Edit: Ketone levels have increased overnight - need guidance

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hellolucy

Member Since 2017
Hi everyone - I've been working with the awesome members over in the ProZinc forum to try to find a good balance of insulin for my kitty cat, Lucy. Lucy was hospitalized for 3 days with severe pancreatitis back in the beginning of December. She was then put on ProZinc with her dose very quickly increased by the vet in 1U increments, from 1U 2x per day all the way up to 4U 2x per day. She seemed to be experiencing insulin overdose/bouncing so we (here at the forum) dropped her dosage to 1U 2x per day and it is currently at 1.25U 2x per day. The ProZinc members suggested I post here as I believe she is experiencing another episode of pancreatitis.

She seemed fine last night and was playing with her toys, etc. She threw up small amounts of clear liquid 2-3x during the middle of the night last night and 1 spot was a larger amount. I fed her (she did not eat that much), gave her the insulin shot, and she proceeded to throw all of her food up (clear liquid with food) 2 -3x and now just seems very tired. Her meow has also gotten quiet which was what happened the last time she had pancreatitis. I currently have a trash bag in her cat box and am waiting for her to pee so I can do a ketone test. As a side note, she had a vet appointment while she was on 4U 2x per day on April 1st and the ketone test came back negative. I've been taking her glucose readings and they are in the spreadsheet. I've been in and out of town the past week but she seems to have lost a little bit of weight and the one time period I was home, she also seemed to eat less food than normal.

I am hoping for any advice or guidance from pancreatitis experts. Is it possible that she can slip back in to pancreatitis with such a large insulin drop (4U to 1U) even though her readings are better numbers? Can her BG numbers be used to determine pancreatitis or is that more the ketone strip? Are there any additional tests I should run? Anything in particular to watch out for? Any point in which she needs to go to the emergency vet (it's the weekend here) ASAP (besides the ketone strip testing positive)? Her trip in December was a healthy cost of $5k and stressed her out beyond belief so am trying to resolve this at home if possible. I have some leftover anti-nausea medication from her December ER stay. However, if and when needed, I have absolutely zero reservations about taking her in to the ER and spending the money as she means the world to me.

Thank you in advance!
 
I don't know of any direct relationship between blood glucose and pancreatitis-- there's a loose link between pancreatitis and diabetes in general, largely because a pancreas stressed by diabetes is more vulnerable to whatever causes pancreatitis, but that's it as far as I know.

Are the empty dose cells in the last few evenings skipped shots, or just not entered? If skipped shots, I'd worry even more about ketones. You know what to do-- get the test as soon as she'll let you, and if positive, it's off to the ER.

Regarding pancreatitis, does she seem to be in any pain (sitting in "meatloaf" position, etc.)? If it's a pancreatitis flare, the anti-nausea might help, but she also might need pain meds and/or fluids to help her feel good enough to want to eat, so it might require a brief ER trip as well. Home care should be sufficient, but if the flare is very severe, she might need some assist feeding to get her through it, so it can be pretty intensive nursing.
 
Has she eaten at all today?

I'm worried about the ketone test, given what you describe, so hopefully she will pee soon.

She has, a few times (but I think she's thrown most of it up), and also just woke up and ate a very small amount a few minutes ago. Still hasn't peed. I just spoke with her regular vet and am bringing her in now just to get some fluids in her as she hasn't been drinking a whole lot of water either. Hoping they can do a quick urine test there for ketones.
 
She has, a few times (but I think she's thrown most of it up), and also just woke up and ate a very small amount a few minutes ago. Still hasn't peed. I just spoke with her regular vet and am bringing her in now just to get some fluids in her as she hasn't been drinking a whole lot of water either. Hoping they can do a quick urine test there for ketones.

Great plan. Definitely have them check for ketones while there (they may be able to do it through a quick blood test if they have the right kind of meter).

The other thing to check out that can cause vomiting and inappetance might be constipation or a blockage-- they should check for that routinely in this case.

Good luck! I hope she's feeling better soon!
 
Please give us an update when you get back from the vet. Sending healing vines for Lucy!
 
Thank you everyone for your quick replies! They did a ketone test twice and she had a 'small' amount based on the strip color (15 mg/dL). They also did a test on her pancreas (I believe it was a blood test but can't remember the name) and said it was not indicative of pancreatitis. The vet also felt her abdomen and said she did not feel particularly swollen, etc. So...good that she doesn't have pancreatitis but still confusing as to why she has ketones in her urine. They did a BG measurement there (at +5 hours, probably semi-inflated due to the stress of being at the vet) which I've added to her spreadsheet. They gave her fluids as well as an anti-nausea injection and said to continue doing ketone and BG testing. She peed on the garbage bag in the litter box as soon as we got home so at least I know she'll use that method now!

Also, the missing measurements in the spreadsheet are just due to missed readings, definitely not missed shots. I haven't missed a shot with her one time since she was put on insulin back in December. I've adding her insulin shot amounts (on the days with recorded readings - she is given insulin 2x every day) to the spreadsheet just to clear that up.

I guess my question is...what the heck is causing her to have ketones in her urine if her BG readings aren't crazy high (although still higher than ideal) and her pancreas seems normal?
 
The "recipe" for ketones is: not enough insulin, not enough food/water, and some kind of infection/inflammation causing systemic stress. The BG readings don't necessarily have to be sky-high.

"Small" ketones are very very worrying-- they can develop into large ketones and DKA very rapidly. It is absolutely crucial that she is eating and getting enough insulin. I am not familiar with ProZinc dosing, but it's possible she needs more than her current dose (of course, that's tough if she isn't eating well). I am going to tag @Kris & Teasel, who has used ProZinc and who went through DKA with her kitty-- hopefully she will be on the boards later and can offer some advice.

I hope the fluids and anti-nausea help Lucy turn the corner and start eating and flush out the ketones, but keep a very close eye on her. If she seems to be worsening, or if you don't think she's eaten enough to give her insulin, take her to the ER. This isn't something you want to fool around with-- if ketones are caught early, they can be addressed fairly easily, but if they develop into DKA, it becomes much harder, and much much more expensive. Hoping the fluids and anti-nausea will do the trick, but keep in mind that there is usually some kind of trigger (infection, etc.), so it's also important to track that down.
 
The "recipe" for ketones is: not enough insulin, not enough food/water, and some kind of infection/inflammation causing systemic stress. The BG readings don't necessarily have to be sky-high.

"Small" ketones are very very worrying-- they can develop into large ketones and DKA very rapidly. It is absolutely crucial that she is eating and getting enough insulin. I am not familiar with ProZinc dosing, but it's possible she needs more than her current dose (of course, that's tough if she isn't eating well). I am going to tag @Kris & Teasel, who has used ProZinc and who went through DKA with her kitty-- hopefully she will be on the boards later and can offer some advice.

I hope the fluids and anti-nausea help Lucy turn the corner and start eating and flush out the ketones, but keep a very close eye on her. If she seems to be worsening, or if you don't think she's eaten enough to give her insulin, take her to the ER. This isn't something you want to fool around with-- if ketones are caught early, they can be addressed fairly easily, but if they develop into DKA, it becomes much harder, and much much more expensive. Hoping the fluids and anti-nausea will do the trick, but keep in mind that there is usually some kind of trigger (infection, etc.), so it's also important to track that down.

Lucy's BG reading this morning was not terrible, but her levels of ketones have increased. Yesterday, she was at 15 mg/dL and the test today shows her at 40 - 80 mg/dL. She ate all of her breakfast, did not throw it up, but seems tired. I am worried...
 
For some reason she's using fat stores for body energy instead of food which is what causes ketones. To stop them, she needs enough insulin, enough food for the insulin to work on and may be developing an infection or inflammation somewhere....starting a round of antibiotics may be needed. She needs plenty of fluids, the more liquid that goes thru the kidneys the more the ketones will be flushed. Ketones for long will change the ph of the blood to acidic - you then have 'DKA'. The increase in ketones is really worrying. Since you're on ProZinc, you can increase easier than one of the depot insulins. Right now it would be better to give more insulin - (LET OTHERS HELP WITH THAT) - and feed a higher carb food than stay with less insulin and her not be able to use it.

HUGS - it stinks when they feel bad...
 
For some reason she's using fat stores for body energy instead of food which is what causes ketones. To stop them, she needs enough insulin, enough food for the insulin to work on and may be developing an infection or inflammation somewhere....starting a round of antibiotics may be needed. She needs plenty of fluids, the more liquid that goes thru the kidneys the more the ketones will be flushed. Ketones for long will change the ph of the blood to acidic - you then have 'DKA'. The increase in ketones is really worrying. Since you're on ProZinc, you can increase easier than one of the depot insulins. Right now it would be better to give more insulin - (LET OTHERS HELP WITH THAT) - and feed a higher carb food than stay with less insulin and her not be able to use it.

HUGS - it stinks when they feel bad...

Thank you for the reply...I gave her the typical dose of insulin this morning since she kept her food down. You had mentioned increasing her insulin (pending others' responses) and feeding a higher carb food. Did you mean that as an immediate course of action? Do you think a trip to the ER is needed right now or should I let her rest for a few more hours and try testing her urine again? Not sure how quickly ketones can reduce themselves, or if they even can at such an increased level?
 
I would take her straight to the vet. Really and truly. This level of ketones is not something you should be trying to treat at home, and if it progresses to full DKA (which it could very quickly), it is life-threatening. Please please take her to the vet as soon as possible, the sooner this is caught and treated, the better the chance for recovery.

Have you read this sticky?
 
I would take her straight to the vet. Really and truly. This level of ketones is not something you should be trying to treat at home, and if it progresses to full DKA (which it could very quickly), it is life-threatening. Please please take her to the vet as soon as possible, the sooner this is caught and treated, the better the chance for recovery.

Have you read this sticky?

I have it bookmarked and just re-read through it. Off to the ER we go :( Hoping its been caught in time since her ketone levels were much lower yesterday afternoon than they were this morning. I just want her to feel better. Will keep everyone posted.
 
Adding: at the ER, they may be able to do enough initial treatment to bring the ketones down and then send you home with fluids to do home care. Hopefully, in addition to addressing the immediate problem, they will also be able to identify whatever triggered it (usually some kind of infection or inflammation).

If she was eating this morning, that's a very good sign, and the fact that you have been giving insulin is going to help a lot too. If you're lucky, the ketones she was throwing in today's urine output are just a reflection of a peak some hours ago, and she's already on the way down.

Hugs, and fingers and paws crossed!
 
Thank you for the reply...I gave her the typical dose of insulin this morning since she kept her food down. You had mentioned increasing her insulin (pending others' responses) and feeding a higher carb food. Did you mean that as an immediate course of action? Do you think a trip to the ER is needed right now or should I let her rest for a few more hours and try testing her urine again? Not sure how quickly ketones can reduce themselves, or if they even can at such an increased level?

I'm thankful you're headed to ER - it's the best path to follow right now. They can chase the ketones and BG as well as help flush ketones that are there. If she goes acidic, they can react quickly. I didn't want to suggest dosing as my brain's on 'overload' right now with injured kitty.
 
Adding: at the ER, they may be able to do enough initial treatment to bring the ketones down and then send you home with fluids to do home care. Hopefully, in addition to addressing the immediate problem, they will also be able to identify whatever triggered it (usually some kind of infection or inflammation).

If she was eating this morning, that's a very good sign, and the fact that you have been giving insulin is going to help a lot too. If you're lucky, the ketones she was throwing in today's urine output are just a reflection of a peak some hours ago, and she's already on the way down.

Hugs, and fingers and paws crossed!


This makes me feel a lot better that her eating is a good sign! I am wondering if it's possible that decreasing her dose so quickly (from 4U to 1U) triggered the state of having ketones? Is there any specific test that the ER can do to determine if she has progressed to full DKA? Would they determine if there is an infection/inflammation with a simple blood test? I just want to make sure I have them cover everything (bringing my notebook with me too). I just called them and let them know we are on their way and they said they'll be able to see her right away. I am taking her to VSH. Previously, she went to VCA and I wasn't super happy with their care so crossing my fingers VSH is better.
 
I am wondering if it's possible that decreasing her dose so quickly (from 4U to 1U)

Not the size of the decrease itself but the fact that 1u wasn't enough for her body to convert the food. All they need to test to determine DKA is her ph balance - they already know she has ketones. As long as that ph stays away from the heavily acidic side, she's not in 'Ketoacidosis'. There's 2 parts to that word ' Keto' refers to ketones, the 'Acidosis' refers to the acidity of the blood. She can be ketonic and not yet be acidic...I think that's where she likely is right now. Hopefully VSH will be better!
 
Would they determine if there is an infection/inflammation with a simple blood test?

They'll have to do an exam-- there are some possible causes (pancreatitis, UTI) that might have simple tests, but I don't know of a general test for infection. And an exam is a good idea anyway-- one member of this site had her cat go into DKA following a spider bite! They only found the bite a few days in, when the swelling had gotten severe enough to be easily visible, before that it was a total mystery what had set her poor kitty down that road.

It really is very very good that she's eating-- the fact that cats with high ketones and/or DKA usually don't want to eat is one of the things that make it really really hard to treat at home (without food, it's hard to get the insulin they need into them, and it's a vicious cycle). If she continues to have a good appetite, she's in a good position!
 
They're running a blood panel now to determine if her blood is acidic and if it is, they say she needs to stay for 24 hours. If not, I am going to get her fluids anyway just in case. I have leftover anti-Nausea medication at home I will probably give her too just to cover all the bases. They suggest doing an ultrasound when the internal medicine doctors are back to look at her adrenal glands. If they're inflamed, she could have Cushing's syndrome. Her fur has also gotten less soft over the past 6 or so months, she has a round/bloated tummy, and her tail randomly shakes/vibrates so they said that could explain those symptoms as well as why she has diabetes that has gone in to remission and then come back. Any one have experience with this syndrome? So frustrating trying to figure out what exactly is going on.
 
if it is, they say she needs to stay for 24 hours.

Yes if it's acidic, that's something that can't be handled at home. They can keep a close eye and work on rebalancing it quickly. You can flush ketones at home. You can also buy test strips that give you the ph balance of the urine altho' that happens quite some time after the blood has changed just like ketones.

I don't know much of anything about Cushing's other than things I've mostly read here and referenced articles from google.

More HUGS
 
Yes if it's acidic, that's something that can't be handled at home. They can keep a close eye and work on rebalancing it quickly. You can flush ketones at home. You can also buy test strips that give you the ph balance of the urine altho' that happens quite some time after the blood has changed just like ketones.

I don't know much of anything about Cushing's other than things I've mostly read here and referenced articles from google.

More HUGS

Thank you! If it's not acidic, what do I need to get from the vet in order to effectively flush ketones at home?
 
Thank you! If it's not acidic, what do I need to get from the vet in order to effectively flush ketones at home?

SubQ fluids and be sure you've got any possible infection/inflammation being treated, enough insulin and enough food even if you have to syringe feed to get enough in. Discuss what you need to do for the ketones with vet since they will release her if she's not acidic. That way they'll understand what your approach to treatment will be...and might add things I might have forgotten.
 
There is some information I posted on another thread about Cushing's post #4 .

http://www.felinediabetes.com/FDMB/threads/cushing-syndrome.166576/#post-1800397

The U/S will generally show enlargement of the pancreas, liver and adrenals. Sometimes only one adrenal is enlarged which indicates the possibility of it being adrenal based Cushing's. With both adrenals enlarged it is an indication of pituitary based Cushings. However more testing is usually required even with an U/S. The cheapest and least invasive test is the UCCR (urine cortisol creatinie ratio) test and involves collecting a sample of urine at home and having the vet send it off to a lab that does this test, such as IDEXX. If it is positive, then other tests can be done to determine the exact type. If it is borderline, then it may indicate early Cushing's. If it is negative then it is negative.

I hope this helps. :bighug::bighug:
 
There is some information I posted on another thread about Cushing's post #4 .

http://www.felinediabetes.com/FDMB/threads/cushing-syndrome.166576/#post-1800397

The U/S will generally show enlargement of the pancreas, liver and adrenals. Sometimes only one adrenal is enlarged which indicates the possibility of it being adrenal based Cushing's. With both adrenals enlarged it is an indication of pituitary based Cushings. However more testing is usually required even with an U/S. The cheapest and least invasive test is the UCCR (urine cortisol creatinie ratio) test and involves collecting a sample of urine at home and having the vet send it off to a lab that does this test, such as IDEXX. If it is positive, then other tests can be done to determine the exact type. If it is borderline, then it may indicate early Cushing's. If it is negative then it is negative.

I hope this helps. :bighug::bighug:

Very, very helpful! Thank you!

Still at the vet but wanted to update everyone that she is not acidic :) Her electrolyte and kidney values are also normal. They're giving her fluids now and reccomend I increase her dose to 2U starting tonight.
 
Lucy ate all of her soupy breakfast this morning ;) She still seems really tired but a teensy bit better today. I was waiting on pins and needles waiting for her to pee this morning to test for ketones :eek: They're down! I was hoping they'd be gone at this point but I'll take anything. Dipped the stick and exactly 15 seconds after, the color matched between the 15 and 40 mg/dL versus the 40 - 80 yesterday.

The vet gave me half of an IV fluid bag to give her at home this afternoon (full 24 hours from her visit yesterday) so hopefully that will help even more. How long should it take for her to completely flush out all of the ketones? Should I get an additional IV bag from the vet or just give her the one this afternoon and see what that does?

Question about the ketostix - they do say to compare to the color chart exactly 15 seconds after quickly dipping the stick in urine. They do tend to darken even more after a few minutes which had me worried but I'm guessing that's why the instructions say to read them 15 seconds after and not any longer...?
 
Question about the ketostix - they do say to compare to the color chart exactly 15 seconds after quickly dipping the stick in urine. They do tend to darken even more after a few minutes which had me worried but I'm guessing that's why the instructions say to read them 15 seconds after and not any longer...?


When reading the ketone panel you look at the results at 15 seconds only. The panel may very well continue to darken after more time passes, but the reading you want is at the 15 second time mark.
 
Just whatever is at 15 seconds is the right ketone reading....ignore anything past that, it means nothing.

Fluids - if vet didn't tell you, once a day - max 100ml at a time, 50-60ml if she has any heart or ascites issues. It may take up to 3 days to flush them but at long as they continue to go down, you're headed in the right direction. It won't happen immediately but that's OK - it's if they start rising again that you need to have vet check again....
 
How many ml of fluids did they recommend giving?

Fluids - if vet didn't tell you, once a day - max 100ml at a time, 50-60ml if she has any heart or ascites issues.

They gave me the remainder of a 250mL bag. It looks like they gave about 100mL yesterday and told me to give the rest to her (150mL) today. So it sounds like I need to give her 100mL this afternoon save the remaining 50mL for tomorrow? She does not have any heart issues.
 
They gave me the remainder of a 250mL bag. It looks like they gave about 100mL yesterday and told me to give the rest to her (150mL) today. So it sounds like I need to give her 100mL this afternoon save the remaining 50mL for tomorrow? She does not have any heart issues.

Sorry, just now getting back - I'd go with 100 today and the rest tmw. That gives enough to keep flushing but not put pressure on other things as it works it way thru her system. I think 150 a day is a bit heavy but that's just my opinion...which that and two bucks will buy a McD's coffee. :)

HUGS
 
Sorry, just now getting back - I'd go with 100 today and the rest tmw. That gives enough to keep flushing but not put pressure on other things as it works it way thru her system. I think 150 a day is a bit heavy but that's just my opinion...which that and two bucks will buy a McD's coffee. :)

HUGS

This was my first time giving IV fluid and it was unexpectedly stressful. I didn't realize the needle was so large and had a hard time trying to hold the IV bag up high by myself, hold the needle in Lucy, and hold Lucy still. She was so, so, so good though. I love that cat! Crossing my fingers for lower ketones tomorrow (and now McD's coffee!). Will be giving the remainder of the fluid late tomorrow afternoon.

I also talked with Lucy's regular vet today and their cost for a UCCR test is $132.50. Called both her previous vet and the ER vet and that was the lowest price so it's happening! I also want to make sure she gets "continuous" care with vets she's been with before, AKA her family vet. Working on collecting her urine for that test now and bringing it in tomorrow (will also be using that same urine for an additional ketone test). I would feel awful if all this time, she had another syndrome that was making her feel bad :( I know it's not directly my fault but can't help thinking like that. I read Tuxedo Mom's Cushing's post and she seems to fit almost all of the symptoms (and the ER/internal medicine vets yesterday all couldn't believe that her symptoms might actually indicate this rare disease in cats. One part I forgot to mention is that her blood separated in to blood and then very, very fatty deposits in the tube [complete separation of red & white] - this also happened at the VCA - they said this might also indicate Cushing's). I'll let everyone know what the test results say!
 
Hint - do it in bathroom, put bag over top of coat hanger - there's a little hangy tab. Coat hanger over shower rod, release roller down toward bottom. Hold cat, stick with harpoon, open and hope she sits still. :) I have a box that's long and narrow that Doc lays in - only time he gets his catnip pillow, a gift long ago from @Ella & Rusty & Stu(GA)

That's a GOOD price for that test!
 
I read Tuxedo Mom's Cushing's post and she seems to fit almost all of the symptoms (and the ER/internal medicine vets yesterday all couldn't believe that her symptoms might actually indicate this rare disease in cats.


My belief is that Cushing's is under-diagnosed. Years ago Acromegaly was considered a rare disease in kitties and now newer findings have found that up to 1 in 4 kitties may suffer from it. There have been at least 4 other kitties positively diagnosed with Cushing's on FDMB in the last 2 years and a number before my time, so it may not be as rare as many vets assume. Early reports were that it was very rare and most vets will say it is not worth testing because it is so rare. My vet has been very interested in the tests we had done and the symptoms with my Cushing's kitty. BTW I chose not to use the trilostane (vetoryl) medication that is used for PDH pituitary based Cushing's, since he was very early stages and he is still around. (2 1/4 years)

Good luck with your testing :bighug::bighug:
 
My belief is that Cushing's is under-diagnosed. Years ago Acromegaly was considered a rare disease in kitties and now newer findings have found that up to 1 in 4 kitties may suffer from it. There have been at least 4 other kitties positively diagnosed with Cushing's on FDMB in the last 2 years and a number before my time, so it may not be as rare as many vets assume. Early reports were that it was very rare and most vets will say it is not worth testing because it is so rare. My vet has been very interested in the tests we had done and the symptoms with my Cushing's kitty. BTW I chose not to use the trilostane (vetoryl) medication that is used for PDH pituitary based Cushing's, since he was very early stages and he is still around. (2 1/4 years)

Good luck with your testing :bighug::bighug:

Thank you!! I am looking forward to the results. I just collected her urine, put it in the fridge, and will be dropping it off tomorrow. On the bright side, her ketone level has dropped even more!!
 
Gave her the remaining 50mL of fluid about two hours ago. Just did another ketone test on her as well and they went up to between 15 - 40 mg/dL, color was closer to 40 :( I was so positive about the whole thing when her ketones reduced so much last night, but am pretty bummed they're back up slightly. She was hungry and did eat this morning and also ate her dinner. She doesn't seem to be drinking a whole lot of water but I'm not sure if that's a cause for concern since she's been getting fluids and her meals have been mixed with quite a bit too. I am going to go back to the vet tomorrow and pick up more fluids and will also try to capture more urine in the morning. I did bring her urine in to the vet today for the UCCR test so will hopefully hear back on that soon.
 
Gave her the remaining 50mL of fluid about two hours ago. Just did another ketone test on her as well and they went up to between 15 - 40 mg/dL, color was closer to 40 :( I was so positive about the whole thing when her ketones reduced so much last night, but am pretty bummed they're back up slightly. She was hungry and did eat this morning and also ate her dinner. She doesn't seem to be drinking a whole lot of water but I'm not sure if that's a cause for concern since she's been getting fluids and her meals have been mixed with quite a bit too. I am going to go back to the vet tomorrow and pick up more fluids and will also try to capture more urine in the morning. I did bring her urine in to the vet today for the UCCR test so will hopefully hear back on that soon.
Keep on with ketone testing. Don't let the ketone level get any higher without consulting your vet. It's easier to get it under control earlier.
 
Keep on with ketone testing. Don't let the ketone level get any higher without consulting your vet. It's easier to get it under control earlier.

Did a test this morning and it came back between negative and neutral!! :cat: I think the color also leans more towards negative. Makes me so happy!! I am going to keep up with the ketone testing now that I've found a very simple method that works for Lucy (the trash bag over the cat box). Hopefully I'll hear something back on the UCCR results today too!
 
Did a test this morning and it came back between negative and neutral!! :cat: I think the color also leans more towards negative. Makes me so happy!! I am going to keep up with the ketone testing now that I've found a very simple method that works for Lucy (the trash bag over the cat box). Hopefully I'll hear something back on the UCCR results today too!
I'm so glad it's better today and you have a good method. Frequent ketone tests are a good idea right now. How is she feeling? If you could update your spreadsheet that would help us to help you better. :)
 
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