09/04 Noodle AMPS 256 Dose increase question--ketones.

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Christianna

Member Since 2014
Noodle has been on 2U for the past few days. Had some days with negative ketones but the nasty buggers pop up, mostly trace, once in a while. One day I got 2 tests, one was negative, one was trace. How is this possible? Anyway, can someone take a peek at my SS and tell me if I'm on the right path? I raised him to 2.25U this morning and can get some good tests in today. He seems to bounce somewhat after a dose increase so am expecting that :-( Otherwise, the 5Ps are great and he seems to feel wonderful, alert and playful, eating and drinking fine but not to excess. I'm just insecure I guess and need to know if I'm doing what's best. Thanks, everyone! I appreciate your advice so much!

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi Christi

Good job raising the dose today. I would stay on top of those increase so every six cycles, if he's above 200 on his nadirs, religiously raise that dose by 0.25u unless he's just seeing pink or higher. In that case, you want to give him increases of 0.5u every six cycles. If he starts showing trace ketones regularly, we might have to decrease the number of cycles before you increase. I actually would have raised is dose to 2.25u on 9/2 a.m. cycle.

Yes, he can be negative one test and have trace ketones the next. There is a delay in the amounts we see in the urine just like there is in sugar due to the amount of time it takes them to make urine and then how long they hold it in their bladder. For example, if a kitty was above renal threshold on a Monday but then comes below it for several days, it could be late Tues or Wed before he's not showing glucose in the urine. The most "real time" way to test ketones is with a blood ketone meter. I'd stay on two times a day on the ketone tests until you are seeing negative every test.

What might look like a bounce after an increase is actually more likely New Dose Wonkiness.

Good luck with the increase. Glad he's doing well!
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi there :cool:

So glad to see you raised the dose.
Christianna said:
One day I got 2 tests, one was negative, one was trace. How is this possible?
Click to expand...
Good job on testing for ketones - they are sneaky little devils. A kitty can go from neg to large very quickly
Below is from BKs ss - in just 24 hours, zero to life threatening.

Anything over trace warrants a call to the vet.

Numbers don't have to be crazy high for ketones to develop.
You may already know however in case you don't the recipe for ketone development is-
not enough insulin + not enough calories + infection/inflamation

with a ketone prone kitty you don't want to hold a dose that is not showing action - 6 cycles maximum then increase according to the TR protocol.
Also make sure he is consuming at least 1.5x the calories required to maintain ideal weight.
Find and address the source of infection/inflammation.
It's a balancing act.

The good news is there are plenty of folks here who have battled ketones and can help you guide Noodle safely to shore.
Keep up the good work :cool:
 

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Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi Marje and Gracie,
Yes, I was afraid I should have raised to 2.25 sooner than I did but had a hospital emergency with my mom and couldn't be home to monitor Noodle much the last 2 days. My "good" vet is on vacation till the 12th but I've checked in twice with his relief vet who wanted me to hold the 2U for 7 days. I ignored that and am relying on forum advice instead. He also doesn't seem concerned with the trace ketones "as long as Noodle is eating and drinking." S-I-G-H. So I'm on here for the helpful advice you guys give. Thanks so much for responding to my posts!

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi Sandy and Black Kitty,
I have to admit, this ketone thing has me scared out of my wits! Especially with my "good vet" being out of town for another week and the lackadaisical attitude of the relief vet. So that's why I'm getting my advice on the TR forum and I do thank you for your explanations and warnings. The thing about Noodle is that he has had many screening and follow-up blood/urine tests in the past few weeks and no infections or inflammatory markers have shown up, so I don't know how to uncover if that might be a component in the occasional ketone development. Can ketones develop simply because his insulin is insufficient? Anyhow, it is a worry and I always hold my breath when waiting for the color to change or not on the sticks. I even use 2 different brand of sticks for verification. :?
He seems to get "new dose wonkiness" or something every time I raise his dose and I was afraid I was being too aggressive and never giving his body a chance to settle into the new dose. He's been having more yellows, at least a few, so fingers crossed. Will continue to monitor and thanks so much!

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

I hope your mom is ok. Family comes first and so does his safety so I'm glad you did what you needed to do. if his nadirs are above 200, you are not being too aggressive by increasing the dose every six cycles. Those six cycles have built into them the premise that NDW will occur at least two of them.

Ketones shouldn't develop just because there is not enough insulin. It has to be a mix of infection + not enough insulin + not enough food/water. So, as Sandy suggested, I'd increase his calories and I'd also be adding a lot of water to his food. I always put about 2 tsp of filtered water into every helping of food our cats get. Some times finding the source of the infection/inflammation can be challenging.
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi Marje and Gracie,
Thank you for your kind words; my mom is better today. You know what they say---when it rains it pours! Started to go to the hospital Mon. night and my brake line had broken leaking fluid all over the place, and no brakes on the car, and on a holiday--so no stress there!
I think I definitely need to add more water to Noodle's food. He barely drinks at all, just getting most of his water from canned food but maybe that's not enough. For so long he was guzzling water and I was relieved when he started to not be water-obsessed but maybe now he needs me to supplement water to help flush the ketones. So, just so I'm clear, if his nadirs are above 200 I could increase .25 unit after 6 cycles? I don't know why I find this so hard to follow :roll:

Thanks!

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Sorry, Marje and Gracie,
I just re-read your post and you made it very clear--I'm an airhead today! But thanks, now I know what to do :smile:

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

No worries at all. Just hope your mom is ok and Noodle's ketones go back to negative.

yes...you got it.....six cycles and if nadirs are 200-300, raise by 0.25u. If they are above 300, raise by 0.5u. If he's got trace ketones consistently, tell us. We might quicken that increase pace.
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Marje and Gracie,
Thanks so much! Tested Noodle at +4 and he was 185. First time EVER!

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

I saw that blue!!

Did your vet happen to check Noodle's teeth? Gingivitis or tartar or a dental problem can be a cause for inflammation and trigger ketones.

Many of us do add water to our kitties food. Diabetes is tough on kidneys and water helps with overall kidney health. Adding water will also help to wash out ketones, as Marje noted.
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

i would definitely add as much water as he'll tolerate to his food. the pate styles are fairly solid, so you can get quite a bit in there. I can add nearly 1/2 can of water to a whole can of cat food and my cats will still eat it.

Yay for the blues! :-D

btw, you're not being an airhead. hardly anyone picks this up quickly - that's why so many of us and volunteer to help teach how to interpret that simple looking protocol. starting this dance is pretty unforgettable! We were all new once.

don't ever worry about asking again - we'd rather have you ask and ask than misunderstand and make a mistake shooting insulin into noodle.
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi Sienne and Gabby,
I specifically pushed the vet to check Noodle's teeth and he said he does have some gingivitis. I am pushing for a teeth cleaning but he said he wanted to get the diabetes a little more stabilized before doing it. But it sounds like Noodle MIGHT have an overall improvement if he hurried up and cleaned his teeth! The vet gets back from vacation the 12th so I'm going to force the issue as soon as he can get Noodle scheduled. I would HATE to think that something so basic would be keeping Noodle's numbers up and contributing to the ketones! Thanks so much for your suggestions :smile:

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi Julie,
Thank you so much for your kind and understanding encouragement. Some days I'm pretty fragmented and don't seem to grasp things the first time out :?
I started today adding a couple of tablespoons of water each time I feed Noodle. He actually likes the food rather soupy so that is not going to be a problem. His favorites are the pate-type food and, as you said, they do come out of the can pretty solid so the water makes them the consistency Noodle likes. When he was so ill at the beginning of this odyssey, I fed him Gerber meat baby foods as part of his recovery foods and they were kind of soupy also. My DH chuckles at Noodle and says he's too lazy to chew and would sip his food through a straw if he could ;-)
Thanks so very much for your continuing advice. I am so grateful to have the many knowledgable members on this board, and you are certainly one of them, to guide me as I learn the sugar dance!

Christi
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

hmmmm, if he prefers soupy food . . . maybe his mouth hurts a little bit. if a vet can see anything in the mouth when they just do a cursory look, that suggests there is going to be more going on when the cat is under anesthesia and the vet can really look. Dental issues, even gingivities, can keep a cat from becoming regulated or even going off of insulin. We've seen it happen.

You gotta get all the ducks in a row - no infections whatsoever, insulin dose to the right amount, food appropriate,etc., - to get a cat regulated.

Other vets have said they wanted to wait for the cat to get regulated before doing dentals. that's not the first time i've heard that. but some cats won't get regulated until the dental has been done and they heal. Typically, people give 1/2 dose in the morning before the dental and then often skip the pm dose. anesthesia can lower blood sugar, and after the dental, if they won't eat cuz their mouth hurts, it can be a problem.

You're welcome - other people, including sienne, sandy & marje taught me. we help because we know how difficult this is to learn. :-D
 
Re: 09/04 Noodle AMPS 256 Dose increase question--keton

Hi there :cool:

Looks like Noodle is working the juice!

since the subject has turned to teeth and gums I had to chime in.
BK could be the poster kitty for the difference healthy teeth and gums can make.

Take a look at his ss for a dramatic example-

10/23/2008 - average total daily insulin approx 45u Lantus and R combined.
Decayed tooth fragment removed while under anesthesia for removal of a benign tumor.
Insulin needs instantly drop 40% :o

Vet recommends veterinary dental specialist.

12/08/2008 - first dental - Lantus dose at the time was 13.0u BID :sad:
01/08/2009 - one month later - Lantus dose down to 7u BID :smile:
02/08/2009 - Lantus dose down to 5.5u BID :-D
04/08/2009 - Lantus dose down to 3.25u BID ! :lol:
then. . .
05/08/2009 - Lantus dose up to 4.0u BID :-|
05/28/2009 - Lantus dose up to 5.25u BID :cry:
05/29/2009 - second dental

10/23/2009 - OTJ :mrgreen: :mrgreen: :mrgreen:


He had annual dental cleanings with his regular vet from then on.
he now is toothless ;-)
 

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