4/16 Silver AMPS 236 +8=203 PMPS 185 BLUE!

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Kris & Teasel said:
My guess is you won't be the only person with trouble getting to work today.
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It's crazy. I managed to get a neighbor to help push my car to the side of the road and hope it's okay there. Might be the bus tomorrow but that causes other issues. If I'm on the bus then I'm late for Silver's shot. I get off the train at 6:15pm and get home in time for 6:30pm shot. If on bus in this weather I could be much later.
 
Wendy&Neko said:
Many a cat here has been prevented from going into regulation by bad teeth. Since you like looking at spreadsheets, Rufus is a recent example. Check out what happened after the dental mid February. Dental specialists may be more comfortable doing a dental with a diabetic, though Neko's vet did her first when she was unregulated.
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Hey, I copied this to my condo as I didnt want to hijack Snowflake's. Given what has been going on with Silver - would you recommend a dental? The vet saw him on Saturday - was not convinced Silver had DKA given that he is on insulin and had only stopped eating for one day. He may be wrong - but we don't know. Silver has been acting fine the past week, no problems with eating, peeing, purring etc all normal.

The vet said he had a touch of gingivitis and is estimating at least two extractions and I booked him in for a dental next week. But I have seen two people say not recommended if numbers are not regulated and if they have had an episode of DKA (not confirmed).

What do you think - would you do the dental?
 
Got this email from the owner of the regular practice Silver goes to. This vet has not seen Silver.

"The test for pancreatitis on Saturday was within normal limits, so no indication of that problem complicating the diabetes.


If you are regulating the blood glucose well, as I know you are, you should not be having issues with high blood ketones which , in turn, cause ketones to appear in the urine.

Only real way ketones appear in the blood (then in the urine) is when you develop long periods of hyperglycemia.

If he is concentrating urine well, you may get a “high” reading in his urine even when the level in his blood at that time is normal. Confusing.

This is why most vets are not big “ketone watchers” in monitoring their patients.


If Silver is normal to you in all other ways, I would just keep your close blood glucose monitoring as guide to insulin treatments.


We could run occasional serum fructosamine levels periodically should help you judge your level of blood glucose control.

Other than that, there is a separate monitor available to measure one of the serum ketone bodies. That would be more accurate than the urine ketone levels.

I am unable to explain ketones in the urine of a well regulated blood sugar . As long as he is doing well, I would see no reason to pursue any other tests.


That article attached is just more scientific data for you to review"

I am glad he does not have pancreatitis. Not sure I understand his view on ketones.

@Sandy and Black Kitty in your experience - do you agree with the vet?
 
My response to the vet

"Good morning.

Thank you for this.

I would not say he is regulated very well at all. I am not getting numbers below 15 mmoL.

I have a blood ketone meter that read 3.5 last time I checked two days ago. That number concerns me although Silver is acting fine in every other way.

He did vomit yesterday four hours after eating so I kept an eye on him and he had not done it since.

I have him booked in for a dental next week to see if dental issues could be the reason why I am finding him hard to regulate the last few weeks.

Glad to hear he does not have pancreatitis.

Thank you"
 
Juliet said:
Only real way ketones appear in the blood (then in the urine) is when you develop long periods of hyperglycemia.
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I personally don’t agree with this. Long periods of hyperglycemia alone do not produce ketones.
Juliet said:
If he is concentrating urine well, you may get a “high” reading in his urine even when the level in his blood at that time is normal. Confusing.
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I have not heard that before.

Juliet said:
If Silver is normal to you in all other ways, I would just keep your close blood glucose monitoring as guide to insulin treatments.
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...along with close ketone monitoring.
Juliet said:
I am unable to explain ketones in the urine of a well regulated blood sugar
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she apparently has a different idea of what ‘well regulated’ is.

Juliet said:
We could run occasional serum fructosamine levels periodically should help you judge your level of blood glucose control.
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save your money.

I don’t have experience with p-titis so don’t know if the test given is enough to rule it out. Hopefully others can comment on that.
 
Sandy and Black Kitty said:
I personally don’t agree with this. Long periods of hyperglycemia alone do not produce ketones.
I have not heard that before.

...along with close ketone monitoring.
she apparently has a different idea of what ‘well regulated’ is.

save your money.

I don’t have experience with p-titis so don’t know if the test given is enough to rule it out. Hopefully others can comment on that.
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Thanks. I didn't understand his comments and agree re the fructosamine. What's the point if I am getting regular tears in. He clearly thinks I am testing ketones in the urine not blood. None at the practice can answer me why ketones showed up. The results said "serum ketones" what does that mean? Is that blood or urine?
 
Juliet said:
Thanks. I didn't understand his comments and agree re the fructosamine. What's the point if I am getting regular tears in. He clearly thinks I am testing ketones in the urine not blood. None at the practice can answer me why ketones showed up. The results said "serum ketones" what does that mean? Is that blood or urine?
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That would be blood.
 
Serum ketones is in the blood. The reason he could have ketones in the urine and not in the blood is becuase urine was made awhile ago, an hour, two hours, who knows exactly, but it’s showing what has past and not what is. All it means is that at the time the urine was being made he did have ketones (which could have since resolved). Sometimes they can have ketones and work it out on their own thus the blood could show negative but urine positive if this were the case. The blood ketone meter is showing what’s happening right now. They also test for different markers of ketones, the blood vs urine test. It really doesn’t matter, any of it, if you ask me. However you choose to monitor ketones, if you see them, you act as if and make sure he’s eating well, hydrated and has insulin.

As far as not a real DKA, that is semantics to me. As far as I would be concerned, he had a DKA episode, he had ketones and was off his food, not doing well and needed critical care. How severe was it? How much were his electrolytes imbalanced? Does it really matter? It happened, he was treated as if he had DKA and he is recovering from it.

The dental could be huge. I would do the dental even if he isn’t perfectly regulated, you can find a vet dental practice that have more knowledge to handle tricky situations if your vet won’t do it. I don’t think anybody suggested you don’t do the dental because he had DKA (quite the opposite), he likely needs the dental, but you want to make sure he is well recovered from this episode of DKA and is strong enough to go under anesthesia. Approximately how much time would that be, I will leave others with experience in post DKA anesthesia to give an educated guess to that.
 
Juliet said:
If he is concentrating urine well, you may get a “high” reading in his urine even when the level in his blood at that time is normal. Confusing.
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The urine strips are designed for humans who would have a specific gravity between 1.007 and 1.020, so in a urine sample more concentrated than that, you can see false positives. The urine pH, if very acidic, can skew the results as well. The strips are good, but have their limitations.
 
Stacy & Asia said:
Serum ketones is in the blood. The reason he could have ketones in the urine and not in the blood is becuase urine was made awhile ago, an hour, two hours, who knows exactly, but it’s showing what has past and not what is. All it means is that at the time the urine was being made he did have ketones (which could have since resolved). Sometimes they can have ketones and work it out on their own thus the blood could show negative but urine positive if this were the case. The blood ketone meter is showing what’s happening right now. They also test for different markers of ketones, the blood vs urine test. It really doesn’t matter, any of it, if you ask me. However you choose to monitor ketones, if you see them, you act as if and make sure he’s eating well, hydrated and has insulin.

As far as not a real DKA, that is semantics to me. As far as I would be concerned, he had a DKA episode, he had ketones and was off his food, not doing well and needed critical care. How severe was it? How much were his electrolytes imbalanced? Does it really matter? It happened, he was treated as if he had DKA and he is recovering from it.

The dental could be huge. I would do the dental even if he isn’t perfectly regulated, you can find a vet dental practice that have more knowledge to handle tricky situations if your vet won’t do it. I don’t think anybody suggested you don’t do the dental because he had DKA (quite the opposite), he likely needs the dental, but you want to make sure he is well recovered from this episode of DKA and is strong enough to go under anesthesia. Approximately how much time would that be, I will leave others with experience in post DKA anesthesia to give an educated guess to that.
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His dental is booked for next week. I thought I'd mentioned that. So obviously my vet has no problem doing it and he himself has two diabetic cats. Vet himself said it wasn't DKA so you can understand my confusion.
 
Janine & Floyd said:
The urine strips are designed for humans who would have a specific gravity between 1.007 and 1.020, so in a urine sample more concentrated than that, you can see false positives. The urine pH, if very acidic, can skew the results as well. The strips are good, but have their limitations.
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This was the vet's comment not mine. I didn't agree with him.
 
I don't envy your weather. :arghh:

I agree with what Stacy said about the dental. If Silver is recovered from his "DKA" episode and healthy enough to have anesthesia, the dental is a good idea.
 
You’ve said that aside from yesterday’s vomiting he’s been doing well. I think that if that continues until the 25th he should be OK to undergo the dental procedure. It seems to be an important factor in keeping his BGs higher than is ideal. There’s also the possibility of weak insulin. Even so, the dental is key.
 
Kris & Teasel said:
You’ve said that aside from yesterday’s vomiting he’s been doing well. I think that if that continues until the 25th he should be OK to undergo the dental procedure. It seems to be an important factor in keeping his BGs higher than is ideal. There’s also the possibility of weak insulin. Even so, the dental is key.
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Yes I was planning replacing the insulin today but I am housebound today.
 
I am with Stacy.

  • Even if the vet isn't going to go to the point of a DKA dx is kind of irrelevant to me as well. He had symptoms of something being wrong and you acted immediately. The ER vet treated it like DKA and Silver recovered quickly.
  • Was it a full blown DKA episode or just the start of the DKA slippery slope? - again it doesn't matter as something was wrong and he does continue to have small keytones as per your test 2 days ago.
  • You have had issues for about a good 8 weeks or so of getting Silver to budge on his numberss...I am beginning to think dental issues could be a root cause that needs to addressed.
  • If Silver has recovered from his episode and continues to do will - eating, drinking, no behavioral issues that you see...I would do the dental.


I am happy for the negative pancreatitis. You can get a false positive on the test but I don't think you can get a false negative. Plus he hasn't had the other clinical signs....repeated vomiting (the flat puddle like vomit), diarrhea (like the flat puddle type), decreased appetite, lethargic, tummy pain (will do the bread loaf position).
 
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Tracey&Jones said:
I am with Stacy.

  • Even if the vet isn't going to go to the point of a DKA dx is kind of irrelevant to me as well. He had symptoms of something being wrong and you acted immediately. The ER vet treated it like DKA and Silver recovered quickly.
  • Was it a full blown DKA episode or just the start of the SKA slippery slope? - again it doesn't matter as something was wrong and he does continue to have small keytones as per your test 2 days ago.
  • You have had issues for about a good 8 weeks or so of getting Silver to budge on his numberss...I am beginning to think dental issues could be a root cause that needs to addressed.
  • If Silver has recovered from his episode and continues to do will - eating, drinking, no behavioral issues that you see...I would do the dental.


I am happy for the negative pancreatitis. You can get a false positive on the test but I don't think you can get a false negative. Plus he hasn't had the other clinical signs....repeated vomiting (the flat puddle like vomit), diarrhea (like the flat puddle type), decreased appetite, lethargic, tummy pain (will do the bread loaf position).
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Thanks. Nope. All seems fine with him except his numbers. The battery died on the ketone meter and I haven't been able to get out the house the last three days due to the ice storm (have you seen pics or is it in your news out west). I also want to change the insulin just to rule everything out.
 
Almost a blue but I fed him as he was asking so nicely. So I guess blues now not happening today.
 
Juliet said:
Thanks. Nope. All seems fine with him except his numbers. The battery died on the ketone meter and I haven't been able to get out the house the last three days due to the ice storm (have you seen pics or is it in your news out west). I also want to change the insulin just to rule everything out.
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Yep we have. We have been talking with family out east. My DH is from Belleville.

We started with drizzle and have now moved to snow. Calgary down south is getting some really bad snow. We are at least warm and I don't think the snow will last long.
 
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