Grayson 3/8 teetering on the edge of the ketone cliff

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Grayson & Lu

Grayson & Lu

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Good evening all -

Grayson keeps teetering on the edge of the ketone cliff, and I keep checking every opportunity I get. He still has his appetite, and no sign of an infection, but his numbers were a little flat again today after some improved smiles since Sunday.

Tuesday the vet had said it was okay to increase one full unit - from 2.5 to 3.5, but I kinda dragged my feet, increasing .2u per preshot. Then he flashed a MODERATE test today, and I promptly gave him fluids. Tonight I increased him to a fat 3.0 and will probably go up again in the morning unless something changes.

This "livin' on the edge" - wondering if they'll flare up if I wait 5 hours to do fluids - is frustrating! It still beats going DKA, but wow... the amt of increase of his insulin in the past three weeks is frightening!

So here is todays report from the cliff:

AMPS 323 Shot 2.8 Fed FF
TRACE ketones
+1.75 340
+4.5 310
MODERATE ketones
100 mL SubQs
1/2 can FF
+5.7 363 (definitely the food)
+8.8 292
PMPS 347 Shot 3.0 Fed FF
 
You are really doing well adjusting as Grayson needs it, Lou. I think the biggest part of this is to stay on top of it..... Wish we understood more about why some cats seem ketone prone and others don't.

I don't know if it will give you any insights, but you might search some of the posts of ketone prone kitties like Nancy and Payne, Violet and Garland and Sandy and Black Kitty. You probably already know how to do this, but in case you don't: Search for their names, choose their Profile button and then choose Search posts. It'll bring up all their old posts.
 
Ugggg...I hate Ketones. I do think you need more insulin and must find a way to drive his BGs down. Now that you are at a higher dose, I wonder about introducing R into the equation to see if you can get the numbers to respond and go down. I have never used R, but I do know that it is used to fight ketones and to lower numbers and a few here use it in conjunction with Prozinc.

Also, I know that you don't like increasing the dose and feel you have increased "a lot" over the last few weeks, but early on, it appears in the ss that he needed much less than now. His spreadsheet indicates, to me, that he needs more. As long as you are increasing at small controlled increments-- like you are--- don't worry about increasing. My Kitty was getting 5 units bid, before going tid. Some cats just need more!

I know it is frustrating, but you are doing a good job of staying on top of the ketones and keeping them flushed. Just continue to stay vigilant.
 
I don't much at all about ketones. Just wanted you to know that i think you are doing such a good job in keeping grayson from being DKA. Jumping right in with that big needle and giving fluids. Awesome! Proud of you! All your efforts will pay off in the end and grayson will give you lots of purrr's and snuggle's.

Hang in there! Hope the 3u will help. Does it take him some time to settle into a dose?
 
owlgal said:
... Does it take him some time to settle into a dose?
Click to expand...

I wish I knew! We've zoomed up from .2 units so quickly I don't know that I would even know if he's settled into it. I know we spent what seemed like AGES "at the IHOP" - he was flat as a pancake! For nearly two weeks, he barely got out of the 300s! But even though it's been fast, it has been gradual - .2 unit increments mostly. And he seems like he's doing okay.

Have to share this... he's sleeping a few feet away from me... but he's having some kind of a dream. His ears were just twitching, and his wiskers looked like he was chattering... the way they do when watching a bird or squirrel. Very cute!

AND... the good news; at 9 pm his ketones were about halfway between NEGATIVE and TRACE! Haven't seen that little tint of yellow in his color for some time! Out of the woods? Probably more like just in from the edge. But I'll take it!

Thanks for all the kind words. ...and Sue - it was Nancy that gave me the "teetering on the edge of a cliff" image.
 
I'm with you- Sneakers lives on that negative to a trace cliff and sometimes she scrabbles off into the small every so often.
 
I wish I could be some sort of help, but I had to be the luckiest bean ever with Bob and ketones. He was DKA, spent 3 days in emergency care, and I never got a higher than "trace" reading after that. He never had any kind of infection while on insulin, so that part of the ketone recipe was just not there for him. I used a blood ketone meter to check (Nova Max), and never used ketostix. The more time I spend on the board, the more I understand how fortunate Bob and I have been.
Knock it off with the ketones, Grayson!!!
Carl
 
My main mistake in the beginning was trying to keep Payne's insulin down while I was fighting ketones. Probably the main reason a kitty goes DKA with ketones is too little insulin. With ketones in the picture you should not worry about how much insulin is necessary now .... Payne has averaged over 12u a day for a year but she has not gone DKA for a year.

Staying out of DKA is your main job right now, later you can fine tune the insulin dose. I also believe that in cats that have ketones, they can cycle in a 24 hr. period .... we have had days where she has gone from trace to 8.2 on a ketone meter. (that is off the meter!) But I would do SQ fluids 2x a day, give R for adequate insulin and feed her constantly!

You will be fine! The only problem about teetering on the edge .... you need to keep dancing! :mrgreen: Try not to look down :)

Nancy and Payne
who thinks it's unfair she can't lay on my keyboard .....
 
nancy and payne said:
My main mistake in the beginning was trying to keep Payne's insulin down while I was fighting ketones. Probably the main reason a kitty goes DKA with ketones is too little insulin. With ketones in the picture you should not worry about how much insulin is necessary now .... Payne has averaged over 12u a day for a year but she has not gone DKA for a year.

Staying out of DKA is your main job right now, later you can fine tune the insulin dose. I also believe that in cats that have ketones, they can cycle in a 24 hr. period .... we have had days where she has gone from trace to 8.2 on a ketone meter. (that is off the meter!) But I would do SQ fluids 2x a day, give R for adequate insulin and feed her constantly!

You will be fine! The only problem about teetering on the edge .... you need to keep dancing! :mrgreen: Try not to look down :)

Nancy and Payne
who thinks it's unfair she can't lay on my keyboard .....
Click to expand...

Thanks, Nancy! (and Payne - clearly she couldn't have sent this without your assistance!)

Do I interpret what you're saying to mean a large insulin jump wouldn't be a bad thing? I gave 3.0 last night, and fully intended to go to 3.2 this morning. Early wake-up means he's staring at me going, "WHERE'S THE FOOD???!!!" I have no issue with volume - or whatever the dose ultimately is. I've never been much of a conformist! ;-)

I thought the early morning would be an opportunity to give fluids, as I did not give them last night with a NEG/TRACE reading. Expecting to see a lovely rose-color this morning, I was pleasantly surprised to see another NEG/TRACE - with even more yellow than flesh color in it! So I can go back to sleep for 1.5 hours and really surprise everyone at work today... coming in rested - imagine that!

I know he's trying to keep me on my toes - and certainly he's succeeding! Gotta keep those dance shoes all shined up real pretty, I guess! You never know when the music is about to start ...again! For now, I think I've gotten a little reprieve. Will shoot the fluids at lunch instead of a couple hrs before AMPS.

Thanks again for the eyes over my shoulder and all the wisdom shared!

BTW +9.5 288! Wish I knew how low he went on the 3.0 units!

Lu-Ann
 
Hi Luann,
I am so sorry for the ketone hell you have been in..
you never know, maybe 3 will be Grayson lucky number!
I am sorry I havent been around, my work schedule is crazy this week and next
but I am trying to keep an eye out..
Praying for you both!
Denise
 
Thanks Denise -

Earlier this week it was crazy, :shock: but once I got through the work-related deadlines/meetings/etc, I felt like the weight of the whole world was lifted off my shoulders! Yesterday I went in well-rested with a smile on my face and "unburdened" shoulders. Dealing with the ketone roller-coaster by itself isn't that bad if that's the biggest thing you're dealing with!

Grayson has been very positive through all of it except the fluids, but he's tolerent of them, so I'm really VERY fortunate! And, although I'd rather NOT be there, I've been to the edge of the cliff before with plenty of other issues and did just fine... I just wasn't wearing my shiny new dance shoes! :-D Thanks for the concern & prayers - that's probably what's keeping it manageable!
 
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