Please Help Cat Tested positive with moderate ketones

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Sasha&Tara

Member Since 2012
My Cat Sasha who is 7 years old was diagnosed with diabetes in 5/2011. He was prescribed Lantus and I have been giving it to him twice daily with 2 units. He eats no dry food. Only Chicken wellness, Merricks, and Fancy Feast classics on scheduled feedings. No grains, or gluten.I moniter his blood sugar pre shot during the week as I work, and more frequently on the weekends when I am off. His normal preshot numbers are around 350, the Lantus brings him between 100-200 at peak. Shot times are 6AM and 6PM
Last weekend his BG never went below 350 at peak, even with the lantus. Sasha was peeing alot, wouldnt eat, and became lethargic. I took him to the vet on Sunday, she said he had Ketones and immediately hospitalized him. She gave him fluids and short acting insulin, he came home Thursday. The bill was $5000.00, so I took out my savings. I love my Sasha. I literally have ten dollars to my name until my next paycheck.
He came home from the animal hospital feeling better. That was Thursday. I have been taking vacation days from work to look after him, and take his BG's, because I live alone. Last night I fed him Wellness Venison, big mistake it had a lot of carbs in it, I had no idea until I took his BG. It was 485 at 12am. 412 at 2 am. I noticed he was getting lethargic again, just a little, and starting to get thirsty again but very hungry. He's not peeing a lot. I didnt know what to do with such high numbers and was afraid he'd get ketones again and dehydrate. So I gave him 2.25 units of Lantus at 2:30 this morning. I just checked his blood again at 12 PM it is a whopping 346. It is not because of food.

I cannot afford to got to the vet. I really mean it when I say that I have ten dollars to my name. I dont know what to do and am afraid that I will have to put him down. He is not as bad as he was on Sunday, but I know they get bad quick. I am not sure if I should give him more Lantus, if that would help. Please help me, I am so afraid.

Thanks
 
Re: Please Help

Tara,
First, BREATHE!!

NO, DON"T GIVE HIM MORE LANTUS! Lantus needs to be given at 12 hour intervals - it does not work like 'immediate delivery' insulins.

I'm going to go ahead and post this now so you'll see it - I'll edit to add more.

Breathe again!

==========
EDIT TO ADD: First, breathe deep again...it does help. I can't help with the ketone or DKA but someone will be along shortly to help answer those questions. Do you have ketone test strips? Most pharmacy's around here carry them but you may have to ask at the counter. This will tell you if there are ketones in his urine. In edit mode, I can't see your original message so am forgetting what your other questions were.

BIG HUG! Breathe again...
 
Re: Please Help

Thank you Thank you I am breathing but so scared!!! He's sleeping now, but I am so afraid he's going to get bad like he did last week. I also forgot to add, the Lantus is a new bottle. Just opened up on Thursday, and I use a one touch ultra glucometer
xoxo- Tara
 
Re: Please Help

unfortunately and I cant believe I'm saying this I dont even have the money for keytone strips until Friday. I literally spent all my money at the vets last week.
With such a high BG, should I still be feeding him as long as he is hungry, or just let his BG drop? Last Saturday before all this went down he was hungry but by Sunday morning wasnt eating and throwing up water. So scared this is history repeating it self.
 
Re: Please Help

I know you're scared right now - we've all been there...all of us here got that same diagnosis so we understand how scary it is. In your case, you've got a bit extra to deal with but there are others here that have lived that same experience and know how to handle it. I'll send a couple of emails and see if we can get you some 'better' help, I'm not much 'help' but I make a really good cheerleader.

Sounds like he may be 'bouncing' from the lower numbers he had for a while. After Sasha's BG's being high before diagnosis, his body got used to the higher BG numbers. Now his liver is going into panic mode when the numbers were lower (closer to real normal) thinking it was getting too low and dumping glucose into the blood. KT does this over and over and over. It can take up to 3 days to clear out that 'liver dump'. Mr. Liver LIKES his sugar bowl....

BIG HUG! You've landed in the right place to help both of you!!!!
 
Re: Please Help

Hang in there, Tara.

I am out of practice with suggestions for new folks, so I will leave it to others, I just wanted to let you know MANY people from all over the globe are reading this and rooting for you and Sasha- even if they don't post to say so.

Take a minute to try to relax a little- our kitties pick up on our energy....(((hugs)))
 
Re: Please Help

Thank you so much guys...I am so grateful for your responses...I am starting to calm down slightly. Big hugs to you and your furry babies!
 
Re: Please Help

Tara, could you possibly post what city/state you live in? Maybe there are members here, who might have the ketone testing strips .. I know if someone is nearby, they will more then likely be willing to share .. We've all been in your shoes, scared, broke and worried .. We will do what we can to help you guys out ..
 
Re: Please Help

Hi Peter, I live in Yonkers, NY. About 20 minutes from Manhattan. Thank you for responding!
 
Re: Please Help

If God forbid he does have ketones, is there even a way to bring him out of this on my own while he's still eating and drinking?
 
Re: Please Help

I've emailed 3 people that I know have dealt with DKA - one of them should be along shortly. Right now, I think you're doing OK.

I can definitely identify with the being broke and needing supplies - we still stand on that spot occasionally but someone here always comes to our rescue. We WANT our sugar babies to stay right where they are with the beans that love them and are willing to do whatever necessary to help!

One of the biggest things I had to pound into my brain is that insulin is NOT a chemical medicine, it's a hormone that kitty's pancreas should be making but isn't. There's no 'take two and call me in the morning' dosing - it's a balancing act of providing enough insulin to allow their bodies to properly turn that food into useable energy. An untreated diabetic can starve while stuffing themselves with food because the body can't USE the food correctly.

I'm glad you're calming down - try another breath now....

BIG HUG!!!
 
Re: Please Help

Hi Tara,

I don't have direct experience with DKA or ketones, but I do know Lantus and I have seen many cats with ketones on the board. I know you are limited on money, but it may be necessary to take her to the vet....if you take her early, it could help you avoid an emergency hospitalization, so it may not cost that much. I would call your vet, see if you can work something out with them, or apply for Care Credit.

Ketostix would really help but I hear what you are saying about $$$$.

First, keep feeding Sasha, and add as much water to the food as she will tolerate...water helps flush ketones out of the system. Do you have subQ fluids, have you ever used them? Does Sasha have any other health problems, heart issues?

Ketones and high BG are not directly related, a cat can develop ketones even when the BG numbers are relatively low. The recipe for ketones is not enough insulin + not eating (or not eating enough) + infection. It's important to make sure she keeps eating, even if you have to syringe feed her. I'm glad you increased the dose of Lantus, but I would not give more now. Let me see if I can get some more experienced DKA folks to look in and help you more....
 
Re: Please Help with Ketone Problems

Sadly, my credit is not so great because of my divorce, so Care Credit is not an option, I tried to apply already. The vet did send him home with an antibiotic called Baytril, I have been giving it to him through a dropped every 24 hours. He just peed and immediately drank more water. He's still alert, just not his normal self.
 
Re: Please Help with Ketone Problems

I was re-reading your post....you gave 2.0u units at 6PM last night, then 2.25u at 2:30AM? No more since then?
 
Re: Please Help with Ketone Problems

Laurie, the last was 2.25 units at 230 this AM. Usually give it to him around 6 am, but didnt know what to do as I saw he was getting worse
 
Re: Please Help with Ketone Problems

UPDATE! I scrounged around and came up with the cash for the ketone strips. How do I do this, his litter box has hard clumping litter?
 
Re: Please Help with Ketone Problems

Lantus dosing is every 12 hours. Please do not keep dosing. Your next shot would be 12 hours from when you last shot. To be honest, I'm worried about Sasha being over dose.

High numbers do not always imply ketones or DKA. Do you have any other test data? One possible scenario is that Sasha had some sort of infection that triggered the DKA. The Baytril may have been clearing the infection and her numbers dropped into lower ranges. She may have then bounced back into higher numbers and that's what you're seeing. Having given a second shot of Lantus could complicate the situation.

So, please get some tests so you know where Sasha's numbers are especially with the double dose. \

You can either stalk Sasha to the litter box and put a strip into her urine stream or use a ladle, spoon, whatever, to get some urine. You dip the paper end of the strip into the urine, wait 15 sec. and compare the color on the strip to the guide on the Ketostix container.
 
Re: Please Help with Ketone Problems

DCIN may be able to help you....I would contact them, Squeem posted the link (thanks!) I'm glad she's drinking, but I would also add water to the food if she will tolerate it. I'm glad that she's on an AB, and glad she isn't acting lethargic at the moment.

I see Sienne posted, she has DKA experience and can guide you better than I can. She answered the question about the ketostix.

How many test strips do you have on hand?

I'm going to list the data you have in a format that makes it easier to analyze, please correct anything I get wrong, ok? We use + hours to indicate how long after the shot. If you can add any more testing data that would be great.

3/5
6 AM ?? 2.0u
6 PM ?? 2.0u
+6 (12 AM) 485
+8 (2 AM) 412
+8.5 (2:30 AM) 2.25u (new PS)
+9.5 (12 PM) 346
 
Re: Please Help with Ketone Problems

Laurie, those numbers are exactly right. there are 50 test strips> Thank you for putting that together for me, still in panic mode. He just ate a little, and now I am waiting for him to pee so I can test him.
 
Re: Please Help with Ketone Problems

Do you have any test data from a day or two ago? If your vet didn't tell you, while pre-shot information is useful, it's also very useful to have test information from other points in the cycle. Lantus dosing is based on the nadir (lowest point in the cycle). If numbers are low, like I said earlier, this can trigger a bounce.

Also, what are you feeding Sasha? The carbohydrate content may be effecting numbers, as well.

Do you happen to know what Sasha's exact diagnosis was at the vet? Was she experiencing ketones vs. diabetic ketoacidosis (DKA)? Was there an infection present? I'm presuming there was given the Baytril. I'm hoping your vet gave you a discharge summary when Sasha came home. This information should be in the paperwork.

With ketones, trace or no ketones can be managed at home if you are diligent (which it sounds like you are). More than trace really requires a vet to intervene. Increasing fluids and insulin can help. However, the insulin increase needs to be done strategically so you don't overdose your cat. You also need to use food in a very strategic manner to prevent numbers from dropping.
 
Re: Please Help with Ketone Problems

Sasha&Tara said:
How do I do this, his litter box has hard clumping litter?
Click to expand...

Stick a long handled spoon (maybe you have one for cooking with?) under the tail to catch the urine. If your cat isn't too self concious about having privacy and you don't mind getting a little wet/dirty, you can stick a small cup under the tail as well.


Sienne and Gabby said:
Also, what are you feeding Sasha? The carbohydrate content may be effecting numbers, as well.
Click to expand...

She mentions this above: He eats no dry food. Only Chicken wellness, Merricks, and Fancy Feast classics on scheduled feedings. No grains, or gluten
 
Re: Please Help Tested positive with moderate ketones

Yes, he's at 354 BG. Moderate ketones. I just IM'd DCIN. Is that the best way to get in touch with them?
 
Re: Please Help Tested positive with moderate ketones

I have never contacted DCIN personally. I'll PM Venita as well..see if we can get you some help.

You really need to get her to the vet, moderate ketones are not something I would suggest dealing with at home. I'm looking for suggestions on dosing...hang on.
 
Re: Please Help Tested positive with moderate ketones

Ok, with so little information, it's hard to know how much insulin to give. If you can monitor, sticking with the increased dose of 2.25u may be ok...but you will need to be prepared to steer the numbers with food...not saying you will need to, but it may be necessary. Is Sasha eating ok, not vomiting? Do you have HC food in the house, karo syrup? Will you be able to monitor her closely?

Of course, hoping that getting her to the vet is possible...that's the best answer.
 
Re: Please Help Tested positive with moderate ketones

please make sure you are reading the ketone strips at exactly 15 seconds
 
Re: Please Help Tested positive with moderate ketones

Hi everyone. I found a vet who was kind enough to let me post date a check so I could get Sasha in. He took his BG it was 346 at 430 PM. Problem was, the vet was acting as though the ketones were no big deal, and he was suggesting Hills MD dry which I said no way to. He suggested I give Sasha 3 units at 6 PM tonight, so I did because he's eating and 2 units of his Lantus tomorrow at 6 AM. I also asked for a bag of SubQ fluids, so the vet showed me what to do and I was able to get 100ml of fluid under his skin. I also gave him the Baytril. He's sleeping now under the bed. I am hoping to flush these ketones out of him. I don't think I should give him any more fluid tonight. I appreciate all of your help and support. As he's still ketone positive, I was wondering if there re any additional tips you guys might have? Again, I can't thank you all enough!!!
Hugs to you and yours!
 
Re: Please Help Tested positive with moderate ketones

Tara, hang in there, I'm trying to get some more eyes in this post.
 
Re: Please Help Tested positive with moderate ketones

Hi there Tara,

Just popped over at Dyanas request . i have been down the ketone path with Black Kitty more than once.

So, you shot the 3u lantus and gave 100ml subq fluids. How many hours ago?
Not sure if you saw Lauries earlier post-
If you could provide the information she requested it will help us to better help you.
Laurie and Mr Tinkles said:
Ok, with so little information, it's hard to know how much insulin to give. If you can monitor, sticking with the increased dose of 2.25u may be ok...but you will need to be prepared to steer the numbers with food...not saying you will need to, but it may be necessary. Is Sasha eating ok, not vomiting? Do you have HC food in the house, karo syrup? Will you be able to monitor her closely?
Click to expand...

I have never used subq fluids, however I think you are OK for tonight with the 100ml. Hopefully someone with experience can confirm that.
Calories, insulin and hydration are all important right now.

I've got to read the entire thread and get up to speed on the details. Please monitor his BGs closely, I say that based on Lauries comment above.

BBL :-D
 
Re: Please Help Tested positive with moderate ketones

Hi! Thank you for responding. I gave him the 3 units of lantus at 6 PM, the 100ml under his skin around 530 PM. He's eaten about half a can of Merrick's cowbow cook out. and has kept it down. He's still peeing, as I expected. I do have Karo syrup and high carb food in case he goes hypo. I'm just not sure whatelse to do at this point for him. He didnt absorb all of the fluids yet. I am taking off of work tomorrow to keep an eye on him, I know it's going to be a sleepless night for me! He seems tired, but is still grooming himself. I will take his BG at 9 PM- that will be 3 hours post shot.

I should also add that the vet looked at the ultrasound results from when he was in the hospital last week and said that Sasha's pancreas is inflammed.

Again, Thanks for all of your support, it really helps knowing Im not alone.
 
Hi again :cool:

Thanks for the info. glad to hear he is eating :-D . The fluids take some time to absorb. It's good you will be home tomorrow.

Can you tell me when and how many units Sashas dose previous to the 3u you gave tonight at 6pm was?
 
Hi! Yes. his last two doses were at 6pm last night (2 units) and then at 230am (2.25units) because i freaked when I saw his bg was above 400. (now I know I shouldnt have done that)

The vet told me to bump him up to 3 units at 6PM tonight so I did. ughhhhh I hope I did the right thing...
 
So - is this correct?

03/06
+8 (2 AM) 412
+8.5 (2:30 AM) 2.25u (new PS)
+9.5 (12 PM) 346
+15.5 (6PM) 3.0u (new PS)

How about grabbing a test so we can get an idea where he is right now?
 
Yes! That is correct thank you so much. I honestly dont have the head to put it otgether like that myself. Just tested him again. He's at 345 now, but he's eating a lot. So he only came down 1 point? Geez...
 
Sasha&Tara said:
He's at 345 now, but he's eating a lot. So he only came down 1 point? Geez...
Click to expand...
So, did you test just prior to shooting tonight and that number was 346?
Sasha&Tara said:
He's eaten about half a can of Merrick's cowbow cook out. and has kept it down
Click to expand...
was that before or after the 6pm shot? If before, about how many hours?
 
And the food relative to the shot?
(I'm trying to get a feel for whether or not that PS number mat have been influenced by food)
and yes, that +3 may be food influenced, how far in advance of the +3 did he eat?
 
Yes, he's been on and off eating all day. Plus, he was at the vet right before that preshot number so he was stressed. And then he ate again before the 9pm test.
 
I feel like I'm up to speed now - thanks!

So, for tonight, let him eat whenever he wants and mix a bit of water into his food.

See if you can get a urine ketone test in. There are various techniques, depending on Sashas style of peeing. . .
I was generally able to place the strip in the urine stream with BK, however sometimes he just squatted too low.
At those times, if he jumped out of the box quick enough and peed a lot and I moved quickly I could dip the strip in the puddle before it was absorbed into the litter.
Some folks have good luck using plastic wrap placed strategically over the litter.

Sasha&Tara said:
He suggested I give Sasha 3 units at 6 PM tonight, so I did because he's eating and 2 units of his Lantus tomorrow at 6 AM.
Click to expand...
With Lantus, the best results are archived with consistent dosing. If the numbers permit, you want to shoot the same in the AM. Let's see how this cycle goes.
Without seeing the numbers on a color coded ss (it's what I'm used to) it's hard for me to get a feel for whether 3u is too much, under the present circumstances.

A big part of getting rid of ketones is to make sure kitty is getting enough insulin.
Your meter will be you best friend in helping to figure this out ;-)
How about getting a +6 for the next spot check?
 
Hi Tara -

Lu-Ann here. My boy Grayson had moderate ketones 2 weeks ago this coming Thursday night. I spent the night staying up with him and talking to the ER vet and NC State Vet School ER. The first wasn't too concerned about the mod ketones, but everyone here was - as was I. Thus, the calls to the vet school. They indicated that most of their clients w/ ketones or DKA had stopped eating for several days, and therefore weren't able to have their insulin. We caught it early because of the strips (best $6-10 insurance policy you've ever bought in a bottle!).

I watched him through the night and first thing in the morning called and got him in. Fortunately, we never got to the point of DKA, however, the ketones were, and still are, a concern. He had a urine and blood tests, was given an antibiotic (AB), and had SubQ fluids. I brought home a bag of SubQs and have been flushing him out twice (first week) or once a day. He's done w/ the AB. The ketones have reduced to trace or small, but they're still there. I plan to continue fluids and testing for ketones at least for the next few weeks. I think they are more susceptible once they've had them. Can't afford to go down that road. Grayson's appetite waned, but is now back in full force. His numbers had been flat, and we increased his dose of Prozinc. I finally have seen signs of a curve (although the Prozinc and Lantus may have different desired curves).

You're doing well. You know what to look for... so now you just need to be dilligent. The fluids are the only part of ALL his treatment that Grayson doesn't like, but he tolerates them. I find he's less bothered when his face is in a bowl of watered down Fancy Feast. Be sure your needle is chisel-side facing up when you insert it. The first time w/ fluids, he looked like the Hunchback of Notre Dame. Now it seems to disburse/be absorbed more quickly. I try to do the fluids at least halfway into the cycle, just so it doesn't flush the insulin out (I don't know for certain that it would, but they are both under the skin). But sometimes I just do it when I can. The biggest thing you can do is stay on top of it.

Sometimes, when it gets really bad, the vet will give him an IV and put some R insulin in, which I understand is a fast-acting insulin, to drop the high numbers. Your numbers seem pretty manageable, so that may not be necessary. My vet did NOT do the R.

I'll be checking back and will be glad to share more of what i've learned if you'd like. It's 10:16 EST, but I'll be up for about 3 more hours, so holler if you need me.

Lu-Ann
 
Sandy, thank you so much. Yes, I will definitely be awake watching over him and will get a +6 test in. He hasnt eaten anything since 9. He's sleeping. He's not peeing alot either, but whenn he was before I was able to get the ketone test right in his stream.(apparently he's not shy!!!) The results came back as moderate. I will test again as soon as he goes to the litterbox.

Lu-Ann,
Thank you !This is very much the same thing that happened to Grayson. I am so glad your baby is doing better and am hoping to get Sasha in the same boat. When Grayson had moderate ketones, how much fluid were you flushing him out with a day? Today I gave him 100 mls. I dont want to over do it.
 
I'm giving him 100mL at a time. The first week or so, 2x/day; now once. I think that's pretty standard unless the cat is small framed or has heart problems.

If Sasha is small, you may want to reduce the number a little (I have a 5 pounder who would float away w/ that much fluid!). Grayson was 21.6# last June. He's now holding about 12#, and like I said, it's being absorbed pretty quickly.

Not sure if there are electrolytes in the SubQs (mine are "Lactated Ringers"), but I think of them as the kitty's version of Gator Ade in the heat of the summer. Except no straw and no 100 degree temps!

It's good that you can do the fluids and manage him at home! Good job!
 
I gave him his first 100ml at around 530 PM today. he's not at all happy with the subq, and I never did it before, the vet just gave me a 5 minute crash course... but when we got home, I was able to do it. He just peed again, the strip still says moderate ketones. He's been sleepy, but I am like a lunatic calling him into the kitchen and trying to keep him interested in his food. Ive been putting his freeze dried chicken treats in the food so he's been eating. ughhhhhhh this is going to be a long night. I took him home from the hospital last Thursday, he was there for 4 nights....5000.00 later and here we go again....but now I dont have 5000 bucks to spend!!! Thank you again!
 
PS: He weighs 9 pounds so I am thinking maybe once a day with the fluids will have to do? I'm not sure... nailbite_smile
 
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