Charlie ketones 1.3 5:30 central

Sarah & Charlie-cat

Sarah & Charlie-cat

Member Since 2022
https://felinediabetes.com/FDMB/thr...s-0-9-at-9-17-pm-central.277626/#post-3072186

Previous thread ^^^

tl;Dr version: Charlie's ketones were 1.3, looks nauseous and my vet's office offered no help and they close basically now. I am at a lose of how to prevent DKA again in the short-term. I know he needs to get his glucose down but it's not budging on a higher dose.

Long version
Charlie didn't devour his afternoon snack. Checked his BG 253. Checked ketones 1.3. which is a little higher than the 1.2 when I whisked him off to the ER vet three weeks ago. He doesn't look nearly as bad. He was in the vet hospital for five days and at an appointment we already had they found a mass in his abdomen. Ultrasound revealed inflamed lymph node. We are waiting on a blood test. Increased Cerenia dose, a month of antibiotics, increased steroids.

Two weeks ago, I dropped him off at the vet when he was 0.8 and they were like he's fine, just get his glucose down. We did a curve and went from 1u to 1.5u. curve repeated this past weekend, lowest was 225. Went up to 2u. He's been in the high 200s at shot time.

I got 14 ccs of wet food mixed with water in him and will do another 14 assuming it stays down. So far it's been 15-20 minutes. So time for more food.

I'm supposed to be on vacation with my husband on Thursday til Sunday. I already told him I don't want to go. I have a vet tech lined up to cat sit but she can't be with him 24/7. I'm at a loss of what to do.

My credit cards are maxed out. I have a little tucked away but my other boy is supposed to have a biopsy in July and maybe surgery. I don't want to lose him.
 
Hi Sarah, if Charlie has a history of DKA, could you put that into the signature please and the date he had it so we are aware when helping you please? It makes a difference to what we may suggest if there is a history of DKA.
Do you have any ondansetron you could give him for nausea? It is often more effective than cerenia and can be given when Charlie is in cerenia as well.
What is the food he normally eat?
If you are having trouble feeding him, I would offer him whatever he wants to eat, even if it is not really diabetic friendly. If there are any ketones in the picture, eating anything is the most important thing.
I don’t know Charlie’s history…do you know what the reason his BGs have been increasing lately?
 
Updated signature.

I asked for ondansetron last time I talked to the vet but she didn't actually write the script.

I can certainly offer him forbidden food. It's all low carb in the house but could exacerbate his IBD.

He just threw up everything I fed him between 5 and 6 central US time
 
Sarah & Charlie-cat said:
Updated signature.

I asked for ondansetron last time I talked to the vet but she didn't actually write the script.

I can certainly offer him forbidden food. It's all low carb in the house but could exacerbate his IBD.

He just threw up everything I fed him between 5 and 6 central US time
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I would chase up the ondansetron script and see if that helps.
I wouldn’t give him any food that exacerbates his IBD but if there is any food that he likes that doesn’t cause an issue with IBD I would try that.
To try and manage the ketones, you need to increase the food intake and increase the insulin dose. I see you increased the dose of insulin to 2 units four doses ago. If the ketones don’t decrease, we may need to look at increasing the dose.
Do you do sub Q fluids? They can help also
 
I'm supposed to bring him in tomorrow.

He's eating about half a lb of food every day. He just threw up. This is exactly how it started last time.

I am planning on fluids soon then his insulin in his flank not the scruff. I can increase his dose again. 2.5? 3?
 
The 1.3 ketones on the blood meter is usually not a concern until it reaches 2.4 unless he is lethargic and showing other symptoms.
Are you able to get tests in during the pm cycles? We really need to see what is happening in that cycle as well before doing another increase.
And any increase in dose would be 0.25 U
So you are saying he is eating about 8 ounces of food a day? That is quite a good amount.
 
Yes, he eats about 8 ounces a day normally. I don't really measure, I just give him food but I've been trying to keep better track now that I'm freezing portions of raw for him. They're about 1 ounce each.

Last time he had DKA he was 1.2 on the blood meter but he looked like death.

I found the damn IV needles last week and now I can't find them again.

ADHD is the worst.
 
I think he just threw up the one time. There was dried puke under the bed when I was under there this morning but hard to say how old and who did it.

He seems calm but not lethargic. He's been low energy since his glucose went up and stayed up in February, so it's a little hard to tell.

Not sure about water. We have four water bowls in different rooms (six cats). He didn't seem dehydrated when I pulled his scruff to give fluids.

No weakness, he just hopped in my lap. Not panting.

Last time he went from not eating, vomiting syringe feeding, to looking awful with in a matter of hours. His eyes were all red and looked swollen. Look ok now. But the speed of throwing up to looking like he was gonna die in my bed was so fast, I'm super anxious.
 
I can get some early evening cycle readings but it's hard for me to either stay up or get up and do it in the middle of the night. I do get up and throw food at him, but that's much less awake than poking him in the ear and doing a test.
 
See what you can do, any tests in the pm cycle would be helpful. We don’t want to increase the dose if he is dropping low overnight.
How much sub Q fluids do you give each time? I’m assuming the vet is OK with you giving the subQ fluids.
Let’s see if the ketones go down after the subQ fluids.
 
I gave like 1 unit on the bag. Probably a little less.

I called just before they closed and got a shrug and bring him in tomorrow. I asked repeatedly in my last conversation with the vet how to prevent in the future, how to get it turned around and got get his glucose down (I have bloody been trying!). I have fluids for my other cat when he had a fever.

Whatever is going on with his intestines, lymph nodes, and pancreas is making it hard to get his numbers down.

He is currently asleep in my lap and not doing his normal pre-shot song and dance of why are you not feeding me now.

Re: the vet, I am indeed frustrated by this new practice. They seem better with the medicine but they have limited hours, their front office staff is a collection of proverbial orange cats. Some of their techs are ok, others are not. I rarely actually get to have a face to face with a vet. They have you drop them off and you will eventually get a call. The internist vet is an hour away. I need to ask for a referral.
 
Sarah & Charlie-cat said:
I gave like 1 unit on the bag. Probably a little less.

I called just before they closed and got a shrug and bring him in tomorrow. I asked repeatedly in my last conversation with the vet how to prevent in the future, how to get it turned around and got get his glucose down (I have bloody been trying!). I have fluids for my other cat when he had a fever.

Whatever is going on with his intestines, lymph nodes, and pancreas is making it hard to get his numbers down.

He is currently asleep in my lap and not doing his normal pre-shot song and dance of why are you not feeding me now.

Re: the vet, I am indeed frustrated by this new practice. They seem better with the medicine but they have limited hours, their front office staff is a collection of proverbial orange cats. Some of their techs are ok, others are not. I rarely actually get to have a face to face with a vet. They have you drop them off and you will eventually get a call. The internist vet is an hour away. I need to ask for a referral.
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The vet situation sounds unsatisfactory.
With the SubQ fluids you need to get a clearance from the vet that it is OK to give the sub Q fluids to Charlie. Any cat with a heart issue is unlikely to be given subQ fluids so you need to check that if you have not already.
The way to prevent further DKA episodes is to make sure Charlie is getting enough food, enough insulin and checking frequently for ketones. Fluids also helps. And treat any infection, inflammation promptly.
Are his teeth OK? Bad teeth can increase the BGs
 
He hasn't eaten since this morning or early afternoon. He didn't eat much of his snack at 5. He threw up what I syringe fed him (between 5:30 and 6pm) at like 6:30.

He refused his normal food, his favorite forbidden food, Dr. E's kibbles and boiled chicken.

He's literally hiding from the food

It is currently shot time now (8:15 pm central)
 
When did he last have the cerenia.? Try and get some ondansetron in the morning
In the meantime try and get him to eat any food you think might tempt him.
 
Very recently. He got out of the hospital on the 15th, I think.

Stuff has been scrambled. My husband was in the hospital the following week for 5 days and I haven't had enough sleep in a long time
 
He refused his raw food with sprinkles (flortiflora and dried duck liver). He refused the kibbles he loves to eat off the floor. He refused the world's best food, fancy feast savory centers and boiled chicken and has climbed up a cat tree to avoid food.

He spat out some of what I tried to syringe feed him. He clearly is nauseous
 
Sarah & Charlie-cat said:
He just threw up what I syringe fed him and is hiding under the dining room table.

I'm a mess
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Big breaths. :bighug::bighug::bighug: I know how hard it is when our kitties are unwell.
I see you gave the PMPS dose of 2 units.
Is there any food at all you can offer him that you think he might eat on his own?
Is he still alert and not lethargic?
 
I have tried the things he usually eats and the other cat's food that he sneaks bites of. He's clearly very nauseous. He's smelling and turning away.
 
Sarah & Charlie-cat said:
I have tried the things he usually eats and the other cat's food that he sneaks bites of. He's clearly very nauseous. He's smelling and turning away.
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Poor baby. I’m assuming it is night time where you are (I am in Australia and it’s day time)…is there an ER near you where you could ask for some ondansetron to tide you over until the morning?
Or maybe you could take him to get an injection of an antinausea med.
 
I called and they said well we have to do an exam and the Dr will do a treatment plan and I was like I just want anti-nausea meds and they didn't even offer that as an option last time.

It was 900 bucks and they just did blood work and had him on an IV for four hours. They didn't test for ketones and my vet kinda went off at me how annoyed she was about that. So it's hard not to feel like I'm just flushing money down the drain
 
Sarah & Charlie-cat said:
I called and they said well we have to do an exam and the Dr will do a treatment plan and I was like I just want anti-nausea meds and they didn't even offer that as an option last time.

It was 900 bucks and they just did blood work and had him on an IV for four hours. They didn't test for ketones and my vet kinda went off at me how annoyed she was about that. So it's hard not to feel like I'm just flushing money down the drain
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I understand your frustration and it is very expensive.
If he remains the same overnight and doesn’t get any worse, maybe you could go to your vet in the morning and get an injection for nausea and the ondansetron script.
 
We are already planning to go to his regular vet in the morning. I just don't want him to go back into DKA again. Because that will be even more money or having to say goodbye and I'm so not ready for that
 
It's 9:40 pm here, I can bring him in at 7am. So that's 9 hours and change. His ketones are down to 0.8.

I am constitutionally not cut out for this and it's one reason I never had children
 
Sarah & Charlie-cat said:
ge. His ketones are down to 0.8.
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That is good. I’m sure the SubQ fluids helped with that.
When you go in the morning, ask for the ondansetron script, ask for an injection of cerenia or ondansetron, and ask him how much you can give if the sub Q fluids each day.
Cerenia and ondansetron can be given together as they work on different pathways.
 
I'm glad Bron mentioned getting a second test at night. Even a +2 or +3 will tell us if he's diving down at night. I'd like to see more data before commenting on dose. I also second the ondansetron as better for nausea, hopefully you can get some tomorrow.

Good to hear the ketones are coming down. Maybe the fluids helping?
 
The way he's acting, I don't think this is a bounce. He's doing some of the same things he was doing last fall before his pancreatitis and diabetes diagnosis. Example, he just sat by the water bowl but didn't drink.
Now that he's not in a cat cave anymore I can try to poke him again.
 
He slept on my chest a good chunk of the night, not his normal MO but he's alive.l

I realized some time last night that he came home from pancreatitis and DKA on May 21st. Only 2 weeks ago. I went to see him the morning before graduation.

Off to the vet. This time she needs to give us the Ondansetron and not just say we could add it.

He needs to be ok enough I can leave him with cat sitter. I wish I had someone lined up that could be here overnight. Arrgh
 
Good luck with the vet. How long are you away.?
I don’t know that he is well enough to leave with a sitter yet.
2 weeks ago is not long since he’s had DKA and pancreatitis. He needs regular anti nausea meds still.
 
Thursday afternoon to Sunday night.

Well enough to board at the vet? I feel like he would get less attention at the vet. Cat sitter is a vet tech. She works with the other gal who watched him this spring and took him in with her and then check on him again in the evening. I could see if cat sitter will stay here

But I also don't think he's well enough to leave. My husband is all, I spent thousands of dollars already and it's non refundable. Like, I chose to go to Vegas when I would never in a million years choose to go to Vegas. So go without me. But I feel like I also can't do that because he got out of the psych ward a week after Charlie got out of the hospital for a suicide attempt.

Ahhhh
 
You are in a very difficult position.
I dont know what ti advise.
See how Charlie goes over the next few days. Im not sure he will be well enough to leave for that length of time. See how he goes with the ondansetron. Make sure you get enough to last at least until after the nest weekend.
 
He didn't eat his breakfast but he did lap up a Tiki broth.

Yeah, it's a rock and a hard place when you can't tell your spouse you think you need couples counseling because he's tried to off himself for the 7th time on his life. He has bipolar disorder and he just ran a really stressful political campaign. They won but he still crashed. He was also sick last fall and went off one of his meds. It's too much
 
Sarah & Charlie-cat said:
He didn't eat his breakfast but he did lap up a Tiki broth.

Yeah, it's a rock and a hard place when you can't tell your spouse you think you need couples counseling because he's tried to off himself for the 7th time on his life. He has bipolar disorder and he just ran a really stressful political campaign. They won but he still crashed. He was also sick last fall and went off one of his meds. It's too much
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I’m sorry you have so much to deal with right now, make sure you look after your self as well as others
 
I tell my school admin students that all the time. I'm trying my best.

I wrote a lot of notes on the intake form. I just want to be able to get the meds we talked about last week without him here all day. Heavy sigh.
 
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