Snickers update, ketones rear their ugly head again

[DreMeister]

Well, back to the vet this morning. She is drinking water like everything, peeing a lot, still eating though, but just very lethargic, only going a few steps from her bowls, and laying down until she eats or drinks again. I had wife take her in today. So, sugars were 215, from 130 Friday, she doesn't have a urinary infection, but has ketones, she has lost weight, and they said she needs more carbs, and to start giving her mixing FF pates with her DM to up her carbs, something about her body burning fat even though she just lays there. Said to keep an eye on her that if she stops eating to get her in there immediately, which is great because my wife goes away on vacation next week and I work so I can't be home very often. Does any of this make sense? Seems like they tell us to do one set of things, then she goes south, then contradicts what they told us to do something else. I just don't know any more. I just think Snickys getting tired and just about done fighting.

 

[Sharon14]

If she's showing ketones, she needs food, water and insulin to get the numbers down. The three things that usually get a cat to throw ketones is lack of food, lack of insulin and infection. Did they give her fluids? Make sure you have ketone test strips and check her daily. I would add ketones to your thread title to get more experienced eyes. It can become serious quickly.

 

[DreMeister]

I know they did jack up her lantus......3 units and 2 units. She does eat though, but doesn't do anything else but lay there. I don't think they gave her fluids, as my wife was the one that took her. She drinks a lot, but pees a lot too. I do have strips here but I can't always catch her using her litter box. I know what's gonna happen, 2 days will go by, she'll get worse, and it'll be another 3 days at the vet. For a long time she has looked like she feels really crappy. I was wondering that, she has ketones but they didn't say what to do about it. At least that my wife heard and remembered. That's why I think she'll be back in there real soon.

 

[Sharon14]

One thing to do is mix plenty water into her food to help flush the ketones. Can you put a non absorbent litter in the box? Some people use aquarium gravel or dry beans. Then you can check the sample when she's done.

 

[Alexi]

Is this the same vet that did a bunch of tests, failed to identify the problem and now says 'ketones'? Ketones are a product of the breakdown of fat but this is a symptom and not a diagnosis. Anything more than a trace needs treatment of the underlying cause. No underlying cause appears to have been identified, so what did they do today in terms of testing? Are you able to find another vet who can give a second opinion because that is what I would do in your situation. I share your frustration because I am hoping whatever the problem is can be treated. Going backwards and forwards doesn't seem to be doing any of you any good. Do you have copies of the test results they have done so far - if so are you able to post them, if not can you get them?

 

[DreMeister]

Is this the same vet that did a bunch of tests, failed to identify the problem and now says 'ketones'? Ketones are a product of the breakdown of fat but this is a symptom and not a diagnosis. Anything more than a trace needs treatment of the underlying cause. No underlying cause appears to have been identified, so what did they do today in terms of testing? Are you able to find another vet who can give a second opinion because that is what I would do in your situation. I share your frustration because I am hoping whatever the problem is can be treated. Going backwards and forwards doesn't seem to be doing any of you any good. Do you have copies of the test results they have done so far - if so are you able to post them, if not can you get them?

I have the copies of test results from about 3 weeks ago, but don't know how to post them. Yes this is the same vet. My wife for some reason isn't keen on taking her to another vet, and next week she'll be away and I have to work and cannot shuttle her around. Again, there is a communication breakdown from the vet to my wife to me. She only gets about half what they say, but they did a BG test, 215, and a urinalysis, which all they told her was ketones. No treatment given, sent home and told to mix FF pates, which we had stopped feeding and only gave her DM and cooked chicken, because she needed MORE? carbs?? I just don't get it. I think she'll be heading back in a couple days with worse symptoms.

 

[DreMeister]

I just feel so bad, kitty isn't getting better and vague answers do nothing but add more questions. Any more I think I'm gonna get up in the morning and find her lifeless.

 

[Callie & Patches]

I am so sorry that you and Rosa have to go through this. It seems that the communication between you and the vet leaves something missing. Can you call him to get the details after every appointment or arrange for him to call you. The situation with your wife as go between just isn't working. If there is some way to get a second opinion with another vet, uou would know what is going on.

 

[Tuxedo Mom]

I just feel so bad, kitty isn't getting better and vague answers do nothing but add more questions. Any more I think I'm gonna get up in the morning and find her lifeless.

((HUGS))

I am so sorry you are having such a difficult time trying to get accurate information. I agree that if you are not able to get a second vet involved that you need to personally ask for copies of ALL the test results and get some input from the members here who are experienced at reading test results. The fact that Snickers had ketones..again.. and was not given any treatment is wrong. If they only used the urinalysis to detect ketones then the level of ketones could be even higher in the blood since it takes longer for ketones to show in the urine. IMO the vet is being very remiss in not addressing these problems and waiting until it becomes an emergency, which is dangerous for Snickers and expensive for you. It sounds like your wife either does not understand the information the vet is giving her or is not aware of how serious ketones can be. I don't know how flexible your schedule is, if you are perhaps able to go personally to the vet, but if you can that may get more answers and better treatment,

 

[DreMeister]

((HUGS))

I am so sorry you are having such a difficult time trying to get accurate information. I agree that if you are not able to get a second vet involved that you need to personally ask for copies of ALL the test results and get some input from the members here who are experienced at reading test results. The fact that Snickers had ketones..again.. and was not given any treatment is wrong. If they only used the urinalysis to detect ketones then the level of ketones could be even higher in the blood since it takes longer for ketones to show in the urine. IMO the vet is being very remiss in not addressing these problems and waiting until it becomes an emergency, which is dangerous for Snickers and expensive for you. It sounds like your wife either does not understand the information the vet is giving her or is not aware of how serious ketones can be. I don't know how flexible your schedule is, if you are perhaps able to go personally to the vet, but if you can that may get more answers and better treatment,

Thank you for the support. Only thing they told wife was she was losing weight even though she is eating and that is causing the ketones. They said to start giving her FF pates again along with her DM to give her more carbs which I thought were supposed to be bad for her. Something ain't making sense here. And they upped her lantus to 3 ui in AM and 2 ui PM. My wife likes status quo and hates the thought of going thru all these tests again with a new vet, but since she'll be away next week, if my schedule allows, and Snicky needs to go, I'll take her to the new vet, unless she goes downhill in the next couple of days, then it's back to the vet for hospitalization......again. There's gotta be something we can do at home to keep her from getting sick?

 

[DreMeister]

One thing to do is mix plenty water into her food to help flush the ketones. Can you put a non absorbent litter in the box? Some people use aquarium gravel or dry beans. Then you can check the sample when she's done.

My wife says she does mix water with her food to make it easier to eat since her teeth and bad. I also had her tell vet to look into her mouth for signs of infection, but there wasn't any.

 

[Tuxedo Mom]

Thank you for the support. Only thing they told wife was she was losing weight even though she is eating and that is causing the ketones. They said to start giving her FF pates again along with her DM to give her more carbs which I thought were supposed to be bad for her. Something ain't making sense here. And they upped her lantus to 3 ui in AM and 2 ui PM. My wife likes status quo and hates the thought of going thru all these tests again with a new vet, but since she'll be away next week, if my schedule allows, and Snicky needs to go, I'll take her to the new vet, unless she goes downhill in the next couple of days, then it's back to the vet for hospitalization......again. There's gotta be something we can do at home to keep her from getting sick?

You can ask for copies of all the test results that you have paid for with the current vet. If you change vets most of the tests will not have to be repeated...at least not right away. When I changed vets with my first FD kitty I had all the test results and the only thing that was done initially was a basic examination.

The reason she is losing weight is because the diabetes is not controlled. Ketones happen when there is not enough food; not enough insulin; and/or an infection...are any combination of those factors. Giving more carbs will not help if she is not able to utilize them properly.

Giving extra fluids to help flush the ketones out will help, although it would have been better if subQ fluids had been given at the vets and some sent home for you to do. Making sure Snickers is eating, even if you have to give some higher carb food to get enough food into her and making sure she is getting enough insulin will help with DKA. Without home testing you can't tell how high her numbers are though. You can test the urine for ketones using ketodiastix, but that will only tell when the ketones are in the urine, which could be showing results from hours before.

 

[Tuxedo Mom]

My wife says she does mix water with her food to make it easier to eat since her teeth and bad. I also had her tell vet to look into her mouth for signs of infection, but there wasn't any.

Just caught this comment. If her teeth are bad enough that it makes it difficult to eat, then she really needs to have some dental work done. The mouth is a good source of infection with kitties. I am really questioning how well the vet "looked" for mouth inflammation or infection. If you yourself notice that there are problems then it should have been obvious to a vet. I don't think I am liking this vet very much from what I hear abut him.

 

[Alexi]

I am not liking this vet either, my kitty has her mouth looked in as part of a basic exam and they always comment that she has a bit of gingivitis but so far she has no problems from it at all. I have had cats in the past who suddenly lost teeth but without it affecting their feeding or their general health, they did have bad teeth. If her teeth are affecting how she feeds then it sounds like a bit of kitty dentistry might be needed, if I had chronic toothache I'd feel pretty rough too.

 

[Tuxedo Mom]

I am not liking this vet either, my kitty has her mouth looked in as part of a basic exam and they always comment that she has a bit of gingivitis but so far she has no problems from it at all. I have had cats in the past who suddenly lost teeth but without it affecting their feeding or their general health, they did have bad teeth. If her teeth are affecting how she feeds then it sounds like a bit of kitty dentistry might be needed, if I had chronic toothache I'd feel pretty rough too.

Plus since ketones keep showing up this could well be the source of infection, which is one of the warning factors for ketones and a possible DKA (diabetic ketoacidosis) If the problem is not fixed it will keep rearing up again.

 

[Meya14]

So I don't think the advice your vet gave was all that bad for a couple reasons. Typically, in a diabetic cat, uncontrolled diabetes is the cause of the ketones, that is, not enough insulin is being given to allow the cat to store fat, so it burns it.

Sometimes, though, fat is burned for other reasons. Chronic anorexia or calorie restriction can be a cause. There have been a number of cats with ketones here that have had too low of calories fed or eaten causing DKA. An average sized cat should have about 200ish calories a day give or take. If you are feeding less than this it might be an issue.

Absorption issues - some cats are unable to absorb all the calories in foods. Cats with IBS, pancreatitis, hyperthyroid, cancer, and other types of bowel or metabolic issues will sometimes need to have diet changes that are easier to digest, absorb, and that are more calorie dense. This is what I think your vet is considering in recommending higher carb. Protein and fats actually have a more complex metabolic path than carbs to utilize. Various enzymes are needed to break down these (lipase, bile, etc). With certain diseases, more calories can be absorbed with higher carb foods, so that when you give the insulin the body can get out of the starvation state that it is in. Some diseases cause starvation by increasing the metabolism like cancer, hyperthyroidism, and infections.

It really helps to think of DKA as a type of starvation state. Treatment requires fixing the calorie deficit if there is one, and fixing the metabolic issues (like giving insulin). Sometimes getting to the root cause takes some time.

 

[DreMeister]

Well she has had dental work done 2wice, the last time in January, when all this started. Usually we know when she has problems, food falls out of her mouth and her breath is horrendous, but we haven't noticed that this time. We are feeding her FF pates along with her DM, and giving her higher dosages of lantus, 3 and 2. I did notice the other day when she stood up her back was showing thin, and she had lost a pound when they weighed her. She used to be 16# at one time and now is about 10#. Thing is there is several vets at this office and you have to see which ever one is available. She's hanging on right now, she purrs when I pet her, so I'm hoping she won't have a relapse this weekend. She always gets sicker on the weekend when it costs 100 bux for an emergency vet visit. Gotta take care of kitty though. As a kid we never took animals to the vet as my Dad didn't want to spend money on them, they just up and died young and that was my job after getting home from school was to dig a hole and bury them. I will not do that again if I don't have to, kitty will get what she needs to keep going.

 

[DreMeister]

So I don't think the advice your vet gave was all that bad for a couple reasons. Typically, in a diabetic cat, uncontrolled diabetes is the cause of the ketones, that is, not enough insulin is being given to allow the cat to store fat, so it burns it.

Sometimes, though, fat is burned for other reasons. Chronic anorexia or calorie restriction can be a cause. There have been a number of cats with ketones here that have had too low of calories fed or eaten causing DKA. An average sized cat should have about 200ish calories a day give or take. If you are feeding less than this it might be an issue.

Absorption issues - some cats are unable to absorb all the calories in foods. Cats with IBS, pancreatitis, hyperthyroid, cancer, and other types of bowel or metabolic issues will sometimes need to have diet changes that are easier to digest, absorb, and that are more calorie dense. This is what I think your vet is considering in recommending higher carb. Protein and fats actually have a more complex metabolic path than carbs to utilize. Various enzymes are needed to break down these (lipase, bile, etc). With certain diseases, more calories can be absorbed with higher carb foods, so that when you give the insulin the body can get out of the starvation state that it is in. Some diseases cause starvation by increasing the metabolism like cancer, hyperthyroidism, and infections.

It really helps to think of DKA as a type of starvation state. Treatment requires fixing the calorie deficit if there is one, and fixing the metabolic issues (like giving insulin). Sometimes getting to the root cause takes some time.

Reading that makes me feel better, Thanx!

 

[Meya14]

Are you testing blood sugar at home?

The best way to get rid of ketones is to increase food (calories and carbs if needed) and to increase insulin to match the food. This helps stop the burning of fat and stops the formation of ketones. Testing the sugars will let you know if it's safe to increse the insulin. These increases sometimes are more effective if done somewhat rapidly (but you gotta be safe about it and test). Also, dehydration is usually pretty severe in DKA, so subQ fluids are very helpful. If you don't have subQ fluids, try mixing plain pedialyte or water in the food or syringing it if she's not eating/drinking enough.

 

[DreMeister]

Are you testing blood sugar at home?

The best way to get rid of ketones is to increase food (calories and carbs if needed) and to increase insulin to match the food. This helps stop the burning of fat and stops the formation of ketones. Testing the sugars will let you know if it's safe to increse the insulin. These increases sometimes are more effective if done somewhat rapidly (but you gotta be safe about it and test). Also, dehydration is usually pretty severe in DKA, so subQ fluids are very helpful. If you don't have subQ fluids, try mixing plain pedialyte or water in the food or syringing it if she's not eating/drinking enough.

We don't test at home. Our kitty is so not personable. The only time I tried to test her I wound up testing myself instead. We can barely give her the insulin shot. The vet increased the lantus and told us to mix mix FF pates with her DM to get carbs back into her. It's all so confusing. Right now,(crosses fingers), she's doing, ok, she just doesn't do much but eat, drink, and lay around. It's almost like she's weak and doesn't get far from her bowls. Even when she uses her litter box, she gets out and lays on the floor in front of it.

 

[Red & Rover (GA)]

Is it possible to check her gums for colour? Are they a darkish pink? or do they look paler than they normally do? Also, have you noticed her ears being cooler than usual?

 

[DreMeister]

Is it possible to check her gums for colour? Are they a darkish pink? or do they look paler than they normally do? Also, have you noticed her ears being cooler than usual?

I can't say I pay attention to her ears, although my wife will say they feel warm. There ain't no looking into her mouth, although I could try again. She acts like Dracula at sunrise when you try to force her mouth open.

 

[Red & Rover (GA)]

I asked because when Rover had anemia, he had no energy and would take a few steps then lie down, including in the litter box. His gums were quite pale and his ears seemed a little on the cool side.

 

[DreMeister]

I asked because when Rover had anemia, he had no energy and would take a few steps then lie down, including in the litter box. His gums were quite pale and his ears seemed a little on the cool side.

She had bloodwork done a couple weeks ago, they found nothing. This time wife said they did look in her mouth but didn't say anything so I assume it was ok, as she has been prone to bad teeth and has had several pulled on 2 occasions. Wife checked her ears tonite and said they were warm.

 

[DreMeister]

I'm afraid kitty is gonna have to go back to vet to stay a bit. She has slowed eating and will only eat turkey lunch meat. I know it's not good for her but we have to get something in her belly. I'm wanting wife to get her to vet tomorrow since she leaves for vacation Wed. and I have to work every day late. Also, when Snickers pees, good gosh her urine is as hard as concrete. It doesn't make little clumps like it used to, but goes right to the bottom of the litter box and is very hard to remove. What causes that? Thanx.

 

[Red & Rover (GA)]

Just a thought. How much fluid did she get at the vet? Bigger than usual pee? What you are seeing might be the fluids working through. Big pee that takes some time to be absorbed by the litter.

 

[DreMeister]

Just a thought. How much fluid did she get at the vet? Bigger than usual pee? What you are seeing might be the fluids working through. Big pee that takes some time to be absorbed by the litter.

She was at the vet last week but they didn't give her any fluids, it's just what she drinks at home and pees out, which is a lot it seems.