Concerned about Tucker, would not eat this morning, blood ketone in "caution" area

Tucker's Mama CS

Tucker's Mama CS

Member Since 2019
Good morning everyone,


Tucker was not feeling well this morning and would not eat his breakfast or even treats. His blood sugar was too high for the meter to read (>600) so I checked his blood ketones with the NovaMax and it said 0.7 which put it in the “caution” area. It has never been in this area since I bought the meter, has always given a result of 0.4 the few times I have checked it. I texted his IM specialist whom has not responded yet. Thoughts?
 
http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/
Here's a link to an info post on ketones DKA in general.

From that link

When do ketones show up on a blood ketone meter such as the Nova Max Plus or Precision Xtra Blood & Ketone meters?

The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:

Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf


So The reading of 0.7 although higher, is not an emergency.
 
Having said that, about the ketones, if Tucker is otherwise unwell and you are worried, then of course visit the Vet, but the reading in itself is not an immediate cause for concern, though you should continue to monitor.

Looking at the SS, I would guess he dropped significantly last night and that Hi this morning is the resultant bounce. I don't see a before bed test last night? given how he likes to drop fast I would try to always get one of those.
 
Gill & George said:
Having said that, about the ketones, if Tucker is otherwise unwell and you are worried, then of course visit the Vet, but the reading in itself is not an immediate cause for concern, though you should continue to monitor.

Looking at the SS, I would guess he dropped significantly last night and that Hi this morning is the resultant bounce. I don't see a before bed test last night? given how he likes to drop fast I would try to always get one of those.
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Thanks Gill
 
Here's the info I was looking for regarding the ranges with Blood ketone meters and the ranges for cats
  • 0.0 to 0.6 is negative,
  • approx. 0.7 to 3 is trace (and would show up as trace on a urine ketone test also), (so the result you got is trace)
  • 3.1 to 4.5 is small ,
  • 4.6 to 5.5 is moderate,
  • 5.6-7.0 is large,
  • 7.1 to 8 is very large and anything over 8 or HIGH is very life-threatening.
ETA
The above info was taken from a post a while back the info came from a rep and it pertained to a diabetic dog. So it may not be accurate for a cat I will try and see if I can find some reliable source that will corroborate it, and will update if I find anything.

 
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Gill & George said:
Having said that, about the ketones, if Tucker is otherwise unwell and you are worried, then of course visit the Vet, but the reading in itself is not an immediate cause for concern, though you should continue to monitor.

Looking at the SS, I would guess he dropped significantly last night and that Hi this morning is the resultant bounce. I don't see a before bed test last night? given how he likes to drop fast I would try to always get one of those.
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I did, but I didn't have time to update his spreadsheet and unfortunately my work computer has Google blocked so I am not able to sign into my account from work to update it. At +3.75 I think it was close to 400.
 
Gill & George said:
Here's the info I was looking for regarding the ranges with Blood ketone meters and the ranges for cats
  • 0.0 to 0.6 is negative,
  • approx. 0.7 to 3 is trace (and would show up as trace on a urine ketone test also), (so the result you got is trace)
  • 3.1 to 4.5 is small ,
  • 4.6 to 5.5 is moderate,
  • 5.6-7.0 is large,
  • 7.1 to 8 is very large and anything over 8 or HIGH is very life-threatening.
Click to expand...
Thank you so much Gill for that information! I feel a little bit better about that now knowing that it's an early trace amount. I am still concerned enough that I'm going to leave work early to go home and check on him. If he is still not eating (it's very unlike him to refuse treats even), then I am going to take him to his ER vet.
 
Tucker's Mama CS said:
I am still concerned enough that I'm going to leave work early to go home and check on him. If he is still not eating (it's very unlike him to refuse treats even), then I am going to take him to his ER vet.
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Sounds like a good plan.
Perhaps recheck the Ketones.

I know of ketone prone cats that have gone from trace to significant levels in a day. So with his DKA history, I would check again, and assess the whole picture.
If he's still not eating, and this is not like him to me that rings alarm bells.
Praying that he is feeling and acting better when you get home.
 
Crista & Ming said:
Phew! Thanks @Gill & George for the clarification! It's interesting that the meter would say caution. But I guess it is result that you should be cautious about. I wonder what the meter would say if it went higher?
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It's a human meter, so perhaps the range for humans is different?
It's trace, so yes caution, we want to make sure it stays that way or goes lower.

With trace, and the DKA history.
We want to
  • make sure he is getting enough insulin
  • try and get enough calories into him
  • address any infection or systemic stress
  • keep him well hydrated to help him flush out his system(add water to his food or Subq's)
  • monitor ketones more often make sure they are not on the rise, they can change very quickly
 
@Tucker's Mama CS just looking at the ss, I know you cannot update from work.

But can you tell us if you gave insulin this morning?
Did you assist feed?
As it's not updated and having read through the thread a second time it's not clear if you shot or not.
 
I have to go out now, and won't be about later when you get home.

If you haven't given any insulin this morning, because he was not eating, then that is quite worrying, as it can add to the DKA risk, what with the numbers being high and his appy being off.
If you shoot late, you would be of schedule which mgiht be difficult for work....????
I hope that he is better when you get home, but do assess the whole picture if the ketones are going up and he is still off his food, I would err to a vet visit (even more so if you did not give insulin).

If you did not get any insulin into him this morning, it is important that he get some, an option might be for the vet to address this with a shorter acting insulin.

I've asked some other folk to look in so hopefully someone will be able to help if you have further questions when you get home.
Sending prayers and vines.
 
Gill & George said:
Sounds like a good plan.
Perhaps recheck the Ketones.

I know of ketone prone cats that have gone from trace to significant levels in a day. So with his DKA history, I would check again, and assess the whole picture.
If he's still not eating, and this is not like him to me that rings alarm bells.
Praying that he is feeling and acting better when you get home.
Click to expand...
Thank you so much! I'll be leaving work in about 45 minutes, have a 40 minute drive, but I'll get an update once I get in and get him assessed.
 
Gill & George said:
@Tucker's Mama CS just looking at the ss, I know you cannot update from work.

But can you tell us if you gave insulin this morning?
Did you assist feed?
As it's not updated and having read through the thread a second time it's not clear if you shot or not.
Click to expand...
I shot half his usual dose (1 unit) and I did not assist feed. I have never had to assist feed him before.
 
Crista & Ming said:
Phew! Thanks @Gill & George for the clarification! It's interesting that the meter would say caution. But I guess it is result that you should be cautious about. I wonder what the meter would say if it went higher?
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The meter is for humans, so that caution doesn't pertain to cats. As Gill noted above the number that ketones show up in Feline blood using a human ketone meter starts around 2.4
 
Gill & George said:
I have to go out now, and won't be about later when you get home.

If you haven't given any insulin this morning, because he was not eating, then that is quite worrying, as it can add to the DKA risk, what with the numbers being high and his appy being off.
If you shoot late, you would be of schedule which mgiht be difficult for work....????
I hope that he is better when you get home, but do assess the whole picture if the ketones are going up and he is still off his food, I would err to a vet visit (even more so if you did not give insulin).

If you did not get any insulin into him this morning, it is important that he get some, an option might be for the vet to address this with a shorter acting insulin.

I've asked some other folk to look in so hopefully someone will be able to help if you have further questions when you get home.
Sending prayers and vines.
Click to expand...
Thank you so so much Gill. Sorry for the multiple replies, I am really not good at using the forum but I should have read through everything prior to replying. Yes, I did give insulin, half his usual dose (I shot 1 unit). I am going to check BG and ketones as soon as I get home and see if it looks like he's nibbled on anything at all or if he will eat for me. It's not always easy for me to tell if he's eaten while I'm out because his sister may get to the food in the feeder as well. Will update everyone as soon as I get home and get him assessed.
 
Just seeing the tag now....I don't believe the reading by itself is a matter for an ER visit however combine it with not eating and a history of DKA I would definitely be taking Tucker in to be seen.
 
Update: Upon arrival home, Tucker was licking his lips as I walked in the door (possible sign he's eaten?). BG was 370 and blood ketone down to 0.4 (normal range). His gums look pink and moist and don’t feel tacky, at least to me. He ate about 4 treats for me but is still just looking icky. Updated his spreadsheet. I texted his vet again to see if he’ll respond, but I am inclined to take him in even though his numbers have improved. I just know how good they are at hiding their illnesses and to me if he visibly doesn’t look like he’s feeling well, that’s concerning, but maybe I worry too much.

Thank you all for your concern and help!
 
Olive & Paula said:
Sounds like nausea.
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I'm thinking so too, but worried about what is making him nauseated. If it's another pancreatitis flare, he can turn to DKA in a hurry like he did last time. He is still having stool inconsistencies, which also worries me that the presumed lymphoma may have returned. He just ate a couple licks of ham baby food for me, but nothing to write home about. Still have not heard back from the vet (I even called the clinic) so I am not sure what to do! Feels like I have one foot out the door and one inside trying to decide which way to turn.
 
The pain from pancreatitis can make cats nauseas as well as I've heard mirtazapine can make cats feel crummy. I've been recommended cypro instead of mirtz by a few people but we haven't tried appetite stimulants ourselves. Have you tried ondansetron for nausea? You can use it alongside cerenia. As well as pain medication like buprenorphine or gabapentin in case Tucker has any pain.

Some cats won't eat if they feel bad.
 
Help remind me, how and when was the GI lymphoma treated, and is he still getting treatment for it?

Sending feel better vines for your little man.:bighug:
 
Crista & Ming said:
The pain from pancreatitis can make cats nauseas as well as I've heard mirtazapine can make cats feel crummy. I've been recommended cypro instead of mirtz by a few people but we haven't tried appetite stimulants ourselves. Have you tried ondansetron for nausea? You can use it alongside cerenia. As well as pain medication like buprenorphine or gabapentin in case Tucker has any pain.

Some cats won't eat if they feel bad.
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I reckon I need to speak to his vet(s) and see if they can work with me on the meds. We have worked so hard to get him stabilized since his hospitalization in December and he's been gaining back some of the weight he had lost, which is good, but perhaps we haven't found the best regimen yet.
 
Wendy&Neko said:
Help remind me, how and when was the GI lymphoma treated, and is he still getting treatment for it?

Sending feel better vines for your little man.:bighug:
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Thank you. Tucker never had a biopsy or any surgery to confirm the diagnosis because he was too sick. The IM specialist that he has been seeing told me he isn't convinced that it was lymphoma without the definitive diagnosis so he refused to give him chlorambucil when we started seeing him back in November. Tucker was on Prednisone for 6 weeks to help with all of the inflammation (lymph nodes, pancreas, kidneys and intestines were all inflamed), and then the pancreatitis and DKA came early December so he was taken off it. The last ultrasound that was done was back in January (I tried to get one on 4/19 but the IM vet refused) and he said it looked like all of the inflammation was gone. The IM specialist has said he definitely believes there is some level of underlying bowel disease.
 
Gill & George said:
How are you and Tucker doing??

Hope all is well.
:bighug::bighug::bighug:
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Aww, thank you for checking on us! The vet said that he sounded stable since the ketones came back down and so did the BG, so he didn't recommend me bring him in yesterday. He told me to keep a close eye on him and bring him in any time if he seems like he hasn't perked back up to his usual self. He did eat some baby food for me in the evening and then followed it up with several teaspoons of his Weruva and was drinking fine last night. His BG this morning was somewhere in the mid-300's but I never have time to update his SS in the morning because I usually run a little late :joyful:
 
I use a Precision Xtra ketone meter for Tig, and let me tell you, getting comfortable with seeing numbers all over the place, esp random ones over 1.0 is nerve wracking. I have read and re-read the article that's on this forum (somewhere) about 10 times. I printed it out and had a doctor read it. Even knowing that the numbers for a cat differ and its not until the number goes ABOVE 2.4 that ketones would even show up on a urine dipstick (which crazily is what the vet would use!) it's still scary. Another thing to consider is trends. Tig will go 0.4, 0,4. 0.8, 0.3 etc. But, if he were to steadily climb it could mean ketones really are increasing. I track Tigger's ketones on the side of his SS and color code them to make myself feel better. Just my 2 cents!
 
Moms2Tigger&Blu said:
I use a Precision Xtra ketone meter for Tig, and let me tell you, getting comfortable with seeing numbers all over the place, esp random ones over 1.0 is nerve wracking. I have read and re-read the article that's on this forum (somewhere) about 10 times. I printed it out and had a doctor read it. Even knowing that the numbers for a cat differ and its not until the number goes ABOVE 2.4 that ketones would even show up on a urine dipstick (which crazily is what the vet would use!) it's still scary. Another thing to consider is trends. Tig will go 0.4, 0,4. 0.8, 0.3 etc. But, if he were to steadily climb it could mean ketones really are increasing. I track Tigger's ketones on the side of his SS and color code them to make myself feel better. Just my 2 cents!
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Wow, his ketones really are all over the place. That is nerve wracking. I wonder what Tucker's would look like if I obtained results more frequently. I was prompted to do so yesterday because he was not eating nor acting himself and his BG was so high, but those blood ketone strips are super expensive!
 
Has Tucker's appetite improved over the past few days? is he back to his old self? I found myself thinking about him this morning.
 
Tucker's Mama CS said:
Wow, his ketones really are all over the place. That is nerve wracking. I wonder what Tucker's would look like if I obtained results more frequently. I was prompted to do so yesterday because he was not eating nor acting himself and his BG was so high, but those blood ketone strips are super expensive!
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Tell me about it! I try skip days here and there, esp when all seems right with him, appetite, BG, water intake. Other times I do it for peace of mind. Not knowing will cause more mental anguish then being poor at the end of the week lol. Plus Tigger is almost a year out from his diagnosis so I feel like he's getting better, stable, never another sign of the DKA occurring again. I guess its more dangerous/likely to reoccur right away, but I'm sure Im never gonna stop worrying. The ones I get are $1 a strip on amazon. I've done 2 in one day when he's read like 1.6, but then 0.4 an hour later. Apparently the numbers are almost arbitrary unless they go higher than 2.4!
 
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