Sasha - Was Doing Great, But Has "Large" Ketones Tonight

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Susan D

Susan D

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Hello, all,

First, I am sending caring thoughts to all of your felines. I have not posted for awhile and have been very busy doing much, much home care of Sasha to bring him back to health. I posted about him in January -- he had chronic pancreatitis and a ketones episode then. Since then, with me doing a lot of home care (daily subQ fluids, home testing, supplements, change of his diet to eliminate high carbs, digestive enzymes), he has been rebounding magnificently. I have been working with a holistic vet and my traditional vet.

Suddenly yesterday, Sasha started not eating as much and by his morning, turned away from any food. (I am wondering -- and the holistic vet concurred -- that adding flexseed oil to his food, the vet's recommendation, may have kicked off inflammation of his pancreas.)

This afternoon, he vomited twice. Then later this afternoon, I found through home urine testing that he has a "large" number of ketones. I had given him 1.25 units of insulin this morning. Tonight when I tested his BG, it was 216 at 7:53 p.m., so I then gave 1.5 units to Sasha.

I am very tapped out from five months of veterinary hospital and vet visits/treatments from October through January, so I need to treat this at home if at all possible. I conferred with my holistic vet late this evening, and she gave additional counsel on what to do. Here is what I am doing to treat Sasha:

INSULIN - 1.5 units at 8:50 p.m.
SUBCUTANEOUS FLUIDS - He had received 150 ML of fluids in two sessions today at home (90 and 60). The vet advised to go ahead and do another 150 ML of fluids tonight.
FOOD: Sasha will not eat, so I have assist-fed him a syringe of food (Instinct chicken grain-free). However, he vomited once after that. I will wait a little bit and see if I can get a little food down him.
ANTI-NAUSEA MED: Ondansetron, 1/4 of a 4-mg tab, twice today
PEPCID AC -- 1/4 of a 10-mg tab administered at 11:30 tonight

Can anyone suggest what I might do to get some food down Sasha and help him on that score? Is there anything else you can suggest in terms of treatment?

I'm feeling disheartened as Sasha had been coming back so wonderfully, and yet I do know how tough both diabetes and chronic pancreatitis are. He has made some great strides, and just recently had more energy and health than he had in the past couple of years (I definitely believe he has been helped by the grain-free diet and supplements like Standard Process Feline Enteric Support and a bi-weekly B-12 injection, plus Total Zymes digestive enzymes.)

I will continue to home test his BG early this morning. I could test him again in six hours and give another .5 unit if his BG is still high. (His insulin is Humulin N. I spoke with my regular vet about changing, and she did not want to do it right now.) I am watching my boy closely, and if he appears to worsen I will take him to the vet ER, but I am seeking to help him get better in every way I can.

Thanks!

Susan
 
Sorry about Sasha.

Talk to your vet about getting an appetite stimulent.

I've used both of these:

mirtazapine
http://www.veterinarypartner.com/Content.plx?P=A&A=2552

cyproheptadine
http://petsmd.com/RX/Cats-And-Dogs/Cyproheptadine

oh - I've also used valium

Your vet can call in rx for you if they don't have any on hand.

Until you get that - try anything you can to encourage him to eat - tuna water on food, baby food, deli slices (turkey, etc), or sprinkle cheese on his food.

I hope he's better pronto.

Pam
 
Susan D said:
SUBCUTANEOUS FLUIDS - He had received 150 ML of fluids in two sessions today at home (90 and 60). The vet advised to go ahead and do another 150 ML of fluids tonight.
FOOD: Sasha will not eat, so I have assist-fed him a syringe of food (Instinct chicken grain-free). However, he vomited once after that. I will wait a little bit and see if I can get a little food down him.
Click to expand...

That sounds like quite alot of fluids for one day, did your vet advise you how to check and make sure all the previous fluids have been absorbed before administering more? You do this by feeling for squishy places, usually unabsorbed fluids will gather underneath the cat even though you probably injected them on top of the cat. If you give too much fluids you risk edema. You should not give more fluids if the previous fluids have not been fully absorbed.

When assist feeding it is a good idea to use a food different from what they usually eat in case they go off that food afterwards. With ketones present you want to get in the highest amount of calories possible in so the best food would be Medi-Cal, you will probably have to strain it through a tea strainer once you mix with water though, so the syringe doesn't get blocked. You didn't mention how much you fed Sasha before he vomited - you should just try to get small amounts in frequently not try to feed a whole meal all at once.

Sending hugs for you Susan, I hope you can get Sahsa back on track soon.
 
My cat had pancreatitis and I was giving 1/2 4MG of Ondansetron twice daily, but ask your vet about any dose you're giving. Also, I believe I have heard that you don't want to give an appetite stimulant while the cat is still nauseus.
I would highly suggest that you send a PM to Karrie and Maverick. She is a very good one to help with eating issues like this.
 
Thanks to all for your good and kind advice. Helps me feel less alone, and I appreciate that so much.

Sasha is slightly better this morning. I just tested his BG, and it was 147 at 12+ hours after his injection last evening. I have been wondering if my meter, a TRUE test purchased at Rite-Aid, is accurate, and I am going to buy a new one ASAP. That said, I plan to give .5 unit of insulin.

Pam, I had thought about the mirtazapine. I have a 1/4 tablet left from when I took him to the ER in February and am not sure whether to give that to him. (The dose I gave him at that time was 1/4 tablet every 3 days, and he came back so quickly, eating-wise, that I didn't dispense the last one.

I am assist-feeding him with a syringe (just gave a half of a 5-ml syringe), and I'm going to get to the vet's this morning for some high-calorie, bland food, and also pick up some baby food.

As for fluids, I, too, questioned my vet about that amount, but she encouraged me to go ahead and do it (to your concerns, VyktorsMum). I am checking for Sasha's fluids absorption. I gave him 250 ml fluids yesterday, and I plan to give 150 today, 50 this morning and 100 later.

Dyana, great suggestion to send a PM to Karrie. She is wise and so knowledgeable -- an angel!

Again, so grateful to all! Sending hugs to your feline dear ones,

Susan
 
Sasha is slightly better this morning. I just tested his BG, and it was 147 at 12+ hours after his injection last evening. I have been wondering if my meter, a TRUE test purchased at Rite-Aid, is accurate, and I am going to buy a new one ASAP.
Click to expand...

The Relion is a great and economical meter, and others are also quite good. I prefer the Bayer Contour, but the strips are more expensive than the Relion. Whatever you do, don't get a Free Style meter as they do not read well for cats and give false lower readings when cats are much higher in reality.

I know some people use the TRU types of meters, but some have had issues with them. You can keep it as your backup meter though.
 
HI Susan, I don't know a lot about pancreatitis (its probably the only disease my cat doesn't have) but as far as a good food to assist feed I would recommend Hills AD or Royal Canin Recovery (both sold at vets office). Both foods are really mushy, high in calories, and easy to get into a syringe. Keeping my fingers crossed that your kitty is feeling better soon. Jan
 
Gayle,

Thanks for the recommendation for meter possibilities...I appreciate it. I was looking at the Bayer Contour, and I'm happy to hear that you prefer it. That will be on my shopping list today.

Interesting that others have had some issues with the TRUE meters.

I hope all is well with you this morning! I thought of you and yours as I was giving Pepcid to Sasha, and recalling how you said it was so helpful for Shadoe.

Take care,
Susan
 
Jan,

Thank you for your food recommendations. I'm heading over to the vet's office to pick up some supplies this a.m., so I will check out the AD. The Royal Canin Recovery is likely to be at a well-stocked local pet supplies store near here. Do you have a preference? When Sasha had DKA in February, I syringe-fed a combo of Hills W-D with a little amount of FF Classic Turkey in it since his tummy was used to both. But I also used Hills I-D for a bit, and he did well on that, too.

Appreciate your good thoughts!

Susan and Sasha
 
When my Oliver was very ill from his vaccines, he stopped eating. The vet opened a can and put a bit on a plate for him, and Oliver licked it and ate a bit.
I don't think much of vet foods, but I did get a couple cans of A/D because it was like a paste and easy to mix for syringe feeding, plus Oliver actually ate some on his own. It helped him alot.
 
Gayle (and all),

I so agree through much of this experience with Sasha over the past six years that many of the vets' foods are high-priced and have many problems.

Sasha ate Fancy Feast classic for many years and as a diabetic cat did quite well on that for a long time.

I have been working to transition Sasha over to grain-free -- working with a holistic vet -- and this is something I should have done right from the start. And one would think that in going to two different vets' offices -- one in the Hudson Valley and one in New York City, because I was living in two places then -- that I would have gotten better advice on the food score than Hills W-D. But I trusted the advice I was getting, since Sasha had no problems. He ate a combo of Hills W-D dry food (which his brother Orlando, with IBD, did very, very well on) and the Fancy Feast Classic/pates. Now, his BG levels have come down very much since I have switched him over, pacing the dietary changes slowly to make sure they were OK, to Nature's Variety and Wellness grain-free wet foods.

Unfortunately, I also tried this past week to put some fats in his diet by adding 1/8 teaspoon of flaxseed oil 2X per day, at the holistic vet's recommendation, starting last Friday. (She recommended 1/4 tsp, but I wanted to try a smaller amount.) I believe, and the vet concurs, that this oil could have sparked a pancreatic inflammation. I understand now, through my reading, that some liquid oils can cause issues to cats who are sensitive to them. I had tried fish oil at one time but he turned away from his food with that in it.

I'm still trying to figure out the link and exactly how the "large" level of ketones occurred (I have been testing him nearly every day for two months). He ate right up through yesterday morning. Now I am thinking that maybe his insulin level was too low based on faulty readings on my home meter. Still, the vet was getting the same lower BG numbers, and we dropped down his insulin in the recent weeks to an average of 1.25 units 2X per day.

Anyway, I am thinking and pondering aloud for any additional answers. The key now is insulin, fluid, foods, anti-pain and anti-nausea meds, and Pepcid, and take care of my boy.

Thank you!

Susan





I
 
I have to say that you are doing an incredible job, and all you need now is to put your test results into a Google spreadsheet.
Create your Spreadsheet

Right now, all the info we can give you is pretty much general. If you were to post your test results in the sheet, others could see how you are doing and give you much more particular feedback.

While guessing at pancreatitis, if you are getting low BG numbers, I don't think it's pancreatitis. In most cases, you will see high BG numbers with pancreatitis, so it could be some other problem.

For pancreas inflammation issues, my Shadoe was calmed by just giving her B12 shots at home weekly. She no longer needed pepcid BID or pain meds or fluids because she had no more attacks. Maybe you could talk to your vets about B12 shots as they are good for many things.

I wish I could comment on ketones but I have been fortunate in having no first hand experience. I do keep hearing people saying not enough insulin + not enough food = ketones. As well, high BG is not needed either to develop ketones. I do get the feeling that some cats are much more susceptible to ketones, and others can be in high BG all the time yet get no ketones ever.

I think if you wanted, you could change your Subject in the first post to ask about 'must add fat in diet, suggestions needed'. I am sure you will catch the eyes of a few people with suggestions.... cats can detect minute traces of 'stuff that's good for them' that we add, and will stubbornly refuse to eat the mixed food, but there are other methods of adding to a cat's intake.
 
Grayson never had LARGE ketones (via urine strips), but threw MODERATE ketones 3 times. He gets 100 mL of fluids once a day now. Initially (2) 100 mL/day, then one, then every other day. I got a blood ketone meter, and was only able to take one reading, but it registered at 5.4 which is in the HIGH category. He's already on 4.5u ProZinc 2x/day, and never lost his appetite. You need to get the food into Sasha, and it would be beneficial to have him checked for an infection.

It sounds like you're pretty much on top of it already, but maybe your vet will give you some Clavamox - just to eliminate the risk of infection, which was just noted, is part of the equation for ketones and ultimately DKA.

I was fortunate enough to hold them off... but we had (Feb 23) done a dose reduction down to .2u.... then had to jump up to 2u... and then kept going upward because of the numbers.

Good luck - keep us all posted.

Lu-Ann

Just thought of one more thing.... the timing of the sub-cutaneous fluids should be at least 2 hours before or after a shot. I'm guessing that's because you don't want them to "thin out" the insulin, as both are under the skin... at least that's what I was told to do.
 
I would not give fluids a couple hours before shots because fluids have been known to bring down BG numbers. I never gave Shadoe fluids on dropping numbers, near nadir or right around shot time.

I think with ketones in the picture, now would be a good time to TELL your vet that you want to use a decent insulin, like lantus or levemir. You can't afford to continue using an insulin that does not last the full 12 hours.
 
When my civvie was very ill, I dropper fed her. I purchased from Craigslist a magic bullet. I would drop a bit of f. feast chicken w/ tuna water and whip it to go thru the dropper. She also received a/d, but she liked and was able to hold down the f. feast as well.
Wishing Sasha purring vibes!
 
Update: Sasha - Was Doing Great, But Has "Large" Ketones Ton

I appreciate everyone's replies and very, very helpful suggestions and care for Sasha. Thank you! Here is a brief update for now, since cat care and work have been pretty exhausting. :c)

Sasha's ketones moved today from "high" to "moderate," in the urine test I did this afternoon -- in the right direction, but still very much a huge concern. Tonight he ate on his own for the first time, thank heaven...not a full meal, but a bit. I took him to the vet this afternoon, and following the vet's and my discussion, she ordered a full chem profile and CBC. His blood sugar at the vet's was 159, 6 hours after his injection of 1.25 units. His weight had stayed very steady from two weeks ago. He received a B12 injection, which I have asked for. (Yes, I need to get the vial and do these from home.)

I am continuing tonight with assisted feeding - making sure today and last night to get a good amount of food into him and mixing Hill's I/D and Instinct Venison grain-free and feeding via syringe. Good points about the timing of administering his fluids, and basically the ones I try to follow. He also chewed two of his supplements that are good for GI issues and whole body support (Standard Process Feline Enteric Support and Whole Body Support...and they have been greatly beneficial to Sasha.)

I still feel very nervous about the ketones but thankful tonight that he has started eating and that his urine test was better than last night's. I will do the ketone tests every chance I get, as I have been for the past couple of months since his first episode.

Thanks for the "purring vibes" (ohbell), thoughts, and care to everyone! It helps so much. And Gayle, I appreciate all of your detailed and supportive responses -- I thought the ketones for dummies site was very smart, and I've read dozens of sites about ketones -- and I'll follow up specifically after some care of Sasha and rest tonight.

Grateful to all!!!!

Susan
 
Gayle,

To your point about my using Humulin N for Sasha and switching the insulin. I have noticed how the Humulin N doesn't have the 12-hour effectiveness between this 2x/per day injections. I spoke with my vet about switching the insulin and I plan to pursue this change. She was reticent, saying it would be a big deal. I see, however, that it would be good to switch so I will follow up. I do not want to do it in the middle of working to clear these ketones, but definitely plan to do so.

Sasha is eating more on his own this morning, and is "purry," more alert, and up and about much more. Continued vigilance on this end!

Thanks, and enjoy your day!

Susan
 
I am glad to hear that Sasha is purry... always nice to have a purry kitty!

I am not sure what your vet meant by switching insulin 'would be a big deal' as it's not any different than what you do know, with shots, and the end result would be a happier and healthier Sasha.

I guess when I look at it that way, it would be a really BIG deal!


I am not sure about the switching when ketones involved... I wonder if you can edit your Subject to ask about when to switch insulins if still ketones present.

I hope you can get the ketones issues resolved quickly.
 
Gayle,

The vet was referring to tracking how well he does on new insulin (or not) and making adjustments, etc. At times some vets believe, well, you've been doing such and such for awhile...why not keep on that track? And the truth is that Sasha was well-controlled and pretty darn happy on Humulin N for 5+ years, hard as that may seem to believe.

Still, I can see the merits in seeking to switch, and I will pursue it. After all, Sasha and I have learned a lot and done a lot together over the course of this chronic illness, so why not this? That's my attitude.

Thanks!

Susan
 
Update, too: Sasha's appetite has been returning so far today, he is roaming to his usual spots, and he just feels more energetic when I'm petting him. I'm eager to get a urine sample this afternoon.
 
Those are some positive signs. Wishing you and him the best for his continued recovery and potential change of insulin. Ketones are NOT my friend - and as you are aware, can't be taken lightly! Kudos to you for getting him through this!
 
Sasha's urine test shows "negative" on ketones, the second consecutive urine test this has happened (just now at 6 p.m. EDT, and last evening.) He is eating much, much better -- more his usual appetite the past two days. He has been energetic and more his usual inquisitive, sweet, and bright self.

I'm keeping a close eye on him, and I plan to talk with both of his vets about changing insulin from Humulin N.

Just wanted to let everyone know, and I will continue to keep you posted. Feeling very grateful.

Susan
 
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