early dka? ketones trace/small

howdy yall! im back with a new diabetic kitty. this one is a foster (with 0 rescue support)

jekyll is 11yo untreated for diabetes since late october of 2022. i got him monday morning at 2am. he was inappetent, wont poop, and smelled like ketones though he was testing negative. i have a super sense of smell though, i smelled it all over him and his stuff.

i took him to the vet monday morning and my vet REFUSED to give me insulin. demanding that 250 was too low for me to shoot. i was flabberghasted! he was given doxycycline and i was treated like a fool. fast forward to tonight he finally tested "small" for ketones.

ive made his SS. i got him started on vetsulin even though i hate it i was desperate for any insulin. he isnt vomiting, i can get him to eat and drink a little, last time he pooped was wednesday afternoon. i have both laxatone and miralax. i feel like the laxatone worked for him on wednesday then i switched to miralax and no poop since. might go back to laxatone. what do you think?

after .5u of vetsulin his bg has stayed around 250, with a low of 217. should i up the dose? its wild. im doing an hourly curve and his next shot will be at 10am est (3.5 hrs from now)

thanks in advance guys

 

I looked at his SS. If he is eating consistently I would up the dose to ¾ unit or 0.8 ud using U100 syringes.

 

I only have u40 at the moment. I can syringe feed him no problem. Ugh I can't believe he didn't respond to it

 

Katrina -

I'm assuming you've used Vetsulin previously? If not, please take a look at our post on Vetsulin info. I would also add as much water to Jekyll's food as he'll tolerate. The water will help to dilute the ketones. If Jekyll is eating, you may also want to increase his caloric intake -- feed him more. Food also helps to get rid of ketones. As Larry suggested, an increase in insulin is another factor in managing ketones. I'd just keep an eye on your testing since Vetsulin can drop numbers quickly. It helps to remember that ketones are the result of an infection or inflammation, not enough calories, and not enough insulin. Did the vet run any labs? It would be good to rule out an infection.

Have you given any thought to looking for a new vet? The idea of not prescribing insulin to a cat who's blood glucose numbers are well outside of normal range is akin to malpractice and could be the reason you're seeing ketones. And good for you for testing for ketones!

 

I used vetsulin for 2 days for my sugar cat Tuna before I switched to prozinc. He went into remission in 2 weeks! I will absolutely ve switching to a generic Lantus hopefully Monday! My husband's dad is a vet and he called in the script for me. I can add about 3 tablespoons of water per can I blend up and he is still drinking on his own. I can try to add more I was worried he'd dislike so much water. I had him eating about 4 cans a day before it all blew up in ny face, now he's closer to 2.5/3 . I'll try harder, I syringe feed him mostly. I would definitely say after this curve to up the vetsulin, you agree right? I only have u40 syringes right now, do you recommend 1u on the u40s? I do have some labs and he does show signs of infection. He is currently on doxy .6ml almost 13lbs of cat. The vet I saw wasn't my normal vet. I go to a low cost clinic because I have so many cats. My normal vet was in surgery, I won't be able to see her til Wednesday because of her surgical rounds. I am going to try to get my money back from the quack vet. I knew I smelled ketones on him even though they weren't registering on Monday. I have super smell so I knew it was coming, hence the vet visit from hell. But I even test my remission kitty for ketones, I try to be hypervigilant!

But he was playing today after his shot. That made me happy, even though his bg didn't fall at all. I don't understand why .5 u didn't do anything!

 

Here they are

 

I would take the Vetsulin dose up slowly. Go to 0.75u rather than doubling the dose. If please read over the link on Vetsulin. You need to make sure you have fed Jekyll before shooting which is different from Prozinc. Vetsulin can seriously tank numbers so having food first is important. Also, once the doxy kicks in, if there is an infection, numbers can drop quickly, as well. And remember to get PM tests!!

You use U40 syringes with Vetsulin. If/when you switch to Lantus/glargine, you'll need U100 syringes. Walmart's Relion brand come in half unit increments or you can get them via mail order. Take a look at the sticky notes at the top of the Lantus/Lev/Biosimilar forum for lots of info on those insulins.

 

His shot is in 3 minutes so your here right on time for me thank you! I'll do .75 then! i have him eating right now Preshot is 242. He has had about half a can of FF with water added

 

With Vetsulin, since it hits so fast and furious, it’s recommended you feed at least 30 minutes before the shot so try for that tonight. Unlike Lantus or prozync, where you can feed and shot immediately after.

I also wanted to say thank you and bless you for taking in a diabetic cat, he’s so lucky you know what you’re doing

 

Absolutely! He was def eating at 9:20 until after his shot. I have to feed him slowly as I'm convincing him to eat

 

Also, he isn't responding to insulin at all. His bg is staying in the 250s if you'd like to check his SS for me

 

Great to see you over here from the FB group, Katrina!

With him just starting insulin and so much going on with him that we don't know, we wouldn't want to rush to increase the insulin. His BG numbers aren't terrible and we sure don't need to be adding a hypo to everything else going on right now!

I'd just concentrate on getting as much food and water in as you can for today.

And WOO HOO on the playing! A cat in DKA usually is too sick to care so just keep doing what you're doing and hopefully he'll never cross the line from ketosis to ketoacidosis.

It's pretty much an experiment to see how much water you can add and have him still eat it. Some cats refuse to eat it if it's got a teaspoon of water added, while others happily lap away with a 1/2 food, 1/2 water mix.

The picture of your labs didn't come through.

Just an FYI...it looks like you mean 10pm here:

 

I got a blood ketone meter, it's says 2.5mmol if that means anything to anyone. I have no idea

 

Thank you! Its been a long time since i was on the fdmb! Haha I did mean pm, I'm so sleep deprived right now! I will make him eat the watery food. I just made some more and have been syringing it. Have you seen a cat not react to insulin before? With how harsh vetsulin is I was worried!

Also I got a blood ketone meter and it read 2.5mmol, that mean anything to you?

 

I'm not sure what 2.5 is converted to US numbers but I know it's low. You need to feed some high carb food & test again

 

@Sienne and Gabby (GA)

 

@Chris & China (GA)

 

Ah it's a blood ketone meter, not a glucose meter. His BG is stable at around 250, I just thought I'd try a ketone meter as well and realized I have no idea what it means lol.

 

Oh okay you had me scared there for a minute. I have no idea about ketones, my boy has never had them knock on wood!

 

From https://felinediabetes.com/FDMB/thr...oacidosis-dka-and-blood-ketone-meters.135952/

 

2.5 on the ketone meter is of concern.
How does he seem? Is he eating OK? I know you are syringe feeding him? Are you managing to get much food into him.
I’m glad you are adding water. How long before the next insulin dose is due.?
Is he lethargic at all?
Can you get another ketones test before the next dose is due….about an hour before so we have time to decide what to do with the dose please?
Amd can you add the ketone results into the results column of the SS please?thanks

 

Just FYI....when dealing with blood glucose numbers, the rest of the world uses mmol/mL while the US still uses mg/dL. To convert a world number to a US number, you just multiply by 18....so if 2.5 was a blood glucose, it would be 45.

 

@Chris & China (GA) the blood ketone meter readings are not changed. We use the reading that @Katsallday posted… 2.5

 

He is acting fairly ok. Talkative, he's eaten 3 cans of FF so far. Did a poop, his next shot is in 2 hours. Still no real change in bg numbers. Actually they look worse. Do I hold the .75 or go back to. 5

 

I redid the ketone blood meter. Now it says 2.9... I'm so confused he seems ok certainly not hospital worthy

 

I am glad he is acting OK.
Is he eating on his own or are you syringe feeding him?
Do you have high carb food at home and some honey or Karo?
With the blood ketone reading increasing to 2.9 I would increase the dose of insulin to 1 unit.
And get him to eat as much as possible without making him sick of course. It is the food and insulin which will get rid of the ketones.
But if he starts to get lethargic, not eating, vomiting , diarrhoea…I would take him to the vet or ER as it could have progressed to DKA.

 

Ok I'll up the dose, is there any chance the dose could be making it worse? I read that too much insulin can cause ketones too.

He eats on his own about a third of the time. He has some sort of uri. Shooting snot out of his nose. My vet opens at 8am, I'll be the first in line

 

If there is an increase in ketones, a cat needs more insulin. This helps the glucose from the food to enter the cells so the body can use it. The increase of insulin will help decrease the ketones, as will extra food if you can get him to eat it. Doesn’t matter what the food is….as long as he will eat it. If he will only eat higher carb food at the moment, that is ok. We just need him to eat. We can worry about him eating low carb later when he is over this current problem.
Poor kitty with a uri. It must be hard to eat. You are so good to help him.
Did you say you had high Carb food and honey or Karo if needed?
I will be around for the next 10 hours so keep posting with updates please.

 

Yes I understand that. Christina had thought that the 2.5 was a blood glucose number at first so I was explaining to her that if it WAS a BG number, she'd just need to multiply by 18 to get the US value

 

Ok 1 unit it is! Ty for explaining! I don't even smell ketones on him anymore and he RAN to a moth in the window. I don't understand he's acting better but his ketones are getting worse? Should I aim for like 5-6 cans of food? I'll syringe him whatever he needs, I don't need sleep anyways lol! His 24hr curve is done in 10 minutes. I'm so confused. I thought tunas fd was hard, jekyll is a mountain to climb! I'm hoping he's ready for a pee soon so I can confirm the blood ketone meter. When I tested his pee last night after the vetsulin the ketostix read between trace and small vs the small I got before that

 

Ok, I get it, thanks Chris!

 

That would be right if the blood ketones meter is saying 2.9
The urine is a bit behind the blood which is accurate to the minute. The urine could have been in the bladder for hours.

We say to feed 1 1/2 times as many calories as they would normally eat post DKA so I’m not sure how much he would normally eat. Also depends how big the cans are. We don’t want to make him vomit. If you can give him something every couple of hours except for the 2 hours preshot, that would be good. Even dry food is OK at the moment if he will eat that.

 

He's eating constantly, just slowly. He vomited once after his 4th can and his dose of doxy before the ketone issue. I'd say 4 cans is his limit. He's 13lbs. He's been eating the FF pates fine, he's on his 4th can with 3/4ths left.

 

My husband wasn't rolling the vetsulin vial. Should I stay at .75u?

 

I think you could go ahead with the 1U dose, especially since you keep such a good eye on him.

 

I agree with the 1 unit

 

He shot 1u, kitty had 2/3 a can FF before shot and the rest he just finished. Such a good boy. His life was so hard recently, his owner died and the daughter left him untreated for diabetes for months. All this could have probably been fixed with diet change forever ago

 

He is so lucky to have you and so lucky he didn't go into DKA during those months.

 

I'm surprised he didn't go dka! I swear he's more loving than most of my cats. I would foster fail him in a heartbeat if I wasn't caring for 17 others. Here's a picture of the handsome man yall been working so hard for

 

17 others! My goodness!
He is gorgeous and looks chilled out!

 

He is so freakin chill with everything I've done to him. 24 hour curve, insulin, syringe feeding, thermometer in the butt, doxycycline, sometimes cerenia pill, laxatone, suctioning out his terrible boogers. Nest never once swiped, growled, moaned, he is a champion. I love him so much

Yup 17. Of the 17 one is tuna who is holding on to that remission very well. The rest are very mild special needs like allergies and slow feeding. Jekyll is my white whale lol

I wish I was zoned for an animal shelter, I want to do thr 501c3 but I'm afraid they'll come check my house if I file. I mean my house is 3000sqft and I'm quite the stress cleaner but I know I'm past the legal limits *which is dumb*

 

You are amazing. How do you manage to feed them all?

 

I do jobs others would look down on to pay for them lol! My stage name is lily because I picked up this specific job to pay for all 17 to go to the vet for bloodwork in 1 day because one ate and vomited up a lily petal. To this day idk which cat ate it but they all were fine and survived. I just went into huge debt lol!

Also ketone update, ketostix came up negative and blood ketone meter went down to 1.7. It was at 2.9 a few hours ago!

 

That is excellent news. Keep up the good work.
I see in the SS he vomited after the doxycycline. Did he lose the doxycycline tablet?

 

It was liquid doxy, he started gagging and vomited up his food and meds within 2 minutes of dosing. He has done this before with doxy but now I'm afraid he aspirated because he gagged while I with shooting it. I have a stethoscope and I don't hear lung crackling but I don't have an xray.

Shall I give him an hr and redose with it mixed into food this time? I try not to mix meds and food often as that can create food aversion

 

Oh I also gave cerenia after he stopped and gave a second to chill

 

The liquid Doxycycline probably does not taste nice.
If you think he vomited it, you could repeat it but disguise it somehow.
Also make sure it is followed by food as doxy can cause oesophagitis.

 

always, im very wary of doxy, every animal gets food before and after

 

His blood ketones went to 1.9 :/ 2 hours until I can get to the vet

 

I’m heading off to bed now and will look in when I wake up.
I hope it all goes well with the vet.
Keep going with the 1 unit unless the BG drops under 90.
hopefully the ketones will remain under 2 with the increase of insulin.

 

Any news @Katsallday ?

 

Sorry! I fell asleep literally dead to the world. I slept through my alarms because I was dreaming that I woke up and tested blood and fed him! Crazy! No more 36 hour awake periods for me lol

Ketones are at 1.4, I ordered more strips of them too. I'm trying to decide if I should bring him back for more fluids tomorrow, what do you think? The vet is a fool saying he doesn't use ketones. What does that even mean??? So I'm practically on my own until my normal vet is back. I trust her she's amazing.

 

I thought you were giving them. If not yes I would get some more sub Q fluids.

I dont know what that means either.

I see in the SS you have swapped to prozinc.....I can't remember talking about that.
I see you reduced the dose to 0.75 U when you did the swap. I would go back to 1 U next preshot.
Can you draw a line across the SS, colour it and say 'changed to prozinc please so anyone helping is aware of the change?
Also you will need to change the signature as well to prozinc. Thanks!

 

I was out of subq, had to tell me vet to do it and then he walked away before I could ask for some for home. He didn't like me and my ketones lol. My husband did the shot while I was driving, I was late leaving the vet almost missed the shot time so before I could ask yall my husband just did it and said anything is better than nothing. And for the second prozinc shot I was in sleep coma. I'll up it to 1u. Is there anything I should be doing differently?

 

So you are swapping to prozinc permanently now? Is it still in date and not opened for more than 6 months? I'm assuming you used it before for Tuna...is that correct?
With prozinc you can test, feed and then shoot one after the other. You don't need to wait. It is a gentler insulin than vetsulin and longer lasting.

 

Actually I got it from the vet. It's the same office as the vet that refused to give me insulin, but a different vet there. I didn't like this vet either but I hate vetsulin with a passion and I needed fluids anyway so I got it. It's brand new, brought a cooler and ice pack to the vet.

 

Here is information about the basics of Prozinc
And another link to Prozinc Dosing Methods

 

Thanks! A great refresher that I really needed. It's been 1.5 years since I've dealt with feline diabetes

 

You are doing a great Job!

 

Thank you! It's all cause of yall that I can handle this in any form. I remember when I posted looking for a cat nurse to deal with tunas diabetes because of my panic attacks now here I am with a foster full of ketones, a bad URI, diabetes, constipation and anisocoria. I couldn't do this is yall weren't here for me

 

Should i do another 200cc of fluids? Or more or less?

 

Ketones popped back to 1.7 back at the vet for fluids, I asked for a bag so well see if they'll actually let me buy it

 

And ofc they don't let me buy it

 

If you can get a prescription from them, you can order online I think even from places like chewy

 

I'm gonna try with my husband's dad, he'll make the script for me. Ketones dropped to 0.7!!! These fluids are liquid gold!

 

How much subQ fluids are you giving? I would not give more than 100ml maximum a day and only if cleared by the vey.

 

I believe the vet gave 200cc again

 

Can you take a look at his spreadsheet? Why isn't he responding to insulin?

And should I bring him for more fluids in the morning?

 

200 ml is a lot of subQ fluid to give a cat in one go. How long does it take for the fluids to totally disappear from under the skin?

The ketones are reducing which is great so I would stay with 1 unit for now and we can review each day.
He has not reached the best dose yet but we don’t want to raise the dose too quickly.
Keep feeding him lots of food. How is his eating going.

 

He doesn't want to eat as much as I want him to, maybe 3-3.5 purred cans a day. His ketones are back to 1.2 I just checked

 

Keep trying with the food. Remember let him eat whatever he will eat. Don’t worry if it is not low carb at the moment….we just want him to eat.

 

Ketones down to 0.9. I want off this Rollercoaster he seemed interested in dry food but considering how he's not responding to insulin I am very nervous to risk really high carb dry. So no fluids in the am?

 

See what the ketones are in the morning. As long as they are under 2 I think I would wait until the next day. Im just concerned about 200mls a day.

 

I'm with you, I've been worried about heart problems from the get go so I'd rather skip fluids today anyways. Still sitting at 0.9 ketones his bg is up to 395?!

Edit: he has had 3 cans of fancy feast in 9 hours. His next feeding is coming up. Did I go too hard? I'm just so worried about ketones