? PLEASE HELP

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Bron and Sheba (GA) said:
The higher BG numbers could be from a bounce from the low green BGs yesterday.
I would check with your regular vet if he is OK with you giving the sub Q fluids with someone hearing that heart murmur…..just to be cautious. He may suggest reducing the dose to 50 mls.
What are the urine ketones tests telling you?
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I will definitely check with our regular vet. She is the one the gave us the fluids yesterday, (we did not see her, but we spoke by phone for 5-10 minutes and she prescribed us fluids by phone) and I forgot to ask her about the murmur at the time, with all this stress- but having said that, she did read Buddy’s file from emergency I believe, so I am guessing she was aware that they thought they may have heard a smal number (and only 1 of the 7 times she was checked was it heard- the rest of the time there was no murmur- do murmurs come and go? Or could it be a mistake perhaps?) when she told us to give 100ml fluid a day. I’m just paranoid and wish I’d gotten the chance to re-confirm with her before she left for the weekend!

Urine ketone results are negative, and blood ketone test is at 0.2 after fluids.
 
D'Arcey Taylor said:
Urine ketone results are negative, and blood ketone test is at 0.2 after fluids.
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These are both normal results. Try and take some deep breaths. You are both doing a great job looking after her. We don’t want either of you to get ill so make sure you are both getting enough sleep and time away.:bighug:
 
It is Buddy’s shot time, and she is at 389. Her blood ketones are now at 0.5. I am hoping to get some dosing advice for how much insulin we can give her tonight. I’m really nervous about the ketones going up. Should I be posting in a new post to ask for help?
 
I’m going to see if I can get @Marje and Gracie to have a look. I am not a Prozinc user and I can’t see any Prozinc users around at the moment.
Can you wait a few minutes please.
Remember the number of ketones on the blood meter you need to be concerned about is 2.4 to 2.55
 
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D’Arcey started a new thread and wrote the following .(just keeping it in this thread for the time being )

Our car Buddy just got back after 4 nights in the hospital for a DKA and severe pancreatitis.

It is Buddy’s shot time, and she is at 389. Her blood ketones are now at 0.5. Yesterday they were at zero on a blood ketone meter. I’m very scared, anxious and conceded. They were at 0.3 this morning, and we gave her 100ml fluids. Then they were at 0.2. Two hours later, they are at 0.5. The 4 days of hospital care cost us $8000 and I want to do everything we can to help her and keep her improving, and to avoid going back to the hospital if we can.

I am hoping to get some dosing advice for how much insulin we can give her tonight. I’m really nervous about the ketones going up.

We are here to monitor her and test her around the clock. In the past she was doing well on 2.5 units prozinc twice a day, and was only lower to 1.5 because we were out of town. The hospital started her back on 1.5, and she was low yesterday, at 50- however my understanding is that the hospital ONLY offers food at shot times, meaning when she reached 50, she wouldn’t have eaten in 11 hours..........

note: we were previously posting in this thread:https://www.felinediabetes.com/FDMB/threads/please-help.250982/#post-2831671
 
Not sure if @Chris & China (GA) is around as she helped us yesterday. We are really wondering if we can go back to shooting 2.5 units. The only reason we ever lowered to 1.5 was because we were not going to be around for mid cycle monitoring. She had been on 2.5 or higher for quite a while, and doing well, and no ketones, and when we lowered to 1.5, that’s when things started to go awry (that and the missed dose). She has never had a hypo before (the lowest she has ever been in the 1.5 years since diagnosis is 47, and no symptoms of a hypo, and the number went right back up). We have heard before that it can be okay to return to the last dose that was working well for your cat, which for us seemed to be 2.5. I just want to get as much insulin as we safely can into her, so we can get her feeling better and get the ketones under control. Yesterday she went quite low after being given 1.5 units at the hospital BUT they don’t seem to have recorded a pre-shot number for her (honestly I don’t know if they even took one...) and they ONLY feed at shot time, so she hadn’t eaten in 11 hours!
 
D'Arcey Taylor said:
Not sure if @Chris & China (GA) is around as she helped us yesterday. We are really wondering if we can go back to shooting 2.5 units. The only reason we ever lowered to 1.5 was because we were not going to be around for mid cycle monitoring. She had been on 2.5 or higher for quite a while, and doing well, and no ketones, and when we lowered to 1.5, that’s when things started to go awry (that and the missed dose). She has never had a hypo before (the lowest she has ever been in the 1.5 years since diagnosis is 47, and no symptoms of a hypo, and the number went right back up). We have heard before that it can be okay to return to the last dose that was working well for your cat, which for us seemed to be 2.5. I just want to get as much insulin as we safely can into her, so we can get her feeling better and get the ketones under control. Yesterday she went quite low after being given 1.5 units at the hospital BUT they don’t seem to have recorded a pre-shot number for her (honestly I don’t know if they even took one...) and they ONLY feed at shot time, so she hadn’t eaten in 11 hours!
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I understand what you are wanting to do but if you increased, I would only recommend you go up in 1/4 unit increments at this point. We don’t want her to drop into very low numbers because we increased too quickly. There are no ketones in the picture at the moment so it is safe to go up slowly.
My only concern is she could be bouncing.
Marje may have gone to bed.
If we don’t hear back from someone soon I think we could increase to 1.75 units. I know you will monitor closely. We need to keep I mind she might be bouncing and could drop back down.
How does that sound?
 
Bron and Sheba (GA) said:
D’Arcey, what have you decided to do?
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Sorry for the delay. And thank you for all the help and advice. My husband decided to call the emergency hospital and they said to give two units because her ketones are continuing to go up on the blood ketone meter. So we gave two units; sorry, just saw you message about giving 1.75. Sorry for all the chaos around this, the extreme stress of this has added panic attacks to my already existing severe anxiety and I’m having trouble thinking straight. I hope we didn’t make a bad decision. We are going to monitor her non-stop, we have high carb food and corn syrup nearby, as well as syringes if she were to stop eating. We are praying nonstop that we are making okay decisions, we just want our baby to be okay and this is so so hard. Thank you so so much for your help, and I’m so sorry that we ended up giving a little bit more than you mentioned, we didn’t see your message until after we had chatted with the vet tech and shot her.
 
Sorry...it's been one of those days. The 2u dose should be OK. I know you had been giving 2.5 before all this started so figured she'd probably need more than the 1.5.

Blood ketones don't even become "trace" until around 2.4 so try not to panic (although we all understand that's easy to say and very hard to do)

Get a +2 and see how she's doing.

As long as she's eating well, that's a good sign that she's not going back into DKA. Cats with DKA look sick, don't want to eat, hide and don't interact the way they usually do so keep those in mind. I'd also try weaning her off the appetite stimulant instead of just giving it when it's due as long as she continues to eat well.

How much does Buddy weigh?

ETA: Tomorrow, it's a good idea to go ahead and start a new thread (I know you started one tonight but since we're all here now, we can continue to use this one). If they get too long, it's too hard to go back and quickly see what's been going on and what advice you've already gotten. In your new post, put the link to this one in so anybody new can go back and read this to get up to speed on what's been happening.
 
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D'Arcey Taylor said:
Sorry for the delay. And thank you for all the help and advice. My husband decided to call the emergency hospital and they said to give two units because her ketones are continuing to go up on the blood ketone meter. So we gave two units; sorry, just saw you message about giving 1.75. Sorry for all the chaos around this, the extreme stress of this has added panic attacks to my already existing severe anxiety and I’m having trouble thinking straight. I hope we didn’t make a bad decision. We are going to monitor her non-stop, we have high carb food and corn syrup nearby, as well as syringes if she were to stop eating. We are praying nonstop that we are making okay decisions, we just want our baby to be okay and this is so so hard. Thank you so so much for your help, and I’m so sorry that we ended up giving a little bit more than you mentioned, we didn’t see your message until after we had chatted with the vet tech and shot her.
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That is OK. I do understand your anxiety and worry and you love your kitty.
We do say here that the CG holds the syringe and must be comfortable with the dose.
But do know that the number of ketones showing up (O.2 to 0.5) in the blood ketone meter is not of concern. A lot of cats show a small amount. Those would not even show up as a trace in the urine.
Get a +2
 
Thank you everyone! Thank you so much.

We got a +1, and will get a +2 as well. Will be updating the spreadsheet to reflect the +1 now and will update throughout the night. Frankly, I will be testing her every hour until we see a nadir, and more than once an hour if she’s dropping quickly.

Buddy weighs 11 pounds.

Good to know about the ketones. Sorry I sound so crazy. My mama heart is having a hard time. I really though I was going to lose her. My greatest fear was leaving her to go on vacation and something happening, and it did. She had great care and it was noonea fault, but I’m struggling through this all and every little possible issue feels like a crisis to me!

Thankfully our regular vet is great, but she only works normal weekday hours, so we could only talk to the emergency vet tech, and sometimes their advice is questionable. I need to try to remain calmer in the future because overall I trust this board far more than most vets!

She seems to be eating well. We are also making sure our hypo kit is ready, and we are preparing to syringe feed or give corn syrup if needed.

Thank you all again for your patience and advice and support, I can’t thank joint enough. Will update with the +2 soon!
 
Also sorry to just get here; we were out. I’m glad you are testing tonight since you are increasing the dose. As others have said, her ketones on a blood ketone meter are fine at the level, they are at. If she’s eating, she’s not likely got much in the way of ketones.
 
I am very very nervous and scared we made a mistake. She went from 397 pre shot to 241 at +2. I’m so sick to my stomach. We have dry food and syrup but I’m so terrified now.
 
I’m scared we could be headed towards a hypo. Is there anything else we should be doing now to prepare or to avoid this? I’m sorry and thank you. I’m praying she’ll be okay
 
D'Arcey Taylor said:
I am very very nervous and scared we made a mistake. She went from 397 pre shot to 241 at +2. I’m so sick to my stomach. We have dry food and syrup but I’m so terrified now.
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Don’t give dry food, it takes longer to get into the system. For the moment just give her a snack of ordinary low carb food. Remember you are in control because you are testing. We are here to help if needed.
If needed do you have wet higher carb food?
We expect a drop in BG at +2 as the insulin onsets
 
Bron and Sheba (GA) said:
Don’t give dry food, it takes longer to get into the system. For the moment just give her a snack of ordinary low carb food. Remember you are in control because you are testing. We are here to help if needed.
If needed do you have wet higher carb food?
We expect a drop in BG at +2 as the insulin onsets
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Okay, good to know. It was a bigger jump than I was expecting so early, but I had a snack myself and am trying to stay calm.

She has her regular fancy feast available. She ate about a can at shot time, and has snacked on it since then. Should I continue to leave food accessible to her all the time, or is it better to just give her snacks when the numbers warrant it?

We have a bazillion strips, two meters, and two people available and willing to test her non stop if needed! Haha

We are just double checking the carb count of the high carb foods we keep around just in case- they appear to both be 18% carbs. Is that sufficiently high carb? We have temptations treats on hand too.
 
D'Arcey Taylor said:
Is that sufficiently high carb?
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should be but try to relax....breathe!!

As long as you are able to test, YOU are in control of her glucose levels

D'Arcey Taylor said:
Should I continue to leave food accessible to her all the time, or is it better to just give her snacks when the numbers warrant it?
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Either is OK. I think most of us feed multiple small meals but others leave food down all the time so there's no real right or wrong answer. My only concern with leaving food down would be if she did start to drop too low, most cats will go looking for food and if the only food down is her regular low carb, she may not want to eat more when we actually need her to.
 
D'Arcey Taylor said:
She has her regular fancy feast available. She ate about a can at shot time, and has snacked on it since then. Should I continue to leave food accessible to her all the time, or is it better to just give her snacks when the numbers warrant it?
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At the moment I would only feed her when we need to because we want to keep her hungry so she will eat when we need her to, but in saying that … we do want to her keep eating because of the DKA.
D'Arcey Taylor said:
they appear to both be 18% carbs. Is that sufficiently high carb? We have temptations treats on hand too.
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We can always increase the carb amount by adding some honey.
 
Sounds good. We will take away food, and see what happens at +3, and go from there.

She had an appetite stimulant today, so will hopefully keep eating well, but just to be save I won’t let her free feed, we will just test and then give snacks as the numbers warrant them.
 
I know how hard it is to leave your beloved diabetic kitty. I hated leaving Sheba.
I hate leaving my kitties now and they are not diabetic cats!
I had to go to hospital unexpectedly and suddenly when I had Sheba, and because I had been unwell, I had nothing organised. The only person who knew how to test was my 9 year old granddaughter and I gave my daughter a 10 second lesson on how to give the dose. My husband at that point wasn’t testing or giving the dose. My daughter had to also go out and buy the raw meat…I fed a raw diet…and I had run out of food….and prepare it all.
My granddaughter taught the adults how to test and give the dose. Early on they texted me to say the BG was 3 and what to do. I sat up quickly and was of course anxious and the heart monitor went crazy…the specialist happened to be there and said he would ban all texts if I couldn’t calm myself!!
So I do get how you are feeling!
When I got home after a week, everyone, including my husband could test and give the insulin!
 
We also have some Whiskas perfect portions cuts in gravy - we have the Turkey one, the mixed grill, the salmon, and the tuna, which may be high carb, but we can’t seem to find the carb info, and there’s no nutritional info listed on the container to calculate it
 
Bron and Sheba (GA) said:
I know how hard it is to leave your beloved diabetic kitty. I hated leaving Sheba.
I hate leaving my kitties now and they are not diabetic cats!
I had to go to hospital unexpectedly and suddenly when I had Sheba, and because I had been unwell, I had nothing organised. The only person who knew how to test was my 9 year old granddaughter and I gave my daughter a 10 second lesson on how to give the dose. My husband at that point wasn’t testing or giving the dose. My daughter had to also go out and buy the raw meat…I fed a raw diet…and I had run out of food….and prepare it all.
My granddaughter taught the adults how to test and give the dose. Early on they texted me to say the BG was 3 and what to do. I sat up quickly and was of course anxious and the heart monitor went crazy…the specialist happened to be there and said he would ban all texts if I couldn’t calm myself!!
So I do get how you are feeling!
When I got home after a week, everyone, including my husband could test and give the insulin!
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Oh my, I’m so sorry you went through that!!! That’s so scary. It’s so hard to leave our babies, and the anxiety and heart racing is real! Also, it’s amazing that your granddaughter taught all the adults to test- that is so cool! What an awesome kid!!!
 
D'Arcey Taylor said:
We also have some Whiskas perfect portions cuts in gravy - we have the Turkey one, the mixed grill, the salmon, and the tuna, which may be high carb, but we can’t seem to find the carb info, and there’s no nutritional info listed on the container to calculate it
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Have a look at the ingredients…that should give you a clue

D'Arcey Taylor said:
Also, it’s amazing that your granddaughter taught all the adults to test- that is so cool! What an awesome kid!!!
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I used to let her do the tests when she was here, which was often. And Sheba was very cooperative. And she asked lots of questions and understood it as well which was good.
 
We just took a +3 reading, and she is at 137. Would that warrant a small snack, perhaps a couple of tbsps of her normal low carb food? She is very hungry, and waiting by the kitchen, likely because of the appetite stimulant. As long as we don’t over feed her, she’ll hopefully be willing to continue eating.

We also have medium carb food available (8% carb or 12%) if that would be more appropriate given the numbers, now or in the future.
 
D'Arcey Taylor said:
We just took a +3 reading, and she is at 137. Would that warrant a small snack, perhaps a couple of tbsps of her normal low carb food? She is very hungry, and waiting by the kitchen, likely because of the appetite stimulant. As long as we don’t over feed her, she’ll hopefully be willing to continue eating.

We also have medium carb food available (8% carb or 12%) if that would be more appropriate given the numbers, now or in the future.
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Sorry I didn’t see this earlier.I didn’t get the notification you had posted.
Because it is still early in the cycle and she is dropping quite fast, I would give her a snack of some higher carb food now . At least 12 % and test in 1/2 hour after the last test
 
Bron and Sheba (GA) said:
Sorry I didn’t see this earlier.I didn’t get the notification you had posted.
Because it is still early in the cycle and she is dropping quite fast, I would give her a snack of some higher carb food now . At least 12 % and test in 1/2 hour after the last test
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Sounds good. We had just taken a half hour reading, and she’s at 104. We will give a medium carb snack now. We will be testing every 30 minutes until she starts coming back up- and more if she keeps going down.
 
D'Arcey Taylor said:
Sounds good. We had just taken a half hour reading, and she’s at 104. We will give a medium carb snack now. We will be testing every 30 minutes until she starts coming back up- and more if she keeps going down.
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Sounds like a good plan. Keep posting the BGs please! :D
It looks like she is coming off the bounce
 
Bron and Sheba (GA) said:
Sounds like a good plan. Keep posting the BGs please! :D
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Yes, will do! Is the way I posted the +3 and +3.5 okay? We are in Canada so I put the American numbers in brackets, as I think multiple numbers/words would have prevented it from automatically calculating it. Happy to change it if I’ve done it wrong though!

We gave a snack of 14% wet food. She ate a bit, about half a tablespoon, right away. We are testing again in ten minutes. Depending on the result I’ll bring the food over to her (perhaps her majesty would like to eat while lounging in bed! LOL) or give her a dry treat perhaps if needed- she’d always been keen to have a temptations if we need to get something into her.
 
D'Arcey Taylor said:
We gave a snack of 14% wet food. She ate a bit, about half a tablespoon, right away. We are testing again in ten minutes. Depending on the result I’ll bring the food over to her (perhaps her majesty would like to eat while lounging in bed! LOL) or give her a dry treat perhaps if needed- she’d always been keen to have a temptations if we need to get something into her.
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She may only need a little bit to slow the drop. We don’t want to send her back the other way. See what the next test says. You can always resize the rest of the 14% for later. I used to have lots of small containers in the freezer which said 12%, 20%, 16%etc.

For the SS you have stacked it correctly and you don’t need to add the US numbers in the world SS. For the +3 plus 1/2 hour you write +3.5 …..so it is 5.8@3.5
Then you have to go over to the US SS and manually write it in as any time you add more than a number, it won’t transfer and convert.
 
Bron and Sheba (GA) said:
Ok I would give some more of the 14% with 1 drop of honey to see if we can slow that drop. You just need a small drop of the honey. She is still in safe numbers
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Okay, sounds good. We have some 20% food, would that be better, or would we still add a drop of honey? (It’s corn syrup we have, is that okay or should it be honey specifically)
 
D'Arcey Taylor said:
I will definitely check with our regular vet. She is the one the gave us the fluids yesterday, (we did not see her, but we spoke by phone for 5-10 minutes and she prescribed us fluids by phone) and I forgot to ask her about the murmur at the time, with all this stress- but having said that, she did read Buddy’s file from emergency I believe, so I am guessing she was aware that they thought they may have heard a smal number (and only 1 of the 7 times she was checked was it heard- the rest of the time there was no murmur- do murmurs come and go? Or could it be a mistake perhaps?) when she told us to give 100ml fluid a day. I’m just paranoid and wish I’d gotten the chance to re-confirm with her before she left for the weekend!

Urine ketone results are negative, and blood ketone test is at 0.2 after fluids.
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How much does she weigh
 
@JanetNJ i think after this cycle tonight, Buddy needs to reduce the dose to 1.75 units? What do you think?
The vet said to increase the dose to 2 units from 1.5 units, but I think she was bouncing and came off the bounce this cycle and she dropped fairly fast. She needed high carb food to slow her down up until +4.5. Thanks
D’Arcey could you fill in the +4 and +5 with green colour please? Thanks
 
Bron and Sheba (GA) said:
@JanetNJ i think after this cycle tonight, Buddy needs to reduce the dose to 1.75 units? What do you think?
The vet said to increase the dose to 2 units from 1.5 units, but I think she was bouncing and came off the bounce this cycle and she dropped fairly fast. She needed high carb food to slow her down up until +4.5. Thanks
D’Arcey could you fill in the +4 and +5 with green colour please? Thanks
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Of course! We have adjusted the cells. Sorry, we just realized today that we had to manually edit some things in the spreadsheet :-)

Just tested at +6, and she is at 113.
 
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