8/27 Noodle AMPS 355 Trace Ketones Should I increase dose?

[Christianna]

Noodle's BG was higher this morning but more worrisome was that he had trace ketones again when he had none yesterday. He has been on 1.5fat for several doses. In view of the ketones, even though they were trace, should I bump him up immediately to 1.75U? If so, should I do it with his PM shot (I can get up to monitor) or wait till tomorrow's AM shot? Weird question, but when his BG is higher is he more likely to develop ketones? Many other kitties' spread sheets show higher BGs than Noodle but luckily for them, no ketones. I don't exactly understand the connection.Thanks so much for advising me.

Christi

 

[Sienne and Gabby (GA)]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

I think it would be wise to both increase Noodle's dose and to try to get another ketone test.

FWIW, unless you are seeing nadirs that are in the normal BG range (50 - 120), I would encourage you to follow the protocol and increase by 0.25u. I'd especially encourage the standard dose increase in a kitty that's prone to developing ketones.

In response to your question, which was not weird in the least, the basic recipe for ketones is not enough insulin + infection/inflammation + not eating = ketones. The "not enough insulin" generally means the numbers are high. However, a cat can be in lower numbers and still develop ketones -- it's just more likely if there's an infection present which can also elevate BG numbers. If you're still dealing with pancreatitis and IBD, both of which are inflammatory, you'll need to be attentive to the amount of insulin and ketones. The other factor is that some cats just seem to be more prone to ketones.

One additional thing you can do is to make sure you're adding water to Noodle's food. You may also want to ask your vet about giving Noodle fluids if you see that ketones are developing. Both adding water to food and/or fluids helps to flush ketones out of your kitty's system.

You may want to check out getting a NovaMax meter. They have a promotion for a free meter. It takes a few weeks to get the meter, though.

 

[Christianna]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Hi Sienne and Gabby,
Thanks so much for the great information and explanations and also the info about the free meter. I just went and ordered it--seems like a really good idea to me!
Noodle had exploratory surgery in May to find out the extent of the IBD (mild-moderate) and that's how the pancreatitis was discovered. The pathologist said his case was unusual as only one lobe of the pancreas was inflamed. As far as we know Noodle doesn't have an active pancreatitis (no symptoms) but the vet also said that some cats have a chronic lowgrade pancreatitis with few to no observable symptoms. He seems great in every other way but I always freak out when I see even a tiny color change in the ketone strip. His IBD has totally quieted down with a diet changed from dry to wet and also eliminating his allergens. Fortunately he never had to go on steroids. No telling what kind of mess we'd be in if that had happened.
I keep a bag of fluids on hand but they are about 6 weeks old. They have been refrigerated so I know I'd need to bring them to room temp. Do you know how long they stay good for?
So your advice is to raise to 1.75? Should I do it with tonight's dose, do you think? Thanks again, so much!

Christi

 

[Sienne and Gabby (GA)]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

I would suggest increasing tonight. Since it's easier to measure in quarter units, increase to 1.75u. After this increase, though, I'd encourage you to give serous thought to changing doses in 0.25u amounts. If you are concerned about the ketones, then increase to a fat 1.75u tonight.

 

[Sandy and Black Kitty]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Hi there

My Black Kitty went 2 rounds with DKA - no fun.

If you are detecting trace ketones, please test Noodles urine at least twice a day. Ketones can quickly develop to a life threatening level.

For an example, check out Black Kitty ss - 06/22/2008 and 06/23/2008 - Negative to Large in 24 hours.

Anything over trace warrants a call to your vet.

 

[Christianna]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Hi Sienne and Gabby,
Thanks so much for answering. I will increase tonight, then do it in .25 units from now on. I appreciate the help and advice :smile: I got another ketone test an hour ago and it was negative. I don't understand how they come and go in one day but I'm sure glad. I will take 2 tests a day for awhile though.

Christi

 

[Sandy and Black Kitty]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

I got another ketone test an hour ago and it was negative. I don't understand how they come and go in one day but I'm sure glad. I will take 2 tests a day for awhile though.

Yay for negative

remain vigilant - ketones are sneaky devils!

 

[Christianna]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Hi Sandy and Black Kitty,
Wow--that is really scary! Trace to large in one day! Maybe I will test 3 times a day or every time I can. I have mentioned it to my vet several times and he keeps saying when we get the sugar controlled they will disappear but maybe that doesn't always happen. It really worries me but he says if they're "only" trace/small and he's eating and drinking fine to just continue monitoring. I gave 70 ml. of fluids today, maybe I'll give another 50 tonight and more tomorrow, to flush things out. Ketoacidosis REALLY scares me and it sounds like you have really been through a tough time with Black Kitty. Thanks for the warning.

Christi

 

[Christianna]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Hi Sandy and Black Kitty,
Wow--that is really scary! Trace to large in one day! Maybe I will test 3 times a day or every time I can. I have mentioned it to my vet several times and he keeps saying when we get the sugar controlled they will disappear but maybe that doesn't always happen. It really worries me but he says if they're "only" trace/small and he's eating and drinking fine to just continue monitoring. I gave 70 ml. of fluids today, maybe I'll give another 50 tonight and more tomorrow, to flush things out. Ketoacidosis REALLY scares me and it sounds like you have really been through a tough time with Black Kitty. Thanks for the warning.

Christi

 

[Sienne and Gabby (GA)]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Christi:

Do NOT increase fluids without talking to your vet. Too much fluid can be a bad thing -- it can put considerable stress on the heart and lungs. A little helps to flush the ketones. Too much and you can have a host of other problems.

 

[Sandy and Black Kitty]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Any diabetic kitty is vulnerable - BGs don't need to be crazy high for ketones to develop.

Like Sienne pointed out - the basic recipe for ketones is not enough insulin + infection/inflammation + not eating.
All 3 of those items must be addressed and brought back into harmony. It's more than getting the sugar under control.
It's a balancing act you have to carefully and safely navigate.

There is infection/inflammation somewhere. Has UTI been ruled out? How are his teeth and gums? could he be in some pain due to the p-titis?

Along with frequent testing for ketones and making sure he is getting enough calories, please let us know the daily WCR (whole cat report), which includes the 5 Ps (purring, preening,playing, pooping and peeing).

 

[Christianna]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

Noodle had a full urinalysis 6 days ago--all clear except of course sugar +++ and trace ketones. He seems to be in no pain whatsoever; in fact I haven't seen him this active and bright-eyed in a long time. He plays, purrs, preens, poops perfectly and has stopped peeing saucer-sized spots. He eats well but the ravenous behavior stopped several days ago. He drinks a small amount but nothing like before. I don't know, without symptoms, how I could tell if he still has any inflammation in the pancreas. His teeth, according to the vet, are "OK" but will need cleaning before the year's out. So with all the positive signs, I am absolutely baffled by the high BG numbers. Tonight's was the worst :cry: I will hold off on the fluids until I talk to the vet. Unfortunately our main vet, the one I trust, is on vacation till Sep.8 so I have to go to the "B team" in the interim and he is not as familiar with Noodle's case. The vet did call me before he left today for vacation and said to go to 1.75U tonight for 4-5 days and if needed, go to 2U b.i.d. Does this sound reasonable to you?
Thanks.

Christi

 

[Sandy and Black Kitty]

Re: 8/27 Noodle AMPS 355 Trace Ketones Should I increase do

in fact I haven't seen him this active and bright-eyed in a long time.

Glad to hear this
Keep a close eye on his appetite and make sure he is getting enough calories to reach/maintain a good body weight.
I can't speak to fluids as they were not part of our experience however many here who do use fluids can offer experienced guidance.

The vet did call me before he left today for vacation and said to go to 1.75U tonight for 4-5 days and if needed, go to 2U b.i.d. Does this sound reasonable to you?

Being that trace ketones are still showing up your best strategy is to be more aggressive. I recommend you hold 1.75 for 4 cycles and then re-evaluate. If numbers are not improved it may be wise to increase to 2.0u at that point. If there are still trace ketones, holding the dose could be risky.

I'll add that aggressive treatment requires aggressive monitoring. Do whatever you have to do to get 1 mid cycle test each and every cycle.

You are on a tightrope here - on one side lies possible DKA and on the other possible hypo - both risky to Noodles life (as well as your checkbook)
The only way to stay safely in the middle and make the best dosing decisions while you navigate Noodle out of this is through close monitoring.

His teeth, according to the vet, are "OK" but will need cleaning before the year's out.

Has he ever had a dental?
Glad to hear a it's in his near future. The impact of even one bad tooth can be huge.
Bad teeth and gums were BKs achilles heel. You can see the dramatic effects of addressing his dental issues on the graph below (and his ss).
He had a decaying tooth fragment removed on 10/23/2008, his first dental on 12/08/2008 and his second dental on 05/29/2009.The rest is history.