? 1/27 Archie pmps 571, amps 570 - ketones 1.3

[cmb]

Hi, we’re having a bit of a situation - Archie’s numbers skyrocketed after being really good for the past couple of days. We just saw that the insulin expired on 1/24 (we only picked it up on 12/28 - it doesn’t even last a month?!). He is a bit lethargic and peed on the couch - so I tested his ketones - there were at 1.3! We decided to not go to the vet because he is eating and it was late. This morning his ketones are down to 1.1 but the BG is still super high. Please note we tested the last 4 Days on Alphatrak. What could be the reason? And what should we do? Getting new insulin now but he was in such a low dose (0.5) that I almost doubt that the expiration is the reason). Please help!

 

[Myagi (GA) and Heidi]

 

[Stacy & Asia]

How is his appetite? I would get him eating as much as you can (even if it's not the ideal food you want him to eat) add a lot of water to his food if he will tolerate that. That insulin was almost expired when you got it, I would definitely pick up a new pen/vial. Hopefully others with DKA experience will be by, but if he is acting lethargic, it might be well worth the trouble of going to vet and letting them help out.

@Sandy and Black Kitty @Sienne and Gabby (GA) @Dyana

 

[cmb]

He is eating, but his appetite for treats is greatly reduced. His hind legs seem extra weak since yesterday. Vet will call me back ASAP.

 

[Stacy & Asia]

He is eating, but his appetite for treats is greatly reduced. His hind legs seem extra weak since yesterday. Vet will call me back ASAP.

Keep us posted, hopefully others will be by soon, but you want him eating and drinking if there is any way you can help that and I would continue checking for keytones in the meantime, things can change quickly.

 

[Nan & Amber (GA)]

Is the 1.3 from a blood ketone meter? Did yours come with any guidelines about what the numbers mean? I have not used them myself, my impression was that something like 1.3 is in the "warning of possible problems ahead" range, but I'm not sure. Glad you are in contact with the vet!

Where did the insulin come from? If it was from a pharmacy or (unopened) from a vet, it might be OK even with the expiration date assuming it was handled well, but how annoying that the expiration date was so soon after you got it-- usually they are far in the future!

 

[cmb]

Yes, both ketone readings (1.3 last night at 8pm and 2am and 1.1 at 8am this morning) are from the nova max blood ketone meter. I’ve seen numbers here that say below 0.6 is normal / low and 0.7-1.5 is moderate and should be monitored.

 

[Christie & Maverick]

There was another recent post regarding ketones, where it looked that under 2.4 was ok...see attached

http://www.felinediabetes.com/FDMB/...2-didnt-eat-all-her-food.190265/#post-2120012

You mentioned that Archie's numbers skyrocketed...from the info sticky on ketones: "The recipe for developing diabetic ketoacidosis is an insufficient supply insulin + an inappetant cat + infection or other systemic stress."

I wonder if something health wise is starting to happen? If he peed on the couch, that might be a symptom of a urinary tract infection, I believe. Something to keep an eye on anyway, and certainly to mention to the vet. I hope the vet gets back to you soon, but hope this helps in the meantime.

 

[Dyana]

The expiration date you're talking about is that just the 28 days past opening date, or does the box actually say "expires on 01/24/18"?
I agree with getting as much food and water into him as you can, and continue to test for ketones every few hours or so, and be home if you can to monitor him. Those blood ketone monitors although expensive for the strips, do come in handy when needed. If the ketones go up, I would start thinking vet visit. I hope he clears them soon.

 

[Jill & Alex (GA)]

He is a bit lethargic and peed on the couch - so I tested his ketones - there were at 1.3! We decided to not go to the vet because he is eating and it was late. This morning his ketones are down to 1.1 but the BG is still super high.

At this time, ketones are not a problem, but it's a good idea to stay on top of it.

Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

"The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf"

The expiration date you're talking about is that just the 28 days past opening date, or does the box actually say "expires on 01/24/18"?

Good question.

 

[cmb]

Hi everyone, thank you for your help! Still waiting on the call back from vet. I’ve checked the expiration date now myself (my husband drive in panic to Walgreens for a new vial and it just says that it expires 28 days after opening on the prescription print - the actual bottle’s printed expiration is 11/19. Phew!

I was out of town for a couple of days and returned when he started reading high. Not sure if that stressed him out?

I agree those ketone meters are super useful, except for that I just ran out of strips and there is nowhere to buy them in the store. Aargh.

We’ll keep feeding & giving water.

 

[Christie & Maverick]

Glad to see the original insulin is ok, I just checked my bottle, and it only shows month and year, i.e. 03/2020. You could keep the new one unopened in the fridge until you need to start using it.

I do think it is very possible if Archie is overly attached to you that he might have been stressed with you being gone out of town. I have ketostix which can measure ketones in urine, probably not as accurate as testing via blood, but good as a backup. You could send your hubby back to Walgreens for those

 

[Tricia Cinco(GA) & Harvey]

The common direction is to only keep an insulin vial for a month before discarding it, but if it is properly handled and stored, it can last up to 6 months (many human diabetics will use it up in that time frame). Don't throw it out yet. In future, consider getting the insulin pen cartridges. You don't use the needle that comes with them - you draw the insulin from them like you do from a vial - but they are smaller and are more likely to retain potency until you use them up.

 

[Sienne and Gabby (GA)]

Did the vet get back to you?

In the meantime, I would keep a close watch on Archie. While the level isn't worrisome, ketones can go from negligible
to full blown DKA in a surprisingly short period of time.

A couple of thoughts based on Archie's SS.

• It's hard to know if the high numbers are a result of a combination of a bounce off of those blues coupled with your having skipped two shots.
• Alternatively, a shift into higher numbers when numbers have previously been better may indicate that your cat has something medical brewing. If that's the case, some sort of infection/inflammation may be causing ketone levels to rise.
• The ketones may be developing because of the skipped shots. If that's the case, we can help you with alternatives if you get a pre-shot number you're not comfortable shooting.

 

[Dyana]

I agree those ketone meters are super useful, except for that I just ran out of strips and there is nowhere to buy them in the store. Aargh.

When I ran out of strips, I called about 5 local pharmacies and found out they did not carry the strips for the blood ketone meter (and you have to be very specific to make sure they know you want the ketone test strips), but they could order them, and most of them said they could have them by the next day. So, just saying, if you can get a pharmacy to order them for you tonight, you may be able to get them by tomorrow.