12/14 Webster AMPS=450+2=444+6=301

[Websterthecat]

Yesterday's condo

Webster has been spending a bit of time in the 300's-400's over the past couple day, despite an increase in his dose from .50-.75.

Over the past few days I have noticed that his ketone test has been coming back with a hint of pink (trace ketones).

I'm sitting here wondering if an infection is a possibility? While he still has a strong appetite and is acting "normal", his BG's are staying high (which I believe that I read that elevated BG can be cause by infection) and the trace ketones could indicate a possibility of an infection.

What do you guys think?

 

[julie & punkin (ga)]

i think you're smart to be concerned about that. this pattern is different than it has been. the trace of ketones means to get on it before it increases. ketones can go from small to large in just hours. i'd give the vet a call asap. Whatever the AB was prescribed for before may not have been resolved.

Typical diabetic cat infections include urinary and dental (typically gums). I'd explore those two options first. Of course there are others as well, but these two are relatively common.

In the meantime, I'd increase his dose by 0.25u.

 

[Marje and Gracie]

Julie beat me to it! I'd also increase the dose and call the vet.

Besides infection, I'd also ask about being able to give fluids at home.

 

[Sandy and Black Kitty]

There you are

To continue from yesterday:

Sandy and Black Kitty wrote:I was reading your notes (ss) and noticed on 11/15 he started a course of Clavamlox and also buprenorphine. What was the reason?

Thanks for looking back on Webster's notes and asking. That's a great question.

I asked the vet about the two meds and her response was that although she couldn't identify a specific infection, she wanted to be cautious and give him the Clavamlox. As for the buprenorphine, she believed that me may be in a little pain. Thinking back, while bringing him to the vet for DKA and shortly after his release, I recall him faintly whining whenever you touched him which I'm guessing that he was in pain.. What are your thoughts on this?

I wonder if the vet suspected possible Pancreatitis, which can be painful?

I agree with Julie on an increase. Stepping up the ketone testing to more than 1x per day would be good as well. Below is from BKs ss and illustrates how ketones can go from none to large in a short time:


I'm also wondering about his teeth and gums, from the profile it sounds like he has not had a dental cleaning yet.

 

[Websterthecat]

Thanks everyone. I'm going to bump him up to 1.0u at his next dosing which is in 5 hours.

The new vet that I chose when I got home took a look at his teeth. He said that they looked okay at the time.

I missed him in the litter box this morning. I'm going to try to catch him this evening. My Ketone meter should be arriving in the mail tomorrow evening... A day couple days too late unfortunately. I guess these urine strips will have to do for now.

The vet opens tomorrow morning at 7:30am. I'll give them a call first thing in the morning.

And no, he hasn't had a dental cleaning yet.

What should I tell the vet? How will he go about diagnosing a possible infection?

 

[Websterthecat]

Hum.. I'm sitting here thinking about the possibility of an infection.

Now that I think about it, I do recall a sudden change in his meow a couple weeks before the DKA occurred. It's like sometimes he would meow and nothing would come out. He would also occasionally sneeze.

Even now (over a month later) when he meows I still hear an occasional raspy sound coming out while other times it sound normal. This is something that I never mentioned to the vet because I didn't think anything of it but now... I'm wondering if there may be an underlying respiratory infection going on?

Edit: Also, I remember seeing a brown line around his nose a few weeks prior to the DKA. At the time I read online that it was likely just dried mucus. Once again I thought nothing of it. After coming home from the vet the brown trace around his nose disappeared.

 

[Dyana]

I'm glad your going to increase the dose. I think that's the smart thing to do, to keep those ketones at bay.

 

[Marycatmom]

I've had that brown line in cat's with URI before. Glad that you're going to check it out. Behave, Webster.

 

[Websterthecat]

I've had that brown line in cat's with URI before. Glad that you're going to check it out. Behave, Webster.

Thanks Mary. I distinctly remember the brown line being there for several weeks prior to the DKA episode. I also remember making a mental note of the line disappearing shortly after the DKA and him taking AB. I never did make the connection between the possibility of a URI and the brown on his nose until now.

I just took a look at Mikeys numbers for the first time in a couple days and he looks like he's doing pretty good, despite the fast early dives. Is he still eating the 3% primarily or the 8%? It looks like hes getting the 3% and an occassional 8% for a boost?

 

[julie & punkin (ga)]

Pain can also drive up blood glucose. Pancreatitis can be painful, although punkin had it and i didn't see any obvious evidence of pain. The symptom that we saw was that he stopped eating. Some cats get into a "meatloaf" position - head tucked down, feet all pulled in under them like they would fit into a loaf pan. Marje wrote a good post on pancreatitis - look here in the New to the Group sticky and scroll down to the bottom to the single topic links. See if anything there sounds like Webster. I've heard people say that palpating the abdomen (where the pancreas is) can sometimes cause a cat to show it obviously hurts.

That's very common in diabetic cats, too.

Regarding the teeth - typically vets can't see much when they just look, since cats are so cooperative about saying "AHHHH" for their teeth to be examined. ;-) If there is anything, like tartar that can be chipped off, it's sometimes worse when they get in there than at first glance. Sometimes cats will actually have teeth rotting or broken off in their mouths and we won't know anything's going on.

I'd just let the vet know that Webster's blood sugar has been rising and you've been slowly & methodically increasing his dose as indicated by his high blood sugar tests, but it's still high, and you've been told that infection or pain can be 2 causes of this, and that you'd like to have him seen to check into things. Then I'd specifically ask for a cystocentesis (getting a sterile urine sample via needle into the bladder) and to have him check for pancreatitis and look at his teeth again.

You might want to show the ss to your vet and point out how well he was doing on 0.5u, even you needing to reduce to 0.25u. It's common to have to tweak doses, as you know, but you're now going to twice as much insulin as what got him into good numbers just 2 weeks ago.

If the vet wants to provide a pain reliever, Buprinorphin is the one most of us use and is safe for diabetic cats. It's also easy to administer. Most people want to stay away from Metacam, which is a pain reliever but has a black box warning on it for causing liver failure in cats. Many people also stay away from Convenia, an antibiotic, because it lasts 2 weeks in the body after injected and if there is an allergic reaction it is a long time to deal with it.

 

[Marycatmom]

Hi Mike! Mikey is eating entirely 8% food at this point. We're playing with when to feed him, because he's all over the place. The last couple of cycles have been better, but I think he's bouncing tonight.

I have to tell you that if your vet gives Webster buprinorphen, you may be in for some good laughs. DK was on it few a couple of days due to minor surgery. You have never seen anything so hysterical in your life. Literally within seconds of giving it, he was high as a kite. Catnip has nothing on this stuff. He would roll around in drunken state and make a complete fool of himself. So funny!

 

[Websterthecat]

Pain can also drive up blood glucose. Pancreatitis can be painful, although punkin had it and i didn't see any obvious evidence of pain. The symptom that we saw was that he stopped eating. Some cats get into a "meatloaf" position - head tucked down, feet all pulled in under them like they would fit into a loaf pan. Marje wrote a good post on pancreatitis - look here in the New to the Group sticky and scroll down to the bottom to the single topic links. See if anything there sounds like Webster. I've heard people say that palpating the abdomen (where the pancreas is) can sometimes cause a cat to show it obviously hurts.

That's very common in diabetic cats, too.

Regarding the teeth - typically vets can't see much when they just look, since cats are so cooperative about saying "AHHHH" for their teeth to be examined. ;-) If there is anything, like tartar that can be chipped off, it's sometimes worse when they get in there than at first glance. Sometimes cats will actually have teeth rotting or broken off in their mouths and we won't know anything's going on.

I'd just let the vet know that Webster's blood sugar has been rising and you've been slowly & methodically increasing his dose as indicated by his high blood sugar tests, but it's still high, and you've been told that infection or pain can be 2 causes of this, and that you'd like to have him seen to check into things. Then I'd specifically ask for a cystocentesis (getting a sterile urine sample via needle into the bladder) and to have him check for pancreatitis and look at his teeth again.

You might want to show the ss to your vet and point out how well he was doing on 0.5u, even you needing to reduce to 0.25u. It's common to have to tweak doses, as you know, but you're now going to twice as much insulin as what got him into good numbers just 2 weeks ago.

If the vet wants to provide a pain reliever, Buprinorphin is the one most of us use and is safe for diabetic cats. It's also easy to administer. Most people want to stay away from Metacam, which is a pain reliever but has a black box warning on it for causing liver failure in cats. Many people also stay away from Convenia, an antibiotic, because it lasts 2 weeks in the body after injected and if there is an allergic reaction it is a long time to deal with it.

Thanks Julie! Tons of great information here.

I gave Webster the 1u dose this evening. Hopefully this will bring him down some until we figure out what is going on.

I felt around his abdomen and didn't notice any reactions that I would associate with pain. Then again, I may have been feeling in the wrong area. :?

I'll mention his teeth again tomorrow and will request the cystocentesis. I'll also inquire about a possible infection. Perhaps URI? In addition, I'll see what he says about sending me home with some fluids as Marje mentioned. Great suggestions everyone!

He was on Bupinorphin (oral) before. I will request this once again if the vet thinks its necessary. I saw on the Marje pancreatitis post the mention of an injectable Bupe. What are the pro's and cons of this? I would much rather inject than do oral dosing.

 

[Websterthecat]

Hi Mike! Mikey is eating entirely 8% food at this point. We're playing with when to feed him, because he's all over the place. The last couple of cycles have been better, but I think he's bouncing tonight.

I have to tell you that if your vet gives Webster buprinorphen, you may be in for some good laughs. DK was on it few a couple of days due to minor surgery. You have never seen anything so hysterical in your life. Literally within seconds of giving it, he was high as a kite. Catnip has nothing on this stuff. He would roll around in drunken state and make a complete fool of himself. So funny!

Mikey's recent numbers are making Webster Jealous. :smile:

I've been feeding Webster 75% of his food in the first 2 hours and the other 25% over the second 2 hours and it seems to have really cut back on those crazy free falls that he was having. Then again, as we have been discussing today, there may be other unknown factors that are contributing to Websters new numbers.

Webster had the Bupe when he came home from the hospital. I didn't notice any such reactions. Maybe his dose wasn't as high as Mikey's. Either way, sounds like some good stuff. I'll have to ask the doc for a little extra so that Webster can share. I kid.. :lol:

 

[julie & punkin (ga)]

uh, if he gets into a drunken state that would suggest the dose is a bit too high! :shock:

I've given it both oral and injections to punkin. I switched to injections because I felt uncertain if punkin was really absorbing it appropriately when i gave it orally. I continued injecting it, but honestly, i'm not sure if it made any difference. I couldn't tell if it did . . .

Sienne recently found this article below on Bupe. If you look at page 5 of the article, lower left column, it suggests that giving it subcutaneous has a poorer absorption rate compared to the other methods of giving it. You might want to just stick with giving it orally, either in his cheekpocket or under his lip on his gums.

 

[Websterthecat]

uh, if he gets into a drunken state that would suggest the dose is a bit too high! :shock:

I've given it both oral and injections to punkin. I switched to injections because I felt uncertain if punkin was really absorbing it appropriately when i gave it orally. I continued injecting it, but honestly, i'm not sure if it made any difference. I couldn't tell if it did . . .

Sienne recently found this article below on Bupe. If you look at page 5 of the article, lower left column, it suggests that giving it subcutaneous has a poorer absorption rate compared to the other methods of giving it. You might want to just stick with giving it orally, either in his cheekpocket or under his lip on his gums.

Wow.. I'm continuously amazed by the amount of knowledge that you guys bring to this community. You guys are full of so much great information!

Effectiveness was the main concern that I had in mind. Thanks for your help!

 

[Websterthecat]

Sorry, a little off topic here but I have been trying to figure out the significance of infection when it comes to the development of ketones.

From what I've been told on here, the perfect storm for ketones are lack of food, lack of insulin and infection. Does infection always have to be present for the development of ketones?

 

[julie & punkin (ga)]

punkin never had ketones, so i don't have personal experience with it, but my understanding is that ketones is indicative that the cat isn't getting enough insulin. If the ketones "grow" and the cat goes into diabetic ketoacidosis, infection is usually present. So it's good you went ahead and increased his dose.

Here'sa recent post from Jill that relates to the blood ketone test. It's in the collection of interesting posts in the Where Can I Find x?post. You said you're waiting for one to arrive and this might be helpful in interpreting results you get from it:

i'd like to amend my post.

in the hours since i posted, kirsten of tillydiabetes.com was kind enough to email two of the latest scientific studies concerning measurement of ketones when using a blood ketone meter. these studies provide an up-to-date interpretation of when a blood ketone concentration of DKA is more likely to be present: 2.4 and 2.55.

Measurement of β-hydroxybutyrate in cats with nonketotic diabetes mellitus, diabetic ketosis, and diabetic ketoacidosis. - published March 2012
and
Point-of-care β-hydroxybutyrate measurement for the diagnosis of feline diabetic ketoacidaemia. - published in June 2012


evidently, we've all been struggling with what to do with the information from obtained from blood ketone meters.
i'd like to personally thank kirsten for passing along the latest information!

 

[Sandy and Black Kitty]

From what I've been told on here, the perfect storm for ketones are lack of food, lack of insulin and infection.Does infection always have to be present for the development of ketones?

Any inflammation/illness can be a trigger regardless of the presence of a bacterial infection. The significance is the body reacts to inflammation and/or infection by producing hormones (like adrenaline or cortisol) that work against insulin. Less insulin, less metabolism and less nutrients making it into the cells. It can pick up momentum fast.

eta- if you can swing it, tonight would be a good night for a PM+10-ish (or anything between and including PM+6 and PM+11 you can manage) test.
Start filling in the bottom half of the PM picture. No telling when but the morning will come when you'll face your 'lowest AMPS ever'. That will be followed by the next 'lowest ever PS. and the next etc So much easier to make your decisions based on data that lets you know where he is coming from and which way he may be is going.
.

 

[Websterthecat]

punkin never had ketones, so i don't have personal experience with it, but my understanding is that ketones is indicative that the cat isn't getting enough insulin. If the ketones "grow" and the cat goes into diabetic ketoacidosis, infection is usually present. So it's good you went ahead and increased his dose.

Here'sa recent post from Jill that relates to the blood ketone test. It's in the collection of interesting posts in the Where Can I Find x?post. You said you're waiting for one to arrive and this might be helpful in interpreting results you get from it:

i'd like to amend my post.

in the hours since i posted, kirsten of tillydiabetes.com was kind enough to email two of the latest scientific studies concerning measurement of ketones when using a blood ketone meter. these studies provide an up-to-date interpretation of when a blood ketone concentration of DKA is more likely to be present: 2.4 and 2.55.

Measurement of β-hydroxybutyrate in cats with nonketotic diabetes mellitus, diabetic ketosis, and diabetic ketoacidosis. - published March 2012
and
Point-of-care β-hydroxybutyrate measurement for the diagnosis of feline diabetic ketoacidaemia. - published in June 2012


evidently, we've all been struggling with what to do with the information from obtained from blood ketone meters.
i'd like to personally thank kirsten for passing along the latest information!

Thank you Julie. This post came just in time as I was anticipating a struggle interpreting the meter reading in the coming days.

The other day Christi (Noodles) who is familiar with DKA was explaining what her vet said Over here. Her vet basically said under 3 and acting normal, getting plenty of fluids, monitor closely. This number seems to be somewhat in like with what these two studies found.

I'm not sure if Christi has seen this post. Is there a way to alert her on the message board and pass this information on?

 

[Websterthecat]

From what I've been told on here, the perfect storm for ketones are lack of food, lack of insulin and infection.Does infection always have to be present for the development of ketones?

Any inflammation/illness can be a trigger regardless of the presence of a bacterial infection. The significance is the body reacts to inflammation and/or infection by producing hormones (like adrenaline or cortisol) that work against insulin. Less insulin, less metabolism and less nutrients making it into the cells. It can pick up momentum fast.

eta- if you can swing it, tonight would be a good night for a PM+10-ish (or anything between and including PM+6 and PM+11 you can manage) test.
Start filling in the bottom half of the PM picture. No telling when but the morning will come when you'll face your 'lowest AMPS ever'. That will be followed by the next 'lowest ever PS. and the next etc So much easier to make your decisions based on data that lets you know where he is coming from and which way he may be is going.
.

Thank you Sandy. The technical explanation really helps me to make sense of what's going on. I understand now.

As for filling in the PM portion of his sheet, I have been wanting to move his shot back so that I am able to stay up and get more PM readings. Right now, hes at 8am and 8pm. I'm normally in bed by 11-12 so a +2 and maybe a +4 is possible. Getting a test in an hour before his shot is doable. I will just have to get up earlier (or convince my wife to do so)

I'm considering slowly sliding back his shot to 7&7 and eventually 6&6. Just fighting with the idea of getting up at 5:45am on the weekends to check, feed and give his shot.