? Urine ketone moderate to large

dwildha

dwildha

Member Since 2021
Is there anything I can do at home for these ketones? Like giving Novalin R during the day and giving her sub-q fluids? Will be increasing insulin dose this am. This morning Sept 22 at 8am ketones are now at moderate to large and when I fed her she wanted food and ate some food but not much.

(September 22 at 1:20am) She is still eating very well as of tonight but her ketones were 2.2 on September 20th at 6:40pm and the next day (September 21 at 6:48pm they were up to 3.5. The urine test was negative on the 20th but just now (September 22 at 1:20am) I did a urine ketone and it was small to moderate! Now I'm worried, I did give her lots of water added food when I took the blood ketone reading that was 3.5, is this possibly ketones being flushed out now or is this just build up and I need to take her to the vet again? I will test blood ketones again in the morning and see if they have gone down at all.
I am including info from my last post below:
  1. All current spreadsheet BG readings are from a Libre. I want to get Tippy's insulin dose right. Her BG is too high. She went into DKA again two weeks ago and is home from a 2 day stay at NC State Veterinary College. She had been on 4.5 units before this second DKA and eating several meals thoughout the day. I tried to update our spreadsheet as accurately as possible but I have way more BG readings in screenshots of her Libreview or I can let anyone view her Libreview results if you download the LibreLinkUp free app. I really think this info would be super helpful especially since we could only fit in a much smaller amount of BG readings in the spreadsheet and since the spreadsheet goes by +hours instead of exact time we just had to out the closest reading for the +hour, so this actually skipped out on some of her lower or really high BG readings from the day. (Or I can post the screenshots in the Facebook page and add the link to the post here so anyone can easily go straight to it.) This post does not let me upload files.. Currently her shot time is around 9:15am and 9:15pm. This can fluctuate by 15 minutes off but we always try to get it within 15 minutes of shot time. She is on 6 units of Lantus Am and 6 units PM right now. We increased to 6 units starting with the am shot on September 15th and have not adjusted it again. She is in the higher 200s most of the time. Two weeks ago when I brought her home she was in the 300s so we increased her insulin. I think she was at 5 units then 5.25 then 5.5. I don't think we did this gradually enough. Someone mentioned her depot was probably messed up when we brought her home or something like that? I can come back and update with exactly what those past doses were from last week if that's needed. Her ketones are really concerning me right now. September 18th 9:34am urine ketone strip was negative (getting new ones tomorrow because these are now several months past the use within 6 months of opening) and at 12:56pm blood ketones were at 1.9 and BG reading from our Prime meter was 282. 1:01pm Libre says BG was 253.

  2. Now at 2:56am on September 18th urine ketone looked slightly pink so that is trace. I then took a blood ketone at 3:09am and it was at 6.0. (Thankfully it had come down later that afternoon to the 1.9.) BG with the Prime meter at that same time was 273. Libre at 2:57am was 248 to compare. (September 18th Libre readings 2:34 am 208, 2:53am 253, 4:03am 250, 4:06am 234, 4:36am 230, 5:01am 278, 9:26am 190, 10:08am 239, 12:33pm 226, 1:01pm 253, 1:12pm 274 and then just stays pretty high for the rest of the day.) Please let me know what other info you need, I want to get her dose right and her Libre ends in a day or two. I know I will still need to check with the Relion Prime but I might put another Libre on while I'm trying to get the insulin dose right. I also recorded how much food and the time given every time I gave her a meal or snack since she's been home if that info is needed as well. I have been feeding her more frequently thoughout the day for the last week. She eats several meals with multiple snacks (all low carb). I also started adding water back into her low carb wet food again now that her appetite seems to be back to normal. Tippy seems to be hungry a lot again, coming up to me when I'm eating dinner and wanting more food.

    Also earlier in the week her ketones were at 4.0, I have a post in here about that. So these ketones are really too high and scaring me right now. How accurate are blood ketone tests? We use the Precision Extra. Please let me know if anything needs to be explained better or if any other info is needed.

    Thank you!
    -Sarah

    Adding updated ketone info:

    She is still eating very well as of tonight but her ketones were 2.2 on September 20th at 6:40pm and the next day (September 21 at 6:48pm they were up to 3.5. The urine test was negative on the 20th but just now (September 22 at 1:20am) I did a urine ketone and it was small to moderate! Now I'm worried, I did give her lots of water added food when I took the blood ketone reading that was 3.5, is this possibly ketones being flushed out now or is this just build up and I need to take her to the vet again? I will test blood ketones again in the morning and see if they have gone down at all.

    At this point I think I need to increase insulin again in the morning because of the ketones.

    -Sarah

 
Can you get a blood ketone test right now?

Just to confirm these were the last few readings of the blood ketone tests:
2.2 at 6:40pm on September 20th
3.5 at 6:48pm on September 21st

How much did she eat this morning and how has her appetite been last night? Any other symptoms? Is she lethargic?

Sorry - your post has too much info!
 
Given the history of DKA , the increasing ketones over the last few days, and slight inappetence, I would take her in. I'm not comfortable saying try to manage at home, I don't think subQ fluids are enough to flush ketones.
 
Bandit's Mom said:
Can you get a blood ketone test right now?

Just to confirm these were the last few readings of the blood ketone tests:
2.2 at 6:40pm on September 20th
3.5 at 6:48pm on September 21st

How much did she eat this morning and how has her appetite been last night? Any other symptoms? Is she lethargic?

Sorry - your post has too much info!
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Yes, that's right and her blood ketone is now 5.4 as of 9:22am Sept 22. She ate nearly a full meal right before shot time this am but she was not eating like normal. She is going under the bed too. BG was 346 at 9:22am Sept 22 (might have got too much blood in the strip and she was upset she was getting her ear warmed and poked).

Is Lantus is supposed to lower her more than what the Libre was showing? It's almost like the insulin wasn't doing anything fir the last two weeks. I am wondering if Walgreens has been giving me bad insulin. They felt the need to label her prescription as "TIPPY THE CAT". Her prescription from the vet says Tippy Wildhagen, I don't know why they would change it.
 
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dwildha said:
I am wondering if Walgreens has been giving me bad insulin. They felt the need to label her prescription as "TIPPY THE CAT". Her prescription from the vet says Tippy Wildhagen, I don't know why they would change it.
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I also get my Lantus from Walgreens and they also put CHLOE CAT in her profile. I think it’s probably more company-wide naming policy for database integrity rather than anything nefarious. They may need to keep track of human vs animal patients.
 
Max cat was the name on on the vial I got there as well. After that I ordered from Canada and got pens. Less waste and a lot cheaper too.
 
tiffmaxee said:
I think you need to take her to the vet. How about calling at least and asking?
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She's on the way to the vet now. I'm just worried because NC State is full and turning away people and none of the vets in town have overnight techs anymore. I tried so hard to prevent a vet trip. I don't know what's going on at this point. After her first DKA in March we switched to Lantus and upped her dose to 4.25 and always added water to her food. But now two weeks after leaving the vet with a mild DKA she appears to be in DKA again. I also want to know if her BG numbers staying so high and not really lowering is normal or if she just needed a higher dose of insulin for the last 2 weeks or what? She was tested for everything at NC State vet college 2 weeks ago and everything is perfect. They said no signs of infection and did an ultra sound and a GI panel which came back normal. Can there still be an infection we're not catching? Is she now insulin resistant? In March they tested for two different things that could make her insulin resistant and said she didn't have either. One was the agro -thing and I don't remember the other. Maybe she is resistant this time though? Who do I ask in here about this? Also, I have some detailed lab reports from NC State that I would like to share in here but the upload doesn't work. Should I post in the Facebook group and share the link here?
 
Btw I switched due to price, not the name. I’m sorry you have dka again. People get turned away now in Los Angeles as well. Darn Covid. Let us know what happens. :bighug:

When all calms down would you please put the doses on your ss. Without that I can’t answer any of your other questions. So 4.5 for two weeks? With TR you should be increasing every 6 cycles until you see blue or green nadirs and once that happens you hold for 10 cycles, not days.
 
Librarianista said:
I also get my Lantus from Walgreens and they also put CHLOE CAT in her profile. I think it’s probably more company-wide naming policy for database integrity rather than anything nefarious. They may need to keep track of human vs animal patients.
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That's good to know! My issue is that while she was on the Libre I could see her BG at all times and it just never seemed to lower much, even at nadir. Made me think the insulin wasn't doing anything.
 
I’m really hoping they don’t think it’s a DKA. The high ketones in and of themselves will not make for a DKA, but with her history it is scary. She’s all over the place with her ketones.
 
dwildha said:
She's on the way to the vet now. I'm just worried because NC State is full and turning away people and none of the vets in town have overnight techs anymore. I tried so hard to prevent a vet trip. I don't know what's going on at this point. After her first DKA in March we switched to Lantus and upped her dose to 4.25 and always added water to her food. But now two weeks after leaving the vet with a mild DKA she appears to be in DKA again. I also want to know if her BG numbers staying so high and not really lowering is normal or if she just needed a higher dose of insulin for the last 2 weeks or what? She was tested for everything at NC State vet college 2 weeks ago and everything is perfect. They said no signs of infection and did an ultra sound and a GI panel which came back normal. Can there still be an infection we're not catching? Is she now insulin resistant? In March they tested for two different things that could make her insulin resistant and said she didn't have either. One was the agro -thing and I don't remember the other. Maybe she is resistant this time though? Who do I ask in here about this? Also, I have some detailed lab reports from NC State that I would like to share in here but the upload doesn't work. Should I post in the Facebook group and share the link here?
Click to expand...
Most people add their labs to their spreadsheet in the tab for labs. And nobody can advise on dosing because the data like units injected are not on the spreadsheet. The whole units column is blank and so are the last couple of days- at least that’s what I am seeing in my view. Sorry. I know everything has been crazy for you recently.
 
I really would like Wendy to take a look at your situation with regard to dosing, but she would need data to get the whole picture.
 
In order to get the whole picture, I'd need the spreadsheet to include doses given. Many things can cause insulin resistance, such as pancreatitis, hyperthyroidism, heart disease, secondary endocrine diseases (acromegaly, IAA, Cushings), or even just plain old glucose toxicity.

It's also handy to add a comment in the Remarks when you start a new container of insulin. It allowed me to go back and see how old the cartridge was. And to compare before and after the new cartridge (pen refill).
 
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