? 5/14 Ozzy- Questions on Bad Insulin, Ketones, etc.

[Ozzy Pawzbourne]

Hi. We are back!

It's been awhile since I've posted. Just checking in with my kitty committee friends to see what you think about our current situation.

I’m wondering if Ozzy’s insulin has gone bad. I called in a new script and will pick it up before his pre-shot tonight so he can start with new insulin. We have about a tip of a finger left in the current pen and we have been having some whacky issues with our fridge temps last few months if the door is left open too long. I've never had a pen go bad in the last 2-3 years we have been on Lantus but I know it can happen.

So ok, here’s my upfront disclaimer: we have a long term diabetic and do not do regular testing now besides preshots and occasionally mid cycle tests to see where Ozzy is at. I know this is not ideal but we have a bustling 1 year old now (can you believe Jakey is that big already!!) and times are tough. And I mean "TIME" is tough. I don't even have time for myself with a child this young so we are doing the best we can with Ozzy. So far, we have managed his diabetes well. He's due for his annual check up next month, but last check up his blood results were stellar, no issues except sugar in his urine (but he's diabetic so that's a normal result for DM). Only thing was we were probably overshooting him because his kitty A1c was in the normal/low range. Dr. called to tell me it's likely he is in remission. Stupid Dr....he's a serious ketone prone diabetic with 200-300 preshot numbers...we've just been overshooting. Made me mad to hear her use the 'remission' word because it's been our unanswered prayer since day 1.

So fast forward to now...here is what is current:

• 1) Ozzy has had some redness on the skin around his eyes along with some brownish red discharge. They gave him some eye drops and it got better but keeps coming back. Kitty committee....what do you think? Could something with his insulin levels or diabetes in general be affecting his eyes??

• 2) He has been getting between 1-1.5U of insulin last few days and his numbers seem to be flat stuck or sky high. Ozzy usually does best between 1 unit and 1+. If we go over, after his depot gets full, he drops to very low numbers. If we keep him on 1unit for too long, we can't get him out of the high 200s to low 300s preshot and can barely get any blue numbers, forget about green. I've been trying to test him more last few days to see what he's doing and here are his recent numbers:

• 5/11
  7:45am – shot 1+u (sorry no pretest)
  +2 273
  +4 220
  +6 223
  +9 285
  PM Preshot- I suck, still didn’t do pretest…. , 1+U
  +2 244

• 5/12
  Preshot- 323, gave 1.5u (see I did better today, but that's a pretty high preshot for Ozzy)
  +2.5 226
  +4.5 217
  PM Preshot 274, 1.5U
  +2 222
• 
  5/13
  Preshot 402- 500 after multiple tests. What the heck!? He hasn’t seen a number like this since he was diagnosed. Maybe 1.5U was too much and he’s bouncing. Gave 1+
  +10 207 (wow, what a rollercoaster for Ozzy today)
  PM Preshot- 226
  +2 264
  +4 287
• 
  5/14
  Preshot 275, gave 1+
  +3 244
  +5 263

Do you think his insulin has gone bad? Or he's being overdosed and bouncing? Or something else? I started new test strips to see if that was the issue but it wasn’t. Going to open new pen tonight and see if that could be the issue, but I suspect it is not.

Ozzy is ketone prone and if he misses shots he will develop low ketones (even if just missing one shot). I test him about once a month or more with a blood ketone meter and lately he’s had low ketones for a few weeks. I usually can flush them out by giving a little higher dose of insulin, feeding him up to make sure his numbers don’t drop, and adding extra water to his meals. His last few ketone tests about a week apart have been 0.8 on the nova max blood meter. It was 1.2 before so going down but I can’t seem to flush them out this time. Some of you folks may remember our back story and that we found out about Ozzy’s diabetic diagnosis a few years back when he was rushed to the hospital and almost died from severe DKA. So clearly my concern in not being able to get the ketones down/out and that things will get worse and we don’t want to be back in that situation. Could the issues with his eyes be affecting his numbers or something else?

Curious your thoughts on the above.

Thank you for your time in reading this far and for any feedback/suggestions you may have.

Hope your sugar kitties are doing well!

 

[Tracey&Jones (GA)]

Infection can increase the numbers, what did the vet say was the issues with the eyes.

The one time I thought the pen was bad, Jones' numbers just kept going up like I wasn't giving him any insulin. I guess you will have your answer when you get the new pen on whether you see different results.

Ozzy looks like he is have a curve to his day, so I am not totally 100% sure that the insulin is the issue.

 

[Ozzy Pawzbourne]

Infection can increase the numbers, what did the vet say was the issues with the eyes.

The vet said that sometimes cats can just have some eye irritation and it's common. There was no real diagnosis or concern for infection.

 

[Ozzy Pawzbourne]

Ozzy looks like he is have a curve to his day, so I am not totally 100% sure that the insulin is the issue.

I'm not sure I understand your comment. You think it looks like he has a curve or he does not? Thanks for responding!

 

[Wendy&Neko]

One year old Jakey - where does the time fly!

Infection or inflammation can indeed increase the numbers. Redness around the eyes and brownish discharge do not sound normal if that's something that just started up recently. What eye drops did you get? Some contain steroids, which also raise the numbers. Diabetes/insulin should not be affecting his eyes, with one small caveat. Cats with acromegaly can have eye issues either from soft tissue growth or more likely from the pituitary tumour pressing on the optic chiasm. Not suggest Ozzie has that, just giving the complete story. With acros it manifests differently. Neko used to get clear weepy eyes because the soft tissue growth blocked her eye ducts.

Without a spreadsheet, I can't comment on dose.

 

[CassAndGordy(GA)]

Do you always shoot in the same spot? Recently, I changed sides I give Gordy insulin on and suddenly his numbers improved.

Other than that, I got nothing.

We'd love to see an updated photo of your boy! (If you're comfy sharing - no pressure )

 

[Ozzy Pawzbourne]

Ok, just did a +7.5 and he's 247. He basically has had the same BG all day (within 30 points and given meter variance it's essentially flat/stagnant/same). And with the exception of the high preshot numbers, he's been like this for the last 4 days.

Let me ask this question: What can cause flat numbers like this?

Also, any thoughts on the ketones??

Thanks!

 

[Ozzy Pawzbourne]

Do you always shoot in the same spot? Recently, I changed sides I give Gordy insulin on and suddenly his numbers improved.

I do actually. Tried to see if I could go in a different spot this morning but same. I will definitely try to move around and see if that helps.

We'd love to see an updated photo of your boy! (If you're comfy sharing - no pressure )

Of course...here is a pic of my sweet Jakey the morning he woke up on his 1st birthday. You can see he was excited to be 1! And go figure his favorite words are "CATTT" and "MEOW".

 

[Ozzy Pawzbourne]

One year old Jakey - where does the time fly!

Infection or inflammation can indeed increase the numbers. Redness around the eyes and brownish discharge do not sound normal if that's something that just started up recently. What eye drops did you get? Some contain steroids, which also raise the numbers. Diabetes/insulin should not be affecting his eyes, with one small caveat. Cats with acromegaly can have eye issues either from soft tissue growth or more likely from the pituitary tumour pressing on the optic chiasm. Not suggest Ozzie has that, just giving the complete story. With acros it manifests differently. Neko used to get clear weepy eyes because the soft tissue growth blocked her eye ducts.

Without a spreadsheet, I can't comment on dose.

Hi Wendy! Thanks for dropping in on my condo and leaving a comment.

I am wondering if infection could be an issue.
Agree redness and the discharge are not normal and vet said the same. It's been going on for a few weeks. The eye drop script we received is called Tobramycin 0.3%. It's an antibiotic eye drop. Thing is, we used it for a few days as prescribed and then haven't used it for awhile. I just put some drops back in Ozzy's eyes again today since the skin around his eyes is looking red again.

Sorry about not having my SS up to date. I knew someone was going to ask which is why I posted my sad disclaimer up front! I have been curving him last few days though to get some data and see what to do next. So glad we are doing new insulin tonight and will know right away if that's the issue or not. SO few more hours till shotty shot time!

 

[Ozzy Pawzbourne]

Curious if anyone has thoughts on the ketones and what can cause flat numbers?

Gave Ozzy insulin from the new pen 2 hours ago. His PMPS was 226. Just did his +2 and he is 156. lowest number in last 4 days Glad to see him blue!

My hunch is he probably had a few doses that were too high and he was bouncing. We really need to try to get. back to more frequent testing to know where he is going on his doses Gonna have to watch him closely tonight. That was almost a 100 point drop in 2 hours so he is headed no where good in the next 4 hours

 

[Ozzy Pawzbourne]

+4.5 124. Yay Blue! We miss you

 

[Sienne and Gabby (GA)]

Ketones can occur if there's an infection + not getting enough calories + not enough insulin. I have no expertise with eye issues. @Marje and Gracie has had some experience but I believe she is traveling at present. If the eye drops lower Ozzy's numbers, you may have your answer about there being an infection or inflammation.

Like Wendy, I'm reticent to make any comments without a spreadsheet to look at. If you're keeping records of Ozzy's numbers somewhere, it's just as easy to save the numbers on a spreadsheet.

 

[Tracey&Jones (GA)]

I'm not sure I understand your comment. You think it looks like he has a curve or he does not? Thanks for responding!

I think he is getting a slight curve which indicates to me that the insulin is working. Now is the dose correct or another issue for the increased numbers....that is another concern.

 

[Marje and Gracie]

1) Ozzy has had some redness on the skin around his eyes along with some brownish red discharge. They gave him some eye drops and it got better but keeps coming back. Kitty committee....what do you think? Could something with his insulin levels or diabetes in general be affecting his eyes??

Any type of infection can cause ketones DKA to develop if the insulin dose isn’t correct and there aren’t enough calories & water. That includes eye infections.

Testing ketones once a month with a blood ketone meter in a cat that is ketone prone isn’t the best option if you want to keep him ketone negative. I know you are busy, I do understand that. I know it’s also not easy to just happen upon Ozzy when he’s in the litter box. Many cats will need to pee first thing in the morning. Can you put him in the litter box each morning and try to catch some pee to check his urine ketones?

As far as the eyes go, when you say red around his eye on the skin do you mean the membranes under his eye lids or the actual skin above and below his eyes? I actually disagree with your vet that some cats just have eye irritation. They might if it’s allergy season but if they do have irritation other than when there’s a lot of allergens around, something is causing it.

I take my Tobey to a veterinary ophthalmologist and that’s where I’d recommend you start, if you have one (I’d think there would be one in SoCal) so they can correctly diagnose his issue. I’ve found general practice vets don’t always diagnose eye issues correctly and then you are giving a med that might or might not be effective.

My Ophthalmologist no longer uses Tobramycin as an antibiotic eye drop and, BTW, it is not a steroid My vet uses Olfloxacin a/b eye drops but that’s an aside because Ozzy might need something different. They need to find out if he has conjunctivitis or some form of herpes.

My Livia and Gracie, have/had reddish discharge but that came from them both being Scottish Folds with really flat faces. It’s typical for that breed. Gracie also had meibomanitis which is infection/inflammation of the glands in the skin above the eye and it made her squint. Both eyes. It it didn’t cause redness. There are different treatments for that condition and that’s why a veterinary ophthalmologist is your best bet.

 

[Ozzy Pawzbourne]

Any type of infection can cause ketones to develop if the insulin dose isn’t correct and there aren’t enough calories & water. That includes eye infections.

Testing ketones once a month with a blood ketone meter in a cat that is ketone prone isn’t the best option if you want to keep him ketone negative. I know you are busy, I do understand that. I know it’s also not easy to just happen upon Ozzy when he’s in the litter box. Many cats will need to pee first thing in the morning. Can you put him in the litter box each morning and try to catch some pee to check his urine ketones?

As far as the eyes go, when you say red around his eye on the skin do you mean the membranes under his eye lids or the actual skin above and below his eyes? I actually disagree with your vet that some cats just have eye irritation. They might if it’s allergy season but if they do have irritation other than when there’s a lot of allergens around, something is causing it.

I take my Tobey to a veterinary ophthalmologist and that’s where I’d recommend you start, if you have one (I’d think there would be one in SoCal) so they can correctly diagnose his issue. I’ve found general practice vets don’t always diagnose eye issues correctly and then you are giving a med that might or might not be effective.

My Ophthalmologist no longer uses Tobramycin as an antibiotic eye drop and, BTW, it is not a steroid My vet uses Olfloxacin a/b eye drops but that’s an aside because Ozzy might need something different. They need to find out if he has conjunctivitis or some form of herpes.

My Livia and Gracie, have/had reddish discharge but that came from them both being Scottish Folds with really flat faces. It’s typical for that breed. Gracie also had meibomanitis which is infection/inflammation of the glands in the skin above the eye and it made her squint. Both eyes. It it didn’t cause redness. There are different treatments for that condition and that’s why a veterinary ophthalmologist is your best bet.

Hi Marje- thanks for your reply!
To clarify, I regularly check Ozzy on the ketone meter monthly just to check in on him. If it shows he has any ketones, I check more frequently (every day or other day) until I can see them flushing out and then after he has been negative for some time. I go back to checking monthly unless I have concerns to check again (unusually high BGs, or he is acting off, etc.). Usually if I increase his water intake and up his dose a little, it goes back to LO on the meter. We obviously monitor closely during these times and check BGs often to make sure he doesn't go low. Our vet was on board with this approach. I will be honest, he has developed low levels of ketones several times over the last year. But it usually starts when we leave town for a night. We don't let him miss more than one day of insulin (usually only one shot) because of how ketone-prone he is.
Couple questions:
1. Isn't it better to get a ketone blood test rather than a urine strip test?
2. Is not getting enough insulin alone (because he eats plenty) enough to cause ketones? Or does an infection also have to be present?

Ozzy's eye diagnosis was periocular mild erythema which basically translates to redness around the eye. He was not diagnosed with an infection. They also did a fluorescent stain to see if he had any scratches or debris in his eyes (negative). It's the skin around Ozzy's eyes that is red (really it's pink), not inside his eyes.I tried to google eye redness in cats and attached is a picture of a cat with similar redness but Ozzy's condition does not look this severe. This photo is of a cat with conjunctivitis. Our vet ruled that out and also herpes. Ozzy doesn't seem to have any squinting and does not rub or paw at his eyes so I don't think it's making him uncomfortable.
I called the vet again today to ask why we were prescribed an antibiotic if there was no infection and was told that it can still help with the redness and swelling. We will finish the round of antibiotics and see how he does. We already saw a huge improvement the first day of usage. If the redness persists, will definitely look into a veterinary ophthalmologist.
I am off for the next 3 days so will curve Ozzy a few times this weekend to see how his numbers are doing.

 

[Marje and Gracie]

Hi Marje- thanks for your reply!
To clarify, I regularly check Ozzy on the ketone meter monthly just to check in on him. If it shows he has any ketones, I check more frequently (every day or other day) until I can see them flushing out and then after he has been negative for some time. I go back to checking monthly unless I have concerns to check again (unusually high BGs, or he is acting off, etc.). Usually if I increase his water intake and up his dose a little, it goes back to LO on the meter. We obviously monitor closely during these times and check BGs often to make sure he doesn't go low. Our vet was on board with this approach. I will be honest, he has developed low levels of ketones several times over the last year. But it usually starts when we leave town for a night. We don't let him miss more than one day of insulin (usually only one shot) because of how ketone-prone he is.
Couple questions:
1. Isn't it better to get a ketone blood test rather than a urine strip test?
2. Is not getting enough insulin alone (because he eats plenty) enough to cause ketones? Or does an infection also have to be present?

Ozzy's eye diagnosis was periocular mild erythema which basically translates to redness around the eye. He was not diagnosed with an infection. They also did a fluorescent stain to see if he had any scratches or debris in his eyes (negative). It's the skin around Ozzy's eyes that is red (really it's pink), not inside his eyes.I tried to google eye redness in cats and attached is a picture of a cat with similar redness but Ozzy's condition does not look this severe. This photo is of a cat with conjunctivitis. Our vet ruled that out and also herpes. Ozzy doesn't seem to have any squinting and does not rub or paw at his eyes so I don't think it's making him uncomfortable.
I called the vet again today to ask why we were prescribed an antibiotic if there was no infection and was told that it can still help with the redness and swelling. We will finish the round of antibiotics and see how he does. We already saw a huge improvement the first day of usage. If the redness persists, will definitely look into a veterinary ophthalmologist.
I am off for the next 3 days so will curve Ozzy a few times this weekend to see how his numbers are doing.

If a cat is currently having issues with ketones, the meter is more “real time”. But just for screening purposes and keeping an eye on them, because they can develop fast, the urine ketone strips are cheaper and work just fine. If you start to see ketones, you can then use the meter.

And, you are correct, ketones develop from not enough insulin. When I wrote that above about not enough insulin , infection, and not enough calories, I was thinking “DKA” and wrote ketones so I’ve corrected it.

I’d be interested in finding out what is causing that eye issue. It looks uncomfortable to say the least so I’m glad Ozzy isn’t bothered by it. It doesn’t look like anything my cats have ever had.