question about ketones

Status
Not open for further replies.
E

equine99

Member
reposted from PZI:

So I just bought some ketone strips, since we're coming out of DKA I thought it would be good to track this, and her pee registered as "small" which is more than trace but less than medium. Since we're coming out of DKA is it okay to assume that it's the remnants of dka working out of her system? She seems much better than she was before, but I see in the sticky that you should rush to a vet if you get anything over trace, so I'm a little confused.
 
I don't know the answer to that. Did the vet tell you what her ketones were when you brought her home? If they are going up, then I would be concerned. Are you giving sub-Q fluids at home? If not make sure she is getting water by adding a little to her wet food - and keep checking ketones.

I hope someone with DKA experience will post a reply.

Also, check the strip in different lighting, sometimes the result can look pinker than it really is depending on lighting. And test yourself for a "control" negative.
 
I am giving her sub-Q fluids and also mixing water into her food. The vet didn't tell me what her ketones were, but I can look through the papers I went home with to see if there's any mention. It was definitely small, not trace. She hasn't peed yet since then, but I expect it won't be drastically different this soon.

Hoping someone with experience will post...
 
Yesterday you said she was acting lethargic, weak, not eating well, and then she perked up later last night? How is she acting today? Eating okay? "Small" is something to be concerned about, but do your best to catch her anytime she pees. If you see an indication that it is higher, you'll need to call the vet for advice. The fluids should help. Is she on some sort of antibiotic as well?

Carl
 
She was lethargic and not eating at all Wednesday night and that's when I took her into the ER. She was there wednesday night and then I transferred her to her regular vet all day thursday and picked her up at 6pm. Right when I picked her up, to show me how to do it, the vet tech gave her 100 ccs of sub-Q fluids. When we got home she wolfed down a bunch of food and was acting better. I brought her in on Friday morning for a check in/to see if she needed to go back on an IV and the vet instructed me to give her 100cc's when I got home and then again at night, which I did. She is also on an antibiotic to treat her uti and/or kidney infection. She's been sleeping a lot, but when she isn't sleeping she's much more energetic, and she's continuing to eat well. I haven't seen her drinking water, but I mix water in with her food and she kind of drinks all of that up (imagine drinking all the broth from chicken noodle soup, and that's kind of what she's been doing).

Also, I didn't give her subQ this morning as I wanted to see if the insulin would react differently without the subQ, but I just gave her another 100 cc's since I gave her her insulin 3 hours ago and I thought it wouldn't interfere.
 
OK, the fact that she continues to eat well, and seems more energetic when she isn't sleeping are good signs. You know how she was acting before you brought her to the vet, and if you see anything that resembles that, bring her back asap. Continue to try to catch her peeing with a stick in hand.
Giving the fluids 3 hours after the shot is good. Maybe post another question asking about "alternate insulin injection sites", and explain you are doing fluids in the scruff. Some people shoot the sides of the abdomen. I think any place you can get a tent of skin are okay. Some people shoot near the back hips. I shot into muscle, not sub-q, so I can't help with alternate sites. And you should definitely NOT shoot into muscle unless your vet specifically tells you to do that like mine did. I only know of one other kitty who gets shots that way, and it is Sid and Lydia's vet instructed her to do so.

Also, I noticed Bob would perk up very soon after getting the 100ml of fluids. I think other people have noted the same thing (Kim I think saw this with her Kitty). It must provide pretty quick relief from what is ailing them. I know this time is very stressful for you, but it's just something you are going to have to keep a close eye on, and make sure you have the ER/vet phone numbers handy, even if it's just so that you can call for quick advice.

Carl
 
That's along the lines of what I was thinking and why I haven't gone to the vet yet. I imagine the sleeping a lot is related to sleeping to recover (I know when I'm sick that's all I want to do). She's acting so much better--when I took her in Wednesday night I literally thought she was dying, and she's just sleepy now. I'll ask about other sites to shoot into in another post, as it would be good to not have to worry about the timing of the two. I just looked back at the notes and from the night I brought her in it says ketones are "mod." so I don't know what that means. Maybe it wasn't severe DKA which is why she was able to go home so quickly.

She doesn't seem to get "perky" after her sub-Q fluids--she tends to nap, which may be related to being cold?
 
Kathryn,
sorry, no ketones advice but most of the time I injected ProZinc into my Pudge's belly where his fur is white and fairly short (the rest of his fur is dark brown and very long - hard to see his skin). Pudge hated tenting and I regularly had fur shots when tenting, even with a short needle. So I learned to shoot perfectly parallel to his body right under his skin. He loves showing his belly for kisses and I loved being able to feel the little lump of insulin under his skin. Pudge went OTJ at 1.6 units of ProZinc so, of course, I could easily feel the tiny lump. Thought you might like to hear of an alternate site - this will also BUMP your question. Best wishes to you and your sweetie, Sophie
 
I would not want to encourage you to treat "small" ketones at home. You do not know if the numbers are coming down or going up. Urinary ketone tests reflect levels that are hours old. (You have to wait until your cat processes waste and then has the urge to pee vs. getting a blood ketone reading which is what your vet does or what you can do if you have a meter that reads ketone levels.) We typically do not suggest home management with ketone levels above trace.

I'm very surprised your vet did not do a blood draw to insure that your cat's electrolytes were continuing to be stable. Do not stop giving fluids unless you discuss this with your vet. Fluids help to wash the ketones out of your cat's system. Do you know if your cat had an infection and if so, is it being treated? Infection + not eating + not enough insulin is a recipe for ketones.
 
Thank you for the advice that small is not something to treat at home, but I think I just may have to go with my gut on this one--since she is acting notably better this morning. Pervious days when I'd try to initiate play she'd look interested and maybe bat once but not really play. This morning she was full out playing, and fought me really hard when I was giving her the sub-q fluids (so I could only get 50 cc's in). She looks *much* plumper and the grab-a-scruff dehydration test is telling me she's fully hydrated (though I will continue to give fluids, as I assume they can't really hurt in the amounts I'm giving). I just fed her and she wolfed down 1/2 a can of fancy fest in one go--this cat is such a grazer that I don't think I've ever seen her eat that much in one sitting before, so everything tells me that she's feeling a whole lot better.

She is on antibiotics as well, as the vet suspected a uti and/or kidney infection. The test results from the test the ER vet ran should've come in yesterday but my vets office is closed for the long holiday so I won't know until tuesday what she has.

The only thing that's left worrying me actively is that her bg still isn't under control. Last night we had a little break through with the first effective dose of insulin since she went off of the humulin r from the vet, and finally dipped into the 200's. However, this morning I woke up at AMPS of 401 :\ I'm going to give her one unit tonight and see what happens over the night, as I'm concerned that since I jumped from 0.4 to 1, that I may have missed her "perfect" dose somewhere in-between there.

I'll do my best to catch her peeing as soon as possible and do another ketone test then.
 
I am so glad she is acting better, eating better - all good signs.

I like the 1 unit dose. You got some yellows for the first time and it could have gone lower at that +6 mark overnight. If that did happen, the red today could be a bounce. I would stick with the one unit for a few more cycles and see what you get. Sometimes it takes a cat awhile to "settle in" to a dose. And if she is recovering from an infection, once that clears, she could get lower numbers also.

Just be sure to get a ketone test daily.
 
The last two readings I've done have been in the 500's (571 and then 558 two hours later). ick. I'll stick with the one unit dose, but I think I'll bump it forward a bit to +10 instead of waiting.

I wonder... her antibiotic smells sweet and is orally dosed. I wonder if it has sugar in it? I looked for the ingredients and couldn't find a list, but I wonder if that might be partially at fault for the spike?
 
equine99 said:
The last two readings I've done have been in the 500's (571 and then 558 two hours later). ick. I'll stick with the one unit dose, but I think I'll bump it forward a bit to +10 instead of waiting.

I wonder... her antibiotic smells sweet and is orally dosed. I wonder if it has sugar in it? I looked for the ingredients and couldn't find a list, but I wonder if that might be partially at fault for the spike?
Click to expand...

It's likely that's the case. Post the name of the AB and see if anyone knows about it. That may be cause for the spike, and there may be alternative ABs that you can use if it seems to continue to be a problem. I typically see a decrease in BGs when giving fluids. I also shoot on alternating L/R shoulders/scruff area. Of course, fluids are given +/- 2 hours or more from shot time.

When I give Grayson fluids, we set him up w/ a bowl of food. When distracted with that, he rarely even notices the SubQs.

Hopefully all is continuing well. Please post more as you find out. I was tied up w/ a graduation yesterday, but will be more available from her on out.

Lu-Ann
 
Those black numbers are scary, given the presence of an infection and the recent presence of ketones. I assume you have already shot the 1u tonight? If you continue seeing reds or blacks at AMPS, I think you may need to consider a higher dose. I know you don't want her to have to deal with more emergency treatment, and I'm sure Snowflake would rather not either. But it looks like either the AB is not getting rid of the infection, or the insulin is not currently working as well as it was a couple of weeks ago when you were only shooting .4 or less. If you increase, can you be there tomorrow to monitor her?

Carl
 
I gave her a full unit at +10 since she was still in 500's, and when I got home 5 hours later she was 340--so much better. An hour after that 322, so it's going in a good direction. Just gave her her second "dose" of Sub-q's and man has she decided that she does NOT like it. There's barely time to get 50 cc's in before she absolutely decides she will have NONE of it anymore and there is nothing I can do about it. She's totally unmotivated by food, so that's a no go. I've been putting the towel in the dryer to warm it up, and I do the whole thing on top of a heating pad so she should feel nice and cozy, but now 5 times into doing it, the second I put her down on a towel she starts growling.

I'm planning on giving her next shot at +10, like I've been doing the last couple of doses, to try to work it closer to a schedule I can maintain when I'm at work (will have to be noon and midnight for a while), so I'll give her her next shot at 1:15am, and then I can do noon tomorrow and get onto it that way.
 
If you are going to be shooting at +10, you will want to make sure that her number is definitely rising before you shoot. You don't want dose overlap on a falling number.
Carl
 
good call. at +8 she's still dropping (218 currently), so I guess I'll just wait until she turns around and rises again. so glad to be out of the 500's.
 
fell asleep for a little too long, but at +14 she was 226! So I reduced dose to 0.5, fed and gave her antibiotic, Clavamox, which I did a google search on and does not contain sugar. looks like we're almost on the other side of this thing!
 
Well, I am extremely glad that I reduced down to 0.5, as at +4.5 she was 35. So I fed her hc canned food and will test again in fifteen min.
 
She's acting totally fine. I just re-tested and she was 477, so either my meter is wrong or she just had a huge bounce--I'm thinking it was a bounce, maybe mixed with the hc food hitting her system.
 
One of those tests is bad. The food wouldn't hit that fast.
Carl
 
have to leave the house for a few hours, but i feel better leaving with her in the 400's than down at 35... I'll see where she is in a few more hours...
 
Yes, I would think the 35 was a bad test. Sometimes too much or too little blood can mess it up.

The hc food will play havoc with your numbers for the rest of the cycle. No real way to know how much it will throw them off.
 
Future reference...when you see a 35, retest before giving the hc if you don't see outward signs of hypo. If you verify the low, then yes, feed the hc immediately.
Carl
 
I am confused with the 400, though. No chance of a fur shot this am? The numbers last night looked great at one unit. The .5 may have been too little this am, but the 400 is a high number early on.

Don't react to a high pmps. It may be the hc food still messing with the numbers. I liked your one unit, unless you have a number in the 200s.
 
Just got home, she was 470, so I gave 1 unit 1/2 hour shy of +12.

I wonder if last night/this morning when I gave the 0.5, she wasn't actually rising (rising/not rising could've been within the 20% error margin) and the combined power of her pancreas starting to work and the insulin hit her hard, causing a bounce that was then followed by the hc food hitting her? I expected her to need a shot around 1am, so I was waking up every hour to test her and by 5am might've been a little out of it. I'll track her carefully tonight, but probably won't be able to give her her shot until +13 (just don't think I can do another all nighter of trying to catch rises since I have work tomorrow).
 
So at +15 she is 303--I'm going to test again in half an hour to see if she's rising or still falling, otherwise, I'm thinking about giving 0.5 if she's rising, and holding out if she's still falling.

Does that sound right to only do 0.5? or should I still shoot 1 unit?
 
I think either dose could work. At this point, you are gathering data. It is complicated by the off schedule of 12 - 15 hours between shots; it makes it harder to figure out what is going on.

If you do the unit, it would be good if you can get a test in around +6.
 
Status
Not open for further replies.
Back
Top