New Member Dealing With Stubborn Ketones

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CaitlynMF

CaitlynMF

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Hi everyone! I’m a new member, at least when it comes to posting in the forums, i’ve always been a silent member here and active on the Facebook group but I really need help. My girl Morticia has Pneumonia and was diagnosed on the 14th of this month, since then her BG has remained in the 300’s and will not budge, so with that she unfortunately also has ketones that just will NOT come down, I feel like i’m at such a loss, she’s been on fluids since the 14th, 5 cans of food a day or more, Amoxi-clav and her insulin (lantus) is now at 2.5 units from her original 1.5 before the pneumonia. Her pneumonia seems to be improving when it comes to breathing, though at her recent appointment on the 25th their Xray machine was down so we couldn’t check her lungs, her pneumonia never showed on an Xray to begin with since it was “caught very early”so i’m not sure if it would have made a difference anyway. She’s still eating and acting normal for the most part but i’m so scared she’s going to take a dramatic turn because of how long she’s presented with ketones. Realistically I know that it’s probably from the inflammation in her lungs causing her BG to stay in the 300’s thus keeping the ketones present but I don’t know what to do anymore besides keep treating her for pneumonia and hope her BG comes down and the ketones follow suit? It just seems so scary to think she’ll have ketones for any longer. I really don’t want to lose my baby.
 
CaitlynMF said:
Hi everyone! I’m a new member, at least when it comes to posting in the forums, i’ve always been a silent member here and active on the Facebook group but I really need help. My girl Morticia has Pneumonia and was diagnosed on the 14th of this month, since then her BG has remained in the 300’s and will not budge, so with that she unfortunately also has ketones that just will NOT come down, I feel like i’m at such a loss, she’s been on fluids since the 14th, 5 cans of food a day or more, Amoxi-clav and her insulin (lantus) is now at 2.5 units from her original 1.5 before the pneumonia. Her pneumonia seems to be improving when it comes to breathing, though at her recent appointment on the 25th their Xray machine was down so we couldn’t check her lungs, her pneumonia never showed on an Xray to begin with since it was “caught very early”so i’m not sure if it would have made a difference anyway. She’s still eating and acting normal for the most part but i’m so scared she’s going to take a dramatic turn because of how long she’s presented with ketones. Realistically I know that it’s probably from the inflammation in her lungs causing her BG to stay in the 300’s thus keeping the ketones present but I don’t know what to do anymore besides keep treating her for pneumonia and hope her BG comes down and the ketones follow suit? It just seems so scary to think she’ll have ketones for any longer. I really don’t want to lose my baby.
Click to expand...
@Bron and Sheba (GA)
@Sienne and Gabby (GA)
 
Hi Caitlyn and Morticia ( I love the name!) and welcome to the forum. I’m glad you made it over from the fb page.I spoke to you over there.
Do you have a spreadsheet you can share with us so we can see what is happening with the blood glucose?
It sounds as if you are home testing which is good.

If you could set up the signature please, which is easy and tell us about Morticia so we don’t have to keep asking you questions. The signature will appear at the bottom of all your posts. If you look at the bottom of mine you can see some smaller paler writing. That is the signature.
Details on how to set up the signature and spreadsheet here HELP US HELP YOU
If you don’t have the spreadsheet set up yet, when you do , if you could add a couple of weeks BGs so we can see what is happening please.

When there are ketones in the picture you need to be feeding 1 and a half times as many calories as you normally do. It sounds as if you are feeding her lots which is great. What are you feeding her and do you think she is eating well?
And you say she’s been on fluids since the 14th. What type of fluids do you mean?
Are you testing for ketones with a urine test strip or a blood ketone meter? If you could share the results with us that would be helpful.
Once you have the spreadsheet set up if you could put any results of the ketones into the remarks columns on the SS, that will tell us a lot thanks.

Do you have any lab results you can share with us?
How long has she been on the antibiotic and does the vet think it needs to be changed to a stronger on?
Looking forward to hearing back from you
Bron
 
Bron and Sheba (GA) said:
Hi Caitlyn and Morticia ( I love the name!) and welcome to the forum. I’m glad you made it over from the fb page.I spoke to you over there.
Do you have a spreadsheet you can share with us so we can see what is happening with the blood glucose?
It sounds as if you are home testing which is good.

If you could set up the signature please, which is easy and tell us about Morticia so we don’t have to keep asking you questions. The signature will appear at the bottom of all your posts. If you look at the bottom of mine you can see some smaller paler writing. That is the signature.
Details on how to set up the signature and spreadsheet here HELP US HELP YOU
If you don’t have the spreadsheet set up yet, when you do , if you could add a couple of weeks BGs so we can see what is happening please.

When there are ketones in the picture you need to be feeding 1 and a half times as many calories as you normally do. It sounds as if you are feeding her lots which is great. What are you feeding her and do you think she is eating well?
And you say she’s been on fluids since the 14th. What type of fluids do you mean?
Are you testing for ketones with a urine test strip or a blood ketone meter? If you could share the results with us that would be helpful.
Once you have the spreadsheet set up if you could put any results of the ketones into the remarks columns on the SS, that will tell us a lot thanks.

Do you have any lab results you can share with us?
How long has she been on the antibiotic and does the vet think it needs to be changed to a stronger on?
Looking forward to hearing back from you
Bron
Click to expand...
Bron and Sheba (GA) said:
Hi Caitlyn and Morticia ( I love the name!) and welcome to the forum. I’m glad you made it over from the fb page.I spoke to you over there.
Do you have a spreadsheet you can share with us so we can see what is happening with the blood glucose?
It sounds as if you are home testing which is good.

If you could set up the signature please, which is easy and tell us about Morticia so we don’t have to keep asking you questions. The signature will appear at the bottom of all your posts. If you look at the bottom of mine you can see some smaller paler writing. That is the signature.
Details on how to set up the signature and spreadsheet here HELP US HELP YOU
If you don’t have the spreadsheet set up yet, when you do , if you could add a couple of weeks BGs so we can see what is happening please.

When there are ketones in the picture you need to be feeding 1 and a half times as many calories as you normally do. It sounds as if you are feeding her lots which is great. What are you feeding her and do you think she is eating well?
And you say she’s been on fluids since the 14th. What type of fluids do you mean?
Are you testing for ketones with a urine test strip or a blood ketone meter? If you could share the results with us that would be helpful.
Once you have the spreadsheet set up if you could put any results of the ketones into the remarks columns on the SS, that will tell us a lot thanks.

Do you have any lab results you can share with us?
How long has she been on the antibiotic and does the vet think it needs to be changed to a stronger on?
Looking forward to hearing back from you
Bron
Click to expand...

I’m not sure if i’m replying to this correctly but I updated the signature, hopefully that looks okay. I do have a spreadsheet, I did do the bulk of it all in one day and haven’t had a chance to clean it up since all my notes were all over the place previously so some of the information prior to these recent bad numbers may be left out till I correct it. I only started her spreadsheet from the start of her coming home from the DKA hospital stay the last time and not from her diagnosis since she was on Vetsulin before that and her numbers were just a mess on it. We currently have her on the Tiki cat after darks since we think her current pneumonia may have been caused by her aspirating her food due to how fast she eats and the tiki cat seems to slower her down a smidge with the whole pieces of meat. She still eats VERY well, she’s a big foodie and has remained very excited about food and her treats for sugar check this entire time, we have also been weighing her daily and she has remained a good 11LB. The fluids she is on right now are subq fluids, I believe it’s the lactated ringer. I do blood and urine checks on her ketones and I prefer blood since she would show trace in urine even at 3 on a blood meter but I have one blood strip left and i’m waiting for more to come in because I cannot find them near me anywhere. She seems to be doing well on the Amoxi-Clav though I know it’s not the best antibiotic her breathing has regulated a significantly already and they noted on her follow up paperwork from the 25th that her heart and breathing rate were good but he wants us to continue antibiotics for another 7 days which I agree with since we could not get our scheduled xray done due to their machine being broken, her pneumonia never appeared on an xray to begin with but they said that is normal if it was caught very early. I have no actual bloodwork results but I am going to request them, I know that since all this she has had the standard liver, kidneys, and heart screening and all has checked out fine.Here is her Spreadsheet, hopefully I attached it correctly, looking at her spreadsheet, i’m kind of wondering if maybe her BG is a case of too much insulin plus still having inflammation in her lungs cause I can’t imagine it going away that fast or potentially the sugar in the antibiotics adding to it as well? https://docs.google.com/spreadsheets/d/1Qwg4bGo53MN5ayhbMEwoQIVHGtAZ7m7Zt2ubCQ_Y6qc/edit
 
CaitlynMF said:
hopefully I attached it correctly
Click to expand...

If you open your Signature box again, the link to your spreadsheet should go there as the last entry. If you look at some of our signatures, you'll see our spreadsheet link is always in our signature (that also keep you from having to remember to enter the link every time you post)

You also need to change the privacy settings on your spreadsheet. If you have a PC, you click on the blue "Share" in the top right corner and when the new box pops up, change the last one to "Anybody with the link can View".

If you don't have a computer and are using a phone, open your spreadsheet. Click on the 3 dots in the top right corner and then choose "Share & Export". Then "manage access" and under General Access change it to "Anyone on the internet with the link can VIEW".
 
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Chris & China (GA) said:
If you open your Signature box again, the link to your spreadsheet should go there as the last entry. If you look at some of our signatures, you'll see our spreadsheet link is always in our signature (that also keep you from having to remember to enter the link every time you post)

You also need to change the privacy settings on your spreadsheet. If you have a PC, you click on the blue "Share" in the top right corner and when the new box pops up, change the last one to "Anybody with the link can View".

If you don't have a computer and are using a phone, open your spreadsheet. Click on the 3 dots in the top right corner and then choose "Share & Export". Then "manage access" and under General Access change it to "Anyone on the internet with the link can VIEW".
Click to expand...

Thank you! I was trying to figure that out. I think I got it this time? Lol
 
I'd encourage you to take a look at the sticky notes at the top of the Lantus board. In particular, with cats that are dealing with DKA, you may want to look at the sticky note on dosing methods and pay close attention to the information on Tight Regulation (TR). One of the basic principles of using Lantus is that it is an insulin that does best with consistency. Part of that consistency is dose. I'd encourage you to give Morticia the same insulin dose at AM and PM shots.

With a cat that is dealing with ketones, you want to be aggressive with insulin dosing. The TR protocol is aggressive -- you evaluate the insulin dose every 3 days/6 cycles.

From what I can tell, the amoxi-clav contains aspartame, not sugar.
 
Sienne and Gabby (GA) said:
I'd encourage you to take a look at the sticky notes at the top of the Lantus board. In particular, with cats that are dealing with DKA, you may want to look at the sticky note on dosing methods and pay close attention to the information on Tight Regulation (TR). One of the basic principles of using Lantus is that it is an insulin that does best with consistency. Part of that consistency is dose. I'd encourage you to give Morticia the same insulin dose at AM and PM shots.

With a cat that is dealing with ketones, you want to be aggressive with insulin dosing. The TR protocol is aggressive -- you evaluate the insulin dose every 3 days/6 cycles.

From what I can tell, the amoxi-clav contains aspartame, not sugar.
Click to expand...
I’ll go look at the TR protocol now! We did put her on 2.5 am and pm as of yesterday, but i’m a little confused because after looking at her spreadsheet, it seems like her sugar started to go up once we bumped her dosage though she seems to be getting better in regards to her pneumonia and now showing negative ketones in urine (haven’t checked on a blood meter again) is that a normal adjustment?
 
One thing that will help us is if you can get at least one additional test each cycle, in addition to the preshot tests. That means the night as well. A +2 or +3 or whatever just before bed for you will help fill in what is happening. Many cats go lower at night. It's possible she's dropping in some of those nights without test, then bouncing. Or she's not, and just needs more insulin. Hard to tell without that data. For safety, the TR protocol requires those tests too.
 
I'm not seeing a jump in numbers after the dose increase. One thing to factor in is that there is a 20% margin of "error" for any test due to measurement issues with meters and strips. As an example, if you get a test result of 300, the actual range is 240 - 360. When you got your PM test on 9/27 of 330 and the PM +2 was 376, you essentially had the same numbers. (I hope I didn't just confuse you!)
 
Chris & China (GA) said:
It really depends on how sensitive Morticia is to carbs and sugar. We've had cats that sneaked 3 or 4 pieces of kibble whose BG went up over 200 points (so very carb-sensitive), but hopefully @Sienne and Gabby (GA) is right and the one you have contains aspartame and not a real sugar.
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Our girl is pretty sensitive with stuff like that, the black numbers on her chart came from eating a few pieces of dogs food and the other times was a tiny piece of breadstick. I believe it was micro crystalline in the antibiotic.
 
Wendy&Neko said:
One thing that will help us is if you can get at least one additional test each cycle, in addition to the preshot tests. That means the night as well. A +2 or +3 or whatever just before bed for you will help fill in what is happening. Many cats go lower at night. It's possible she's dropping in some of those nights without test, then bouncing. Or she's not, and just needs more insulin. Hard to tell without that data. For safety, the TR protocol requires those tests too.
Click to expand...
I thought maybe she was dropping at night as well and I typically try and get atleast a +2 at night or my husband will but he forgets to log them sometimes. Unfortunately though, her numbers didn’t seem much different at this point. Before when she was regulated we would have to worry about her going hypo at night so we would check periodically if we woke up and at the +2, now she just seems stuck in these numbers.
 
Sienne and Gabby (GA) said:
I'm not seeing a jump in numbers after the dose increase. One thing to factor in is that there is a 20% margin of "error" for any test due to measurement issues with meters and strips. As an example, if you get a test result of 300, the actual range is 240 - 360. When you got your PM test on 9/27 of 330 and the PM +2 was 376, you essentially had the same numbers. (I hope I didn't just confuse you!)
Click to expand...
That makes sense and i’ve been having to factor the 20% into her readings more because her meter has been giving us some weird readings lately, not like 20% differences but it would go from 500 to 330 in a matter of a minute so when she gets a random off reading we test two more times to figure out which two are 20% off of each other or in the same range I guess. Her numbers just seemed because she seemed to be reading more on a low scale of 300’s now it seems she’s reading on the higher scale even though it’s still in the same range, just seemed weird lol
 
CaitlynMF said:
I typically try and get atleast a +2 at night or my husband will but he forgets to log them sometimes.
Click to expand...
The numbers should be in the meter history for the last couple weeks. If you can, try to fill in the spreadsheet with those missing numbers. 4 out of the last 5 nights had no second tests.

You are testing more than you need to during the day. When you see that at +5 to +6 she's essentially the same as preshot, you don't need those later tests. Since you are using those expensive AT test strips, best to use them when it counts, such as those second PM tests.
 
Wendy&Neko said:
The numbers should be in the meter history for the last couple weeks. If you can, try to fill in the spreadsheet with those missing numbers. 4 out of the last 5 nights had no second tests.

You are testing more than you need to during the day. When you see that at +5 to +6 she's essentially the same as preshot, you don't need those later tests. Since you are using those expensive AT test strips, best to use them when it counts, such as those second PM tests.
Click to expand...
Yeah i’ve been a little invasive with her testing during the day, I’ve just been a bundle of nerves lately since she got sick. Which points would be best during the day. I know we need the +2 for pm and any other time during the night right? Also would you suggest maybe bumping her again, I believe tonight would make day three on 2.5 so if her numbers are still high on her pm tests, do we increase? Her vet had us have an Acro test done at her appointment on the 25th and didn’t really want us increasing till it came back but I really don’t want her staying in these numbers since she’s ketone prone and i’m not even sure she has Acro since it was my understanding Acro cats are not considered truly diabetic thus they start their journeys never truly being regulated on low doses, right?
 
CaitlynMF said:
i’m not even sure she has Acro since it was my understanding Acro cats are not considered truly diabetic thus they start their journeys never truly being regulated on low doses, right?
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I've seen several cases of acros that were diabetic, went into remission, then came back and went to higher doses. I've also seen the same on cats with IAA (insulin auto antibodies). If the vet wants to test for acromegaly, they should also test for IAA. The blood goes to the same place (MSU) for both so the IAA is a cheap add on test.

CaitlynMF said:
I believe tonight would make day three on 2.5 so if her numbers are still high on her pm tests, do we increase?
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Without those night tests, as I said before, I can't tell if she is dropping and night and then bouncing. Which would make an increase at this point unsafe. The TR protocol that allows you to increase after 6 cycles, requires that those six cycles have at least two tests per cycle for those six cycles.

CaitlynMF said:
Which points would be best during the day. I know we need the +2 for pm and any other time during the night right?
Click to expand...
Get a +2 or +3 in the AM as well. And a test around mid cycle. If there is a big drop from preshot to the +2 or +3, you may need to do more testing as that can indicate a more active cycle.
 
Wendy&Neko said:
I've seen several cases of acros that were diabetic, went into remission, then came back and went to higher doses. I've also seen the same on cats with IAA (insulin auto antibodies). If the vet wants to test for acromegaly, they should also test for IAA. The blood goes to the same place (MSU) for both so the IAA is a cheap add on test.


Without those night tests, as I said before, I can't tell if she is dropping and night and then bouncing. Which would make an increase at this point unsafe. The TR protocol that allows you to increase after 6 cycles, requires that those six cycles have at least two tests per cycle for those six cycles.


Get a +2 or +3 in the AM as well. And a test around mid cycle. If there is a big drop from preshot to the +2 or +3, you may need to do more testing as that can indicate a more active cycle.
Click to expand...
I asked about the IAA test and he said he wasn’t concerned about that for some reason though I assumed they’d go hand in hand. Starting tonight i’ll get her a +2 and +3 or 4 test and update. Do you happen to know what other symptoms would come with acro? I’ve looked online and a bit in the forums and Facebook group but none seem to fit her very well other than her sugar remaining high right now which is hard to gauge considering her pneumonia.
 
CaitlynMF said:
I asked about the IAA test and he said he wasn’t concerned about that for some reason
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That's a vet lack of knowledge thing. They think it's rarer than it is.

As for acro symptoms, it's all over the place. Neko's only symptom on diagnosis was her dose and crazy hunger, and eating inappropriate food - like bread/muffins. Later I found her one teary eye was likely due to excess soft tissue growth. I've seen that only 35% of acros have clinical symptoms on diagnosis.

Getting the pneumonia better is a good first goal. That will help.
 
Wendy&Neko said:
That's a vet lack of knowledge thing. They think it's rarer than it is.

As for acro symptoms, it's all over the place. Neko's only symptom on diagnosis was her dose and crazy hunger, and eating inappropriate food - like bread/muffins. Later I found her one teary eye was likely due to excess soft tissue growth. I've seen that only 35% of acros have clinical symptoms on diagnosis.

Getting the pneumonia better is a good first goal. That will help.
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He did admit his lack of knowledge in those cases due to the fact it was always considered rare but he said in this month alone he has had two cats come back positive which is why I think he is just be trying to cover all grounds by testing. I really only knew about it because I had seen things about Acro and IAA in the group.
That’s very interesting, Morticia also gets teary eyed but it’s mostly just after she eats, we assumed it may be from how quickly she eats, which is how she ended up with pneumonia, I suppose we’ll only really know once the test comes back. Till then i’ll focus on her pneumonia and getting her BG in check to keep these ketones from causing more problems. I have one more blood ketone strip, I might test her with tonight since she is finally showing negative on her urine strips so I assume they at least have to be a little lower now maybe at a 2 on a blood meter since that’s what she was at before when she showed negative on the urine sprips, I don’t know if they’ll go away completely if her BG is still in the 300’s, would they?
 
Wendy&Neko said:
I've seen several cases of acros that were diabetic, went into remission, then came back and went to higher doses. I've also seen the same on cats with IAA (insulin auto antibodies). If the vet wants to test for acromegaly, they should also test for IAA. The blood goes to the same place (MSU) for both so the IAA is a cheap add on test.


Without those night tests, as I said before, I can't tell if she is dropping and night and then bouncing. Which would make an increase at this point unsafe. The TR protocol that allows you to increase after 6 cycles, requires that those six cycles have at least two tests per cycle for those six cycles.


Get a +2 or +3 in the AM as well. And a test around mid cycle. If there is a big drop from preshot to the +2 or +3, you may need to do more testing as that can indicate a more active cycle.
Click to expand...
So I got some testing last night at +2 and +4, I know we need to go a couple more days doing that to get a better view of things but she seems to be so stuck in these numbers I feel terrible for my baby. I did her +2 am check a few minutes ago but our meter just seems to be giving us more and more issues, I got 498 and 365 in a minute span which doesn’t seem like 20% range at all and i’m not sure which one to add on the spreadsheet. It’s making me wonder if her preshot number last night of 410 was accurate or not since I didn’t get a chance to test again in that moment.
 
As far as I'm concerned, 498 and 365 are still in the category of "too high". If not tested on the same blood drop, there could be differences. Meter reading differences are much more important in lower numbers.

Some meters are fussier than others about getting large enough blood drop, and will give a lower number if not quite enough.
 
Wendy&Neko said:
As far as I'm concerned, 498 and 365 are still in the category of "too high". If not tested on the same blood drop, there could be differences. Meter reading differences are much more important in lower numbers.

Some meters are fussier than others about getting large enough blood drop, and will give a lower number if not quite enough.
Click to expand...
Oh yes, absolutely both are still too high but I should have added this was taken with the same drop of blood for the context of my confusion so it was also decent enough in size to get two readings. I do also have a human meter to compare numbers if need be though.
 
Wendy&Neko said:
I've seen several cases of acros that were diabetic, went into remission, then came back and went to higher doses. I've also seen the same on cats with IAA (insulin auto antibodies). If the vet wants to test for acromegaly, they should also test for IAA. The blood goes to the same place (MSU) for both so the IAA is a cheap add on test.


Without those night tests, as I said before, I can't tell if she is dropping and night and then bouncing. Which would make an increase at this point unsafe. The TR protocol that allows you to increase after 6 cycles, requires that those six cycles have at least two tests per cycle for those six cycles.


Get a +2 or +3 in the AM as well. And a test around mid cycle. If there is a big drop from preshot to the +2 or +3, you may need to do more testing as that can indicate a more active cycle.
Click to expand...
So we have been able to get some more PM testing done the past three nights I fell asleep last night before I could get her +3 or 4 test but she still seems to be high. Should we go up to 2.75 tomorrow morning, or tonight with the numbers she’s had so far?
 
Thanks for the extra tests, that helps give confidence on what is happening. Just confirming you are following Tight Regulation (which is what your spreadsheets says, please add to the signature as well. If so, if nadirs are all above 300, you can increase any time by 0.5 units to 3.0 units as your new dose.
 
Wendy&Neko said:
Thanks for the extra tests, that helps give confidence on what is happening. Just confirming you are following Tight Regulation (which is what your spreadsheets says, please add to the signature as well. If so, if nadirs are all above 300, you can increase any time by 0.5 units to 3.0 units as your new dose.
Click to expand...
Yes, we are going to follow the tight regulation protocol moving forward as I believe that best suits us. I’ll add that to my signature now. Should we start 3 units tonight or tomorrow morning?
 
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