Problem with ketones .....

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nancy and payne

nancy and payne

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Hi!
My name is Nancy and my cat Payne was found to have diabetes a month ago, and what a month it has been!
Payne is only four years old, female and quite a pain! We have been taking her to U.C. Davis teaching hospital,
and feel we get decent care and much kindness with them.

Payne is on ProZinc, 1 cc 2X a day and we test her BG with a FreeStyle monitor and her ketones with urine strips.
Her original diagnosis was diabetes and IBD. The first time she was brought home she was sent with Hills ZD but
once she was out of the hospital, she would not eat it, so they told us she had to eat, feed her what she will
eat. We fed her Wellness wet and some boiled chicken and baby food, chicken and turkey. Her ketones started
to go up and she went downhill from there.

Back to the hospital with ketones over 40 and went up to 80 before they were able to level her off. She has been
in the hospital since Thursday and we thought we were going to lose her ...... they finally started her on antibiotics,
pred. and pepcid, mostly at my insistence! now they want to release her but they are feeding her the ZD and I
want them to feed her a low carb food in the hospital and see how she does before we bring her home. My feeling
from reading this list and everything I can find on feline food, says she needs the low carb diet but they say because
of the IBD she needs the ZD. So in the hospital they level her off, feed her the ZD, we bring her home and she won't
eat it (don't blame her it wiggles!) feed her the low carb and she tanks.

The interesting thing is at home even while her ketones are rising, her BG is not until the end when we rush her to
Davis. Makes no sense. So ...... they wanted us to pick her up today, no ketones, BG good but I wanted one more
day of good numbers and that they change her diet to low carb and they are resistant! saying that is not good for the
IBD! I feel like I am on a merry-go-round!! Has anyone had this problem? We bought a second monitor to make sure
we were getting accurate readings and they were.

Sorry, I know this is long but I'm afraid to bring her home and have her go into ketoacidosis again, since it almost
killed her last time. Any help would be most appreciated!

Much thanks,
Nancy and the Payne
 
You have had your hands full! How wonderful you are testing for ketones and bg testing so you can catch these emergencies.

We have people here treating both IBD and diabetes, and I am sure they will be along to give you advice. Here is what Dr.Lisa Pierson (FD vet) says about diet and IBD:

Please see a discussion of food choices at Commercial Canned Foods. This list was originally compiled in order to benefit the food intolerant/IBD (Inflammatory Bowel Disease) cats that I work with. The culprit in this disease process is often specific hyperallergenic/high carbohydrate grains such as corn, wheat, and soy. In addition to these grains, yeast can also be hyperallergenic. So for this reason, you will note that the list is split into two sections - With Grains and Without Grains. The "With Grains" list only includes products that do not contain corn, wheat, or soy.

The list she is talking about is here: http://www.catinfo.org/?link=cannedfoods

Hope that helps until someone with direct IBD experience comes along.
 
I'm hoping this bumps up to the top again. No help with the IBD but when I adopted Mishka, apparently at 5yrs of age, she was in ER the next morning with DKA. Spent almost a week, came home for the weekend, no ketones, back again on Mon. for another week. We battled like this with DKA and some hi ketones for almost 3 months. At one point her blood pH was close to imment death. It took that long to get her body used to canned food, insulin and it all coming together to work. She then battled DKA approx. once a year and it is now 7 years later and so far we have gone that past 2 years without a problem. Mishka had also lost 10 1/2 lbs. before I adopted her so if her good weight now is 10 1/2lbs. you can imagine how obese she must have been.

Hopefully others will see your post that have dealt with IBD.
 
Just a couple quick notes:

My IBD kitty has done better on Wellness than on anything else I have tried. ZD made him sick. I think the better quality food is what helps, but so many different things can be the triggers for their problems, it is hard to say for sure there's one right answer. I would say if you have food that she likes and is doing well on it, you might not want to mess with what is working. But if she's not doing great on it, then I would definitely try other things. If the IBD is more of a "diagnosis" than a problem you are really seeing (?) I would go with better quality food. Off the top of my head I'm thinking ZD probably isn't the best food out there, but I haven't looked at the label in years.

Did they give you some really specific info about her IBD and why ZD is best? I'm thinking if she literally is allergic to chicken or something, then the process they use for ZD that supposedly takes the allergy factor out of it may indeed be what she needs (although I would think a novel protein diet would be an option as well, though those may not be LC either). Vs. she has sort of "sensitive-stomach" IBD, in which case I would be surprised if the ZD is really the way to go.

Others know a lot more about food stuff than I do, so hopefully more will chime in...

On a different note, I have read that ketones come from too little insulin, rather than from high BGs per se. Not sure if that helps :) but it does seem like sometimes the BG readings aren't the final answer on how they are doing, though I'll admit I can't quite get my mind around it.
 
I feel as if I'm getting a little calmer, finally. And specifically you give me hope, Hope. You have battled
DKA and survived! thanks for answering! Joanna I'm not sure how they came up with the IBD because other
than the weight loss (she was a little oval :) she had no other signs of IBD. I just had
a fight with the vet at Davis who is handling Payne's care while she is in the hospital, over the food issue,
especially how it relates to IBD but if your using a high carb food, won't that hurt the diabetes?

I don't like the ZD, Payne doesn't like it but eats it in the hospital but refuses it at home (it's slinky!) I
understand what he is saying about it being a novel protein, but to come across as an expert, when I think
this is not an exact science ..... we have agreed to start on a duck/venison/rabbit diet that is natural,
but I am pissed!

We had opted not to get a biopsy because for us, the dangers out-weighed the knowing factor, and he
tossed that back at me. He is not our regular vet but I don't appreciate being treated this way. My main
worry is still her ketones but I've read so much on feline food, my mind is reeling! Glad to have found this
list, thanks in advance.
 
wooaaaa you put your cat on Prozac?

seriously?

Would you put your kid on Prozac?
What is wrong with our country when people think that they can solve any medical/behavior problems with drugs? I will tell you you whats wrong. the pharmaceutical companies who are raping every one of us!
 
The OP (original poster) said her cat was on ProZinc insulin not Prozac. There is nothing really wrong with having a Kitty on Prozac (generic-Fluoxetine). My Smokey was on Fluoxetine for over two years because of aggression, it worked and was better for him than locking him up alone. If I had kids and Fluoxetine was the right drug for him/her I would not hesitate.

Ed and Bally said:
wooaaaa you put your cat on Prozac?

seriously?

Would you put your kid on Prozac?
What is wrong with our country when people think that they can solve any medical/behavior problems with drugs? I will tell you you whats wrong. the pharmaceutical companies who are raping every one of us!
Click to expand...
 
It was the same with me and the home testing, vet did not want me to do ..... which I thought was just stupid and we did anyway, plus used urine strips, which caught the ketones
as soon as they started. She (Payne) was suppose to come home today but started to throw of ketones this morning. Now they are saying she MUST have the surgery to find out why.
They have added a short acting insulin which seems to help. They wanted me to pick her up yesterday morning but I said they needed to stop sub-fluids and have her like she would
be at home AND had I picked her up we would be back in ICU this A.M.

I feel like crying ..... I battled cancer with our dog last year, and lost in the end. I feel as if I am letting Payne down. I have had her since day one, her and ten others I fed and got
through ringworm! (11 kits with ringworm!) but I loved Payne from day one.

ProZinc is PZI? sorry, I'm really new at this and feel as if I am too far behind.

We are about tapped out money wise but if anyone thinks the surgery would be helpful? I will find $ but my feeling is it won't be because the vet claims treatment would "probably"
be the same, they would just know .... that sounds stupid. I don't know what to do, feel way over my head and I am usually not a stupid person.
Thanks and I will look in to the insulin group.
 
This is such a hard decision for you.

If he really has ketones, he needs to be treated at at vet. But maybe not your vet? Ketones are too difficult to safely treat at home. What are they looking for if they do surgery? I think you need to get more info.

But it sounds like you may not be confident that they know what they are doing - maybe they are wrong about the ketones?

You certainly can feed him at home using a feeding tube: http://pets.groups.yahoo.com/group/Feli ... d=74800744 (I am not sure I have the address right. It is the assisted feeding group on Yahoo.) Lots of people here have done it successfully.

I am just concerned that you aren't sure your vet is sure what he is doing. If I were you, I would look at 3 choices: Bringing him home, tube feeding and testing religiously for ketones. At the same time, finding a new vet in case you have problems. This is a scary option.... OR leaving him there and doing surgery. It may be necessary but I am not sure what they are looking for.... Or getting a second opinion from another vet.
 
My vet just called and an "expert" just returned from somewhere, this is a teaching hospital and has
gone over Payne's chart and he disagrees with the road we have been on ..... (big yell here!!)

Whereas my vet was going to introduce a second insulin, the new expert thinks the ProZinc is the best
but she is not getting enough. (was 1 cc X2) They have raised it up to 2 cc and her BG is sitting around
300, with slight ketones, I have also lost the student we had, new rotation which is one of the
downsides but I do like everything is in the hospital.

As for the surgery they cannot do with her on pred. And I don't think she is strong enough anyhow.
They wanted to do the surgery because the ultrasound found thickening at the base of the pancreas.
Thank all of you for answering.
 
ProZinc is a type of PZI insulin.

Also I thought I would note that from my experience if you did have any biopsies taken, Davis is one of the best places to have any pathology work done on a suspected lymphoma sample. So you would be very fortunate in that regard. But weather or not you kitty needs surgery at this at this time is something I cannot answer.

I agree with Sue. What are they looking for? If lymphoma, I would think that could wait until you get the ketones under control?

Thought I would also note that the likely "expert" is very aware of Janet & Binky's food charts. And IMHO feeding a grain free food gave us a big improvement on the IBD. Wellness is grain free and low carb. Several of the Merrick flavors are grain free and low carb too [and have a lower fat content than the Wellness which might help with pancreatitis - though this is very controversial].
 
I would ask them for more info on how they reached the IBD diagnosis. If it is simply weight loss they are basing it on... hmmm. Maybe I'm missing something. Even a novel protein diet may not be needed, it just doesn't sound from what you've said like she has the symptoms (barfing, liquipoo, etc) to warrant it...?

On the surgery, I would find out what the benefit of it would be if they find something. A lot of things can't really be treated all that much, so personally I would be highly skeptical unless it is something where they can tell you that the surgery will really add years to her life. Just my perspective, but sometimes you go through extensive tests, aggressive treatment, etc., only to discover there isn't really that much they can do to treat things anyway, so I've gotten pretty pushy about asking a lot of questions as to what they really can & can't do depending on what they find.

Are you now giving her 2 units of ProZinc twice a day (BID) then? I'm not sure I got that right. If you have #s you want to post, there is a lot of knowledge here on the board about how to tweak the doses to get good results. Ketones as I understand it result from too little insulin (in combo with other factors like infection or not eating), so the vets call on raising the dose makes sense to me. Still nice to see the numbers though, as there are lots of angles to looking at getting to the right dose.
 
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