1/1/25 Raven AMPS 453 +2 479 +6 439 +9 465 PMPS 445 +4 464 Ketones on meter

SophieFRA

SophieFRA

Member
Hi all, Raven‘s numbers are slightly down from yesterday’s all time high in mid 500s and now at 453. He is eating some food, but getting the majority of his calories through the e-feeding tube.

I just measured his ketones with my meter and got a very concerning 1.2. The highest I ever detected on my meter just before I had him admitted to ER on 12-23 was 0.6. At the ER they (I believe) said that he had no blood ketones.

Is this something he should go back to ER over? Or should I continue to monitor? He seems ok all things considered. He is peeing a lot (which makes sense given that he gets a lot of liquids). Last afternoon past midnight he used the litter box 4 times to pee and once peed on his puppy pad where he lies. This morning he had 3 more pee spots in thr litter box. He also pooped yesterday afternoon and once overnight.

yesterday’s thread: https://felinediabetes.com/FDMB/thr...er-and-pancreatic-gallbladder-surgery.297067/

Spreadsheet:
https://docs.google.com/spreadsheets/d/1pw2gozDXz_UhGSs897ptj3iAeUPqD-dGnxrcCwXgfWg/edit

Thanks so much!
Sophie

@Wendy&Neko @Bandit's Mom @Margaret (and Pearl)
 
Hi Sophie! Sorry to hear about the ketone reading. From what I’ve seen, that number isn’t too alarming yet. Maybe you could test again during the day, I think ketone values can fluctuate during a cycle. Let’s see what other members say.
 
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Sienne and Gabby (GA) said:
This is our primer on ketones so you have it handy. If ketones are around 2.4, it would be very worrisome. I would keep an eye on the ketone level and make sure that Raven is getting enough calories and enough fluids, although it sounds like he's OK on the fluid end of things.
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Thank you so much also to @Tim & Pookey - I tested again around 12:40 and ketones were 1.1.

He has been peeing very frequently and always small amounts. I just noticed a small speck of blood on the puppy pad. He did have a urinary catheter until Monday and occasionally there was some blood in the tube. I asked ER staff and internist about it on those occasions and they all said it is not unexpected with catheter. I’m hoping that this still applies even now that catheter is out. I’m just so worried about every little thing that is off with him. I just hope I’m not missing something. It’s quite a chance from being under 24hr supervision at ER.
 
Lots of food and liquid will be your tools to help him. As is enough insulin. Do you know what dose the clinic gave him while he was there? If ketones go up, you may need to increase the insulin dose.
 
The clinic has been giving him 2.5u which is the dose he’s been on at home and internist wants him to stay on. But the ER also gave him short acting insulin to manage his numbers. Just remeasured and back at 1.2 for Ketones.
 
Did the clinic say anything about using short acting insulin yourself? Or tell you why they wanted you to stick with what is looking like too low a dose?
 
@Wendy&Neko @Bandit's Mom
- unfortunately blood ketones are increased to 1.4 for his preshot (BG 445) Still nowhere near 2.4 ketones thankfully but going in wrong direction. I just finally managed to stick a Ketone strip under his pee. I definitely got it wet and it seemed to be negative to me. Of course possible that I didn’t do it right.

The internist did not tell me to use short acting and I don’t have any. The rational was that the numbers are artificially/temporarily inflated by pancreatitis. I don’t really kniw what to do. Do you think I should increase by 0.25? I’m open to doing that if you think that would be better seeing that he’s getting tube fed even when not eating. But he only gets fed am and pm - no more snacks as before.

Shot due in 10 mins.

Thanks so much!
Sophie
 
Just asking a couple of questions about the food… why do the vets only won’t him fed twice a day? Did they have a specific reason not to feed him more often?
And what are you feeding via the tube?
 
Bron and Sheba (GA) said:
Just asking a couple of questions about the food… why do the vets only won’t him fed twice a day? Did they have a specific reason not to feed him more often?
And what are you feeding via the tube?
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This is what I’m tube feeding given by vet b/c good for pancreatitis. https://www.chewy.com/hills-prescription-diet-dd-skinfood/dp/54776?utm_source=google&utm_medium=cpc&utm_campaign=12195565633&utm_content=115868951686&gad_source=1&gbraid=0AAAAADmQ2V27Y6W8UKBehoOUcDT69AcrD

I don’t know, they all told me that. Er vets (different vet every day) and internist. I flagged that he usualky gets snacks every 3-4 hrs. But I did tube feed him 30 cals about 3 hours ago, because he didn’t end up eating his food and I was worried about underfeeding with ketones.
 
I have not seen that particular Hills food before. Usually they feed the Hills a/d which is a recovery food and easy to use with a feeding tube.
I would ring and ask the vets if you can use the Hills a/d instead and give more snacks. The only reason I am not pushing for snacks is becasue Raven has had an operation and there may be a reason but with ketones in the picture I think more food is needed.
 
The internist and my primary vet are not available today given that it’s a holiday. I tried calling the ER and they are not very helpful with providing information now that he’s discharged (which is frustrating given that I spent over 15k in ER care alone last week) not counting surgery and other expenses. I will try getting their take on ketones. I expect they will say if you are worried bring him in, but human ketone meters are not reliable in determining whether ketones are present.

On food they have told me feed him whatever he will eat ( except his normal diet of raw). That this is not the right long term food but that we’ll worry about that longer term. That for now all that matters is that he eats/gets food via feeding tube. I think they are avoiding feeding chicken because he’s IBD.

Both my vet and internist have recommended this food longer term for IBD factors (novel protein). https://www.chewy.com/royal-canin-veterinary-diet-adult/dp/35147

I am feeding that on plate. Can also make mixture for tube feeding from that if better. I am totally overwhelmed. Typing this while doing everything.

i did give him 2.5 u of Lantus (normal dose) - was already 20 mins late. This site keeps logging me out but not telling me and I am checking for responses not seeing any. Then I see hours later that someone had posted response.
 
Hills a/d does have chicken in it so that might be why they suggested the one you are currently using.
The human ketone meter is reliable for cats btw!
If they said to feed him as much as he will eat, I would increase the amount of feeding tube food. Do it slowly but gradually. We need him to be eating more because of the
ketones. I know how overwrought must be feeling but lean on us as much as you need. We are always here.
 
I called them and spoke to discharge on the phone. Asked them to please have a vet call me back or weigh in when available. On feeding twice a day they said it’s because it’s the gold standard in veterinary medicine to feed twice a day to make sure numbers are as stable as possible - to feed about an hour before shot.

Om ketones they said that generally when ketones are present cats should be brought in but that their meter only says ketones yes or no - and not a number.

please note this is the front desk discharge person speaking not a vet or vet tech.
 
SophieFRA said:
On feeding twice a day they said it’s because it’s the gold standard in veterinary medicine to feed twice a day to make sure numbers are as stable as possible - to feed about an hour before shot.
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I find I am not agreeing with these 2 statements. We recommend feeding snacks throughout the day and well as the two main meals. Only feeding twice a day is old thinking. And if you are using one of the newer insulins such as Lantus, levemir or Prozinc there is no need to feed an hour before. That is for the old insulins that hit hard and fast.
SophieFRA said:
that their meter only says ketones yes or no - and not a number.
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I think they need to get one of the newer ketone meters that give a number of ketones.
Anyway it’s good you rang them. It will be interesting to hear what the vet says when he rings.
 
Bron and Sheba (GA) said:
I find I am not agreeing with these 2 statements. We recommend feeding snacks throughout the day and well as the two main meals. Only feeding twice a day is old thinking. And if you are using one of the newer insulins such as Lantus, levemir or Prozinc there is no need to feed an hour before. That is for the old insulins that hit hard and fast.

I think they need to get one of the newer ketone meters that give a number of ketones.
Anyway it’s good you rang them. It will be interesting to hear what the vet says when he rings.
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I don’t know what to do or whose advice to follow. I will call the internist tomorrow. I hope he will be ok until then. Will measure ketones again this evening. I am so exhausted and so behind on work between hours of caring for Raven every day, posting in all the groups and going down the google rabbit hole.

But I really appreciate your input!
 
Sorry I was late for the dosing help. Before he went to the hospital, when he was eating low carb raw food, he wasn't seeing low numbers on 2.75 units. His numbers will be higher now with pancreatitis, and higher carb food. If you can continue monitoring like you have, and you don't see blues overnight, I think you are OK to increase back to 2.75 units. I not surprised the ketones have crept up given the higher numbers, so that's a second reason to increase. Especially since the clinic was also giving a rapid insulin as well as the 2.5 units and he was fine with that.

Regarding feeding times per day, not sure what they call the "gold standard". Anyway, quoting from (2018) AAHA Diabetes Management Guidelines for Dogs and Cats
Feeding portioned meals has several advantages for dietary management of diabetic cats: It is easier to monitor intake and appetite. Portion control is facilitated. Free-choice feeding is acceptable if a cat’s eating habits cannot be changed (the Task Force recommends that the daily ration be divided into multiple meals. The use of timed feeders may be helpful in this scenario).
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Emphasis mine. BTW, the Royal Canin they recommend is also too high in carbs for a diabetic cat. It is 15% carbs. We have a number of IBD kitties eating commercially available low carb canned rabbit products. That's a discussion we can have later.
 
Wendy&Neko said:
Sorry I was late for the dosing help. Before he went to the hospital, when he was eating low carb raw food, he wasn't seeing low numbers on 2.75 units. His numbers will be higher now with pancreatitis, and higher carb food. If you can continue monitoring like you have, and you don't see blues overnight, I think you are OK to increase back to 2.75 units. I not surprised the ketones have crept up given the higher numbers, so that's a second reason to increase. Especially since the clinic was also giving a rapid insulin as well as the 2.5 units and he was fine with that.

Regarding feeding times per day, not sure what they call the "gold standard". Anyway, quoting from (2018) AAHA Diabetes Management Guidelines for Dogs and Cats
Emphasis mine. BTW, the Royal Canin they recommend is also too high in carbs for a diabetic cat. It is 15% carbs. We have a number of IBD kitties eating commercially available low carb canned rabbit products. That's a discussion we can have later.
Click to expand...
If you have any recommendations on canned rabbit or other novel protein that is ok for diabetes and potentially CKD (ie low phospherus) that would be very much appreciated.

I will track numbers and might do the increase tomorrow. I used to view this community’s advise as gold standard, but now I just don’t know what to do anymore given that so many vets seem to see this differently and I’n generally at a loss with this situation (and very sleep deprived). I very much appreciate your dosing and general advice!
 
Do you know he's allergic to chicken? How about other poultry? Identity Duck is on the low carb/low P list. CKD food Chart (CKD Facebook group - 2024)

Neko used to eat raw, which her IM vet described as the best food for her. It was low P, I didn't feed much rabbit as it tends to be a higher P meat. Raw rabbit tends to have ground bone in it. Look for ones with egg shell calcium. The EZComplete's FoodFurLife was a meal completer that was low P.

Go to sleep, he's safe tonight. :bighug:
 
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