6/18 - Fiona not doing well - ketones, low BG

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Sharyn & Fiona

Member Since 2009
Princess Enigma strikes again. Her BG's have been under 250. 215 this AM, 208 last night, 245 yesterday morning - all on no insulin. She's still not eating, although yesterday she was nibbling a lot. Appetite stimulant worked for a bit. Now her ketones are up to 3.5bbk. I was thinking we were safe since her BG's were low'ish - wrong. It's been 4 years since I've gone thru this with her. I forgot that infection can cause ketone too. sigh. She's not showing any outward signs of infection, like urine issues but she wasn't the last time either. I know I'm the ketone queen but my crown is a little dusty. Could use suggestions. I'm giving her fluids right after I send this.
 
Hi guys .. don't think I've been in fiona's condo yet .. so welcome from us .. sorry to hear things are not going well .. I have no experience with ketones myself but hopefully this bumps your post up and others can get their eyes on it ...
 
Sending the strongest of snowflakes to Fiona.
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Feel Better, Fiona.

From what I remember, she needs to eat (like 1 and 1/2 times her normal amount) and get enough insulin and fluids.
I am not sure about the insulin or the fluids, but have you been syringe feeding her?
 
She was walking very wobbly before I gave her fluids so I took her to vet for IV fluids which I confirmed they would get her on right away - versus last time when they waited half the day. Hope to come home with AB too.

Yes, to syringe feeding, just once yesterday because she was nibbling all day. 30cc's last night and this am - AD+water to thin for syringe. I should have given her fluids last night.

thanks for the welcome. for those who don't know us, we're old timers from the other board. Fiona has IAA and ridiculous insulin needs which I don't track in a spreadsheet anymore because I couldn't figure out how to write down 9.5u fat minus one drop in that small little box on the ss.
 
Sharyn --

Remember Jojo's recipe for ketones = infection + not eating + not enough insulin.

If you have to give Fiona HC to get her to eat, the calories are critical. Often, you may need to go to 1.5 times her usual amount of calories. Adjust the amount of insulin if you have to to offset the food. Food and insulin are critical. It doesn't matter if you have to give Fiona ice cream, she needs the calories as much as she needs the insulin.

Am I correct in that you know how to use R? If so, if Fiona is having ketone issues and it's warranted, a TOR may be another strategy to consider.
 
Sharyn & Fiona said:
Princess Enigma strikes again. Her BG's have been under 250. 215 this AM, 208 last night, 245 yesterday morning - all on no insulin. She's still not eating, although yesterday she was nibbling a lot. Appetite stimulant worked for a bit. Now her ketones are up to 3.5bbk. I was thinking we were safe since her BG's were low'ish - wrong. It's been 4 years since I've gone thru this with her. I forgot that infection can cause ketone too. sigh. She's not showing any outward signs of infection, like urine issues but she wasn't the last time either. I know I'm the ketone queen but my crown is a little dusty. Could use suggestions. I'm giving her fluids right after I send this.
blech! i really didn't want to see this post! your crown may be dusty, but it'll all come back to you.

we all have a tendency to forget ketones can rear their ugly heads at bg numbers of 120 or 520. when kitties are in high numbers we watch for ketones, but when the "right" set of circumstances presents itself (insufficient insulin, inappetence, and infection or certain other systemic stresses) ketones can and do develop at much lower numbers. your vet should treat infection (if present) or figure out what else is going on in fiona's little body. there could be another health issue concurring besides an easily identifiable infection.

i understand the reluctance to give her insulin while her numbers are under 250 and she's not eating, but she needs insulin... even if she has to be put on a glucose drip or have a feeding tube put in order to feel comfortable administering insulin safely. home treatment normally consists of administering an adequate supply of insulin, fluids, treating the underlying cause, making sure kitty gets as much food as possible, an appetite stimulant if necessary, and testing for ketones as often as possible. we usually suggest the normal amount of calories plus half that amount everyday... especially when syringe feeding because not all of it gets into the cat. food is so important that i'd give her whatever she'll eat whether it's low or high carb foods... even if it's "people" food. that's how important food is. in most/many instances it's necessary to incorporate the use of R even if you have to feed high carb foods to prevent her from tanking.

karrie/maverick and linda/bear man will probably be along with med suggestions if fiona is experiencing any nausea. both of them have extensive experience.

i know how fiona has struggled with ketones in the past. i hope this is a short-lived episode and she's back to her normal self as quickly as possible.

sending positive thoughts and hugs...
 
Jill & Alex said:
Sharyn & Fiona said:
karrie/maverick and linda/bear man will probably be along with med suggestions if fiona is experiencing any nausea. both of them have extensive experience.

Sharyn, I am so sorry that Princess Fiona is unwell. I don't have any experience with dealing with ketones, but the meds that I would recommend for nausea are Ondansetron and Cerenia. I used Ondansetron in pill form, and Cerenia in injectable form. Ondansetron is primarily intended for nausea, and Cerenia for vomiting, but I have had good results with using both for nausea. The two drugs can be given together. Cerenia is normally used for a short duration, such as 3 - 5 days.

Karrie/Maverick is the assist feeding expert here. I wonder if at some point you might also need to consider a feeding tube, to get the required number of calories into her.

I hope that the vet can get an antibiotic started to get any possible infection under control. Has the vet done a urine culture on a sterile specimen? Sometimes cats will have a UTI and not show any classic symptoms other than feeling extremely unwell.

I am sending lots of healing vines to Fiona.
 
Oh, gee, nothing to add but I just want to lend my support because I can feel your frustration. Even a dusty crown is better than none, though, and I'll bet you get right back into the swing in no time.
 
Home from vet, has bladder infection, feeling very punky, got some new R and gave first dose at 1u - that's what vet was giving. Doing hourly curve to see how she works the R. vet doesn't want us to give lantus until over this hump and to give R IM. I always gave SubQ. BG around 200. force feeding. long night ahead. poor baby girl. thanks for snowflakes and vines.
 
1 unit of R can be a lot. I would test hourly, until you know her reaction to that dose. Do you have experience with R?
 
I agree with Dyana regarding frequent testing. Injecting IM may effect absorption but I'm not sure whether that's the case for every cat. The only way you'll know is if you curve. Please update when you can.

(Remember that when you re-start Lantus, you will need to cut back on the R dose.)
 
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