Lethargic and ketones above 2

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pablo'smom

pablo'smom

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I decided to make a new thread because now we are having a whole new set of issues/complications. I’ll try to link the previous one when I can but I’m typing this from my phone at the moment so it’s a little difficult to hyperlink.

At 5:30ish this morning I woke up because Pablo was crawling on me and purring like usual but he felt so so so hot so I got up to check his levels and glucose was 343 and ketones 2.2. I have him some turkey and then at 7am before his insulin his levels were 308 and 2.2. I got his ketones all way down to 1.2 thru the insulin and turkey but then he started getting lethargic and his paws and ears are so hot so his vet said to take him into the emergency vet since they couldn’t get him in until 3:30. So I get there and they quickly triage and they tech tells me his glucose is 178 when right before we left it was 252 and they told me he was stable enough to wait and the wait was 2 hours so his primary vet had me bring him home to bring him into there at 3:30 (so in 2 hours from now). And I’m so confused as to why he is reading low at the vet but high at home. We got home and I immediately checked and he is reading as 257 and 2.0 for ketones. They said he didn’t have a fever but he feels so warm and I checked my own glucose to make sure the meter wasn’t broken and mine came back normal so I feel like the reading at the vet was off. Also I got him to eat more turkey just now to help with those ketones and he ate and drank and now is laying around. His 3rd eyelid keeps showing a bit too which is also how I know he’s at the start of feeling sick.
 
While the majority of cats will experience higher blood glucose levels in stressful situations like going to the vet's office, some cats react with a lower blood glucose reading. It may also be that it was a bad test at the emergency vet. I'm assuming they used a glucometer? If so, there's always the possibility of a bad test or a bad strip.

Did they take his temperature at the emergency vet?

My feeling is that you know your cat. If you're worried, then getting Pablo to the vet was the right thing to do.
 
They triaged him in the back so I’m not sure how they got his glucose. They said his temp is 100.3 which is normal but his poor ears and paws are burning up and I even had someone else feel them to see if they felt hot. I’ll bring his meter with to his primary vet so we can also check it there using both his meter and theirs to compare the two. Hopefully he pulls through this. I can’t handle another DKA.

Also, part of me is thinking the chicken I was giving him was increasing his levels. I know biologically it shouldn’t because it’s protein and 0 carbs but I was reading that sometimes chicken breasts are injected with salt brines to make them plump and this could have a part in messing up sugar levels OR it could just be the URI he has been fighting off even though he is past all the URI symptoms. I’m switching him back to the turkey breasts for snacks in the meantime. It’s skinless, season-less, low sodium turkey breast from the deli and it is also 0 carb etc but I don’t even know what food labels to trust anymore.
 
You might want to think about poaching or roasting chicken or turkey yourself. I don't trust much from the deli for just the reason you noted -- the poultry products are often brined. Brining often contains both salt and sugar.
 
I originally was buying the turkey from the deli but then switched to buying Perdue raw chicken breasts and boiling it but then we started having all these issues so I now am going back to the turkey to figure out what is causing all of this. I never knew that even raw meat was sometimes injected with brine but maybe I’ll try a different brand or go organic from whole foods
 
update: no fever, no ketones in the urine despite his blood ketones being 3.1 from vet stress (they have already gone down to 2.4 and will hopefully continue to drop), everything is good for the most part besides having to get his sugar under control. His vet has me doing a glucose curve Sunday since that will be day 4 on the 2 unit doses.

He is acting normal other than he has little turds that randomly plop out and I think its from the high protein diet. He isn't used to this much chicken/turkey and overall protein and he is on 1/4 teaspoon of MiraLAX a day but he keeps having random small pieces that are almost the consistently of clay but slimy on the outside? Sorry that is gross but it is the best way to explain it. It happened once today and 2x yesterday so I'll keep an eye on him and maybe cut back on his chicken/turkey snacks. Speaking of...his vet told me that she prefers for him to only have his two main feedings a day and no snacks in between but I thought high protein snacks were good throughout the day.

Also, they are recommending I use the alpha track meter specifically for cats because it is supposedly more accurate. At the vet today, his readings were 432 on their alpha then 312 on his ReliOn and this was seconds apart. The emergency vet had him at 178 when he was reading 250s before and after so I'm not sure what is accurate anymore. Any advice for meter help?
 
If you are buying plain chicken or turkey at the meat section (e.g., the Purdue chicken breast), they should not be brined. When the same products are prepared at the deli or purchased by the deli from an outside source, you need to ask if the product has been brined. Tell them you're a diabetic and the brines contain sugar so you have to know how the product is prepared. Be persistent. Sometimes the people at the counter have no clue as to how the products they sell are prepared.

I'd encourage you to do some reading about constipation in cats.

The AlphaTrack and a human meter use a different system for testing blood glucose. The numbers differ and they differ to a much greater extent the higher the numbers are. For example, with Lantus, a reading of 50 on a human meter is equivalent to a 68 on an AlphaTrack. It's a small difference. Once the numbers are in a much higher range, the difference is bigger and we do not have a means of determining how equivalent the numbers are. One of the other moderators did a comparison and we still couldn't sort it out! The issue your vet may be unaware of is the cost of strips. I doubt the vet knows that the AT strips cost $1.00 each versus the Relion strips cost $0.17 each. (As an example, if you are getting the minimum of 4 tests per day for a month, that would cost $120 with the AT. The cost with the Relion would be around $20. You are saving $100 each month with a Relion meter.) To be honest, the numbers matter the most at the low end when you need to consider a dose reduction. If the numbers are high, you're going to have to increase the dose regardless of how much the two meters differ. The other issue is that all of our dosing methods are based on a human meter. I'd vote for the Relion and if your vet wants you to do a curve, use the AT for the times the vet asks.
 
LINK TO PREVIOUS THREAD

That's helpful to know about the food! thank you! And he is notorious for his constipation issues so I will try to figure it out because I really don't want him to need another enema.

I didn't realize how expensive the strips are for AT. I'll just stick to Relion and then use AT for his vet.

He seems himself this morning. Ketones and sugar are high and I gave him his insulin but a little did leak out this time and I'm not sure why but I'm really upset with myself over it. I did everything how I usually do it so I don't know if it was a weird air bubble by chance or what. I'll just keep an eye on him but I hope he got most of it or at least some - I know not to reshoot as that can be dangerous and messy.
 
pablo'smom said:
I originally was buying the turkey from the deli but then switched to buying Perdue raw chicken breasts and boiling it but then we started having all these issues so I now am going back to the turkey to figure out what is causing all of this. I never knew that even raw meat was sometimes injected with brine but maybe I’ll try a different brand or go organic from whole foods
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Raw human turkey cutlets are frequently available in the grocery store. Or ground turkey that you could cook and give a teaspoon or two as a snack during the early portion of the cycle. Read the fine print on the packaging. They are supposed to disclose anything injected with sodium or other additives. I often find that pork is injected with a sodium solution. I purchase mine from a natural meat store that sells locally produced meats.
 
pablo'smom said:
Speaking of...his vet told me that she prefers for him to only have his two main feedings a day and no snacks in between but I thought high protein snacks were good throughout the day.
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This is not good advice for a cat on insulin. They do much better with smaller amounts of food given spread out during the early portion of the cycle (usually up to about +6.) These snacks can really help prevent steep drops in BG, which can trigger a bounce. The snacks help to smooth the cycle in general. Your cat is running high right now so you may not notice it as much, but when he gets into better numbers it will be even more important to give the snacks.
 
pablo'smom said:
LINK TO PREVIOUS THREAD

That's helpful to know about the food! thank you! And he is notorious for his constipation issues so I will try to figure it out because I really don't want him to need another enema.

I didn't realize how expensive the strips are for AT. I'll just stick to Relion and then use AT for his vet.

He seems himself this morning. Ketones and sugar are high and I gave him his insulin but a little did leak out this time and I'm not sure why but I'm really upset with myself over it. I did everything how I usually do it so I don't know if it was a weird air bubble by chance or what. I'll just keep an eye on him but I hope he got most of it or at least some - I know not to reshoot as that can be dangerous and messy.
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You did the right thing. Never re-shoot more insulin after a fur shot or partial fur shot. It risks an overdose.
 
As to the pooping small amounts of mucosy pieces. He may well be constipated and only small bits are escaping around some very hard stool. It definitely happens.
 
Finally, I highly recommend a probiotic. I have had excellent results with Visbiome Vet probiotics in my IBD cats. In addition they have a new product called Constipation Care. I have not tried it yet because it’s new, but their products are extremely well-researched and are being used in clinical trials as well. The reference information is available on the VisbiomeVet site.
 
Thank you for that website link! I’m definitely going to look into it and probiotics to help him since he has had constipation issues on and off for some time now.

Also today I did a glucose curve and his numbers over the last few days are confusing me. I’m sure the added stress from his vet visits didn’t help but he will randomly go high then back down a little before insulin.
 
Looking at the time he’s been on 2 units. That looks a little better. Today nadir was at +8. I don’t see anything unusual about his numbers/patterns. They’re pretty typical of what I see in a lot of ProZinc cats. Don’t try to compare numbers too much. A pink is a pink and if there’s a slight variation in the numbers, it’s not a big deal. Also, there’s what we call “meter variance” and that’s a whole other kettle of fish. He goes up at the end of a cycle and then starts to go back down after about +2 (which is the typical onset time for ProZinc.)

You are doing an amazing job of testing and recording all these numbers! If his numbers stay like this with the yellow nadirs, it will be safe to increase the dose up to 2.25 units after a total of 14 cycles (7 days) of the 2 unit dose. He is making progress!
 
Thank you! I’m trying my best. This has been so difficult but luckily I’m on winter break from school so I’ve been able to be home with him more. I’m going to just keep checking levels and monitoring to hopefully get him better. Starting this journey off DKA was not great and his ketones have been sitting 2-3s now but he didn’t have any ketones in the urine at the vet on Friday so that’s good. The vet said once we get his BG under control then we should see progress with the ketones going down. I’m monitoring him like crazy to make sure he doesn’t show any signs of DKA again.
 
I think having both meters is a wise idea: not only can you provide your vet curve numbers from an AT but if you ever have a result on the relion that worries you you can use the AT for a more accurate number. For day to day it’s probably not worth the extra cost.

visbiome constipation care probiotic for cats has maltose which is in theory a non-adsorbable sugar. I asked the company if they included this an an “inert ingredient” to act as an osmotic laxative (similar to miralax) and they avoided the question. So I take that as “yes”. I’d ask a vet if it can be used along with miralax (also an osmotic laxative) for that reason.
 
SmallestSparrow said:
I think having both meters is a wise idea: not only can you provide your vet curve numbers from an AT but if you ever have a result on the relion that worries you you can use the AT for a more accurate number. For day to day it’s probably not worth the extra cost.

visbiome constipation care probiotic for cats has maltose which is in theory a non-adsorbable sugar. I asked the company if they included this an an “inert ingredient” to act as an osmotic laxative (similar to miralax) and they avoided the question. So I take that as “yes”. I’d ask a vet if it can be used along with miralax (also an osmotic laxative) for that reason.
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I’m going to call his vet tomorrow about the constipation to see what she recommends. I cut back on any chicken or turkey breasts to try to help with the constipation because he is unfortunately prone to it.
 
pablo'smom said:
Thank you! I’m trying my best. This has been so difficult but luckily I’m on winter break from school so I’ve been able to be home with him more. I’m going to just keep checking levels and monitoring to hopefully get him better. Starting this journey off DKA was not great and his ketones have been sitting 2-3s now but he didn’t have any ketones in the urine at the vet on Friday so that’s good. The vet said once we get his BG under control then we should see progress with the ketones going down. I’m monitoring him like crazy to make sure he doesn’t show any signs of DKA again.
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Since you are at home and since he has a history of DKA and ketones are present, we don’t need to wait the full 7 days to do the increase. We can fast track him a bit and go ahead with the .25 increase. I feel very confident that with your testing— and with the consistent numbers I am seeing on his spreadsheet, it would be safe.
 
pablo'smom said:
I didn't realize how expensive the strips are for AT
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They are pricey. If you buy a meter it comes as a starter kit with a vial of 50 strips, lancets, and control solution. The control solution is also crazy expensive. This is my advice: if you eventually need more strips or especially if you need more control solution consider buying a whole new starter kit. Generally it’s only about $15 more than buying strips and control solution so it’s like getting a back up meter. And when you do it look for specials —sometimes a diabetic supply or pet supply place has a new customer discount—i bought a starter kit that way and saved $
 
pablo'smom said:
I’m going to call his vet tomorrow about the constipation to see what she recommends. I cut back on any chicken or turkey breasts to try to help with the constipation because he is unfortunately prone to it.
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Are you using a fiber supplement in his food like psyllium husk fiber or plain pumpkin (I use freeze dried pumpkin for convenience and the long shelf life.) This would be in addition to MiraLax. How much MiraLax are you using? You may need to increase it in small amounts, until you get consistent bowel movements. Consider adding a little water to his food as well.
 
He gets 1/4 teaspoon a day. He used to be at 1/2 a teaspoon a day before he was diagnosed with diabetes but then he was DKA and his diet is completely changed etc so we started him back on 1/4 teaspoon so maybe we will have to slowly go back to 1/2. I have tried pumpkin in the past and he won’t touch anything pumpkin unfortunately.
 
Just let me know
pablo'smom said:
He gets 1/4 teaspoon a day. He used to be at 1/2 a teaspoon a day before he was diagnosed with diabetes but then he was DKA and his diet is completely changed etc so we started him back on 1/4 teaspoon so maybe we will have to slowly go back to 1/2. I have tried pumpkin in the past and he won’t touch anything pumpkin unfortunately.
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some cats do not like pumpkin(or psyllium.) Most assuredly, before I try anything else, I would increase the MiraLax back up to 1/4 tsp. In the morning and 1/4 tsp. in the evening. That is the nice thing about MiraLax, most cats cannot seem to detect it in their food.
 
His ketones are 4.6 right now when they were 2.9 this morning. I’m freaking out because they shot up so fast. Today I just gave him his usual 2 units in the morning then I gave him 2.25 this evening because his vet hasn’t gotten back to me yet about increasing the dose and also I was gone most of the day. Im super nervous. He is acting normal and I just gave him some turkey breast.
 
pablo'smom said:
His ketones are 4.6 right now when they were 2.9 this morning. I’m freaking out because they shot up so fast. Today I just gave him his usual 2 units in the morning then I gave him 2.25 this evening because his vet hasn’t gotten back to me yet about increasing the dose and also I was gone most of the day. Im super nervous. He is acting normal and I just gave him some turkey breast.
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Hopefully @Bron and Sheba (GA) or @Suzanne & Darcy will be on to help. In the meantime did you repeat that test just to make sure it’s accurate. I’m glad he’s acting normally —I’m new here so can’t advise you but I hope things turn out good
 
I just rechecked and got 4.2. He got his insulin ~30 mins ago so hopefully they go down. I’m going to recheck in a few hours. This makes me really nervous considering he was DKA once already. On Friday he tested negative for ketones in his urine.
 
Totally understand! This happened with my cat, too. My number one question is: is he eating, drinking normally? Any vomiting? Try adding water to his food. Can you give sub-q fluids? Do you have the supplies at home.
 
He is eating and drinking normal. He eats all his food and drinks plenty of water. He is still constipated so hopefully he has a bowel movement soon. No vomiting. He has been running around and playing all day per my mom who’s been home with him. He is purring and following me around at the moment. I don’t know how to give sub q fluids nor do I have the supplies. The only thing I have are the purina hydro care packs but I don’t know the sugar content in them so I haven’t given him them since being diabetic.
 
You did do the .25 increase tonight, correct? I recommend it due to his numbers and the ketones. We perhaps will need to even increase a little more. However, I wanted to see how he would do for a few days with the 2.25 unit dose.

if you see any lethargy or vomiting please take Pablo to the vet. How is he now?
 
pablo'smom said:
He is eating and drinking normal. He eats all his food and drinks plenty of water. He is still constipated so hopefully he has a bowel movement soon. No vomiting. He has been running around and playing all day per my mom who’s been home with him. He is purring and following me around at the moment. I don’t know how to give sub q fluids nor do I have the supplies. The only thing I have are the purina hydro care packs but I don’t know the sugar content in them so I haven’t given him them since being diabetic.
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Okay. From this update on Pablo, I feel much better. If he were in DKA, he would not be doing this well. Keep an eye on him and let him eat if he’s hungry- low carb food. Test his BG tonight a bit. I don’t like the pinks today. Ketones, in and of themselves, will not cause DKA. Some cats do produce a lot of ketones. My cat did for quite a while after his DKA. When he got into better numbers his ketones went down.
 
I gave him 2.25 tonight. He seems okay. If I notice anything off at all I’ll go right to the emergency vet. I have all the vet phone numbers saved in my phone because of the DKA episode. When he was DKA I first noticed a tiny bit of loose stool but then quickly followed by lethargy and not eating so we went straight to the hospital. Prays he doesn’t go DKA again. I’m worried I’m not giving insulin correctly or something but I have watched so many videos and read so much on it and on the prozinc page as well.
 
pablo'smom said:
I gave him 2.25 tonight. He seems okay. If I notice anything off at all I’ll go right to the emergency vet. I have all the vet phone numbers saved in my phone because of the DKA episode. When he was DKA I first noticed a tiny bit of loose stool but then quickly followed by lethargy and not eating so we went straight to the hospital. Prays he doesn’t go DKA again. I’m worried I’m not giving insulin correctly or something but I have watched so many videos and read so much on it and on the prozinc page as well.
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You are probably doing everything correctly. It sounds like you are. You’re right that things can change quickly — and that is why you need to keep an eye on him. Ketones can fluctuate quite a bit throughout the day/evening also. It’s likely you could get a lower number if you test again. But if he’s acting like you say he is, then you may want to hold off until morning.
 
Just to be clear, ketones show up in the blood before the urine, so I’d trust a blood ketone meter over the readings on urine sticks. Just because he was “negative” for ketones in his urine at the vet clinic doesn’t mean he was truly negative … it just means the ketones weren’t showing up in the urine yet (due to lag time).

Sounds like you’re doing everything right, as others have said. Blood ketones give you an earlier warning than urine, so just want to emphasize to not wait to go to the vet if his demeanor or appetite changes for the worse.
 
Update: ketones are 3.3 and glucose is 257 so we are making progress. I’m hoping the 2.25 units is a good dosage for him and can help us get through these high numbers
 
Update: his ketones went down to 2.7 today 5 hours post insulin but his sugar has been stuck around 280 all day. I’m really confused because he definitely got his insulin and he’s acting fine but his sugar just basically has been the same. The vet used a big needle on Friday so it’s been hard getting blood from the ear since they did poke both and they are scabbed a bit so I’m not sure if that could impact it. I’m going to try the other ear tonight to see if it’s just the ear I usually poke him on. I noticed today and yesterday he is drinking less water than the last few days and peeing less. He is still drinking and peeing a normal amount but it has slowed down a bit from the crazy amounts. I was getting worried because for ~3 days he kept peeing maybe 5 times a day and now it’s 2-3 again which is normal for him. It probably was from the high numbers making him thirsty and peeing the glucose out since I could smell it in his urine.
 
I just checked everything 30 mins ago and his glucose is 328 and ketones back to 4.0. He is due for insulin in 1.5 hours so hopefully the insulin brings his levels back down. He is acting completely normal and has been very energetic today so that is good.
 
update: Pablo has been acting normal. His ketones keep going up and down which is driving me crazy but I keep looking out for clinical signs. He was 3.2 this morning and now 4.3 about 2 hours later. I guess they do very a lot throughout the day but he has been eating and drinking a lot so hopefully that'll help. I have been giving 2.25 units of Prozinc and his sugar seems to drop then go back up. I'm thinking it might have to do with his body not being used to going lower so I'm not sure if I need to back down to 2 for a bit or just hope his sugar regulates on the 2.25 soon. This morning the insulin brought him from 337 to 231 in 3.25 hours and now it seems like it might be rising back up even though its only been 6 hours post shot. Also yesterday his sugar was sitting around 350 9 hours post shot and he was SCREAMING for food for the last 3 hours.
 
Did you feed him when he asked for food? Unless it is the 2 hours preshot, I would let him eat. Food helps keep ketones away.
I would not reduce the dose. He may need an increase very soon. I will tag @Suzanne & Darcy as she uses Prozinc and I do not.
 
I’ll start giving him snacks of turkey or chicken again. We were trying to see where he was sitting level wise without snacks. His ketones went from 3.5 to 5.5/5.2 (I took it 2x back to back to be sure) in 3 hours. He is still acting okay and ate all of his dinner etc. I don’t understand why they go up and down. I assume it’s from being uncontrolled still. Also, his vet is having me up him to 2.5 units in the morning and 2.25 units in the evening.
 
How do you get their urine? I honestly think it’ll be really hard with him since he doesn’t like being watched in the litter box let alone interfered with. I have the strips and can try next time he goes.
 
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