Ketones and confused

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Stephanie91215

Stephanie91215

Member Since 2018
So missy was diagnosed a little over three weeks ago and it's been a bit of a rollar coaster. The doctor sent us home with vetsulin 1 unit twice a day. I did this for a couple days and switched her food to low carb. I started home testing and she had a couple hypo incidents so I decided to start tracking and lower her dose. Her spreadsheet is a bit nuts looking but I am keeping track of everything. I am testing her ketones on the max nova. And yesterday she showed at 3.9 and this morning she is 2.5. She is eating and drinking like normal and her energy level is about average I would say. I have been giving extra tuna juice and water mixed into her food. I am just trying to find some kind of pattern. She went to the vet a couple days ago and they ran a blood panel-most of her numbers improved but her bun was up to 39 from 19 when it was taken three weeks ago. The vet was not helpful in the slightest besides telling me to buy an animal glucose meter and to bring her in for a curve. Any advise would be helpful. Also if anyone has any questions on her ss just ask. Thank you
 
Stick with 0.5 u consistently for several cycles. She can't be without insulin when you had those blood ketone measurements. That's concerning. Anything above 2.5 or so on your Nova Max would translate to "trace" or likely higher on urine test strips. That would cause us to recommend a call or trip to the vet.

Immediate action steps:
  1. keep insulin at 0.5 u AM and PM for now
  2. test BG in the +3 to +7 range (once or twice)
  3. get as much water into her as you can by adding it to all her wet food meals. Aim for around 200 mL extra daily (1 Tbsp = 15 mL) by giving her "soup" that has 3-4 Tbsp of water or tuna juice in it. That will flush out ketones.
  4. Monitor her appetite - she NEEDS extra calories so she uses food instead of her own body fat to make energy (that's the cause of ketone formation).
  5. Feed higher carb food if needed to support a high enough dose of insulin. The 0.5 u might be barely enough to stop ketone formation.
  6. Get her to the vet immediately if she shows any signs of lethargy, not wanting to eat, vomiting, etc. Diabetic ketoacidosis can develop quickly and is very costly to treat (in ER).
Let us know how she's doing.
 
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Good for you on home testing and taking charge of your furbaby's healthcare. Some vets like what they like and want you to conform to them rather than work with you on what you can avoid. True, an animal glucose meter would likely be more accurate but the strips are way too expensive and may have to be ordered online whereas the strips for the Relion Micro you can walk into Walmart and get. When you may be going through multiples of strips in just a week's time, it is great to have a less expensive source at the ready for when you need it. You may want to take your meter and a strip in next vet trip and compare results with their meter. I did that with my FreeStyle Lite meter when I first got it and it measured about 9 points lower than their AlphaTrak.

I can't comment on the blood panels or the ketone meter. I test Bama for ketones using Relion Ketone urine strips from Walmart. I used to hate Walmart. Now I just love Walmart for having lower cost insulin [Novolin N $25 or so for a vial]; 1/2 unit syringes in a box of 100 for $13, $20 box of 50 Relion Micro test strips, and a bottle of 50 ketone urine strips for less than $7.
 
She is was playing earlier and comes running every time she hears the can pop for fresh food. I have high carb food on hand-just holding off because I am afraid what it will do to her bs. Should I risk it until I get her ketones in a good spot?
 
Oh no worries. I figured so. Just checked her for her pm shot. She is actually lower than she was +7. Fed her some high calorie food and gave her .50 a unit. She is acting normal and eating. So I will recheck her ketones tomorrow. I will continue to add additional water to her food and feed her lots.
 
She seems good. I checked her bs this morning expecting a much higher number with the high calorie food but she is lower than she has been. I gave her half a unit and going to check her around +3. She woke me up wanting to be fed and took down a fair amount of water and food. So I think she is better.
 
Stephanie91215 said:
She seems good. I checked her bs this morning expecting a much higher number with the high calorie food but she is lower than she has been. I gave her half a unit and going to check her around +3. She woke me up wanting to be fed and took down a fair amount of water and food. So I think she is better.
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Good report!
 
Hi everyone. Thought I would just repost on my post. She has been doing really well. Her activity level has seriously improved. Jumping on counters and demanding attention. Eating so much. Once again I decided to check her ketones and she is at 3.8. Eating and drinking like normal and no vomiting or lethargy. I'm so confused on what I'm doing wrong.
 
Stephanie91215 said:
Hi everyone. Thought I would just repost on my post. She has been doing really well. Her activity level has seriously improved. Jumping on counters and demanding attention. Eating so much. Once again I decided to check her ketones and she is at 3.8. Eating and drinking like normal and no vomiting or lethargy. I'm so confused on what I'm doing wrong.
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She might need a slight dose increase.
 
Would you recommend .75 or 1 full unit? When she was getting a full unit she had a couple hypo incidents but this could be because we changed her food and she didn't have much time to adjust. Just so unsure.
 
I agree with Janet about needing a dose increase. Try bumping her up to 0.75 u for a few cycles. She seems to be a kitty who produces ketones easily and more insulin is key to keeping them at bay.
 
Stephanie91215 said:
Would you recommend .75 or 1 full unit? When she was getting a full unit she had a couple hypo incidents but this could be because we changed her food and she didn't have much time to adjust. Just so unsure.
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Go with 0.75 u. Keep it for 3-4 cycles then increase to 1 u if you don't see any blues.
 
Okay. Will do. I'll start .75 with pm shot. And just so I know is a cycle one day or one dose? Thank you so much for your guys input.
 
Stephanie91215 said:
Would you recommend .75 or 1 full unit? When she was getting a full unit she had a couple hypo incidents but this could be because we changed her food and she didn't have much time to adjust. Just so unsure.
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Do .75 for a couple days and see. Let’s get her down to around 80-100 kind of range.
 
Oh okay. Thank you. So I increased her pm shot to .75. Going to test her bs at +2 and +4 just to make sure she is handling the increase alright. Still acting completely normal. Playing and eating every time fresh food is put out which about every hours.
 
I'm glad you increased. Give that dose about 4 cycles (12 hours each) and then go to 1 u if you don't see any blues. With ketones in the mix you don't want her BG high for any length of time.
 
Okay. So today her numbers have had some ups and downs. Confused on why she went so high tonight were her pmps. She has been eating alot so maybe that's why.
 
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Stephanie91215 said:
Okay. So today her numbers have had some ups and downs. Confused on why she went so high tonight were her pmps. She has been eating alot so maybe that's why.
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It looks like a bounce after that nice blue today. Also the drop in BG from AMPS to that blue was substantial and that can trigger a bounce. If she ate quite a bit in the second half of the cycle (+6 on) it can reduce the duration of the dose also. So, several factors:
  1. large drop
  2. lowest BG was possibly lower than has been the case recently
  3. extra food after +6 (?).
 
She definitely ate more the second part of the cycle. Throughout the day she probably eats 10 oz or more and then I wake up once at night to feed her. Do you think I am feeding her too much? She is around 9lbs maybe more now. With her ketones I just want to feed her as much food and water as she will take.
 
I am going to increase to her dose to 1 unit starting with this evenings shot. She drops to the 200's +4 and +5 and then she crawls her way back up. Still eating and drinking normal. Getting frustrated. Just want to see some progress.
 
Stephanie91215 said:
I am going to increase to her dose to 1 unit starting with this evenings shot. She drops to the 200's +4 and +5 and then she crawls her way back up. Still eating and drinking normal. Getting frustrated. Just want to see some progress.
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Good idea. You can increase after only 3 cycles if the numbers are still on the high side. Once you start seeing a fair bit of blue you can slow the rate of increase.
 
I think she is bouncing. Last night she was at 477 pspm and 4 hours later she had dropped to 188. To me this seems like a very large drop which probably accounts for her morning number of 465. Any way to avoid the bounce?
 
Stephanie91215 said:
I think she is bouncing. Last night she was at 477 pspm and 4 hours later she had dropped to 188. To me this seems like a very large drop which probably accounts for her morning number of 465. Any way to avoid the bounce?
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Some kitties are bouncier than others but the action of Vetsulin can also cause bouncing. It has the ability to begin working quickly and to get BG down quite aggressively - conditions that can lead to bouncing. You have to focus more on how low the dose takes her. The hope is that if she spends more time in better numbers the bouncing *might* be reduced and the PSs *might" come down.

It looks like an increase to 1.25 u is in order.
 
Okay. Good to know. I increased her dose this morning to 1.25 units. Last night her number dropped pretty slowly. At +4 she had only dropped to 300. At +1 this morning she has only dropped to 397 from 422. I hope the insulin is still working. She is eating alot. Took down 3oz can plus some with this morning's injection. Not sure if I am doing something wrong.
 
Stephanie91215 said:
Okay. Good to know. I increased her dose this morning to 1.25 units. Last night her number dropped pretty slowly. At +4 she had only dropped to 300. At +1 this morning she has only dropped to 397 from 422. I hope the insulin is still working. She is eating alot. Took down 3oz can plus some with this morning's injection. Not sure if I am doing something wrong.
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Your insulin should still be good if you're storing it in the fridge and rolling it gently before drawing up a dose. Just keep up those regular 0.25 u increases after 3 or 4 cycles until the blues increase. They can become insulin resistant after they sit in high numbers for a while because the excess glucose affects the body's ability to respond. It's called glucose toxicity and can be conquered with careful dose increases. Some kitties become resistant more easily than others.

Have you been checking ketones?
 
Will do. I just checked. I was waiting on her strips to come in and they came in yesterday. She is 0.7-which for her is really low and if I remember correctly ketones don't show up until 2.4 or 2.5 which is a trace. Is that correct?
 
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She seems a bit more sluggish today. Still eating just not as ravenous as normal. Her ketones are good. I am wondering if this is because of the increase in her insulin. I feel like I am always worried and can't relax. Does this feeling ever get better?
 
Stephanie91215 said:
Will do. I just checked. I was waiting on her strips to come in and they came in yesterday. She is 0.7-which for her is really low and if I remember correctly ketones don't show up until 2.4 or 2.5 which is a trace. Is that correct?
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That's correct. That's when they'd show as "trace" on a urine test strip. High BG can make them feel under the weather. They can also be lethargic when they first get good numbers. Yes, over time you'll become more confident in figuring out her patterns, what dose to give, etc. and that will make you more relaxed. You'll take all of it in stride more.
 
Yikes that black number scares me. I know it's probably in reaction to the increase in dose but it worries me. Thank you for taking the time to work through all of this. I really don't have anyone to talk to about this and her vet has not been extremely helpful.
 
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Kris & Teasel said:
That's correct. That's when they'd show as "trace" on a urine test strip. High BG can make them feel under the weather. They can also be lethargic when they first get good numbers. Yes, over time you'll become more confident in figuring out her patterns, what dose to give, etc. and that will make you more relaxed. You'll take all of it in stride more.
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Her Ketones have remained in check and her post shot numbers are looking great. She drops to 120 ish 3-4 hours after her shot. No matter what her starting number is so I really do think she is bouncing. She has had a couple days where her preshot numbers are lower and so I am just learning on what to shoot when that happens. I know her preshot numbers are on the high side but I am afraid if I increase her dose much more we might go into hypo territory. Food and water are still going in like normal and her activity level as really increased. Can you tell me if there is something else I should do or if I should just maintain the course?
 
Stephanie91215 said:
Her Ketones have remained in check and her post shot numbers are looking great. She drops to 120 ish 3-4 hours after her shot. No matter what her starting number is so I really do think she is bouncing. She has had a couple days where her preshot numbers are lower and so I am just learning on what to shoot when that happens. I know her preshot numbers are on the high side but I am afraid if I increase her dose much more we might go into hypo territory. Food and water are still going in like normal and her activity level as really increased. Can you tell me if there is something else I should do or if I should just maintain the course?
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With Vetsulin it's very important to look at the nadir numbers when assessing the dose, not the pre shot numbers. Your goal is a nadir in the 90 to 110 range. The PSs are often fairly high because of the action of this insulin. Aiming for lows in the 90 to 110 range gives you a safety cushion against the more aggressive action of this insulin.

You don't have a lot of mid cycle data at 1.25 u so it's hard to know if that's the best dose for now. That 125 a couple of evenings ago suggests it's close. I suggest you keep 1.25 u for now (PS allowing) and try for some data between +3 and +7 in the days ahead. The weekend is a good time to try for that. You might need to go to 1.5 u to get that desired 90 to 110 range but wait on that.
 
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