9/28 Oberon +10.5 416, AMPS 395, +7.25 410 (vet AT), PMPS 335 ketones 3.5; dexa question

Small vet update: we're going to hold off on the Libre for now. She was fine with adding the IAA and senior panel + T4 and skipping fructosamine. She wants me to continue with Baytil even if the urine culture is negative; she's concerned there could be infection elsewhere (kidneys, liver). So I have to figure out how to get pills into this cat. She suggested crushing the tablet in water and syringing it into him. (Apparently the normal liquid form is "tutti frutti" flavor and cats hate it; he hypersalivated when they gave it to him on Friday, which is why they gave me tablets instead.) I need to ask later about continuing with fluids and Pepcid. More news when I get it... for now I need to try to get some work done.
 
It’s amazing the techs just got hypersalivation vs an open mouth head shake and tutti frutti bath :p!

I use the tiniest, thinnest piece of a Greenie pill pocket to wrap my pills to disguise the taste (in case the pill tastes bad as well) and I am able to get it down that way. T is easy and actually helps shuffle the pill in the right place for me...crazy luck for me. My others I have to get it toward the back of their throat and then make sure they swallow it which is probably why the vet is suggesting the fluid syringe method. They are SO good at maneuvering the pill back up and out!!I then give them a little water to make sure the pill goes down. I recently gave a friend a pill shooter that you put some water in and then the pill in its rubber tip (looks like a syringe) and then you put it toward the back of their mouth toward their throat. This particular cat was biting them :mad: so they definitely needed a way to get the thyroid pill down without using their own fingers :eek:.

Trial and error. The vets recommendation may be the most reliable and easiest way to do it. The only caveat is if that pill has an awful taste (some don’t) that they can taste in the water you are syringing. Hopefully it doesn’t &/or it doesn’t dissolve quickly & then it won’t be an issue :).
 
I hope the vet can find some answers for you and poor Oberon isn't too overwhelmed with the poking and prodding. One day only Oberon, then you're home.

I'm not sure if Amy is referring to the Krause pill popper, but it was my go-to pill shooter. In spite of spending a few years at a shelter pilling cats, Neko made me up my game in pilling. :rolleyes: The pill pockets trick worked for a couple years and back then there were low carb pill pockets. But eventually as her appetite faded and she got mouth issues (soft tissue growth due to acromegaly), bigger things were not well received in her mouth. For pills that tasted bitter or multiple meds, and at one point when I was giving meds for arthritis, heart, lymphoma, and kidneys, I would combine what meds I could into a gel cap and use the pill shooter to get those down. Size #3, 4, and 5 gel caps work well for cats. With Neko's acro growth in her throat, I usually stuck to size 4 and 5 (larger number = smaller gel cap). You can get them at Amazon or Capsuline to name two places. I could get some at the local compounding pharmacy and even the specialty vet clinic if I needed them quickly. Another alternative is seeing if there is a local compounding pharmacy that will do meat flavour meds. Neko was particularly fond of the "chicken soup" flavour, not so much the roast chicken one. :p I got buprenorphine and eventually budesonide as flavoured liquids cause those were easiest of all to give.
 
Yes—that’s the one....Krause Pill Popper :)! Saved some fingers :D!!

Hope the appointment went well and Oberon is home resting comfortable....and you are as well :bighug:
 
Back from the vet a little late; he got his Lantus at 7:30 instead of 7. BG was 410 at the vet at +7.25. PMPS 335, ketones 3.5 and he looks a little wobbly so I'm feeding him (he's starving) and I'm going to give him fluids asap and keep a close eye on him.

ETA: I know they fed him at the vet (DM, not the FF I sent along), but no idea how much. I also don't know how dexamethasone might affect BG/ketones; any ideas?
 
Welcome home Oberon :bighug:!

Dexamethasone will most likely increase the BG & the BG may be higher at first until the Dex reduces the underlying inflammation I am assuming they are using it for. Inflammation also causes an increase in BG, so hopefully, as that is treated and reduced it will help lower the BG. The challenge is being careful not to be too aggressive with insulin dosing because as the Dex wears off and hopefully, the inflammation starts to reside, you won’t need a much higher dose of insulin. How fast or how slow this happens and how much each (Dex and inflammation) effects the BG, both with increasing it and decreasing it, is an unknown right now (and differs with each cat) so usually the recommendation is to increase the dose but then hold it longer than you normally would to watch for any changes so you can adjust it easily.

I hope you and Oberon get some rest!
 
Tomlin said:
Welcome home Oberon :bighug:!

Dexamethasone will most likely increase the BG & the BG may be higher at first until the Dex reduces the underlying inflammation I am assuming they are using it for. Inflammation also causes an increase in BG, so hopefully, as that is treated and reduced it will help lower the BG. The challenge is being careful not to be too aggressive with insulin dosing because as the Dex wears off and hopefully, the inflammation starts to reside, you won’t need a much higher dose of insulin. How fast or how slow this happens and how much each (Dex and inflammation) effects the BG, both with increasing it and decreasing it, is an unknown right now (and differs with each cat) so usually the recommendation is to increase the dose but then hold it longer than you normally would to watch for any changes so you can adjust it easily.

I hope you and Oberon get some rest!
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He got the dexamethasone suppression test today to test for (or rule out) Cushing's Disease. So it's a one-time thing. I was assuming it would mess with BG a bit in the short term. I'm more concerned right now with his ketones. 3.5 is the highest he's had. He was at 2.7 Thursday night with some mild symptoms (threw up dinner and just looked a little "off") and I took him to the ER, which kicked off this weekend's adventures. He looks ok now; he ate a fair bit and I got 100 ml of subq fluids into him. (Still have to give him his Pepcid and Baytril, but one thing at a time...) Hoping the food + insulin + fluids will conspire together to bring his ketones down, but meanwhile, I'm nervous.
 
Keep checking those ketones, that 3.5 reading is a bit worrisome. Fluids should help, and add as much water to food if he'll take it. He needs to stay hydrated. You want to keep those ketones in check, the basic recipe for DKA is insufficient supply of insulin + inappetance + infection or other systemic stress. The ketones can build up quickly, please read this info, and watch for symptoms.

https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

Sorry, no experience with the Dex.

Hope Oberon feels better soon.
 
Christie & Maverick said:
Keep checking those ketones, that 3.5 reading is a bit worrisome. Fluids should help, and add as much water to food if he'll take it. He needs to stay hydrated. You want to keep those ketones in check, the basic recipe for DKA is insufficient supply of insulin + inappetance + infection or other systemic stress. The ketones can build up quickly, please read this info, and watch for symptoms.

https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

Sorry, no experience with the Dex.

Hope Oberon feels better soon.
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Yep, rereading stickies and stuff like crazy right now. One thing I just saw is that glucocorticoids can cause false positive readings on the urine ketone test. No idea whether that's also the case for the blood test, and I'm not going to make any assumptions. His appetite is good and I'm watering down his food a bit.

Ketones were 3.5 again at +1; any feel for how often I should really be checking right now? I know it probably won't change as fast as BG.
 
I'm not sure about frequency, I would think once he is settled, I think if it were me, I'd try and check again before bed, at the very latest tomorrow a.m., but maybe others will chime in. I'm very glad to hear he is taking food/water, and those fluids you gave should get absorbed soon which will help. Let us know how the evening goes, I'll keep an eye out for your posts.
 
Christie & Maverick said:
I'm not sure about frequency, I would think once he is settled, I think if it were me, I'd try and check again before bed, at the very latest tomorrow a.m., but maybe others will chime in. I'm very glad to hear he is taking food/water, and those fluids you gave should get absorbed soon which will help. Let us know how the evening goes, I'll keep an eye out for your posts.
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Thanks!

Also, I just spent 5 minutes on Google and and therefore now an expert on dexamethasone. ;) Apparently dexamethasone itself is technically a ketone, so I wonder whether metabolites of it might show up on the meter and give false positives. (No idea how specific the meter is for particular ketones.) I also found a study looking at the effect of dexamethasone on ketogenesis in rats; it increases ketone production in kidneys and liver. So there are a couple of possible things that might be linking the dexa test to the high ketones. If so, that has me less concerned in the long term, though still worried about how he's doing right now. I'll keep pushing food/water and check him again before bed.
 
Good ol' Dr. google lol.... that is actually very interesting, Lisa. I was also thinking you could call your vet and and ask about frequency of testing, but it may be you've found a possible explanation of higher ketones - it would have been nice if you had been forewarned that ketones might increase, you have enough to worry about! Hope Oberon takes his pills like a good boy.
 
Lisa & Oberon said:
Thanks!

Also, I just spent 5 minutes on Google and and therefore now an expert on dexamethasone. ;) Apparently dexamethasone itself is technically a ketone, so I wonder whether metabolites of it might show up on the meter and give false positives. (No idea how specific the meter is for particular ketones.) I also found a study looking at the effect of dexamethasone on ketogenesis in rats; it increases ketone production in kidneys and liver. So there are a couple of possible things that might be linking the dexa test to the high ketones. If so, that has me less concerned in the long term, though still worried about how he's doing right now. I'll keep pushing food/water and check him again before bed.
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That’s right—Dex for the suppression test!! Sorry about that! BG I know but effects on ketones is a good question.

By any chance was the work up done at an emergency clinic/specialty clinic? I ask because if it is a 24 hour place you could reach out to them to ask for some more info specifically with regard to ketones.
 
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Checked just now at +4.25. BG 265 (yay) and ketones 4.6 (boo). Not sure what to make of that... would ketones lag behind BG dropping? Still eating, and peed for (I think) the first time since we got home.
 
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