911 Urgent help: Poncho Ketones Moderate Range

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christoph

christoph

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Thought we were near the end.
Update: Old vet called, gave me a guideline for doing his version of a curve (which is identical to this forum's) and wants me to keep him updated, so I cancelled the "grim reaper" appt. and will give this a try. Poncho has perked up some. At least his pancreas has healed.
 
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Here is a link to Poncho's thread on the Prozinc board.


http://www.felinediabetes.com/FDMB/threads/end-of-the-road-for-poncho.134488/

Poncho is throwing ketones. Here is the opening post from the above thread:

He's extremely weak lately esp today. He used his litter box, climbed out and still peeing, laid down in it on his stomach. He walks like his back legs are made of fragile glass and just barely holds him up. I tested for ketones Sat was neg, but today midrange -40-on the bottle scale. I called the mobile vet and scheduled for him to be put down later today, then got a dose of pain med from the other vet to help him until then.....and she told me the pancreas test came back as good.....it has healed. I'm waiting on my old vet in St Louis to call and give me some guidance.....if he thinks there is some hope I'll drive him there, 250 miles so he can try to curve him, which he was able to do with Poncho's sister in 1-2 days a few years ago, but she wasn't as sick. I just feel that I'm putting Poncho through unnecessary discomfort/pain. I'm wondering if the present vet was even doing the regulation attempt correctly. She said today that Poncho's got something else preventing regulation....suspect #1 Cushings. I'm hoping for one last glimmer of hope here.....just don't know what to do! Comments please?
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(no replies to above as at 20:56 GMT).
 
Chris,

I strongly recommend that you keep this request for help here on the main Feline Health board because more people visit here than the Prozinc board.

Go to the opening post on this thread then click the Thread Tools option on the right hand side of the screen. Choose "Edit Title" then use the 911 prefix and change the title to something like "Urgent Help: Poncho Ketones in Moderate Range".


('ll go to the other thread and post a link to direct people here.)
 
Thank you Aine. I cancelled the mobile vet and my old vet called and is going to guide me with doing a curve. Now I recently fed Poncho and he just threw it up, even tho he's on the ondansetron. The present vet did give him a strong dose of oral Bupren so hopefully that's why he threw up. Looking back last few days he was on the Bupren and lost his appetite.
 
Oh no not again. Well you got poncho through this before and so I am more than hopeful you can again.

It's the same drill as before. Vet being the best place to deal with ketones but if that not possible or wanted then it is fluids, water and insulin as before.

@Meya14 @Elizabeth and Bertie @Carl & Polly & Bob (GA) and whoever helped before.

Christoph can you go back and review you older ketone thread? It might have some helpful tips
 
Yes, I'll review that thread if I can find it. Last time the ketones were stronger. I'm going to test again in case of a false read.
 
I searched your threads and I think it was this one

http://www.felinediabetes.com/FDMB/threads/poncho-diagnosed-diabetic-1-15.132642/

@BJM helped a lot before.

As the prozinc doesn't seem to be getting poncho blood glucose under control I wonder what you old vet thinks of lantus or levemir.

In the meantime do you have sub q's still at home if not I would go back to the oral syringe and assist feed as before. Make sure the ondansteron is in the system beforehand and give food and water little and often
 
I posted over in the other thread. But I second the lantus/levemir idea. You need a basal insulin for a cat who gets ketones, and I think it'd help regulate him. The prozinc is wearing off too fast, that's why you can't find a happy dose.
 
I still have sub qs and will continue to syringe feed often. Next ondansetron due in 4 hrs. He had a strong dose of bupren so I think has some nausea from that.
 
Meya14 said:
I posted over in the other thread. But I second the lantus/levemir idea. You need a basal insulin for a cat who gets ketones, and I think it'd help regulate him. The prozinc is wearing off too fast, that's why you can't find a happy dose.
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I think you are probably right. I'll ask my old vet tomorrow when I report Poncho's nadir. Thanks.
 
Also, if he is eating anything on his own, when Max was really sick and first started eating again I made a soup/slurry out of wet food (kind with gravy), smashed up dry kibble, and water. This seemed to be much more palatable when he had nausea. Remember, carbs aren't bad when ketones are present, so feed him whatever he'll eat.
 
Meya14 said:
Also, if he is eating anything on his own, when Max was really sick and first started eating again I made a soup/slurry out of wet food (kind with gravy), smashed up dry kibble, and water. This seemed to be much more palatable when he had nausea. Remember, carbs aren't bad when ketones are present, so feed him whatever he'll eat.
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Will try that. Need to go pick up some high carb food now. Be back.....
 
If you need to give pain relief then try smaller amounts three time a day. I would find that remi's symptoms never quite tied up with the test results so you might be right. What were the symptoms ?

Meya also mentioned testing for things like low potassium as this can cause weakness and lack of movement (which you interpreted as pain??).
 
Symptoms were lethargy weakness esp hind legs. He's supposed to have potassium in his fluids, but maybe they forgot to infuse this batch.
 
Your goals for managing the ketones will be:
- Keeping food going in
- Keeping him hydrated; be sure to check if the potassium is in those fluids
- Keeping the glucose between 200-300-ish on a pet glucometer; you may need to dose every 8 hours to do this, as you were before.
 
  • Thanks BJM. I've gotten about 110 ml of food in him today so far. I've been giving him 75ml fluids twice daily. The fluids do have potassium. Somehow I have to convince the present vet to still give supportive meds while I try a different method of trying to regulate via my old vet. I guess my old vet could do that but by law he might have to see Poncho before prescribing anything. I'll know tomorrow. I told him about the ketones and he said keep doing what I'm doing. As far as insulin, to give 1 unit tonight, then 1 in am unless BG is under 200, then test mid cycle and call him with the number. He bases dose on the mid cycle number and tries to stick with that dose for a bit before trying ti increase/decrease. I'm going to ask him about a longer lasting insulin also.
 
Haven't checked ketones yet. Last night pre shot BG470 (same as am).
This am BG 206 gave 1 unit and will feed 25-30ml AD/test every 2 hrs,
+2 BG 179
+4BG 156
+6BG 156
+12BG 99 ???!!!! No smile here!
 
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You are doing great so far Chris.

I think you can just buy potassium supplements without a prescription (tumil k) but not sure how much you would need if you are also giving potassium in the fluid.

Would the vet you are with now not consider changing poncho over to lantus?
 
Hi Sarah,
I'll bring up the idea to my former vet of switching insulin later today. I still need the present vet so I have to be careful not to let her know another vet is advising me. I guess I'll also ask former vet if he can prescribe from 250 miles away. Poor Poncho's back legs are so weak it's hard to watch him walk. He might need more potassium. I have an appt with present vet tomorrow so will bring up potassium. I know this vet thing is confusing. Present vet is the one I've been using for a month, old or former vet is the one I used for 20 years when I lived in St Louis (moved from there to Kansas City, MO 2011). He treated Poncho's sister's diabetes very well and she was on same dose Prozinc for several years with no BG rechecks. She also had an enlarged heart and she passed away from complications with heart meds and diabetes.
 
Are you also giving a MethylCobalamin supplement as it could be diabetic neuropathy if ponchos number have been high but yes would definitely check out the levels of potassium with the new vet.

Will the new vet not consider switching the insulin (not mentioning the old vet to them)?
 
I'd strongly recommend discussing everything to do with potassium levels with your vet. From what I've read here, both too much and too little can both cause problems.
 
phlika29 said:
Are you also giving a MethylCobalamin supplement as it could be diabetic neuropathy if ponchos number have been high but yes would definitely check out the levels of potassium with the new vet.

Will the new vet not consider switching the insulin (not mentioning the old vet to them)?
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I didn't know about MethylCobalamin but will ask about getting him on it and will ask about potassium level. Just did +4 test/feeding (post #19). +6 coming up 1 1/2 hrs....that's the one my former vet wants. I wonder if I'm feeding too frequently (@2 hrs) or too much (25ml) per feeding for this curve.
 
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Do you think I'm feeding too frequently (every 2 hrs) or too much per feeding (25 ml) for this curve? At 12 hrs he will have had about a full 5.5 oz can, then the next 12 hrs much less (overnight) so less resistance to the insulin. Should I save a feeding or two for late night before bed time? Given the ketones I guess I shouldn't be too concerned.....right?
 
Feed as much as you both can tolerate (at least 1 x 5.5 oz can per day). You are right, you should space out the feedings in AM and PM cycles to keep his BS steady.
 
Remi was suffering from low potassium and it made him weak so it looked similar to neuropathy but not sure if that is the correct name for it if the cause is potassium. I bought the zobaline but never gave it as the potassium supplement seemed to do the trick. A word of warning the supplements can cause nausea and I found slowly increasing the amount given helped to over come this.

As critter mom said you really want to double check potassium levels with a quick blood test before you give supplements to check it is low.

Here is a link to Tayna's ckd page on potassium
http://www.felinecrf.org/potassium.htm
 
What the heck? +12 pre shot (no shot) BG 99 (Alphatrak) 62 (Relion) Started new thread so more people can see. What is going on?
 
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