9/7 Kirby AMPS 550; +6 469; +8 666 (Alphatrak) +10=46 +11=73

Kirby's levels are all over the map again. His level was so high last night, the Alphatrak just told me "HI" with no number. I've tested the control strip and it was fine. Today, he tested 4.5 on the blood ketone meter. I'm in contact with my vet, who had me give Kirby 1 unit Humulin R at lunchtime with a snack. However, his levels kept rising to 666 at +8, which she says may be from the food. [side note: a few days ago I went to feeding two large meals a day, with no snacks unless authorized by my vet, after he had a "near perfect" glucose curve on Tuesday at the vet clinic with no snacks]

Every adjustment I've made to dose has come from my vet. She is now thinking we need to increase to 2 units Lantus, up from 1.75. It does seem to me that his dose is too low. Aside from a few times where he was "too low to shoot" - those times have been rare on Lantus, and with Ketones, we need to bring his blood sugar down. Any thoughts appreciated.

Also, the vet is having me give him subcutaneous fluids again, starting today. Kirby seems to feel OK; still eating, using his litter box. Not perky but also not as bad as he was a month or so again when he had DKA.

 

Ketones 4.5 really? I think Kirby needs to be seen at ER. Anything over 2.44 is an emergency. If kirby had dka before, he is very susceptible to it again, insulin should not be skipped.

Put the ? on your title, you need more eyes on this.

 

This has not helped the ketone situation.

You really need to get to an ER. It cannot be handled at home.

 

I agree. I’ve never dealt with it but from what I have seen here this is nothing to just watch.

 

I agree with Olive about the vet visit, Staci. Kirby's ketones have been building for days and the vets are much better geared up to flush them out of his system than trying to do it at home. Speed is of the essence to prevent him going into a DKA relapse.

I see from your signature line that Kirby is currently underweight and eating quite a low carb food (4%). It's possible that his current weight may be contributing to your difficulty finding a safe dose for him. I suggest asking the vet ASAP about feeding Kirby a higher carb diet for the time being because it might help him to safely receive the amount of insulin he needs to keep the ketones at bay without taking him too low and also help him to regain weight. A more calorie-dense food would help him too.


Mogs
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I'll make it 5 votes - time for a visit to a vet. They can help get those ketones down before it turns full DKA if not there already.

Just two meals a day is part of the problem. Kirby need to eat lots and gain weight to fight the ketones. One fluke good cycle at the vet can happen anytime. He hasn't had any good cycles like that since. Managing diabetes is a combination of the right insulin and the right feeding regime. More carbs are needed to give him the dose he needs. Or feeding him during the cycle so he doesn't bottom out and earn a reduction.

 

Thanks everyone. I asked my vet about going to the ER, she said her opinion is he will be less stressed at home and as long as we get the bg down, his ketones will go down. I will revisit this if he shows any symptoms of DKA. Right now he is acting normal and eating his meal. I just gave him some MC food and put water in it. And will give him more fluids later and check ketones again.

I am very confused on what to feed, as I read on here that low carb is best. The low carb food he's been getting is supposed to be also good for weight gain It does look like he did better eating more meals per day, although my vet didn't like that.

 

An underweight uncontrolled diabetic cat needs to eat as much as he wants as often as he wants. My opinion. FWIW. .

 

Thank you. The vet has OK'ed the higher carb food. The low carb was my idea to begin with.

 

A cat with ketones needs at least 150% (1 1/2 times) the normal calories + insulin + fluids.
The food helps the ketones from forming.
The insulin brings down the glucose numbers.
The fluids help flush the ketones out of the system.

 

Should I feed him a high carb food tonight? I have some of the FF gravy in case of emergencies, but with his blood sugar already high, I don't know if that is wise. He ate some of his normal LC food and some MC food with baby food on top. He ate a decent amount but I will keep trying to feed him more this evening.

 

I also have tuna that I could feed him.. but my understanding is that is basically all protein, not carbs.

 

To add weight, you want higher calories. To give a higher insulin dose, you want slightly higher carbs. Maybe you could try the Instinct lamb limited ingredient version? It's slightly higher carbs but still LC. You probably don't need high carbs tonight. Unless he's really diving by your before bed test.

 

At the ER with Kirby. He is in good spirits and ate more but started vomiting.

 

Glad you guys are getting some help. (((Staci and Kirby)))

Be sure to let us know how you both get on.


Mogs
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ER vet says as long as Kirby is eating and taking his insulin, the ketones are not a huge concern right now. If we can get his levels better.

Giving us meds for nausea and diarrhea.

 

Thank you!

 

Kirby is at 46 at +10.5. I just gave him some food. He acts better then when his levels were high. I know this number is dangerous so I will continue to monitor.

 

Could you quickly get another test? [to check if it was a bad strip on the 46]

If he is that low on an Alphatrak, he needs high carb (a tsp of gravy, or a few drops of honey) immediately.

 

He is now at 73

 

Excellent!

I was pretty sure he was lower than usual based on this:

but 46 is scary-low on an AT, so you want to be sure. Hopefully the 73 means he'll stay in the safe zone.

Wonder if there was something bothering him to cause the high numbers (and ketones ), something that maybe has gotten better recently?

 

Just realized, you gave Humulin R yesterday according to the spreadsheet. Did you give it again today, and when?

[apologies: I got myself completely mixed up on times while looking at the spreadsheet, thinking last night's PM cycle was today's AM cycle in a far-flung time zone if that makes sense. So, switch AM/PM references, and disregard questions about Humulin R in the current cycle, and disregard requests to update the spreadsheet. It's updated, I just somehow missed the PM cycle numbers . Time for more !!!!]

Your PM [edit: AM] shot may be tricky-- you don't want to skip with ketones around, but he may still be low in an hour.

I don't know if I can help with the PMPS [edit: AMPS] decision-making, especially if there is the short-acting insulin on board today. You may want to attract some other eyes by putting up the "?" and changing the title. It would also be a good idea to update the spreadsheet with today's numbers and any additional insulin, so everyone has all the information in front of them.

Whew! It's great that Kirby is in better numbers, and feeling better, at least!

 

I wish I knew! Bg 99 now

 

OK!

So, after I got over my panic at seeing that 46 and properly looked at your spreadsheet , I see that you've shot some greens in the recent past-- an 80 on 9/6 and a (reduced-dose) 78 on 9/3.

With the ketones ongoing, you want to make sure he's getting enough insulin. If no one else comes on with an opinion, I will go ahead and say I think you can shoot now. Probably a good idea to get another ketone test in soon, too, to see how that is progressing. I see the 4.8 last night at PM+1, was that before the ER visit?

With any luck, he'll go a little higher again for at least a couple hours and let you get a nap in!

 

Thank you! He just tested at 110. I wanted to make sure he's rising.
Would you keep him at dose 1.75? Or 1.5?

The ketone test was before the ER, that's correct. I tried to do another this morning but didn't get enough blood. I will try again soon.

 

Ack. This is where I'd like someone with more ketone experience to weigh in.

The 46 definitely "earned a reduction" down to 1.5 under normal circumstances, but I'm not certain if it would be taken here. Arrgh. Hopefully someone who knows will pop up soon?

 

My vet said she is ok with 1.75 as long as I can watch him. So we just did that.

I have a sort of unrelated question... I read yesterday that when you draw up a dose of Lantus, you should not push air or fluid back up into the vial. So I am now trying to do it without doing that, but there is always a little air bubble in the syringe that I can't figure out how to get rid of.

 

Ah! That I can help with!

One trick to get rid of air bubbles is to always draw up a little more than you need, then turn the syringe up so the air bubble floats to the top (tapping gently to encourage it if necessary) and is pushed out when you adjust to the desired dose.

 

Removing Bubbles From Syringe

* Draw up about 1 - 1.5 units more than the dose you need (e.g. if giving a dose of 1 unit, draw up 2 - 2.5 units of insulin).

* Hold the syringe with the needle pointing upwards.

* Flick the side of the syringe to move any bubbles up to the top of the barrel. If there are several small bubbles, try flicking until the small bubbles 'pop' and form a single larger bubble (easier to remove).

* Try to centre the single bubble directly under the needle if possible. (Easier to shift than when it's stuck to the side of the barrel.)

* Keep the syringe needle pointed upwards and express most of the excess insulin. This should remove the air bubbles.

* Finish by doing the fine adjustment to set the required dose.


Mogs
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Thank you! that's very helpful!

Link to today's thread : https://www.felinediabetes.com/FDMB/threads/9-8-kirby-amps-99-2-143-alphatrak.234934/