Ketones, IBD, PZI - Blood 134

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Haley&Pilot

Haley&Pilot

Member Since 2020
Hi everyone,

Pilot (15) is very sick. She's down to under 7 lbs and was diagnosed with IBD 2 months ago. She's on daily .2 budesonide, pzi 2.5 units (I home test and she rarely needs this much), and now subq fluids daily, anti nausea, and appetite stimulant since Wednesday. Her appetite is touch and go but today much better (fresh tuna, FF pate or gravy, and limited ingredient turkey... She makes the rounds to different bowls I have set up in her cozy spots). She's using the litter regularly. I haven't seen her drink a drop of water. She's lethargic but bright eyed, grooming only where she can easily reach.

On Wednesday she had ketones in her urine. This am her blood was at 227 and I gave her 2 units. 12 hrs later she's at 137. Yesterday morning she was 143 and then 54 later that night. Edit:: 45 min later after watching her eat she's now at 122

Not sure what to do about the insulin at the moment. Doc was adament about the 2.5 units even when I bring up her low numbers and touchy appetite. I'm 32 and I've had her since I skipped school to rescue her. I'm confused and scared I'm going to make the wrong move. Please help!

PS my spreadsheet is outdated that of which I regret but it's been an insanely stressful couple of weeks dealing with this rollercoaster of a disease
 
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Have you tested for ketones since the result on Wednesday? What was the level then?

If she's throwing ketones she needs insulin to help keep them at bay. I'm not a prozinc/PZI person so I can't really help on dosing, but if you can update your spreadsheet it will really help those who are more knowledgeable about this insulin.

It does sound like there's something else going on with Pilot that is the root of the problem, possibly the IBD but possibly something new. When was her last vet visit?
 
If you could update your SS that would be helpful.
Looking at the SS the 2 units is too much as the BG dropped to 45. However with ketones in the picture you definitely need to be giving some insulin.
I am not a Prozinc user either but I think you need to give some insulin if she still has ketones in the urine. Have you tested her again for ketones since Wednesday? If you could get a test done now that would be very helpful.
Do you think she would eat some higher carb food so you can give some insulin? 122 is not very high to be giving Prozinc

I’m going to tag prozinc user. Not sure if she’s around though. @Deb & Wink
Also tagging @Sienne and Gabby (GA)
@Marje and Gracie as it’s getting late at night for me.

Try and get her to eat as much as you can as that will help combat the ketones.
 
Hi Haley,

I'm really sorry to hear that Pilot is feeling so poorly. :bighug:

I strongly agree with Bron's recommendation that you get Pilot to a vet to ensure that she gets enough insulin to keep the ketones at bay.

A couple of suggestions on common issues/treatments:

* Cats with IBD often also get pancreatitis. Assuming that one hasn't been done already, when you get Pilot to the vet I suggest asking them to run a Snap fPL test to check for pancreatitis. The test gives an immediate result. If it were to be positive then the vets could add pain relief (buprenorphine) to Pilot's current meds and that should hopefully make eating more comfortable for her and therefore help her appetite (can make a world of difference).

* Again assuming that it hasn't already been done, ask the vet about starting Pilot on a course of B12 injections. They are recommended for IBD kitties and also those with pancreatitis. B12 is thought to have anti-inflammatory properties and can also help improve appetite. (Texas A&M University B12 dosing protocol here.)

* Ask the vet to make sure Pilot isn't constipated (can cause vomiting and inappetence and needs to be sorted before anti-nausea meds will work properly). If poor gut motility is an issue, a few days' treatment with metoclopramide (Reglan) can help with that. (Note: Reglan is useless for treating cat nausea. It is thought by IDEXX that cats have very few of the receptors it works on.)

* Both Cerenia and ondansetron can be used in combination to treat nausea (they have different modes of action in the body). Cerenia is believed to convey some anti-inflammatory benefit. Overall, I've found ondansetron to be the better of the two, but it can take 24-48 hours for the full benefit of a given dose to show. That said, it is worth sticking with it till you get to the right dose size and frequency. At an appropriate dose size, ondansetron can be administered every 8 hours. The vet should be able to guide you on this.

* One fights off ketones with calories and insulin. I suggest you have a discussion with the vet about whether feeding a medium carb food that Pilot tolerates well might be the best thing to do for the time being, reason being that it could make it easier to consistently administer sufficient insulin to fight off the ketones while reducing the risk of Pilot going too low.

When you have a chance, be sure to let us know how the two of you get on. Again, I really think the best thing to do is get Pilot seen by a vet.

Sending prayers that Pilot will feel much better very soon.

(((Pilot)))


Mogs
.
 
I agree with what the others are suggesting. If pancreatitis is part of the picture, you need pain meds (e.g., buprenorphine). You also need to know if ketones are present, if your cat needs to be at the vet's office or if you can manage them at home.

This could be an IBD flare. Is Pilot nauseous/vomiting or having bouts of diarrhea? Treating IBD usually involves novel proteins -- not just limited ingredients. Protein, such as poultry or beef or fish may be what's setting off the IBD. Likewise, additives like gums or carrageenan can also be problematic. One of my kitties has IBD. I use a combination of raw (either pork or lamb and sometimes goat) that I add a pre-mix to in order to supply the necessary nutrients (i.e., EZ Complete) and ZiwiPeak canned food in either venison or rabbit and lamb.

If this is IBD, anti-nausea meds (e.g., Cerenia and/or ondansetron) and an appetite stimulant can help. They can also help with dealing with the ketones.
 
Hi! Thank you for your reply. I actually have never tested ketones but read all about it last night on here and will be testing today. I will report back!

-She vomited twice on tuesday when this started (she got in on wed)
-She is so picky when it comes to food. She doesn't like raw chicken or turkey. She loves seafood and at this point I've been desperate to feed her whatever she will eat.
 
Bron and Sheba (GA) said:
If you could update your SS that would be helpful.
Looking at the SS the 2 units is too much as the BG dropped to 45. However with ketones in the picture you definitely need to be giving some insulin.
I am not a Prozinc user either but I think you need to give some insulin if she still has ketones in the urine. Have you tested her again for ketones since Wednesday? If you could get a test done now that would be very helpful.
Do you think she would eat some higher carb food so you can give some insulin? 122 is not very high to be giving Prozinc

I’m going to tag prozinc user. Not sure if she’s around though. @Deb & Wink
Also tagging @Sienne and Gabby (GA)
@Marje and Gracie as it’s getting late at night for me.

Try and get her to eat as much as you can as that will help combat the ketones.
Click to expand...

- The spreadsheet is now updated from when I could gather from my contour next when she came down with her flare
-I will be testing ketones today!
-She is so picky that right now she's only eating gravy like FF, creamy tuna, raw tuna, and limited ingredient turkey. Won't touch raw food.
 
Panic said:
I agree, it would really help if you update the SS even for just the past week so we can help. If 2u is too much you need to reduce, but skipping isn't an option with ketones in the picture. I would want to take her in for a pancreatitis test and ketones to rule them out.
Click to expand...

-Pancreatic test was negative, spreadsheet updated! Can't get a drop this morning :| going to take a breather and come back for another poke in a sec. Update, blood 78
 
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Critter Mom said:
Hi Haley,

I'm really sorry to hear that Pilot is feeling so poorly. :bighug:

I strongly agree with Bron's recommendation that you get Pilot to a vet to ensure that she gets enough insulin to keep the ketones at bay.

A couple of suggestions on common issues/treatments:

* Cats with IBD often also get pancreatitis. Assuming that one hasn't been done already, when you get Pilot to the vet I suggest asking them to run a Snap fPL test to check for pancreatitis. The test gives an immediate result. If it were to be positive then the vets could add pain relief (buprenorphine) to Pilot's current meds and that should hopefully make eating more comfortable for her and therefore help her appetite (can make a world of difference).

* Again assuming that it hasn't already been done, ask the vet about starting Pilot on a course of B12 injections. They are recommended for IBD kitties and also those with pancreatitis. B12 is thought to have anti-inflammatory properties and can also help improve appetite. (Texas A&M University B12 dosing protocol here.)

* Ask the vet to make sure Pilot isn't constipated (can cause vomiting and inappetence and needs to be sorted before anti-nausea meds will work properly). If poor gut motility is an issue, a few days' treatment with metoclopramide (Reglan) can help with that. (Note: Reglan is useless for treating cat nausea. It is thought by IDEXX that cats have very few of the receptors it works on.)

* Both Cerenia and ondansetron can be used in combination to treat nausea (they have different modes of action in the body). Cerenia is believed to convey some anti-inflammatory benefit. Overall, I've found ondansetron to be the better of the two, but it can take 24-48 hours for the full benefit of a given dose to show. That said, it is worth sticking with it till you get to the right dose size and frequency. At an appropriate dose size, ondansetron can be administered every 8 hours. The vet should be able to guide you on this.

* One fights off ketones with calories and insulin. I suggest you have a discussion with the vet about whether feeding a medium carb food that Pilot tolerates well might be the best thing to do for the time being, reason being that it could make it easier to consistently administer sufficient insulin to fight off the ketones while reducing the risk of Pilot going too low.

When you have a chance, be sure to let us know how the two of you get on. Again, I really think the best thing to do is get Pilot seen by a vet.

Sending prayers that Pilot will feel much better very soon.

(((Pilot)))


Mogs
.
Click to expand...

THANK YOU <3 !

-Snap test negative
- Noted on B12, vet has not recommended
-He didn't want to send me home with Cerenia because "it was an injection" (as if she's not getting enough needles now with the subq and insulin...) she is on Leukeran oral every 3rd day
-She's using the litter regularly with healthy movements
- We were just at the vet on Wednesday and they said to administer fluids for a week. Only call if she isn't eating at all or if she throws up but she is eating (small) portions and is bright eye'd, mobile, getting up to eat and drink a little water, but still mostly just lying around and sleeping.
- Spreadsheet updated. 73 this AM
 
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Not much to go by without mid-cycles but I would say no more than 0.75 units for now. Can you start testing during the day, maybe a before bed test each night? Any ketone test to share?
 
Panic said:
Not much to go by without mid-cycles but I would say no more than 0.75 units for now. Can you start testing during the day, maybe a before bed test each night? Any ketone test to share?
Click to expand...

JUST got a ketone reading by putting a tiny piece of flat Saran wrap where she peed!! Literally did not think I would get it and what a relief after a down day. I've been preparing myself for the worst and refusing to leave the house. This is mentally and emotionally so hard. I'm so grateful for this group.. none of my friends or family understand the extent to which these diseases take you and your pet.

Photo shows (what I assume) halfway between negative and trace, I'm sure others can help me clarify.

Her blood is 261 it's 8pm and she doesn't get her shot til 1030 - she did not get one this am because she was low. Do I wait?? Do I still shoot 2 units? She's still eating very little. She had her subq today.
 

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Won't be able to tell with the pic, it has to be exactly 15 seconds or whatever the time on the bottle says but as long as it's not higher than trace your good. She looks like she's going to be high enough for insulin too.

Haley&Pilot said:
-He didn't want to send me home with Cerenia because "it was an injection" (as if she's not getting enough needles now with the subq and insulin...) she is on Leukeran oral every 3rd day
Click to expand...
They make cerenia tablets?? :mad:

If you/someone you know has ondansetron or zofran you can use that, 2mg every 12 hours I THINK. With vomiting though you really need cerenia.

I don't know what leukeran is though or if it shouldn't be mixed with the two.
 
Panic said:
Won't be able to tell with the pic, it has to be exactly 15 seconds or whatever the time on the bottle says but as long as it's not higher than trace your good. She looks like she's going to be high enough for insulin too.


They make cerenia tablets?? :mad:

If you/someone you know has ondansetron or zofran you can use that, 2mg every 12 hours I THINK. With vomiting though you really need cerenia.

I don't know what leukeran is though or if it shouldn't be mixed with the two.
Click to expand...

Leukeran, he says, is what is prescribed to cancer patients for anti-nausea. She is no longer vomiting since before her vet visit Wednesday. That pic was 15 seconds so we're good there. I'll wait until her scheduled shot time and administer 2 units as prescribed.
 
Haley&Pilot said:
Leukeran, he says, is what is prescribed to cancer patients for anti-nausea.
Click to expand...

Huh. I don't really know anything about this drug, but Dr. Google suggests that it's an anti-cancer drug (probably being used here to try to address the IBD on the assumption that the cause is lymphoma). I don't see anything about it having anti-nausea properties, though-- in fact just the opposite, at least in humans.

The cerenia injection apparently really stings, so they usually don't send it home with caregivers. They like to do it in the vet's office by injecting into an iv bag. But, as Elizabeth says, there are cerenia tablets that they could have sent home with you! I would definitely put a call in to the vet if the nausea continues, to ask about cerenia tablets and also ondansetron. Sometimes you have to attack nausea from several angles before you find something that works. Just because she isn't vomiting doesn't mean you don't have nausea-- the lip-licking and inappetance both point in that direction.
 
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