Ketones

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Information on bouncing
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
On 12/6 I was up until 3:00am watching the Libre
readings bounce down very quickly. (I am using both the Libre for readings every fifteen minutes and Alphatrak 2 or 3 times a day.) I was very fearful that
he would dip below 50 and I was ready to take him to the ER. Fortunately this did not happen.
Same thing happened today. It seems that when the readings go down the BG automatically bounces way down. Fortunate I was home to feed him and give honey if needed but what if I am out? Looks like this pattern might have gotten extreme when I went up to 3.25 units. At 3 though he remained very high most of the time though. Why is this happening and how can I change this pattern? Guess it's called brittle diabetes. Thank you.
 
When you are following SLGS as a dosing method, you reduce the dose when you see them go below 90. Try 3.0 units again, he may do better at it this time. Was that 62 on the Libre or AT? You really don't want him that low on the AT. Anything below 68 on the AT means give higher carb food to bring him up.

To prevent fast drops down at the first part of the cycle, it may help to give him several small meals.
 
The 62 was on the Libre which appears to run lower than AlphaTrak. It is confusing to use both the Libre and AlphaTrak. I brought back the Libre to limit the amount of ear pricks for my Toby. This process makes him very unhappy.
I had to withhold insulin tonight because he wouldn't eat. He ate great this morning and for the last few days but his pattern is to return to refusing to eat.
Is this common for our diabetic kitties?
 
Not giving insulin to a cat with recent DKA is not a good idea. What was his PMPS? If high like the previous test showed on the spreadsheet, no problem giving his full dose. You can almost always give at least a half dose. Cats undergoing anaesthesia who cannot have any food at all can have at least a half dose. Insulin does more in the body than combat the carbs in his food.
 
I thought that I posted this already but do not see any evidence of that. Sorry if I'm double posting.
Toby's ketone reading tonight was
2.5. This is with the NovaMax Plus blood ketone monitor. He is eating very well, not hiding and is alert.
Should I be concerned? Should I take him to the vet
tomorrow or perhaps the ER?
 
I can see you posted it on another of your threads. On that you said the reading was 2.3
Here is that thread https://www.felinediabetes.com/FDMB/threads/new-member-constant-high-reading.295443/
Are you using the alpha track meter to test the BGs?
Can you tell me if the green BGs you have on the SS on 12/8 and 12/6 were the libre or the alpha track meter? This is important for us to know.

I am glad to hear he is alert and eating well. However ketones of 2.3 or 2.4 are of concern.
Can you feed him extra food please and if you could let me know about green reading on the 12/8 and 12/6 asap that would be helpful.
I’m going to tag @Wendy&Neko to see what she thinks about a dose increase.
 
Bron and Sheba (GA) said:
I can see you posted it on another of your threads. On that you said the reading was 2.3
Here is that thread https://www.felinediabetes.com/FDMB/threads/new-member-constant-high-reading.295443/
Are you using the alpha track meter to test the BGs?
Can you tell me if the green BGs you have on the SS on 12/8 and 12/6 were the libre or the alpha track meter? This is important for us to know.

I am glad to hear he is alert and eating well. However ketones of 2.3 or 2.4 are of concern.
Can you feed him extra food please and if you could let me know about green reading on the 12/8 and 12/6 asap that would be helpful.
I’m going to tag @Wendy&Neko to see what she thinks about a dose increase.
Click to expand...
 
If you find Toby gets lethargic, vomits or goes off his food at any time with those higher ketones, please go straight to the vet.
Are you able to retest the ketones?
 
@Susan Pressman
On your spreadsheet up top where you have the meters listed Please put after the Alpha Trak the date you switched to it , I see that Bron had asked above which meter you were using. I see it was 11-15 as noted on the blank line you put on the spreadsheet. Maybe highlight that any color so it stands out to members
I would also put 11-15 after the Alpha Trak you have on your signature
I would also put the ketones in the remarks section on your spreadsheet

Please do it :cat: so members don't have to keep asking you what meter you are now using now
 
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Susan, how is Toby today? Have you managed to get another ketones test? Have you managed to switch him to all wet food now?

If he was going down to 62 on the AT, that means the 3.25 units dose is too high for him and he should go back to 3.0 units. But I'm worried about the ketones reading. I wouldn't increase the dose at this time, pending another ketones test result.
 
Bron and Sheba (GA) said:
On Monday you said the 62 reading was on the libre. See above.
Click to expand...

My mistake. 62 reading was on the AlphaTrak.
This morning he would not eat...even baby food mixed with Churu. So I gave him only 1/2 a unit.
Gave him some Zofran so I hope he'll eat before evening shot.
I mentioned that last night his ketones were 2.3.
I tested him twice this morning and he went from 1.0
to .5. Can he go down so quickly overnight. I did a controlled solution test so I know the strips are good.
Thank you!
 
Is he lethargic or active today? Ketones can come down. With such a high number for AMPS, you could have given the full dose.

Can you try offering food today to see if the Zofran is helping? Let us know how it goes.
 
Toby clearly is unwell today. Very lethargic. Was hiding when I got home but now he is in the living room. I offered him some kibble which he usually loves and he only ate a few bites. This was a couple of hours after giving him Zofran. I doubt that he will eat again before PM dose. I could be wrong but unlikely. I was told earlier here to give him 1/2 dose if he doesn't eat. Guess you disagree. Should I force feed him?
Should I check his ketones again even though reading was .5 early this morning?
 
Yes, please check his ketones again. With all the other signs, this may mean a trip to the vet. Do you have the ability to give fluids?

You can give at least half a dose if not eating, more if he's really high. And do assist feed him.
 
Susan Pressman said:
Toby clearly is unwell today. Very lethargic. Was hiding when I got home but now he is in the living room. I offered him some kibble which he usually loves and he only ate a few bites. This was a couple of hours after giving him Zofran. I doubt that he will eat again before PM dose. I could be wrong but unlikely. I was told earlier here to give him 1/2 dose if he doesn't eat. Guess you disagree. Should I force feed him?
Should I check his ketones again even though reading was .5 early this morning?
Click to expand...
My cat has gone from 1.0 to 0.2 in a few hours, and 0.1 to 0.6 in a few hours. For Methos, he can improve a lot with feeding him (extra), making sure he drinks and/or giving him fluids, and after his next insulin dose
 
Wendy&Neko said:
Yes, please check his ketones again. With all the other signs, this may mean a trip to the vet. Do you have the ability to give fluids?

You can give at least half a dose if not eating, more if he's really high. And do assist feed him.
Click to expand...

I checked his ketones with his BG PMS.
Ketones were 1.8. He did eat tonight but only wanted
high carb Purina Pro kibble and a jar of baby food.
His BG was 674. Vet left message with nurse that she
wanted him on 3.5 units rather than 3.25.
I do have the ability to give fluids but not the bag or
lines. He does drink a lot of water though.
 
He needs calories, give him what he will eat. The higher carb food may help keep him safe in that higher dose.

You might want to see if you can get a bag and lines, fluids can help flush out ketones.
 
Does 3.25 to 3.5 make a difference?
Vet doesn't think so since it is such a tiny amount.
It has been difficult measuring half of a half unit.
Is it better to adhere to your recommendations rather than the vet? I'm not trying to challenge you.
I am more inclined to take your advice.
I really like his vet though. She is devoted to his care.
Hard to be duplicitous.
I don't think that I will be able to pick up fluids until
Monday. I'll keep checking his ketones.
 
Susan Pressman said:
Does 3.25 to 3.5 make a difference?
Vet doesn't think so since it is such a tiny amount.
It has been difficult measuring half of a half unit.
Is it better to adhere to your recommendations rather than the vet? I'm not trying to challenge you.
I am more inclined to take your advice.
I really like his vet though. She is devoted to his care.
Hard to be duplicitous.
I don't think that I will be able to pick up fluids until
Monday. I'll keep checking his ketones.
Click to expand...
Susan how is your eyesight? Is that part of the quarter unit issue? I’m a tiny bit younger and without my thick glasses have super near vision but I know a quarter U is tough even in the brightest light—my eyes aren’t what they were.

@Wendy&Neko do you think it would be ok for the weekend if she has trouble with the quarter to do a half—then maybe get calipers etc later?

now I will be quiet and go away. Sorry.

except to say a pet er might sell you fluids and a line. Now I’m going. Sorry.
 
You can get craft head lamps with lights and magnifiers that help too. It doesn't have to be calipers. Or some people set up an arrangement that has a magnifying glass resting flat, and load the dose below the glass.

If you shoot 3.5 units, you will need to test at least 4 times per day, the preshots plus one other each cycle, including at night before you go to bed. The 3.25 units got him down to 62 on the AT, which is too low. If he keeps eating higher carb food, that may help him stay safe.
 
Wendy&Neko said:
You can get craft head lamps with lights and magnifiers that help too. It doesn't have to be calipers. Or some people set up an arrangement that has a magnifying glass resting flat, and load the dose below the glass.

If you shoot 3.5 units, you will need to test at least 4 times per day, the preshots plus one other each cycle, including at night before you go to bed. The 3.25 units got him down to 62 on the AT, which is too low. If he keeps eating higher carb food, that may help him stay safe.


I am afraid that I messed up. I am sorry to be so confusing. I went through the memory on AlphaTrak and did not find a 62 reading. I now recall that the 62 was with the Libre. I rechecked the number with AlphaTrak shortly after and got 86. I will make a very strong effort to avoid this in the past.
This morning I gave 3.5 units (doctor's orders.) to check this out. That was a big mistake as his BG was bouncing down very quickly! I needed to leave for an appointment at +5. I gave him some high carb kibble
to make sure that BG was on the rise before I left.
His PMPS reading was 734! I got scared and gave him 3.5 units again. That was probably a mistake.
BTW his ketones were 1.2 .7 yesterday.
I learned a lesson to turn over dose recommendations to you. Now I am using both the Libre and the AlphaTrak. I use the AlphaTrak when the Libre is unable to read high numbers and to double check very low numbers. Is this OK to use both?
I have those craft glasses without a light. Will
use them with strong lighting. Problem isn't really my eyesight but it is difficult to be in the middle of such a small space.
I can see why the dose has to be based on the lowest reading. Besides diet, what advice do you have on dealing with consistently high numbers?
Can this be changed?
Click to expand...
 
Susan Pressman said:
He eats a full can of fancy feast pate AM&PM and 1/2 can in the middle on good days.
At least several times a week though he doesn't want to eat so he will take only a few bites of kibble and baby food sometimes mixed with Churu if need be.
Click to expand...
That really is not enough for him to be eating with ketones in the picture. I know how hard it can be to get cats to eat if they don’t want to.
Is he getting Zofran regularly 3 times a day? And what is the dose of the zofran ?
What are the ketones today?
And how is he generally?
 
Zofran doesn't last a full 12 hours, 3 times a day would be better. You want to stay ahead of inappetance.

The night of the 6th, were the 76 and 67 also on the Libre? Or the AT? It is OK to double check the Libre lows with the AT. In fact, we recommend it. You don't need to worry about double checking the high numbers. High is just high and it doesn't impact how we change the dose.

The high number for PMPS was probably due to the steep drop from AMPS to +3. They don't "bounce down", bounces are going up and are a result of his system dumping sugar into his system to counter lower numbers than he is used to, or fast drops. Tonight's number also had the impact of the high carb food. He will get over it.
 
76 and 67 were with the Libre.
His pattern is to go down very quickly or stay high for much of the day. Both are not good. I feed him Purina dm when I see his readings drop so radically. Will be transitioning him to Epigen 90 tomorrow.
They say start with 10% with regular food but do not know how to proceed from there. Fortunately, he is eating wet food exclusively since increasing the Zofran.

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Ketones

Zofran doesn't last a full 12 hours, 3 times a day would be better. You want to stay ahead of inappetance.

The night of the 6th, were the 76 and 67 also on the Libre? Or the AT? It is OK to double check the Libre lows with the AT. In fact, we recommend it. You don't need to worry about double checking the high numbers. High is just high and it doesn't impact how we change the dose.

The high number for PMPS was probably due to the steep drop from AMPS to +3. They don't "bounce down", bounces are going up and are a result of his system dumping sugar into his system to counter lower numbers than he is used to, or fast drops. Tonight's number also had the impact of the high carb food. He will get over it.
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Susan do you think you could put some information into the remarks column of the spreadsheet? Information such as ketones results, how and what he is eating, if he is getting zofran, when you checked with the AT. All this help s us understand what is going on without having to go back days to look something up.. thanks!
I don’t understand the second part of your post.
 
Susan Pressman said:
Will be transitioning him to Epigen 90 tomorrow.
Click to expand...
I don't understand that post either .
When you start feeding the Epigen 90 please put that in your signature and the date, also please add SLGS to your signature. On your spreadsheet up top where you have the Meters you use please put 11-15 after the Alpha Trak and if you can where you did note on the blank line first day of Alpha Trak can you highlight it any color so it stands out please
@Susan Pressman
 
Diane Tyler's Mom GA said:
I don't understand that post either .
When you start feeding the Epigen 90 please put that in your signature and the date, also please add SLGS to your signature. On your spreadsheet up top where you have the Meters you use please put 11-15 after the Alpha Trak and if you can where you did note on the blank line first day of Alpha Trak can you highlight it any color so it stands out please
@Susan Pressman
Click to expand...

Record keeping is very difficult for me. (ADD) Especially trying to document details of when I gave Zofran and day by day records of how and what he eats. I lost track of dates when I started the Libre or the AlphaTrak. When the Libre stops working and I just use AlphaTrak in between. I will try to the best of my ability to adhere to your direction.
Also I do not know how to use colors to highlight. I know that for the past 4 days since I have been giving him more Zofran, he has been eating well...
one can of FF before AMPS, one can of FF before PMPS and a half a can in between. I know that this can change quickly though to his refusal to eat.
Please tell me how to document all this? Also if possible how to make this as simple as possible.
Regarding ketones: since his BG has been lower I have not tested him in the last few days.
There are only 5 test strips in a vial. They are extremely expensive. How often do I need to check if his BG readings are not that high? I certainly will spend the money based on your recommendation.
What reading do I need to call the vet?
Regarding the Epigen 90- the company says to mix this with his regular food very slowly in 10% increments. Is this necessary? Hopefully he will continue to eat only wet food though.
My big concern is the almost daily bounce.
 
Susan Pressman said:
Record keeping is very difficult for me. (ADD) Especially trying to document details of when I gave Zofran and day by day records of how and what he eats. I lost track of dates when I started the Libre or the AlphaTrak. When the Libre stops working and I just use AlphaTrak in between. I will try to the best of my ability to adhere to your direction.
Also I do not know how to use colors to highlight. I know that for the past 4 days since I have been giving him more Zofran, he has been eating well...
one can of FF before AMPS, one can of FF before PMPS and a half a can in between. I know that this can change quickly though to his refusal to eat.
Please tell me how to document all this? Also if possible how to make this as simple as possible.
Regarding ketones: since his BG has been lower I have not tested him in the last few days.
There are only 5 test strips in a vial. They are extremely expensive. How often do I need to check if his BG readings are not that high? I certainly will spend the money based on your recommendation.
What reading do I need to call the vet?
Regarding the Epigen 90- the company says to mix this with his regular food very slowly in 10% increments. Is this necessary? Hopefully he will continue to eat only wet food though.
My big concern is the almost daily bounce.
Click to expand...
@Bron and Sheba (GA)
 
Diane Tyler's Mom GA said:
please add SLGS to your signature. On your spreadsheet up top where you have the Meters you use please put 11-15 after the Alpha Trak and if you can where you did note on the blank line first day of Alpha Trak can you highlight it any color so it stands out please
Click to expand...
@Bandit's Mom
Hi Bhooma I asked Susan to add this information , she really doesn't know how to do this also the Purina DM is kibble, in her post #9
Thank you Bhooma :bighug::bighug::bighug:

@Bandit's Mom
 
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Thanks for putting the ketone results in the remarks column of the SS.
I would test for blood ketones once a day. If it is above 2.4 I would test again a few hours later. If he is lethargic at all or not eating can you tell us please and put that into the remarks column of the SS too? And post and tell us that as well. If the ketone level is above 2.4 and he is lethargic and/ or not eating I would tell the vet.

I am glad he is eating better. Can you increase the amount of food he eats between the cycles from 1/2 can to 1 can?
You are doing a very good job caring for Toby Susan
 
Diane Tyler's Mom GA said:
@Susan Pressman
Did you start the Epigen 90 yet?
Are you still feeding any of the Purina DM Dry?
Click to expand...

Can I start him on the Epigen 90 by itself without mixing it with the Purina DM dry at first?
Actually though, I haven't given him any dry this week. He is eating the FF wet very well.
Hope he keeps it up! Only time I gave him the DM
is when he refused the wet before his AM and PM
doses.
 
Bron and Sheba (GA) said:
Thanks for putting the ketone results in the remarks column of the SS.
I would test for blood ketones once a day. If it is above 2.4 I would test again a few hours later. If he is lethargic at all or not eating can you tell us please and put that into the remarks column of the SS too? And post and tell us that as well. If the ketone level is above 2.4 and he is lethargic and/ or not eating I would tell the vet.

I am glad he is eating better. Can you increase the amount of food he eats between the cycles from 1/2 can to 1 can?
You are doing a very good job caring for Toby Susan
Click to expand...
I actually gave him a full can in between but he only ate about 3/4 of a can. I will order more ketone strips
and test him daily. Is it OK that he stays at such high readings if there are no ketones or below 1.0 present?
 
We will keep working at getting him into better numbers. We can see the current dose is getting him into blues which is good, but he’s bouncing from them which is very normal, so don’t worry. He just has to get used to the normal numbers again and not think they are too low. That can take time. For now he will have to stay with the current dose, unless he drops below 50 for 10 cycles, and then we can evaluate.
Did you choose a dosing method? With ketones we recommend TR.

He doesn’t have to eat the full can all at once during the cycles…he can graze with that.

Susan Pressman said:
Is it OK that he stays at such high readings if there are no ketones or below 1.0 present?
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The higher numbers are from bouncing, and while it is not ideal, there is nothing we can do about bouncing except get the cat used to the lower numbers again. The things that help keep ketones away is enough food, enough insulin, testing daily for ketones, and getting plenty of fluids. While it is not nice to see those high BGs, you are doing everything to help make sure the ketones are kept away. So try to concentrate on seeing how good the lower numbers are instead of seeing the higher numbers. I know it is hard.
 
Bron and Sheba (GA) said:
We will keep working at getting him into better numbers. We can see the current dose is getting him into blues which is good, but he’s bouncing from them which is very normal, so don’t worry. He just has to get used to the normal numbers again and not think they are too low. That can take time. For now he will have to stay with the current dose, unless he drops below 50 for 10 cycles, and then we can evaluate.
Did you choose a dosing method? With ketones we recommend TR.

He doesn’t have to eat the full can all at once during the cycles…he can graze with that.


The higher numbers are from bouncing, and while it is not ideal, there is nothing we can do about bouncing except get the cat used to the lower numbers again. The things that help keep ketones away is enough food, enough insulin, testing daily for ketones, and getting plenty of fluids. While it is not nice to see those high BGs, you are doing everything to help make sure the ketones are kept away. So try to concentrate on seeing how good the lower numbers are instead of seeing the higher numbers. I know it is hard.
Click to expand...

I am terrified most every day when I see his readings drop so radically on the Libre that he will become hypoglycemic. Sometimes when I see it drop quickly to around 100 I will stay up with him to make sure that it doesn't go any lower. It does bounce up from there with food. Does their body automatically prevent the numbers from being dangerously low? When I am gone for the day I am especially worried. I can't leave food out for him to graze because my two other cats that will immediately eat it all up. Can I give him 3 units rather than 3.25 on those days just in case he reads too low?
 
Chris & China (GA) said:
@Susan Pressman I would be happy to help you with your spreadsheet. I sent you a private message if you would like some help. We will soon be adding a new tab for 2025 and it sounds like you are stressed enough without having to worry about the record-keeping.
Click to expand...
Thanks Chris
This is what I asked Susan to do


When you start feeding the Epigen 90 please put that in your signature and the date, also please add SLGS to your signature. On your spreadsheet up top where you have the Meters you use please put 11-15 after the Alpha Trak and if you can where you did note on the blank line first day of Alpha Trak can you highlight it any color so it stands out please
Also the Purina DM is kibble which also has to be added to her signature that it's Dry

@Chris & China (GA)
 
Susan Pressman said:
Does their body automatically prevent the numbers from being dangerously low?
Click to expand...

While the liver will release stored sugars and hormones to bring the BG up, it's not something you can depend on happening when you need it to, so no, don't depend on it "saving the day".....but 100 isn't too low. It's in the normal range, not low. Normal on the Alpha Trak is 68-150.

Susan Pressman said:
Can I give him 3 units rather than 3.25 on those days just in case he reads too low?
Click to expand...

No. Lantus craves consistency so needs to be given at the same dose both AM and PM. Also, because it's a depot insulin, just reducing for one cycle may not make any difference. One of the reasons Lantus is such a good insulin for cats is because of the depot which (in very simple terms) is kind of like a time-release. When you give the shot, it goes into the depot and gradually releases into the bloodstream which makes it last longer and each shot has some "carry-over" from the last. So just reducing from 3.25 to 3.0 wouldn't necessarily make a difference because the depot is still full enough to release the 3.25 dose over the next cycle.

Susan Pressman said:
When I am gone for the day I am especially worried. I can't leave food out for him to graze because my two other cats that will immediately eat it all up.
Click to expand...

Can you put Tyler in another room by himself during the day? Or there are feeders that work on a microchip and will only open for the cat with the chip (which can be implanted or they have a collar that has the chip in it)

Please start a new post. We don't like for threads to go over 50 comments and this one is approaching 100. It makes it very hard to quickly catch up on what's been going on and what advice you've already gotten.
 
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