All current spreadsheet BG readings are from a Libre. I want to get Tippy's insulin dose right. Her BG is too high. She went into DKA again two weeks ago and is home from a 2 day stay at NC State Veterinary College. She had been on 4.5 units before this second DKA and eating several meals thoughout the day. I tried to update our spreadsheet as accurately as possible but I have way more BG readings in screenshots of her Libreview or I can let anyone view her Libreview results if you download the LibreLinkUp free app. I really think this info would be super helpful especially since we could only fit in a much smaller amount of BG readings in the spreadsheet and since the spreadsheet goes by +hours instead of exact time we just had to out the closest reading for the +hour, so this actually skipped out on some of her lower or really high BG readings from the day. (Or I can post the screenshots in the Facebook page and add the link to the post here so anyone can easily go straight to it.) This post does not let me upload files.. Currently her shot time is around 9:15am and 9:15pm. This can fluctuate by 15 minutes off but we always try to get it within 15 minutes of shot time. She is on 6 units of Lantus Am and 6 units PM right now. We increased to 6 units starting with the am shot on September 15th and have not adjusted it again. She is in the higher 200s most of the time. Two weeks ago when I brought her home she was in the 300s so we increased her insulin. I think she was at 5 units then 5.25 then 5.5. I don't think we did this gradually enough. Someone mentioned her depot was probably messed up when we brought her home or something like that? I can come back and update with exactly what those past doses were from last week if that's needed. Her ketones are really concerning me right now. September 18th 9:34am urine ketone strip was negative (getting new ones tomorrow because these are now several months past the use within 6 months of opening) and at 12:56pm blood ketones were at 1.9 and BG reading from our Prime meter was 282. 1:01pm Libre says BG was 253. Now at 2:56am on September 18th urine ketone looked slightly pink so that is trace. I then took a blood ketone at 3:09am and it was at 6.0. (Thankfully it had come down later that afternoon to the 1.9.) BG with the Prime meter at that same time was 273. Libre at 2:57am was 248 to compare. (September 18th Libre readings 2:34 am 208, 2:53am 253, 4:03am 250, 4:06am 234, 4:36am 230, 5:01am 278, 9:26am 190, 10:08am 239, 12:33pm 226, 1:01pm 253, 1:12pm 274 and then just stays pretty high for the rest of the day.) Please let me know what other info you need, I want to get her dose right and her Libre ends in a day or two. I know I will still need to check with the Relion Prime but I might put another Libre on while I'm trying to get the insulin dose right. I also recorded how much food and the time given every time I gave her a meal or snack since she's been home if that info is needed as well. I have been feeding her more frequently thoughout the day for the last week. She eats several meals with multiple snacks (all low carb). I also started adding water back into her low carb wet food again now that her appetite seems to be back to normal. Tippy seems to be hungry a lot again, coming up to me when I'm eating dinner and wanting more food. Also earlier in the week her ketones were at 4.0, I have a post in here about that. So these ketones are really too high and scaring me right now. How accurate are blood ketone tests? We use the Precision Extra. Please let me know if anything needs to be explained better or if any other info is needed. Thank you! -Sarah Adding updated ketone info: She is still eating very well as of tonight but her ketones were 2.2 on September 20th at 6:40pm and the next day (September 21 at 6:48pm they were up to 3.5. The urine test was negative on the 20th but just now (September 22 at 1:20am) I did a urine ketone and it was small to moderate! Now I'm worried, I did give her lots of water added food when I took the blood ketone reading that was 3.5, is this possibly ketones being flushed out now or is this just build up and I need to take her to the vet again? I will test blood ketones again in the morning and see if they have gone down at all. At this point I think I need to increase insulin again in the morning because of the ketones. -Sarah
Hi Sarah. I can't advise on any of this but hope your Tippy's ketones come down. Maybe Bhooma is around to advise. @Bandit's Mom
It seems like, if you have been on the same dose since the 15th, you need to increase - based on those numbers I see on the spreadsheet. Could you enter the number of units shot in the blue columns for AM and PM? And you say that the spreadsheet data is not showing the highs and lows that the Libre is showing. It’s very important to put in those numbers- especially the low since doses with a depot insulin- are determined based on the nadirs. You can always enter more than one value into a single cell of the spreadsheet simply by typing it in there and putting, for example, “250 @4.5” or whatever fraction of the hour the reading was taken. People usually do it in increments like .15, .5, .75, for the quarter hours. Then you have to color code the cell yourself by using the “fill color” icon at the top of the spreadsheet (it looks like a little paint pot with paint spilling out of it.).
Now, as to ketones, if Tippy is hungry and eating well then that’s a great sign that you aren’t dealing with a DKA. You said that Tippy has no infection going on right now so you should be safe. I’m just trying to lower your stress level about it a little. My boy had high ketones for a long time. I understand the stress about the DKA. I nearly lost him and, financially it was also a disaster from which I have yet to recover (still on my care credit card and I am about to run out of the interest grace period!). So keep checking ketones and I know you will get good dosing advice here. Are you thinking that you actually increased too fast and may have missed Tippy’s best dose? Is that what you were saying?
There are a few times she went down to 235 or 216 etc. and these were not at her nadir. Just random lower 200's scattered in between the higher 200s. She doesn't seem to dip down that low in the middle of the insulin cycle. These numbers all just look too high to me at all times pretty much. I'm wondering if this is normal? What did you do for the high ketones that lasted for a while? I'm battling this right now. She is still eating very well as of tonight but her ketones were 2.2 September 20th at 6:40pm and now (September 21 at 6:48pm they were up to 3.5. The urine test was negative on the 20th but just now (September 22 at 1:20am) I did a urine ketone and it was small to moderate! Now I'm worried, I did give her lots of water added food when I took the blood ketone reading that was 3.5, is this possibly ketones being flushed out now or is this just build up and I need to take her to the vet again? I will test blood ketones again in the morning and see if they have gone down at all. Yes, I was worried that we have missed her correct dose especially since she doesn't get that low at what is supposed to be nadir. I don't know how normal that is or if this is insulin resistance. At this point I think I need to increase insulin again in the morning because of the ketones. I'm in the same boat with care credit and NC State Vet School sending a debt collector. I am trying to take care of this at home. It's expensive and not good for Tippy if I have to run her to the emergency vet every time her ketones start going up. I will take her to the vet but I'm trying not to freak out and take her unnecessarily. If the insulin dose would just keep her BG in a safer zone this wouldn't be happening but I'm so scared to increase too fast because thenI heard I'm going to make her insulin resistant. I don't know what to do, honestly I feel like she needs more insulin asap.
September 15th we started giving her 6 units am and pm up until September 19th when we increased the PM shot to 6.25 and have been doing that since. Libre ran out on Sept 20th at 9:50am. I haven't updated the spreadsheet with the last two days of Libre info but they were still in the high 200s. Will work on that tomorrow. Got one BG reading with the Relion Prime meter Sept at 6:45pm and she was 296 and was unsuccessful on the 21st. Trying to get another Libre put on so we can get her insulin dose right without worrying about trying to get a bunch of BG tests ourselves. I'm thinking we increase to 6.5 in the am today? Especially with these ketones.
Hi Adam, your spreadsheet doesn't have the units given in the U column. Could you please add that? Thanks!
Hi, this is Sarah! My husband is asleep and I was not able to edit the spreadsheet, it's not letting me. I can have Adam do it in the morning. For now this is the info I have that's not in the spreadsheet: September 15th we started giving her 6 units am and pm up until September 19th when we increased the PM shot to 6.25 and have been doing that since. Libre ran out on Sept 20th at 9:50am. I haven't updated the spreadsheet with the last two days of Libre info but they were still in the high 200s. Will work on that tomorrow. Got one BG reading with the Relion Prime meter Sept at 6:45pm and she was 296 and was unsuccessful getting a BG on the 21st. Trying to get another Libre put on so we can get her insulin dose right without worrying about trying to get a bunch of BG tests ourselves. I'm thinking we increase to 6.5 in the am today? Especially with these ketones.
Yes, for doses between 5U and 10U, increases and decreases are in multiples of 0.5U and not 0.25U. So you could have increased from 6U to 6.5U directly!
