing up and down.
Questions:
1) How often should I be checking ketones?
2) Is it normal for ketones to bounce up and down so quickly (for example, 4.9 to 0.1 and back up again within hours)?
3) Is there a time of day ketones tend to run higher or lower (ala what we see with BG running lower in some cats overnight)?
4) How long should I hold the 0.5u Lantus dose?
The insulin schedule has been a bit erratic given the constant vet visits and hospitalizations, with some late or missed shots mixed in as a result, so I’m trying to get RK settled into a consistent routine. It doesn’t help that we started with N and were shooting TID with it.

@Wendy&Neko to answer your question about shot times and R, I’m not sure exactly what schedule we’re going to land on (hopefully) long term—for now I’m just trying to get consistent insulin in her so we can evaluate dose. But but I can be flexible, so if there’s a time you or Sandy or whomever can work with me on an appropriate R dose, I can most likely make it happen.

I added a drop of R today on both shots to pull us out of the stratosphere. I technically know how to use it but it’s been awhile and I appreciate that one of you will be my wingman and guide me. It’s always easier to be objective when you’re not eyeball deep in the weeds of DKA.

Any other suggestions anyone? I really anppreciate the help.
@Bron and Sheba (GA)
 
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She's gotten to blues both yesterday and today, and the Lantus depot is still building. I'd be a little patient on the Lantus dose yet.

Higher ketones seem to be corresponding to her higher numbers, she's been good in the blues. I'd say test at least twice a day.
 
Wendy&Neko said:
She's gotten to blues both yesterday and today, and the Lantus depot is still building. I'd be a little patient on the Lantus dose yet.
Click to expand...
That’s what I was thinking but wasn’t sure if the “rules” were different with DKA in picture (I admittedly tend to be conservative with dosing so thanks for the reality check).
 
We would break the rules with DKA, if she starts climbing and not coming down, or showing signs of lethargy etc.
 
Spreadsheet updated. I’m back out the door for awhile.

@Wendy&Neko so my logic was that the drop of R might give her an “assist” in getting out of the 500s in the early part of the cycle until the Lantus could take over, especially given that her ketones were spiking and we needed time for the depot to build. I’m pondering now whether we’re far enough into the Lantus shots that the depo is stable (or nearing stable) and perhaps I should skip the R for a couple of cycles to see just what Lantus can do on its own. It’s also good to have the data showing that the ketones pop up and down rather than a straight upward trajectory. And although she gets more muted when BG and/or ketones are higher, she doesn’t seem quite as much in crisis (read: looking/acting “half dead”) as she did on initial diagnosis. Thoughts?
 
Agreed, getting a better handle on her L action by itself (onset, typical nadir) will help figuring out what timing is best for R. I'm also worried about R dropping her too fast and setting up another bounce cycle. I'd also like to know if she's getting to blues on just the L.
 
She had a pretty strong response and hit green on her very first dose of Lantus, which I know can happen, but haven’t seen it since. The N should have been mostly out of her system by then, but who knows. There were quite a few variables with vet visits and hospitalizations and missed/late shots in the first few days of L. She seems a bit more stable than she was (knock on wood) so I’ll hold the R for now and see where the Lantus takes us.
 
I might also need to be mindful of subQ timing. I saw impact on BG after giving fluids to both Charlie and Tubby, so maybe best to not stack them on top of R action.
 
It's ECID if subq has an impact. It might more so on a dehydrated cat. I gave fluids back half of the cycle when she was going up anyway.
 
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