2/13 Jonesy AMPS 247=1.25;+2=270 ;+12 40 +1.5=72;+2=97; 2.5-95 SHOT 1.U; +1.5 post shot 110

Darcy and Jonesy

Darcy and Jonesy

Member Since 2015
Morning,

I'll link both of yesterdays threads. He's eating well this morning. I've not been able to get a sample as I have to get ready for work and will be away all day :( But should I be increasing his dose? I'll go check the TR rules right now . . .

EDIT: never mind, I've read through the TR rules and as per @LizzieInTexas I'm going to increase by .25 (thanks LizzieInTexas!)

Send good vibes to my boy please

Link re ketones: http://www.felinediabetes.com/FDMB/...trace-and-small-what-now.225589/#post-2525756

Regular daily posting: http://www.felinediabetes.com/FDMB/...ps-274-1u-trace-ketones-when-to-panic.225563/
 
Darcy and Jonesy said:
I'll link both of yesterdays threads. He's eating well this morning. I've not been able to get a sample as I have to get ready for work and will be away all day :( But should I be increasing his dose? I'll go check the TR rules right now . . .
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Have you considered a blood ketone meter? We never even tried the urine strips as we don't really have time to chase FA around all day to try and get a sample. The test strips are a little expensive but I think it's worth it for the convenience.
 
Thanks everyone for your support. I'm off to work now. I've got a call into the vet; I'm going to see if I can buy a Ketone meter; he's got lots of soupy food; AND I've loaded him up with about an "orange" size amount of sub q fluids. I know they won't flush ketones, but it's all I have on hand and it will help with his hydration.

Will update you when I can, thanks again.
 
Fluids are good. Ketone meters are great. Strips are expensive and you only get 10 in a bottle.

Might need to find out if there is an infection brewing somewhere. Gingivitis or UTI are the more common ones.
 
Olive & Paula said:
Fluids are good. Ketone meters are great. Strips are expensive and you only get 10 in a bottle.

Might need to find out if there is an infection brewing somewhere. Gingivitis or UTI are the more common ones.
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We know he needs a dental, I’v got him booked but due to February being “dental month” my vet clinic is booked up till mid March ☹️ But he is booked.

Should I be going elsewhere to get it done more quickly? I trust my clinic literally with my cats lives. When you ask about infection, can that be causing ketones???
 
Darcy and Jonesy said:
When you ask about infection, can that be causing ketones???
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Yes, it’s a main ingredient in setting the stage for development of ketones:
Not enough calories + Not enough insulin + Infection/inflammation/or some other systemic stress.

infection raises BG, which in turn raises insulin needs.

Insulin is required to deliver energy from food consumed to the cells of the body. When there is not enough energy from food making it into the cells, the body will breakdown it’s fat and protein stores to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.
 
Darcy and Jonesy said:
We know he needs a dental, I’v got him booked but due to February being “dental month” my vet clinic is booked up till mid March ☹️ But he is booked.

Should I be going elsewhere to get it done more quickly? I trust my clinic literally with my cats lives. When you ask about infection, can that be causing ketones???
Click to expand...

Nice on ketone meter. If his teeth seem to find now, I would wait if you trust your vet. Feb is dental month, most give discounts for Feb. Usually need to book way in advance for Feb appts.

Recipe for ketones is not enough insulin, not eating and infection/inflammation/illness somewhere.
 
OMG.

So glad he's eating and active-- those are good signs. First step, I'd re-test both those numbers immediately. Then... what is your evening vet situation? I feel like this is probably going to require a visit-- the "take action" number for the blood ketone meters is usually in the 2's, so 3.7 needs action.
 
Wendy&Neko said:
Could you change the PMPS on the subject line to either +12 or PMBG. Don’t want people to think you shot that 40!

Deep breath. How much did you feed? Retest in 20-30 minutes.

Is your vet open tonight?
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He's eaten about 2/3rds of a bowl of LC fancy feast. I gave him sub q fluids this morning, and honestly, he seems to be doing great. But those *&($% ketone Did I test properly? It's the first time I've used the meter. I can try for another pee test with a strip tonight, sitting in the office with him until he pees.

Yeah, freaking out and horribly confused :'( (Edit, I've removed the 911)
 
Darcy, I'm sorry that you've got a combination of things going on. For the low BG level, can you tell us what % carbs you fed? Please retest again in 20 minutes. The ketone reading is worrisome.
 
@Wendy&Neko I'm going to copy and paste the entire email that I just got from my vet. Please give me your thoughts.

Hi Darcy,


If there truly are ketones in Jonesy’s urine, that would be cause for concern. Persistent ketonuria is due to an upset in energy metabolism, when the body is using fat stores rather than glucose for energy production. It can therefore be seen in unregulated diabetes, or from malnutrition or starvation.

Also, I say “truly” because ketones strips can be misread – for example, diabetic cats are prone to getting urinary tract infections due to the high glucose levels in their urine. If this is causing red blood cells or other impurities to come out in the urine, it could falsely change the colour on the test strip.

If Jonesy still has ketones in his urine that would make me think that his diabetes is not well regulated. If Jonesy is showing signs of increased thirst and urination, this would be even more likely. There can be many reasons for this. His insulin dose may not be adequate, he may be resistant to insulin, he may have another infection occurring, he may have pancreatitis (the pancreas is responsible for producing insulin in the body, pancreatitis means it’s inflamed), or he may have another disease occurring that we are unaware of that is playing a role in insulin regulation, such as another endocrine disorder.


Therefore, we would need a full urinalysis and complete bloodwork, or at the very least an accurate blood glucose reading, to know what may be happening. Abdominal imaging is often a good idea as well, so we can visualize the pancreas and urinary tract to check for any abnormalities that may be causing him to not regulate.

For these reasons, we don’t recommend testing ketones regularly in diabetic cats as it does not tell us much about what is going on, but gives us more questions than answers. We do recommend performing blood glucose curves (checking blood glucose immediately before an insulin injection and then every 2 hours until the next injection) to more accurately judge whether a cat is well controlled. We do these every 6 months or so in “well” diabetics, and more often in diabetics showing signs of increased urination and drinking, or a couple weeks after changing an insulin dose.

The last blood glucose curve I see from Jonesy is an email from January 7th. At that time the doctor recommended increasing the dose to 2 units twice a day, and repeating a curve in 3 - 4 weeks. Was a repeat curve done then? Vanessa mentioned that a reading came back low, and so you brought the dose down to 1.5 units twice a day, was a curve done at this time or since this change?

In summary, at the very least, I need a blood glucose curve to be done on Jonesy so I can get an idea of what exactly may be going on. A full urinalysis would also be a good idea.

Let us know if you have further questions,

Dr. Melissa Cavanagh
 
Darcy and Jonesy said:
He's scarfing down the gravy like he's not been fed . . . ever . . .
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Again, the fact that he's eating so well is a really good sign. It is possible for cats to develop high ketones with no outward signs (she's not on much these days, but I think @Bobbie And Bubba 's Bubba was one), so it's not like it's not also dangerous, but it's a whole lot easier to address when they're eating than when they're not.

Christie & Maverick said:
Okay thank you for that test, that helps. The HC gravy should kick in shortly, so let's see in another 20 minutes, unless others think differently.
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I agree, let's see what that HC can do, and keep a close eye on things.
 
Looks like the LC brought him up some. Please limit the HC to a couple tsps. We don't want to fill him up in case you need him to eat again later.

Can you try retesting with the blood ketone meter? Maybe test on you too, to make sure you are doing it right. Sorry, expensive strips I know.
 
Nan & Amber (GA) said:
Is there an ER vet in your area? Not saying you have to go there right now, just gathering information.

Glad you are bumping up the carbs-- 40 is way too low. Plus, with ketones in the background, you may need to find a way to shoot some insulin eventually tonight (though not yet!!!!)
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Yes, there are a couple of ER vets in the city, but I'm not going to sugar coat things, I can't handle another $2000 bill. I can't :arghh: That was only a month ago, and my other cat cost me about $1000 a few weeks ago. This will break me. I'd have to put him down . . . Jesus, I can't even think right now
 
Well that's ONE wasted strip :banghead:

This ruckusfruckus piece of sh*t meter. I've now wasted two strips, on myself, the meter is reading an error of "either not enough blood, or problem with test strip, or incorrect testing procedure"

I want to throw this thing out into the snow right now as my finger bleeds all over the keyboard . . . not enough blood my ass

I'm sorry, now I'm into the pissed off, yet still ready to cry stage. It's not pretty :(
 
Ugh, I totally understand that situation. Luckily, we're not nearly at a crisis point yet.

Let's try to get that ketone meter re-test as the next step. I don't have one of these meters, so I don't know how they work-- can you get the BG and ketones from one sample/strip, so that you could combine the BG re-check with this?

Darcy and Jonesy said:
Well that's ONE wasted strip :banghead:
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Yearrrgghhhh..... :blackeye:
 
Nan & Amber (GA) said:
Ugh, I totally understand that situation. Luckily, we're not nearly at a crisis point yet.

Let's try to get that ketone meter re-test as the next step. I don't have one of these meters, so I don't know how they work-- can you get the BG and ketones from one sample/strip, so that you could combine the BG re-check with this?



Yearrrgghhhh..... :blackeye:
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I'll do another glucose test (it's been 25 minutes) and I'll *try* another ketone strip. But I'm SO frustrated at how much blood it takes! If it shows an error again, I don't know what the heck is going on
 
Darcy and Jonesy said:
I'll do another glucose test (it's been 25 minutes) and I'll *try* another ketone strip. But I'm SO frustrated at how much blood it takes! If it shows an error again, I don't know what the heck is going on
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Well, this one is just a sanity check on that previous reading so it's not a critical monitoring thing-- just hoping against hope that maybe that 3.7 was an error and you don't need to be freaking out tonight, so it seems worth doing for that reason. But if the meter/strips keep making it difficult, then we'll just move forward assuming the 3.7 is real, and try to get a urine test somewhere down the line.
 
Hah! "See, I'm not sick, mom! Or, wait... maybe if I'm sick I get to eat pizza????"

I feel like we should try to shoot some kind of dose eventually tonight to help keep the ketones down, but it's going to be tricky with him just barely hitting 50 after the HC-- I'd like some definite signs that he's rising first. Also, you're now already an hour off schedule, so it'll probably be at least two hours late by the time we could possibly make that call. Will that be a problem for you?
 
Nan & Amber (GA) said:
Hah! "See, I'm not sick, mom! Or, wait... maybe if I'm sick I get to eat pizza????"

I feel like we should try to shoot some kind of dose eventually tonight to help keep the ketones down, but it's going to be tricky with him just barely hitting 50 after the HC-- I'd like some definite signs that he's rising first. Also, you're now already an hour off schedule, so it'll probably be at least two hours late by the time we could possibly make that call. Will that be a problem for you?
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No, I have time in the morning to always "back up by 15" his shot. So if I'm two hours late tonight, I technically could shoot tomorrow. BUT, that would be I'm having to shoot and leave. I'm gone for about 9 1/2 hours and there isn't any way for me to get home as I'm the only one "on the floor" tomorrow at work. Can't even call in sick
 
Nan & Amber (GA) said:
Hah! "See, I'm not sick, mom! Or, wait... maybe if I'm sick I get to eat pizza????"

I feel like we should try to shoot some kind of dose eventually tonight to help keep the ketones down, but it's going to be tricky with him just barely hitting 50 after the HC-- I'd like some definite signs that he's rising first. Also, you're now already an hour off schedule, so it'll probably be at least two hours late by the time we could possibly make that call. Will that be a problem for you?
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I did take away the HC after he ate a good portion of it, but he didn't have the whole tin.

It's hard for me to understand wanting to getting his numbers back up, only to get them down low again :( If his numbers are low, isn't that even healthier in regards to keeping control of any ketones? I'm so confused :(
 
Darcy and Jonesy said:
I did take away the HC after he ate a good portion of it, but he didn't have the whole tin.

It's hard for me to understand wanting to getting his numbers back up, only to get them down low again :( If his numbers are low, isn't that even healthier in regards to keeping control of any ketones? I'm so confused :(
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Overall, yes, the lower numbers are healthier. The ketones story is more complicated than that, though, it's not just about low BG-- insulin has a separate, additional role to play in keeping ketones down/away. So, sometimes it makes sense to bump up carbs to try to deliberately bump up BG just to be able to shoot more insulin.

In this case, there's also the fact that Jonesy was just too darn low to shoot at 50 (post-HC dose). 72 is much better-- how long has it been since he had that gravy?
 
I'll also start off the dose discussion by suggesting going back to 0.75U. @Wendy&Neko , your thoughts?

[Edited to add: though I would still like to see one more rising number before shooting, I'm just starting the discussion now so you can have the plan in place]
 
Nan & Amber (GA) said:
Overall, yes, the lower numbers are healthier. The ketones story is more complicated than that, though, it's not just about low BG-- insulin has a separate, additional role to play in keeping ketones down/away. So, sometimes it makes sense to bump up carbs to try to deliberately bump up BG just to be able to shoot more insulin.

In this case, there's also the fact that Jonesy was just too darn low to shoot at 50 (post-HC dose). 72 is much better-- how long has it been since he had that gravy?
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hmmmm, maybe an hour since the gravy? Should I give him more?
 
With ketones in the picture, I wouldn't reduce too much, maybe to 1.0 units. But you really do have to be vigilant. I don't see any tests last night. Especially after a day of flat yellows.

If you start to see him really zooming up, without any additional food given, you may be safe to shoot.

Could we do a food/BG/time summary? Food should be carbs plus amount.

+12 BG 40 - how much LC given?
+12.25 BG 47 - food given?
+13 BG 50 - food?
+13.5 BG 72 - food?

Note, including extra food given in the Remarks of the spreadsheet is helpful for next time for you too.
 
Darcy and Jonesy said:
Only this morning I moved him up to 1.25. He was in the pinks and yellows for a good five days :( (I have to be away from the computer for about 15 minutes) will check back asap!
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Yes. I'm being a bit conservative here because I'm thinking that we can more or less consider that tonight's lows came off of the 1.0U depot finally filling up (rather than the single 1.25 dose this morning), and reducing from there. Plus, even on the three official days of the 1.0, you did see at least one blue. And then for a third reason, you are not going to be able to monitor at all tomorrow, so going a little conservative seems safer.

That said, on the other side of the ledger is what I said above; sometimes, when ketones are in the picture, it's better to aim for more insulin, increasing carbs if it's necessary to do that safely. I'll be interested to hear what others who have more direct ketones experience than I do have to say. The boards are kind of quiet tonight, but I'll go ahead and tag @Sandy and Black Kitty on this question, just in case she checks in later. [ETA: oh good, Wendy has checked in with advice!]
 
Wendy&Neko said:
Could we do a food/BG/time summary? Food should be carbs plus amount.

+12 BG 40 - how much LC given?
+12.25 BG 47 - food given?
+13 BG 50 - food?
+13.5 BG 72 - food?
Click to expand...

I've no idea how to determine the exact carbs :( I'm sorry, I just know low versus high

+12 BG 40 - how much LC given? He ate approx. 2/3rds tin of FF classic chicken, then I also gave him the HC gravy FF food. He was eating that between the +12 and the +12.25

+12.25 BG 47 - food given? I took away the high carb food at this time.
+13 BG 50 - food? None
+13.5 BG 72 - food? None

I was under the impression I didn't want him to continue eating (endlessly) in case he *needed* to eat something later??
 
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