11/10 B the C PMPS:463 +2:412 ketones-medium

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kotek

Member Since 2011
Ready for some blues after the last few days of pinks/yellows...B's condo from 11/09

She was up eating/drinking a lot through the night...or, at least, I noticed it more. Still couldn't get a ketone test in though -- stealthy cat!

It has been 2 weeks since our switch to Lantus. I am wondering if it's time to go for her follow-up blood work...she is hyperthyroid, but has been off her meds because her thyroid was very low when she had her DKA (maybe one of the contributing factors?), and was only 15 (not sure about US/international numbers, sorry) 2 weeks ago. I would like her to be feeling a bit better before she goes in again...but hard to say if the hyperthyroid is complicating things?

In any case, yay for weekends!

UPDATE: finally caught her. Trace ketones :sad: Hope she dips down into some good numbers to help clear those out.
 
Re: 11/10 B the C AMPS:297 +2:313

Okay, any thoughts here? She is still not going down...should be by now from her AM shot, based on her previous pattern.

With the ketones, I am concerned about leaving her up in the pinks much longer...

I think I might give the vet a call. Would be grateful for your thoughts!
 
Re: 11/10 B the C AMPS:297 +2:313

I was just looking at your sheet. I know we were both hoping for a drop again but looks like she has her own plans. However I dont like the ketones being there. Maybe a call to the vet is required. Also it might merit a dose increase again... but lets see what the vet says.
 
Re: 11/10 B the C AMPS:297 +2:313

I don't like those ketones appearing either. Keep feeding her as much as she wants and you'll probably want to fatten up that dose.
I'm glad it's the weekend, and you can be around to monitor her.
 
Re: 11/10 B the C AMPS:297 +2:313

Kotek

I think she's been at this dose too long now. I'd increase the dose at your next shot, add water to her food even if she is drinking (unless she drinking gallons) and make sure she is getting enough to eat. I'd also call the vet and ask about giving subq fluids at home.

Three things help combat the DKA: enough insulin, enough food, enough water.

Is there any potential she has any type of infection going on? UTI? Dental?

Also...there is no difference between 297 and 313....those numbers are easily within meter variance so she is high and flat.
 
Re: 11/10 B the C AMPS:297 +2:313

It's looking to me like the dose reduction didn't hold. I'd increase B's insulin back to 0.5u tonight.

I'd also get water/fluids into B as best you can. Adding water to B's food is one way to increase fluids. Are you still giving sub-q fluids? If not, I'd give fluids until you see the ketone levels back to negative. I would try to get a ketone test whenever you can. There are blood ketone meters that are available. That's the good news since it makes testing easier. The downside is that the strips are really expensive.

I don't think a vet visit is a bad idea. Kidney infections are notoriously hard to treat and if the infection from Sept. wasn't completely knocked out, it could be effecting B's numbers.
 
Re: 11/10 B the C AMPS:297 +2:313

Thanks everyone. I am with you Marje -- high and flat. :sad:

I have put water in her food. She is drinking, but I have been adding water these days anyway and it seems to go okay. She is eating *very* well, if anything this has gone up rather than down over the last day or so.

She already gets 100mL of subQs per day, in the evening. I have been working towards splitting this into 50x2 but haven't gotten there yet (she hates the subQs). I am not advised to raise this due to her heart murmur, but could ask the vet.

Raising to 0.75 next time then. Vet advises the same, incidentally. And keeping an eye on ketones.

Infection -- hard to say? Is there any signs I would look for? With the diabetes combined with CKD, hyperT, she is positioned well for UTIs.

CLARIFICATION: I am adding about 30mL of water to her food twice a day, give or take...doesn't seem like very much, but more made things very watery.
 
Re: 11/10 B the C AMPS:297 +2:313

I'm glad you called the vet. It sounds like you are doing all you can and thanks for reminding us you are still giving her fluids. I couldn't remember. Once you said you went to once a day because she didn't like it, I remembered. DUH on me!

I'd also be cautious about the fluids and that's probably why your vet had you try and give it bid instead of sid. You do have to be careful with a heart murmur kitty esp if she hasn't had an echo to see what her heart actually looks like.

Question....did they do an U/S to determine if her kidney infection was completely cleared up? Normally to clear a kidney infection, it takes at least six weeks on Baytril or a similar antibiotic. The only way to know positively that it cleared the infection is a follow up U/S.
 
Re: 11/10 B the C AMPS:297 +2:313

Yeah she hates the fluids a lot! She is good for me for almost everything else. I can test her ears 20 times a day -- nothing. SubQs she just wants AWAY from. Been better since we moved to the scruff, though...

She was on Baytril for the kidney infection...don't think it was 6 weeks, though. I did ask about needing to extend it, as I was nervous, and they really didn't think it was needed.

She had an ultrasound after that, during her DKA hospital stay. It wasn't specifically to check about the kidney infection, but they had her history (and presumably remembered it), and didn't see anything abnormal except for her kidneys indicated the CKD.

She was also on Clavamox after her DKA "just in case". White blood cell count didn't indicated anything though -- for the DKA or two weeks ago when we switched to Lantus.

I just have a call into the vet to see if it is worth bringing her in for a blood test. See below -- she is due for one soon to check thyroid levels (which could be messing us up here a bit too, I understand), so if this would be a good time to check for other stuff too might as well. Will see what the vet thinks.

Was thinking I'd also ask about adding a bit more fluids in this kind of situation...after her kidney infection we had her on 100+50, but that was before the murmur, so not sure.

Thanks for your help and support!

ADDITION: The theory is that her anemia is a contributing factor to the heart murmur.
 
Re: 11/10 B the C AMPS:297 +2:313

I think it's a great idea to discuss these things with your vet. Clavamox is not a good A/B for urinary tract issues. If the Baytril was not given long enough, the kidney infection could come back. My Gussie, who has CKD, has been a little prone to kidney infections and it has never been noticeable in his pee habits and did not show on a urine culture and sensitivity or any bloodwork. We had him U/S for something else and they discovered it. Now we do recheck U/Ss every so often to monitor his kidneys. So far, so good.
 
Re: 11/10 B the C AMPS:297 +2:313

So glad Gussie has been infection-free!

This aging thing may not be all it's cracked up to be... >:(

We are going for a blood test. Will report back soon.
 
Re: 11/10 B the C AMPS:297 +2:313

Okay, we're back! Vet is a 5 min walk away -- a real gift. Especially considering that they're very good if, like the rest of us, not perfect. :smile:

They got enough blood for the T4 test, but B was being very uncooperative so not more for a more general check -- and no urine to get. That's something -- the thyroid is worrying me -- but not as much as I hoped. But I'm sure it's the right balance between the check and traumatizing her.

B being uncooperative definitely means she's feeling okay. When she was there for her kidney infection they were all rooting for her to get cranky again...it was sweet. When she started snapping at the tech again they were all happy!

She has gained 100 grams in about a week and a half, which is not bad. And right now her hydration is okay but not great. The vet said while she is showing some ketones I can give her another 25mL, then her 100mL at the usual time. What a crazy balance: what will hurt her more, additional fluids or ketones? ACK!
 
Re: 11/10 B the C AMPS:297 +2:313

Question: So I am upping her dose and she has been flat and in the 300s/18ish for a while.

Any chance this might be a time I could also adjust her timing, say, an hour or so earlier? Or still no?

If no, I think the Daylight Savings stuff indicated we could probably go half an hour earlier without too much impact? Or 15 min today and 15 tomorrow?
 
Re: 11/10 B the C AMPS:297 +2:313

You have a choice when it comes to moving shot times. If numbers are low or your concerned that moving the time earlier will have an effect on numbers (i.e., an early shot acts like a dose increase), you can either move the shot by 15 min. at each shot time OR you can move the shot by 30 min. once a day. That said, if numbers are high, you can easily move the shot an hour early but you will need to be able to monitor.

However, I don't feel comfortable suggesting moving the shot by an hour if you are simultaneously increasing the dose. So, you could either shoot an hour early and increase tomorrow morning or increase tonight and shoot 30 minutes early. No matter which you opt for, you've got to monitor but, it looks like you've gotten good a that already.

BTW, I meant to say earlier you can move B's shot back to 0.75u. (I typed what I was reading. Duh!)
 
Re: 11/10 B the C AMPS:297 +2:313

Thanks--starting tomorrow seems wise.

Now we are in emerg...was trying to get a ketone test and caught her straining to defecate. Then she threw up, then collapsed. She has perked up but still very worried. She needed an enema before, maybe again...

More soon...
 
Re: 11/10 B the C AMPS:297 +2:313

OMG poor baby.. sending healing vines your way. Glad you were there to catch it. Glad you have an animal emergency near u.. our nearest is Whitby ( I live in Oshawa) '

Is B her full name or is it short for something?
 
Re: 11/10 B the C PMPS: 463

Okay, we are back, and things seem okay. She definitely perked up after the scary collapse -- I think she was probably just straining really hard.

They couldn't get anything out manually but she had an enema, and as soon as we got home she had a BM, so that's all good.

Had them test her ketones at the vet and they seemed a bit higher, which is worrysome. But they cautioned that different stick brands have different scales, so might not be a good comparison. Instructed to keep watching closely, make sure she's eating, give subQs etc.

Hopefully this new 0.75 dose will bring her down, which I think is what would really help. PMPS: 463/25.7 -- but with the stress hyperglycemia I actually don't think that's too bad.

Thank you for your thoughts and good wishes -- they really helped!

More in a bit as I read back in more detail...

MORE: B is short for Brontë, but we call her B a lot. We are a house of letters (B the C = Brontë the Cat). :smile:

Wendy -- I am right in Toronto, so we are lucky with emergs...and there is actually a new, small emerg vet very close by. They remember her from her DKA -- whee!
You're in Oshawa...I am wondering if you might know a friend of mine who has worked in shelters a lot...she is from Raglan...

As it turned out, we were 20-25 minutes late with the shot... :YMSIGH:
 
Re: 11/10 B the C AMPS:297 +2:313

Oh thank goodness, we were really worried. Question though is why she is having problems with BMs, I find both my diabetic boys are too soft more than anything. I wonder if anyone has suggestions?
 
Re: 11/10 B the C PMPS: 463

I am wondering about the constipation, too...I was going to pose the question here.

Might have something to do with the dehydration? But she has so many other things going on...could be part of the CRF, or the hyperthyroidism...

Her food is really high fat, although low fibre/carb. One suggestion was to add metamucil or pumpkin to her food, but I was advise not to experiment until we had her better regulated. Any thoughts on the impact of those on her BG? I believe the point is they are not digested, so maybe that would work?

Fingers crossed she is going to go down tonight on the 0.75! Here's something only you guys will be able to relate to: I was so concerned about getting insulin in her that I basically ran in the door, measured the dose, and shot her (thankfully I had practiced the new dose earlier). Then I realized I forgot to test her first -- ACK! Small panic. Of course, the chances of her being low after an enema were almost non-existent, but still, I don't think I've shot before testing ever since I started testing! Just goes to my state of mind -- whew...
 
Re: 11/10 B the C PMPS:463

I will let someone else hopefully respond on the constipation and treatment of it.

But I just wanted to say keep an eye on her BG tonite. The level you got tonite when you measured was probably high due to stress as you noticed. However once the stress is off it will start to drop.. And you don't know to what level or how fast.
 
Re: 11/10 B the C PMPS:463

If you shot and then tested immediately after, there's not going to be a big difference in numbers. I'd be concerned if you testing and had a number in the 40s, but as it is, you're fine.

Many people here use Miralax with a cat prone to constipation. (I believe it's called Restoralax in Canada.) Given that B has a number of things going on medically, I'd discuss using this with your vet before doing anything. It acts as a stool softener by pulling water into the colon.

So, since you are increasing the dose tonight, if B's numbers are above 300, you could shoot an hour early as long as you'll be around to monitor.
 
Re: 11/10 B the C PMPS:463

Hmmmmm. Her ketones are reading medium now on my sticks....

This is apparently 40 g/dl or 4 mml/l.

She just got 100mL of subQs. Tried to get her to eat right before that,but she wasn't interested...she ate a little when we just got home from the vet. Normally she doesn't eat much until after +2.

Will test her at +2 to see if she's going down.

Meanwhile, suggestions appreciated.

I guess if she has enough ketones it is worth going to the vet to get some fast acting? She wasn't really high enough for them to want to do that yet.
 
Re: 11/10 B the C PMPS:463 ketones-medium

I am not comfortable suggesting that you try to manage ketones that are above a trace amount at home. A reading on the ketostix at 40 mg/dL should be treated by a vet. Do you know what the reading was at the clinic? I'm concerned that they didn't treat her. I'd call them or go back.
 
Thanks, Sienne. The reading I got was similar to what she had at the clinic -- see above.

Basically, they said her having ketones did not mean she was going to progress to DKA and to keep an eye on her, make sure she's eating, give her fluids etc.

I have called them and they basically reiterated the same. They said it was normal for her blood glucose to be high given her enema, and I should give it some time to go down. Let her rest/relax, and check her BG/ketones again early in the morning.

Or, if I am uncomfortable, I can leave her with them for the night to monitor. Both the vets are in surgery and one will call me back when they're out (a couple hours, likely).

I don't know what to do... trying to weigh my options... there is another emergency clinic, but my previous interactions with them have been unpleasant...
 
I do agree with Sienne. I don't agree with your vets. The problem is that elevated ketones "can" progress to full blown DKA quickly. That is what I'd be concerned about.

It takes adequate insulin, lots of calories, and adequate hydration to fight DKA and to suppress ketones. Is she still on A/Bs? Because of her heart murmur, you have to walk a fine line with subq fluids. I worry about you trying to treat ketones at home.

Please let us know if you take her back to the vet. The one thing that always drives me crazy about leaving cats at the vet is the vets and techs don't work hard to get food into the kitty. I'd insist they either syringe feed her the calories she needs or they allow you to do it.

Sending prayers.
 
Looks like she is starting to come back down I hope. Keep giving her those fluids and foods - maybe also some tuna water or something to get her to drink more naturally? Hopefully the vet will call back soon.
 
Okay, I decided to go to the other emerg clinic. The first one...has good things about it, but they were really harried tonight and I felt this was affecting their response. They were also great with the DKA but much less good about suporting me afterwards. Along what Marje was saying.

Not sure what to expect here...will kerp you posted.

Thanks for your advice -- and your thoughts.
 
Well, they want to admit her, and are saying it might take as much effort/cost as if she was in full blown DKA. A few daysin the hospital, depending.

I am distraught. I don't know how many more times she can be in the hospital in the space of a month...both psychologically and financially...as well as her poor little body...
 
:YMHUG: :YMHUG: :YMHUG: I'm so sorry! We've had a few kitties that have experienced the same thing and now they are doing great. We must have hope. Sending her healing vines and I hope you can get some rest.
 
((((Kotek))))
There is no doubt the emotional stress is hard to deal with. However, it's got to be harder on B physically to not get the ketones treated than to get healthy. In the grand scheme of things, they are not doing anything more invasive than running an IV or taking blood. When you visit, bring a smelly t-shirt or something along those lines so your scent will be with B.

I would ask them to make sure there are no infections. I'm assuming they will have run blood work. That's the only way to be certain this hasn't progressed to DKA. Typically, a blood panel will give a clue if there's an infection. As both Marje and I mentioned earlier, kidney infections are notoriously hard to both diagnose and get rid of. Infection will make a cat more prone to problems with ketones.

Also, just so you understand, you didn't do anything wrong. Some cats who have a bout of DKA become more prone to developing ketones. It's something to be very attentive to and intervene as quickly as possible.
 
(((Kotek and B the C)))

You may have answered this before, but what size are the needles you use for fluids? Are they the thin-walled type? I think you can get 22g as opposed to the 18g ones I used on Bob. There's a reason that size are referred to as "harpoons":-)
Carl
 
Carl is right on the needles but I wouldn't get 22g. My Gussie would sit for hours getting fluids he's so calm but the 22g take longer than I want to stand there. I think the 21g are perfect...small enough to not leave big holes or develop scar tissue if you change the I section area around but fast enough that I can do 150 mls in about 5-7 mins.

Sending prayers. Please update when you can. You did wonderful by getting her in. I hope this clinic is responding to your needs.
 
I gave Grayson fluids for a couple of months when he threw "MODERATE" ketones (on the stix) 3 times. We never got to DKA, thankfully, and were successful managing them at home... but he's also a high dose kitty, and he never stopped eating. That was key for him and my ability to treat him here. The NC State Vet School said they usually treat DKA after the kitty hasn't eaten for 2-3 days.

I used the 20s (yellow package). Gave Grayson a can of FF, and gave the fluids while he ate. Took about 4-5 minutes for 100 mL. He barely noticed. I used 18s initially, but the size was overwhelming to me!

At the time there was no sign of an infection; however we put him on ABs anyways. Later we determined that he had an ear infection. It took 2 different ABs to get that taken care of, then 2 cycles of them.

Wishing you both the best in whatever path you take.

Lu-Ann
 
Hello everyone -- I am up for a bit and wanted to put a last personal message in this condo, although I will start a new one right after this with B's medical update.

I can't tell you how much all of your support means to me and my partner (does DH mean Dear Husband? if so, close enough). Amidst all the stress and worry and sadness it is a great gift to have you there helping and listening and sending good thoughts and wishes. Thank you so much.

And thank you for being very clear in your advising the ketones needed attention. I am new to ketones. I probably should have not left the first emerg without insisting they treat her. I felt a bit weird about them not reacting more to medium ketones even with my limited experiences, but there is that dynamic of listening to an expert, right? And...I *wanted* them to be right that she could just push through it. :sad: In any case, I will be giving them some pointed feedback.

Sienne, I want to thank you particularly for saying something I really needed to hear: that I didn't do anything wrong. I am unhappy and frustrated that we are here again, but it helps tremendously to know that I didn't make things worse.

Again, I deeply appreciate your help and support. Posting new condo now...you'll probably see that first.
 
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