? Buddy’s ketones going up post DKA

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DArcey and Buddy

Member Since 2020
Buddy’s ketones are going up and I’m getting quite scared. The highest we’d ever seen on the blood meter was 0.9 previously. Half an hour ago she was at 1.3, and now she is at 1.6.

I’m just really scared. We are trying so hard. I know I’m supposed to try not to worry until they get above 2, but they seem to be rising so fast, and I know how quickly things can unravel with DKA so I’m freaking out.

@Bron and Sheba (GA) @Chris & China (GA) @Judy & Fritz

Link to the previous thread: https://www.felinediabetes.com/FDMB/threads/uti-buddy-post-dka-part-4.251337/#post-2836780
 
The 1.6 is still OK.
Have you given the SubQ fluids today?
Is she eating well?
Is she acting normally? ie not lethargic?

We are giving 100ml subq fluids in 25 minutes. It’ll be an hour earlier that we gave them yesterday (so it’s be 23 hours, not 24 hours since the last time), but yesterday we only gave 50ml.

Right now she is acting normally. I’m just scared because when she went into DKA last time, she was acting energetic and cuddly the night before (although, she had stopped eating and so my parents, watching her at the time, skipped her insulin dose).

She is eating decently. We haven’t tracked the exact amount today but she is eating small meals/snacks frequently (basically we offer her food very frequently and she eats some most of the time.

We just shot, and I admit, we increased by .25. We should have waited for advice, but I wanted to get the insulin into her ASAP. We will be testing all night.

This is just so hard.
 
I know you are worried and how much you love her and of course you are anxious, but I want you to remember you are in a very different position to when she went into DKA before. She had stopped eating and the dose was skipped. That is not happening now.
She is eating well, she is getting the insulin, and she is getting those extra fluids…..theses are all the things you need to be doing to keep those ketones away.
Because you increased the dose, make sure you monitor closely….I know you will and you can always give the higher carb food like we did before if she drops low.

I’m going to tag @Liz & Minnie for you. She has been through DKA with Minnie some time ago, and Minnie still shows up with the amount of ketones that Buddy does. . I’m sure Liz will be able to reassure you.

Remember Buddy can feel your anxiety so big breaths and try and not stress too much. (I know it’s easy for me to say) You are doing everything right. :bighug:
 
How are the urinary symptoms? The vet should be able to find out if there were any bugs growing in the urine by now…..but not the sensitivities to any antibiotics……that will take a couple of days. Might be worth ringing the vet and asking if he can find out any preliminary results.
 
I know you are worried and how much you love her and of course you are anxious, but I want you to remember you are in a very different position to when she went into DKA before. She had stopped eating and the dose was skipped. That is not happening now.
She is eating well, she is getting the insulin, and she is getting those extra fluids…..theses are all the things you need to be doing to keep those ketones away.
Because you increased the dose, make sure you monitor closely….I know you will and you can always give the higher carb food like we did before if she drops low.

I’m going to tag @Liz & Minnie for you. She has been through DKA with Minnie some time ago, and Minnie still shows up with the amount of ketones that Buddy does. . I’m sure Liz will be able to reassure you.

Remember Buddy can feel your anxiety so big breaths and try and not stress too much. (I know it’s easy for me to say) You are doing everything right. :bighug:

Thank you @Bron and Sheba (GA), you are such a kind and lovely person :bighug: I am trying to stay calm(ish). My mama-brain really kicks in and I find it so hard, but I’m trying to re-center and tell myself all the things you’ve reminded me of above. Thank you for being so continually patient with me as I freak out.

We will definitely be monitoring her extra close, promise :cat: Now that she has the insulin and fluids in her, we will monitor, and make sure she is eating as well as possible (bed side food service while being petted, which is her favourite way to be pampered, is available 24 hours a day! She knows she has us under her thumb, lol).
 
She knows she has us under her thumb, lol).
I think most cats have their owners under the thumb!:joyful: Mine do!

am trying to stay calm(ish). My mama-brain really kicks in and I find it so hard, but I’m trying to re-center and tell myself all the things you’ve reminded me of above. Thank you for being so continually patient with me as I freak out.
It’s perfectly normal to feel as you do after you have been through DKA with Buddy.
She is an extra lucky girl to have such a devoted mama and papa.

As a matter of interest…did you test the ruined when you had the higher numbers on the blood meter?
 
I think most cats have their owners under the thumb!:joyful: Mine do!


It’s perfectly normal to feel as you do after you have been through DKA with Buddy.
She is an extra lucky girl to have such a devoted mama and papa.

As a matter of interest…did you test the ruined when you had the higher numbers on the blood meter?

Aww thank you :bighug:

We haven’t gotten a urine test in a few hours, but we will definitely get one the next time she pees!!!

We are cuddling her and loving on her, and trying to to stay calm (and hoping and praying!)
 
How are things going over there in Canada? Hopefully you have managed to get some sleep.
Hi @Bron and Sheba (GA) :bighug: sorry for the late reply! We eventually did manage to both get some sleep! Not a lot, but some, haha.

Just spoke with the vet, and there’s still no news on the urine culture, not even whether or not there was bacteria in it, sigh. A bit frustrating; I guess they are quite slow at the lab.

After the highest ketones of 1.6 last night, she eventually went down in ketones after fluids and insulin, thank god. This morning she was back up to 1.0, and I approached it more calmly, made sure she ate, drank and had insulin, and then retested and she was down lower again.

As hard is it is on me, Buddy seems relatively unphased at the moment. If she could talk, she would probably roll her eyes and say, “wow, mama is really dramatic!!” Lol.

At some point, I will attempt to add a column to our SS just for tracking ketone information, which I think would be helpful for us to have.
 
Thanks for the tag @Bron and Sheba (GA) and sorry about the delayed reply, I didn't even log in yesterday. The good side of that (for me) is I read this to the end and things are looking much better.

You have all my sympathy with the ketone situation, it's terrifying once a) you've been through it and b) fully understand the implications. I feel that getting the blood ketones are a double-edged sword - it's great to have those readings so early that you can take action, but on the other hand you start worrying a lot earlier when you see the numbers going up. One of the things I like to do to calm myself when I see an increasing blood ketone is to also get a urine ketone reading because (for Minnie at least) what I think is a worryingly high blood ketone reading doesn't even show up on the urine reading. I've just looked back and on 29March just in the middle of her ICU-cation (3 times in/out - 'she's fine to be at home' followed by re-admitting within 2 days) her blood ketone showed 5.9 and urine was still 'trace'. Now, knowing that doesn't stop me taking action or worrying, but it's like having an advance warning like the yellow gas tank warning light in the car.

It's great you can give fluids, I haven't had to do that yet - I was all ready to do it but she ended up in the hospital, way back in the spring. And great that you gave the insulin, too! Has the vet talked to you about giving Regular insulin for when the ketones are high? Our IM introduced me to it this last go-round - her advice when ketones are increasing is fluids, feeding and continue with the insulin (even if not eating). And when she's got increasing ketones and 'high' BG I will give R insulin. I put "high" in quotes because you have to work out the right dose of regular insulin for your cat and it's a trial and error effort, not to be carried out without supervision. Reading your latest update though, seems that you are doing great without the supplemental R.

Oh, the urine culture. I've had to wait for that too. I'm not entirely sure how much is due to the lab communication and how much is because they have to wait for the culture to grow. Last time round, they took a sample on Tues for in-house culture and Sat morning I hadn't heard back and she was in/out of the tray again so I called them. Confirmed a UTI, but they wanted to send it out for another culture to identify the exact bacteria and that was yet another week...but, we got the right antibiotic which cleared things up (though it was 10 unpleasant days injecting her with a stinging antibiotic! I had to bring in a second pair of hands and a serious kitty burrito to do that).

Sorry for the rambling, thought it might be comforting to hear someone else's inner voice who has a ketone-prone kitty. I have a column on my s/s for ketones - way over on the right. I have lots of columns, you'll notice...

AND, to end on a positive and hopefully encouraging note for you - Minnie's ketones have been fine for ages. Her blood ketone has never been lower than 0.2 - for her she is typically in the 0.3 - 0.5 range.

Good luck, I'll look out for you - feel free to tag me if you need moral support or have questions on my experiences!
 
Jess,I will ask @Bandit's Mom if she will add that extra column for the ketones if you like?
That is a great idea. @Liz & Minnie has the column for ketones and it is very easy to look through and see the results.
I’m glad you both got some sleep…It is so much easier to think and cope when you are less tired.
Bron
 
Hey Jess and D’Arcey…..how are things with Buddy?
It’s good seeing those blues creeping backinto the SS.
Hey Bron,
Buddy has had a pretty good day. She has been eating and been super cuddly with us. I think she is in some discomfort due to the antibiotics (the clavaseptin doesn’t agree with her tummy poor thing). Her ketones have been okay. She had got up to 0.8 just prior to her AMPS, and 0.9 before her PMPS, but after her insulin, eating, and getting her evening fluids, she dropped to 0.1. I think we are getting the hang of handling her ketones and not panicking straight away, but is still nerve wreaking.
 
Lovely long run of blues during the PM cycle!
Yeah! She did amazing last night. We are wondering is she is bouncing a bit, or if the high numbers are just part of the post DKA process. I guess time will tell!!

Thanks for the tag @Bron and Sheba (GA) and sorry about the delayed reply, I didn't even log in yesterday. The good side of that (for me) is I read this to the end and things are looking much better.

You have all my sympathy with the ketone situation, it's terrifying once a) you've been through it and b) fully understand the implications. I feel that getting the blood ketones are a double-edged sword - it's great to have those readings so early that you can take action, but on the other hand you start worrying a lot earlier when you see the numbers going up. One of the things I like to do to calm myself when I see an increasing blood ketone is to also get a urine ketone reading because (for Minnie at least) what I think is a worryingly high blood ketone reading doesn't even show up on the urine reading. I've just looked back and on 29March just in the middle of her ICU-cation (3 times in/out - 'she's fine to be at home' followed by re-admitting within 2 days) her blood ketone showed 5.9 and urine was still 'trace'. Now, knowing that doesn't stop me taking action or worrying, but it's like having an advance warning like the yellow gas tank warning light in the car.

It's great you can give fluids, I haven't had to do that yet - I was all ready to do it but she ended up in the hospital, way back in the spring. And great that you gave the insulin, too! Has the vet talked to you about giving Regular insulin for when the ketones are high? Our IM introduced me to it this last go-round - her advice when ketones are increasing is fluids, feeding and continue with the insulin (even if not eating). And when she's got increasing ketones and 'high' BG I will give R insulin. I put "high" in quotes because you have to work out the right dose of regular insulin for your cat and it's a trial and error effort, not to be carried out without supervision. Reading your latest update though, seems that you are doing great without the supplemental R.

Oh, the urine culture. I've had to wait for that too. I'm not entirely sure how much is due to the lab communication and how much is because they have to wait for the culture to grow. Last time round, they took a sample on Tues for in-house culture and Sat morning I hadn't heard back and she was in/out of the tray again so I called them. Confirmed a UTI, but they wanted to send it out for another culture to identify the exact bacteria and that was yet another week...but, we got the right antibiotic which cleared things up (though it was 10 unpleasant days injecting her with a stinging antibiotic! I had to bring in a second pair of hands and a serious kitty burrito to do that).

Sorry for the rambling, thought it might be comforting to hear someone else's inner voice who has a ketone-prone kitty. I have a column on my s/s for ketones - way over on the right. I have lots of columns, you'll notice...

AND, to end on a positive and hopefully encouraging note for you - Minnie's ketones have been fine for ages. Her blood ketone has never been lower than 0.2 - for her she is typically in the 0.3 - 0.5 range.

Good luck, I'll look out for you - feel free to tag me if you need moral support or have questions on my experiences!

Thank you so much for this detailed reply! So sorry for my delayed response. This is a lot of helpful info. I may indeed tag you in the future, especially if we find ourselves with ketones high enough that we aren’t sure if we should head to the hospital!! The highest we have seen is 1.6 since getting home almost two weeks ago after her DKA. I was very very worried but feeling a little calmer now. I was not aware the we might be able to get R insulin for when ketones go up! None of the vets have ever mentioned it. I’m not sure if they would be eager to give us any- it seems like the trend is to think that owners have no clue what they are doing- but it’s worth looking into!
 
I was not aware the we might be able to get R insulin for when ketones go up! None of the vets have ever mentioned it. I’m not sure if they would be eager to give us any- it seems like the trend is to think that owners have no clue what they are doing- but it’s worth looking into!
We don’t use this option of using R a lot here. It is mostly used for high dose kitties such as Acros.
There are only a couple of people here who can help with this process. It is specialised. You would not want to do this without out having someone who knows what they are doing, to help you. We can usually manage the ketones by just increasing the dose of the main insulin being used. I don’t think Buddy needs this option at the moment.
I will tag @Wendy&Neko to talk to you about it.
 
Just a word of caution about R insulin … it can be a very powerful and dangerous insulin if you don’t understand its action and how to use it. And please do NOT look at how others have used it for guidance. As Bron said, many of those folks have cats with very specific illnesses, such as acromegaly, and the doses they use can kill an “average” diabetic. Think of it as your current Prozinc insulin being a somewhat gentle roller coaster with some ups and downs vs R insulin being a steep/fast/whipping roller coaster with 2G force.

I don’t want to scare you, but it is important to understand the gravity of using R so that you have the correct information and guidance when/if the time comes. Wendy is great at advising on it so hopefully she can jump in should you need to go that route.
 
We don’t use this option of using R a lot here. It is mostly used for high dose kitties such as Acros.
There are only a couple of people here who can help with this process. It is specialised. You would not want to do this without out having someone who knows what they are doing, to help you. We can usually manage the ketones by just increasing the dose of the main insulin being used. I don’t think Buddy needs this option at the moment.
I will tag @Wendy&Neko to talk to you about it.

@Bron and Sheba (GA) and @JL and Chip thank you both for this information! If I understand correctly, it sounds like that R insulin would be a last resort, if we are unable to get get stabilized and keep her stabilized using other methods.

So for now, we will just remain focused on: getting the Prozinc dose right for Buddy, keeping her on all her meds, keeping her eating well to keep ketones down, testing often for BG and for ketones, general monitoring and giving subq fluids as needed!

Buddy has been home from the hospital for 11 days now, and although I’m always afraid to jinx it, she seems to be doing fairly well overall. She does still have *some* ketones in her blood, but they have always been between 0.2 and 1.6 (and thankfully we have only seen 1.6 once- on every other day, the highest she has ever been is 0.9, and once, 1.0). She has also regained energy (along with some grumpiness, lol), plays for an minute on occasion when prompted, eating pretty well (knock on wood! And she is still being a picky eater, and eating most high carb food, and though we want to transition fully back to low carb, our main priority is that she be eating frequently and eagerly) and even appears to have gained back the little bit of weight she lost while refusing to eat while in the hospital! And, today we finally got the result of her urine culture- we confirmed that the previous antibiotic was no good for this bacteria, and today we switched her over to the new one. So we are hoping and praying that this is all as good as it seems. As always, so thankful for all of your help- and sorry I am so long winded when talking about my baby girl, lol!!
 
R would indeed be a last resort. We recommend you do not start it unless you have a person experienced in R to help you. There is a lot to learn about when to use it, and equally if not more important, when not to use R. Unfortunately all our R users use either Lantus or Levemir as their main insulin, and understanding how the basal insulin works with the bolus (R) is an important part of it. Not to say it couldn’t be done, but we’d have to be very conservative in our approach. I think your idea of working on the Prozinc dosing is a good one, and hopefully that will put the ketones in the rear view mirror.
 
Great about the new antibiotic! I had a feeling that was the problem. Thinking of you guys and little Buddy. You’re doing amazingly well. Talk about your baby all you want.
 
Glad Wendy and other moderators did some clarification and level setting. Something I should have pointed out about our introduction to R insulin (Minnie is on Levemir by the way) - this was introduced to us by our Internal Medicine vet. I didn't even realize there were specialist vets (though now it seems obvious) until after our 2nd hospitalization when our primary vet recommended we stay under the care of the IM vet for the diabetes. The primary vet wasn't even familiar with Levemir (we started on Lantus). It was a long wait to get the first appointment with the IM but I'm so glad to have her on our team even though I am managing the diabetes with help here, pretty independently of the vet - just tell her what we're doing.

Also - when Minnie was in a bad way with her ketones (hospitalized) the blood ketones were at 5.7 and 5.9 with urine ketones reporting 'trace'. 7.6 was moderate. But to repeat what is said everywhere, ECID and the time it takes for those values to change varies. I also have the bonus feature that Minnie smells of acetone round her head when she has high levels of ketones - that was my first clue she was even diabetic. All this to say - keep tracking Buddy's blood ketones and over time you will build a better picture of when to be concerned. (e.g. some people are concerned when they see 0.3 but for Minnie I know that's pretty normal). Doesn't have to be TOO frequent, those are little strips of gold!

Glad to hear you've got the right antibiotic and hope little Buddy is back to himself very soon. You're doing great!:bighug:
 
That is good news! I’m sure getting onto the correct antibiotic will help! :)
I am hoping so! Her stomach seems to be quite unhappy with the antibiotic (veraflox) so far. She always has diarrhea when on antibiotics, but it seems worse now. Today she lay down in the litter box twice, which distressed me a bit! We are giving her Fortiflora SA once a day, but I just posted to the FB group to see if anyone has any insight into whether using s boulardi would be okay/better. She is on a lot of meds, so I only want to add that in if it would be safe and helpful.
 
I am hoping so! Her stomach seems to be quite unhappy with the antibiotic (veraflox) so far. She always has diarrhea when on antibiotics, but it seems worse now. Today she lay down in the litter box twice, which distressed me a bit! We are giving her Fortiflora SA once a day, but I just posted to the FB group to see if anyone has any insight into whether using s boulardi would be okay/better. She is on a lot of meds, so I only want to add that in if it would be safe and helpful.
S boulardii is very good. Keep it away from the antibiotics though by at least two hours.
@Sienne and Gabby (GA) has a good regime for s boulardii which diarrhoea.
 
Hi Jess and D’Arcey, how are things today?
How is that gorgeous girl? Has her tummy settled?
No results in the SS for ketones for a few days…I’m assuming they are Ok?
I think you could probably go up in dose again. What th8nk?
I’ll just tag @JanetNJ ti ask her opinion.
Bron
 
Hi Jess and D’Arcey, how are things today?
How is that gorgeous girl? Has her tummy settled?
No results in the SS for ketones for a few days…I’m assuming they are Ok?
I think you could probably go up in dose again. What th8nk?
I’ll just tag @JanetNJ ti ask her opinion.
Bron

Hi @Bron and Sheba (GA)! We are doing okay here! How are you?

Ketones have been ranging between 0.1 and 0.9 every day, basically. Thanks for the reminder- I will update the SS! I think D’Arcey added a new column for us to track this info.

Her belly definitely seems upset. She only wants to lie on the floor (as opposed to couch or bed) which stresses me out, but she is still eating and acting fairly normal. Her energy is a bit lower, but not to the point that I’m too concerned. She is also a bit moodier/hissing a little but the past two days. It just seems she is feeling a bit “off” and given it started when the new antibiotic did, I’m assuming that’s the cause. The few times we can convince her to cuddle, she is still purring and content! She is not “meatloafing” so I don’t think she is necessarily in pain, but perhaps just feeling off.

We got blood work done Tuesday, and got the results today. She is still anemic (PCV 24%) but she was as low as PCV 21% in hospital and was at 26% when she went home, so I am hoping that decrease isn’t too bad of news. She also has very high pancreas values (not surprising at all to me). However her kidney values have returned to normal, with the exception of phosphate which is elevated, thyroid looks good, and white blood cells look good. One liver/gallbladder level was marginally elevated, but it has been for about a year now. Overall, I took this to be fairly positive news!

I agree that it might make sense to go up by .25 again but with wait until we hear what others think! We are content with her numbers lately but would eventually like to go back to seeing some dark greens around her nadir!

Jess
 
Can you post the lab results? There is a spot on the SS for them. If you do I will ask Marje to have a look and comment on them.She is very good.
When you say the pancreas levels are very high….which test is that?
Great the kidney values are back to normal.
 
Can you post the lab results? There is a spot on the SS for them. If you do I will ask Marje to have a look and comment on them.She is very good.
When you say the pancreas levels are very high….which test is that?
Great the kidney values are back to normal.

Good idea! Yes, I will post them once I have them- right now I only have the summary from the vet, not the actual results.

For the pancreas, she said the following: specfPL (specific feline pancreatic lipase) is high. normal is 0.0 - 3.5, 3.5 - 5.4 is grey area, > 5.4 is considered likely pancreatitis. Buddy 's level is sitting at 34.8.
 
2.75 dose sounds good.

@JanetNJ and @Bron and Sheba (GA), we are getting ready to do Buddy’s evening shot, and she is the lowest that she has been pre-shot in ages- she is at 290 (16.1). We are planning to shoot the full amount, but we don’t think it’s a good time to raise the dose for that reason. We will have to monitor her closely. Perhaps the antibiotics are taking away the infection now, and hence the slightly lower preshot number?
 
@JanetNJ and @Bron and Sheba (GA), we are getting ready to do Buddy’s evening shot, and she is the lowest that she has been pre-shot in ages- she is at 290 (16.1). We are planning to shoot the full amount, but we don’t think it’s a good time to raise the dose for that reason. We will have to monitor her closely. Perhaps the antibiotics are taking away the infection now, and hence the slightly lower preshot number?
Ok so 2.5. :)
 
@JanetNJ and @Bron and Sheba (GA), we are getting ready to do Buddy’s evening shot, and she is the lowest that she has been pre-shot in ages- she is at 290 (16.1). We are planning to shoot the full amount, but we don’t think it’s a good time to raise the dose for that reason. We will have to monitor her closely. Perhaps the antibiotics are taking away the infection now, and hence the slightly lower preshot number?
I agree. Stick with the current dose. The antibiotics could be doing the job. Good to see a lower preshot…..progress! I know you will monitor closely.
 
I see you have increased the dose tonight. Not a lot of movement in the numbers but I do see that green BG a couple of nights ago.
Do you think the antibiotics have helped at all?
How is her appetite? Ketones.?…….oh I see you have a column for ketones now!
 
I see you have increased the dose tonight. Not a lot of movement in the numbers but I do see that green BG a couple of nights ago.
Do you think the antibiotics have helped at all?
How is her appetite? Ketones.?…….oh I see you have a column for ketones now!

Hi @Bron and Sheba (GA)! Thanks for asking!

Yes, I was happy to see one green number last night! We upped the dose by .25 tonight. Looks like we only got her into the blues tonight- but we will give this new dose some time to work it’s magic!

With the antibiotics, I think it has helped her bladder- she is spending a lot less time in the litter box. She has been pretty tired the last day or so- though whether she is more tired than usual or whether I’m just more paranoid is debatable, haha. She has taken to lying on the floor- and I think if she were lying on the couch, I would feel better about things- but then again, the weather is boiling hot here, so ever with the air conditioning on, she is likely just lying where she feels most comfortable.

We are still seeing ketones, but I am trying to be calm about them! We are testing at shot times for ketones, and maybe 1-2 additional times during the day, depending. We have not tested for urine ketones in quite a few days now- we weren’t getting much useful info out of that, compared to the blood ketone meter- and she is peeing a lot less now that she’s on antibiotics for the UTI!

Her appetite seems pretty good (knock on wood!)! The last time she had an appetite stimulant was four days ago. We have also started to cut back slowly on the anti nausea and the pain meds. We are still giving the bupe three times a day, but at a lower dose than before, and have reduced the gabapentin to 2 time a day instead of three. We have paused the cerenia for now, and are just giving the ondasentron now, still half a pill twice a day. It’s hard to be completely sure if she is still experiencing some pain and/or nausea, but I generally feel that if she is eating willingly and she is not in the meatloaf position, that she is doing okay!

We have also paused giving daily fluids. We still have them on hand in case ketones go up, or in case she seems dehydrated, but we have not given any fluids the last 5 days.
 
That sounds overall a good report and progress!
Going in the right direction which is great.
Hopefully the BGs will start to come down further soon, especially the preshots.
 
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