Ketone levels vs clinical signs?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Willow71, Mar 9, 2018.

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  1. Willow71

    Willow71 Member

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    Just wondering if anyone else finds that their cat can be high in ketones but not really show signs of being unwell? Twice now willow has had blood ketones reading of 3.7. Yesterday with subcut fluids and insulin an hour earlier seemed to rectify it. But today she won’t let me do subcut fluids so I got some extra water in her food... but she doesn’t seem unwell. Can their ketones come down on their own sometimes? I’m possibly increasing her Caninsulin dose from 1.5 to 2 units twice daily from tonight. She just continues to be high since coming home in the 1 unit then 3 nights later increased to 1.5 units. I know it’s not good to increase too fast but im concerned it isn’t working enough and we will have yet another emergency hospitalisation which are stressing her out. Today 7.5 hrs post insulin she is back up to 25.6 BG
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Please consider setting up a spreadsheet like the one we use here. Are you following the recommended basic testing routine of AM/PM pre shot tests along with at least one other mid cycle or before bed test? We really want to help but without good data it's almost impossible.
     
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  3. Willow71

    Willow71 Member

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    Dec 27, 2017
    Yes I will try to put a spreadsheet together. I’ve been checking preibsulin and middle of the day at a minimum but often s frw more tunes. The vet keeps telling me to test less and maybe test every few days unless she seems unwell but I’m concerned to do this as when she gets unwell it seems to happen so quickly.
     
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  4. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Yes. I'm tagging @Bobbie And Bubba . She's probably offline for the evening, but I'm sure she'll log back on tomorrow.

    It's been a few years, but if I recall correctly, Bubba was throwing moderate ketones and yet was eating and seemed to be feeling fine. Bobbie will be able to tell you more about how he was acting back then.

    Throwing ketones is an indication that more insulin is required. A couple of us helped Bobbie use R insulin as a bolus along with Lantus as a basal insulin. This technique allowed her to get more insulin into Bubba without bottoming him out. Check out Bubba's spreadsheet beginning around December of 2015.

    It'll be helpful if you set up a spreadsheet as Kris suggested...
     
  5. Willow71

    Willow71 Member

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    Dec 27, 2017
    Will definitely sort out a spreadsheet. I have all her info on my phone diabetes app. Just don’t have the headspace to do it today but will set it ASAP. I trusted my instincts and based on what her levels have been over the past few days and gave her 2 units ( an increase from 1.5). She’s sitting at 17.6 at 2 hours post insulin shot and ketones down to 1.9. So I’m much happier with that. Will keep an eye on her but hopefully she won’t bottom out. Even though she’s been a bit high at least the Caninsulin seems to be a more stable curve. The lantus was causing her to bounce all over the place.
     
  6. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Hi there, yes Bubba was throwing moderate ketones ( 5.5 on the ketone meter) starting in Dec. 2015 and was otherwise acting fine, eating like crazy because he was literally starving and he had no symptoms of illness. From that time until we discovered he was throwing ketones, he hung out in the 200-260 range and would not budge.

    Jill and Libby helped me give Novolin R ( Bolus insulin ) along with the Lantus (Basal insulin) to help get enough insulin in him and get his numbers moving downward.

    Just curious as to why you stopped the Lantus ( a longer acting insulin) and went with Caninsulin ( a shorter acting insulin) She would probably get better overage over a longer time span with the Lantus. Was she throwing ketones on Lantus?


    Meantime, keep pushing the water to help rid the ketones, make sure she keeps eating and that she is doesn't have any illness. The recipe for a DKA event is not enough insulin + in appetence + and a systemic stress or infection.

    If you set up a SS the peeps here would be able to help you better. Keep us posted.
     
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  7. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    This all sounds so familiar.

    My Dweezil was on Lantus for 3 years but it would be all over the place, even before we had a monitor and started trying to help him even more. He'd dip down low 16 hours after his shot sometimes and we couldn't maintain a stable routine.

    He had 2 DKA incidents last year but thankfully survived. Both happened while we were away. The cattery is good and saved his life twice, as did our wonderful vet, but his insulin needs just seemed to increase hugely at the cattery (where previously 1.8 units would be ok or sometimes too much, 3 or even 4 units at the cattery would have little effect. Thus, the ketones developed as nobody knew this).

    One thing of note. They CAN get ketones if they eat. Dweezil always ate and he still got ketones and then DKA rapidly.

    In November last year we found some ketones at 1am but managed to treat at home with extra insulin and lots of water.

    After his Lantus just started to often not work anymore early this year, we switched to Vetsulin (Caninsulin) in the hope that as a shorter acting insulin, it would eliminate the low & late low points of the Glargine.

    It was definitely a gentler action than the Glargine, which surprised me actually, as I thought Vetsulin was a harsher insulin.

    Unfortunately, by the time we were able to try the Vetsulin, Dweezil had been DKA 3 times in a week and the ketones just would not go away fully. They kept discharging him in 24 hours as his PH and other levels were ok, but his BG was never lower than the pinks. It was always a balancing act as he HATED being in the hospital or vet and would become SO highly stressed and extremely aggressive to the point nobody could get near his cage. He had his monitor on but to scan him they had to stick the scanner to a long pole just to try to get it close enough

    So he SHOULD have been in hospital long enough for the IV rapid insulin to bring him down lower than pinks. They kept stopping it at pinks and then starting the normal Vetsulin shots. 1 unit. Not enough.

    They kept saying he can't get ketones if he's eating. This is the specialist. He has before, I said, many times. If there isn't enough insulin, the body can't use the food so all the eating in the world won't stop the ketosis process from progressing.

    One time Dwee was sent home from the specialist WITH mild ketones that by that night increased to moderate ones and he was not well. Would not eat much. Back yet again to our normal vet for intra-muscular insulin and fluids. He perked up nicely, but by the next day was flagging again already.

    I believe if we had have been able to get RID of those ketones by the hospital getting his BG down lower, we could have then upped the Vetsulin from 1 (not enough but not hideously bad) to 1.5 (seemed to do NOTHING) to 2 units and he may have been able to be saved.

    As it was, by then he had lost so much weight from being too high for too long, and his shots just simply did not seem to work many times, both the Glargine and the Vetsulin. We don't know why. Everything just seemed to stop working and whenever it didn't work, up his BG would immediately shoot and back the ketones would immediately come.

    He is now...elsewhere and I am devastated. I am angry at the specialists and at Diabetes in general, and just want the light of my life back.

    Please try with the Vetsulin. It may work well for your furbaby. Try hard to get rid of those ketones. You never want to see those, ever.

    Good luck.
     
  8. Willow71

    Willow71 Member

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    Dec 27, 2017
    So sorry for the loss of your sweet baby. I’m so worried we will never get things under control. This morning Willow was 19 BG instead of in the 20s and I thought... great... things are starting to go down but then three hours later she was back at 24.1 BG. The lantus she was on was just not stabilising my her... she was hitting lows suddenly and also going too high.
     
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  9. Willow71

    Willow71 Member

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    Thankyou .
    Thankyou for sharing your experience. I’m going to try to sort the spreadsheet ASAP.
     
  10. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Dec 15, 2014
    How are you today? I still think unless there is an absorption issue, that a dose of 2 units of Vetsulin should start to bring the numbers down to at least the mid teens (Australian numbers) / yellows on the spreadsheet.

    In the end, we didn't care about perfect close to normal numbers or great control. We just wanted Dwee to be safe from both ketones and hypo. Yellows and blues. Sadly, we couldn't get that chance.
     
  11. Willow71

    Willow71 Member

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    She went back to the vet yesterday to get fluids and they started her back on intramuscular insulin Actrapid. Her blood ketones were 15.2! And her temp was a bit low. This improved after a day at the vet. We are giving her 1 unit every 4-6 hrs as directed by our vet. Tomorrow she may transition back to Caninsulin.
     
  12. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    I wish you so much luck. Those ketones need to be kept away.
     
  13. Willow71

    Willow71 Member

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    Dec 27, 2017
    Thankyou. She’s back on the Caninsulin 2 units and we are giving her a break from testing BGs to help her to be less stressed... unless she seems unwell. I also do a utine test daily if I catch one.?The vet wants us to look at doing a curve after about a week back on the Caninsulin. I did check once today just for reassurance and her sugars are up as they have been ... 24.6 today but ketones just at 0.7. So far the ketones are staying at a minimum and not showing in her urine.
     
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  14. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Ok, well, at least for now she's stable. I have my fingers crossed for you.
     
  15. Willow71

    Willow71 Member

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    Thankyou! She was outside in the yard today stalking things (no catching lol). Was nice to see her running around being a “cat” again. Even heard her purr this morning very quietly which I haven’t heard in ages!
     
  16. Booger's Mom

    Booger's Mom Member

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    Mar 12, 2018
    Why did my vet not say anything about needing to check ketone levels?!?!?!
     
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  17. Kris & Teasel

    Kris & Teasel Well-Known Member

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    They don’t usually recommend it. My vet didn’t and when I asked about it she said she’s reluctant to suggest anything that could create litter box avoidance. It hasn’t been a problem for me ever.
     
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  18. Booger's Mom

    Booger's Mom Member

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    Mar 12, 2018
    Maybe get some sand and spray it with starch and let us dry and that should be the same thing as the "special sand" the vets have that they use for you to get urine samples at home. I am so going to try this now lol.
     
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  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Another person on the Lantus forum was successful in getting her kitty to pee in dry lentils in the litter box. They can be washed and reused for pee testing. You could try that. They probably have the right texture, etc, when kitty is digging.
     
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  20. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    We never had any issues testing Dwee's pee. He never fully put his little butt down and we knew his routine so well we just would be there ready to subtly stick the test strip under the stream. It never bothered him. Only needed to hold it there for a few seconds and make sure the pee got on the right part of the strip.

    Unless the BG is really consistently well controlled, you should ALWAYS test for ketones!

    We tested every pee we could get. Vets say every 24-48 hours is enough but no, it isn't if their BG is high.

    That is SO GOOD that Willow was playing and sprightly! It used to light up my life when Dweezy would have those moments.
     
  21. Willow71

    Willow71 Member

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    Dec 27, 2017
    Unfortunately Willow is back st the emergency vet. We transitioned from 2 units to 2.5 of caninsulin (vetsulin). But her BGs have stayed high. We had been testing less with bloods and just catching urine and going by her other signs of being well or not. Last night she became less interested in food and stopped eating this morning... she was very flat. On going to the vet they confirmed she was in DKA again and tummy a bit sore. She vomited at the vets too They treated her with fluids and rapid insulin. She is apparently eating a bit this afternoon already which is good. But they are talking about whether there is any gallbladder infection going on as they questioned this last time though she had had pancreatitis too. Has anyone else had issues with their kitties gallbladder? They said that sometimes it can be treated with meds but can need gallbladder removal. I’m concerned about her going through a big operation like that. To be honest we are really starting to worry about her lack of quality of life since Christmas.
     
  22. monty_dweezil (GA)

    monty_dweezil (GA) Member

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    Oh no, I'm so sorry to hear this.

    We found with Dweezy, he would recover quickly from each DKA bout, but they would release him from hospital too early (due to his enormous stress there) and he'd come home, his insulin wouldn't do much or enough, and 1-2 days later he'd have those dreaded ketones again.

    It still haunts me.

    Willow needs to get her BG down in the blues / yellows at least for some of the day and night to keep the ketones away I think, as a mininum.

    As far as gallbladder, I have no info on that. Dwee had a questionable liver, pancreas, kidneys, lymph nodes...no mention of gallbladder, but who knows, there could have been that too!
     
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  23. Kris & Teasel

    Kris & Teasel Well-Known Member

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    There's a syndrome called triaditis that can involve pancreas, liver and gall bladder inflammation. Has your vet ever mentioned that? Ongoing inflammatory conditions like this can make BG regulation extremely difficult. You usually need a variety of meds to to treat the various aspects of triaditis.
     
  24. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Over the years we've seen a few kitties with gall stones come through here. If there aren't any blockages, a med called ursodiol is sometimes used to dissolve cholesterol gall stones and/or treat primary biliary cirrhosis (liver disease).

    Many vets think ursodiol can only be used for dogs, but it's also been successfully used for cats. Alex took ursodiol for liver disease and and an inflamed gall bladder. My vet had it compounded into a chicken flavored liquid which she took with ease. I think it helped her a lot.

    You might want to ask your vet if ursodiol would be appropriate for whatever is going on with Willow. However, it's believed ursodiol depletes taurine in the body. If they prescribe ursodiol, you'll want to supplement with taurine.
     
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