? Ketones 2.0 on Precision Xtra. Help!

[Elle D & Hugo]

I'm lost, guys.

Hugo has not been evening out with his numbers. He's been too high or too low, and last night he didn't eat all his food like he usually does. I tested for ketones with a dipstick, and it came back trace. We then tested with our blood meter and it came back 1.7. I called the ER vet and they said to watch him and take him in to see our normal vet in the morning. We tested him this morning (he also didn't eat all his food, but most) and he was at a 2.0. Our vet doesn't open for another 15 minutes, and he's so blase about Hugo's levels, I don't know what I'm going to get. My boyfriend is now unemployed with all this COVID-19 stuff, and I dont know how I can afford to get him in the hospital. We've been giving him his shots, feeding him the low carb food, testing him, on time. What am I doing wrong? I'm so scared.

 

[jt and trouble (GA)]

((((Elle)))) I'm so sorry this has become so difficult. Lets see are you new here? I know its daunting. I know you might feel like you are failing but one thing you need to know is you are doing the bast you can. It sounds like your vet isnt too up on the treatment of diabetes. (unless I read into that wrong) I'm hoping @Deb & Wink might see this if shes feeling better or maybe even
@Wendy & Neko. ugg my tags arent working
off to wave a flag in this direction

 

[Nan & Amber (GA)]

Ack!

2.0 on a ketone meter isn't great, but usually the cutoff for "time to really worry" is above that, 2.4-2.5 or so.

Most likely, the bump is due to his appetite being a little off last night. The best thing you can do for him is to get him eating well again-- food, insulin, and hydration are the main things that will help keep ketones at bay.

Off to look at Hugo's SS now, just wanted to say this quickly.

 

[jt and trouble (GA)]

Thank you Nan!

 

[Nan & Amber (GA)]

From Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

"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
"

(the blue pdfs are actual links in the original Ketones post, they are a little old at this point but I don't believe these cutoffs have changed since then"

 

[Nan & Amber (GA)]

OK, looking at your spreadsheet, my first impression is that you have a lot of dose changes in a very short period of time, definitely way more than would be recommended under SLGS. In the last week alone you've done 2, 1.75, 2, 2.25, and 2.5, often bouncing back and forth between doses.

I think it's time to step back and breathe a bit. I think his high numbers in the last day or so are him bouncing from some nice low numbers. I know it's hard to see the high numbers, but you just have to let them bounce if they want to bounce and wait them out before assessing what a dose is doing for them. Not just because of the bouncing, but also because lantus, as a "depot" insulin, does better if you give the depot a chance to stabilize.

I'm not sure how to assess the dose at the present time, with all the changes. I think it might be wise for you to start posting in the Lantus forum (if you haven't already; I am only around intermittently lately, so I apologize if you have been there and I've missed you!) to get some detailed guidance. I'm going to tag @Wendy&Neko as well, she knows the L+L insulins backwards and forwards, and might be able to help here.

One more thing: you say you are following SLGS, but you definitely test enough for TR, and it seems like it might be more suitable for you. It allows faster dose changes than SLGS, which can be helpful in heading off issues in a ketone-prone kitty. I assume that Hugo has had bouts of ketones in the past, and that's why you are using the ketone meter? It can be helpful if you put that info in your signature (ketones or DKA, the date of any incidents) so that people can see it at a glance when giving advice.

These are scary stressful times for everyone, even without a kitty going off his feed and (maybe) developing ketones! I do think you have caught this problem early, hopefully it won't go any farther and you can avoid a vet visit. If he continues to have a poor appetite, you may have to take him in to figure out what is wrong before it gets worse (and more $$$) to treat, but fingers crossed it was just a passing thing and he'll be back to normal soon.

If you can, could you take the "911" off the post? You can always put it back on if things take a downwards turn and you need eyes back on, but we try to reserve the 911 for immediate, life-threatening emergencies, and I think things are under control for now.

 

[Elle D & Hugo]

From Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

"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
"

(the blue pdfs are actual links in the original Ketones post, they are a little old at this point but I don't believe these cutoffs have changed since then"

What does this mean? That he actually doesn't have ketones yet?

 

[Elle D & Hugo]

OK, looking at your spreadsheet, my first impression is that you have a lot of dose changes in a very short period of time, definitely way more than would be recommended under SLGS. In the last week alone you've done 2, 1.75, 2, 2.25, and 2.5, often bouncing back and forth between doses.

I think it's time to step back and breathe a bit. I think his high numbers in the last day or so are him bouncing from some nice low numbers. I know it's hard to see the high numbers, but you just have to let them bounce if they want to bounce and wait them out before assessing what a dose is doing for them. Not just because of the bouncing, but also because lantus, as a "depot" insulin, does better if you give the depot a chance to stabilize.

I'm not sure how to assess the dose at the present time, with all the changes. I think it might be wise for you to start posting in the Lantus forum (if you haven't already; I am only around intermittently lately, so I apologize if you have been there and I've missed you!) to get some detailed guidance. I'm going to tag @Wendy&Neko as well, she knows the L+L insulins backwards and forwards, and might be able to help here.

One more thing: you say you are following SLGS, but you definitely test enough for TR, and it seems like it might be more suitable for you. It allows faster dose changes than SLGS, which can be helpful in heading off issues in a ketone-prone kitty. I assume that Hugo has had bouts of ketones in the past, and that's why you are using the ketone meter? It can be helpful if you put that info in your signature (ketones or DKA, the date of any incidents) so that people can see it at a glance when giving advice.

These are scary stressful times for everyone, even without a kitty going off his feed and (maybe) developing ketones! I do think you have caught this problem early, hopefully it won't go any farther and you can avoid a vet visit. If he continues to have a poor appetite, you may have to take him in to figure out what is wrong before it gets worse (and more $$$) to treat, but fingers crossed it was just a passing thing and he'll be back to normal soon.

If you can, could you take the "911" off the post? You can always put it back on if things take a downwards turn and you need eyes back on, but we try to reserve the 911 for immediate, life-threatening emergencies, and I think things are under control for now.

He hasn't had ketones in the past, but this all started with a hospital stay with hepatic lipidosis, and I never wanted to go through anything like that with him again. So I bought a blood meter and dipsticks.

We were doing SLGS, but now I work from home, so we were trying to use the time to get his levels right. So maybe I'll change it to TR for this next month or so. His ears are looking pretty beat up, though, with all the testing.

I can't figure out if he's bouncing or if he's not getting the right kind of food or something. I'm worried he might be starving even though he's eating, cause his body isn't using it. Also, when he gets on the low side, I dont know how to keep him leveled without bouncing him back up.

 

[Nan & Amber (GA)]

What does this mean? That he actually doesn't have ketones yet?

He might have something starting to develop, but it's not yet at a level to cause worry. You have caught things very early!

 

[Nan & Amber (GA)]

Note to those reading this thread and thinking of joining: Elle is getting some great detailed feedback in the Lantus forum now, might be good to concentrate discussion there.