Moderate Ketones Help!

I just tested Jaspers urine and unless the strips weren't working correctly he has ketones....he just had DKA two weeks ago! It wasn't until today when I posted under the PZI forum that the vet has had me dosing him wrong...1 unit-once daily....I was going to change his dosage this evening. Now I don't know what to do. I cannot keep up with these bills.

 

With a history of DKA and the strips showing moderate ketones he definitely needs to see an ER vet right away. Once it is showing to that point in the urine then the chance of him going into full blown DKA is very possible,

 

UPDATE - Sarah is headed to ER with Jasper right now...

 

Oh no! Sarah, I'm so sorry! Please please update us when you can. I know the bills are a concern, but you'll get through this.

 

Praying for you & kitty!!

 

I believe DCIN is helping her altho' their critical care fund is pretty empty right now. I saw a request for donations fly across my fb newsfeed.

Nothing new other than she posted they had arrived...

 

We are home now! Thank you all! He does have ketones, she said 2+ on that. I tested him before I left and his meter showed 400-at the clinic the vet got 360 so she just gave him some fluids and sent us on our way until I call his regular clinic in the morning.

 

Without going through all your posts....it is critical that you be home testing for both glucose levels and ketone levels. Jasper has a history of ketones/DKA and it is imperative that his levels..both glucose and ketones..be monitored very closely. In your other post you said your vet was only wanting you to shots one time a day. You MUST do shots every 12 hours and test the glucose levels. you were doing 1 unit once a day. MY suggestion as long as you are able to monitor carefully...would be to do 1 unit TWICE a day...every 12 hours


This is only my opinion and hopefully others will weigh in with their opinions.

 

Thank you! Oh yes I am monitoring his BG at home for sure! I would never feel comfortable giving him insulin otherwise! When his vet first had me change to the 1 unit once a day it seemed off....but felt I could trust her. I do think she is trying though but maybe she doesn't know? From what I have read here and on the FB group that vets just do not know much about feline diabetes in general. I do for sure need to be more vigilant in checking for ketones, I usually keep the strips in a drawer and always forget about them so I am surprised I thought about checking today. I will be keeping the bottle out so when I do catch him using the 'bathroom' I will check him right away. A few others have posted in another thread under the PZI page that I posted last night suggesting I start him with .5 units twice a day and see how that works instead of the once a day the vet wanted me to try...she actually yesterday wanted me to try to go up to 2 units...once a day. Thank you again for your help!

 

When does he have his nadir? And how is his appetite?

 

What's the latest on Jasper?




Mogs
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There is another thread for Jasper that seems more active:

http://www.felinediabetes.com/FDMB/threads/vet-wants-to-jump-up-to-two-units.156438/#post-1657192

 

Yes thank you Tuxedo Mom! For my poor wrist it was easier posting once in that thread. Jasper is doing well! He was low all this morning so I ended up not giving him any insulin and will give him .5 units at regular time and go from there. =)

 

@Tuxedo Mom -

Thanks for the heads-up, Mary Ann.


Mogs
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I've posted a reply on your other thread. Delighted to hear Jasper's doing OK.


Mogs
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It's very important that we know his ketone status. Ketone status changes in a short time.
Did the vet do urinalysis? If so, could you post results? And could you recheck and post ketones now?
Ketones mean not enough insulin. If sugar is low or normal and there are ketones, it means not enough calories and not enough insulin.

 

Sugars are very high again indicating that 0.5 units twice per day isn't enough. But the correct way to handle this depends somewhat on current ketone status today.

 

I agree with you. But I think Sarah is getting mixed messages.
Jen

 

Sarah,
Your posts say you gave no insulin yesterday morning 4/20. But your spreadsheet says you have 0.5 units yesterday morning. Could you review and correct your spreadsheet?

 

Sorry! I updated the SS, I didn't do insulin yesterday morning! The vet did not do anything yesterday other than show me how to give him fluids. =/ She was going on that these numbers are normal after him going through all of this mess.... and than told me to give him no insulin at all that day. =/

I've been waiting to catch Jasper in the litter box so I can do a urine sample but I did just check his BG and he is 331 =(

 

Okay. I saw on the Facebook page that it looks like from the pic he has trace to small ketones. I would increase his Prozinc to 0.75 units twice daily, feed him frequently and keep him well hydrated. Are you giving the subq fluids? If so, how much and how often? Is the fluid LR?

 

Thank you! I posted on the FB page as well that I just checked his numbers and they are 288. I assume I should still increase to the .75 correct? I have not given him any extra fluids besides the 100 mil he got at the vets office. He has done very well at drinking on his own-unless I should be giving him some additional fluids? LR? Lactated Ringers? That is what I have =)

 

I would give him fluids every day that he has ketones. How much does he weigh?

 

Ok! He weighs just over 12 lbs. =)

 

I would give him 100 ml of fluids each day as long as he had ketones if he was my cat. What did your vet say to do? She taught you to do the fluids but did she tell you when to give them?

 

I didn't get a chance to give him fluids last night but I will be looking at doing it today. My vet told me that I shouldn't need to use it at all and that he was fine-she didn't tell me when to give it to him. Ah the questions that I don't think to ask, but than not sure if I would get the right answer from her anymore. =/

 

Sarah - you've got to get enough EXTRA fluid into his kidneys to help him pee enough to flush those ketones out of his body. Fluids every day until ketones don't show in urine any more.

 

Just make sure that all fluids from the day before's fluid session are absorbed before giving additional fluids.

 

Thanks you guys! After reading these I did it! I gave Jasper 100 ml of fluids! A little proud of myself, that large needle was a bit intimidating and took a couple tries to actually pierce his skin. I gave him treats and he sat still for me! =D

 

Remember that ketones can come back quickly so it's a good idea to keep testing at least once daily for several days.
Could you update your spread sheet? It's very important to get his insulin up to where it needs to be so that he won't keep becoming ketotic.
I haven't had a cat on Prozinc in awhile but I usually am comfortable increasing dose every day until I get into the 200's then I do it more slowly.

 

Ok, I will be sure to keep checking on the ketones! It sure helps to leave the bottle out compared to when I used to leave it in the drawer. I also updated the SS as well. =)

 

I would increase to 1.0 units twice daily tonight. But good to try to get a few evening sugars once you do this.

Once you get where the numbers are mostly below 250-300, you will normally want to hold a dose for at least 3 days before increasing. It would be different if you were using Lantus or Levemir which slowly "fill the depot" over 3 days which produces a delayed effect.

What is your current feeding schedule right now?

 

Ok! Right now he is getting between 3-4 feedings. I alternate between splitting 5.5 oz and 3 oz Wellness grain free with my cats. So They of course get food in the morning and evening. I give a can around lunch time and if I remember and if there is no food in the bowls at night before I go to bed I will give some more food than as well. =)

 

How many evening sugars should I try to get? I feel lucky sometimes if I remember to check twice before I head to bed.

 

Always get at least a "before bed" test.....depending on what's going on then, you can set an alarm if you need to so you can get more tests on later in the cycle

 

Great! Thank you so much!

 

Are you going to give 1 unit tonight?

 

Sure did! He was 401 when I checked him =/ ugh

 

So we will be at 1 unit twice daily and we will continue increasing. Don't forget to check ketones and consider giving fluids until he gets into a safer range.

 

Remember to try to get as many sugars this evening and into the night as you can. I think the reason your vet tried not dosing at night was because there were a couple of times when there seemed to be a sugar drop in early evening.
Does he eat a lot more during breakfast at lunch than he does at dinner and bedtime?

 

Oh I wish I saw this, I only grabbed on test before I went to bed. I will try and get more tonight. And I will see about giving him some fluids today as well. Hmm for the food he normally eats well during the day for sure...but sometimes it depends on the food. I have a couple different flavors and I am noticing him favor some over others. Although normally for the 3rd feeding for dinner if they eat all of the food before bed I will give them some more but if not they will only get that 3rd feeding. I hope that makes sense.

 

It's much better to feed a diabetic kitty consistently. He should have a bedtime meal every night. This may be why your first morning sugar varies so much with a given dose of insulin. I believe this variance is why your vet thought it better to eliminate the bedtime dose.

What time does he get his shots and when is your bedtime? When do you feed them their mid day meal?

 

OK yea he always gets his dinner it was just if there is food left in the bowl or not before I head to bed that I give them some more. I know the vet has never really asked about his food other than suggesting the food that they sell there of course. He gets his shots about 8 am and 8 pm. Mid day meal is around noon time. I suppose I should get on a better feeding schedule? Put timers in my phone to help me remember. I remember someone mentioning to not feed him within two hours of the evening test before insulin since that can make his numbers wonky-I hadn't known that before until a few days ago. I normally go to bed between 10 and 11 depending on school work.

 

Do you keep track of what Jasper actually eats or is he always eating in a group?

When we first adopted Dewey, he was on Vetsulin and had crazy sugars. We switched to Lantus, filled the depot than increased him somewhat aggressively the first few days because he was so high. As his sugars fell, like many cats, he was very hungry. He would eat his way back up to his old numbers. He would sneak the other cats' food, LOL. He had to slowly get used to the numbers going lower over time.

So you were at 292 in the morning but increased the dose and went up over 400. The question is why. Is this because he got a bedtime snack last night but not the night before? Did he eat some of the other cats' food and eat his way to a higher value? Was there a fur shot in there? Or is it a bounce from a low value somewhere? Sugar checks in the evening at night and keeping track of when and how much he eats are necessary for figuring that out.

 

He eats with our other cat-but I do know that for some reason they like to switch bowls about half way through. BUT he is known for being a fatty and taking more than he should of the other cats food...maybe I should put them in two different rooms for feeding time than? So he doesn't get into the other cats food.
I normally split a 5.5 oz can between them or give them each a 3 oz can. I guess it may have been bad...but I did give him a couple pieces of chicken I grilled up yesterday. A few tiny bites-could that have a large effect on his numbers?
I always check now after I give him his shot if I did a fur shot and I haven't accidentally done that in long while.

 

It makes a big difference that you feed "lunch" at +4 but feed bedtime meal at +2, +3 or not at all. What time do you get up in the morning?

Can you do evening sugars tonight and set your alarm for once or twice during the night?

If you feed at +4 during the day but not at night, he may well need a different insulin dose at night than the morning. Do you vary on how much you feed? Is he sharing with other cats?

 

Yes. It would help if you fed him separately so that when his glucose falls and he is hungrier, he doesn't have the ability to eat more of the other cats' food.

The grilled chicken is zero carb so unlikely to cause a problem.

I would feed at bedtime every night. I would actually give a bedtime meal that is at least as large as his dinner because he isn't going to eat for 9-10 hours.

When do you get up in the morning?

 

during the week I wake up just before 8, the weekends...that's where I'm bad...I tend to sleep in until 9
oh my! I had no idea!! writing this down....
I know I cannot be waking up during the night every night to feed him...should I look into doing only two feedings a day? But than I wonder if they are grazing on their food instead of eating it all at meal time.
Or like you were saying the one dose in the morning and a different at night? oh my...
I try to keep him about 10 oz a day but with him getting into the other cats food as well I'm not entirely sure.

 

I wouldn't increase what I fed him but would try to evenly space his calories into those 4 feedings and try to be more consistent at bedtime.

 

I wouldn't do 2 feedings per day. I would just make sure he gets a bedtime snack every night.

 

I'm wondering so if I feed him at about 8 am and pm and I normally go to bed about 10/11 I should feed about the same time again during the day and again at night?

 

I suspect when you increase his insulin, he steals more of the other cat's food.

Many of us have luck with using one of those timed feeders to provide a middle of the night meal. You either put frozen food in there or use a feeder that has a cold pack. You could set it to open up at midnight for instance.

Does 10 ounces of food per day maintain his weight? Has he been gaining or losing?

It will be much easier to get him in control if his feeding schedule is consistent and if he can't eat the other cat's food some meals but not others.

10 ounces per day would be a hair less than a 1/2 of a 5.5 ounce can four times per day. That would be well over 300 calories for most foods so is quite a bit of calories. My almost 16 pound cat eats more than that but my average size cat eats less than that.

Also, there are some cats that seem to have inconsistent absorption with Prozinc. We had that problem with Noah and switched to Lantus. It seemed like one day Noah's Prozinc would wear off in 8 hours and the next day it would wear off in 13 hours.

So think about options. Best is probably to used a timed feeder to give him a midnight meal every night.

Try to even out his calories more between meals. And try to keep him from eating the other cat's food.

 

What?! That is genius! I've seen the timed feeders but didn't know how they would work with the wet food. I love the freezing idea! And the ice pack!
I had used a calculator from Nature's Variety...granted that was their website...and it showed he needed about 8 oz to maintain his weight. Is there another way to figure out how many oz he needs to maintain his weight? When he was weighed the other day he was 12.4 lbs so he has gained a tiny bit since he was sick, maybe about a half lb.
I will be looking into a feeder now asap and keep them eating in different rooms as well although I suppose will be a little hard to do with the night feeding, is there a way to get around that at all?

 

Looking at the Wellness website (don't know why I didn't think of this before...) it says 1 can (5.5 oz) per 8 lbs of body weight. So with him being 12 lbs that looks like a can and a half so about 8 oz? Which would put me where Natures Variety brand had recommended as well.

 

I use the broad recommendation of 20-30 calories per pound per day with more active kitties needing calories at the higher end. I have a digital baby scale and weigh my cats to refine that.

Where do your cats hang out at night? Sometimes cats need to be kept separate at night. Easier to keep them out of each others' food dishes when you are at home.

Weight gain is another sign that he may be eating more to increase his sugar.

A 12 pound cat gaining half a pound in a short time is like a 120 pound woman gaining 5 pounds. Of course, when sugar is very high, they don't absorb all those calories. How much did he weigh normally before he got sick?

How long do the kitties take to eat?

I would feed breakfast and dinner and remove the dishes after they are done. I wouldn't let them switch and wouldn't leave dishes down more than an hour. I would let them spend more time with noon and midnight bowls.

Is your second kitty fat?

 

The pets mate 5 feeder is popular. You can put 5 portions a day in it. There is also a 2 2compartment feeder. Another for keeping it cold is when you set it for overnight meal, just put one ice cube right in the food. When it melts it gives a little bit of extra fluid.

 

Normally Jasper is on the bed with me most of the night and my other kitty Jack is usually in the living room. He's been around 12 lbs for the past month but looking back at an old receipt for him he was 14 lbs on March 30th right before he got sick-when the vet switched him over to the 1 unit once a day. On April 4th he was 12.08 and on the 5th he was 12.10 and then on the 18th he was 12.03.

Dependent on the flavor they will either gobble all of the food or they may let it sit out for a while. I've noticed one flavor they do not particularly like so I won't be buying it again and it sat I believe for most of the day before I tossed it out.

Second kitty is not fat-sometimes I wonder if he eats enough actually. He sure doesn't eat as much as Jasper and he has always maintained his weight nicely. He's always been 11 lbs and some odd oz-he's never weighed more or less than that.

 

Thank you! It sure does look appealing and not as expensive as the fancy feed and go that I was eyeballing.

 

Just close the bedroom door at night so you can feed them separately.

What do you think Jasper should weigh? So he went from 12.03 to 12.4 pounds in one week?

Do you know what he weighed a year ago? And do you know what he weighed when diagnosed with diabetes? That was in November, right?

 

You can actually program the Petsafe 5 for 9 different mealtimes during the 24-hour period. You would need to reload the feeder tray part way through the day but it saves fiddling round with the timer all the time.


Mogs
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I know the vet, well both vets from here and the one in Japan said that 12 lbs is a good weight for him to be at. Last September he weighed 13.11-he's fluctuated a bit...sadly. All day today and even last night I have kept them separate when they ate to keep an eye on that better until I get an automatic feeder.

Yea he was diagnose November 2014

 

Yea I think for sure I will get a feeder and I was leaning towards this one, just need to wait until payday but I think for sure that it will help with feeding time.

 

aggh I just checked his BG and he's 512!! I don't get it...I was good with making sure they were separated last night for dinner and for their food today. I gave Jasper a 5.5 oz can that he ate for breakfast and lunch. Dinner he had a 3 oz can. Although I do realize I need to make his portions probably a little smaller since I realized after that 3 oz he wouldn't have anything the rest of the night. So I sat out what was left of my other cats food that might be about 3oz. =/

 

Try not to get to frustrated. Fluctuations will happen.

 

Is he at +3?

 

Yea he was +3, needing to get to bed but I'll see about staying up a little bit later so I can get one more test in.

 

Sounds good.

 

Updated =)

 

Just another thought...

Is it possible that your insulin is no good? What brand do you use? Insulin is a biological compound and can and will go bad.
In humans, if we see little response from a shot, one of the first things we do is try a new bottle of insulin.

I would love to see what his sugar is at 4 am.

 

I have ProZinc, that's what I thought last time but I literally just bought new insulin not even a month ago. My last vile I had a couple months but the numbers haven't really changed since getting the new vile. I will go ahead and get that 4AM check as well.

 

I would increase her to 1.25 U with tomorrow morning's dose.

 

ok got updated info but for some reason when I read this last night and when I went to dose him this morning I could have sworn you said 1.75...
So that is what he got I cannot believe I just didn't recheck to make sure what dose you said to give him.

 

That's okay. We'll just see how he does on that.

 

But here's the thing. Your 4 am sugar is 202 and that is a big drop from his preshot number. So he is going to stabilize on less insulin at night.

Do NOT give him more than 1 unit tonight.

Is there some way you can do an overnight sugar curve one of these days?

So... 1 unit tonight unless that changes based on today's numbers.

 

Yea I was surprised to see he was 202, but relieved with seeing a good number!

So go ahead with 1.25 unit in the AM and 1 unit at PM correct?

I should be able to do a curve tonight! I go to school online so other than taking my son to school and picking him up I will be home. Though tired, I know I want Jasper's numbers under control-and he deserves it. I've been doing well with the separate feedings but I know for sure I will invest in the feeders to help out. =)

 

Great!
Do you have any more sugars from today?

 

Updated! I will be checking his BG here in a half hour-then 2AM, 4AM, 6AM, then regular check at 8AM. =)

 

All updated for the day, no 400+ for the last couple days which is nice. Getting there =D

 

I would increase to 1.5 units tomorrow morning and 1.25 U tomorrow evening.

Tell me about how his feeding schedule is now.

Things are definitely better. Hang in there and keep up with checking sugars. Have you tested ketones lately?

 

Great thank you!!

I have been feeding in the morning at 8-again around noon-than in the evening about 8 and at night normally right before bed. Although tonight I feed him a little early at about 1045

I checked his ketones I believe yesterday it was and he was all good! I will try to catch him tomorrow and get a sample. =)

 

Typically in a cat prone to ketones, it's good to check 2-3 times per week until their sugars are all down below 180 or so.

 

Thank you for the tip! I really think he doesn't like going to the bathroom when I'm around, it is so hard to catch him! Even when the litter box is right next to my office! I swear he waits until I'm busy somewhere else then goes to the bathroom.

 

Could you update his spreadsheet?

 

Updated! Not sure if the dose increase caught his body off guard or that I think he was stressing because he was hungry (a bit early) for lunch.

 

Don't change insulin tomorrow since you aren't sure what is happening.

Does he have any symptoms of being sick at all? Was he really that stressed out?

 

He vomited earlier before lunch-not much of anything but some fur but not enough to consider it a fur ball. But that was it, still good appetite, playing, being his normal self. But of course as soon as I catch him in the box I will get a test done (and he is hydrated, I did check that). He had been for a while although not too much now that he was ripping his fur out, the vet didn't seem at all concerned in trying to figure out why he is doing it. But I really think he does it because he's hungry. So I'm sure he ingested some of that fur.

 

High sugars can cause them to rip out fur. So can thyroid disease, liver disease and skin disease.

Puking can cause stress hormones to rise so sugar goes up.

 

Ok yea now that I think about it I believe I did read somewhere that the numbers can do that. That's probably what it was. I will be keeping an eye on him of course, not too hard since he loves to hang out with me while I work and comes to bed with me at night. =)

 

Updated for the weekend. =)

 

I wouldn't give no insulin at all for a number like 163. 163 is still a pretty high blood sugar level. It's reasonable to give a little bit less but holding insulin completely means you have to pretty much start all over again. Or maybe there is something I am not aware of? Was he acting strangely?

 

Did you see the note on the side? I did give him 1.25 units when we reached 269 about 30-40 minutes later. He wasn't acting strangely at all so I'm not sure why his numbers were low. I forgot though that food kind of messes up his actual numbers (agh!). I didn't think to dose him at 163 since I've been told to not dose under 200. I will be prepared now! How should I approach his dosing when he is under 200? And at what point should I definitely not dose him? I took him to the vet today (possibly for the last time since it has been recommended to change his vet). And all she ran was a fructosamine-his numbers were a little high-on the low end of the 'high' scale-which was a tiny bit higher than the last time.

 

Dewey's sugar is typically 110 when we dose him. The only number I would use to not give any insulin is below about 60. If I have had a big drop in the sugar or if lower than usual, I decrease the dose a bit. We are on Lantus so it's a bit different.

I think you have the same problem I did with protamine zinc. The nadir and duration of action between shots seemed to vary so it was hard to figure out dose changes.

I didn't realize you have the insulin late. I'm on my iPhone and it gives me tunnel vision of the Google sheets.

Remember you want his sugar to ideally be 80-120 so not giving any insulin when it hits 200 makes no sense. I've heard vets say no insulin before 150 but that is usually for the shorter acting insulins. Never heard of withholding protamine zinc at less than 200. Weird.

 

Agh I should have asked about that, since a lot of the times he isn't under 200 at test time I never thought to ask.

Do you think that he may need to switch insulins?

He has definitely been acting fine this whole time and plays a lot more now than he had prior to getting sick in early April. He plays with his mice toys at least a couple times a day!

Is there, I guess a rule of thumb at how much insulin to give under 200? I would be a little nervous about overdosing him.

 

There isn't an exact rule of thumb. But the curves you did don't have much of a nadir then every once in awhile he has a 150 or so point drop on the random testing. Lantus and Levemir are less likely to do this.

 

Oh my! I suppose I need to look into a new vet and a new insulin than! I will work with what I have now while I locate a possible new clinic and make an appt for him.

 

Vet Interview Topics

 

I scheduled an appt for Jasper at a new vet on Monday, fingers crossed!

 

I was just going to look for this! Thank you BJM!

 

Is everything okay? I haven't seen any updates on Jasper's spreadsheet for 4 days.

 

Agh I didn't realize it had been so long since I posted. All is well over here, just updated his SS. I have been swamped with homework now the semester is almost over so trying to hurry and get everything in before the due date along with a large final paper that is due as well.