Ketones 1.0 and URI

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pablo'smom

pablo'smom

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Pablo has been doing a lot better since being DKA last week but today his ketones are 1.0, I’ve given him turkey and chicken breasts and ff pate in hopes it will bring it down. His BG levels have been better today but now his ketones are high. On top of that, he has had so many sneezing fits about 1 every 20-30mins and the vet didn’t want to prescribe antibiotics with everything going on lately since she believes it is most likely viral. I’m going to check his ketones in a couple hours as I just gave him more food. At what point should I be worried about DKA and take him into the emergency vet? He is acting completely normal otherwise.
 
pablo'smom said:
Pablo has been doing a lot better since being DKA last week but today his ketones are 1.0, I’ve given him turkey and chicken breasts and ff pate in hopes it will bring it down. His BG levels have been better today but now his ketones are high. On top of that, he has had so many sneezing fits about 1 every 20-30mins and the vet didn’t want to prescribe antibiotics with everything going on lately since she believes it is most likely viral. I’m going to check his ketones in a couple hours as I just gave him more food. At what point should I be worried about DKA and take him into the emergency vet? He is acting completely normal otherwise.
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Here is your most recent post for continuity.https://www.felinediabetes.com/FDMB/threads/ketones-keep-rising.296576/

I’m just looking at your SS and wondering why you reduced the dose of insulin back to 1 unit instead of 1.5 there is nothing in the SS that indicates reducing the dose. I would go back to 1.5 unit.
I’m going to tag @Suzanne & Darcy re the dose as she is a ProZinc user.
If Pablo is eating well, not vomiting and is not lethargic at all, I would not be concerned about the ketones at 1. But continue to feed him lots of food, encourage fluids and increase the dose of insulin back to 1.5.
Let us know what the next test of ketones is.

Keep an eye on the sneezing fits as we don’t want getting any type of infection or inflammation.
 
His vet is cautious about dosing around the 250 mark since she doesn’t want him dropping hypo. His ketones when down to 0.6 then back to 1.0 now. I’m going to just stick with the 1.5 units 2x a day and keep pushing food and fluids. I’ll call the vet in the morning to see about starting an antibiotic to prevent his URI from getting worse (although it could be viral). Hopefully his ketones are below 1.0 in the morning. It’s frustrating figuring out how to keep his ketones down especially when first starting insulin. I’m trying everything to help him since I’m terrified of DKA after going through it once.
 
pablo'smom said:
Update: his ketones are 1.1 this morning
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Again just a newbie so I can’t advise but wanted to say I know what you’re going through. I did an experiment the other day and from Amps to +8.5 methos went from 0.8 to 0.1 with his extra food and insulin kicking in (and he did get a little sub q fluids but was already on the way down then. Good luck and i hope an advisor comes on soon

edit: 17 Dec on my SS
 
Hello. I am sorry about your kitty’s DKA. We went through that and it was very scary. By the way, my cat went into DKA when he was getting BG mostly in yellows. Ketones can fluctuate around even over the course of a day. Just watch for lethargy, lack of appetite, vomiting. Looking over your spreadsheet data, you will be safe to shoot 1.5 units with any preshot value in the 200s.
 
What we can do is gradually work your preshot number down as we gather data — we will make sure it’s safe. Right now it looks like you should do an increase of .25 units (to 1.75 units.) I am sorry that I have just been called in to look on your situation/spreadsheet (so I may ask questions you have already answered.) What is Pablo currently eating?
 
Please feed him some smaller meals/snacks during the first six hours of the cycle. Don’t just feed at preshot time. Our ProZinc kitties do best with some snacks by at least +2 and +4 and even +6 possibly. The ProZinc will onset (start to lower BG) at around +2. This is when you should start to see the BG drop. We want a nice gentle drop; the snacks will help with that.
 
Hi everyone, his ketones have just been all over the place and I don’t know if the URI has played a role in that since I know when they are sick it makes their diabetes all wack. They were 1.2 this morning but I got them down to 0.7 after insulin and food. I’ve been giving him little snacks between meals. He gets his FF pate then turkey and or chicken breast throughout the day. His water intake has gone up a lot which makes me nervous as so did his numbers. Tonight I’ll give him 1.75 units and just keep an eye on him. They have him on an antibiotic to hopefully help with the URI. He is eating and drinking plenty and is still very active.
 
His ketones went back up to 1.2. I gave him his insulin but some leaked out this time. I think I pulled it out too fast and should have given it a few more seconds (this has only happened once before and it’s only when he moves on me which he usually doesn’t). :( Hopefully he does better soon. I have given a lot of food and snacks and his ketones go down then go back up when he is due for his shot.
 
He is not getting out of the 200s. With ketones in the picture, I would increase to 1.75 units. You have plenty of room for an increase, and we must try to get his BG numbers down.
 
Ketones are 1.8!!! I’m freaking out a bit because of how high his ketones are and I’m not sure when to go into the emergency vet. I gave him some shredded chicken breast and he’s been drinking more water and peeing more. I’m hoping that tomorrow is better. I’ll call his vet on Monday to check in because of how scary everything is. He gets insulin in 5 hours so hopefully his ketones start dropping tomorrow.
 
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Yesterday Suzanne suggested you increase the dose to 1.75 units but I can’t get see you have not done so, although you said you were going to. Did you maybe put the wrong dose in the SS?
 
His syringes only have 1 unit marks so I tried my best to be a little above 1.5 so it is more like 1.6-1.75 but I’m waiting for the new ones to come in tomorrow so this way I can be more accurate. This morning he went down to 1.1 after food then back up to 1.3 before his insulin. It’s been 3 hours post shot and it’s still 1.3 but I just gave him more food and so hopefully between the insulin and food it’ll improve.
 
I won’t be home for most of the day but my mom will be so I’ll make sure she checks his levels for me and keeps an eye on him. At least his URI seems to be better, less sneezing and snot.
 
Update: ketones were 1.6 pre shot then went down to 1.2 about 2.25 hours post shot. I’m giving him a snack right now as well then I’ll recheck around 6-7 hours post shot. I feel like his ketones are just going up and down and I don’t know how to end this cycle. His new syringes come in today so hopefully the 1.75 units will help.
 
Update: ketones are 1.8 again. I just want them to stay steady and below 0.6. I’m giving insulin and pushing water, protein etc and it’ll go down then right back up. I’m so frustrated and I’m hoping once he is past his URI and we increase insulin it will steady out. His new syringes come tomorrow (they got delayed with the holidays) so I’ll make sure I’m giving exactly 1.75 once I have them and then we will probably have to increase to 2 if his numbers don’t improve. Is it always this frustrating and difficult at the start? I feel like I’m doing everything but getting no where at the same time.
 
Are you saying Pablo is vomiting his food?
Do you have any cerenia or ondansetron? If not I would try and get some today as tomorrow Is Christmas Day.
 
Bron and Sheba (GA) said:
Are you saying Pablo is vomiting his food?
Do you have any cerenia or ondansetron? If not I would try and get some today as tomorrow Is Christmas Day.
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He’s not vomiting at all. He’s acting completely normal but he is sneezing and has a running nose from his upper respiratory infection but it’s getting better.

My apologies -by going down and right back up I meant his ketones. They’ll get to upper 1s then back to right below 1 then back up again.
 
pablo'smom said:
He’s not vomiting at all. He’s acting completely normal but he is sneezing and has a running nose from his upper respiratory infection but it’s getting better.

My apologies -by going down and right back up I meant his ketones. They’ll get to upper 1s then back to right below 1 then back up again.
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That is good. I thought he was vomiting.
Keep testing for ketones. I think once or twice a day is plenty of times to test for them unless they are over 2
They will fluctuate. And as long as he is eating well, not vomiting or lethargic, that is good. I’m glad the URI seems to be improving.
Having the DKA at the start of the journey always makes it harder but you are doing well. It will get easier.
 
His vet said she’s not too worried with his ketones being in the 1s. She said as long as he isn’t showing any signs such as vomiting, diarrhea, lethargy, etc then he should be okay. We have him at 1.75 units twice a day (I finally got the new syringes in). He has been drinking and peeing a bit more but not nearly as bad as when he wasn’t on insulin (before he was diagnosed).
 
Update: his ketones are 1.9 and BG is 358!! I’m going to up his insulin to 2 units because for the last couple of days his BG has been rising and I’m not sure why.
 
Update: his sugar won’t stay out of the 300s, his ketones are 2.2, and his ears are warm which is what happened before he was DKA last time. I’m going to call his vet in the morning to get him in to get him evaluated because I’d like to catch it all early this time to avoid DKA. I’m getting really nervous now. He is acting normal and I got him to eat some turkey breast no problem so hopefully that’ll bring his ketones down
 
So Pablo is home now? I am sorry you had to take him to the vet. I had a very hard time getting my vet to take my blood ketone meter readings seriously. They relied solely on urine ketone strips.
Since you are having ketones and your nadirs are all yellow, I would increase the dose. Does he currently have an infection? Was blood drawn at the vet and if so, can I see the results? Is he on antibiotics? What is he eating? Is it low carb wet food? I just want a little more information before suggesting a new dose. I think we may be able to increase by as much as half a unit as long as you will be able to monitor his BG. Is your meter a pet meter or a human meter. A lot of this information needs to be added to your signature so that we don’t keep asking you!
Also, I would not change the timing of the shots (shooting early). We need to do something more sensible and permanent like adjusting the dose.
 
I started a new thread because of a million new questions and issues that occurred so let me link it here. He is doing okay. Ketones when to 3.1 from vet stress and now are just hanging out in high 2s but he had no ketones in his urine.

Does he currently have an infection?
He still getting over an URI so yes. He has finally stopped having sneezing fits but is still congested.

Was blood drawn at the vet and if so, can I see the results?
They didn't do a full blood draw since he just had one last Thursday. I don't have the labs from the vet but everything besides his glucose came back great. They did a urinalysis and blood glucose yesterday. Urinalysis just shown glucose.

Is he on antibiotics?
He is on doxycycline for his URI - the vet researched into it to double check it wouldn't mess with his diabetes.

What is he eating? Is it low carb wet food?
He eats FF pate 1.5 cans in the morning and 1.5 cans in the evening then gets chicken or turkey breast snacks between dosing.

The vet believes his URI played a role in all of this chaos. She said we just need keep giving him insulin and push through this URI. Since he started 2 units of prozinc 2 days ago, the vet is having me do a glucose curve tomorrow to see how he is responding to it before we up the dose more. Also, she said since he is fighting off a URI we have to be careful dosing around that.

This morning when I went to give him his 2 units, a little leaked out which rarely happens so now I'm upset with myself because he needs all the insulin he can get right now. I didn't give more because I know that isn't safe but I just hope he is okay. I made sure to inject slowly and hold it for a few seconds and then pull out but for some reason a little still came out after the needle. Maybe it was a weird air bubble? I try to make sure there are no air bubbles.
 
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