3/5 Ducia AMPR 262,1.25U,+3 233, ketones Large

[Tanya and Ducia]

http://www.felinediabetes.com/FDMB/...0-5-increase-no-shot-105-after-1-hour.174243/

Hello,
I wanted to post an update on Ducia:

On Friday 3/3 PMPR 317, Lantus dose 1.5U an increase from 1U then she was
+3 BG 197, +6 BG 206

Saturday 3/4 AMPR 68, skip the shot, fed, +1 105, +2 124, +4 178, +6 320, +9 382
PMPR 370, fed low carbs, 1U, +3 330, +6 294, +9 266
ketones positive Large on dip strips

Sunday 3/5 AMPR 262, fed low carb, 1.25U (best eyeballing we could manage) and +3 233.
ketones positive Large.
The +3 is taken 2 h 15m after a meal and 2 h 35m after 75 ml SQ fluids per vet advice.

We are very new to FD- post DKA- post Hypo that we are dealing with and we cannot understand her readings well. She dropped to 68 after 1.5U, remained high after 1U yesterday PM cycle, but relatively unchanged today AM after 1.25U which was 0.25 increase. I cannot figure out what to make out of it.

Vet called with the urine analyzes, ketones >80mg, urine glucose >2000. He didn't email the results as was agreed so I do not have them at the moment.

 

[Sienne and Gabby (GA)]

Large ketones really cannot be managed at home. This could easily be an emergency situation. I'm very surprised your vet did not tell you to come in or go to an emergency vet.

 

[Jill & Alex (GA)]

Sunday 3/5 AMPR 262, fed low carb, 1.25U (best eyeballing we could manage) and +3 233.
ketones positive Large.

I agree with Sienne's comments in her post above. If ketones are large treatment involves hospitalization.

We are very new to FD- post DKA- post Hypo that we are dealing with and we cannot understand her readings well. She dropped to 68 after 1.5U, remained high after 1U yesterday PM cycle, but relatively unchanged today AM after 1.25U which was 0.25 increase. I cannot figure out what to make out of it.

Ducia is bouncing from the low yesterday morning (68).
Here's a short and simple explanation of what bouncing means:

Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

[Tanya and Ducia]

He did. We cannot afford hospitalizations any more.
Her physical condition is actually good if to judge by behavior, eating/ drinking and litter box visits.
We going to monitor closely, give SQ fluids 75 - 100 daily and we also can control her food/water intake as she is fit with Esophagus tube.

 

[Tanya and Ducia]

I took her ketone urine dip strip test just now still at the lower level of Large.

 

[Jill & Alex (GA)]

I took her ketone urine dip strip test just now still at the lower level of Large.

That's still to high to expect to successfully treat at home.

As you already know, diabetic ketoacidosis can develop quickly when kitty is throwing ketones. It's a life threatening condition. Given the circumstances, the best advice I can offer is to start applying for assistance to every organization in this post: Financial Help Links. Perhaps you can find an organization to help.

 

[Tanya and Ducia]

best advice I can offer is to start applying for assistance to every organization

Thank you.

 

[Tanya and Ducia]

That's still to high to expect to successfully treat at home.

We can monitor closely at home, give food/water via Tube and adjust dosage. we have hopes because her actual behavior is better now. Much healthier than we've seen in weeks. The goal as we see it is to keep her within the range of 100 - high mid 200s for some time continuously.

 

[Jill & Alex (GA)]

We can monitor closely at home, give food/water via Tube and adjust dosage. we have hopes because her actual behavior is better now. Much healthier than we've seen in weeks.

These are all things that will help and her behavior is a positive sign, but throwing "Large" ketones is extremely worrisome. There's more to treatment than food/water and insulin. That's why hospitalization is highly recommended. Perhaps you'll find help on the list I gave you. It's really in Ducia's best interest to look for any possible help available to you.

 

[Tanya and Ducia]

Thank you , I will check the list right now.

 

[Squalliesmom]

Please, please try to find a way to get Ducia back to the vet and hospitalized. I am afraid this is more than can be managed without veterinary intervention. You and Ducia have been through so much, and fought so hard for her to get well, I would hate to see anything happen to her now! Please do look over the list of financial help, and try contacting some of them. Ducia needs help and she depends on you to get it for her.

 

[Nan & Amber (GA)]

I will add my voice to say please do everything you can to get Ducia back to the vet. A ketone situation can turn very bad, very fast.

I took a look at Ducia's spreadsheet and see that she is back in blues this afternoon. I hope you have found a way to take her to the vet so that she is undergoing professional care, but either way I want to emphasize: she cannot afford any skipped insulin shots at this point, no matter what her BG numbers are. Give her the highest-carb food you have if you have to, to increase the BG numbers and keep her safe, but she must have insulin to help deal with ketones. It's not all about the BG numbers at this point-- others can explain why better than I can.

Keeping you guys in my thoughts, hoping you are able to find a way to get her to a vet ASAP.

 

[Tanya and Ducia]

she must have insulin to help deal with ketones.

She will have her shot at the reg time, at 6:30pm pacific. The dosage will depend on how she reads thru the day.

 

[Nan & Amber (GA)]

Any luck on getting her to a vet? We're all very worried!

 

[Tanya and Ducia]

please try to find a way to get Ducia back to the vet and hospitalized

Should our fin circumstances were better off I would agree without a moment of hesitation. But they are not. The critical care hospital she's been the last time did excellent job getting her out of critical condition after hypo and she left with urine glucose significantly lower. But she had high 300s BGs.
We thought that if we follow the food protocol (1 can given in 4 portions over 24 hours), monitor frequently her BGs and adjust the Lantus dosage accordingly we would be successful in stabilizing her in the wide range of 100 - 230-ish as highest. If such range can be achieved, the urine glucose would lower, too. We monitor her now with ketone dip strips. The last one was in the lower large, which is still dangerous, I understand that. There are many complications to her FD, in addition to lurking ketons. The ER approach was to have some more very expensive procedures done to figure out what is actually going on with her p-tities, her liver, etc. That would be right on my own expense as it is more of a maintenance, a long term treatment than an emergency for which we already received more than generous help. Secondly, I couldn't shake off a feling that although the procedures were highly desirable we've been "milked" in a way. The resolution of all -DKA, p-titie, fatty liver is dependent on stable BG. We do our best at home. We monitor, we can get her SQ fluids as needed. The food/water intake is easier with the etube which as our vet verified placed well and has no issue with it. Her condition - behavior, sleeping, litter box visits are improved tremendously. I haven't seen her like tat in weeks.

Just in +9 BG 91, 1/4 can food eaten; ketone test result in color at the trace level but I want it to be verified @ litter box visit. She also passed a poo which is much closer to a normal color, not the jaundice like variety she has yesterday. I guess I am trying to say that although professional care would be incomparable better we see here at home improvements.

 

[rhiannon and shadow (GA)]

is that a 5 oz can or a bigger can?

one 5 oz can isn't enough for daily calories.... unless its special.

 

[Nan & Amber (GA)]

I am going to tag @Meya14, @Marje and Gracie , and @Jill & Alex (GA) , who might be able to explain things better than I can (looks like @rhiannon and shadow (GA) are already here, which is great). In the meantime, I'm just going to repeat what I said earlier about the BG numbers not being the whole story here. The insulin itself acts to help keep ketones down. It is better to run higher numbers and shoot the full dose than to give a reduced dose because numbers are low. You can always feed high-carb food to get numbers high enough to be able to shoot the full dose.

I'm not experienced enough to give any more specific advice than that, but those are the general guidelines. Additionally, even in a non-DKA case, we don't recommend changing Lantus doses in response to pre-shot numbers-- it is a "depot" insulin, and works better with a consistent dose.

 

[rhiannon and shadow (GA)]

yes.... you need to give insulin.... it can be a reduced amount....but you need some. Don't worry about the numbers right now except being too low.....

not enough insulin + not enough water + infection is the recipe for dka.
Is there an antibiotic being given?


editing: I said that wrong.....

The typical cause for ketones developing is not enough insulin + infection/inflammation + not enough calories

 

[Tanya and Ducia]

That's still to high to expect to successfully treat at home.

We do hope that a week within stable BG range can give us an opportunity to access her condition better and to work on further plan of action.

 

[Tanya and Ducia]

one 5 oz can isn't enough for daily calories.... unless its special.

It is 5.5 can however yesterday she had more than that -about 1 and 1/4 can, and it looks she is going to have more than 1 and 1/4 today.

 

[rhiannon and shadow (GA)]

her bg numbers aren't causing the ketone issue......
The typical cause for ketones developing is not enough insulin + infection/inflammation + not enough calories

I don't see any mention of an antibiotic.

 

[Tanya and Ducia]

You can always feed high-carb food to get numbers high enough to be able to shoot the full dose

I have high carb Soulistic canned food with gravy.

 

[rhiannon and shadow (GA)]

you can give her a little more food than that .....
How is her appetite?

 

[Tanya and Ducia]

I don't see any mention of an antibiotic

she is currently is on antibiotics

 

[Tanya and Ducia]

How is her appetite?

Great after 6 hours fasting

 

[Tanya and Ducia]

unless its special

It is low carb Friskie classic pate, but she is getting more for the 2nd day, about 1 and 1/4.

 

[rhiannon and shadow (GA)]

why is she fasting..... do you just mean the time in between meals?

Will she take little bits in between? I would be offering kitty milk .... for the calories....

 

[Tanya and Ducia]

You can always feed high-carb food to get numbers high enough to be able to shoot the full dose.

Thank you!

 

[Tanya and Ducia]

do you just mean the time in between meals

yes, the time between the meals. She supposed to get her 24h ratio in 4 portions. It works good because by her preshot test she gulps it in 3 min and receives her insulin. Otherwise it is etubing which we for now reserve for med, or an emergencies.She eats more thou for thhe 2nd day now.

 

[Tanya and Ducia]

You can always feed high-carb food to get numbers high enough to be able to shoot the full dose.

we are going to test in 10 min, high carb food ready as well as the regular. I will ask your advice as soon as tested. All depends on BG.

 

[Tanya and Ducia]

The typical cause for ketones developing is not enough insulin + infection/inflammation + not enough calories

She getting Metranidazol 0.5x2 for 7 days. Vet took urine test yesterday no mentioning of infection. Visible no fever, improved physical condition, CBS on 02/23/17 hasn't shown any infection/inflammation.

 

[Tanya and Ducia]

I'll take a break for +10 test. Be back shortly

 

[PumpkinsMom]

Tanya,

As I said via text, she can and should eat as much as she wants right now.

Do not give high-carb food unless she is legitimately having low numbers.

You are doing great with subq fluids and free water via e-tube.

 

[Tanya and Ducia]

As I said via text, she can and should eat as much as she wants right now.

Do not give high-carb food unless she is legitimately having low numbers.

+10 BG 77. eats another 1/4 of can regular , not high calorie food.
I me4ant not high carb food

 

[Tanya and Ducia]

What are the constipation signs in cats? Ducia just went to the litter box, pushing pushing and nothing happens. She left the box. It has happened twice already today however earlier she left 1 small fecal ball in there. Is she constipated? If yes, what can we do?

 

[Tanya and Ducia]

As I said via text, she can and should eat as much as she wants right now.

She ate about half of the 1/4 can and walked off. She maybe constipated. Should I finish the rest of whatever she left thru etube?

Her shot is at 6:30pm pacific,

 

[PumpkinsMom]

Yes, finish the 1/4 can in the tube and give 10mL of water after.

She could be constipated but that would be odd considering how much fluid she is getting. Is she walking around and having some activity?

 

[rhiannon and shadow (GA)]

she may be willing to eat more in a bit....

for constipation, many add pumpkin to the food....
but you can also let her lick some butter or even put vaseline on your finger and put it on her palate. She will have to swallow it.

 

[Tanya and Ducia]

She could be constipated but that would be odd considering how much fluid she is getting. Is she walking around and having some activity?

Yes, she walks around and gave more headbumps this afternoon that we have seen in the weeks.

 

[Tanya and Ducia]

I'll take a break to finish her extra 1/4 can meal via etube. Be back soon
Decided to postpone until reg feeding at preshot.
Ducia lost interest in food for now

 

[Dyana]

Just in +9 BG 91, 1/4 can food eaten; ketone test result in color at the trace level

Tanya, I have been at work all day and worrying and hoping for the best for you and Ducia. I am SO GLAD that her BGs are down, and that her ketone test result was trace. That is such good news! Please keep testing her for ketones at least twice a day, for the next few days. I always tested twice a day whenever I could when my cat was high or not feeling well. With the recent problems with ketones Ducia has had it is extremely important for you to monitor them, and I'm so glad you got the urine test strips. You have so much going for you, the good insulin, knowing how to test her BGs, the E Tube already placed, and Thanks to DCIN's generous help in doing that, and this forum, to help you. So many other people with diabetic cats in this situation have none of that.
I have heard it said before on many occasions that when fighting ketones, "I don't care if you have to feed her an ice cream sundae to keep her BGs up, she needs the insulin". That's why I was trying so hard last night to encourage your to give it. If she was at the vet hospital, they would be giving her a fast acting and strong insulin to get her numbers down and also at the same time be giving her a dextrose drip to keep her BGs up enough to take the insulin. That's how ketones are fought at the vet.
I hope to God, that her next ketone test is trace again ! You are fighting the good fight. Don't give up. Hang in there. This may take a while.

 

[Tanya and Ducia]

Yes, finish the 1/4 can in the tube and give 10mL of water after.

let's hold on it until +11. She ate as much as she wanted, groomed, sleeping. It is her natural sleeping time.

 

[Tanya and Ducia]

test result was trace.

It is my 1st day of using. I'd like to verify @next potty session.

 

[Tanya and Ducia]

vaseline on your finger and put it on her palate. She will have to swallow it

I don't have Vaseline but Mineral oil. The ER doctor who gave an enema on her discharge time advised against Mineral oil but forgot why exactly.

 

[Tanya and Ducia]

add pumpkin to the food

I have high carb Soulistic pouches which are Tuna in pumpkin soup. I can scoop out the liquid only and add to her next meal. Will that work? She used to enjoy that food but that's exactly what gave her FD. Hate to tough it. Don't even know why I kept it.

I meant "hate to touch it"

 

[Tanya and Ducia]

With the recent problems with ketones Ducia has had

Our vet called with urine test earlier. Her ketones are at the pre-hospitalization level of >80mg. But as I said, the strip test color was seemed to be lightening. We will keep monitoring.

 

[PumpkinsMom]

I am going to strongly disagree with the advice being given to shoot a low number.

This cat was diagnosed with diabetes and DKA 9 days ago. 5 days ago she suffered a symptomatic hypo with recurrent seizures on 1u of Lantus.

Giving honey or ice cream or Karo is not even remotely the same as having IV access for D50 or possessing Glucagon in the event of low numbers.

This cat is waaaaay too sensitive to even suggest the use of R at home. In a vet's office, this cat would be titrated with a constant rate infusion using a syringe pump.

She has a very late nadir and needs to be shot to her cycle as her body dictates.

Sidenote: DCIN has spent $2700 helping Ducia and we would be sincerely appreciative of any support from our loyal FDMB supporters.

 

[Tanya and Ducia]

Tanya, I have been at work all day and worrying and hoping for the best for you and Ducia. I am SO GLAD that her BGs are down, and that her ketone test result was trace. That is such good news! Please keep testing her for ketones at least twice a day, for the next few days. I always tested twice a day whenever I could when my cat was high or not feeling well. With the recent problems with ketones Ducia has had it is extremely important for you to monitor them, and I'm so glad you got the urine test strips. You have so much going for you, the good insulin, knowing how to test her BGs, the E Tube already placed, and Thanks to DCIN's generous help in doing that, and this forum, to help you. So many other people with diabetic cats in this situation have none of that.
I have heard it said before on many occasions that when fighting ketones, "I don't care if you have to feed her an ice cream sundae to keep her BGs up, she needs the insulin". That's why I was trying so hard last night to encourage your to give it. If she was at the vet hospital, they would be giving her a fast acting and strong insulin to get her numbers down and also at the same time be giving her a dextrose drip to keep her BGs up enough to take the insulin. That's how ketones are fought at the vet.
I hope to God, that her next ketone test is trace again ! You are fighting the good fight. Don't give up. Hang in there. This may take a while.

Thank you Dyana,
we are going to test in 15min and then advice as to dose will be much needed.

 

[Kris & Teasel]

I am going to strongly disagree with the advice being given to shoot a low number.

This cat was diagnosed with diabetes and DKA 9 days ago. 5 days ago she suffered a symptomatic hypo with recurrent seizures on 1u of Lantus.

Giving honey or ice cream or Karo is not even remotely the same as having IV access for D50 or possessing Glucagon in the event of low numbers.

This cat is waaaaay too sensitive to even suggest the use of R at home. In a vet's office, this cat would be titrated with a constant rate infusion using a syringe pump.

She has a very late nadir and needs to be shot to her cycle as her body dictates.

Sidenote: DCIN has spent $2700 helping Ducia and we would be sincerely appreciative of any support from our loyal FDMB supporters.

I made a donation a couple of days ago.

 

[Nan & Amber (GA)]

I am going to strongly disagree with the advice being given to shoot a low number.

I will definitely defer to the opinions of the experts here.