Moderate Ketones Help!

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Hine87

Hine87

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I just tested Jaspers urine and unless the strips weren't working correctly he has ketones....he just had DKA two weeks ago! It wasn't until today when I posted under the PZI forum that the vet has had me dosing him wrong...1 unit-once daily....I was going to change his dosage this evening. Now I don't know what to do. I cannot keep up with these bills.
 

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With a history of DKA and the strips showing moderate ketones he definitely needs to see an ER vet right away. Once it is showing to that point in the urine then the chance of him going into full blown DKA is very possible, :bighug:
 
Oh no! Sarah, I'm so sorry! Please please update us when you can. I know the bills are a concern, but you'll get through this.
 
I believe DCIN is helping her altho' their critical care fund is pretty empty right now. I saw a request for donations fly across my fb newsfeed.

Nothing new other than she posted they had arrived...
 
We are home now! Thank you all! He does have ketones, she said 2+ on that. I tested him before I left and his meter showed 400-at the clinic the vet got 360 so she just gave him some fluids and sent us on our way until I call his regular clinic in the morning.
 
Without going through all your posts....it is critical that you be home testing for both glucose levels and ketone levels. Jasper has a history of ketones/DKA and it is imperative that his levels..both glucose and ketones..be monitored very closely. In your other post you said your vet was only wanting you to shots one time a day. You MUST do shots every 12 hours and test the glucose levels. you were doing 1 unit once a day. MY suggestion as long as you are able to monitor carefully...would be to do 1 unit TWICE a day...every 12 hours


This is only my opinion and hopefully others will weigh in with their opinions.

:bighug: :bighug:
 
Tuxedo Mom said:
Without going through all your posts....it is critical that you be home testing for both glucose levels and ketone levels. Jasper has a history of ketones/DKA and it is imperative that his levels..both glucose and ketones..be monitored very closely. In your other post you said your vet was only wanting you to shots one time a day. You MUST do shots every 12 hours and test the glucose levels. you were doing 1 unit once a day. MY suggestion as long as you are able to monitor carefully...would be to do 1 unit TWICE a day...every 12 hours


This is only my opinion and hopefully others will weigh in with their opinions.

:bighug: :bighug:
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Thank you! Oh yes I am monitoring his BG at home for sure! I would never feel comfortable giving him insulin otherwise! When his vet first had me change to the 1 unit once a day it seemed off....but felt I could trust her. I do think she is trying though but maybe she doesn't know? From what I have read here and on the FB group that vets just do not know much about feline diabetes in general. I do for sure need to be more vigilant in checking for ketones, I usually keep the strips in a drawer and always forget about them so I am surprised I thought about checking today. I will be keeping the bottle out so when I do catch him using the 'bathroom' I will check him right away. A few others have posted in another thread under the PZI page that I posted last night suggesting I start him with .5 units twice a day and see how that works instead of the once a day the vet wanted me to try...she actually yesterday wanted me to try to go up to 2 units...once a day. Thank you again for your help!
 
Yes thank you Tuxedo Mom! For my poor wrist it was easier posting once in that thread. Jasper is doing well! He was low all this morning so I ended up not giving him any insulin and will give him .5 units at regular time and go from there. =)
 
Hine87 said:
Yes thank you Tuxedo Mom! For my poor wrist it was easier posting once in that thread. Jasper is doing well! He was low all this morning so I ended up not giving him any insulin and will give him .5 units at regular time and go from there. =)
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I've posted a reply on your other thread. Delighted to hear Jasper's doing OK. :bighug:


Mogs
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It's very important that we know his ketone status. Ketone status changes in a short time.
Did the vet do urinalysis? If so, could you post results? And could you recheck and post ketones now?
Ketones mean not enough insulin. If sugar is low or normal and there are ketones, it means not enough calories and not enough insulin.
 
Sugars are very high again indicating that 0.5 units twice per day isn't enough. But the correct way to handle this depends somewhat on current ketone status today.
 
Tuxedo Mom said:
Without going through all your posts....it is critical that you be home testing for both glucose levels and ketone levels. Jasper has a history of ketones/DKA and it is imperative that his levels..both glucose and ketones..be monitored very closely. In your other post you said your vet was only wanting you to shots one time a day. You MUST do shots every 12 hours and test the glucose levels. you were doing 1 unit once a day. MY suggestion as long as you are able to monitor carefully...would be to do 1 unit TWICE a day...every 12 hours

:bighug: :bighug:
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I agree with you. But I think Sarah is getting mixed messages.
Jen
 
Sorry! I updated the SS, I didn't do insulin yesterday morning! The vet did not do anything yesterday other than show me how to give him fluids. =/ She was going on that these numbers are normal after him going through all of this mess.... and than told me to give him no insulin at all that day. =/

I've been waiting to catch Jasper in the litter box so I can do a urine sample but I did just check his BG and he is 331 =(
 
Okay. I saw on the Facebook page that it looks like from the pic he has trace to small ketones. I would increase his Prozinc to 0.75 units twice daily, feed him frequently and keep him well hydrated. Are you giving the subq fluids? If so, how much and how often? Is the fluid LR?
 
JenzyandtheFurkids said:
Okay. I saw on the Facebook page that it looks like from the pic he has trace to small ketones. I would increase his Prozinc to 0.75 units twice daily, feed him frequently and keep him well hydrated. Are you giving the subq fluids? If so, how much and how often? Is the fluid LR?
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Thank you! I posted on the FB page as well that I just checked his numbers and they are 288. I assume I should still increase to the .75 correct? I have not given him any extra fluids besides the 100 mil he got at the vets office. He has done very well at drinking on his own-unless I should be giving him some additional fluids? LR? Lactated Ringers? That is what I have =)
 
I would give him 100 ml of fluids each day as long as he had ketones if he was my cat. What did your vet say to do? She taught you to do the fluids but did she tell you when to give them?
 
I didn't get a chance to give him fluids last night but I will be looking at doing it today. My vet told me that I shouldn't need to use it at all and that he was fine-she didn't tell me when to give it to him. Ah the questions that I don't think to ask, but than not sure if I would get the right answer from her anymore. =/
 
Thanks you guys! After reading these I did it! I gave Jasper 100 ml of fluids! A little proud of myself, that large needle was a bit intimidating and took a couple tries to actually pierce his skin. I gave him treats and he sat still for me! =D
 
Remember that ketones can come back quickly so it's a good idea to keep testing at least once daily for several days.
Could you update your spread sheet? It's very important to get his insulin up to where it needs to be so that he won't keep becoming ketotic.
I haven't had a cat on Prozinc in awhile but I usually am comfortable increasing dose every day until I get into the 200's then I do it more slowly.
 
Ok, I will be sure to keep checking on the ketones! It sure helps to leave the bottle out compared to when I used to leave it in the drawer. I also updated the SS as well. =)
 
I would increase to 1.0 units twice daily tonight. But good to try to get a few evening sugars once you do this.

Once you get where the numbers are mostly below 250-300, you will normally want to hold a dose for at least 3 days before increasing. It would be different if you were using Lantus or Levemir which slowly "fill the depot" over 3 days which produces a delayed effect.

What is your current feeding schedule right now?
 
Ok! Right now he is getting between 3-4 feedings. I alternate between splitting 5.5 oz and 3 oz Wellness grain free with my cats. So They of course get food in the morning and evening. I give a can around lunch time and if I remember and if there is no food in the bowls at night before I go to bed I will give some more food than as well. =)
 
How many evening sugars should I try to get? I feel lucky sometimes if I remember to check twice before I head to bed.
 
So we will be at 1 unit twice daily and we will continue increasing. Don't forget to check ketones and consider giving fluids until he gets into a safer range.
 
Remember to try to get as many sugars this evening and into the night as you can. I think the reason your vet tried not dosing at night was because there were a couple of times when there seemed to be a sugar drop in early evening.
Does he eat a lot more during breakfast at lunch than he does at dinner and bedtime?
 
Oh I wish I saw this, I only grabbed on test before I went to bed. I will try and get more tonight. And I will see about giving him some fluids today as well. Hmm for the food he normally eats well during the day for sure...but sometimes it depends on the food. I have a couple different flavors and I am noticing him favor some over others. Although normally for the 3rd feeding for dinner if they eat all of the food before bed I will give them some more but if not they will only get that 3rd feeding. I hope that makes sense.
 
It's much better to feed a diabetic kitty consistently. He should have a bedtime meal every night. This may be why your first morning sugar varies so much with a given dose of insulin. I believe this variance is why your vet thought it better to eliminate the bedtime dose.

What time does he get his shots and when is your bedtime? When do you feed them their mid day meal?
 
OK yea he always gets his dinner it was just if there is food left in the bowl or not before I head to bed that I give them some more. I know the vet has never really asked about his food other than suggesting the food that they sell there of course. He gets his shots about 8 am and 8 pm. Mid day meal is around noon time. I suppose I should get on a better feeding schedule? Put timers in my phone to help me remember. I remember someone mentioning to not feed him within two hours of the evening test before insulin since that can make his numbers wonky-I hadn't known that before until a few days ago. I normally go to bed between 10 and 11 depending on school work.
 
Do you keep track of what Jasper actually eats or is he always eating in a group?

When we first adopted Dewey, he was on Vetsulin and had crazy sugars. We switched to Lantus, filled the depot than increased him somewhat aggressively the first few days because he was so high. As his sugars fell, like many cats, he was very hungry. He would eat his way back up to his old numbers. He would sneak the other cats' food, LOL. He had to slowly get used to the numbers going lower over time.

So you were at 292 in the morning but increased the dose and went up over 400. The question is why. Is this because he got a bedtime snack last night but not the night before? Did he eat some of the other cats' food and eat his way to a higher value? Was there a fur shot in there? Or is it a bounce from a low value somewhere? Sugar checks in the evening at night and keeping track of when and how much he eats are necessary for figuring that out.
 
He eats with our other cat-but I do know that for some reason they like to switch bowls about half way through. BUT he is known for being a fatty and taking more than he should of the other cats food...maybe I should put them in two different rooms for feeding time than? So he doesn't get into the other cats food.
I normally split a 5.5 oz can between them or give them each a 3 oz can. I guess it may have been bad...but I did give him a couple pieces of chicken I grilled up yesterday. A few tiny bites-could that have a large effect on his numbers?
I always check now after I give him his shot if I did a fur shot and I haven't accidentally done that in long while.
 
Hine87 said:
OK yea he always gets his dinner it was just if there is food left in the bowl or not before I head to bed that I give them some more. I know the vet has never really asked about his food other than suggesting the food that they sell there of course. He gets his shots about 8 am and 8 pm. Mid day meal is around noon time. I suppose I should get on a better feeding schedule? Put timers in my phone to help me remember. I remember someone mentioning to not feed him within two hours of the evening test before insulin since that can make his numbers wonky-I hadn't known that before until a few days ago. I normally go to bed between 10 and 11 depending on school work.
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It makes a big difference that you feed "lunch" at +4 but feed bedtime meal at +2, +3 or not at all. What time do you get up in the morning?

Can you do evening sugars tonight and set your alarm for once or twice during the night?

If you feed at +4 during the day but not at night, he may well need a different insulin dose at night than the morning. Do you vary on how much you feed? Is he sharing with other cats?
 
Hine87 said:
He eats with our other cat-but I do know that for some reason they like to switch bowls about half way through. BUT he is known for being a fatty and taking more than he should of the other cats food...maybe I should put them in two different rooms for feeding time than? So he doesn't get into the other cats food.
I normally split a 5.5 oz can between them or give them each a 3 oz can. I guess it may have been bad...but I did give him a couple pieces of chicken I grilled up yesterday. A few tiny bites-could that have a large effect on his numbers?
I always check now after I give him his shot if I did a fur shot and I haven't accidentally done that in long while.
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Yes. It would help if you fed him separately so that when his glucose falls and he is hungrier, he doesn't have the ability to eat more of the other cats' food.

The grilled chicken is zero carb so unlikely to cause a problem.

I would feed at bedtime every night. I would actually give a bedtime meal that is at least as large as his dinner because he isn't going to eat for 9-10 hours.

When do you get up in the morning?
 
during the week I wake up just before 8, the weekends...that's where I'm bad...I tend to sleep in until 9 :banghead:
oh my! I had no idea!! writing this down....
I know I cannot be waking up during the night every night to feed him...should I look into doing only two feedings a day? But than I wonder if they are grazing on their food instead of eating it all at meal time.
Or like you were saying the one dose in the morning and a different at night? oh my...
I try to keep him about 10 oz a day but with him getting into the other cats food as well I'm not entirely sure. :arghh:
 
Hine87 said:
during the week I wake up just before 8, the weekends...that's where I'm bad...I tend to sleep in until 9 :banghead:
oh my! I had no idea!! writing this down....
I know I cannot be waking up during the night every night to feed him...should I look into doing only two feedings a day? But than I wonder if they are grazing on their food instead of eating it all at meal time.
Or like you were saying the one dose in the morning and a different at night? oh my...
I try to keep him about 10 oz a day but with him getting into the other cats food as well I'm not entirely sure. :arghh:
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I wouldn't do 2 feedings per day. I would just make sure he gets a bedtime snack every night.
 
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