? Post DKA Millie Moderate for Ketones! AMPS 404. Back home. NEED DOSING ADVICE

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Sylvia & Millie

Sylvia & Millie

Member Since 2017
Post DKA twice, Millie tested moderate for ketones this a.m. I have an 11:30 appointment with vet. Any advice to ask, etc? She's been hospitalized before. Yesterday she wasn't looking too good (thought it was the heat & humidity) and she didn't eat last night. I force fed her and was up testing during the night. We can't spend another $6,ooo to hospitalize her. So upset and worried. Advice PLEASE!!!


http://www.felinediabetes.com/FDMB/...-160-havent-seen-blues-in-a-long-time.179208/
 
I can't help with the ketones. I see you are following TR so you may want to consider increasing the dose every 3 days if you aren't seeing better numbers. That will help Millie a lot. I hope she doesn't require hospitalization. :bighug:
 
Mandy & Rex said:
I can't help with the ketones. I see you are following TR so you may want to consider increasing the dose every 3 days if you aren't seeing better numbers. That will help Millie a lot. I hope she doesn't require hospitalization. :bighug:
Click to expand...
Do you know who might be a good person to tag? Her 1st episode she stayed at the vet's (not a 24hr facility). The vet did not give fast acting insulin. We brought her home after a few days. Two days later she ended up being hospitalized. I need to know what insulin she should be given when DKA and what other possible treatments.
 
@Meya14 is very knowledgable about DKA treatment. The main things are food, insulin, and fluids to help "flush" the ketones. The other thing to address while at the vet is to try to identify the trigger for the ketones-- usually, some kind of infection or inflammation, although I wonder if it's possible that the discomfort from the heat would have been enough in a ketone-prone cat. If there is an underlying infection, it's important to treat that ASAP. It may be that anti-nausea meds will be helpful in getting her to eat again-- she needs to eat so that you can give enough insulin to counteract the ketones.

That's pretty much all I know-- I hope that the vet visit will be helpful and that the ketones do not develop into a full-blown DKA. :bighug::bighug:
 
Nan & Amber said:
@Meya14 is very knowledgable about DKA treatment. The main things are food, insulin, and fluids to help "flush" the ketones. The other thing to address while at the vet is to try to identify the trigger for the ketones-- usually, some kind of infection or inflammation, although I wonder if it's possible that the discomfort from the heat would have been enough in a ketone-prone cat. If there is an underlying infection, it's important to treat that ASAP. It may be that anti-nausea meds will be helpful in getting her to eat again-- she needs to eat so that you can give enough insulin to counteract the ketones.

That's pretty much all I know-- I hope that the vet visit will be helpful and that the ketones do not develop into a full-blown DKA. :bighug::bighug:
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Thank you, I appreciate your response.
 
Hi there Sylivia,

It is possible, in the early stages to give Millie the help she needs at home.
Things to discuss with vet
1) as some have mentioned, dehydration is a factor, so learning how to give Subq fluids at home if she's dehydrated can be helpful, perhaps you can get the vet to show you.
2) Assist feeding, and getting as many calories as you can get into Millie is important, this might involve giving her some higher calorie (perhaps a recovery food may be suitable in the short term speak to your vet about those) DKA is more likely if cat is not getting enough calories.
3) Possible infection inflammation? check teeth/UTI/pancreatitis??? Vet will need to examine Millie to try and determine if anything else is going on, urine analysis/pancreatitis test
4) Millie's dose may well need adjusting, if she is not getting enough insulin this can also be a factor in recurring DKA, but with the data you have at the moment I don't feel comfortable suggesting an increase in dose, I would suggest that aside from testing amps and pmps, that you get a couple of readings on every cycle (am and pm) to give you an idea if Millie is staying high all the time or if she is in fact dropping somewhere in the cycle and then jumping back up (bouncing) by the next PS. The 2u got her down to 160 a while ago (and she may have gone lower, earlier in that cycle) given that she bounced up to pink by +2, that's not to say that this dose is still 'working for her'

Here is a link to a post that might help with how to entice Millie into eating, there's also a link to feeding tubes, which is another option that is used when a cat won't eat and you need to get food and insulin into them.
http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/
 
If she's just ketonic and not yet ph acidic, you can flush those at home with lots of attention and a vet visit to fix the problem causing this. Ketonic means she's not using the food you're giving her, she's burning her body's fat stores. She MUST have enough insulin even if you end up having to feed her higher carb food to balance it. She needs LOTS of liquids and fluids to help her kidneys flush the toxins and the source of the issue such as brewing infection or inflammation must be resolved. That usually involves a round of antibiotics. Ketones in the blood will quickly cause it to move to an acidic state - at that point it's DKA (diabetic ketoacidosis). Syringe feed a lot more than you're currently doing.
 
Ok, since this is the second time with ketones, a bunch of questions first. There is probably some unresolved issue in play here.

1. What is her typical diet like? What kind of food/how much per day?
2. What is her current weight and do you feel that she is thin, average, or overweight for her build?
3. What medications are you giving in addition to insulin if she is on any?
4. Any other chronic illnesses that you know of?
 
Sylvia, you can handle this, with advice from your vet, and help from us. Meya is very knowledgeable about DKA, so please answer her questions when you have the chance. I don't know where you're located, so don't know if you're already at the vet or home, or what. I am sending my strongest appy vines to help Millie eat well and some go away ketones vines, too. :bighug:
 
Gill & George said:
Hi there Sylivia,

It is possible, in the early stages to give Millie the help she needs at home.
Things to discuss with vet
1) as some have mentioned, dehydration is a factor, so learning how to give Subq fluids at home if she's dehydrated can be helpful, perhaps you can get the vet to show you.
2) Assist feeding, and getting as many calories as you can get into Millie is important, this might involve giving her some higher calorie (perhaps a recovery food may be suitable in the short term speak to your vet about those) DKA is more likely if cat is not getting enough calories.
3) Possible infection inflammation? check teeth/UTI/pancreatitis??? Vet will need to examine Millie to try and determine if anything else is going on, urine analysis/pancreatitis test
4) Millie's dose may well need adjusting, if she is not getting enough insulin this can also be a factor in recurring DKA, but with the data you have at the moment I don't feel comfortable suggesting an increase in dose, I would suggest that aside from testing amps and pmps, that you get a couple of readings on every cycle (am and pm) to give you an idea if Millie is staying high all the time or if she is in fact dropping somewhere in the cycle and then jumping back up (bouncing) by the next PS. The 2u got her down to 160 a while ago (and she may have gone lower, earlier in that cycle) given that she bounced up to pink by +2, that's not to say that this dose is still 'working for her'

Here is a link to a post that might help with how to entice Millie into eating, there's also a link to feeding tubes, which is another option that is used when a cat won't eat and you need to get food and insulin into them.
http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/
Click to expand...
Gill & George said:
Hi there Sylivia,

It is possible, in the early stages to give Millie the help she needs at home.
Things to discuss with vet
1) as some have mentioned, dehydration is a factor, so learning how to give Subq fluids at home if she's dehydrated can be helpful, perhaps you can get the vet to show you.
2) Assist feeding, and getting as many calories as you can get into Millie is important, this might involve giving her some higher calorie (perhaps a recovery food may be suitable in the short term speak to your vet about those) DKA is more likely if cat is not getting enough calories.
3) Possible infection inflammation? check teeth/UTI/pancreatitis??? Vet will need to examine Millie to try and determine if anything else is going on, urine analysis/pancreatitis test
4) Millie's dose may well need adjusting, if she is not getting enough insulin this can also be a factor in recurring DKA, but with the data you have at the moment I don't feel comfortable suggesting an increase in dose, I would suggest that aside from testing amps and pmps, that you get a couple of readings on every cycle (am and pm) to give you an idea if Millie is staying high all the time or if she is in fact dropping somewhere in the cycle and then jumping back up (bouncing) by the next PS. The 2u got her down to 160 a while ago (and she may have gone lower, earlier in that cycle) given that she bounced up to pink by +2, that's not to say that this dose is still 'working for her'

Here is a link to a post that might help with how to entice Millie into eating, there's also a link to feeding tubes, which is another option that is used when a cat won't eat and you need to get food and insulin into them.
http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/
Click to expand...
Millie will stay at the vet's for the day. She checked her thoroughly, I will ask her about urine & blood when I call her at 4:00. She will give her fluids, anti-nausea meds and try to get her to eat. I left Millie's Lantus at the vet's (she doesn't keep extra insulin at the office, guess they don't have diabetic cats). I mentioned to the vet that I did give her 2 units this morning and that Millie reaches late radar and tends to bounce so she doesn't give her too much extra. Thanks for the ;link, I read it and bought the tuna flakes.
 
Squeaky and KT (GA) said:
If she's just ketonic and not yet ph acidic, you can flush those at home with lots of attention and a vet visit to fix the problem causing this. Ketonic means she's not using the food you're giving her, she's burning her body's fat stores. She MUST have enough insulin even if you end up having to feed her higher carb food to balance it. She needs LOTS of liquids and fluids to help her kidneys flush the toxins and the source of the issue such as brewing infection or inflammation must be resolved. That usually involves a round of antibiotics. Ketones in the blood will quickly cause it to move to an acidic state - at that point it's DKA (diabetic ketoacidosis). Syringe feed a lot more than you're currently doing.
Click to expand...
I will see how she's eating when she gets home and definitely step up the syringe feeding. TY
 
Meya14 said:
Ok, since this is the second time with ketones, a bunch of questions first. There is probably some unresolved issue in play here.

1. What is her typical diet like? What kind of food/how much per day?
2. What is her current weight and do you feel that she is thin, average, or overweight for her build?
3. What medications are you giving in addition to insulin if she is on any?
4. Any other chronic illnesses that you know of?
Click to expand...
Millie eats CORE Wellness Chicken or Friskies Pate (all flavors). She was on FF Classic but got bored (which happens with her). She has a hardy appetite, eats 1 1/2 5oz cans . Sometimes she will eat 2 5oz cans (yes, you read that correctly). She is slim and has always kept about the same weight (11 lbs). She is currently down a little bit. Millie is not on any meds. No chronic illness although she had a UTI and possible pancreatitis last DKA (they weren't completely sure). She does have an innocent heart murmur. Her teeth are in good shape as well. She does have a cough occasionally but not sure if that's hairball or heart.

Sorry for the late reply, I was at the vets then had to run some errands and come home. I will be talking to the vet at 4 and picking up Millie around 8.
 
Tricia Cinco(GA) & Harvey said:
Sylvia, you can handle this, with advice from your vet, and help from us. Meya is very knowledgeable about DKA, so please answer her questions when you have the chance. I don't know where you're located, so don't know if you're already at the vet or home, or what. I am sending my strongest appy vines to help Millie eat well and some go away ketones vines, too. :bighug:
Click to expand...
I was at the vet's. I'm unable to answer the massage board on my phone (don't know why). I tried to answer all of Meya's questions. Thanks!
 
Sylvia & Millie said:
I was at the vet's. I'm unable to answer the massage board on my phone (don't know why). I tried to answer all of Meya's questions. Thanks!
Click to expand...
I figured that was the case. I'm glad Millie is getting some treatment. I hope there is a simple explanation for the ketones and things will get back to normal quickly.

When you have a chance, can you please take down the 911? Thanks.
 
I just got the tag, but I see you got some immediate help. Sending vines for Millie.:bighug:

First thing I did was look at the spreadsheet and from the amount of testing, I thought you were doing SLGS. Then I saw the signature said TR. With TR, we don't hold doses as long as you have been if the aren't a good dose. Millie may very well need more insulin, but I cannot tell from the test data. Please try to get at least two tests per cycle. If you need to increase to address the "not enough insulin" part of the equation, you will need to do it safely and possibly aggressively.
 
Wendy&Neko said:
I just got the tag, but I see you got some immediate help. Sending vines for Millie.:bighug:

First thing I did was look at the spreadsheet and from the amount of testing, I thought you were doing SLGS. Then I saw the signature said TR. With TR, we don't hold doses as long as you have been if the aren't a good dose. Millie may very well need more insulin, but I cannot tell from the test data. Please try to get at least two tests per cycle. If you need to increase to address the "not enough insulin" part of the equation, you will need to do it safely and possibly aggressively.
Click to expand...
I tend to hold the dose because Millie is a major 'bouncer' and I feel insecure about whether she's really high or it's a bounce. I thought I read that if the cat is new to certain numbers (200s for example) to hold it. I know I held it too long last time. I was trying to check in a bit more this time and get a correct nadir. She was showing better numbers then this happened. I've been ill for a bit so caring for her is a little difficult.
 
OK, so I called the vet's office. The vet was in surgery so couldn't talk right now. The receptionist relayed the message that the vet said Millie's BG is going down and Millie appeared hungry but didn't eat anything. I wasn't too happy with this. I assumed they would have given her something to stimulate her appetite and they would have (force) feed her by now. I was told I could pick her in a few hours or leave her overnight. They are not a 24hr facility so no one is there overnight. I prefer to bring her home and monitor her at home, especially with input from the board.
 
Wendy&Neko said:
First thing I did was look at the spreadsheet and from the amount of testing, I thought you were doing SLGS. Then I saw the signature said TR. With TR, we don't hold doses as long as you have been if the aren't a good dose. Millie may very well need more insulin, but I cannot tell from the test data. Please try to get at least two tests per cycle. If you need to increase to address the "not enough insulin" part of the equation, you will need to do it safely and possibly aggressively.
Click to expand...

This is key. When you hold doses too long, hyperglycemia can cause the further destruction of the beta-cells in the pancreas (the ones making insulin) this can lead to more insulin resistance, pancreatitis, and a harder time getting them under control. With recurrent ketosis or DKA it basically means that either there is not enough food (seems like this is ok) or not enough insulin, or both. It's important to be somewhat aggressive with insulin increases after DKA or ketones to prevent them from recurring, but you need more testing to be able to do this safely.

About "bouncing" - I am an unbeliever. Yes, there are compensatory mechanisms that can raise blood glucose, but this should not be a reason to hold a dose that is not producing euglycemia for most of the cycle, and not ever a reason to reduce doses. A lot of "bouncing" can be explained by the mechanism of lantus, that the duration is dose dependent. So if you are giving too low of a dose you may see a nadir but preshots will be high. A safe dose increase will both increase the duration (and time in good numbers) and will be able to lower increased sugar from compensatory mechanisms.
 
Meya14 said:
This is key. When you hold doses too long, hyperglycemia can cause the further destruction of the beta-cells in the pancreas (the ones making insulin) this can lead to more insulin resistance, pancreatitis, and a harder time getting them under control. With recurrent ketosis or DKA it basically means that either there is not enough food (seems like this is ok) or not enough insulin, or both. It's important to be somewhat aggressive with insulin increases after DKA or ketones to prevent them from recurring, but you need more testing to be able to do this safely.

About "bouncing" - I am an unbeliever. Yes, there are compensatory mechanisms that can raise blood glucose, but this should not be a reason to hold a dose that is not producing euglycemia for most of the cycle, and not ever a reason to reduce doses. A lot of "bouncing" can be explained by the mechanism of lantus, that the duration is dose dependent. So if you are giving too low of a dose you may see a nadir but preshots will be high. A safe dose increase will both increase the duration (and time in good numbers) and will be able to lower increased sugar from compensatory mechanisms.
Click to expand...
OK. So I will be aware of this moving forward. Millie is home now. She did not eat ALL DAY (actually since yesterday). I just force fed her. She is still dehydrated and drinking a lot (should I not allow too much drinking so she doesn't throw up?).

Next important question: Millie had her AM Lantus shot at 9am, 2U. The vet gave her 1U at 2:30pm. She is due to have a shot at 9 (in an hour). The vet said to skip a shot but I don't think that's a good idea. I really need help here. Her numbers remained in the mid 300s all day (they checked her hourly). I am going to need help getting through this tonight.
 
Let her drink-- the fluids are good for her.

The shoot/no shoot question is out of my league, but I'd be afraid to skip with ketones in the mix. Let's see what the experts recommend. Are you able to stay up and monitor, all night if need be? How much food did you get into her on this feeding? I'm guessing that you'll have to do a lot of these sessions tonight-- she needs food.

Did they measure her ketone level at the vet, or have you gotten a recent test in?
 
The problem is that the vet gave a shot mid day, at +5.5 of the AM shot. We are used to giving shots 12 hours apart.

Did the vet give her fluids today?
 
Wendy&Neko said:
The problem is that the vet gave a shot mid day, at +5.5 of the AM shot. We are used to giving shots 12 hours apart.

Did the vet give her fluids today?
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Yes they gave fluids all day and then extra before releasing her. She is drinking non-stop. Her PMPS BG is 349. I found I found her bg numbers on the receipt, will add to spread sheet.

Yes, the vet gave extra Lantus that's why I need help with PM dose.
 
I have asked a few people for help. Not sure what to suggest. It would have been better if the vet had given a short acting insulin like R that would be out of the system by now.

How late can you stay up and monitor tonight? Just hoping you are over your recent illness.
 
I
Wendy&Neko said:
I have asked a few people for help. Not sure what to suggest. It would have been better if the vet had given a short acting insulin like R that would be out of the system by now.

How late can you stay up and monitor tonight? Just hoping you are over your recent illness.
Click to expand...
mentioned a short acting insulin to the vet but she doesn't keep insulin around, I brought Millie's Lantus with me. I was thinking of giving her 1U instead of her 2U but not sure.
 
I updated Millie's spreadsheet with today's numbers. They didn't tell me they listed the BG numbers on the bill receipt (which is good). I want to feed her again to get calories in but I'm afraid of gouging her since she is drinking so much.
 
The reason I was asking about how late you can stay up is that one option is a +18 after the morning shot, which would be just over 12 hours after the 1 unit shot. But that would mean getting up at 3AM for the test and shot. You could probably get some rest this evening before then. But it would also mess with your shooting schedule unless you followed up with another 18 hour cycle, or could move her back each day to your regular time.
 
Wendy&Neko said:
The reason I was asking about how late you can stay up is that one option is a +18 after the morning shot, which would be just over 12 hours after the 1 unit shot. But that would mean getting up at 3AM for the test and shot. You could probably get some rest this evening before then. But it would also mess with your shooting schedule unless you followed up with another 18 hour cycle, or could move her back each day to your regular time.
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She received her 2U at 9Am. 1U at 2:30. Is 1U at her scheduled time (PM too much? or should I wait to start all over in the morning?
 
Sylvia, whether you shoot has to be your decision. Your vet suggested a skip which would get you back on schedule. However, it's tricky to do that with moderate ketones. If you shoot, you have to be willing to stay up with her, possibly quite late. You have to decide if you can stay up as late as is needed.
 
I know you are waiting anxiously for advice, and I don't see anyone else chiming in, so I'll just stick my neck out and say that, if it were my cat, and I was pretty sure I was going to be able to get some food into her when needed, I would give one unit and monitor closely through the night. Let the test results be your guide to how often you need to test. However, Millie is not my cat. You hold the syringe and you have to make the decision. I'll be checking back to see what you decide.

ETA: Wendy and I posted at the same time. I'll keep checking back with you to see how it's going.
 
Tricia Cinco(GA) & Harvey said:
I know you are waiting anxiously for advice, and I don't see anyone else chiming in, so I'll just stick my neck out and say that, if it were my cat, and I was pretty sure I was going to be able to get some food into her when needed, I would give one unit and monitor closely through the night. Let the test results be your guide to how often you need to test. However, Millie is not my cat. You hold the syringe and you have to make the decision. I'll be checking back to see what you decide.

ETA: Wendy and I posted at the same time. I'll keep checking back with you to see how it's going.
Click to expand...
As a compromise I gave her .5. I didn't want to give too much but felt she needed something. I remember after her last DKA the importance of having insulin in her was stressed (& calories & fluids). I fed her again (20 minutes ago). Just gave her more water. I will test before going to sleep. I haven't been sleeping well since I've been sick so I'll just test her during the night & feed her as necessary.
 
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