? 1/24 Need advice !!

[JanetMR]

My cat Bella was diagnosed 12/23/17.
It’s been a bumpy ride. She was started on Vetsulin.. hospitalized after 2 1unit doses. Switched to wet food low carb 12/26/17. Taken off insulin. Started home testing. ( BG ranges from 86-289) started testing “small”’for ketones in her urine. Started on Lantus .25 unit 1/16/18 for three nights.
( held the am doses because of BG below 200)
Third night dipped to 64. Got her levels back up but she wouldn’t eat and started having loose stools. Went to the vet. Vet said to take her off insulin and try just the diet. Will re-evaluate her need for insulin then.
Her loose stools stopped and her appetite returned after a day or two off Lantus.
She’s a cat that looks and feels terrible when her levels drop below 200. She won’t eat and seems lethargic. When her levels go back up... she seems to feel better. I realize that this is because her body is used to functioning at the higher blood glucose levels. I just don’t know what to do. The vet suggested trying her on oral hypoglycemic medication. I’ve discovered that this is NOT a good option at all.
If we do decide and need to put her back on insulin... how would the dosage be determined? She did not seem to tolerate .25 unit. I want to do what is right, but I don’t want to makes things worse for her or me!
Advice and guidance appreciated.

Janet

 

[Sandy and Black Kitty]

Hello Janet and welcome

started testing “small”’for ketones in her urine

This has me very concerned.

How frequently are you checking Bellas urine for the presence of ketones? A reading above 'trace' warrants a call to the vet.
However I also have concerns about your vets familiarity with FD.


Please read about Diabetic Ketoacidosis (DKA)
Ketones can quickly develop to dangerous levels.

A kitty does not need to have crazy high BGs for ketones to develop. The recipe is:

Not enough calories +Not enough insulin+infection or inflammation of some sort

Not eating well and not getting insulin and "small" ketone test...all open the door to ketones

 

[Steph & Quintus & L & O]

Could you catch some of her numbers along the day when she’s off insulin so we get an idea what they look like? That’s where I’d start until somebody with more experience can give you information to help you decide on a dose. More data helps, generally!

Hugs, this must be frustrating!

 

[JanetMR]

Could you catch some of her numbers along the day when she’s off insulin so we get an idea what they look like? That’s where I’d start until somebody with more experience can give you information to help you decide on a dose. More data helps, generally!

Hugs, this must be frustrating!

It is frustrating.
I did test this morning. She was 183.

 

[JanetMR]

Hello Janet and welcome

This has me very concerned.

How frequently are you checking Bellas urine for the presence of ketones? A reading above 'trace' warrants a call to the vet.
However I also have concerns about your vets familiarity with FD.


Please read about Diabetic Ketoacidosis (DKA)
Ketones can quickly develop to dangerous levels.

A kitty does not need to have crazy high BGs for ketones to develop. The recipe is:

Not enough calories +Not enough insulin+infection or inflammation of some sort

Not eating well and not getting insulin and "small" ketone test...all open the door to ketones

I get it about the ketones.
I’m doing the very best that I can.

 

[Sandy and Black Kitty]

Started on Lantus .25 unit 1/16/18 for three nights.

Were you only dosing once every 24 hours?

 

[JanetMR]

Were you only dosing once every 24 hours?

I was going by my vets recommendations.
Give her .25 unit every 12 hours if her blood glucose is 200 or above. Held tha am doses because she was under 200.

 

[JanetMR]

I get it about the ketones.
I’m doing the very best that I can.

I have two vets that I’m working with...
Again.. I’m doing my best.

 

[Sandy and Black Kitty]

How did you discover Bella had FD?

I'm not seeing the hypoglycemic event you mention in your signature block.
Those two green cells on the ss are normal cat BG levels. They appear to be the only ones.

 

[JanetMR]

How did you discover Bella had FD?

I'm not seeing the hypoglycemic event you mention in your signature block.
Those two green cells on the ss are normal cat BG levels. They appear to be the only ones.

Bella was diagnosed several weeks after a diet change. My other cats had bladder stones and I switched everyone to a prescription diet for urinary health. ( I did this gradually over a two week period) She did not tolerate the diet.. vomiting and weight loss. I switched her back to her old food. 24 hours after her brother had emergency surgery for bladder/ urethra stones she stopped eating. At first I thought it was stress related, but her blood glucose was elevated as was her fructosamine.
After the vetsulin doses she stopped eating and we ended up in the emergency Er. They told us it was due to hypoglycemia.
After three evening doses of Lantus the same thing happened. You may not consider the number hypoglycemia, but I do.

 

[JanetMR]

Bella was diagnosed several weeks after a diet change. My other cats had bladder stones and I switched everyone to a prescription diet for urinary health. ( I did this gradually over a two week period) She did not tolerate the diet.. vomiting and weight loss. I switched her back to her old food. 24 hours after her brother had emergency surgery for bladder/ urethra stones she stopped eating. At first I thought it was stress related, but her blood glucose was elevated as was her fructosamine.
After the vetsulin doses she stopped eating and we ended up in the emergency Er. They told us it was due to hypoglycemia.
After three evening doses of Lantus the same thing happened. You may not consider the number hypoglycemia, but I do.

What I’m trying to say is: it’s not the numbers it’s the cat. How she acts and responds to insulin. It’s not my imagination.

 

[Juliet]

There’s no hypo numbers on the ss however if she’s not eating then that’s a worry. When you say you put her back on the regular food what is that? Mostly an alternative can be found for prescription diets which often cause more issues than not. Most here use Fancy Feast classics or Friskies pate. Dry isn’t good for the diabetics.

If this was my cat with the blues and yellows you are seeing, I’d say she does need insulin. Starting dose would depend on the protocol you want to follow. I follow SLGS which has a starting dose of .5u twice a day 12 hrs apart. Lantus is s depot insulin so needs to be given twice a day. Take a look at these two stickies and see which fits your lifestyle best then go from there.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

 

[Juliet]

What I’m trying to say is: it’s not the numbers it’s the cat. How she acts and responds to insulin. It’s not my imagination.

Agreed. Every cat responds differently. How does she respond when on insulin?

 

[Veronica & Babu-chiri]

Like your vet the protocols we follow recommend for a newly diagnosed kitty to either stall and ask here in the forum or skip a dose when you get a low number ( usually below 200) not because you can not shoot with a number lower that 200 (eventually you will shoot with numbers below that ) but because you need to have information on how your kitty reacts to insulin and know how he acts before you do it.

When you get your firsts green numbers is scary, very scary ( I think I panicked at 80 ) but as Sandy mentioned it does not mean he had a hypoglycemic episode, that would be below 40 on a human meter but still is good to give them some food to raise their numbers if you notice a big drop.

Were you following some protocol TR (Tight regulation) or SLGS ( start low go slow) ?

I suggest you read how each one works so that you can decide which one suits you better, and that will help you decide your starting dose, also it would be good if you could do some spot tests to help know what are her numbers right now.

Based on the numbers on her SS I think she may benefit with a little bit of insulin for a while because you are getting numbers above normal, your kitty may need some micro doses, there are smaller doses than 0.25, not very easy to measure but possible (Babu liked to use this mini micro doses) you could read the information in this link to get an idea about how to do it

http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

And above all keep asking we will try to help you

 

[Juliet]

Like your vet the protocols we follow recommend for a newly diagnosed kitty to either stall and ask here in the forum or skip a dose when you get a low number ( usually below 200) not because you can not shoot with a number lower that 200 (eventually you will shoot with numbers below that ) but because you need to have information on how your kitty reacts to insulin and know how he acts before you do it.

When you get your firsts green numbers is scary, very scary ( I think I panicked at 80 ) but as Sandy mentioned it does not mean he had a hypoglycemic episode, that would be below 40 on a human meter but still is good to give them some food to raise their numbers if you notice a big drop.

Were you following some protocol TR (Tight regulation) or SLGS ( start low go slow) ?

I suggest you read how each one works so that you can decide which one suits you better, and that will help you decide your starting dose, also it would be good if you could do some spot tests to help know what are her numbers right now.

Based on the numbers on her SS I think she may benefit with a little bit of insulin for a while because you are getting numbers above normal, your kitty may need some micro doses, there are smaller doses than 0.25, not very easy to measure but possible (Babu liked to use this mini micro doses) you could read the information in this link to get an idea about how to do it

http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

And above all keep asking we will try to help you

This is good. I posted links to the two protocols above.

 

[JanetMR]

There’s no hypo numbers on the ss however if she’s not eating then that’s a worry. When you say you out her back on the regular food what is that? Mostly an alternative can be found for prescription diets which often cause more issues than not. Most here use Fancy Feast classics or Friskies pate. Dry isn’t good for the diabetics.

If this was my cat with the blues and yellows you are seeing, I’d say she does need insulin. Starting dose would depend on the protocol you want to follow. I follow SLGS which has a starting dose of .5u twice a day 12 hrs apart. Lantus is s depot insulin so needs to be given twice a day. Take a look at these two stickies and see which fits your lifestyle best then go from there.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

I know about the low carb high protein wet diet. She’s been on it since 12/26/17.
She had previously been on Iams sensitive stomach with a friskies canned pate supplement.
The problem is when she is on insulin she stops eating.

 

[Stacy & Asia]

Do your urine ketostix test for glucose as well? They make ketodiastix that do both, it would be interesting to see at what levels she starts dumping glucose in her urine.

 

[JanetMR]

Agreed. Every cat responds differently. How does she respond when on insulin?

This is my dilemma. She responds negatively to insulin. She becomes lethargic and won’t eat.

 

[Juliet]

I know about the low carb high protein wet diet. She’s been on it since 12/26/17.
She had previously been on Iams sensitive stomach with a friskies canned pate supplement.
The problem is when she is on insulin she stops eating.

I don’t know the answer to this except try all sorts to encourage her to eat: warm water in the food; freeze dried chicken on the top; fortiflora - are things others have tried. She does need the insulin and must eat while on it.

 

[Juliet]

Unfortunately if she does not get the insulin and continues as an unregulated diabetic a while host of other issues will arise. My cat I wasn’t diagnosed for some time and we had to deal with diabetic neuropathy. As someone else mentioned - ketoacidosis can become an issue.

 

[JanetMR]

Like your vet the protocols we follow recommend for a newly diagnosed kitty to either stall and ask here in the forum or skip a dose when you get a low number ( usually below 200) not because you can not shoot with a number lower that 200 (eventually you will shoot with numbers below that ) but because you need to have information on how your kitty reacts to insulin and know how he acts before you do it.

When you get your firsts green numbers is scary, very scary ( I think I panicked at 80 ) but as Sandy mentioned it does not mean he had a hypoglycemic episode, that would be below 40 on a human meter but still is good to give them some food to raise their numbers if you notice a big drop.

Were you following some protocol TR (Tight regulation) or SLGS ( start low go slow) ?

I suggest you read how each one works so that you can decide which one suits you better, and that will help you decide your starting dose, also it would be good if you could do some spot tests to help know what are her numbers right now.

Based on the numbers on her SS I think she may benefit with a little bit of insulin for a while because you are getting numbers above normal, your kitty may need some micro doses, there are smaller doses than 0.25, not very easy to measure but possible (Babu liked to use this mini micro doses) you could read the information in this link to get an idea about how to do it

http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

And above all keep asking we will try to help you

I don’t know the answer to this except try all sorts to encourage her to eat: warm water in the food; freeze dried chicken on the top; fortiflora - are things others have tried. She does need the insulin and must eat while on it.

I don’t know the answer to this except try all sorts to encourage her to eat: warm water in the food; freeze dried chicken on the top; fortiflora - are things others have tried. She does need the insulin and must eat while on it.

I don’t know the answer to this except try all sorts to encourage her to eat: warm water in the food; freeze dried chicken on the top; fortiflora - are things others have tried. She does need the insulin and must eat while on it.

I don’t know the answer to this except try all sorts to encourage her to eat: warm water in the food; freeze dried chicken on the top; fortiflora - are things others have tried. She does need the insulin and must eat while on it.

I’ve tried these tips and more....

 

[Veronica & Babu-chiri]

What I’m trying to say is: it’s not the numbers it’s the cat. How she acts and responds to insulin. It’s not my imagination.

You are right every cat is different, there's some very valuable information about low numbers in here that may help you

http://www.felinediabetes.com/FDMB/threads/how-low-is-too-low.142105/

Also more than one issue may be in place here, if she's getting traces of ketones she may be feeling week and losing her appetite and depressed , your vet will have to asses this before it gets worse, but also you need to give her insulin, because the basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

Here's some information about ketones

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

 

[JanetMR]

Unfortunately if she does not get the insulin and continues as an unregulated diabetic a while host of other issues will arise. My cat I wasn’t diagnosed for some time and we had to deal with diabetic neuropathy. As someone else mentioned - ketoacidosis can become an issue.

I am well aware of this... I’m trying to make make an informed and compassionate decision for Bella and for me.

 

[Juliet]

I am well aware of this... I’m trying to make make an informed and compassionate decision for Bella and for me.

You’re doing great. You’re numbers on the ss are not nearly as high as I’ve seen other cats. @Veronica & Babu-chiri is right. The vet needs to assess her and she does need to get the insulin.

 

[JanetMR]

You’re doing great. You’re numbers on the ss are not nearly as high as I’ve seen other cats. @Veronica & Babu-chiri is right. The vet needs to assess her and she does need to get the insulin.

Thank you. I appreciate your kind words

 

[Veronica & Babu-chiri]

You are doing great really!! But feline diabetes requires a LOT of patience.

You also have to take into account that when a kitty starts having low, not necessarily normal numbers just lower than he was they tend to feel a little bit low, also a kitty in low numbers will tend to eat and drink less ( he no longer needs to) is like when kids eat a lot of candy for a while they have all the energy in the world but when the sugar burns out they fell asleep really deep, well when your kitty gets the insulin she burns that extra sugar and at the beginning she feels a little bit down but she'll get used to it and start feeling better .

Still you should look if there's something other than the insulin affecting her ketones, UTI, or maybe some food allergies or IBD?

 

[JanetMR]

Like your vet the protocols we follow recommend for a newly diagnosed kitty to either stall and ask here in the forum or skip a dose when you get a low number ( usually below 200) not because you can not shoot with a number lower that 200 (eventually you will shoot with numbers below that ) but because you need to have information on how your kitty reacts to insulin and know how he acts before you do it.

When you get your firsts green numbers is scary, very scary ( I think I panicked at 80 ) but as Sandy mentioned it does not mean he had a hypoglycemic episode, that would be below 40 on a human meter but still is good to give them some food to raise their numbers if you notice a big drop.

Were you following some protocol TR (Tight regulation) or SLGS ( start low go slow) ?

I suggest you read how each one works so that you can decide which one suits you better, and that will help you decide your starting dose, also it would be good if you could do some spot tests to help know what are her numbers right now.

Based on the numbers on her SS I think she may benefit with a little bit of insulin for a while because you are getting numbers above normal, your kitty may need some micro doses, there are smaller doses than 0.25, not very easy to measure but possible (Babu liked to use this mini micro doses) you could read the information in this link to get an idea about how to do it

http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

And above all keep asking we will try to help you

You are doing great really!! But feline diabetes requires a LOT of patience.

You also have to take into account that when a kitty starts having low, not necessarily normal numbers just lower than he was they tend to feel a little bit low, also a kitty in low numbers will tend to eat and drink less ( he no longer needs to) is like when kids eat a lot of candy for a while they have all the energy in the world but when the sugar burns out they fell asleep really deep, well when your kitty gets the insulin she burns that extra sugar and at the beginning she feels a little bit down but she'll get used to it and start feeling better .

Still you should look if there's something other than the insulin affecting her ketones, UTI, or maybe some food allergies or IBD?

You are doing great really!! But feline diabetes requires a LOT of patience.

You also have to take into account that when a kitty starts having low, not necessarily normal numbers just lower than he was they tend to feel a little bit low, also a kitty in low numbers will tend to eat and drink less ( he no longer needs to) is like when kids eat a lot of candy for a while they have all the energy in the world but when the sugar burns out they fell asleep really deep, well when your kitty gets the insulin she burns that extra sugar and at the beginning she feels a little bit down but she'll get used to it and start feeling better .

Still you should look if there's something other than the insulin affecting her ketones, UTI, or maybe some food allergies or IBD?

You are doing great really!! But feline diabetes requires a LOT of patience.

You also have to take into account that when a kitty starts having low, not necessarily normal numbers just lower than he was they tend to feel a little bit low, also a kitty in low numbers will tend to eat and drink less ( he no longer needs to) is like when kids eat a lot of candy for a while they have all the energy in the world but when the sugar burns out they fell asleep really deep, well when your kitty gets the insulin she burns that extra sugar and at the beginning she feels a little bit down but she'll get used to it and start feeling better .

Still you should look if there's something other than the insulin affecting her ketones, UTI, or maybe some food allergies or IBD?

You are doing great really!! But feline diabetes requires a LOT of patience.

You also have to take into account that when a kitty starts having low, not necessarily normal numbers just lower than he was they tend to feel a little bit low, also a kitty in low numbers will tend to eat and drink less ( he no longer needs to) is like when kids eat a lot of candy for a while they have all the energy in the world but when the sugar burns out they fell asleep really deep, well when your kitty gets the insulin she burns that extra sugar and at the beginning she feels a little bit down but she'll get used to it and start feeling better .

Still you should look if there's something other than the insulin affecting her ketones, UTI, or maybe some food allergies or IBD?

I understand...it could be she has something else going on.
Bella has always been extra sensitive.. she has never responded “normally” to anything.
Had a reaction to being wormed as a kitten and had a reaction to her ( unnecessary) rabies vaccine. I realize her body is used to higher than normal levels of glucose. But if she doesn’t eat and has diarrhea on insulin... what exactly is the point?

 

[Veronica & Babu-chiri]

Had a reaction to being wormed as a kitten and had a reaction to her ( unnecessary) rabies vaccine. I realize her body is used to higher than normal levels of glucose. But if she doesn’t eat and has diarrhea on insulin... what exactly is the point?

She does have some history of allergic reactions then, could it be the food she is reacting to has she had any tests regarding food allergies ? it may not necessarily the be the insulin that's causing her the problem

 

[Sienne and Gabby (GA)]

You are absolutely correct that lower numbers may cause your kitty to feel awful. A former member here once noted that she had a friend who was diagnosed with diabetes. As long as her numbers where higher, she felt fine. If insulin brought her numbers into a normal range, she felt terrible. However, she had to take insulin. It took a while for her body to re-acclimate to being in normal numbers. Once that happened, higher numbers made her feel rotten.

Like Sandy noted, the presence of ketones are a concern.

Are you willing to try to shoot a lower dose than 0.25u? If you press really hard on the plunger, insert the syringe into the pen/vial, then release the plunger, you should draw up what amounts to a drop of insulin. It may be that starting at a very low amount may work.

I also want to make sure that you are using U100 syringes. In other words, are you using syringes with an orange cap and not the same syringes you were using with Vetsulin? If your vet didn't tell you to use different syringes when you switched insulin, you are using U40 syringes. Lantus is much more concentrated than Vetsulin and this could be part of the problem. The concentration of the insulin needs to match the calibration of the syringe.

 

[JanetMR]

You are absolutely correct that lower numbers may cause your kitty to feel awful. A former member here once noted that she had a friend who was diagnosed with diabetes. As long as her numbers where higher, she felt fine. If insulin brought her numbers into a normal range, she felt terrible. However, she had to take insulin. It took a while for her body to re-acclimate to being in normal numbers. Once that happened, higher numbers made her feel rotten.

Like Sandy noted, the presence of ketones are a concern.

Are you willing to try to shoot a lower dose than 0.25u? If you press really hard on the plunger, insert the syringe into the pen/vial, then release the plunger, you should draw up what amounts to a drop of insulin. It may be that starting at a very low amount may work.

I also want to make sure that you are using U100 syringes. In other words, are you using syringes with an orange cap and not the same syringes you were using with Vetsulin? If your vet didn't tell you to use different syringes when you switched insulin, you are using U40 syringes. Lantus is much more concentrated than Vetsulin and this could be part of the problem. The concentration of the insulin needs to match the calibration of the syringe.

 

[JanetMR]

Thank you for your kind reply.
I have U-100 syringes and I found some that measure in half unit increments. I would be more than willing to use a lower dose. I think that is just what she needs!
Would this be the equivalent of waving the insulin over her head? Ha ha

 

[Fiona & Ruby]

I'm just going to pipe in on the back of some great advice and insight from @Sienne and Gabby (GA) and say you've done an amazing job to get your head around so much in such a short period of time. To call this start-up phase overwhelming is an understatement of seismic proportions! It is so hard to know how our kitties are going to respond to treatment and I would be asking the same questions if I was seeing similar signs in my Ruby. Hopefully with a really gentle take off Bella's body will be able to adjust to then find her good dose.

 

[LizzieInTexas]

Bella has always been extra sensitive.. she has never responded “normally” to anything

I have one of those . Thankfully his eating has been pretty good, but his reaction to meds, foods and supplements are not what should be expected.

How long has it been since Bella had a full blood workup and urinalysis?

 

[JanetMR]

She does have some history of allergic reactions then, could it be the food she is reacting to has she had any tests regarding food allergies ? it may not necessarily the be the insulin that's causing her the problem

Not that I’m aware of... she’s just super sensitive.

 

[JanetMR]

I have one of those . Thankfully his eating has been pretty good, but his reaction to meds, foods and supplements are not what should be expected.

How long has it been since Bella had a full blood workup and urinalysis?

She had a full work up when she was diagnosed.

 

[JanetMR]

I'm just going to pipe in on the back of some great advice and insight from @Sienne and Gabby (GA) and say you've done an amazing job to get your head around so much in such a short period of time. To call this start-up phase overwhelming is an understatement of seismic proportions! It is so hard to know how our kitties are going to respond to treatment and I would be asking the same questions if I was seeing similar signs in my Ruby. Hopefully with a really gentle take off Bella's body will be able to adjust to then find her good dose.

It’s been a delightful experience ( insert sarcasm). I’m hoping with a lower dose we will help her find balance.

 

[LizzieInTexas]

She had a full work up when she was diagnosed.

And nothing else was evident? Did vet check her teeth? If you want to put the results n the lab-tab on the spreadsheet (verify the given range #'s and adjust if necessary) there are some here that can look at the numbers for anything that may be of concern.

Bella is beautiful.

 

[Sienne and Gabby (GA)]

I'm glad you have the U100 syringes and even happier that you have ones that measure in half unit increments!

A drop is pretty much like waving the bottle over Bella's head. Frankly, it's a dose that we use as a kitty is nearing remission. But in Bella's case (well, really like wit all of our cats) we need to follow our kitty's lead. Aside from trying a teeny dose of Lantus, because you've seen ketones raise their ugly head, please test as much as you can. If it's way too hard to get a urinary ketone test, there are blood ketone meters (e.g., Novamax, Precision Xtra). The ketone strips are pricey but it can be a much easier way to test for ketones.

 

[JanetMR]

And nothing else was evident? Did vet check her teeth? If you want to put the results n the lab-tab on the spreadsheet (verify the given range #'s and adjust if necessary) there are some here that can look at the numbers for anything that may be of concern.

Bella is beautiful.

Thank you.
I will post lab work when I can.

 

[JanetMR]

I'm glad you have the U100 syringes and even happier that you have ones that measure in half unit increments!

A drop is pretty much like waving the bottle over Bella's head. Frankly, it's a dose that we use as a kitty is nearing remission. But in Bella's case (well, really like wit all of our cats) we need to follow our kitty's lead. Aside from trying a teeny dose of Lantus, because you've seen ketones raise their ugly head, please test as much as you can. If it's way too hard to get a urinary ketone test, there are blood ketone meters (e.g., Novamax, Precision Xtra). The ketone strips are pricey but it can be a much easier way to test for ketones.

I raised the concern of ketones to both vets.
( she has one that does home visits and one that I use for lab work/ procedures etc) both of them told me that the presence of ketones is not a concern in itself... it depends on how the cat is acting. I know it’s a concern, but I cannot do anything about it without the back up of a vet. I got her back on insulin ( Lantus) BECAUSE of this!! I basically told the vet she needed insulin.
I am trying to do the right thing.. believe me.

 

[Sienne and Gabby (GA)]

I'll pick a bone with your vet(s) because there are at least a few things you can do. The concern with ketones, as I suspect you know, is that it can turn into diabetic ketoacidosis in the space of a heartbeat. So...

• Test for ketones as often as you can -- at least once a day. If you see more than a trace amount, contact your vet.
• Make sure Bella is eating. Calories are critical. (I've been known to tell people to feed their cat a hot fudge sundae -- minus the hot fudge -- if that's what it takes to get their cat to eat.)
• Add water to Bella's food. It can be water, chicken broth, the water from canned tuna (just make sure none of the broths contain onion-- read the labels), etc. Hydration helps to dilute ketones.
• If she seems lethargic, be worried. Lethargy in a ketone prone cat scares me. We've caught symptoms of DKA early only because a caregiver mentioned that their cat seemed lethargic. You're knowing what's typical for Bella is very important.

 

[JanetMR]

I'll pick a bone with your vet(s) because there are at least a few things you can do. The concern with ketones, as I suspect you know, is that it can turn into diabetic ketoacidosis in the space of a heartbeat. So...

• Test for ketones as often as you can -- at least once a day. If you see more than a trace amount, contact your vet.
• Make sure Bella is eating. Calories are critical. (I've been known to tell people to feed their cat a hot fudge sundae -- minus the hot fudge -- if that's what it takes to get their cat to eat.)
• Add water to Bella's food. It can be water, chicken broth, the water from canned tuna (just make sure none of the broths contain onion-- read the labels), etc. Hydration helps to dilute ketones.
• If she seems lethargic, be worried. Lethargy in a ketone prone cat scares me. We've caught symptoms of DKA early only because a caregiver mentioned that their cat seemed lethargic. You're knowing what's typical for Bella is very important.

I know.
I add water to her food and always make sure she eats. ( small frequent meals a day) This is why her reaction to insulin is so frustrating... she won’t eat.
She’s also lethargic on insulin.

Tonight she was playing with a toy mouse.. it was wonderful to see!

 

[Sienne and Gabby (GA)]

Would she eat a higher carb food or treats or is she totally disinterested in any food?

 

[JanetMR]

Would she eat a higher carb food or treats or is she totally disinterested in any food?

If she doesn’t want to eat... she doesn’t want to eat. I will try anything. I have a Bella box with all the treats I can think of in it.
It’s so frustrating because I end up following her around with food, hand feeding her.. anything I can think of.
She will sniff it and walk away.
And this is ON insulin.

 

[Amy&TrixieCat]

Since normal numbers seem to make her feel so yucky that she doesn't want to eat, I wonder if using an anti-nausea med like cerenia or ondansetron would help her over the hump while her body adjusts to being in normal numbers again. That could be something to ask your vetty about.

 

[Stacy & Asia]

If she doesn’t want to eat... she doesn’t want to eat. I will try anything. I have a Bella box with all the treats I can think of in it.
It’s so frustrating because I end up following her around with food, hand feeding her.. anything I can think of.
She will sniff it and walk away.
And this is ON insulin.

I second Amy's suggestion. My cat has recently had a bout of inappetence and cerenia has made a world of difference! She was looking like she was eating food, but only taking a few licks and then walking away. She also did some lip licking (which is a common sign that cats are nauseated).

If you have ketodiastix and test for glucose the same time as keytones, if the glucose test is positive, that tells you without a doubt, Bella needs insulin. Asia felt really bad in lower numbers at first too, she was very sleepy, mostly. The inappetence may or may not be related to getting insulin specifically, but if you can get some insulin in her consistently and get something to help keep her eating (like cerenia) you will have a clearer picture of what's going on.

I'm a bit wary that your vet seems rather dismissive of the keytones. I know it's hard to trust s bunch of people you don't know on the internet over your vet, but I would seriously consider it. The people here know diabetes inside and out and typically have loads more combined experience than most vets could ever dream to have.