12/16 Webster- Positive ketones - Dosing advice

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Websterthecat

Member Since 2014
Yesterday's condo

Waiting to hear back from vet with Webster's lab results.

Just checked for ketones with urine strip and came back the same - brown with a hint of pink.

I received my Novamax plus last night and read over the instructions. I'm planning on testing him today and comparing the blood reading to what the ketone strips have been telling me.

UPDATE: We just checked his ketone levels using a meter for the first time and the reading came back at 3.4 mmol/l (61mg/dl).

Just an hour ago the strip came back the same as it has always been for the past 7 days - brown with a hint of pink which according to the color chart on the ketone strip bottle, this reading indicates something between 0-5 mg/dl or between negative and trace.

I learned here that ketones are going to show up in the blood long before urine.

For several days now he has been acting completely normal and has a huge appetite. All 5 p's are present and everything seems okay.

I just called the vet and asked about his test results. I was told that the doc will call me back in 1 hours to discuss. I didn't bother to mention that his ketone reading just came back at 3.4 because he apparently has not even heard of a blood meter that tests for ketones. How the heck is he going to advise on what to do about this high reading if he has no idea what I am talking about! I'm so FRUSTRATED dealing with these vets.

From the information that Julie posted concerning 2 scientific studies, 2.4 and 2.55 seems to be the range where DKA is likely present.

The information that Christi received form the rep at novamax (who happened to have a diabetic dog) said "He said that 0.0 to 0.6 is negative, approx. 0.7 to 3 is trace (and would show up as trace on a urine ketone test also), 3.1 to 4.5 is small ,4.6 to 5.5 is moderate, 5.6-7.0 is large, 7.1 to 8 is very large and anything over 8 or HIGH is very life-threatening."

In a previous post Christi further wrote "She (the vet) did not feel that rushing the cat to the vet at a reading of 1 to 3 was necessary, UNLESS those other factors of inappetance, dehydration or obvious illness were present, or of course BGs were skyrocketing.

So from what I am gathering, Webster is very borderline right now. He acting perfectly normal, good appetite, good hydration, grooming, pooping, peeing, out and about, etc but I know how quickly this can change.

I'm going to wait out the next hour. Hopefully this doc will have some answers for me... nailbite_smile
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Hope you get the bloodwork results soon.



I remembered you mentioning teeth yesterday.
- He said that his teeth look surprisingly well for his age. When opening his mouth i saw a small red spot on his gums at his back teeth. I forget what he said it was but he didn't seem overly concerned about it.
Click to expand...

infection in teeth is hard to determine just by looking.
The red spot could be a tooth/gum area that is suspect.
feline resportive lesions are more common than reported in cats.
Has Webster ever had a dental?

the teeth are very key with diabetes.
It could explain the high numbers too.
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Hi Mike,
I hope you can get some answers, too. Have you had an opportunity to test the ketone strips and the Novamax meter on yourself? This might give you some idea of how accurate they are.

I don't have any experience with ketones, but you are in good hands here on the Board.

Hang in there!

Ella & Rusty
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

rhiannon and shadow said:
Hope you get the bloodwork results soon.



I remembered you mentioning teeth yesterday.
- He said that his teeth look surprisingly well for his age. When opening his mouth i saw a small red spot on his gums at his back teeth. I forget what he said it was but he didn't seem overly concerned about it.
Click to expand...

infection in teeth is hard to determine just by looking.
The red spot could be a tooth/gum area that is suspect.
feline resportive lesions are more common than reported in cats.
Has Webster ever had a dental?

the teeth are very key with diabetes.
It could explain the high numbers too.
Click to expand...

Lesions. That sounds like it may what he was talking about.

I agree. I would like more than a visual inspection. I just don't know how to emphasis this to the vet without him becoming offended.

If the redness was in fact lesions, would it show up in his bloodwork somehow?
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Ella & Rusty & Stu(GA) said:
Hi Mike,
I hope you can get some answers, too. Have you had an opportunity to test the ketone strips and the Novamax meter on yourself? This might give you some idea of how accurate they are.

I don't have any experience with ketones, but you are in good hands here on the Board.

Hang in there!

Ella & Rusty
Click to expand...

I thought about it and would really like to test myself to verify that the meter is working correctly. However, right now my anxiety is running at an all time high (a whole another bag of worms) and all I need is for the meter to come back telling me that I have ketones. :-|

Anyone who has dealt with anxiety issues in the past can relate to what I'm referring to.
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Hi there :cool:


I want to add my voice to Rhiannons about the teeth. That 'small red spot' to me is a huge red flag. It would be a good idea to start looking for a good veterinary dental specialist (and putting a few $$$ aside in preparation). I'll save BKs dental stories for later.
Right now it's critical that the ketones be beat back.

Websterthecat said:
So from what I am gathering, Webster is very borderline right now. He acting perfectly normal, good appetite, good hydration, grooming, pooping, peeing, out and about, etc but I know how quickly this can change.
Click to expand...
That is correct.
I'm so glad you got the meter - it's your early warning system since ketones do appear in the blood before the urine.

Now my first instinct when I see a kitty flirting with ketones is to suggest more insulin. However as you know I suspect it possible some lows are being missed on the overnights (12/3, 12/14). If that is the case the missed lows are triggering the release of counter-regulatory hormones, raising the BGs. High BGs = less nutrients to the cells - opening the door for further ketone development.

Beating back ketones and keeping them back is a balancing act and requires extreme vigilance and the best possible decisions. Without data for the PM+5 through -PM+11 block, you are missing approx 1/3 of the picture. IMHO it's not possible to make the best decisions without 1/3 of the picture.

Fortunately, that can easily be remedied with a few strategically placed BG tests. The next time you see a scenario like 12/14/PM I encourage you to do whatever it takes to get further testing during that cycle. Many were the nights that I slept with my mobile phone next to me - the alarm set and re-set, for 1 or 2 hours later - whatever the circumstances called for. We have all had to do it sooner or later (we call it sleep testing)

I know it's a drag however it beats a trip to the ER/hospitalization (and will have the added benefit of getting me to shut up about it ;-) )
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

We were suppose to hear back from the Dr. 2 hours ago. We called back to find out whats going on and they said that he was in surgery.

We told the receptionist that Webster's ketones were elevated. The receptionist said that he checked with the doc and said that he will call back in 2 hours... which was 1 hour ago. I don't know how much longer I can hold on for answers.. nailbite_smile
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Sandy and Black Kitty said:
Hi there :cool:


I want to add my voice to Rhiannons about the teeth. That 'small red spot' to me is a huge red flag. It would be a good idea to start looking for a good veterinary dental specialist (and putting a few $$$ aside in preparation). I'll save BKs dental stories for later.
Right now it's critical that the ketones be beat back.

Websterthecat said:
So from what I am gathering, Webster is very borderline right now. He acting perfectly normal, good appetite, good hydration, grooming, pooping, peeing, out and about, etc but I know how quickly this can change.
Click to expand...
That is correct.
I'm so glad you got the meter - it's your early warning system since ketones do appear in the blood before the urine.

Now my first instinct when I see a kitty flirting with ketones is to suggest more insulin. However as you know I suspect it possible some lows are being missed on the overnights (12/3, 12/14). If that is the case the missed lows are triggering the release of counter-regulatory hormones, raising the BGs. High BGs = less nutrients to the cells - opening the door for further ketone development.

Beating back ketones and keeping them back is a balancing act and requires extreme vigilance and the best possible decisions. Without data for the PM+5 through -PM+11 block, you are missing approx 1/3 of the picture. IMHO it's not possible to make the best decisions without 1/3 of the picture.

Fortunately, that can easily be remedied with a few strategically placed BG tests. The next time you see a scenario like 12/14/PM I encourage you to do whatever it takes to get further testing during that cycle. Many were the nights that I slept with my mobile phone next to me - the alarm set and re-set, for 1 or 2 hours later - whatever the circumstances called for. We have all had to do it sooner or later (we call it sleep testing)

I know it's a drag however it beats a trip to the ER/hospitalization (and will have the added benefit of getting me to shut up about it ;-) )
Click to expand...

I understand that he needs more testing at night and its something that I really need to do. You think a +6 would help things out? My health has been deteriorating over the past month and getting at least 6-7 hours of solid sleep is all that I have left before I crash myself. I'm going to talk with my wife about getting these reading because I understand the importance.

So what if he is crashing hard while we sleep? Aside from staying up all night feeding his possible free fall every night what am I to do??

Also, how do I go about finding a specialist? While the gum redness appears to be a possible issue, how do I know that its directly related to the problems that he is having now? I want to treat the cause of his problem and while dental may be the reason, it may not be and could cause me to get side tracked while searching for a solution to Websters problem.
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Hi again, Mike,
You've got to take care of yourself, too. Everyone understands that. Did you know that modern sleep patterns--that full 6 or 7 hours of sleep a night--are relatively recent? I heard a story about this on National Public Radio last month. In former times it was normal for people to wake in the middle of the night, read or do something around the house for a couple of hours, and then go back to sleep. This suggests that as long as you can get back to sleep, it is not harmful to the body to wake in the middle of the night. Why don't you try for a +7 one night, a +6 the next night, a +8 the night after that. In this way you won't have to set more than one alarm per night. And you'll get some of that nighttime data.

I hope you hear back from that vet. Why don't you ask his office to e-mail you the labs results. That way the folks here will be able to see them and help you out.

Ella & Rusty
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Hi mike

It sounds like you are really having a tough time of it and I just wanted to say what an excellent job you are doing with Webster. I hope you get some answers soon.
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Okay. I. give. up. on vets. @*#&#^! I am so frustrated right now and I don't know where to begin!

The doctor finally called me back at 4:00PM and I talked with him in circles for literally an hour. Why did I waste 1 hour talking with someone who is not very well versed in feline diabetes? I don't know, desperation I suppose. My time would have been better spent reading old post on here gathering more information.

Keypoints of our conversation:

- Test results all came back in normal range except Glucosamine (of course) which was at 530. He just emailed me the results.

- His advice - Go with Purina/hills diet, switch to .50u BID and leave there for a couple weeks. Don't touch dose. Very typical vet response. When asked what makes prescription food superior to LC Friskies pate his response was that the manufacturing process of these prescription diets are is very controlled and what makes them different is proprietary and not disclosed by the manufacturer. He has seen it work well with his diabetic cats. Do I think he that he was trying to give me bad advice and sell me on this expensive prescription food? Not likely. Do I think that he has been drinking the "Purina Kool-aid" for many many years and has been brainwashed into thinking that they sell a superior product? Very likely.

-During our conversation I asked him about Ketones several times and he carefully maneuvered and danced his way out of answering each and every time. He even admitted yesterday and at one point today that he was not familiar with using a blood meter to measure ketones and that it was not standard procedure for treating FD. When I repeatedly mentioned Webster's ketone level being at 3.4mmol/L where according to what I have been reading, he has crossed over into dangerous territory, the best that he could come up with was to make sure that he's eating and seems okay and that diabetic cats are going to have some ketones. He refused to give me a definitive answer obviously because he simply did not know.

-When asked again about the redness around one of his teeth in the back and the possibility of this causing pain/infection and elevated BG levels his response was "not likely"

- When he spoke about DKA as it relates to cats on insulin I (as gently as possibly) told him about the many instances of cats on this message board who have as recently as this past month been hospitalized with DKA even while on higher doses of insulin. He didn't have much to say about that.

- He asked me what I was going to do. I responded by telling him that I appreciate his diet recommendations and that I was going to do my research prior to making a decision to change his diet. I told him that I did not feel comfortable lowering his insulin dose as high BG's and a 3.4 mmol/L with the realization of ketoacidosis staring at me right in the face.

- He said that he was willing to work with me to help me achieve my goals of getting Webster regulated. He wanted to know what he could do to work with me. I really wanted to tell him to spend some time reading up on modern FD, becoming familiar with the latest treatment, and getting back with me. Instead, I just bit my tongue and told him that I really don't know what he could do to help.

I just keep thinking to myself.... With over 30 years in the business, you would think that he had a better answer than give him a dose and check him a couple weeks later while downplaying the risk of DKA.

I am beyond frustrated and feel like I have just about exhausted all of my options. Even if I move to another vet, I will probably experience the same frustrations as they all seem to read from the same book.

So... Sorry about that long rant. I really need everyone's help right now. Websters BG's are high, his ketones are high, and although hes not showing signs of DKA, I KNOW that a full blown episode is coming and I'm not emotionally prepared to deal with this again. Please help me guys. I'm desperate here. I really want to up his dose to knock these numbers back down. I also want to get to the root of this problem.

My concern with raising his dose, as Sandy mentioned, is that he might be taking a trip to the lowlands at night and this might drop him even more.

I don't know what to do. I have normal test results from a seasoned doctor who is incompetent and my boy is facing another round of DKA. Please help. I am desperate.
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

Ella & Rusty & Stu(GA) said:
Hi again, Mike,
You've got to take care of yourself, too. Everyone understands that. Did you know that modern sleep patterns--that full 6 or 7 hours of sleep a night--are relatively recent? I heard a story about this on National Public Radio last month. In former times it was normal for people to wake in the middle of the night, read or do something around the house for a couple of hours, and then go back to sleep. This suggests that as long as you can get back to sleep, it is not harmful to the body to wake in the middle of the night. Why don't you try for a +7 one night, a +6 the next night, a +8 the night after that. In this way you won't have to set more than one alarm per night. And you'll get some of that nighttime data.

I hope you hear back from that vet. Why don't you ask his office to e-mail you the labs results. That way the folks here will be able to see them and help you out.

Ella & Rusty
Click to expand...

The debate on sleep has been an ongoing interest of mine. It's always interesting to hear all of the different opinions on how much sleep we really need.

As for the suggested testing, I like that idea and will start tonight. Thank you.
 
Re: 12/16 Webster AMPS=473 KETONE=3.4

phlika29 said:
Hi mike

It sounds like you are really having a tough time of it and I just wanted to say what an excellent job you are doing with Webster. I hope you get some answers soon.
Click to expand...

Thank you. I'm trying hard to keep it together. The past couple of days have been extremely difficult. I'm frustrated and beginning to feel defeated. Thanks for thinking about me and Webster.
 
Re: 12/16 Webster- Dosing advice, I need help please.

Hi Mike,

I'm so sorry that you're dealing with all of this. You probably don't know this, but I am a cancer survivor. When I went through treatment, I had a few medical professionals give me a really hard time. (Thankfully not my doctor.) The chemo place was plain horrible. I learned that, although I wanted to be respectful to them and listen to their professional opinion, sometimes I had to stand up to them and tell them that what they were doing or proposing was unacceptable, and that I wasn't going to do it. I became quite adept at using the words "no" and "unacceptable". Your vet works for you, and he knows it. You can fire him at any time. Don't feel guilty about respectfully disagreeing with him. You know your cat far better than he does, and you probably know more about diabetes than he does. The fact that he wanted to know what he could do to work with you, sounds to me like he 1. doesn't want to lose your business and 2. he may be willing to learn. Personally, I'd tell him that if he really wants to understand what your doing, he should come here and do some studying. I doubt he has the time to read everything carefully, but even if he just gets a feel for the high competence level here, he may be willing to back down a bit.

Please remember that you're not alone in this. The experienced members are going to see both of us through this, and we newbies will give each other moral support. You are going to get through this. We both are.
 
Re: 12/16 Webster- Dosing advice, I need help please.

Mike

Can I suggest you edit the title of your thread to include ketones positive or something like that.

I have been searching for a very helpful post I read on ketones by one of the mods in green ie Carl or Jill or maybe someone else but can't find it now. As I was reading a old post Jill mentioned about flagging up the ketone result in the title so help could be offered quickly.

Re the ketones I have no experience but am aware it is like the a fire- various elements are required to keep a fire going or to put it out. For ketones to develop you need a lack of water, a lack of food and a lack of insulin. So you need to interrupt these three things. Have you ever tried syringing water in websters mouth (I remember you added it to his food didn't you)? You could do this every hour perhaps, just a 5 or 10 ml syringe of water might help flush the ketones through. What about sub q's ? I think you said he was eating okay.

I am sure others will help more.
 
Re: 12/16 Webster- Dosing advice, I need help please.

Mike,
I pulled up your ss to stare at it.... and what I see is that when you have seen green, you later see black.
It doesn't mean he's gotten "dangerously" low.... it could be a high green but as others have said....
it's good to get that data. Like Ella said, pick a time, set an alarm and test....move it around each night.
the only time you should continue staying up is if you have a low blue or even better, a green.


on dec 14... if I had seen the yellow 260... I might have set an alarm for 4 hours later.... just for the data...


I'm not one of the voices for dka...
but I want to let you know that my cat showed one symptom for forl. ( the resportive lesions._)
when I scratched her chin, her mouth would chatter .... like shivering.... I didn't know that was a sign of intense pain.
Not all cats do that, it probably depends on the degree of pain and how they deal with it....
but I have seen countless examples of teeth being a major factor in diabetes. It's hard to get a cat regulated with teeth problems.
The only way to check for Forl is x-rays. There would be hairline cracks in the teeth that aren't visible when you look.
A red spot is more indicative of gum problems, but it could be far more involved.

I think you are on the right path, try to get at much extra water as your cat will accept...
and those who know dka will continue to help.
 
Re: 12/16 Webster- Dosing advice, I need help please.

Marycatmom said:
Hi Mike,

I'm so sorry that you're dealing with all of this. You probably don't know this, but I am a cancer survivor. When I went through treatment, I had a few medical professionals give me a really hard time. (Thankfully not my doctor.) The chemo place was plain horrible. I learned that, although I wanted to be respectful to them and listen to their professional opinion, sometimes I had to stand up to them and tell them that what they were doing or proposing was unacceptable, and that I wasn't going to do it. I became quite adept at using the words "no" and "unacceptable". Your vet works for you, and he knows it. You can fire him at any time. Don't feel guilty about respectfully disagreeing with him. You know your cat far better than he does, and you probably know more about diabetes than he does. The fact that he wanted to know what he could do to work with you, sounds to me like he 1. doesn't want to lose your business and 2. he may be willing to learn. Personally, I'd tell him that if he really wants to understand what your doing, he should come here and do some studying. I doubt he has the time to read everything carefully, but even if he just gets a feel for the high competence level here, he may be willing to back down a bit.

Please remember that you're not alone in this. The experienced members are going to see both of us through this, and we newbies will give each other moral support. You are going to get through this. We both are.
Click to expand...

Thank you Mary. I had no idea that you were a cancer survivor and I'm glad to hear that you stood your ground and are okay today.

As for the vet, I really don't want to burn any bridges (yet) but I came really close today. I suggested that he comes on here and take a look around. Maybe he will, maybe not.

Thank your for the support.
 
Re: 12/16 Webster- Dosing advice, I need help please.

phlika29 said:
Mike

Can I suggest you edit the title of your thread to include ketones positive or something like that.

I have been searching for a very helpful post I read on ketones by one of the mods in green ie Carl or Jill or maybe someone else but can't find it now. As I was reading a old post Jill mentioned about flagging up the ketone result in the title so help could be offered quickly.

Re the ketones I have no experience but am aware it is like the a fire- various elements are required to keep a fire going or to put it out. For ketones to develop you need a lack of water, a lack of food and a lack of insulin. So you need to interrupt these three things. Have you ever tried syringing water in websters mouth (I remember you added it to his food didn't you)? You could do this every hour perhaps, just a 5 or 10 ml syringe of water might help flush the ketones through. What about sub q's ? I think you said he was eating okay.

I am sure others will help more.
Click to expand...

Title changed. Thanks for pointing this out. I usually water down his food with a bit of water but will water it down more tonight. Never tried syringing water - afraid he will choke. He seems to have a very big appetite still and appears okay and not dehydrated. I mentioned sub q fluids to the vet and he said that he could show me how to do it but didn't think it was necessary at this point.
 
Re: 12/16 Webster- Dosing advice, I need help please.

As to finding a veterinary dentist, NC State has a vet school and here's the link to their dentistry service.

Ketones...
The basic recipe for ketones is not enough insulin + infection/inflammation + not eating. It's possible that there's something going on dental-wise. Gabby has FORL and has never had the chattering that Rhiannon described. However, the only way to determine if there's a dental problem is with your kitty under anesthesia (or sedated) since it's unlikely that Webster is going to keep his mouth open for the vet to really get a good look when he's awake or with X-rays. Gingivitis or a dental problem can be the source of an infection or inflammation. The good news is that Webster's labs -- especially his white blood count -- was normal.

If you are not already adding water to Webster's food, it's time to do so. Water helps to flush out ketones.

You might suggest that your vet read the article below. It's from a leading veterinary journal and is authored by people who are doing research on Lantus.


I hate to complicate the picture, but I don't think Webster is dropping too low. What I do suspect is that the size of the drop is what is triggering the bouncing. My inclination would be to have you raise the dose but do careful monitoring. You can always add carbs to bring the numbers up if you need to. The best way to offset ketones is with insulin. In kitties with DKA, we've had a caregiver feed a higher carb diet in order to get more insulin into his/her cat.
 

Attachments

Re: 12/16 Webster- Dosing advice, I need help please.

rhiannon and shadow said:
Mike,
I pulled up your ss to stare at it.... and what I see is that when you have seen green, you later see black.
It doesn't mean he's gotten "dangerously" low.... it could be a high green but as others have said....
it's good to get that data. Like Ella said, pick a time, set an alarm and test....move it around each night.
the only time you should continue staying up is if you have a low blue or even better, a green.


on dec 14... if I had seen the yellow 260... I might have set an alarm for 4 hours later.... just for the data...


I'm not one of the voices for dka...
but I want to let you know that my cat showed one symptom for forl. ( the resportive lesions._)
when I scratched her chin, her mouth would chatter .... like shivering.... I didn't know that was a sign of intense pain.
Not all cats do that, it probably depends on the degree of pain and how they deal with it....
but I have seen countless examples of teeth being a major factor in diabetes. It's hard to get a cat regulated with teeth problems.
The only way to check for Forl is x-rays. There would be hairline cracks in the teeth that aren't visible when you look.
A red spot is more indicative of gum problems, but it could be far more involved.

I think you are on the right path, try to get at much extra water as your cat will accept...
and those who know dka will continue to help.
Click to expand...

Thank you rhiannon. I'm thinking that teeth are going to be the next thing to look at, although the doc doesn't believe this is a contributing factor.(Although I'm hearing from everyone here that it can be) .

Right now, I'm very concerned with the possibility of waking up tomorrow to find Webster in a pile of vomit and spaced out. I don't want to go through this again..
 
I also agree that as long as numbers are high, you should increase the dose by 0.25u possibly every four cycles. I'd like the chance to discuss it with the other ladies as well as the possibility of you using some R insulin to bring the numbers down.

The other thing is, I would call the vet back tomorrow and ask about getting those fluids and possibly giving him a small amount at whatever schedule the vet recommends. As an example, possibly 50 mls every other day. 50 mls is 10 tsps of water and I know you are already putting a lot of water in his food. I'd also up his calories a little more if it were me.

One of us will get back to you in a bit on the dose changes and also the R.
 
Preshot at 274 - lowest PS that I have seen since 12/12. Its 1 min past insulin time. I'm going with my gut and going to stick with 1u. I still need help dosing in the morning.
 
Marje and Gracie said:
I also agree that as long as numbers are high, you should increase the dose by 0.25u possibly every four cycles. I'd like the chance to discuss it with the other ladies as well as the possibility of you using some R insulin to bring the numbers down.

The other thing is, I would call the vet back tomorrow and ask about getting those fluids and possibly giving him a small amount at whatever schedule the vet recommends. As an example, possibly 50 mls every other day. 50 mls is 10 tsps of water and I know you are already putting a lot of water in his food. I'd also up his calories a little more if it were me.

One of us will get back to you in a bit on the dose changes and also the R.
Click to expand...


Thank you Marje.

I'm really having a difficult time with the idea of trying to get my vet to prescribe R insulin when hes insisting on my cutting Websters insulin dose back even when I stressed that this ketones were elevated. What is this guy thinking?? :?:

I want to find another vet who has more knowledge on the subject matter. I'm however afraid that I will continue to hit the same road block over and over because they all seem to have similar mentalities.

As for the fluids, how do I explain that he needs fluids? He doesn't seem dehydrated at the moment.
 
Hi Mike,
Good news: you don't need a prescription for R, so your vet doesn't have to be involved! Marje et al. will tell you how to use it. It has helped many kitties.

Ella
 
Ella & Rusty & Stu(GA) said:
Hi Mike,
Good news: you don't need a prescription for R, so your vet doesn't have to be involved! Marje et al. will tell you how to use it. It has helped many kitties.

Ella
Click to expand...

That's fantastic news and I can now breath a sigh of relief. I really don't want to deal with my vet anymore unless absolutely necessary. While a very nice guy, he has proven many times over that he lacks knowledge when it comes to the subject of FD.
 
Re: 12/16 Webster- Dosing advice, I need help please.

Sienne and Gabby said:
As to finding a veterinary dentist, NC State has a vet school and here's the link to their dentistry service.

Ketones...
The basic recipe for ketones is not enough insulin + infection/inflammation + not eating. It's possible that there's something going on dental-wise. Gabby has FORL and has never had the chattering that Rhiannon described. However, the only way to determine if there's a dental problem is with your kitty under anesthesia (or sedated) since it's unlikely that Webster is going to keep his mouth open for the vet to really get a good look when he's awake or with X-rays. Gingivitis or a dental problem can be the source of an infection or inflammation. The good news is that Webster's labs -- especially his white blood count -- was normal.

If you are not already adding water to Webster's food, it's time to do so. Water helps to flush out ketones.

You might suggest that your vet read the article below. It's from a leading veterinary journal and is authored by people who are doing research on Lantus.


I hate to complicate the picture, but I don't think Webster is dropping too low. What I do suspect is that the size of the drop is what is triggering the bouncing. My inclination would be to have you raise the dose but do careful monitoring. You can always add carbs to bring the numbers up if you need to. The best way to offset ketones is with insulin. In kitties with DKA, we've had a caregiver feed a higher carb diet in order to get more insulin into his/her cat.
Click to expand...

Somehow missed this post. Thanks for doing that research. I will check it out tonight.
 
Lab work uploaded into SS under "LABS" Tab.

Can anyone tell me where to find "MA" under urine test? I doesn't seem to appear on my results.
 
Evening Mike. Quite the day. :YMHUG: I'm still with the original vet who diagnosed Neko's diabetes, but I refuse to deal with the older vet who though I was nuts getting the "exotic tests" for acromegaly and IAA. My vet didn't think I needed them either, but she humored me and was very surprised at the positive results. Having a vet willing to work with me and learn really helps.

Good to see that yellow start tonight. :-D

Sorry I can't help with the MA, my labs report doesn't have it either.

As for NC State, they have some very good endocrinology knowledge there. Dr. Kathy Lunn is one of the most knowledgeable researchers on feline diabetes and acromegaly in the US. Veterinary research hospitals will often do work cheaper than a regular vet's office.
 
Hi. Were all but the fPL done in house or were all the results sent out? Webster definitely doesn't have pancreatitis so that is a good thing. Her liver values are low and I don't know that that means. Max has had a high ALT in the past but never low. His urine USG is good so he is concentrating his urine and the kidney values weren't highlighted so there should not be any worries about kidney disease either. The white blood cells often clump so that isn't anything to worry about either. So it looks to me that his problem is diabetes that will get regulated here. Marje is the pro on labs and Im sure she will chime in if she sees anything that I have missed.
 
Hi Mike!

Can you get another blood ketone test this evening, please? Testing twice a day at this point is important.

The strategies for dealing with ketones are to increase water to flush them out, increase insulin & increase food consumption. The infection component needs to get dealt with as well.

This is serious, no doubt, but I do want you to know that we've seen lots of cats with ketones here. We'll do our best to help you. Please don't let yourself move them to DKA before it's happened. Take a deep breath, take a look at Webster and see that he's doing ok at this point, so you've got time to take action to help him.

We're talking. Hang in there.
 
Wendy&Neko said:
Evening Mike. Quite the day. :YMHUG: I'm still with the original vet who diagnosed Neko's diabetes, but I refuse to deal with the older vet who though I was nuts getting the "exotic tests" for acromegaly and IAA. My vet didn't think I needed them either, but she humored me and was very surprised at the positive results. Having a vet willing to work with me and learn really helps.

Good to see that yellow start tonight. :-D

Sorry I can't help with the MA, my labs report doesn't have it either.

As for NC State, they have some very good endocrinology knowledge there. Dr. Kathy Lunn is one of the most knowledgeable researchers on feline diabetes and acromegaly in the US. Veterinary research hospitals will often do work cheaper than a regular vet's office.
Click to expand...

I am so glad that you told me about Dr. Lunn. I would LOVE to speak with her and give NC state a try. Interestingly enough I was speaking with my neighbor who had a dog that was once being cared for at the NC state vet program. After looking into it, it seems as if you need a referral??

Does anyone here know Dr. Lunn personally and is willing to put me in contact with her?? I would really appreciate it! :-D
 
tiffmaxee said:
Hi. Were all but the fPL done in house or were all the results sent out? Webster definitely doesn't have pancreatitis so that is a good thing. Her liver values are low and I don't know that that means. Max has had a high ALT in the past but never low. His urine USG is good so he is concentrating his urine and the kidney values weren't highlighted so there should not be any worries about kidney disease either. The white blood cells often clump so that isn't anything to worry about either. So it looks to me that his problem is diabetes that will get regulated here. Marje is the pro on labs and Im sure she will chime in if she sees anything that I have missed.
Click to expand...

I believe that some were done in house. One of the results has "Antech diagnostics" written at the top while the other says "Idexx laboratories"
 
I have both talked and emailed with Dr. Lunn. She's the best. I would absolutely trust her with my cat. When I took punkin to CSU to be treated for his acromegaly she was on vacation and I saw other staff in her department instead, but she was the one I talked with in advance and she spent a lot of time with me.

As far as his teeth go, punkin had teeth pulled with both dentals he had. That red spot on his gum is a red flag. If I were you, I'd contact NC and schedule a dental with them. As others have said, diabetic's teeth can be a real problem. Resorption is relatively common. I'd get that done as soon as you can. I've seen a couple of other cats with bad teeth (not saying that Webster's are this bad) that had very zig-zag spreadsheets. I don't know what role that plays, but dental infections definitely can make it difficult to get a cat regulated.
 
julie & punkin (ga) said:
Hi Mike!

Can you get another blood ketone test this evening, please? Testing twice a day at this point is important.

The strategies for dealing with ketones are to increase water to flush them out, increase insulin & increase food consumption. The infection component needs to get dealt with as well.

This is serious, no doubt, but I do want you to know that we've seen lots of cats with ketones here. We'll do our best to help you. Please don't let yourself move them to DKA before it's happened. Take a deep breath, take a look at Webster and see that he's doing ok at this point, so you've got time to take action to help him.

We're talking. Hang in there.
Click to expand...

Thank you Julie! I will test ketones once again tonight.

I've been adding lots of water to his food and he has been eating well.

I'm trying to stay calm but the ketone readings and vet have me all upset today. I am very thankful that Webster seems fine (on the outside) and am working hard to keep him that way.

Thank you everyone for your help.
 
julie & punkin (ga) said:
I have both talked and emailed with Dr. Lunn. She's the best. I would absolutely trust her with my cat. When I took punkin to CSU to be treated for his acromegaly she was on vacation and I saw other staff in her department instead, but she was the one I talked with in advance and she spent a lot of time with me.

As far as his teeth go, punkin had teeth pulled with both dentals he had. That red spot on his gum is a red flag. If I were you, I'd contact NC and schedule a dental with them. As others have said, diabetic's teeth can be a real problem. Resorption is relatively common. I'd get that done as soon as you can. I've seen a couple of other cats with bad teeth (not saying that Webster's are this bad) that had very zig-zag spreadsheets. I don't know what role that plays, but dental infections definitely can make it difficult to get a cat regulated.
Click to expand...

Do I need a referral? This seems to be what I hear from my neighbor and when I called down there last week.
 
If you do, call your vet and ask them to give you a referral. I took punkin to Oregon State University's vet school for a second opinion when he developed a weird growth in his mouth. They were good. I did find it annoying that when I referred to punkin being in a bounce at the time we were there and therefore his BGs were high, the vet student nodded her head and commented about Somogyi. ohmygod_smile

CSU, however, was top-notch. I think OSU was good too, it was just that comment that made me go *headdesk*. When I left punkin at CSU for the day, my husband and I looked at each other and said "so this is what it feels like to have confidence in the pros." They knew acromegaly and FD inside and out.

I used a veterinary dentist for punkin. She had a regular dental practice in a neighboring town 10 miles away, plus she travelled to several local cities and treated cats dental needs there. That is probably sufficient if you can't get a referral to the university. You can look here for the American Veterinary Dental Specialists across the country: http://www.avdc-dms.org/dms/list/di...onid=B8A7CF9FD313BC3AF99CDA6A88ABF60C.cfusion That was very expensive (i want to say maybe $1300) but with acromegaly, I was very concerned about him undergoing anesthesia, so i sucked it up and got the specialist. Cats with acromegaly have special concerns that, in my mind, needed that.
 
Webster's ketone update:

10:00PM= 1.7 (3.4 earlier today)

I'm not sure about this variation. The instructions say to take with BG above 250, his were 240 just now.

The earlier reading was taken with his BG at 430.. Do you think that the difference in BG had something to do with the decreased ketone reading?
 
julie & punkin (ga) said:
If you do, call your vet and ask them to give you a referral. I took punkin to Oregon State University's vet school for a second opinion when he developed a weird growth in his mouth. They were good. I did find it annoying that when I referred to punkin being in a bounce at the time we were there and therefore his BGs were high, the vet student nodded her head and commented about Somogyi. ohmygod_smile

CSU, however, was top-notch. I think OSU was good too, it was just that comment that made me go *headdesk*. When I left punkin at CSU for the day, my husband and I looked at each other and said "so this is what it feels like to have confidence in the pros." They knew acromegaly and FD inside and out.

I used a veterinary dentist for punkin. She had a regular dental practice in a neighboring town 10 miles away, plus she travelled to several local cities and treated cats dental needs there. That is probably sufficient if you can't get a referral to the university. You can look here for the American Veterinary Dental Specialists across the country: http://www.avdc-dms.org/dms/list/di...onid=B8A7CF9FD313BC3AF99CDA6A88ABF60C.cfusion That was very expensive (i want to say maybe $1300) but with acromegaly, I was very concerned about him undergoing anesthesia, so i sucked it up and got the specialist. Cats with acromegaly have special concerns that, in my mind, needed that.
Click to expand...

Might end up asking my vet for a referral. I will look into this tomorrow. Thanks for the link. I just bookmarked it.
 
Re: 12/16 Webster- Dosing advice, I need help please.

hi mike. i've been around here for quite awhile and had a sugar kitty who was prone to ketones. unfortunately, i lost her to cancer 3 months ago. in spite of being ketone prone, with a little luck and being proactive... we were able to avoid of DKA a second time in the 8+ years alex was diabetic.

Sienne and Gabby said:
If you are not already adding water to Webster's food, it's time to do so. Water helps to flush out ketones.
Click to expand...
i agree with sienne and will take her suggestion one step further...
use a syringe to get more water into webster whenever you can. when you syringe water you want to insert the oral syringe into the side of kitty's mouth and gently dispense small amounts. the key here is to relax and syringe small amounts at a time. think of syringing as feeding an infant for the very first time. small amounts. don't force the issue. talk to webster to reassure him. explain how you're trying to help him. until he gets used to it, i wouldn't try to syringe any more than 5 mL in one sitting. you might want to do it on a counter top, a table, or sit on a tile floor with him. it's easier to clean up any mess. the first few times he might spit out more than he takes in. don't worry. it's normal. he'll get better at it and so will you. :smile:

the simple act of getting more water into him could very well flush out ketones within a short amount of time.

Sienne and Gabby said:
I hate to complicate the picture, but I don't think Webster is dropping too low. What I do suspect is that the size of the drop is what is triggering the bouncing. My inclination would be to have you raise the dose but do careful monitoring. You can always add carbs to bring the numbers up if you need to. The best way to offset ketones is with insulin. In kitties with DKA, we've had a caregiver feed a higher carb diet in order to get more insulin into his/her cat.
Click to expand...
i'm seeing the same as sienne. i think her comments are on target. webster has no trouble dropping a good 200 points in a single cycle. that kind of drop will cause most kitties to bounce like a yo-yo. having said that, i agree with a dose increase combined with careful monitoring... unless he drops unusually low between now and AMPS. if that should happen, re-thinking the suggested dose increase would be prudent.

something to remember... when you're fighting ketones, use food to keep him from bottoming out. it's the insulin that he needs. if you have to feed him foods that are higher in carbs in order to safely hang on to the dose... so be it.

Marje and Gracie said:
I also agree that as long as numbers are high, you should increase the dose by 0.25u possibly every four cycles. I'd like the chance to discuss it with the other ladies as well as the possibility of you using some R insulin to bring the numbers down.
Click to expand...
i agree with an aggressive dosing approach... re-evaluating the dose after the every 4 cycles. because he has shown the ability to drop 200 or more points in a cycle, if i were going to use R i would use it with due caution and ONLY at the beginning of a bounce. also... at this point, i would only use R if there was an experienced R user were around on the board to help and guide you.

Marje and Gracie said:
The other thing is, I would call the vet back tomorrow and ask about getting those fluids and possibly giving him a small amount at whatever schedule the vet recommends. As an example, possibly 50 mls every other day. 50 mls is 10 tsps of water and I know you are already putting a lot of water in his food. I'd also up his calories a little more if it were me.
Click to expand...
when alex threw trace ketones i'd up the calories fed, syringe water, and administer 50 mLs fluids per day with my vet's blessing.

i understand the frustration, feeling desperate, and the exhaustion. you're getting great advice. hang in there!
 
I take Neko to a veterinary dental specialist too, also because of her acromegaly. All I had to do was tell the regular vet I wanted a referral to the specialist. They sent the referral in and there was no charge.

Great news on the ketones. :-D
 
Websterthecat said:
Webster's ketone update:

10:00PM= 1.7 (3.4 earlier today)

I'm not sure about this variation. The instructions say to take with BG above 250, his were 240 just now.

The earlier reading was taken with his BG at 430.. Do you think that the difference in BG had something to do with the decreased ketone reading?
Click to expand...

The ketone situation can change fairly rapidly. I'm glad to hear the last test is back in normal range. Please keep testing 2x/day and keep updating here.
 
Websterthecat said:
Webster's ketone update:

10:00PM= 1.7 (3.4 earlier today)

I'm not sure about this variation. The instructions say to take with BG above 250, his were 240 just now.

The earlier reading was taken with his BG at 430.. Do you think that the difference in BG had something to do with the decreased ketone reading?
Click to expand...
it's certainly possible.

however, it's important to mention, one must not get too comfortable thinking a ketone prone cat will only throw ketones when BG numbers are high. cats, especially ketone prone cats, can and do throw throw ketones even when their BG numbers are in the 100s. :shock:

example: click on the 2012 tab at the top of alex's spreadsheet and scroll down to 12/07/2012. she threw trace ketones in the AM cycle @ +10.5.
 
Mike,
Just wanted to add a word of support, as I know how frightening the threat of DKA developing again is. It sounds like Webster is acting well and eating and drinking fine so that is a positive sign. When Noodle went into DKA the last time, he was acting obviously ill, and didn't want to eat (very unusual for him). I know how frustrating it is to have a vet who is cavalier about ketone readings. I fired one who told me "not to worry" about ketones and almost let Noodle go into DKA. I hope you can see the NC vet that was mentioned and get Webster on the right path. Please take care and try to get some rest yourself. The worry can really wear you down, but you are getting really good advice here and these folks will never let you down.

Christi
 
Thank you everyone. Such a tremendous response.

I read everyone's comments and have bookmarked this thread to look back on tonight into the future.

I would like to respond to everyone but have so much going on right now it's becoming overwhelming.

I thank you all for your support and input.
 
Mike,
Just wanted to add a word of support, as I know how frightening the threat of DKA developing again is. It sounds like Webster is acting well and eating and drinking fine so that is a positive sign. When Noodle went into DKA the last time, he was acting obviously ill, and didn't want to eat (very unusual for him). I know how frustrating it is to have a vet who is cavalier about ketone readings. I fired one who told me "not to worry" about ketones and almost let Noodle go into DKA. I hope you can see the NC vet that was mentioned and get Webster on the right path. Please take care and try to get some rest yourself. The worry can really wear you down, but you are getting really good advice here and these folks will never let you down.

Christi
 
As Ella said, a script is not needed for R. You can buy Novolin R at Walmart the cheapest. You might buy it and never need it. And as Jill said, it's best to only use it when there is an experienced R user to guide you. There are several stipulations about using it safely including using it as soon as the bounce starts. Julie, sandy, Jill, Libby, Dyana, Suzanne, and I have used it. There are others as well.

You do need a prescription for fluids or you can get one bag from the vet. I was just suggesting 50 mls every other day as an example but it would need to be discussed and decided with your vet. Giving fluids, in this case, has nothing to do with dehydration.....it has to do with flushing ketones.

The MA is microalbuminuria which refers to protein In the urine.

His labs look pretty good. I don't see any red flags there. The AST can be low due to him still recovering from not eating as it can be associated with malnutrition. I believe he was on metronidazole right? It can also cause lower AST.

I just saw the blue on his SS so you might want to see how much he comes down and reconsider raising the dose if he spends any time in blue tonight. You might give him six cycles.
 
Marje and Gracie said:
As Ella said, a script is not needed for R. You can buy Novolin R at Walmart the cheapest. You might buy it and never need it. And as Jill said, it's best to only use it when there is an experienced R user to guide you. There are several stipulations about using it safely including using it as soon as the bounce starts. Julie, sandy, Jill, Libby, Dyana, Suzanne, and I have used it. There are others as well.

You do need a prescription for fluids or you can get one bag from the vet. I was just suggesting 50 mls every other day as an example but it would need to be discussed and decided with your vet. Giving fluids, in this case, has nothing to do with dehydration.....it has to do with flushing ketones.

The MA is microalbuminuria which refers to protein In the urine.

His labs look pretty good. I don't see any red flags there. The AST can be low due to him still recovering from not eating as it can be associated with malnutrition. I believe he was on metronidazole right? It can also cause lower AST.

I just saw the blue on his SS so you might want to see how much he comes down and reconsider raising the dose if he spends any time in blue tonight. You might give him six cycles.
Click to expand...

Thank you Marje.

Metronidazole Doesn't ring a bell. He was taking Calv/Amox up until the end of November.

Thanks for looking over his lab results. This is much appreciated.

I was watching your video earlier on giving fluids. I'm wondering how I can get Webster to sit still long enough to give him fluids? Once the chicken treats run out Webster tends to disappear pretty quickly.
 
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