.2 ketones, 80-250bg Yay!

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Obsidian's Servants (Sid)

Obsidian's Servants (Sid)

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Hello everyone,

Sorry in advance for not fully setting up my account and spreadsheet yet.

So Sid was diagnosed with feline diabetes May 26 after not eating and loosing a lot of weight.
We've had a few ups and downs over the last two months with a few trips to the vet and urgent care and one 3 night stay at the animal hospital after initial diagnosis and diagnosed with Gastroenteritis.

So here we are, back to not eating, throwing up a little and high ketones (7.0 as of right now) with a 300 BG.

She started to show an increase in ketones 7/26 and steady increased everyday until she was 5.5 yesterday and today. We first increased her insulin from 1 unit to 1.5 then 2 units to try and combat it but it didn't help.
She lost her appetite and energy. So we reduced her back to 1 unit. Then she didn't eat through the night so we didn't give her anything this morning and took her to the vet/urgent care.

We told them that she had high ketones, and the rest of her symptoms. They ordered a GI tract to be sent to Texas and back in 7 days. They told us that they don't check for ketones in diabetic cats..... They suggest we give some appetite stim which we already did and take her home and we will see what the GI tract says....

So she still isn't eating, can barely keep her head up (will prop it up on her water dish or a shoe) and she's shaky on her feet. We've give her app stim and received a shot of Cerenia from the vet.

We asked how long we should let her go like this without eating and they told us 2 to 3 days.....

So first thing, I can't believe they didn't care about ketones.

Second, should we take her to the animal hospital. Her ketones keeps going up and she isn't eating. I can't giver her insulin without her eating.

Thanks in advance. I just have such litter faith in our vets, this is our 3rd vet which each having their own ideas and lack of info.
 
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Obsidian's Servants (Sid) said:
They told us that they don't check for ketones in diabetic cats...
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What!!??! So glad you were testing ketones. This is an emergency and you should try to find another vet hospital willing to treat her. She needs to eat. Not enough insulin + infection/inflammation + inappetance is the formula for DKA. Meaning, no skipped insulin doses, assist feeding if necessary so she gets some food in her.
She may need fluids to help flush the ketones. Vets can show you how to do this at home. You also need to have her electrolytes blood tested.

This post helps explain. Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

I find ondansetron a better nausea med than Cerenia. You get a prescription from a vet and fill it at any human pharmacy. I've heard Costco has good prices in the US. If she still won't eat, she might need a feeding tube. Sounds worse than it is, feeding tubes save lives.
 
Thank you for the response. I'll give the animal hospital a call and get her in.

Our current vet said that diabetic cats can't go into DKA because they are receiving insulin.....
 
Obsidian's Servants (Sid) said:
Thank you for the response. I'll give the animal hospital a call and get her in.

Our current vet said that diabetic cats can't go into DKA because they are receiving insulin.....
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This is very wrong. My cat went into DKA while having been on insulin for a long time. His BG was not even super high. He nearly died. He was being treated for DKA in an emergency hospital, but he was still not eating. I kept sounding the alarm every day about the fact that he was not eating in emergency care — pointing out the fact that he could get hepatic lipidosis — which he eventually dod, but a feeding tube saved his life, I believe.
 
Obsidian's Servants (Sid) said:
They told us that they don't check for ketones in diabetic cats..
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Obsidian's Servants (Sid) said:
Our current vet said that diabetic cats can't go into DKA because they are receiving insulin.....
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Obsidian's Servants (Sid) said:
So here we are, back to not eating, throwing up a little and high ketones (7.0 as of right now) with a 300 BG.
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I can hardly believe I am reading this. It is outrageous.
I hope you have managed to get Sid into an emergency vet.
 
Thank you for all your replies and support.
We weren't able to get her into the vet hospital last night.
So we settled for syringe feeding her and giving her one unit of insulin. Her numbers were: 371 BG and 6 ketones
She was extremely lethargic and allowed us to feed her.
We syringe fed her again in the middle of the night and she seemed to have some energy to fight us this time.

This morning she was pretty much passed out in her water dish.
Her numbers were: 539 BG and 6.9.
We loaded her up and made it to the animals hospital right as they opened.

She's now with them getting checked out.

So glad we made it here.

I'll keep you updated.

Thanks again.
 
They do care about ketones and a diabetic cat can go into DKA!!
They've got her checked in for hospitalization for 24 hours, they are running a blood panel, get her on fluids til she stabilizes and eats again. We did inform them as soon as she is stable we have happy to do the at home care with subq fluids and such.

So happy we have insurance. Definitely a life saver!!

I'll keep you updated. Thanks again for the help and the reassurance.
 
I’m quite speechless about the vet who doesn’t check for ketones in diabetic cats and says they can’t go into DKA if they’re on insulin. That’s egregiously bad information and patently false. OMG.

Anyway, what insulin have you been using?

I’m relieved that Sid is at the animal hospital and am sending positive thoughts your way.
 
Thanks for the update, sending positive vibes . :bighug::bighug::cat:
Giving the sub fluids at home would be great , I hope they go along with it.
Not hard at all
 
Checking in also for an update.
If you have insurance I would leave her at the vet until she is very stable. It is safer for her there until ketones have gone and the electrolytes are back to normal. It is very hard to look after a kitty with active DKA at home successfully.
 
Apologies for the delay, I've been working extra to make up for the time I took off for the the vet visit.

So yesterday we checked her in at 8:00 am.

They called us with an update at 6:00 pm.
She's still not eating, but they gotten a lot of fluids and trying to manage the pH of her blood and her BG. They said her ketones were borderline, she was dehydrated, low on potassium and Cl. (Trying to remember everything they said, I asked for an email of everything but still haven't received it, I'll updated as soon as I get it). She had abnormal kidney and liver numbers.

So today they called at noon and said pretty much no new news, still not eating and she seems "depressed" . Still not eating and just still giving her fluid in hopes that she will feel better and start eating.

We tried to get ahold of them to make sure they aren't trying to only feed her Hills Prescription ID food (like last time), because during one of her episodes, she got really sick and seems to associate that food with it. Even when she is was feeling pretty good, she won't do near it.

At 3:00 pm, we got back the GI panel. It shows numbers that seem to indicate she has a B12 deficiency, which her litter mate brother had the same thing and required once a month shots.

So now we are still waiting to hear back, we were are planning on going to see her tomorrow, (the animal hospital is 1.5 hrs away) and bring some tasty gravy food to see if we can get her to eat.

Yes, we are planning on leaving her as long as necessary to get her better (thank you insurance)
 
Thanks for the update, wish it was a bit more positive, but she's where she needs to be right now.

Low potassium can make them not want to eat. Not eating can impact liver numbers, and dehydration can negatively impact kidney numbers. Are they assist feeding her?

Good plan to try to go and see here and tempt her with some other foods.
 
Just got another update.
She's still very dehydrated, and her numbers aren't improving.
They are going to administer a nasogastric tube and start with fluids then a lite diet.
They think it could be from a UTI and now a kidney infection. Which I guess is super common in diabetic cats.

She's pretty rough I guess, just hovering over her water dish but not drinking...

Hopefully tomorrow with some more fluids and food in her, she will start to get better, then they will do an ultrasound to check all of her organs.
 
Kidney infections can definitely increase the kidney numbers. It'll mean a longer course of antibiotics, but glad to hear they think they have a solution. UTI can be common in diabetics, all that extra sugar in the blood stream. A feeding tube will help.
 
The food and hydration can really help them gain strength. My boy had an esophageal feeding tube inserted when he was in DKA and he really improved after they began “slow feeding” him (with a special machine.) Hopefully they are regularly checked to balance electrolytes.
 
We were able to spend an hour with her and tried to get her to drink and eat with no success, but she's doing better! Shes still not really lucid but reacted to us and rubbing her belly. They are keeping a close eye on her electrolytes and BG.

She definitely seems to be improving.

I'll keep you updated. They think she will at least be with them for couple more days.
 
It does take time to recover and sometimes the progress is slow and it’s very scary.

I had a vet tech offer to euthanize my cat for me about three days in to the DKA — telling me that “this cat is not going to get better” — that night I asked them to place the esophageal feeding tube and he started to improve. I was so happy to show him off to that vet tech after he was all better!
 
We called last night at about 9pm and talked to them about it concerns of her not being able to open her mouth but was reassured that now she tried to at least lap at her water vs just resting her chin in it.

At that point she's gone 5 hours so far with a diet of 25% of her resting calorie requirement and was keeping it down. They will steady start increasing her diet.
They say it's a very slow process to restart all her systems.

Hopefully we will get another update about 12 or so.
 
I've got updates.

She's still at the hospital, they moved her care over to the internist, they performed a ultrasound to check her organs and found her liver was enlarged. They took a sample of her liver and got it tested. Turned out she has Hepatic Lipidosis in Cats (Fatty Liver Syndrome in Cats). So visited her last night and got her to eat for the first time but she already had a fairly full belly from the feeding tube in her nose.

So the next thing is today, they want to put in a esophagostomy tube in her neck for feeding and medication.
They are recommending this as really the only option to get her to eat the amount of calories she needs to recover and to take the 5 different types of medications (which she is never good with any oral meds, after the first one that is).

They are going to do a blood test this morning to make sure she is sound to do this operation.

Does have any experience with this? They said it's very easy and perfect for this situation.

Also the GI panel came back with nothing too exciting besides maybe a B12 deficiency which her bother had also.

They say with the tube in she may be able to come home tomorrow :)
 
Feeding tubes save lives. One of my cats had a tube three times over the years and I had another cat that we considered putting one in. A feeding tube sounds much more daunting than it is. It takes a bit to get used to it but it is so much easier to get nutrition and meds into them with a tube. I wouldn’t hesitate to get another one if my cat needed it.
 
SHES HOME!!!! And we've had our first successful tube feeding!!! She's so happy to be home (us too). We have along road of recovery but we are here for her for the long haul.
So the census is her DKA was caused from either her Hepatic lipidosis, her UTI or other non diabetes related.
I've got her on meds, and hills prescription A/D food to try and fatten her up (she is so skinny now).
She is eating a little bit, then we are finishing her off with the tube.

Thank you everyone for all the support and positive vibes.
 
JL and Chip said:
I’m quite speechless about the vet who doesn’t check for ketones in diabetic cats and says they can’t go into DKA if they’re on insulin. That’s egregiously bad information and patently false. OMG.

Anyway, what insulin have you been using?

I’m relieved that Sid is at the animal hospital and am sending positive thoughts your way.
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She's on Lantus.
 
I’m so glad she is home.
Are you testing the blood glucose?
What dose of Lantus?
Are you testing the urine for ketones ?
How much did the vet say to feed her?
Sorry for all the questions! Just gathering information.:)
 
Bron and Sheba (GA) said:
I’m so glad she is home.
Are you testing the blood glucose?
What dose of Lantus?
Are you testing the urine for ketones ?
How much did the vet say to feed her?
Sorry for all the questions! Just gathering information.:)
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She's doing really great considering. She's taking the feedings like a champ, mostly sleeps through them.
We are testing her BG twice again, she's been 290-300 with our meter(we ordered the alphatrac 3) will be here tomorrow.
We are giving her 1 unit of Lantus twice a day.
We aren't checking her urine for ketones but are going to check her blood for ketones tonight.
They have us feeding her 220 kcals a day.
 
I’m glad she is coping ok at home
Why did you need to buy the alphatrak meter? Wasn’t the ReliOn premier working?
How much does Sid normally weigh?
Can you let us know the result of the ketone test please.
 
The vets keep telling us how "ReliOn isn't calibrated for cat" "they reading are going to be 40 plus numbers off". We are wanted to verify the accuracy of it and with insurance paying for 80% of everything, we'd rather be safe than sorry.

Her ketones on my human Amazon meter by KetoBM was 3.4 last night. The base line is .8 . We are going to test get again tonight and try the urine strips.

So her goal weight was 12 lbs when she weighed 17 two years ago. This last bout of DKA she weighed 11.5 when we took her in. She weighs 9.6lbs.

I guess get exit weight was 10lbs. She has lost some weight, we will keep a close eye on her.
 
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Ketones are 6.4.... on my blood test meter. Why?!
We are going to try and test her urine with Ketostix.
Are these the correct ones? The vet had mentioned there are 3 different types of ketones to check for.

So here's everything she's on:
-Pradofloxacin(antibiotic) 25mg/ml: 1.5ml every 24hrs
-Denamarin advanced (hepataprotecant for her liver): 1/4 tab of small dog type every 24hrs
-Utsodiol 250mg (hepataprotecant for the liver): 1/4 table every 24hrs
-Cerenia 16mg tablet(anti nausea): 1/2 tablet every 24 hours
-Potassium gluconate gel(potassium supplement): 1/2 teaspoon every 8 hours
-b12 injection .025ml every 7 days
-lantus insulin: 1 unit twice away.

Any input on all this.
She's not throwing up but did have some very loose stools. She's getting all her meals and water.

Thanks
 
Obsidian's Servants (Sid) said:
The vets keep telling us how "ReliOn isn't calibrated for cat" "they reading are going to be 40 plus numbers off". We are wanted to verify the accuracy of it and with insurance paying for 80% of everything, we'd rather be safe than sorry.
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Until the advent of the pet meter, all vets used human meters. They do read slightly less than the pet meter but they are completely reliable and safe for cats. Most of us use them here. But if you want to use the pet meter that is fine too.
Do you have a spreadsheet set up? We really need to be able to see all the Bg data.
If you need help with setting it up just let me know.
With a ketone result of 6.4 I would be ringing the vet. In my experience and opinion you need to be increasing the amount of food …and not just by a little bit, and probably the dose of insulin but until I can see some BG data I can’t really suggest the dose.
Cats with post DKA need to be getting 1 and a half times the number of calories they normally get every day to try and keep the ketones away.
Yes Ketostix is the correct one.
Please don’t just take a ‘wait and see’ approach. With ketones at 6.4, that is an emergency really.
 
We are at the vet hospital right now, they are checking her out.

She threw up about half her breakfast from her feeding tube (but there was a hair ball in it, which she never throws up hairballs). You can tell she isn't feeling very well.

We were able to test her urine for ketones and it was as dark as the scale goes.....

So the plan was to test her for ketones and compare it to my meter.

I'll keep you updated.
 
I’ve been following along quietly and just want to add that I’m VERY glad you’re at the vet hospital. Ketones can get out of hand very quickly. :(

Some cats have a rough go and the ketone monster rears up several times before things finally settle down. I hope the docs can find the underlying triggers and get Sid back on the right track soon. I went through multiple rounds of ketones/DKA with RK (one of my diabetics) and know how stressful and exhausting it can be. I’m sending healing thoughts your way.
 
They are going to run some test, check her blood (red blood cells), check her ketones, do a quick ultrasound.
We know she's anemic which is common I guess for cat in this situation.

So far, they aren't wanting to admit her which is fine by us. There are some other meds they can give us to take home and hopefully get this under control.

Thank you so much for the healing thoughts.
This has been very rough on both myself and my spouse, from the financial burden to the emotional/mental toll this takes on you.
 
Test results:
Her ketones are 6.5, liver numbers are better going to discontinue her Denamarin advanced and Utsodiol. Red blood cells are up.

They want us to increase her insulin to 1.5 to combat the ketones.

They've also prescribed metoclopramide for nausea.

We asked what they did that was different while she was at the vet to lower her ketones and it was insulin drip. So now we are upper her dose and will be checking her BG often.
 
She's currently at 7.7 ketones, 534 BG and threw up her meal with her antibiotics and anti nausea at 6:30pm. Our urgent care vet suggest I up to 2 units.

Luckily she still has her feeding tube, so we going to try small meals and worst case just water.

Can anyone weigh in on trying to reduce her ketones this way.

Any help or advise would be muchly appreciated(again).

Thank you.

Oh and I've filled out her SS for the pass couple weeks I'll work on adding more history.
 
Food and Insulin to combat ketones; food is critical for cats who are trying to heal, and ketones develop when they can't get the fuel from glucose and burn fat instead. Insulin allows them to use the sugars for fuel instead of using fat.

if she is throwing up, I'd recommend an anti-emetic (like Cerenia - it makes them not vomit, not just make them not nauseous). If she won't keep that down, then she'll likely need a shot of it for the first round (they last 24 hours).

If she's actively vomiting everything, you want to do the Cerenia and then wait for it to kick in (maybe 30-60 mins) and then any other meds and food.

smaller, more frequent meals might be good as well, and yes make sure she's getting enough water because dehydration is another concern.
 
Kara & Ember said:
Food and Insulin to combat ketones; food is critical for cats who are trying to heal, and ketones develop when they can't get the fuel from glucose and burn fat instead. Insulin allows them to use the sugars for fuel instead of using fat.

if she is throwing up, I'd recommend an anti-emetic (like Cerenia - it makes them not vomit, not just make them not nauseous). If she won't keep that down, then she'll likely need a shot of it for the first round (they last 24 hours).

If she's actively vomiting everything, you want to do the Cerenia and then wait for it to kick in (maybe 30-60 mins) and then any other meds and food.

smaller, more frequent meals might be good as well, and yes make sure she's getting enough water because dehydration is another concern.
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Thank you for the response and info. She's only threw up once this evening and that was at the last 4ml of her tube feeding.
So now we are trying small meals now. So far she's keeping now her first 10ml feeding. We are just planning on keeping up the small feeding through the night and slowly increasing them.
She will get her Cerenia in the AM. Unfortunately she threw up metoclopramide(nausea and vomit) and her antibiotic. But perhaps they didn't sit well together or with her food.
I'll test her BG at her next mini meal.

Thanks again.
 
Did the vet give you any feedback regarding her electrolytes? I would hope they would have checked, since electrolyte imbalances like low potassium need to be addressed. I’m worried that she has been vomiting which can contribute to a likely dehydrated cat with high ketones becoming even more dehydrated. Try to give as much water as you can, which can help flush out the ketones. Feed small meals, and increase the calorie content if you can. Keep an eye on her behaviour, especially if you find she is becoming lethargic, and keep checking her breath. If it smells like acetone, I’d be taking her in to the vet.
 
Christie & Maverick said:
Did the vet give you any feedback regarding her electrolytes? I would hope they would have checked, since electrolyte imbalances like low potassium need to be addressed. I’m worried that she has been vomiting which can contribute to a likely dehydrated cat with high ketones becoming even more dehydrated. Try to give as much water as you can, which can help flush out the ketones. Feed small meals, and increase the calorie content if you can. Keep an eye on her behaviour, especially if you find she is becoming lethargic, and keep checking her breath. If it smells like acetone, I’d be taking her in to the vet.
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Yes they said her numbers were better. We have her on potassium supplements, luckily she's only thrown up twice for us and she still is drinking water on her own.
We took get to the ER this morning because of the high ketones and acetone on her breath, but since she already is on all the meds, has a feeding tube, they said there's really nothing more they would do for her that we aren't.

Just have her her second mini meal and so far so good on staying down. Her BG has gone up to 578.
She's beyond lethargic, she keeps trying to drown herself in her water bowl. Breathing is normal but if always has been during both episodes of DKA.
 
Obsidian's Servants (Sid) said:
they said there's really nothing more they would do for her that we aren't.
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I somewhat disagree with the ER vet — they could put her on IV fluids which can help flush the ketones as well as continue to monitor her electrolytes and make adjustments if needed. They can also add a fast-acting insulin to help bring the BG down and monitor that as well.

Did they mention having you give subcutaneous (subQ) fluids at home?
 
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I would think at the vet they’d be using a rapid insulin to help bring down the high BG numbers, continuing to monitor and manage electrolytes and provide fluids. Giving water frequently at home helps, but it doesn’t work as well as fluids particularly when a cat is chronically dehydrated. There is a Hill’s a/d food that you may want to see about getting, most cats find it very palatable and its texture is very fine which makes it easier to use in feeding tubes.
 
I also think Sid would be better in the hospital on an IV drip. It is very hard to manage her at home with such high ketones and vomiting and nausea. If it is not the expense which is stopping her being in hospital, I would ask that she be managed in hospital until she is more stable. As mentioned they can bring down the BG with short acting insulin quicker than Lantus.
Also ask about ondansetron for nausea. That is a better option than cerenia for nausea, although cerenia is better for vomiting. And ondansetron can be given in conjunction with the cerenia as they work on different pathways.
Smaller more frequently meals is better too, but make sure she is getting enough calories as it is both insulin and calories that will combat ketones.
Just checking it is Hills a/d that you have been giving her via the tube.
Please keep us updated.
 
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Obsidian's Servants (Sid) said:
Ketones are 6.4.... on my blood test meter. Why?!
We are going to try and test her urine with Ketostix.
Are these the correct ones? The vet had mentioned there are 3 different types of ketones to check for.

So here's everything she's on:
-Pradofloxacin(antibiotic) 25mg/ml: 1.5ml every 24hrs
-Denamarin advanced (hepataprotecant for her liver): 1/4 tab of small dog type every 24hrs
-Utsodiol 250mg (hepataprotecant for the liver): 1/4 table every 24hrs
-Cerenia 16mg tablet(anti nausea): 1/2 tablet every 24 hours
-Potassium gluconate gel(potassium supplement): 1/2 teaspoon every 8 hours
-b12 injection .025ml every 7 days
-lantus insulin: 1 unit twice away.

Any input on all this.
She's not throwing up but did have some very loose stools. She's getting all her meals and water.

Thanks
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Loose stools are not surprising because of the very high fat content of the A/D food. She will adjust to it most likely.
 
JL and Chip said:
I somewhat disagree with the ER vet — they could put her on IV fluids which can help flush the ketones as well as continue to monitor her electrolytes and make adjustments if needed. They can also add a fast-acting insulin to help bring the BG down and monitor that as well.

Did they mention having you give subcutaneous (subQ) fluids at home?
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They didn't mention subq fluids, possibly because her numbers look good, and she being fed and watered through her tube.
 
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