I can't control the ketones

Alyce & Elkie

Alyce & Elkie

Member
My sugar cat was recently hospitalised for 3 days with DKA, I got him back home and the next day (11th April) he read 3.3 on the blood ketone monitor I purchased, then 3.6 later that day. I managed to get him to eat significantly more than usual, next day on the 12th I was relieved to see his ketones had dropped to 0.8. They'd built back up to 1.8 yesterday on the 13th. I continued feeding extra to keep them at bay and today the 14th they've jumped up to 2.4, Happy Birthday to me... They're still only showing as either negative or traces on urine KetoStix. I don't know what else to do.


His glucose levels have remained high since I got him home too. They're down from the 33 he went up to at the vets on a pet monitor AlphaTrak, but I can't get them to drop below 17 on a human monitor which is possibly around 19 on a pet monitor. He's on 3 units of Lantus, he was on 2 units before going into DKA and his blood sugars would go between 11 (uncommon) to 18 (uncommon), averaging around 15. Is he higher because of the DKA? The vet wanted him on 4 units but I thought it would overdose him. He's not going low then bouncing as I've checked him multiple times daily. Please help. I'm starting another work week today, my mother will be home on and off to check on him (not test) through the day, but I can't focus on work knowing his levels are rising again!
 
Do you have the half unit marked syringes? I think you'd be OK going to 3.5 units. Note, this is a more aggressive that what we'd suggest for people following SLGS, but would be OK if following TR for dosing. Given you are dealing with ketones and recent DKA and test frequently, it would get you to a better dose faster, but still safely.
Alyce & Elkie said:
Is he higher because of the DKA? T
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Part of the formula for DKA involves and infection or systemic stressors. Did the vet find either of those? Both of those can also cause higher BG numbers.
 
Alyce, have you contacted the vet again about subQ fluids? I think they could help bring down the ketones so I would press to get the vet to allow you to give them at home. The vet would need to have checked Elkie heart to see it is ok to give the subQ fluids.
Keep up the extra food and I agree with Wendy about the dose increase.
And I agree, I would ask about any infections or inflammations.
 
Wendy&Neko said:
Do you have the half unit marked syringes? I think you'd be OK going to 3.5 units. Note, this is a more aggressive that what we'd suggest for people following SLGS, but would be OK if following TR for dosing. Given you are dealing with ketones and recent DKA and test frequently, it would get you to a better dose faster, but still safely.

Part of the formula for DKA involves and infection or systemic stressors. Did the vet find either of those? Both of those can also cause higher BG numbers.
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Thanks for the advice. No I don't, because they're coming from America, as we can't get them in NZ. Problem is I can only test regularly overnight and on my days off, but not during the day Mon-Fri. The vet didn't test for anything no. :/
 
Bron and Sheba (GA) said:
Alyce, have you contacted the vet again about subQ fluids? I think they could help bring down the ketones so I would press to get the vet to allow you to give them at home. The vet would need to have checked Elkie heart to see it is ok to give the subQ fluids.
Keep up the extra food and I agree with Wendy about the dose increase.
And I agree, I would ask about any infections or inflammations.
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No, they won't let me take fluids home unfortunately, they explained it wasn't an option.
 
The vet didnt test for any inflammation or infection and isn't taking me seriously about the ketone monitor, as she hadn't heard about them being used in cats and didn't know how to calculate it. She doesn't want to see him for more blood tests right now due to his stress levels at the vet, she said it's not in his best interest. She never gave him sub-Q fluids, apparently she tried but he was a difficult patient.
 
I've already paid the vets over half my 2-week wages within the last week or so alone, and I'm still a couple thousand in debt with them so everything else needs paid at the time of consultation. Makes things a bit harder...
 
Are you using the BD syringes? There is a paper rule you can use if so, that helps you with smaller doses.
 
Excellent, you will need the syringes. More information here about syringes, including a video towards the bottom on how to use them:
Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

Here is that link to the paper ruler:
And this paper has a description of how to use it, starting page 255 with section titled "Administration of small doses of glargine..."
 
Wendy&Neko said:
Excellent, you will need the syringes. More information here about syringes, including a video towards the bottom on how to use them:
Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

Here is that link to the paper ruler:

And this paper has a description of how to use it, starting page 255 with section titled "Administration of small doses of glargine..."

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Thanks, will these work for me? It says it's for the BD syringes with half-marks 8mm, mine are 12.7mm and don't have half marks.
 
8mm and 12.7 are the length of the needle. Can you tell me exactly what it says on the syringe box? We do have people who have used the paper ruler with syringes with whole unit markings only.
 
Wendy&Neko said:
8mm and 12.7 are the length of the needle. Can you tell me exactly what it says on the syringe box? We do have people who have used the paper ruler with syringes with whole unit markings only.
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BD Ultra-Fine Insulin Syringe
0.3mL 0.33mm (29G) x 12.7mm
30 units of insulin or less, U-100 only
 
Wendy&Neko said:
8mm and 12.7 are the length of the needle. Can you tell me exactly what it says on the syringe box? We do have people who have used the paper ruler with syringes with whole unit markings only.
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I failed tonight, I practiced with a syringe but had a huge air bubble no amount of tapping would remove, was also having trouble figuring out where half was as the plunger line wasn't perfectly straight. Ended up opening his new pen as this one was almost empty anyway, and shooting 3 units closer to the left shoulder than the middle like I usually do. His blood sugars were at 20.6 preshot so feel like I've failed him again, that's the highest I've recorded him in days. I was also half an hour late for the shot as I was picked up late, then was practicing with a syringe. He still isn't receiving his insulin exactly 12 hours apart as since the vet dosed him at 3pm I've been moving his shot time forward by 15 minutes each time (15 mins late) until I get back to 9am and 9pm. There was one instance where I wasn't able to make the 15 min time so ended up shooting 30 mins late, then shot same time in the morning as I'm moving it by 30 mins max per day. The same has happened tonight which is unfortunate.
 
Alyce & Elkie said:
I failed tonight, I practiced with a syringe but had a huge air bubble no amount of tapping would remove, was also having trouble figuring out where half was as the plunger line wasn't perfectly straight. Ended up opening his new pen as this one was almost empty anyway, and shooting 3 units closer to the left shoulder than the middle like I usually do. His blood sugars were at 20.6 preshot so feel like I've failed him again, that's the highest I've recorded him in days. I was also half an hour late for the shot as I was picked up late, then was practicing with a syringe. He still isn't receiving his insulin exactly 12 hours apart as since the vet dosed him at 3pm I've been moving his shot time forward by 15 minutes each time (15 mins late) until I get back to 9am and 9pm. There was one instance where I wasn't able to make the 15 min time so ended up shooting 30 mins late, then shot same time in the morning as I'm moving it by 30 mins max per day. The same has happened tonight which is unfortunate.
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The 30 min late time tonight actually meant he'd gone 12 hours and 45 minutes between doses, as I did the morning dose at 6am, intending to the the evening dose at 6:15, which ended up being 6:45. Maybe I should have just guessed the 3 1/2 units as it would have still been between 3-4, or just given the 4 like the vet did the first day as I'm home all night. Only thing is he was reading at 33 when they did 4 units, which is a lot different than the 17-19 he's been since coming home. The 4 units took him from 33 down to 20.5, so I think it would be too high a dose to do now. I just know I'll feel so guilty if anything happens due to not giving enough insulin, as I promised him I'd give him enough and get him better once I got him home. So far I've failed to do either, he spends most of his time stretched out on the floor when he's not eating.
 
You can print off that ruler and see if it lines up for the unit marks with your syringes. The rules is for the BD Microfine, but might work. The other option you can use for smaller in between doses is a digital caliper. This post shows you how, including video. Dosing with calipers. My hubby got calipers for me at his favourite woodworking and metal working store. You can also get them at Amazon or equivalent. It'd be good to increase him to 3.5 units.
Alyce & Elkie said:
I practiced with a syringe but had a huge air bubble no amount of tapping would remove,
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I used the BD Ultrafines too, bubbles were horrible! One thing you can do with a bunch of bubbles is point the syringe with the needle up. Draw down the plunger enough so that you get a little pocket of air on the top of the syringes. Then try tapping. For some reason, little bubbles like to migrate towards bigger bubbles.

When needing to make up time, you can shoot 15 minutes earlier each shot, or 1/2 hour once per day with Lantus.
 
When my Wiggles last had high blood ketones and was not eating well I added a little R insulin (~$28 for 10ml vial@Walmart) to help bring down BGs I still frequently use a little (0.1 to 0.3U) R now to quickly bring BG down. Yes, it is hard to measure such small amounts because of bubbles and because the Zero marks on BD syringes have been off up to 0.5 units.
 
Larry is very experienced in dealing with diabetic cats.

@Alyce & Elkie Please do not consider R insulin unless you have someone ready to help you out with it. There are more things to learn about when NOT to use R than how to use it. And given you only have access 1 unit marked syringes and just a tiny dose is needed, R might not be a good idea.
 
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Wendy&Neko said:
One thing you can do with a bunch of bubbles is point the syringe with the needle up. Draw down the plunger enough so that you get a little pocket of air on the top of the syringes. Then try tapping. For some reason, little bubbles like to migrate towards bigger bubbles.
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I have also found this to be true. It's probably something sciencey like cohesion of fluids. Pull the plunger down very slowly. Sometimes spinning it helped.

Sometimes the pressure would be "off" a little on Kobe's pen... like the insulin didn't want to come out. I found it helpful to twist the end of the pen a bit like I was going to use the pen in the way it was designed and then depress the button. It helped with the pressure in the pen and made insulin easier to draw. Good luck!
 
Wendy&Neko said:
Larry is very experienced in dealing with diabetic cats.

@Alyce & Elkie Please do not consider R insulin unless you have some ready to help you out with it. There are more things to learn about when NOT to use R than how to use it. And given you only have access 1 unit marked syringes and just a tiny dose is needed, R might not be a good idea.
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Okay thank you, I won't. Doubt my vet would prescribe me it anyway. Think I've underdosed tonight, really tried to do 3.5 but think it was a bit under... I messed up this morning too. I'd set multiple alarms to do his insulin and must have somehow turned them off and not gotten up. I'd stayed up late and only went to bed around 45 minutes before his shot, should have stayed up. Luckily he woke my mother scratching in her room wanting fed at 9am, 2 hours late... we're back to his normal shot time now because of it but totally gutted he went 2 hours without insulin.
 
Kobe (Dean and Lesley) MO said:
I have also found this to be true. It's probably something sciencey like cohesion of fluids. Pull the plunger down very slowly. Sometimes spinning it helped.

Sometimes the pressure would be "off" a little on Kobe's pen... like the insulin didn't want to come out. I found it helpful to twist the end of the pen a bit like I was going to use the pen in the way it was designed and then depress the button. It helped with the pressure in the pen and made insulin easier to draw. Good luck!
Click to expand...

Thanks, I'll try it :)
 
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