Help with Preventing & Treating Ketones at Home

[Sarah & Charlie-cat]

Chris & Kim on the Facebook group suggested I post here as well about preventing and treating ketones at home, specifically if anyone has experience using Humulin R at home.

Charlie is currently developing ketones, 2.1 at 10:30 central, up from earlier in the day. Higher than he was when we went to the ER vet and he ended up hospitalized for DKA for five days. He's eaten some at 8 pm and 10:30 central and I gave a second round of fluids around 11:30 central. He wouldn't eat then. We essentially have no where to go as the VCA practice an hour away is closed because their vet got bit by a dog and the place here is full and said they could examine him but not keep him and just to give more fluids.

He has IBD and pancreatitis. The oncologist couldn't find a mass to aspirate so that's a question mark and we have an appointment at the internist this week. That's another story

I have begged our regular vet for help with managing this at home but so far have nothing except fluids.
Previous post and I think all the others should be linked successively.

https://felinediabetes.com/FDMB/threads/charlie-ketones-2-1-at-2-pm.279838/

 

[Bron and Sheba (GA)]

I see you are talking to Wendy on the LLB page.
It looks like he was only on a small dose of insulin until the DKA and it has gone up since then. Is that correct?

Do they still think he has pancreatitis? If so what are they doing for it?
Are you giving him pain meds and antinausea meds routinely still? Or just every so often?
I can see where you say giving the zofran is difficult, If you could get the wafers, they are much easier to give as they will stick to the tongue and dissolve. YOU just need to make sure you have dry hands yourself!

It looks like you are giving Sub Q fluids... How much and how often are you giving them?

And how is his appetite? and how often are you feeding him?

To try and keep ketones away you need to make sure Charlie is:

• getting enough food (try and give 1 and a half times as many calories as normal a day). It is more important that he eats, than what he eats at this point.
• getting enough insulin... don't skip any doses
• getting enough fluids
• test daily for ketones...please put results into the remarks column of the SS please
• giving antinausea meds first before appetite stimulants
• giving pain meds if needed

 

[Sarah & Charlie-cat]

Thanks for the follow up questions.
It looks like he was only on a small dose of insulin until the DKA and it has gone up since then. Is that correct? Yes, we had been on SLGS and with me being gone more days in April than I was home, we were overdue for a curve and dose increase. Our regular vet said, you have to get his glucose down so we switched to TR in mid June.


Do they still think he has pancreatitis? If so what are they doing for it? Are you giving him pain meds and antinausea meds routinely still? Or just every so often?
I can see where you say giving the zofran is difficult, If you could get the wafers, they are much easier to give as they will stick to the tongue and dissolve. YOU just need to make sure you have dry hands yourself !
I think he has chronic pancreatitis, yes. He gets 8mg if Cerenia every morning and 1/2 a Zofran every 12 hours (not sure the mgs off the top of my head). I had been giving fluids daily around noon or one (skipped yesterday because he seemed fine, stupid me). I have asked for pain meds and been told no. But the IM vet said he didn't seem painful when she was examining him a couple weeks back, so that's good. She wants to stick a needle in his pancreas if she finds anything to stick to see if there are cysts or cancer. If he had malignant pancreatic cancer, it seems like he would be very poorly or already dead from what I've read.


It looks like you are giving Sub Q fluids... How much and how often are you giving them? 100ml, once a day. Yesterday he got two doses. Our AC was out so that probably wasn't helping and for whatever reason he wouldn't stay in one of the two rooms when have window ACs in

And how is his appetite? and how often are you feeding him? He gets Mirtazapine every 3-5 days or whenever he's not eating like it's going out of style. I feed him about 8 or more times a day and he's been eating over half a pound of raw food. IM vet wants him on cooked. I made a batch and while he was way into it fresh after I froze and thawed it, he's not really been eating it. I don't blame him, it's all separated down into dry chicken and liquid, whereas right out of the blender it had a pate like texture.



To try and keep ketones away you need to make sure Charlie is:
getting enough food (try and give 1 and a half times as many calories as normal a day). It is more important that he eats, than what he eats at this point.
getting enough insulin... don't skip any doses
getting enough fluids
test daily for ketones...please put results into the remarks column of the SS please
giving antinausea meds first before appetite stimulants
giving pain meds if needed

There's a separate column now in my SS to make it easier for me to look at just ketones. And one for his weight, which has gone up since his DKA, I take that as a good sign. I haven't been testing ketones daily. I have a panic response every time I do, even when it comes up fine, I stress out. But yes, I need to do it daily.

The good news is he ate a big meal at 4 am so I'm about to feed him and test him and see where we are at and if I need to take him to the vet or if I can go to this dissertation defense for a student.

 

[Sarah & Charlie-cat]

His Ketones on the meter were 0.4, although his glucose was 392. Not great on the BG but happy to see the ketone number and he ate his breakfast without any coaxing (and he came into my room just before 8 am breakfast time and scratched at the scratching post by my bed, which I think was his way to wake me up)

 

[Bron and Sheba (GA)]

read.
It looks like you are giving Sub Q fluids... How much and how often are you giving them? 100ml, once a day. Yesterday he got two doses

I would not give more than 100 ml a day in subQ fluids.

She wants to stick a needle in his pancreas if she finds anything to stick to see if there are cysts or cancer. If he had malignant pancreatic cancer, it seems like he would be very poorly or already dead from what I've read.

I wouldn’t let her stick a needle into the pancreas. If she wants to look, an ultrasound would give answers.

feed him about 8 or more times a day and he's been eating over half a pound of raw food. IM vet wants him on cooked. I made a batch and while he was way into it fresh after I froze and thawed it, he's not really been eating it. I don't blame him, it's all separated down into dry chicken and liquid, whereas right out of the blender it had a pate like texture.

Vets seem to have this thing about cats eating raw. If that is what he likes, I would stay with it. It sounds as if he is eating well which is great.
Why change something that is working?

haven't been testing ketones daily. I have a panic response every time I do, even when it comes up fine, I stress out. But yes, I need to do it daily.

Testing ketones daily will tell you if you have the balance right with the insulin and the food. 0.4 ketones is nothing to be concerned about on the blood ketone meter.

You mentioned to Wendy you were doing TR (which is a good idea) but it doesn’t look like TR on your SS. With TR you can increase every 3 days if the BGs are indicating that you should. With ketones on the picture, we like to get the BGs down to more normal levels and not hang around in higher numbers longer than necessary.
Some cats take longer than others to get over DKA. Some cats need anti nausea meds for some time.
Has the vet or IM specialist done an ultrasound or fPL test to check if he still has pancreatitis.
Why are you seeing an oncologist?

 

[Sarah & Charlie-cat]

I cannot get enough tests in a day, especially at night. So I've been trying to at least hit the middle of the day and +3 at night. It is why I chose SLGS in the beginning, I knew TR was going to be impossible and it's grinding me down to have to be up til 11 every night. Getting up earlier is not a great answer either. And stopping what I'm doing at work every hour even if I can means I'll never get anything done. I have ADHD and it makes it hard to sleep and hard to switch tasks. It also doesn't help with my anxiety. If you think about having an air traffic controller in your brain that directs your attention and helps control your emotions. Having ADHD is like not having one at all... But we have increased his insulin more frequently than previously.

We saw an oncologist because after he was released from the hospital our vet found a mass in his abdomen and we did a blood test that suggested LCL. I wanted to see an oncologist and she found nothing on ultrasound but said his pancreas looked inflamed, as had his regular vet in early June. That blood test also included the fPL test and said, pancreatitis. So my vet and the oncologist agree on that.

The IM vet wants to do an ultrasound and then cytology of his pancreas which I don't think I want. She wants to repeat the fPL test, which feels redundant as well but it's been a few months now. Something is going on that is making his numbers stay high. There are a few blues in there but I couldn't tell you what was different about those days except I was gone midday and didn't test til later in the afternoon.

The little jerk is eating his sister's food. It's low carb but tends to come right back up, so hopefully it stays down today.

 

[Wendy&Neko]

Getting a +3 at night is fine for following TR, if you can get that mid day test too.

 

[Sarah & Charlie-cat]

That's what I try to do. I think I would test more if I wasn't just getting 200s and up.

The vet wanted him up to 6.5u today. But he's now on antibiotics so will have to keep closer tabs because that's a much bigger dose.

(We ended up going to the vet today and he had a fever and his white blood cell count was indictive of an infection... I'm not crazy the cat was wrong).

 

[Wendy&Neko]

I would wait at least six cycles at this dose, and get those before bed or +3 tests. Then increase. His numbers are high enough I wouldn't worry about him being on antibiotics. Not eating enough, not enough insulin, and infection/inflammation are a bad combo and in the recipe for DKA. Don't delay the increase.

 

[Sarah & Charlie-cat]

And then the emergency vet insisted I was giving him too much insulin and said we should go down to 4. We've been at 4 and his numbers are as bad as before. He had one mysterious 84 the day he was at the vet. But since then, more of the same.

 

[Bron and Sheba (GA)]

Have you been testing for ketones most days? If not I would recommend you do so as it is important we know if any keontes are creepping back in.
If you could put the results of the ketone tests into the remarks column of the SS that would be helpful.
How is his appetite? Are you giving snacks during the cycles?
Are you able to get in any tests during the PM cycle? even a before bed test would be helpful. At the moment we dont really know what is happening at night.

 

[Sarah & Charlie-cat]

Yes, there's a column in my spreadsheet now for ketones. It gets lost in the notes. I also added a column for his weight and the foods he's eaten each day.

He's been eating well without Mirtaz. He eats 6-8 times a day, including 2-3 times over night. Usually he asks but if he hasn't, I'll bring him food.

I'm trying to get +2s. Im going to try 7:30/7:30 and see if that splits the difference between being brain dead at his morning shot and how hard it is to get a.PM number.