10/23 - Dolly AMPS236 - 244+1 223+4-182+6.5 -0.9 ketones

https://www.felinediabetes.com/FDMB...-230-0-5-on-ketone-meter.237331/#post-2664651
I have to take my husband for surgery. Dolly's ketones are up. Due for insulin at 6:15am (California) Gave her food early to make sure she eats. Afraid to give insulin before I leave for surgery 6:30am, I will be gone 4-5 hours. I am worried and scared as to what is the best thing to do. Not eating much, early for her. Can I hold off insulin until I get home and can monitor? I will take her to the vet when I get home - no time now, no one even open.

I will have to read responses when I get to the hospital. Insulin the big question. She is eating .

 

I am not familiar with a situation that involves ketones - except that food and insulin are critical for ketones. Let me tag @Sienne and Gabby (GA) @Sue and Luci @tiffmaxee for help.

 

I'm not familiar with ketones either, but I do know insulin is important. She's been surfing in yellows lately. Your AMPS is almost identical to yesterday and you gave insulin. Since she is eating, I think you can safely shoot. Sending prayers for your DH's surgery and for Dolly's ketones.

 

I don't have personal ketone experience but just one observation - her ketones are on the rise but you are still below 2.4-2.6 (Wendy referenced a post yesterday with this info). Great job testing and keeping up with her - sorry this is all coming up at not an ideal time.

@Lisa & Oberon has been working to manage Oberon's ketones and might be able to share her experience.

 

I have to leave in 10 minutes. Can’t monitor insulin. Do you think it’s okay? Didn’t eat a ton. 1/3 to 1/2 Fancy Feast

 

2.4 is considered the "take action" number, meaning that it's time to call the vet. One study showed that cats under that number were never in DKA (diabetic ketoacidosis- potentially dangerous situation where the ketones affect blood pH level). Cats over that number were considered in ketosis (high ketones) but not always ketoacidosis (ph level affected). They hypothesized that some cats with high ketones might be able to use some other blood buffering system to maintain normal pH levels even though ketones were elevated. Oberon has had ketones as high as 6.8 with no symptoms (loss of appetite, etc.), but other cats at the same numbers might be having problems. His ketone numbers clearly parallel his blood glucose numbers, but with a lag of maybe 12-24 hours.

Long story short, unless you're seeing symptoms of some sort like loss of appetite or vomiting, I would suggest that a ketone value of 1.6 is worth keeping an eye on and maybe giving the vet a call to check in when you get a chance, but it's not an immediate crisis. Insulin, food, and fluids are the things that will help bring that number down. For anything above 2.4, you should check in with the vet because there's no real way to know on your own whether it's DKA or just ketosis with normal pH.

Having said that, I totally get how you're feeling... when I first checked Oberon I freaked out that he had detectable ketones at all, then rushed him to the vet when he randomly threw up his dinner.

 

If you can leave food down, give insulin. Add some water to food. Depending on how far away from hospital you are, maybe you can run home for a test at some point. Ketones needs to be watched. Maybe see a vet, if not eating there could be an infection starting somewhere causing the elevated glucoses.

 

Gave her insulin. Hosp is about 1/2 hour. I will run home after I drop him off. I am making her nervous so she won’t eat now. Too much stress.

 

Ran home. BG 244 @+1, Ketones dropped to 0.3 and 0.5. Won't eat now, I've totally stressed her out. Have to go back to the hospital. Thank you everyone for being here for me. Removed my ramblings. Sorry

 

Dolly’s ketones are coming back up. How often should I check? What is causing the thirst and peeing like pre diagnosis? Her vet is not in but trying to get a call back from vet that is there. Adding water to food. Gave her Mirtazapine to get her appetite moving, hope that was okay. Thank you. Anything else I can do?

 

My experience with Oberon is that his ketones change fairly slowly compared to blood glucose numbers, but I don't know if that's the same for every cat. Initially I tested him every few hours because I was worried. Now I do spot checks twice a day when he gets his insulin. I can usually roughly predict whether his ketones are going to go up or down based on what his glucose has been for the past cycle or two. But also keep in mind that Oberon has IAA, so his glucose patterns and insulin response are different than typical diabetic kitties. I don't know how that might or might not affect his ketones.

 

I can’t imagine dealing with IAA, just read a little about it. I guess we learn. It sounds so scary. I feel the more I read the less I really understand about Feline Diabetes. My brain has definitely changed since getting older and being retired. It’s sort of sluggish. I guess right now I want to know when I need to act. I am just so exhausted from dealing with health issues with my husband and Dolly. There have been some very scary times and a day like today with my husband having surgery and Dolly’s ketones elevated. Give insulin or not because I couldn’t be home. Making good decisions. I am waiting on the vet to call me but have a lot of trouble trusting their knowledge of diabetes. Thank you for sharing your experience with Oberon and for writing me, trying to help and give support. I am truly grateful for you and everyone on this forum.

 

Hi Adrienne! You've had a big day - first take a deep breath - and try to relax and regain your composure. It's hard to do when you're tired and stressed out from all that's been going on.

First - how's your hubby? Surgery go ok? Do you now have a patient to take care of there at home?

Looks like you shot the full dose this morning and Dolly safely rested in her lemon tree....

So with that said, any improvement on the ketones later in the day? Is she still eating/drinking okay?

I do hope she'll start to feel a little bit better and that those ketones will get down and out of the way.

I hear you on your reliance on your vet for good information - unfortunately they know so little about FD. Would there by any chance be an internal medicine vet specialist anywhere nearby who you could consult with on the ketones issue?

I'm wishing you well and a peaceful evening...it's been a long long day.

Sending you prayers and get well wishes for DH and for Dolly's ketones to improve...

 

I just wanted to add that Dolly has chronic sinusitis. Her appetite is definitely affected by her inability to smell her food. I try not to give Mirtazapine too often but days like today I need to make sure she eats. She vomited right after eating the other morning but was fine right after. It is very rare for her to vomit not even hairballs. I wish there were signs to let me know she is in the danger zone. I am trying not to test her too often, trust issues begin but likewise I don’t want to miss a high ketone number. She has been 1.6 at 5:30am then 0.3 & 0.5 two hours later. 0.9, 4.5 hours later. 3 hours since last tested. Eating well, drinking a lot for her. Unfortunately it’s the weekend but I will definitely look into Internal medicine doctor. Waiting on vet to call.

 

Hoping the surgery went well and things start settling down a bit for you now

 

Dolly is avoiding me. How do I get her BG numbers down? Is she getting enough insulin? Do I continue to adhere to SLGS? I just raised her 3 days ago. How often do I check ketones? My husband is in pain but doing okay. Thanks so much for asking. Thanks for being there.

 

Do I sound unhinged? She’s hungry and it’s fasting time, what do I do?

 

You sound like you're under a lot of stress.

Is she avoiding you because she doesn't like the testing OR is she mad at you for leaving her alone today?

You can change to TR if there's no dry food being fed and you can get enough tests...from the looks of her SS recently you've got the testing part covered.

You could increase tomorrow - put TR on your SS and signature - and hopefully those numbers will come down.

Were you able to order a blood ketones meter? I think it's more accurate than the urine meter (I've heard/read that). I've not had to deal with ketones...since the early days of Luci's diagnosis...I tested her pee multiple times and there were never any again...thankfully.

In the meantime, are you able to capture her urine and test for ketones at least daily?

 

I have a meter, Keto-doc. Last test was over three hours ago, 0.9. She is over all the testing. She is totally compliant but done for the day. I’ve become her nurse not her mom. I hate it. It has affected our relationship. Her ear is sore and she only lets me do one. She gets a small amount of Dr Elsey’s on occasion but I guess I could stop it for TR. I am just exhausted.

 

Me too but for different reasons...

Test her once more and go to bed... get some rest tonight... tomorrow is a new day.

 

I need to know if it’s more important to feed her or stay with her pre shot fast another hour and a half??? She’s looking for food.

 

Do you have freeze dried treats you can give her? A few freeze dried treats won't raise her BG's for her next test.

Luci demands some too...especially in that last two hours before the tests...I always try to feed her a snack around 9.5+ just to make sure she's not going to starve to death...although you'd think she'd not had anything to eat for days by the time it's time for her breakfast or dinner...she's always been a grazer so she likes to find food when she wants it...

I'm signing off for the evening...I've been up working since 5 a.m. and am exhausted.

Good luck this evening! I hope you get some rest

 

Thank you.

 

I hope Dolly lets you have a good night’s sleep tonight, what a day (well week really) that you’ve had you can consider eliminating the dry and swapping to TR once you are feeling a bit more human.

 

I really only use the dry for overnight until pre shot fast. I only leave about 1/8 of a cup and I don’t think she goes out to eat until maybe a couple hours before fast. I think she mostly eats carpet dust (treat dust). She then gets on the little makeup stool next to my side of the bed and stares at me for a couple hours. I can feel it . “Wake up, I’m hungry”. I just like her to have food available during the night. Thanks for your response. Definitely considering TR.