At ER vet with ketosis

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Melissa and Rascal

Melissa and Rascal

Member Since 2015
Hi. I'm pretty worried about my girl Rascal. She has ketones for the first time. I've been having a difficult time regulating her due to all sorts of other health conditions at play. Last night she was breathing rapidly and was very wobbly when she tried to stand. I took her in at midnight, and the ER vet got fluids going and started monitoring BGs and insulin.
Rascal is on Lantus, is a crazy bouncer, and her numbers have been crazy lately. At her age (18) and with IBD and other issues I'm wondering how serious this is and how much to put her through. SHE IS NOT ACIDOTIC, but only had ketones. Other blood work and labs came back normal.
I'm waiting to see her regular IM vet, but the emergency crew made it sound like she might need to be hospitalized for a couple days to flush out these ketones (even though she is not in DKA yet), and I'm not sure I'm willing to put her through all of that.
This seemed to come out of nowhere. 48 hours ago she was fine. Yes, BGs were running high, but she's on prednisolone, and I can't push the insulin dose since she sometimes doesn't eat or vomits due to the IBD, so I've just been trying to do my best balancing everything.
Any thoughts on what is going on, what the likelihood is she can get past this, and what I should do?
Thank you!
 
When the appetite and/or vomiting cause the glucose to be erratic, it may work better to use a non-depot insulin which can, with test data showing it is safe, be adjusted based on the pre-shot test and knowledge of the drop from various dose levels. ProZinc and BCP PZI are 2 that last roughly 12 hours. For some, Vetsulin/Caninsulin may work, and if you're home to monitor frequently, Humulin or Novolin NPH might work although NPH typically lasts around 8 hours.

Another, advanced alternative, is to use a low dose of the Lantus as a basal insulin, then as needed when the glucose is elevated, use a tiny amount of a short-term insulin to handle those times. This requires curving the short term insulin, and much more extensive testing.
 
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Rascal is not herself yet by any means but no more ketones!!! Yes, we are treating the IBD. We had switched back to pred from budesonide that wasn't working as well for her. Obviously her IBD makes this all a lot more complicated, but she is eating right now, which is always a huge relief.

I don't know where we are going long term. We are addressing possible contributing factors to this episode like a recurrence of UTI or pancreatitis. I also will need to keep figuring out the insulin issue, but for now what seems to be working well is indeed some Lantus as a base and then a little Novolin to keep the peaks down. Of course I'm testing a LOT but at the moment this is getting her and keeping her in pretty good numbers. I had never even thought of combining the two and the vet never mentioned it.

Thanks for all your responses and encouragement! :)
 
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