Possible ketone development/dosing??

Emily&Bun

Emily&Bun

Member
Augh! To give an update of where things are going and how freaked out I am, we're boarding Bun at our vet because we're going on a trip (we can't bail out) in 2 days, and I discussed with my vet how she deals with anxiety and refuses to eat when she's anxious so I'm concerned about her stay, especially being diabetic and needing to eat. He gave us some Gabapentin to try over the weekend and see how she does with it, as well as seeing what her test numbers give us. Today was the first day we tried it, and she was acting mildly sedated all day and wasn't eating much, like she usually does. I tested her for her PM insulin dose, and she's at 116. However, after her test, she ate almost a full can of the FF pate. Leads me to believe the Gabapentin is wearing off. Along with the Gabapentin symptoms, this morning Bun started to smell like maple syrup (on her back, not her breath. Her head smells like nothing)... So I decided to run a test on our Keto-Mojo meter tonight because I foolishly thought nothing of it this morning, and it came back with a 1.2. Like I said, she wasn't really eating much all day and not drinking much water, so I don't know if that plays into it or not but I'm freaking out!! Also, there are NO 24 HOUR VETS on this little island I live on, so I will have to wait until the morning to contact my vet. What do I do? Do I wait and then give her a late insulin dose if she starts coming back up? Do I feed her high carbs? Is this a major concern for tonight? I am terrified, please help. ETA now with some more food in her, she's acting normally! Way more alert. Super worried about her ketones though??
 
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Emily&Bun said:
Augh! To give an update of where things are going and how freaked out I am, we're boarding Bun at our vet because we're going on a trip (we can't bail out) in 2 days, and I discussed with my vet how she deals with anxiety and refuses to eat when she's anxious so I'm concerned about her stay, especially being diabetic and needing to eat. He gave us some Gabapentin to try over the weekend and see how she does with it, as well as seeing what her test numbers give us. Today was the first day we tried it, and she was acting mildly sedated all day and wasn't eating much, like she usually does. I tested her for her PM insulin dose, and she's at 116. However, after her test, she ate almost a full can of the FF pate. Leads me to believe the Gabapentin is wearing off. Along with the Gabapentin symptoms, this morning Bun started to smell like maple syrup (on her back, not her breath. Her head smells like nothing)... So I decided to run a test on our Keto-Mojo meter tonight because I foolishly thought nothing of it this morning, and it came back with a 1.2. Like I said, she wasn't really eating much all day and not drinking much water, so I don't know if that plays into it or not but I'm freaking out!! Also, there are NO 24 HOUR VETS on this little island I live on, so I will have to wait until the morning to contact my vet. What do I do? Do I wait and then give her a late insulin dose if she starts coming back up? Do I feed her high carbs? Is this a major concern for tonight? I am terrified, please help. ETA now with some more food in her, she's acting normally! Way more alert. Super worried about her ketones though??
Click to expand...
Emily&Bun said:
Augh! To give an update of where things are going and how freaked out I am, we're boarding Bun at our vet because we're going on a trip (we can't bail out) in 2 days, and I discussed with my vet how she deals with anxiety and refuses to eat when she's anxious so I'm concerned about her stay, especially being diabetic and needing to eat. He gave us some Gabapentin to try over the weekend and see how she does with it, as well as seeing what her test numbers give us. Today was the first day we tried it, and she was acting mildly sedated all day and wasn't eating much, like she usually does. I tested her for her PM insulin dose, and she's at 116. However, after her test, she ate almost a full can of the FF pate. Leads me to believe the Gabapentin is wearing off. Along with the Gabapentin symptoms, this morning Bun started to smell like maple syrup (on her back, not her breath. Her head smells like nothing)... So I decided to run a test on our Keto-Mojo meter tonight because I foolishly thought nothing of it this morning, and it came back with a 1.2. Like I said, she wasn't really eating much all day and not drinking much water, so I don't know if that plays into it or not but I'm freaking out!! Also, there are NO 24 HOUR VETS on this little island I live on, so I will have to wait until the morning to contact my vet. What do I do? Do I wait and then give her a late insulin dose if she starts coming back up? Do I feed her high carbs? Is this a major concern for tonight? I am terrified, please help. ETA now with some more food in her, she's acting normally! Way more alert. Super worried about her ketones though??
Click to expand...
@Sienne and Gabby (GA)
@Diane Tyler's Mom GA
@Bron and Sheba (GA)
 
Emily&Bun said:
Augh! To give an update of where things are going and how freaked out I am, we're boarding Bun at our vet because we're going on a trip (we can't bail out) in 2 days, and I discussed with my vet how she deals with anxiety and refuses to eat when she's anxious so I'm concerned about her stay, especially being diabetic and needing to eat. He gave us some Gabapentin to try over the weekend and see how she does with it, as well as seeing what her test numbers give us. Today was the first day we tried it, and she was acting mildly sedated all day and wasn't eating much, like she usually does. I tested her for her PM insulin dose, and she's at 116. However, after her test, she ate almost a full can of the FF pate. Leads me to believe the Gabapentin is wearing off. Along with the Gabapentin symptoms, this morning Bun started to smell like maple syrup (on her back, not her breath. Her head smells like nothing)... So I decided to run a test on our Keto-Mojo meter tonight because I foolishly thought nothing of it this morning, and it came back with a 1.2. Like I said, she wasn't really eating much all day and not drinking much water, so I don't know if that plays into it or not but I'm freaking out!! Also, there are NO 24 HOUR VETS on this little island I live on, so I will have to wait until the morning to contact my vet. What do I do? Do I wait and then give her a late insulin dose if she starts coming back up? Do I feed her high carbs? Is this a major concern for tonight? I am terrified, please help. ETA now with some more food in her, she's acting normally! Way more alert. Super worried about her ketones though??
Click to expand...

So sorry you are going through this! Don't panic for ketones at 1.2. They are attention grabbing and need to be addressed at 1.2, but not a crisis. Encourage food. Have you tried a little extra water in the wet food?

How long ago was the skipped shot?

@Sienne and Gabby (GA)
@Diane Tyler's Mom GA
@Bron and Sheba (GA)
 
Kobe (Dean and Lesley) MO said:
So sorry you are going through this! Don't panic for ketones at 1.2. They are attention grabbing and need to be addressed at 1.2, but not a crisis. Encourage food. Have you tried a little extra water in the wet food?

How long ago was the skipped shot?

@Sienne and Gabby (GA)
@Diane Tyler's Mom GA
@Bron and Sheba (GA)
Click to expand...

The skipped shot was now about 10 hours ago, I just let it go for the night which probably was the wrong move. I just tested her for her morning dose, her BG is 366 and ketone meter is reading 1.9. Ugh. She’s eating well, need to give her more water though. I’m so stressed, oh my gosh. (Just gave her our normal 3 units insulin)
 
Emily&Bun said:
The skipped shot was now about 10 hours ago, I just let it go for the night which probably was the wrong move. I just tested her for her morning dose, her BG is 366 and ketone meter is reading 1.9. Ugh. She’s eating well, need to give her more water though. I’m so stressed, oh my gosh. (Just gave her our normal 3 units insulin)
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Most members skip the shot if they can't give it within 2 hrs of shot time. Her PMPS was pretty low for you to shoot. Have you talked to your vet today? Insulin and food help keep ketones away. You are doing the right things.
 
Kobe (Dean and Lesley) MO said:
Has anyone talked to you about subcutaneous fluids? If Kobe's ketones went up again, I would ask my vet for another bag of sub q fluids. It cost me about $30.
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Kobe (Dean and Lesley) MO said:
Most members skip the shot if they can't give it within 2 hrs of shot time. Her PMPS was pretty low for you to shoot. Have you talked to your vet today? Insulin and food help keep ketones away. You are doing the right things.
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I called and left a message with the receptionist for someone to call me back but haven’t heard yet. And no, we haven’t had subQ fluids suggested to us but I definitely will ask. She’s being boarded there starting tomorrow for the next couple of weeks so I’m sure they’ll give her fluids there but I’ll ask about having that as an option at home. The possible dehydration is concerning to me :(
 
Emily&Bun said:
I called and left a message with the receptionist for someone to call me back but haven’t heard yet. And no, we haven’t had subQ fluids suggested to us but I definitely will ask. She’s being boarded there starting tomorrow for the next couple of weeks so I’m sure they’ll give her fluids there but I’ll ask about having that as an option at home. The possible dehydration is concerning to me :(
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The extra fluids help flush out the ketones so that they leave the body in the pee! Fluids can't get rid of ketones alone, but they definitely support the food and the action of the insulin. I don't know that your cat is dehydrated, if she is, the fluids will help that too.

Hopefully the ketones go down with her insulin dose and her food. My cats will drink extra water if they get ice cubes in it.

Try checking the ketones again when the insulin has had a chance to kick in. Would you keep us updated?
 
Emily&Bun said:
Augh! To give an update of where things are going and how freaked out I am, we're boarding Bun at our vet because we're going on a trip (we can't bail out) in 2 days, and I discussed with my vet how she deals with anxiety and refuses to eat when she's anxious so I'm concerned about her stay, especially being diabetic and needing to eat. He gave us some Gabapentin to try over the weekend and see how she does with it, as well as seeing what her test numbers give us. Today was the first day we tried it, and she was acting mildly sedated all day and wasn't eating much, like she usually does. I tested her for her PM insulin dose, and she's at 116. However, after her test, she ate almost a full can of the FF pate. Leads me to believe the Gabapentin is wearing off. Along with the Gabapentin symptoms, this morning Bun started to smell like maple syrup (on her back, not her breath. Her head smells like nothing)... So I decided to run a test on our Keto-Mojo meter tonight because I foolishly thought nothing of it this morning, and it came back with a 1.2. Like I said, she wasn't really eating much all day and not drinking much water, so I don't know if that plays into it or not but I'm freaking out!! Also, there are NO 24 HOUR VETS on this little island I live on, so I will have to wait until the morning to contact my vet. What do I do? Do I wait and then give her a late insulin dose if she starts coming back up? Do I feed her high carbs? Is this a major concern for tonight? I am terrified, please help. ETA now with some more food in her, she's acting normally! Way more alert. Super worried about her ketones though??
Click to expand...

My cat started on Vetsulin because it is what the vet had available when we brought him in. It's not impossible for cats to go into remission on Vetsulin; there are cats on this forum that have done it. But Vetsulin is really great for dogs; it's harder for cats to use successfully. It doesn't last in cats as long as it does in dogs, so the last dose of Vetsulin wears off before kitty gets the new shot. This means that there is a window of time where kitty is between doses and doesn't get the regulatory benefit of insulin. This leads to higher PreShot numbers and less time in normal range numbers.

The sooner you get your cat into consistent lower numbers the better the chance she gets at regulation and remission. My cat got much better numbers pretty quickly after switching to Lantus. And even before he got better numbers, his curve was much flatter and predictable on Lantus so I slept better. Lantus has a longer action so that, as one dose wears off, the other is ramping up to take over. The doses overlap. This makes the curve flatter and not so up and down.

This was not your question, so I'm sorry if I over-stepped, but if I were you, I'd want some busy body to let me know that there were options. This forum says that the right insulin is the one that works for your cat. Lantus works for a lot of cats.

Keep posting!
 
Emily&Bun said:
She’s eating really well today. Her ketones 2 hours ago were 1.9, just ran another test and she’s at 1.4. She’s acting fine, not lethargic or vomiting or anything weird like that. I’ll update my SS!!
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Has she not had any insulin since the skipped dose?
I'm glad she is eating well. It is really important she is eating lots of food. Are you adding any water to the food. Even a teaspoon each time helps
Try not to skip any doses of insulin. If the preshot is lower than normal, stall and test again in 20 minutes to see if it is rising.
You can always feed a higher carb food and give at least a 1/2 dose of insulin. I would normally not suggest this but if a cat has ketones it is important he eats and gets insulin.
When is Bun going to the vet? Are they going to be able to monitor him all the time and make sure he gets the insulin?
 
Bron and Sheba (GA) said:
Has she not had any insulin since the skipped dose?
I'm glad she is eating well. It is really important she is eating lots of food. Are you adding any water to the food. Even a teaspoon each time helps
Try not to skip any doses of insulin. If the preshot is lower than normal, stall and test again in 20 minutes to see if it is rising.
You can always feed a higher carb food and give at least a 1/2 dose of insulin. I would normally not suggest this but if a cat has ketones it is important he eats and gets insulin.
When is Bun going to the vet? Are they going to be able to monitor him all the time and make sure he gets the insulin?
Click to expand...
I did give her the normal dose this morning.
Kobe (Dean and Lesley) MO said:
My cat started on Vetsulin because it is what the vet had available when we brought him in. It's not impossible for cats to go into remission on Vetsulin; there are cats on this forum that have done it. But Vetsulin is really great for dogs; it's harder for cats to use successfully. It doesn't last in cats as long as it does in dogs, so the last dose of Vetsulin wears off before kitty gets the new shot. This means that there is a window of time where kitty is between doses and doesn't get the regulatory benefit of insulin. This leads to higher PreShot numbers and less time in normal range numbers.

The sooner you get your cat into consistent lower numbers the better the chance she gets at regulation and remission. My cat got much better numbers pretty quickly after switching to Lantus. And even before he got better numbers, his curve was much flatter and predictable on Lantus so I slept better. Lantus has a longer action so that, as one dose wears off, the other is ramping up to take over. The doses overlap. This makes the curve flatter and not so up and down.

This was not your question, so I'm sorry if I over-stepped, but if I were you, I'd want some busy body to let me know that there were options. This forum says that the right insulin is the one that works for your cat. Lantus works for a lot of cats.

Keep posting!
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I think when we get home from our vacation, we'll look into other options. Our vet only carries Vetsulin so I'm comfortable leaving her on that while they board her, and maybe when they're the ones doing her tests and administering her insulin every day, they'll see that it's not the best choice and be willing to discuss something else with us. Is Lantus the one for humans? I know options are super limited where I live but if it's a human insulin, the chances I could get it here are decent.
 
Bron and Sheba (GA) said:
Has she not had any insulin since the skipped dose?
I'm glad she is eating well. It is really important she is eating lots of food. Are you adding any water to the food. Even a teaspoon each time helps
Try not to skip any doses of insulin. If the preshot is lower than normal, stall and test again in 20 minutes to see if it is rising.
You can always feed a higher carb food and give at least a 1/2 dose of insulin. I would normally not suggest this but if a cat has ketones it is important he eats and gets insulin.
When is Bun going to the vet? Are they going to be able to monitor him all the time and make sure he gets the insulin?
Click to expand...
That's good info about giving her a half dose... This is all just so confusing to me! She's going tomorrow (unless they want me to bring her in today) and they'll make sure she's getting her insulin and reassured me they'll test her several times a day. They do leave for the night, around 8pm, so unfortunately not 24/7 but I trust their treatment. I know they'll do what they need to do to keep her as safe as possible.
 
Emily&Bun said:
Is Lantus the one for humans? I know options are super limited where I live but if it's a human insulin, the chances I could get it here are decent.
Click to expand...
Yes its a human insulin and should be easy to get.
It the moment with ketones in the picture. It is better for Bun to be getting the vetsulin as it is an 'in and out' insulin, whereas Lantus is a depot insulin which takes a few days for the depot to fill and the full effect of the dose to be felt. .
 
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