Ketones close to 40 mg/dL (medium - Keto-Diastix)

My cat, Mookie, just got out of the hospital 2 days ago where he was treated for ketoacidosis for 5 days. He is doing great and eating well BUT his keytones have been increasing over the past two days and they are now close to 40 mg/dL (medium)! His AM-preshot was 311 and his 6 hour (just taken now - same time as last keytone test) was 282. He is on 0.5 U of Lantus morning and night. Is there anything I can do at home to get the keytones down or do I need to take him back to the ER right away?

I'm super concerned. Any help is appreciated!

Unfortunately, I don't have time to input update all his BG values on the spreadsheet. I hope you can help me without them.

Thanks!
Amber

 

You need to bring his BG down, make sure he eats, better if he eats alot. Add a lot os water into each of his meal. He needs to pee the ketones out.

I cannnot help you without SS updated all the time. Sorry.

But I can share what I did for my cat post DKA at home, is it ok?
It's going to be more general and maybe not very efficient but it is all I can offer without seeing the progression of BG.

 

Call them.
As their recent released patient you are entitled to call and ask questions.

Ketones are very dangerous and must be addressed asap.

 

Absolutely, please share. Anything advice is great Thanks!
Amber

 

Ok.
I have to ask about eating first.
How is the appetite?, and is he interested in food as much as you are confident that he will continue to eat for you.
It is imperative that he eats and drinks a lot of water. He needs extra water now - up to 100 ml a day if he eats wet food and up to 300 ml if eats dry.

If there is any hint at potential no appy event than it is a trip to ER.
If appy decreased recently - make sure you talk it over with ER personnel.
Yo are entitled to call if stayed over recently.

 

Hi Tanya,

I have sub-Q fluids at home, would that help to pee out the keytones?

Amber

 

That is the part of daily routine however I CANNOT tell you go ahead and give 50 ml because of potential heart complications. Are yo aware of his heart condition?

 

I never had Medium Ketones ...I just hope you are mistaken with it.
Can you take another urine sample any time very soon?
I used to put Ducia in LB past her very watered meals and she would pee for me a little.
Can you try.

If the Medium level results repeats it is definitely ER.
Did you call them?
It really worth your while.

I am not pushing you to the ER right away only because you mentioned that he was doing ok and eating. Unfortunately it can turn very quickly.

 

His appetite isn't back to normal. He's been slowly eating his raw food throughout the day - part of the difficulty with the insulin not getting the BGs down as it should. I have sub-Q fluids and could give him 100ml.

I gave him an extra 0.5 U of Lantus 1/2 an hour ago, hoping that it will kick in a couple hours from now.

He just ate a bit about 1/2 an hour ago.

Amber

 

At home we were giving insulin BID, all the meds she required with food, added 100 ml SQF and fed 1.5 5.5 oz can of Friskie to make up to 205 KCal a day. Split even portions thru the day.

The dose is arch important.
You may need to increase faster then normally recommended due to ketones.

 

'medium' is just on the label. I've given him some water. I'll take another test as soon as he pees next. I'll call the ER in the mean time.

Thanks!
Amber

 

you need to be sure he can handle extra fluids.

 

No heart problems.
Amber

 

That makes me insist on you getting the SS updated right away.
You are going to have 2 nadirs - maybe a nadir overlapped with the other dose onset and it potentially hypo.
Please start the SS updates right now.
I need to see where the 2 doses can potentially over lap and send him crushing. ETA: It is difficult to trace nadir or onset without knowing how much time has elapsed since each shot.

Make sure the vet in ER knows about it too.

ETA: I really insist.

 

@cataphraz
did you get a chance to talk to the ER people?

 

What was the amount of insulin you shot this AM? And I agree with Tanya about dealing with 2 Nadirs , it can be tricky. It’s not advisable to shoot an extra Lantus in the middle of a cycle.

Please get your SS to date. I am not seeing any data for 2019. If you could give data for the last couple weeks on a new SS, that would be helpful. It’s hard to guide you otherwise.

 

I have a message in with the ER doctor and am waiting for their call.

He's still doing very well - eating on his own and taking the water that I'm feeding him via syringe (just to get the fluids in him for time reasons)

Unfortunately, I don't have recent values other than the past two days, because he was in hospital on an insulin drip and was just started back on Lantus 2 days ago. In the past, on Lantus, his nadir has usually been around 9 hours after he has been on Lantus for some time. He was in remission before going into Ketoacidosis 7 days ago, so he hasn't be on Lantus for 3-4 weeks. I'm aware of the two overlapping nadirs. I've been closely watching his values for the past 2 years and and am very familiar with the amplitude of his curve and nadirs. There is evidence of rebounding in his past, so even with a low, he will likely rebound. I hear you... I'm taking a big risk for sure. I'm watching him like a hawk. I will watch his values nadir, overlap and beyond. I greatly value any help you can give

Here are the past two day's values:

June 25th (Thursday)
7am was given 0.5 Units Lantus in hospital, after 5 days on insulin drip - 144 (8.0mmol/L)
1pm (at home - 6 hours) - 147.6 (8.2 mmol/L)
8pm - 338.4 (18.8 mmol/L) (gave 0.5 U)

June 26th (Friday)
8am - 408.6 (22.7 mmol/L) (gave 0.5 U)
1pm (5 hours) - 253.8 (14.1 mmol/L)
2pm (6 hours) - 259.2 (14.4mmol/L)
8pm - 19.4 - 349.2 (19.4 mmol/L) (gave 0.5 U)

June 27th (today)
8am - 311 (17.1 mmol/L) (gave 0.5 U)
1pm (6 hours) - 275.4 (15.3 mmol/L) ***(gave 0.5 U)***
3:30pm (9.5 hours) - 232.2 (12.9 mmol/L)

As I was typing, I missed his latest pee - I'll get more water in him. He's still eating on own & taking water.

Thanks!
Amber

 

I am so relieved to read this!

 

I never tried TID but I know it has been done here.
Good to know you know what to expect and when.

If it were for my cat I would increase the dose and give it BID instead of TID.
You may need to monitor closer tonight beginning with +1 or +2 because extra dose will add to the depot, and it is usually acts the following cycle; do monitor regardless of whether you increase the dose or not.

Of course there are ketones to mind...
I hope you 'll get negative or trace read soon - those pads are so very easily misread!

We fed Ducia every 3 - 4 hours watereddown Friskies Pate with all meds we were given in ER; 100 ml SQF - at least 2 hours apart from the dose because it might interfere. Eating is a key - it's cats #1 medicine.

 

He's eating super well right now - watereddown raw food - and I hope to get another keytone reading soon with some more water. Thank you for the heads up on the BG monitoring and your experience. I really appreciate it

Amber

 

Thanks Julie Mookie has been on a human meter for a while, so the values are human meter BG values. I haven't had a chance to update my spreadsheet. I will take it off my posts to avoid any confusion.

Amber

 

I deleted my post...

Don’t remove your spreadsheet, good to leave it.

I would just add your human meter to your signature. Also you can update title on spreadsheet, that is what I did. Only difference on spreadsheet is if under 68 it will still show color for pet meter. I am just changing the color of cell manually on mine if my kitty goes under 68...

 

you are very welcome and the great many healing vines for Mookey!
There is someone else in L&L who just nursed her girl back to health from DKA at home - what a marvelous story!
I hope Mookey will do the same! The other kitty's mom will be happy to share, I am sure of it.

 

Awesome! That would be great
Thanks
Amber

 

Please take your cat to the vet. We typically do not try to manage anything more than trace levels of ketones based on input from the board. If you've been through an episode of DKA, your cat may be prone to develop ketones for some time. This is a dangerous level of ketones and can get worse in the blink of an eye.

 

I am sorry to nag about the SS again but if you can make the SS even with what you 've got so far since July 25 it would be tremendous help. The third dose at AMPS +6 today can be simply added to the same cell as the +6 BG. (
Unless of course you want to continue TID. In that case micro dose of a Rapid acting insulin added to 12/12 Lantus might be better approach, safer for sure.)

It is said to be harder to get them into remission for the 2nd time and - I guess here that it means they are harder to regulate as well. Until the ketones reads come Negative consistently for several days at the very least some fast tracking might be good strategy.ETA: it is harder without SS.

Watch for the appy.
Any small change is an early warning that things might be turning the wrong direction. And I had seen changed taking place very rapidly. Just post hospitalization Ducia was so frail I could never be sure how exactly was she doing... Urine test for ketones and tight monitoring helped a lot.

Will you post an update on what the ER vet said?

 

Please take Mookie to the vet. Two things here are scaring me. The first is ketones above trace in a kitty very recently in DKA. The second is no spreadsheet and a second dose of insulin given. No one here should be commenting on dose without a spreadsheet. There are just too many ways this could go wrong. We are not vets.

 

As a third very experienced member (Sienne and Wendy being the other two), I strongly agree and urge you to get him back to the vet. Ketones can increase rapidly and he can go from moderate ketones and eating ok to being in full blown DKA fast.

I also agree on shooting extra Lantus. Usually with DKA kitties, we use a quick acting insulin like Humulin R to get high numbers down. It does it much more effectively than Lantus and you aren’t dealing with a depot with it. Lantus cannot pull down high numbers.

I hope you’ll get to the ER.

 

@cataphraz

please hear what @Sienne and Gabby (GA) and @Wendy&Neko had to say.

Since you missed the urine sampling just now it may take him very long while before he'll need to go again.
And that time maybe too long for the risky situation you are in. It does escalates very quickly.

I would say go to ER if the 2nd test was positive. But I do not want you to wait too long and loose valuable or maybe life saving time.

Please listen to the said above ; I am in agreement 100%.

 

The +hours aren't right in the above.

311 @ AMPS ? (8am) 0.5u
275 @ +5 ? (1pm) 0.5u
232 @ +7.5 ? (3:30)

Without seeing a spreadsheet it's impossible to tell, but right now you have the possibility/probability of nadir from the first shot overlapping with onset of the second. This is not how one would attempt to shoot TID!

I agree with the others. It sounds very much like a vet visit is in order.

 

Just something to remember. The recipe for a DKA event: Is not enough insulin, in appetence , and a systemic stress or infection.

Please keep us posted.

 

@cataphraz

I hope Mookey is ok and that you will post an update soon, out of respect to the interest taken in your cat by strangers, if for nothing else.

I can hardly imagine any reason for you not to post a brief update until now - 8 pm PST on Saturday, whatever that might have being. You knew people were interested/ cared/ or were willing to help. I waited since noon to hear from you.

I meant this Saturday for myself but than Mookey popped up and I was foolish enough to wish him well and got engaged, thought it is better spent SA. Waited for the update for hours. Silly me.It is 8 pm now.

I hope he'll survives.

I won't be answering your posts.

 

Thank you for your post Mookie's blood sugars all of a sudden increased rapidly and he still hadn't peed to take another keytone test so we went to the ER. No ketoacidosis. His BG was 338 by the time we arrived but there were no other signs for concern. The vet said we could go home. When we got home at midnight EST, Mookie had a big pee and it was negative for keytones. Glad we went to get things checked out. It was worth the peace of mind.

 

Hi Tanya, thank you for the information and all your help The ER vet was not concerned. According to the tests they ran, Mookie wasn't in ketoacidosis. His blood sugar was just high. Although Mookie's BG was 338 by the time we got to the ER, he was very alert and mobile during the consult, so the vet just said to monitor him at home.

 

My apologies Tanya. I didn't know that you were waiting on an update. I greatly appreciate your help and the help of all the others who posted to help Mookie today. I had received the post from Sienne suggesting that we go to the ER and for some reason I didn't get email notices on my cellphone about posts that were made afterwards.

When Mookie's BGs started to rise, even though it was almost the mid-point of the second dose, I felt it was necessary to go get him checked out. Luckily, everything turned out fine. Again, my apologies. I didn't realize that you were continuing to follow the situation.

Thank you again for all your help today!

 

Thank you all for your help today! I greatly appreciate it. Mookie is well and in good spirits. Luckily, no ketoacidosis and no keytones upon returning home from the ER late this evening.

All the best,
Amber & Mookie

 

Great news! I’m sure you feel much relieved. If he stops eating or starts acting sick , that will be your cue to get him vet attention. If you can keep your SS update , peeps here can help you with his dose questions.

 

Can i suggest you get a blood ketone meter so you don't have to wait for him to pee? It works just like a bg meter

 

I'm relieved that all was good. Just an FYI -- there are times when vets are not "alarmed" by a ketone level that will have us biting our nails. There have been too many times that we've seen a cat that has had a hospitalization for DKA end up back in the hospital because ketones developed. If the caregiver had opted to intervene sooner and perhaps had their cat at the vet for a few hours (e.g., for fluids, labs, etc), it would have prevented what can easily become a very serious situation. The rule of thumb for those of us who have been around here a long time is if ketones are more than trace, especially in a cat that may be prone to ketones, is to encourage you to head to the ER.

You may want to get a blood ketone meter. The Precision Xtra or NovaMax are good brands and available through ADW. (There are a number of meters that are now available but they seem to be focused on the keto diets. I haven't a clue if they are similar to meters for diabetes.) The strips are expensive but you don't have to wait for your cat to use the litterbox.

 

That would be great! Where can I find one? Do you recommend any particular ketone meter?

 

Thank you for your wise advice! I'll definitely check into the ketone meters.
Amber

 

I use the Abbott Precision Xtra. The meter itself isn’t too expensive. Maybe around 35 dollars. The strips are expensive! If you were to get that one let me know and I’ll send you a link to an online Canadian pharm that offered them the cheapest I found.

 

Thanks! I think I'm going to go with the Nova Max. There is a place here in Toronto that sells the meter for $40 CDN and 10 strips for ~$20 CDN (www.diabetesexpress.ca). That said, if you know of a cheaper option for the Abbott Precision Xtra meter/strips, please send it my way

Thanks again
Amber

 

KetoMojo is $1 per strip. Only used a couple times but I was happy with it. Diet-oriented. Nice website and good support.

ETA: Whoops, sorry, looks to be US-only.

 

No worries Thanks for the suggestion!
Amber

 

The border might not be close to you but I’ll throw this suggestion out to you anyway: getting a mailbox or PO Box in the states and driving down there to pick up your parcel. But by then, it might cost the same

 

Thanks for the suggestion Crista After some number crunching, the cost of the meters from the US and the one I can get in Toronto are almost comparable in price taking into account currency conversion, shipping and duty. I'll be able to pick up the meter tomorrow here in Toronto, whereas one from the US would take a minimum of a couple days via courrier. It's quite a trek down to the border from Toronto, so unfortunately, the cost of gas would probably eat up any savings. I appreciate the thought though

 

this is the one i use... https://www.amazon.com/Keto-Mojo-Gl...KEYTONE meter&qid=1564344541&s=gateway&sr=8-3 whichever one you get, get extra strips. 10 goes fast.

 

That price for strips sounds great!