Never ending Ketones

pablo'smom

pablo'smom

Member
Hi guys! Here is the link to the last thread.

So far Pablo is okay. His ketones got into the 5s yesterday but right now they are 3.6. I emailed the company about a control solution and went out and bought a different brand ketone meter to compare the 2 and they are within 0.2 of each other. This morning we upped the units to 2.5 so let’s hope that helps. I’m going to give him a snack of turkey right now since it’s 3 hours post shot and I want to get rid of those ketones. Also the attempt at using plastic wrap to catch urine did not work. He dug it out of the litter box. He is acting normal and drinking and eating good so hopefully we stay away from those scary ketones.
 
pablo'smom said:
Hi guys! Here is the link to the last thread.

So far Pablo is okay. His ketones got into the 5s yesterday but right now they are 3.6. I emailed the company about a control solution and went out and bought a different brand ketone meter to compare the 2 and they are within 0.2 of each other. This morning we upped the units to 2.5 so let’s hope that helps. I’m going to give him a snack of turkey right now since it’s 3 hours post shot and I want to get rid of those ketones. Also the attempt at using plastic wrap to catch urine did not work. He dug it out of the litter box. He is acting normal and drinking and eating good so hopefully we stay away from those scary ketones.
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You don’t need to bother with the urine ketone strips if you have a blood ketone meter especially since you got a new one.
 
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He is eating over 300 calories a day. I can increase more but I’m worried it’ll mess with his insulin dosing even if it’s FF pate. He is acting like he is starving (which his body thinks it is) but is acting normal otherwise. The vet wanted me to do 2.5 units in the morning and 2.25 in the evening but I decided to do 2.5 both morning and evening because his levels are high and I’m able to monitor him. He hasn’t been even close to hypo after a few days on 2.25 so I feel comfortable with the 2.5. Should I start giving him more FF? He currently gets 3 cans plus turkey/chicken.
 
If he acts starving, I would feed him some more. He needs the calories right now.

I am glad you went ahead with the increase. If his ketones keep up and his BG stays where it is now, we will need to increase again. We will see after a few more days though.
 
Should I start giving him 4 cans of FF a day instead of 3? Right now he eats 1.5 cans before insulin and although 2 cans at once seems like a lot I have no doubt he will finish it all in one sitting before insulin as he inhales the 1.5 cans and licks the bowl clean.
 
I am giving him turkey/chicken 2 times after the AM shot. I try to give it during the first 6 hours. Then I usually just give him a snack once after the PM shot before I go to bed so again with in the first 6 hours. It’s not a ton as I don’t want him getting constipated or having too much straight protein but enough to get some extra calories in.
 
I would give 2 snacks in the pm cycle as well. Or even three snacks in each cycle. He needs the food to try and get rid of the ketones. Don’t worry about it affecting the dose. If needed we can change that but more food won’t necessarily raise the BGs.
 
pablo'smom said:
I am giving him turkey/chicken 2 times after the AM shot. I try to give it during the first 6 hours. Then I usually just give him a snack once after the PM shot before I go to bed so again with in the first 6 hours. It’s not a ton as I don’t want him getting constipated or having too much straight protein but enough to get some extra calories in.
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How much does he weigh? Id give him more if he's hungry. I had a non diabetic who ate 4-5 a day. He was a big cat. Fighting ketones he is extra hungry. They don't process the food the same way so they need more. As long as you can monitor this week if raise that dose to 3 twice a day. We want to push that bg number down into the blues to get those ketones down. If you're nervous to do 3 than do 2.75 a few dayys before doing 3. You don't want to hold an ineffective dose too many days when there's ketones.
 
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He is ~14 pounds and that is a healthy weight for him because he’s a big framed cat. When he got down to 13.5 he was nearly underweight. I decided to give him 2 cans of FF for breakfast with 2.5 units to see how it goes. His sugar was 277 this morning which is lowest AMPS in many days so hopefully that’s a good sign. I’ll keep you guys updated.
 
pablo'smom said:
He is ~14 pounds and that is a healthy weight for him because he’s a big framed cat. When he got down to 13.5 he was nearly underweight. I decided to give him 2 cans of FF for breakfast with 2.5 units to see how it goes. His sugar was 277 this morning which is lowest AMPS in many days so hopefully that’s a good sign. I’ll keep you guys updated.
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Hold this dose for six cycles. Keep giving lots of food. If after 6 cycles he’s still stuck in yellows, increase to 2.75 units (see caveat below.) Keep up the ketone testing so we can factor that into the decision-making as well. Depending on ketones, I may recommend that you increase to 3 units (bypassing 2.75 entirely.) I am sure I have said this before, but ketones, in and of themselves, will not put him into DKA, but they are a risk factor and we really want to at least lower them. My cat had high ketones for a long time after his DKA, but he never went into DKA again. So keep on feeding Pablo and keep him hydrated. Any signs of lethargy, vomiting, inappetence, illness means a trip to the vet. You already know that, of course. Hang in there, you are doing great!
 
pablo'smom said:
He is ~14 pounds and that is a healthy weight for him because he’s a big framed cat. When he got down to 13.5 he was nearly underweight. I decided to give him 2 cans of FF for breakfast with 2.5 units to see how it goes. His sugar was 277 this morning which is lowest AMPS in many days so hopefully that’s a good sign. I’ll keep you guys updated.
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If he wasn't diabetic a 14 lb cat would need 3 cans of ff to maintain the weight... About 280 calories. A diabetic needs more than that so 4 cans or even 5 is an expected need. I'm glad to hear you had good numbers.
 
Good job increasing the dose. I see those ketones are still high. It looks like he could have used the full half unit dose increase. He’s got ple ty of room since he’s stuck in yellows. Let’s see how the rest of today goes. Is he still eating okay? Hungry? Normal activity level?
 
Hi, he is still acting okay-eating, drinking, playing etc. I am still giving him lots of food and then today I started 2.75 units because these ketones are driving me crazy. I’m back to school today so I have to be careful he doesn’t go hypo when I’m not home so I’m trying to increase slowly. I’m hoping we find a dose that works soon.
 
I understand about being at work. It will be important to get a few tests at night then (although you got some good one today.).

We need to get him out of the yellows during mid cycle at least. We just have not arrived at the good dose yet. It’s not always linear, i.e., you hope to, but don’t always see an immediate reduction in BG with every increase in insulin. Hopefully, we will get there soon.
 
I’m going to up him to 3 tonight since not much has changed. It also has been hard because I was gone all day and couldn’t test often but my mom was able to get it once for me while I was gone. This morning I had a faulty ketone strip that read 7.6 and almost gave me a heart attack so I took it 2x more time and got 4.8. Still high but better than 7.6.
 
Hi! I haven’t been able to check his levels like crazy because of med school but this weekend I’ll be doing so. I’m upping him to 3.25 tonight because his ketones are 6.4 and I’m not sure why. He is acting completely fine otherwise. I’m going to keep pushing food, fluids and then the increase in insulin. Hopefully we see improvement soon. He has been very active and happy and eating and drinking etc normal.
 
I am new, but I saw Ketones in your thread title while looking for my cat's ketone thread. My cat, Kobe, was on PZI too until about a week ago. I took him to the Vet because of his ketones. Long story short, after getting fluids and switching to Lantus, Ketones are down to 0.1.

I don't think our situations are exactly the same. Your Pablo is eating quite a bit; my Kobe has been on an appetite stimulant to make sure he's eating enough to get rid of ketones. We had our vial of PZI a little longer than you, I think. It's possible I compromised the integrity of the the vial with the way I put air into it and adjusted the dose. I didn't know that the lubricant in the syringe could contaminate the insulin. I was very careful to keep the vial cold, but I might have ruined it in a different way is what I am saying.

It was also suggested to me to get a bag of Subcutaneous fluids from the vet to have on hand to administer at home. I actually administered the fluids last Monday, and it wasn't as scary as it looked. I thought Kobe's ketones were going up again, so I did the fluids, but I might have just touched the ketone test strip in the wrong spot.

I am sorry you and Pablo are going through this. You are lucky to have each other. Again, I am new, so it's probably a good idea to let the people know what they are talking about have their say about the post from the newbie who likely contaminated her cat's insulin and gave fluids after touching the wrong part of the strip. But I thought maybe there was something in my bungling that might help you and Pablo.
 
Hi everyone, ketones went from 5.7 this morning to 4.1. However, I just took his sugar with 3 different meters because I was getting a variety of numbers. I usually use ReliOn but all within minutes of each other I had the ReliOn read 317, 262, 271, alpha trak 3 read 307, and a keto mojo meter that can do both glucose or ketones read 319. I am really confused as to how I had so many numbers. I put 262 on his chart because I always use ReliOn so its most accurate in comparison to his chart numbers, but I don't know where he is actually sitting. He ketones did go down which I assume means the insulin is working at least some. I'm now worried I might be contaminating his insulin or something. I try not to inject air into it when adjusting the dose but I've noticed the syringe has a little space at the top. Should I push out the air at the top then insert the syringe into the vial? Also at what point should we consider switching to Lantus?
 
First, you will drive yourself crazy using different meters.

There is what's referred to as "measurement error" that's inherent in any meter (or any measurement device, for that matter). Between the meter and strips, it's typically about 20% difference between different meters or even two tests from the same meter. So, if you took all of the tests and looked at plus or minus 20% from each test, you'd see they are largely overlapping. You're within the margin of error.

Also, the AlphaTrack is calibrated differently from a human meter. Numbers from the AT are higher than a human meter. With lower numbers, there's not a huge difference between the tests. As numbers get higher, the spread between AT and human meters is much greats.

If you're using a vial, there's less of an issue with contaminating the insulin. How I draw up insulin:
  • before I do anything, I move the plunger up and down the barrel of the syringe so it moves smoothly
  • I press the plunger down and keep it down when I insert the syringe into the insulin
  • I release the plunger and draw up a small amount more of the insulin than what I will need. This helps with dealing with any extra air or bubbles.
  • Holding the syringe so the needle is pointed toward the ceiling, I flick the syringe so any air or bubbles go to the top.
  • I rotate the plunger so it slowly moves toward the needle and any air or bubbles are expelled.
A month is not a sufficient amount of time to know whether Prozinc is working. I suspect that Pablo is not yet at what would be a good dose for him. I would also be curious as to what @Suzanne & Darcy think about the switch to Lantus.
 
Why are you concerned about contaminated ProZinc? Since you are using a vial (and not an insulin pen which works on negative pressure) you are SUPPOSED TO inject air into the vial. You draw the empty syringe back to the correct dose (plus a little extra to squirt out when getting rid of air bubbles) then you take the “air filled” syringe and insert it into the ProZinc vial and press the plunger to inject all of the air into the vial make sure to get as much air out of the syringe as possible before letting go of the plunger and then drawing back your dose including the little extra bit that you can squeeze out when you’re flicking air bubbles. The manufacturer instructions for the ProZinc vial indicate that you do inject air into the vial. The only thing you don’t want to do is to inject insulin back into the vial. Any excess insulin should be expelled into the sink or onto a paper towel, etc.

One month isn’t very long on ProZinc, but you do have ketones to consider. I think we need to keep increasing pretty quickly until ketones start going down. Have you spoken with your vet about using a different insulin?
 
His ketones were 6.5 and his levels haven’t been great so I decided to up him to 3.5 units even though he wasn’t on 3.25 for long. He is still acting normal and I’m going to keep a close eye on him. The only unfortunate thing is I have class this week and my mom is out of town for work so I’m nervous about leaving him home alone during the middle of the day on 3.5 units.
 
I’m going to test as much as I can tonight to make sure he doesn’t go hypo. She won’t be home until Thursday night. I’ll be gone Monday from 11:30am-4pm, Tuesday from 7:30am-4pm, Wednesday 10am-1:30pm, and then Thursday 11am-3pm.
 
Should I keep him at 3.5 for tomorrow or go back to 3.25? I’m going to take his glucose in another hour to see where he is sitting.
 
Sorry. I am just seeing this now on Monday afternoon. If Pablo were my cat, I would keep the 3.5 unit dose. He seemed fine on it last night when you gathered good data. Try it again tonight and see how it goes. He doesn’t seem to budge out of the yellows so I doubt if a .25 increase will send him too low (and you already tried it and got tests so I feel confident he will be safe.)
 
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