HELP! ketones again! help me walk it through .....

I posted weeks ago about my cat Payne and her high ketones and our fight to get her stable.
Since then she has spent 2 weeks, at different times, at Davis, the last time was 10 days ago, so she
has not had ketones for 2 weeks.

We have not been able to do a spreadsheet because of working schedules, but plan on doing over the
holiday. She is on ProZinc 3cc b.i.d. and Novolin 1cc b.i.d. and has done very well on this dose. In the
last 10 days her #'s have been in the 300's before her shots and the few times I could get home in the
high 190's +6.

She is one pred. pepcid and an antibiotic. ( tylosin, famotidine,pred) s.i.d. we have changed all the
cats food to canned, low carb. and it has been amazing! (another post)

This is what I think happened ..... we had friends over for early dinner and apparently she got to
some rice soup that was left at cat level .... that was bad enough, but when she got her evening shots,
another cat jumped up, Payne jerked as the needle of the 3cc was going in and we felt some moisture,
but not sure how much she got? Her BG before the shot was 371 and 2.5 hrs. later was 304 and then she
deep sixed and we could not find until morning. During the night she threw up quite a bit of the chicken
that was in the soup.

When we found her at 6:30 a.m. her BG was 292 and we gave her her shots. 3.5 hrs. later her BG 229
but finally got ketones and they were mod-high around 60. I called vet he is in surgery and will call
soon so we started sub-fluids but only got 1/2 cc in her before she darted (left with a kid for a moment!)
and now she is on the sofa.

She looks like crap! but she ate this morning and it stayed down. She has gained weight and I thought
was doing great until last night. At 5:30 (Pacific time SF) last night no ketones! I think the combination
of the food and probably not enough insulin caused this?? I hate to take her back if we can work through
this but I do understand how serious ketones are but they say not to stress out the cat and she hates
the hospital.

I stayed home from work and I am ready to cry ..... we almost lost her twice and we thought we were
on the upside, and with this list, felt we had hope. Please, please any suggestions? anyone else fought
ketones? Any thoughts on my feeling it was food/insulin????

ANY suggestions please.
waiting for vet ....

 

Now that Payne has settled down, can you get more SubQ fluids in?

 

We are looking for her .... how much more sub-fluids? would be good?
Thanks

 

Did your vet give you directions when s/he gave you the SubQ fluids? If not, call the vet's office back and at least speak to one of the vet techs for directions on how much more to administer. Also, perhaps Payne might eat a little snack for you?

Also, be sure and note how much you will give/have given SubQ and how much (if anything) Payne eats. This will be important info for the vet to have, especially if s/he wants you to bring Payne back in this afternoon.

 

If you truly meant 1/2 cc of fluids, then 100 mls would be okay to give her if she is a normal size kitty, not a tiny cat. As for the ketones, I never really worried about Mishka if she went into the 300's in the beginning. I worried when she went into the mid 100 range....that's when she got them. Sounds like Payne is very prone to them so it may take a few months before her system regulates to everything....food, insulin, etc. I know it did with Mishka. The first 3 months were hell. Then she would get them approx. once a year, so bad she would have to go to ER for several days. Other than a UTI one time, no reason ever found for why she would get them. Every test and culture run......fine except for maxed out on ketones. I don't mess with them at home unless it is trace reading.......then I wait, watch like a hawk, get another pee sample and see where we are.

 

We found her and gave her the rest of the subQ so she has had 100 ml in 2 hours but
have not been able to get her to pee. Any suggestions on getting a cat to pee? We
are watching her carefully. Just spoke with the vet and since her BG is good and we
are giving her liquids, he recommends giving her 1 cc of Novolin now and another
100 ml in 2-3 hrs. Apparently human insulin helps bring down ketones ..... who knew?
From your responses there is life after ketones, please make it so! Thanks!

 

I hope you will give only one UNIT of Novolin Insulin.

Insulin is measured in units. There are 100 units of insulin in 1 cc of Novolin liquid.

The first little mark on the insulin syringe is "1" unit. Not 1 cc.

 

Putting a little extra water in her canned food will help her get fluids which should, in turn, help her pee. If she hasn't pee'd by tomorrow AM, I would contact the vet again.

And yes, there is life after ketones - but they have to be monitored carefully, because it is a situation that can go south in a big hurry.

 

Please don't give her another 100 mls of fluid so soon. You can overload the heart and the kidneys. She's got a 100 in her now, I would wait until a.m. As for peeing, give her time to work through the fluids you just gave. Is she showing any sign of dehydration at all? Pick up her scruff and see how fast it snaps back.

 

Sorry about not being so good with terminology, cc's, ml, units .... we have only been dealing
with the diabetes for five weeks, and half the time she was critical in hospital. I have never been
around anyone cat/dog/human with diabetes, that alone is strange, I know. But I am DOING what
I am suppose to be doing, I found you guys and I have managed (with good hospital care) to keep
her alive. She is only four and I have had her since she was a day old, with 10 others (2 litters)
that I hand fed and got through ringworm
Thanks for the advice on subQ's .... she is alert now and not dehydrated, I will hold off any
more today unless she is showing signs of dehydration. And yes, she finally pee'd and the ketones
are just a tad better. (sorry tad is not medical) And thanks for the advice on adding water to
canned. I actually came up with this one a couple of weeks ago, trying to lure in one of mine
that loved the dry, hated the wet but loved water. I just took the dry out over time .... still
don't think he has noticed
Thanks again everyone, I am breathing again.
Nancy and Payne

 

Thanks to everyone we have passed this crisis! No ketones! BG 258 and she is
prowling for food! This was a hard day and this list is great! A lot to learn but
hopefully I will have time .....

 

Fiona is very ketone prone. We use the Precision Xtra glucometer that tests blood for ketones. MUCH easier than getting cat to pee on command. You can test whenever you want! And it's more accurate ketone readings since they are real time. Pee could be sitting in kidneys for hours so what would current ketones be? You can get meter at Walmart for $15'ish. Strips are tough to find and pricey. You'll have to call around or buy off ebay (best prices). If you call around, verify that it's a box of 10. They'll tell you they have them and they'll be the glucose strips (box of 50 or 100). Some pharmacies can order ketone testing strips but you may need to inform them that they are available. Precision Xtra numbers for cats based on data collected on old board and my own cat using meter for 2+ years are below.

Keep Payne eating. Very important. Tuna with water is good. I add more even more water. Easy way to keep fluids in her. Ketones will come and go until infection is resolved or she is regulated so continue to keep an eye on them. Why is she on Tyloson? Does she have IBD? Before we got the meter, I moved the litterbox into the TV room so I'd have something to do while waiting for Fiona to pee. :roll:

I learned how to use fast acting insulin (Humlin R) here on the board. Saved Fiona's life, but she's also got a condition that makes her VERY insulin resistant (IAA). Is Novolin fast acting?


Precision Xtra Readings for Cats
**'Normal' for cats is 0.0-0.3 (Fiona's normal is 0.1, D & Shadow's normal is 0.3)

**3.0 is aproximately when ketones start showing on urine ketodiastix strips at a trace - at least that is the case for Fiona.

**As BG's go down so will ketone levels (in most cases). If I can get Fiona's BGs under 250 for even a couple of hours her ketone level will go down.

**Other than being DKA at dx, the only other time Fiona has had ketones above 1.0 was when she had some kind of infection.

**Other cats get elevated ketones for other reasons, too high BGs for too long, etc...
Here's a post that says kinda the same thing but has some other info too. http://www.felinediabetes.com/phorum5/r ... ?8,1684726

 

Re: was HELP! ketones again! now ketone meters and thanks ..

Thanks for the advice on the meter for ketones, wasn't sure how well it worked but now I have ordered one.
I can see how knowing instantly if the ketones are moving upward can really help. We were actually able to
get through this bout of elevated ketones at home with advice from the vet. Plus especially what I have
learned from this list is invaluable! I home test, watch for ketones, changed diets, etc. etc. I really believe
that had I not learned all this from here??? Payne might not be alive because she was/is really, really sick

We are an hour from Davis, coming in as an emergency and days in the hospital, has saved us a lot of
money, although that doesn't matter because it is about the animals and what wouldn't we do for them ....
we had a dog with cancer last year, now that is major money!

Payne is on Tyloson because they thought she had IBD although she never showed those signs .... but she
had an ultra sound and they thought from that. I think Novolin is fast acting because she started to perk up
shortly after her shot and her Ketones started going down and she wanted to eat! now!

Thanks to all! I still have a lot to learn but having a large hand to hold makes it a LOT easier. It is hard when
you are responsible for something you know nothing about and on some level hate. (blood,needles,lancets)
Nancy and Payne

 

A story I like telling is when I first got the meter Fiona was in the ER because of ketones. They had her on IV fluids over night. They tested her urine the next day and voila! no ketones! I tested her blood at the same time and it came back 7.6! Didn't know then that normal for Fiona being 0.1! ER vet put no stock in meter since he had no data. I now know that 7.6 is ridiculously high. Of course the next day the ketones were showing on pee stick again. Fortunately, Fiona kept eating and I learned how to give fluids at home and how to use Humlin R.

 

I second the advice to use the Precision Xtra Meter...if only for peace of mind in being able to get an immediate, accurate number. I had a scare not long ago with ketones showing up on a strip which we've never had before. I was able to grab my Precision Xtra and test, only to find that his ketones were in the normal range and had actually gone down from the day before. I think my strips may have been old or exposed to too much air or heat (as in DH or I left them too near our old, energy inefficient stove).

Strips are pricey, no doubt about that.