Footfoot ketones 1.6

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HelenR

HelenR

Member Since 2022
I've just tested Footfoot's ketones for the first time, this morning before eating: the reading is 1.6, which puts her into 'large' presence of ketones, just. What should I do? She seems fine, though she has been especially ravenous the last couple of days. Should I just feed her as much as she'll eat, of low carb wet food?
I was planning to take another week to slowly remove Hill's d/d dry food from her diet, moving her to low carb wet food completely. If low carbs is the way to go for ketones, I can stop the d/d today.
Advice?
 
I am assuming you are testing the ketones with a blood ketone meter. Has Footfoot had ketones before?
1.6 ketones on a meter for cats is not at a dangerous level. It is when it gets to 2.4 that I would be concerned.
However I would increase the amount of food you are feeding Footfoot and also try and add a teaspoon of warm water to each snack you give her. I would offer her a small snack every couple of hours. Let her eat whatever she will eat. Don’t try and change the diet and remove all the dry food straight away, I would keep to the schedule you have to remove the dry.
I also think I would increase the dose to 1.25 units twice a day as long as you can monitor the cycles and get at least one test in each cycle…including the pm cycles.. I will tag @FrostD to see if she agrees with the increase in dose as I am not a Prozinc user.
I would also test for the ketones twice a day at the moment.. if you could put all the results of the ketones tests into the SS remarks column, that would be very helpful please.
 
Bron and Sheba (GA) said:
I am assuming you are testing the ketones with a blood ketone meter. Has Footfoot had ketones before?
1.6 ketones on a meter for cats is not at a dangerous level. It is when it gets to 2.4 that I would be concerned.
However I would increase the amount of food you are feeding Footfoot and also try and add a teaspoon of warm water to each snack you give her. I would offer her a small snack every couple of hours. Let her eat whatever she will eat. Don’t try and change the diet and remove all the dry food straight away, I would keep to the schedule you have to remove the dry.
I also think I would increase the dose to 1.25 units twice a day as long as you can monitor the cycles and get at least one test in each cycle…including the pm cycles.. I will tag @FrostD to see if she agrees with the increase in dose as I am not a Prozinc user.
I would also test for the ketones twice a day at the moment.. if you could put all the results of the ketones tests into the SS remarks column, that would be very helpful please.
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Thank you so much! I'll retest, and follow your advice on food. Will wait to see what the consensus is on insulin dosage.
 
HelenR said:
First test was at 10:10. I've tested her again at 12:00, it's reading 1.1, so yes it has gone down!
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Ketones can fluctuate but it is good they have gone down. I would still give the extra food and fluids and increase the dose of insulin at the next dose.
Apart from ketones. Lethargy, loss of appetite, vomiting, diarrhoea, dehydration are all red flags.
 
yeah ketones climbing up can be scary. I'm not sure how informed you are on what causes them and why they are a concern, if you are looking to learn more check this out:

https://felinediabetes.com/FDMB/thr...and-diabetic-cats-a-primer-on-ketones.239971/

Hendrick went into Diabetic Keto-Acidosis and was hospitalized for 2 days ($4600, oof). After that, we watched his ketones levels closely and followed the advice given here to feed 150% of normal calories, make sure plenty of water is available to help flush those ketones away, and of course insulin, insulin, insulin. Those are the 3 keys to keeping DKA at bay.

Not sure if you have the general rule of thumb info for ketone levels but if not, here is what I was given by the experts here:

below .6 = trace amount, no worries
.6 to 1.2 = possible sign ketones are climbing, monitor closely
above 1.2 = call the vet IF in addition to the ketone level, kitty shows any symptoms (as Bron said -- Lethargy, loss of appetite, vomiting, diarrhea, dehydration)

however, ECID (every cat is different). Some cats have higher ketone levels and never show symptoms or signs of incoming DKA. Hendrick's would go up and down from day to day, always keeping me on my toes and worried. But after about 4-6 weeks on insulin, all good. No more ketones!

[edit] - bonus pic of my boy Hendrick in the hospital, but feeling better. He would be released that same day. Man, I bawled my eyes out lol

upload_2022-9-16_10-58-40.png
 

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I've tested ketones again today, and they're 1.8 (AMPS). Since raising her dose of Prozinc from 1U to 1.25 on Friday, I was hoping to see both her ketones and her BG go a little lower. But today they're both higher. My guess is that I need to give it a few more days before I react, but it is looking as though I'll need to raise the dose again?
She still seems fine, though ravenously hungry.
 
Ok given ketones we're going to be a little more aggressive and follow MPM until she gets into some lower numbers. Increase to 1.5U either tonight or tomorrow morning. Hold for 6 cycles before considering an increase.

I'm not too concerned about ketones yet but they're definitely higher than I'd like to see. They may also indicate she's fighting some sort of infection or inflammation still. Just keep pushing food and fluids as best you can.
 
HelenR said:
@Hendrick Cuddleclaw , @Shelley & Jess , @Bron and Sheba (GA) - do you guys think I should increase to 1.5U, too?
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you can take what FrostD (Melissa) recommends to the bank, her expertise outweighs mine by a metric $%*ton

I don't give dosing advice period, I'm just a guy who has been through it with his own kitty and experts like FrostD were crucial in helping me along the way. Also, I did not use PZ with Hendrick. We were Lantus/Basaglar users.

MPM is Modified ProZinc Method.
 
HelenR said:
Thanks, @FrostD . What is 'MPM'?
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Like Diane and Kyle mentioned, Modified ProZinc Method. It essentially allows for faster increases based on nadir.

Ordinarily we would NOT follow it due to the higher carb food/diet transition. So anyone reading this now/in the future should understand this is a special case.

But right now you are getting enough tests in that we won't get any surprises, and I don't want those ketones much higher. It's possible she's a cat that just runs a little higher on ketones (time will tell), but in my opinion it is better to increase the dose a little sooner vs risk ketones going up (just for the time being). My main concern is the UTI hasn't cleared up, or she'll get another one (factors in DKA) so in this instance the scales lean more towards proactively preventing DKA than following the methods as-written.

So hold the 1.5U for 6 cycles and then we'll re evaluate; more than likely you'll end up holding it closer to 8-10+ cycles as I suspect she'll start to see blues from the combination of increased dose and food transition.
 
HelenR said:
do you guys think I should increase to 1.5U, too?
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Yes I agree with Melissa. When there are ketones, higher BGs and possibly an infection, we need to be more aggressive with dosing.
Are you giving plenty of food…snacks as well as main meals?
How is her appetite?
 
Just for your knowledge as you're only just joined us recently Helen:

These are some of the top FDMB Expert advice-givers that I am most familiar with, most of them can give dosing help depending on what insulin you are using, guide you when needed, etc: Bron and Sheba, Suzanne & Darcy, Wendy&Neko, Christie&Maverick, FrostD (Melissa), tiffmaxee (Elise), Bandit's Mom (Bhooma)

Very knowledgeable and a super great resource for nearly all things FD but not likely to be comfortable giving dosing advice: Diane Tyler's Mom

Just a guy who owes all the people mentioned above a debt he can never repay for getting his boy Hendrick into diabetic remission: me :bighug: (Kyle)

Feel free to tag me whenever and ask whatever, and I will do my best to help. I work from home and I'm looking at the forums a lot both while working and after work, sometimes I'm most useful in getting one of the experts above to hop in a thread and provide guidance to whomever needs it at that moment.

@Shelley & Jess please don't take offense to the lack of a mention, I'm not super familiar with you and what level of expertise or assistance you bring to the table. You may have even given me advice in the past and I forgot if so I apologize!

and there's probably a few people I am forgetting. Let's blame age. :D
 
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Yesterday her BG numbers were looking a bit lower and I thought, great, we're starting to get on top of this.
But today, all her numbers are in the red! What's going on, do we think? :-o
 
that looks like what we call bouncing

going a bit lower into the yellows could have caused her liver to "panic" and release stuff that sort of artificially raises the BG


bounces can take 2-3 cycles to clear iirc
 
found it in the glossary:

BOUNCE: When a cat’s BG numbers drop into a low range, drop fast, or drop into a range the cat is no longer used to, the liver and pancreas may respond by releasing a stored form of glucose along with counterregulatory hormones. This causes numbers to spike back upward. It can take up to 3 days/6 cycles for a bounce to clear.
 
looking at her spreadsheet, she could have gone even lower last night than 256. Low point (nadir) looks to be more around +5 to me so if she got down into the blues that would explain the bounce for sure, I think
 
HelenR said:
Sure enough, today, our first blue! 10.3 (185mg/dl) at 3 hours post-morning-shoot. I'll test again in an hour.
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yeah that's a fairly significant drop from AMPS, if she keeps dropping at that rate you might see green today even. Probably flattening out by now though based on history
 
Hendrick Cuddleclaw said:
yeah that's a fairly significant drop from AMPS, if she keeps dropping at that rate you might see green today even. Probably flattening out by now though based on history
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I should have tested again at +5, just to be really sure where the nadir is, but yes - rising again now.
 
doubtful she was any lower at +5 imo. Nice blues today though!! If she was bouncing, she cleared it nice and quick. Things seem to be happening on this dose, good progress!

You're doing a great job with the testing, spreading them around different times of day. The picture is filling in.
 
And today, some reds, some pinks, some yellow, and a blue! I'm curious as to what tomorrow will bring. It would be great if the picture looked a bit more comprehensible, but I HAVE been warned that patience is required. There's a bit of a gap in testing from today, as I've gone down with a virus and slept all afternoon and evening. :-/
 
I'm glad.you got the extra test last night, that was quite a big drop. If she keeps dropping hard like that, we may need to feed slightly higher carbs in those first few hours. I'll keep an eye on the trends over the next week or so - but for now you're holding the dose!
 
FrostD said:
I'm glad.you got the extra test last night, that was quite a big drop. If she keeps dropping hard like that, we may need to feed slightly higher carbs in those first few hours. I'll keep an eye on the trends over the next week or so - but for now you're holding the dose!
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Thanks so much Melissa. Yes, I stayed up and tested again, just to be sure.
Today it's been looking pretty good. Unfortunately she did sick up her dinner tonight, so I had to give her a second dinner 2 hrs later. Her BG reading looked OK.
I had experimented with giving her a bigger portion, to see if she might leave some to come back to later in the night: nope, eat it all and then throw it up! Doh! I've ordered a timed feeder, I'm thinking that way I could give her a meal in the middle of the night so she's less desperate with hunger by the morning... she currently gets fed at more or less 3-hr intervals though the day, but then has to get through the whole night, while the good-for-nothing humans are asleep, on just one meal! :D
 
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