Frosty - 2.75 units too much, 2.5 too little? In 400s all day

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Ana & Frosty (GA)

Ana & Frosty (GA)

Member Since 2018
https://docs.google.com/spreadsheets/d/1XOMhovhTJ2xDJG3fFSEgSBZe-uddrR-qn_ARZeW6ZOk. Not sure if something else is going on since he threw up today and also has had a few accidents around the house lately. Could also just be upset because he was kicked out of the kitchen multiple times because he’s not allowed in it due to stealing food. Maybe UTI? He’s never had one. Urine clear and doesn’t smell bad. Will continue to monitor. If continues to be high may need a vet appointment. No ketones though.

Here if you’re patient enough to read through all the posts, you can figure out why his dose was changed from 2.5 to 1 up to 2.75: http://www.felinediabetes.com/FDMB/...o-test-for-ketones-does-timing-matter.194927/ this is also my previous post.
 
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Ana and Frosty said:
https://docs.google.com/spreadsheets/d/1XOMhovhTJ2xDJG3fFSEgSBZe-uddrR-qn_ARZeW6ZOk. Not sure if something else is going on since he threw up today and also has had a few accidents around the house lately. Could also just be upset because he was kicked out of the kitchen multiple times because he’s not allowed in it due to stealing food. Maybe UTI? He’s never had one. Urine clear and doesn’t smell bad. Will continue to monitor. If continues to be high may need a vet appointment. No ketones though.
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It looks like he's bouncing to me. Hold the dose for now until the bounce clears.
 
Hi Ana and Frosty,
It is quite possible that he is bouncing from the greens yesterday, it's probably a little early to know if the 2.5u is not enough. You'll need to see where he lands when he clears the bounce, before deciding the reduction hasn't held.

I noticed that on the ss you not that he has 0.8 ketones/blood. That's considered trace, I'm only mentioning it because from your post it sounds like you feel that something is off with Frosty. With his numbers being high and something feeling off, I would recommend that you test daily for ketones, they can develop very quickly and the situation can become critical very quickly.

Is he still eating OK?
 
Gill & George said:
Hi Ana and Frosty,
It is quite possible that he is bouncing from the greens yesterday, it's probably a little early to know if the 2.5u is not enough. You'll need to see where he lands when he clears the bounce, before deciding the reduction hasn't held.

I noticed that on the ss you not that he has 0.8 ketones/blood. That's considered trace, I'm only mentioning it because from your post it sounds like you feel that something is off with Frosty. With his numbers being high and something feeling off, I would recommend that you test daily for ketones, they can develop very quickly and the situation can become critical very quickly.

Is he still eating OK?
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It depends on whether she is testing blood or urine for ketones. If using a ketone blood meter 3 is trace so below 1 would mean urine is clear and ketone free.
 
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Gill & George said:
Hi Ana and Frosty,
It is quite possible that he is bouncing from the greens yesterday, it's probably a little early to know if the 2.5u is not enough. You'll need to see where he lands when he clears the bounce, before deciding the reduction hasn't held.

I noticed that on the ss you not that he has 0.8 ketones/blood. That's considered trace, I'm only mentioning it because from your post it sounds like you feel that something is off with Frosty. With his numbers being high and something feeling off, I would recommend that you test daily for ketones, they can develop very quickly and the situation can become critical very quickly.

Is he still eating OK?
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The problem with testing daily is that this meter requires a ridiculously large amount of blood, and I wasted probably 5 strips last week trying to check them. I’m worried about causing anemia, and also, they are expensive. So I think for now I’m gonna stick with once a week, or if he isn’t acting right. He ate fine this morning but vomited twice. If this cat will ever refuse food he will go straight to the vet bc he’s a ravenous former stray, constantly begging and looking for food, as u may have read in multiple posts. He has severe food anxiety.
 
Juliet said:
It depends on whether she is testing blood or urine for ketones. If using a ketone blood meter 3.5 is trace so below 1 would mean urine is clear and ketone free.
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I thought based on an article someone shared here that anything over 2.4 -2.6 in blood could mean DKA?
 
Ana and Frosty said:
The problem with testing daily is that this meter requires a ridiculously large amount of blood, and I wasted probably 5 strips last week trying to check them. I’m worried about causing anemia, and also, they are expensive. So I think for now I’m gonna stick with once a week, or if he isn’t acting right. He ate fine this morning but vomited twice. If this cat will ever refuse food he will go straight to the vet bc he’s a ravenous former stray, constantly begging and looking for food, as u may have read in multiple posts. He has severe food anxiety.
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You won't cause anemia by testing blood even if you were to tear every single hour. Re the ketones. Just be aware of them. If they start creeping up AT ALL then it's a warning sign something is wrong. Silver had two episodes of DKA and he went from 0.3 to HI in the ketone meter in a matter of days. So long as he is eating well, is infection free and getting his insulin you should be ok.
 
Juliet said:
You won't cause anemia by testing blood even if you were to tear every single hour. Re the ketones. Just be aware of them. If they start creeping up AT ALL then it's a warning sign something is wrong. Silver had two episodes of DKA and he went from 0.3 to HI in the ketone meter in a matter of days. So long as he is eating well, is infection free and getting his insulin you should be ok.
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The only time his ketones started to go up (max was 2) was when I lowered his dose. Even now with sugars of 400 his ketones are 0.8. If he continues to act weird or vomit I’m gonna take him to the vet, I’m not messing around lol. I don’t know if the accidents are due to food anxiety or something else, but if it continues he also is going to the vet.
 
Silver also had accidents until he was regulated. It's not uncommon. Not much vet will do. Vomiting not so good as that can cause dehydration very quickly.
 
Ana and Frosty said:
Do you use the nova meter? It takes SO MUCH BLOOD! I can never get enough before it times out and gives me an error... poor guy stops bleeding before I can get enough. The AlphaTrack2 takes like 1/8th if what the nova requires. I really don’t like it, but it was the only option available.
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Yes I use nova max. I don't find it uses that much. Just need a good sized drop. Bigger than for glucose reading. Are you warming the ear first? Helps to get that drop.

You need to fill the whole strip to avoid the error.
 
Juliet said:
It depends on whether she is testing blood or urine for ketones. If using a ketone blood meter 3.5 is trace so below 1 would mean urine is clear and ketone free.
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Hmm this is the info I have on blood ketones
  • 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),
  • 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.
Ana and Frosty said:
The problem with testing daily is that this meter requires a ridiculously large amount of blood, and I wasted probably 5 strips last week trying to check them. I’m worried about causing anemia, and also, they are expensive.
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Just a thought, due to the difficulties, perhaps checking urine ketones daily might be an easier/more economical alternative, from a monitoring perspective, if you see an increase it would raise alarm bells and you could double check with the blood meter.

Ana and Frosty said:
If this cat will ever refuse food he will go straight to the vet bc he’s a ravenous former stray, constantly begging and looking for food, as u may have read in multiple posts. He has severe food anxiety.
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I gathered from your earlier post that he was very food 'motivated' so definitely a change in his appy would set alarm bells off.
 
Juliet said:
Silver also had accidents until he was regulated. It's not uncommon. Not much vet will do. Vomiting not so good as that can cause dehydration very quickly.
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He has never had accidents before. I’ve had him for 5 months now, and he’s better regulated now than he was a few weeks ago. He peed on my shoes after my bf brought him out of the kitchen and closed the door, then on the dining room table overnight (the kitchen door was also closed). Today he was allowed in the kitchen bc he was feeling sick and he slept so soundly on the dog bed that I got concerned. Idk if he’s not feeling well, or he’s SO HAPPY he’s finally allowed in the kitchen. He’s a super smart cat considering he survived in NYC being declawed and all. But either way, whether it’s a UTI, or anxiety related, he may need to see a vet. We’ll see how this week goes...
 
Ana and Frosty said:
He has never had accidents before. I’ve had him for 5 months now, and he’s better regulated now than he was a few weeks ago. He peed on my shoes after my bf brought him out of the kitchen and closed the door, then on the dining room table overnight (the kitchen door was also closed). Today he was allowed in the kitchen bc he was feeling sick and he slept so soundly on the dog bed that I got concerned. Idk if he’s not feeling well, or he’s SO HAPPY he’s finally allowed in the kitchen. He’s a super smart cat considering he survived in NYC being declawed and all. But either way, whether it’s a UTI, or anxiety related, he may need to see a vet. We’ll see how this week goes...
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Not uncommon for them to pee outside LB when they have a UTI....... but as you have observed anxiety could also do it.

If he did have an infection present, then the prescence of ketones would be worrisome (even at trace levels), especially in light of the high numbers and if you throw anxiety/stress into the mix, all those can be a 'recipie' for DKA, I have seen ketones go from trace to high very quickly, and that's the reasoning behind my caution.
 
Gill & George said:
You are correct in your thinking Ana

Here is a link to a post by Jill where she gives a link to a couple of studies

http://www.felinediabetes.com/FDMB/...max-plus-ketone-question.108294/#post-1146088
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*Could being the operative word - Silver was at 6 on the ketone meter and not DKA. According to what you posted above - 0.7 - 3 is trace - and we don't rush to the vet with trace. So 2.4 - 2.6 is not possible DKA - just keep an eye out because it can rapidly increase.
 
Juliet said:
*Could being the operative word - Silver was at 6 on the ketone meter and not DKA. According to what you posted above - 0.7 - 3 is trace - and we don't rush to the vet with trace. So 2.4 - 2.6 is not possible DKA - just keep an eye out because it can rapidly increase.
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Juliet, I have not suggested rushing to the vet, just that ketones should not be ignored, I would think that your recent experience would have highlighted that.

The difference in those numbers, if you had cared to look at the link I posted or in fact the one you posted, is because they come different sources, I am not making these numbers up, one is from the meter company the other is from two studies, I am giving ana the information so she can make an informed decision. By the time silver was at 6 he was in a critical situation requiring hospitalisation and he soared to hi, I would rather not see ana and frosty go through the same experience.

Just saying that in light of some of the other factors here, high numbers, anxiety, possible uti, ana has said above something is off, Frosty has developed higher ketones just recently when dose was dropped, all this says to me keep an eye on those ketones, test daily because we have seen them escalate quickly (just like you have just last week).

With my advice I am hoping we find that Frosty stays just fine at trace levels, but should things change, testing daily while numbers are high and he is off, will be the heads up that ana needs to take action. I'd rather be proactive than reactive.
 
It sounds like 0.8 is borderline. Don’t
Juliet said:
*Could being the operative word - Silver was at 6 on the ketone meter and not DKA. According to what you posted above - 0.7 - 3 is trace - and we don't rush to the vet with trace. So 2.4 - 2.6 is not possible DKA - just keep an eye out because it can rapidly increase.
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what do you guys mean when you said “ketones begin to show up at 2.4”. Show up where? In urine?
I remember I reviewed one of those studies, and it said that DKA started at 2.4-2.6. I will read both of them again though.

@Gill & George - the reason frosty had a higher ketone level a week or 2 ago was bc the insulin dose was decreased from 2.5 to 1. Once we went back up, his ketone levels went down. He was around 0.6-0.7 on a higher insulin dose, and 0.8 is within the margin of error. If I recheck I will likely get 0.6 or 0.7, or maybe even 0.9 or 1.

But I get what you guys are saying. I’ll keep an eye on him. Thanks for your help.
Ana
 
Ana and Frosty said:
It sounds like 0.8 is borderline. Don’t

what do you guys mean when you said “ketones begin to show up at 2.4”. Show up where? In urine?
I remember I reviewed one of those studies, and it said that DKA started at 2.4-2.6. I will read both of them again though.

@Gill & George - the reason frosty had a higher ketone level a week or 2 ago was bc the insulin dose was decreased from 2.5 to 1. Once we went back up, his ketone levels went down. He was around 0.6-0.7 on a higher insulin dose, and 0.8 is within the margin of error. If I recheck I will likely get 0.6 or 0.7, or maybe even 0.9 or 1.

But I get what you guys are saying. I’ll keep an eye on him. Thanks for your help.
Ana
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Every cat is different and you have to know how your cat responds. If he is throwing up and not eating then immediately take to vet no matter if ketones is low. As I said. Silver was right up at 6 on the novamax and was NOT in DKA. Trace is not DKA. You need to monitor often and if you have ketones and symptoms then ASAP to vet.
 
Gill & George said:
Juliet, I have not suggested rushing to the vet, just that ketones should not be ignored, I would think that your recent experience would have highlighted that.

The difference in those numbers, if you had cared to look at the link I posted or in fact the one you posted, is because they come different sources, I am not making these numbers up, one is from the meter company the other is from two studies, I am giving ana the information so she can make an informed decision. By the time silver was at 6 he was in a critical situation requiring hospitalisation and he soared to hi, I would rather not see ana and frosty go through the same experience.

Just saying that in light of some of the other factors here, high numbers, anxiety, possible uti, ana has said above something is off, Frosty has developed higher ketones just recently when dose was dropped, all this says to me keep an eye on those ketones, test daily because we have seen them escalate quickly (just like you have just last week).

With my advice I am hoping we find that Frosty stays just fine at trace levels, but should things change, testing daily while numbers are high and he is off, will be the heads up that ana needs to take action. I'd rather be proactive than reactive.
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Incorrect completely. Silver was at six long long before he was anywhere near hospitalization. He ONLY was hospitalized when meter said HI. Several weeks later.
 
Going to the vet sounds like a good idea since vomiting is unusual for your cat -- well, for most cats. Please let us know what the vet says when you're able to post.

@Juliet -
The general rule of thumb is that trace levels of ketones can sometimes be managed at home provided the care giver can monitor, the cat is eating, and is otherwise asymptomatic. Further, as Gil noted, one reading at a trace level is not reason to go running to the vet. However, readings that are greater than trace are cause for concern. Small to moderate levels of ketones would have most of us who have been through this ourselves and/or counseled members here strongly encouraging a member to get their cat to the vet. The most important consideration on this Board is to do no harm. If that means being overly cautious because we are not vets, so be it. I would not sleep well if the only data I took into consideration was one reading on a meter. You are correct in that we do our best to take the entire picture into consideration. I would also point out that you said, "If using a ketone blood meter 3.5 is trace." That is not correct and in the link you provided, the information differs from what you posted here. The blood ketone ranges Gil provided are, indeed, correct. What your experience was with Silver needs to be separated from the advice you give to other people.

With a situation like Ana isn describing, where her cat mom radar is pinging and her cat has vomited several times, even if the ketone reading is trace, I think she's doing the smart thing by having Frosty seen by a vet.

 
Sienne and Gabby (GA) said:
Going to the vet sounds like a good idea since vomiting is unusual for your cat -- well, for most cats. Please let us know what the vet says when you're able to post.

@Juliet -
The general rule of thumb is that trace levels of ketones can sometimes be managed at home provided the care giver can monitor, the cat is eating, and is otherwise asymptomatic. Further, as Gil noted, one reading at a trace level is not reason to go running to the vet. However, readings that are greater than trace are cause for concern. Small to moderate levels of ketones would have most of us who have been through this ourselves and/or counseled members here strongly encouraging a member to get their cat to the vet. The most important consideration on this Board is to do no harm. If that means being overly cautious because we are not vets, so be it. I would not sleep well if the only data I took into consideration was one reading on a meter. You are correct in that we do our best to take the entire picture into consideration. I would also point out that you said, "If using a ketone blood meter 3.5 is trace." That is not correct and in the link you provided, the information differs from what you posted here. The blood ketone ranges Gil provided are, indeed, correct. What your experience was with Silver needs to be separated from the advice you give to other people.

With a situation like Ana isn describing, where her cat mom radar is pinging and her cat has vomited several times, even if the ketone reading is trace, I think she's doing the smart thing by having Frosty seen by a vet.
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And I didn't say otherwise. Obviously if the cat is vomiting she needs to go to the vet. I said exactly that if there were symptoms.

Please read the article I posted further up AND the numbers quoted above. 0.7-3 is trace as I said.
 
Healing vines for Frosty. Such a good boy. He is so lucky to have his new home with you. I hope you are able to get a good diagnosis on him.:bighug:
 
Ana and Frosty said:
Just for our own knowledge, @Gill & George and @Juliet - frosty had no urine ketones at the vet yesterday.

Hoping to get lab results back soon so at least we know we don’t have a UTI or any other infection on top of our other issues.

He’s going to see an IM specialist on a Saturday about the possible Cushing’s.
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That's great.
Sending prayers as you await the results.:bighug::bighug::bighug:
 
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