Ketone after Senvelgo Part 2

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Jan -

Please remove the "GA" from your subject line. The abbreviation means either "Gone Ahead" or "Guardian Angel." If indicates that a cat has died.
 
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Ketone 2.0 again.

Have you read the information in this thread about Ketones? If you scroll down some, you'll see some links to scientific studies on ketones in cats.

Here is that part but it's a good idea to read the entire post.
Two of the latest scientific studies (linked below) concerning measurement of ketones when using a blood ketone meter provide an up-to-date interpretation that when a blood ketone concentration of 2.4 and 2.55 are obtained, DKA is more likely to be present.

Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf


Earlier today, I think I remember seeing that urine ketones were negative. (if that was you). Can you get another urine ketone test the next time he pees?
 
Have you read the information in this thread about Ketones? If you scroll down some, you'll see some links to scientific studies on ketones in cats.

Here is that part but it's a good idea to read the entire post.
Two of the latest scientific studies (linked below) concerning measurement of ketones when using a blood ketone meter provide an up-to-date interpretation that when a blood ketone concentration of 2.4 and 2.55 are obtained, DKA is more likely to be present.

Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf


Earlier today, I think I remember seeing that urine ketones were negative. (if that was you). Can you get another urine ketone test the next time he pees?
Yes I did test his urine by the test paper last night, it was Negative. He had wee 30 mins ago and i missed it. will try my bet to give him a test by the paper later today.
 
Have you read the information in this thread about Ketones? If you scroll down some, you'll see some links to scientific studies on ketones in cats.

Here is that part but it's a good idea to read the entire post.
Two of the latest scientific studies (linked below) concerning measurement of ketones when using a blood ketone meter provide an up-to-date interpretation that when a blood ketone concentration of 2.4 and 2.55 are obtained, DKA is more likely to be present.

Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf


Earlier today, I think I remember seeing that urine ketones were negative. (if that was you). Can you get another urine ketone test the next time he pees?

Just tested by urine test paper it’s negative of Ketone.
 
Thank you for all the support and we are trying are best to monitoring and take care of Max.
All subs fluid absorbed for sure when we do the next on. BTW, I had gave Max 50 ml sub cut fluid at 1230 an hour ago which is Seattle time 2100/ Miami time 0000 and for safety reason we will give Max 50ml twice a day .
I had tested his ketone by blood meter it was 2.1 and glucose was 19.0 mmol/L just 22 mins ago at 1300 HK time which is Seattle time 2200 / Miami time 0100.
 
The vet just received the IGF-1 test result and this is NOT supportive of acro.
The vet commented that “so his insulin resistance is of other caus(es),I would say the best way to get to the bottom of his case would be see IM and radiology specialist but total cost of a full investigation is likely to be very high.if you choose not to see specialist or cost is prohibitive, then following your dose adjustment protocol is probably the best you can do, but as I have commented before, using doses of insulin this high without CGMS monitoring is high risk.
I would say the ketones is the main criterion……
When I asked him what made Max had ketone? He said probably total lack of endogenous insulin, no beta cells left in the pancreas.
That’s mean Max reply on insulin so he need much more than what we guess.
Anyway the vet is flying back home for two weeks, I won’t take Max to visit any vet. What I concerned is please read the spread sheet his BG level is high since yesterday.
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes
This is for human but I found it’s the same as cats ,”If you treat your diabetes with insulin, your body should be using the insulin you give it to change blood sugar into energy. But if you don’t have enough insulin, you’ll start to use fat for energy. And when you use fat for energy your liver starts to produce ketones. You can have low levels of ketones in your blood without it being a problem.“

Again, Im concerned about the glucose and ketone level both. Can someone explain to me that how can we get the balance to avoiding things getting worse?
 
That is good that Acro has been ruled out.
The best way to combat ketones is to feed lots of food and give adequate amounts of insulin and to test daily for ketones.
Also we look at the cat… is he acting normally or is he lethargic. Is he eating ok. Or is he vomiting. All these things build a picture of how the cat is.
At the moment you are reporting there are no ketones in the urine. And the blood glucose is bouncing around a bit when Max drops into blues or greens.
I’ll ask @Sienne and Gabby (GA) and @Wendy&Neko to comment as well.
 
That is good that Acro has been ruled out.
The best way to combat ketones is to feed lots of food and give adequate amounts of insulin and to test daily for ketones.
Also we look at the cat… is he acting normally or is he lethargic. Is he eating ok. Or is he vomiting. All these things build a picture of how the cat is.
At the moment you are reporting there are no ketones in the urine. And the blood glucose is bouncing around a bit when Max drops into blues or greens.
I’ll ask @Sienne and Gabby (GA) and @Wendy&Neko to comment as well.
Max is thirsty and keep drinking! That’s mean he has ketone. He has slightly less appetite than yesterday. He is not in mood today as I pricked him every 3 hours plus check the ketone 3 times a day then sub cut water. No ketone in the urine but 2.1 when do the blood test.
I supposed to check his ketone by using test paper 30 mins later. I would like to delay an hour or later before next meal and insulin injection. As I want to find out the number difference between empty stomach and full stomach .
I really don’t want to take the risk that remain at 4 unit and cause him had Ketone in urine. He will need to stay in hospital. My maid gave him 5 unit by mistake on 25/09 at 1900. It’s been 96 hours soon (1833 now) and I hope that you will consider me to give Max 4.25 unit for the next injection.

Another question is if short + long acting insulin does help with Max’s case? Any idea? Thanks a lot .
 
Just weighted 4.6 kg. He was 4.83 kg when last visit the vet on 22/09 the day before yesterday his weight was 5kg but now he lost some weight. We fed him more than before (from 200g raw meat to 240-250g per day. I even fed him some 1x steam chicken fillet and around 4 cube of freeze dried. Obviously he needs more insulin.
Coz it’s burning his fat and high blood sugar now.
Please advise how many more days we should observe and remain in 4 unit?
Thank you.
 
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Being thirsty and drinking water does not mean there are ketones. You have tested and there are no ketones in the urine.
If Max was my cat I work continue with feeding lots of food, giving the sub Q fluids and giving the 4 units of insulin. Maybe increase the amount of calories you are giving him.
I would not delay giving food and insulin if it is due
Let’s see what @Wendy&Neko and @Sienne and Gabby (GA) think about an increase in dose tomorrow
 
Being thirsty and drinking water does not mean there are ketones. You have tested and there are no ketones in the urine.
If Max was my cat I work continue with feeding lots of food, giving the sub Q fluids and giving the 4 units of insulin. Maybe increase the amount of calories you are giving him.
Let’s see what @Wendy&Neko and @Sienne and Gabby (GA) think about an increase in dose tomorrow
He is grumpy and refused to eat today when the food left 1/3, not sure it’s because he has no appetite or he hates the blood test.
I did reassure him that I just wanted to help him and sorry for making him unset and painful. Then he replied and meowed softy. This is so rare in these 9 years! Coz he always had Man voice. I couldn’t control my tears and I deeply regret that I made the wrong decision and caused him pain.
I tried my best to feed him and he took a an hour to finish the food .
Sorry my mind is in blank and anxiety .
 
He is grumpy and refused to eat today when the food left 1/3, not sure it’s because he has no appetite or he hates the blood test.
I did reassure him that I just wanted to help him and sorry for making him unset and painful. Then he replied and meowed softy. This is so rare in these 9 years! Coz he always had Man voice. I couldn’t control my tears and I deeply regret that I made the wrong decision and caused him pain.
I tried my best to feed him and he took a an hour to finish the food .
Sorry my mind is in blank and anxiety .
Try not to be too anxious. I know it is hard but you are doing all the right things.
It’s really important he eats well so even if you need to give him something that is not low carb, that is ok. Eating is more important than what he eats at the moment.
 
Try not to be too anxious. I know it is hard but you are doing all the right things.
It’s really important he eats well so even if you need to give him something that is not low carb, that is ok. Eating is more important than what he eats at the moment.
Just tested, ketone 2.7 glucose 18.0 PMPS in 20 mins later! He keeps drinking water since in 2/3 hours ago and lots of urine. I haven’t got chance to test the urine yet, I really don’t want him getting DKA.
His ketone from 2.1 jumps to 2.7 and non stop drinking water.
 
It sounds like getting a test for insulin auto-antibodies (IAA) might be problematic. This is the test that assesses for insulin resistance. Insulin resistance tends to be self-limiting. In other words, keep working at raising the dose using the dosing protocol and ideally, the insulin will overcome the resistance.

Like Bron said, drinking is not s symptom of ketones. It is, however, a symptom of diabetes. When Max's blood glucose numbers are high, he's going to drink more.
 
The vet just received the IGF-1 test result and this is NOT supportive of acro.
Did the vet share the number with you? I've seen a few vets get this wrong. I hope it's not acro, but wondering if the vet saw any clinical signs that made him think the test should be done.
using doses of insulin this high without CGMS monitoring is high risk.
He'd love some spreadsheets I can show him, with manual tests done for doses of above 20. CGMS are a relatively new device. It wasn't that long ago there was no option but hand held BG meters. You are monitoring more than enough to know you aren't missing any low numbers.
He is grumpy and refused to eat today when the food left 1/3, not sure it’s because he has no appetite
It's common that cats with recent DKA can have nausea, is he getting any anti nausea medications such as ondansetron or Cerenia (maropitant)? One of the signs of nausea can also be a lot of drinking.
 
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