Cadmium's BG (crosspost) Trace Ketones Detected.

apollonia-artemisia

apollonia-artemisia

Active Member
Hi there, I posted this info in the main thread too, but wanted to make sure it was somewhere more accessible and less likely to get lost.

Starting out, here's the BG for both cycles for 11/27/2022

AMPS 469
+1 444
+3 359
+5 390
PMPS 423
+2 381
+6 398

I am giving the SLGS method a try, considering how Cadmium's pancreas.... loves to make me worry. When he dipped to 78 really rapidly, I was able to help him coast in the greens until I fell asleep. When I woke up from his +6 alarm, he spiked up pretty high. Lowered his dose as he would have rapidly sunk past not just 90 or 75, he might have gone below 50 if he was left alone with no food. Tried lowering his dose to 0.25, but his values have been pretty damn high lately. Trying to determine if Cadmium truly is bouncing, or if he failed this reduction.

I'll update each days test results in the replies to this post. Thank you.
 
Today (11/28/2022) he received a slightly elevated dose for the morning, somewhere between 0.25F-0.5S. This was done as when it was tweaked yesterday, it seemed to really assist with his symptoms. Interestingly, I've noticed that when his sugars have been high for a while, he gets incredibly itchy- especially on his face. He's also been having way more energy lately and getting multiple zoomies a day. He's even jumping during play, something he hasn't really done since his spinal infection in 2020! His distended abdomen is also looking more normal, and his gut has been more regulated :cat:
 
11/28/2022 readings
AMPS: 431. 0.25U, whole can
+2: 326
+5: 365
+6: 405
+9.5: 386
PMPS: 422. Ketones detected- trace values. 0.5U, whole can
+1: 391
+2: 334
+3: 217, half can
+6: 126
+7: 176, no ketones detected, confirmed with two test strips
+11: 379

Will edit to add readings as I get them.
 
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11/29/2022
AMPS: 404, 0.5U, whole can
+4: 335, finished eating his breakfast not too long ago
+6: 370, he managed to find some stray kibbles on the floor, urgh. I did not give him an additional half can like I did last night, so I might need to do that for both cycles.
+6.5: Ketone strip between negative and trace? Unsure if last nights negative strips were false negatives...
+9: 429
PMPS: 449, 0.5U, whole can, ketones - trace
+2: 325, half can
+6: 416
 
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When will his pancreas let me sleep?! :banghead:

I know a significant part of why I'm feeling so frustrated is due to sleeping about 3-4 hours cumulatively last night, but I somehow keep missing when he's going to the litter box so I keep not being able to test for ketones. His sugars today are elevated again, and of course theres a few potential factors for what is causing it.

Sighs....
 
I used a blood ketone meter. The Nova Max Plus ketone meter that I purchased from ADW Diabetes Supply. The strips are expensive, but it was much easier than having to stalk my cat to the litter box (especially with many cats.) My boy had DKA and was in intensive care for a week, so I didn't want to take any chances.
 
Lovely to see those blues on his spreadsheet last night! Stick with the .5 unit dose as long as he doesn't drop below 90. He's been bouncing from those blues today and let's see how long it takes him to clear the bounce, okay?
 
Suzanne & Darcy said:
I used a blood ketone meter. The Nova Max Plus ketone meter that I purchased from ADW Diabetes Supply. The strips are expensive, but it was much easier than having to stalk my cat to the litter box (especially with many cats.) My boy had DKA and was in intensive care for a week, so I didn't want to take any chances.
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Oh man, how expensive are we talking here? I'm scared to look :nailbiting: still would be less expensive than ER vet for that long. He got admitted over two days for his spinal infection with an MRI and spinal tap, that was 4K dollars.
Suzanne & Darcy said:
Lovely to see those blues on his spreadsheet last night! Stick with the .5 unit dose as long as he doesn't drop below 90. He's been bouncing from those blues today and let's see how long it takes him to clear the bounce, okay?
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Yeah... I was hoping it was just a bounce. After his persistent hyperglycemia for this past week, I was nervous about it. But if it doesn't clear soon, maybe I should switch dosing methods to make sure he's getting the correct level of insulin faster? But his curve really looked beautiful last night!!
 
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upload_2022-11-29_19-10-50.png

I had used a website that allowed me to plot these points- it doesn't understand having the curve going across multiple days, so I was just pretending the times were AMs instead of PMs. But that's a much better shape versus what it was not that long before- which was this:
upload_2022-11-29_19-13-27.png
 

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11/30/2022
AMPS: 410, 0.5U, whole can
+2: half can
+6.5: 386, food influenced, as he finally finished his half can
+9: 401
PMPS: 393, 0.5U, whole can with water added
+1.5: 315
+2: half can
+2.5: ketones - negative
+3: 184
 
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Spoke with his vet clinic today, and I was told that any time I see readings in the 400s-500s or even high 300s, expect to see trace levels of ketones in his urine. That's to be expected, due to his body needing to seek out other forms of energy. It can also happen when theres big swings from 500s down to say, 100s, as that can send his body into crisis mode. Also explained that ketones in urine is something that will show up even up to 6 hours later, because it all depends on how frequently the cat pees! The name of the game is consistency, and top priority goes to managing his blood sugar. Once that gets appropriately managed, then the ketones will disappear, but they also understood my concerns about preventing DKA.

The vet is thankful for all this data, but is concerned I might be testing a little too much and getting anxious over too many variables and changing things too much for poor Cadmium to get used too. The curve from the 28th though was very helpful! They said that they see Cadmium as likely settling down and needing somewhere around 0.5U or 0.75U doses for management. Apparently managing him will be difficult due to how sensitive to changes he is, especially where his food and insulin is concerned. Man, don't I know it!

But for now, to hold his dose at 0.5U, keep his feeding schedule consistent, and we can reevaluate and go from there.
 
I'm going to tag @Bron and Sheba (GA) for some things you can do to help with the ketones. Namely, making sure he has enough food, plenty of water (even so far as making food a little soupy), and being vigilant about any changes in behavior.

While your vet is correct, the downside is that should he get an infection or inflammation like pancreatitis, that often is enough to tip the scales. They go off their food and water, and then DKA becomes an issue. I'm not trying to scare you - just making sure you're aware and giving some things you can do to be proactive.

As far as testing - start with a +3 each cycle you can get one. If that's within about 20% of the preshot, you can take a break. But if it shows a bigger drop (like 11/28 PM) then you'll want to get some further ones. How long to wait between depends on the size of the drop and the numbers. I'm not quite sure where his nadir is on a non-bounce cycle, so +4 or +5 is a good place to start.

I suspect he will drop further tonight, so if you see this I'd try for a +4 or +5.
 
FrostD said:
I'm going to tag @Bron and Sheba (GA) for some things you can do to help with the ketones. Namely, making sure he has enough food, plenty of water (even so far as making food a little soupy), and being vigilant about any changes in behavior.

While your vet is correct, the downside is that should he get an infection or inflammation like pancreatitis, that often is enough to tip the scales. They go off their food and water, and then DKA becomes an issue. I'm not trying to scare you - just making sure you're aware and giving some things you can do to be proactive.

As far as testing - start with a +3 each cycle you can get one. If that's within about 20% of the preshot, you can take a break. But if it shows a bigger drop (like 11/28 PM) then you'll want to get some further ones. How long to wait between depends on the size of the drop and the numbers. I'm not quite sure where his nadir is on a non-bounce cycle, so +4 or +5 is a good place to start.

I suspect he will drop further tonight, so if you see this I'd try for a +4 or +5.
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I have started giving an extra can of food (split in half, giving it at around the +2 mark of each cycle) and keeping a pitcher of water to make refilling it a bit easier for me. He gets suspicious of water in food as thats how his gabapentin was initially prescribed ~4 years ago, but I'll try to add a smallish amount and slowly increase to make sure he doesn't get too suspicious to eat. I am also going to try and go to the store tomorrow in order to get some churu, as thats a reliable way for him to increase his water intake.

Because of the half can, should I still try and get that reading at +3, even though it'll be food influenced?
 
I’m not on the same page as your vet with saying that when the BG gets high 300s , 400s and500s expect to see trace ketones in the urine. That is not my experience at all. We have many many cats that are in higher numbers that do not show ant ketones at all.
Some cats are more prone to ketones than others. It’s true that when you have higher numbers you are more at risk of ketones but if they are seeking ‘other forms of energy’ that means they are not getting enough of their normal food and you need to be feeding more. That is why we say make sure you are feeding plenty of food or increase the amount. What we don’t want is for them to seek other forms of energy such as fat as that is when the ketones appear. Being proactive is key.
I would concentrate on making sure he is getting enough food, insulin and fluids.
@FrostD when you feel comfortable increasing the dose to 0.75U I would do so. We need to get the BG down lower when it is safe to do so.
 
Bron and Sheba (GA) said:
I’m not on the same page as your vet with saying that when the BG gets high 300s , 400s and500s expect to see trace ketones in the urine. That is not my experience at all. We have many many cats that are in higher numbers that do not show ant ketones at all.
Some cats are more prone to ketones than others. It’s true that when you have higher numbers you are more at risk of ketones but if they are seeking ‘other forms of energy’ that means they are not getting enough of their normal food and you need to be feeding more. That is why we say make sure you are feeding plenty of food or increase the amount. What we don’t want is for them to seek other forms of energy such as fat as that is when the ketones appear. Being proactive is key.
I would concentrate on making sure he is getting enough food, insulin and fluids.
@FrostD when you feel comfortable increasing the dose to 0.75U I would do so. We need to get the BG down lower when it is safe to do so.
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Yeah.... I initially based his food intake from the calories count from his old dry food that he's no longer allowed to have. But I suppose it wasn't enough :( I've been changing his water more frequently so he doesn't think its too nasty, I'll add a bit of water to his food too tonight, I think he wont get as suspicious if I mash his food up a bit. I'll also try to get a test strip done as soon as I'm able.
Bron and Sheba (GA) said:
Yes. We don’t worry about food being given during the cycles and it being food influenced as this is what normally happens during all the cycles. The only one is the Preshot BG we don’t want food influenced.
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Ah ok, thanks for letting me know. I'll set an alarm to make sure I don't forget or doze off.
 
Don't remember if I mentioned this part specifically, but he's been getting his zoomies especially after his insulin doses! Usually after about 30 min-1 hour later, and he wants to run around and play very intensely. I'm glad about that. However, when he's waiting for his dinner, he's used to his old dinner time of 6:30pm and will sulk until it's time for his new dinnertime and pm dose, which is at 10:30pm. I feel so bad when the non diabetic kitties get their dinners before he does, because he looks so upset about it :'(((
 
apollonia-artemisia said:
Don't remember if I mentioned this part specifically, but he's been getting his zoomies especially after his insulin doses! Usually after about 30 min-1 hour later, and he wants to run around and play very intensely. I'm glad about that. However, when he's waiting for his dinner, he's used to his old dinner time of 6:30pm and will sulk until it's time for his new dinnertime and pm dose, which is at 10:30pm. I feel so bad when the non diabetic kitties get their dinners before he does, because he looks so upset about it :'(((
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There is no reason why he can’t have a snack at 6.30 pm when the other cats eat their dinner. He doesn’t have to know that his portion is not as big as the others.
 
Bron and Sheba (GA) said:
There is no reason why he can’t have a snack at 6.30 pm when the other cats eat their dinner. He doesn’t have to know that his portion is not as big as the others.
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Oh he is? I was warned by someone that he shouldn't eat past his nadir, as that can make his insulin less effective/wear off faster- so that's why he hasn't been getting one. For right now though I need to keep feedings as consistent as possible for his vets to analyze his sheet without other factors muddying it. I think the most anxiety inducing part of all this is I'm getting multiple conflicting messages- he sees two vets, both at the same clinic, and based on whoever is available. Plus on this board there's multiple methods utilized, as every cat is different after all :confused:
 
apollonia-artemisia said:
Oh he is? I was warned by someone that he shouldn't eat past his nadir, as that can make his insulin less effective/wear off faster- so that's why he hasn't been getting one. For right now though I need to keep feedings as consistent as possible for his vets to analyze his sheet without other factors muddying it. I think the most anxiety inducing part of all this is I'm getting multiple conflicting messages- he sees two vets, both at the same clinic, and based on whoever is available. Plus on this board there's multiple methods utilized, as every cat is different after all :confused:
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It is true that we say that feeding in the first half of the cycle is best. But a small snack when the other cats eat would be fine and he would be so much happier….who likes to watch others eat when you are hungry. We need to look at quality of life too! If you just give him a teaspoon of low carb, that would be absolutely fine and he would not know he is getting less than the others. And if he is showing ketones at times, the extra food is needed.
 
Bron and Sheba (GA) said:
It is true that we say that feeding in the first half of the cycle is best. But a small snack when the other cats eat would be fine and he would be so much happier….who likes to watch others eat when you are hungry. We need to look at quality of life too! If you just give him a teaspoon of low carb, that would be absolutely fine and he would not know he is getting less than the others. And if he is showing ketones at times, the extra food is needed.
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I was thinking about giving him a treat during the others dinners :0 churu for the boy!!

Also, just did a reading and it's just about +1.5, and hes at 315. Seems like he's going on another dive tonight :nailbiting:
 
apollonia-artemisia said:
Trying to remind him that he still has access to food with that half can I gave him as he only ate part of it, I'm going to encourage him to eat the rest by hand feeding him
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I would get a test again at +4.
When they are coming off the bounce, sometimes they can drop quite fast and keep dropping to the next preshot. As long as you are testing him and feeding to keep him from dropping too low, you can keep him safe.
Post the +4 and I will watch for it.
 
Bron and Sheba (GA) said:
I would get a test again at +4.
When they are coming off the bounce, sometimes they can drop quite fast and keep dropping to the next preshot. As long as you are testing him and feeding to keep him from dropping too low, you can keep him safe.
Post and the +4 and I will watch for it.
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Handfeeding him worked, I'm going to edit this reply for the +4 reading as it's due in 5 minutes, preparing it now: +4: 191
 
apollonia-artemisia said:
He jumped up to 407 at +5 when I dozed off. I don't think he had any of the snack i left out just in case- as there's no signs of anyone munching on the food.
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Looks like he is bouncing again from the blue BGs. Frustrating but this is normal behaviour for newly diagnosed cats as they have to get used to the normal numbers again without the body overreacting to it. Hope you can sleep well.
 
12/1/2022
AMPS: 402, 0.5U, whole can, ketones - negative
+1.5: 420
+2: half can
+4: 325
+9: 363
+10.5: 476, ketones - trace (?)
PMPS: 446, 0.5F, whole can
+0.5 ketones - negative
+1: 394
+2: half can
+3: 277, making sure he actually eats his half can
+4: 264
 
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FrostD said:
Ok, I was waiting for the break! Just wanted to make sure he wouldn't go into greens. I would increase to 0.75U.
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I am going to hold off on doing that for a bit, as my vet instructed me to hold the same dose and same feeding schedule to make sure other factors aren't muddying things. I think I will do that after 14 cycles! Does that sound ok with you? Plus the last time he went into greens for 3 hours was also on 0.5U, so I'm wanting to make sure that after being on this dose for a bit it wont be too much to do 0.75U
 
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@FrostD of course the exception for me holding this dose would be if it becomes clear that he really is needing more insulin, such as ketones returning and hes been drinking and eating with this new strategy I started! or if his high levels that are seen during bounces simply won't go away. He's still reading lower than previous bounce cycles, so I think the next time it breaks it might go lower too.
 
The time he had greens was a much lower than usual preshot, and it's been some time since then. You don't want him getting too used to the higher numbers, and knowing ketones may be an issue I'd lean towards increasing sooner rather than later.

I certainly understand trying to balance what vet says vs what we say. We just want to make sure you have all perspectives and can make informed decisions.
 
FrostD said:
The time he had greens was a much lower than usual preshot, and it's been some time since then. You don't want him getting too used to the higher numbers, and knowing ketones may be an issue I'd lean towards increasing sooner rather than later.

I certainly understand trying to balance what vet says vs what we say. We just want to make sure you have all perspectives and can make informed decisions.
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Of course, I just don't want to potentially rush things and cause a drastic hypoglycemic episode either... I know that prolonged hyperglycemia is bad too, but if I feel its important to raise the dose, I want my vet to understand the reasons why. Theres two vets, Dr K and Dr J. Dr K was the one that scolded me and said I was testing too much and falling into a trap of changing too much too quickly based on the numbers, and thats why he doesn't think its important to hometest. Dr J, however, understood why I made those changes and approved of them, even if it happened before I got into contact with her. I just.... Want him to be okay :'(

Maybe I give him 2-4 more cycles, evaluating how he's doing, and if nothing has changed, I'll bump up his dose. That way, he's had about 3-4 days with this set of conditions?
 
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Actually, I've changed my mind, considering his long stretch of high numbers and the fact that he has been acting a bit depressed, he will go on 0.75U tonight. Dr K will just have to deal with it when I tell him why I don't want Cadmiums numbers to stay this high for much longer. He can observe the period after the increase- and if he scolds me again, I can just keep seeing Dr J. Cadmium is still alert, will play with me, and grooming himself, but he is sleeping more. I don't know if this is due to the change of weather and he wants to stay warm, but I don't want to make this change too late.
 
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Since your spreadsheet says you are following SLGS, the protocol says to hold this dose for a week. But, I would at least wait until he’s broken this bounce to increase to .75 units. Now, if you can continue to test and intervene often, it may be safe to go ahead and increase to .75. You are doing a fantastic job of that, by the way! But if Cadmium was my cat, I might wait at least another cycle or two to see if he will come down from the bounce before increasing. I think he’s going to need the increase anyway, but we need to be careful.
 
Suzanne & Darcy said:
Since your spreadsheet says you are following SLGS, the protocol says to hold this dose for a week. But, I would at least wait until he’s broken this bounce to increase to .75 units. Now, if you can continue to test and intervene often, it may be safe to go ahead and increase to .75. You are doing a fantastic job of that, by the way! But if Cadmium was my cat, I might wait at least another cycle or two to see if he will come down from the bounce before increasing. I think he’s going to need the increase anyway, but we need to be careful.
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I was considering trying to do a 0.5F dose tonight and the increase tomorrow morning, but he has been acting different today. I can't tell if it is due to his high sugars, the trace ketones returning (they were gone for 2 tests and just now came back, and I really want them to stay gone!!), or if he's simply bored or tired. Stupid high sugar levels for 8 days with a couple of brief breaks, on this dose for 3, modified his feeding routine for 2. He has also had his bad leg start slipping on him, he has an arthritic knee but it seems to act up even worse with higher sugars :(

Edit: this was the strategy I went with, considering he drops lower at night. Let's see how he does in the morning, and see if he keeps with 0.5F or 0.75
 
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