Niko - AMPS 243, ketones 8 - ketone sensitivity question

Niko's Mom

Niko's Mom

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Previous post: https://felinediabetes.com/FDMB/thr...55-9-133-dosage-question.298160/#post-3244240

Been a while since I posted. I’m just very confused with Niko’s numbers.

we are entering month 3 of Lantus. He recently started having very high ketones again despite being low for almost 3 weeks. Today he presented with over 8 in his blood.

he is normal with no symptoms which is common when he runs high in ketones. Usually, upping the insulin dose helps him but if he doesn’t go below 200 in a cycle, it seems he develops them again. The vet isn’t sure what’s happening either - we did a urine lab a couple days ago which didn’t show any infection. No symptoms.

we are currently at 1.75 units since last night. He still bounces like crazy. Should I be considering something secondary to test for because of his ketone sensitivity? Insulin resistance? IAA or acromegaly?
 
Sorry to hear about the appearance of ketones again. Is he eating any dry food? If not, do you think you'd be able to get at least 4 tests per day/2 tests per cycle? It'd be really beneficial for Niko if you could follow TR for dosing. That would get him out of ketones faster.

A couple other notes on dosing. You've been increasing by less than 0.25 units. Stick to 0.25 unit increases at this point. With SLGS you hold the dose for 7 days, get a curve somewhere in the last half of those 7 days, then increase. It'll be best if you can do those 0.25 unit increases then hold that same dose. Increasing after just holding the dose a couple days can cause wonky numbers as the depot isn't fully built yet if you increase after a couple days. Remember, we dose based on nadirs, not preshots. With ketones in the picture it's possible to increase sooner than 7 days, if the depot is built and there is enough data to tell you how low the dose is taking kitty.

It's possible you are dealing with some glucose toxicity, where his body is getting used to higher numbers. The solution is to keep increasing. It's just a slower process when following SLGS for dosing.

It's always possible a cat can have acromegaly or IAA, but I think it's too early to test for those, unless you have seen some physical signs of acromegaly. Note, the majority of acros do not exhibit physical signs on diagnosis. We typically tell people to wait until they get a much higher dose before testing. You also don't have enough data for me to see any pattern yet other than "not enough insulin yet".
 
Wendy&Neko said:
Sorry to hear about the appearance of ketones again. Is he eating any dry food? If not, do you think you'd be able to get at least 4 tests per day/2 tests per cycle? It'd be really beneficial for Niko if you could follow TR for dosing. That would get him out of ketones faster.

A couple other notes on dosing. You've been increasing by less than 0.25 units. Stick to 0.25 unit increases at this point. With SLGS you hold the dose for 7 days, get a curve somewhere in the last half of those 7 days, then increase. It'll be best if you can do those 0.25 unit increases then hold that same dose. Increasing after just holding the dose a couple days can cause wonky numbers as the depot isn't fully built yet if you increase after a couple days. Remember, we dose based on nadirs, not preshots. With ketones in the picture it's possible to increase sooner than 7 days, if the depot is built and there is enough data to tell you how low the dose is taking kitty.

It's possible you are dealing with some glucose toxicity, where his body is getting used to higher numbers. The solution is to keep increasing. It's just a slower process when following SLGS for dosing.

It's always possible a cat can have acromegaly or IAA, but I think it's too early to test for those, unless you have seen some physical signs of acromegaly. Note, the majority of acros do not exhibit physical signs on diagnosis. We typically tell people to wait until they get a much higher dose before testing. You also don't have enough data for me to see any pattern yet other than "not enough insulin yet".
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thank you for your fast reply! We have been doing drop increases because or what we thought was a potential hypo seizure but I see now I think that has contributed to potential glucose toxicity.

It is weird because it seems if he has a bounce and doesn’t clear it below 200, he immediately develops ketones by the next PS. He is only on wet Weruva and FF, and freeze dried raw dinner morsels so no dry food.

we can do some more testing for him, just been a bit hectic. I do want to follow TR because I think it’s more beneficial for him, considering how quickly he builds ketones. We have the capability for testing to do this I think.

okay, thank you. I wasn’t sure about acro or IAA, he has no other ailments besides some skin issue allergies we resolved before even getting on insulin. No physical signs of afro either. I guess I’m only jumping to that conclusion because I have not seen any other cats present with such high ketones at such low BG values — do we have anyone like this in the forum?

Do you think he just needs to get to a dose that better regulates him to see a consistent decrease of ketones?

thanks for your help.
 
I've seen a couple other cats with higher ketone values, one of which has IAA. But that cat was on a much higher dose too. I do think that getting him to a better insulin dose faster will help with the ketones.

Has he been checked for any signs of infection/inflammation? Teeth look ok?
 
Wendy&Neko said:
I've seen a couple other cats with higher ketone values, one of which has IAA. But that cat was on a much higher dose too. I do think that getting him to a better insulin dose faster will help with the ketones.

Has he been checked for any signs of infection/inflammation? Teeth look ok?
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he had his blood work and urine work done last time he was at around 9 ketones in his blood in January. Had a physical examination by a few vets (ER and his regulars). Temperature taken too. No concerns from the vets. They said we could do an ultrasound if we really wanted but it’s like 2K and they didn’t push for it because nothing seems out of the ordinary.
It’s really weird hence why I’m trying to see if I’m missing something.
 
How frustrating! Same with Lisa and her Oberon. She even had a vet test for Cushings! Which is less common than acromegaly.
 
Wendy&Neko said:
How frustrating! Same with Lisa and her Oberon. She even had a vet test for Cushings! Which is less common than acromegaly.
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Yes, I actually looked at Oberons sheet which is why I was wondering if it would be worthwhile to push for this testing with Niko!
 
The only thing I would add to Wendy's comments would be how much is Niko drinking. Water can help to flush ketones. If you're not already adding water (or broth or any liquid) to his food, it may be something to consider.
 
Sienne and Gabby (GA) said:
The only thing I would add to Wendy's comments would be how much is Niko drinking. Water can help to flush ketones. If you're not already adding water (or broth or any liquid) to his food, it may be something to consider.
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Yep, his pate is always watered down to a soup and he tends to drink a lot on his own when his ketones are high. He’s really good at listening to his body and eating/drinking/peeing out the ketones more when he’s running high.

despite all this, the only thing that seems to reliably make his ketones come down is more insulin.

based on his sheet, do you guys think he may be experiencing insulin resistance? He had a URI as a kitten and still has eye discharge (will have it for life), which makes me wonder if he is inflamed somewhere. I brought this up to the vet but they brushed it off. I’m just debating broaching the IAA testing conversation.
 
Have you tried giving him lysine? It can help with the eye discharge and is often recommended to help boost a cat's immune system.

I would be more confident answering your question about insulin resistance if you were sticking to dose increases of 0.25u. With tiny increases, it's hard to know what's contributing to how your cat's responding to insulin.
 
Sienne and Gabby (GA) said:
Have you tried giving him lysine? It can help with the eye discharge and is often recommended to help boost a cat's immune system.

I would be more confident answering your question about insulin resistance if you were sticking to dose increases of 0.25u. With tiny increases, it's hard to know what's contributing to how your cat's responding to insulin.
Click to expand...
Yes we got nutri-lys which I think is a form of lysine specifically prescribed for his eyes. I just am not sure if I should push the vet for checking if he is inflamed because of that past URI or if it’s a nothing burger.

And got it, we will be more consistent with the .25 moving forward.
 
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