POSITIVE FOR KETONES

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Red'sMomHeather

Red'sMomHeather

Member Since 2015
Red only got half dose yesterday morning, no insulin last night but got full dose this morning. Barely ate this morning (unfortunately I wasn't home to know this. Ended up syringe feeding him for his "dinner". I feed him three meals a day. With all this going on I tested his urine last night - negative for ketones. Tested again just now and it was positive. Called the emergency number, spoke to the vet who said considering what happened with the insulin and that he's still unregulated that this was normal and not so with to worry about. Everything on here says ketones = emergency???!!?
 
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Ketone levels that are above trace are an emergency. I would do one thing first. Test yourself. If the ketone strips are old or contaminated, you could have a false reading so one quick way to know is for you to test yourself.

If the strips are reading accurately, it's in your cat's best interest to get to an emergency vet clinic. There is likely an infection going on that is contributing to ketones developing. An infection, not enough calories, and not enough insulin contribute to ketones. Fluid (either in food but sometimes administered subcutaneously) also helps to flush ketones.
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You don't want to be skipping doses right now.
 
The skipped dose was due to having run out of insulin. He got his normal dose this morning and tonight. I'm going to syringe feed him again now so that I know he's had enough food. :/
 
be adding water to his food too... as much as he will accept.... I'd even be syringing some of that....

What level did your strips indicate?
And did you go test the strips on yourself?

I would definitely get to a vet tomorrow at the latest.
 
I haven't tried the test on myself but I will as soon as I can.
I'm adding water to his food so that I can feed it to him via syringe but I can syringe feed him some water as well.
The emergency vet I spoke to is at the same clinic but not my usual doctor. If I bring him in tomorrow, other than explaining the situation what should I ask them to look for/do?
 
How much did the ketone test read? Anything more than a trace is usually treated by the vet. Here is a good post on ketones, so you understand what's happening. There are a few older discussions in the bottom of that info post - it's worth it to read through those to see how they are dealt with. This info will help you know what to talk with your vet about tomorrow.

No, it's not normal to have ketones in a diabetic cat. It's not uncommon to have them upon diagnosis, but they need to be dealt with immediately.
 
I have Bayer ketostix that read negative, trace, small, moderate, and large. I would have said the strip read moderate but it might've been small. Either way, not trace.

I am entering serious freak out mode. :(
 
You have to be careful with your timing on the ketostix between the time they get wet and when you read them - follow the directions exactly. Try them on yourself and see what it reads. Obviously it should be negative.

Heather, what does this part of your signature line mean?

Dx 01/05/15~3 mth h*n*ym**n until 03/23/15


At the moment, since you've already talked to your vet, for tonight, I'd be concentrating on getting enough food and as much water as you can into him. Now that you have your insulin refilled, make sure he's getting his insulin in the morning. If you can get a spreadsheet going we could look at the tests and help you figure out what to do with the dose. That's a pretty hefty dose which could either indicate that he's overdosed, or that he's got a high dose condition. Since you've got ketones showing up, which indicates not enough insulin, I'd be suspicious that he may have a high dose condition.

Save this for now, but when things settle down, let's talk about the possibility of changing insulins. Cats do best on an insulin that lasts as long as possible in the body, providing good control in spite of cat's fast metabolism. The two longest lasting insulins are Lantus and Levemir - most people with a high dose cat (over 6u per shot) choose Levemir because it has a neutral ph and it doesn't sting when injected. We stayed with Lantus and punkin didn't react to the shots (he got up to 15.5u per shot), but if I were starting now I'd go with Levemir. Caninsulin doesn't last nearly as long in the body, which means that there are hours when there is no insulin helping to control the blood sugar. There is a good post that talks about the differences between Lantus and Levemir here.

I'll grab the link for how to do a spreadsheet in a minute.
 
Reading some of these old threads...speaking of infections - it might be his liver...he's had problems with it ever since diagnosis (actually that's how Dx happened). And of course bc I'm being a terrible mother I ran out of his liver pills so he went a few days without them. He has more today but I'm sure I've screwed things up and caused all these problems.
I really need to be more on top of things. :'(
 
They are definitely scary. We all tend to err on the side of caution.... as we aren't there with you....

Does he show signs of dehydration? his skin is slow to slide back in place if you pull his back skin up... like when you tent ...
and are his gums sticky?
 
Also make sure you are testing the ketones and reading in a good light so you get the right level.

Are you testing his blood sugar at home? The 8 U of Caninsulin is a larger dose. Neko started out on Caninsulin, but it wasn't lasting the whole 12 hours and her blood sugar would shoot up for the last couple hours of the cycle. In Canada, we don't need a prescription to switch insulins.
 
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

try that and if you need help, just ask.

hmm, looking at your signature line after I posted it, does that mean honeymoon? so he wasn't getting insulin for those 3 months? Can you fill us in on the story of that? Do you have a profile done? We suggest people tell the story on a google doc, then link it to your signature so you don't have to keep retelling all the essential stuff over and over.

Don't beat yourself up over things you can't change. We've all made mistakes with our diabetic cats, all you can do is learn and move on. No one here will lay blame on you.
 
Got a mid-stream sample with the strip, it started to show colour immediately and was at least at the "small" colour by 15 seconds indicated as the required check time.

When I first brought Red in he hadn't been eating, was lethargic, not grooming. Vet showed me he was jaundiced and dehydrated. Blood tests showed both high glucose and elevated liver values on his blood work. He was on 3 units insulin but ended up going hypo and then not needing any after only a couple of weeks. His blood sugar was fine, liver values returned to normal. Vet said to re-check his blood in a 6 months but the exact same thing ended up happening after only a couple of months, just caught earlier the second time around. I should change it if it's confusing.

I've also been wondering about switching insulin but didn't know how to start going about it.
 
Wendy&Neko said:
Also make sure you are testing the ketones and reading in a good light so you get the right level.

Are you testing his blood sugar at home? The 8 U of Caninsulin is a larger dose. Neko started out on Caninsulin, but it wasn't lasting the whole 12 hours and her blood sugar would shoot up for the last couple hours of the cycle. In Canada, we don't need a prescription to switch insulins.
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Do you mean to tell me I can get insulin from any pharmacy??
 
julie & punkin (ga) said:
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

try that and if you need help, just ask.

hmm, looking at your signature line after I posted it, does that mean honeymoon? so he wasn't getting insulin for those 3 months? Can you fill us in on the story of that? Do you have a profile done? We suggest people tell the story on a google doc, then link it to your signature so you don't have to keep retelling all the essential stuff over and over.

Don't beat yourself up over things you can't change. We've all made mistakes with our diabetic cats, all you can do is learn and move on. No one here will lay blame on you.
Click to expand...

Thanks for that link. I'll try to get it done asap.
 
rhiannon and shadow said:
They are definitely scary. We all tend to err on the side of caution.... as we aren't there with you....

Does he show signs of dehydration? his skin is slow to slide back in place if you pull his back skin up... like when you tent ...
and are his gums sticky?
Click to expand...

Doesn't seem to be any problems with dehydration as far as I can tell. I added a lot of water to his food and I know he's been drinking as he drinks from the tap when I use the bathroom.
 
Red'sMomHeather said:
Do you mean to tell me I can get insulin from any pharmacy??
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I buy mine at Safeway in British Columbia, but have also bought at Real Canadian Superstore, others have bought at Costco, basically any pharmacy. It pays to shop around for prices. Lantus and Levemir are insulins used by humans and are long lasting in cats. That's the down side of Caninsulin - only available from the vet's office. You can also get the U-100 syringes from any pharmacy, as Lantus/Levemir use different syringes too. I had a locum vet help get me started on the switch to Lantus. The pharmacist has a lot of diabetic kitty clients and was very helpful. But I'd make sure you are testing and have a spreadsheet up first, so we can help with dose. As Rhiannon said, those ketones make things tricky.

I was just reading some of your other threads. Popular meters used in Canada are the Bayer Contour and the Accucheck Aviva. Good prices for strips on Ebay. The Bayer is my backup, though I cross border shop for the Relion.
 
Hi Julie. Thanks for asking.

He's doing better today in terms of acting "normal." I syringe fed him in the am. He ate a half can Friskies for dinner but it took him 1.5 hours to do so. He got his full dose of insulin this morning. Haven't had a chance to check his ketones today. I did get a chance to check them myself last night (negative). I spoke to my vet today who reiterated what the other vet said last night - ketones are due to his diabetes being unregulated. Get his bs under control and ketones won't occur. She did say, however, that if he wasn't much better by tomorrow to bring him in for more blood work. Last blood work was only 1.5 weeks ago.

I've begun a spreadsheet. I only have reliable numbers for the past couple of weeks. Seeing all that black and red is an easy way to put things in perspective. :/
 
The nadir, or lowest glucose, for Caninsulin/Vetsulin is about +4 to +5 hours post-shot. When you can, test about then.
 
When he was first diagnosed we got his bs under control within about a week and I think that gave me a false impression of how easy this would be.

Due to work that's usually not possible but I will be able to do that tomorrow as well as a full curve on Thursday.
 
You test mid-cycle when you can - weekends or days off, some folks even set an alarm at night. Whatever works for you.
 
Heather, I'm looking back over your old posts and trying to piece together the picture of how he got to this high of a dose. Can you just put whatever you remember into the spreadsheet so we can see how the dose came to be? Or write the story out? If you can recreate any BG tests and the doses that would be really helpful. If I understand correctly, he was only on insulin for a short time (a few days?) and then was off of insulin for a couple of months - til March, maybe? And now he's been on insulin since March? How did the dose increases happen?

As I mentioned yesterday, cats can have high blood sugar if they are overdosed, or they can have high dose conditions and just need more insulin. I'm trying to sift through the story to see if we can tell if his dose needs to be increased. The ss right now looks like he does, but sometimes the dose is the problem.

I see your answer here:
Red'sMomHeather said:
When I first brought Red in he hadn't been eating, was lethargic, not grooming. Vet showed me he was jaundiced and dehydrated. Blood tests showed both high glucose and elevated liver values on his blood work. He was on 3 units insulin but ended up going hypo and then not needing any after only a couple of weeks. His blood sugar was fine, liver values returned to normal. Vet said to re-check his blood in a 6 months but the exact same thing ended up happening after only a couple of months, just caught earlier the second time around. I should change it if it's confusing.
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During that time he was off insulin, it sounds like no blood sugar tests were done - is that right?

When did he go back on insulin, how much insulin was he given at that point, and how did the dose increases happen?

If you are able to change insulins, I suspect you'll see an improvement. Caninsulin (hear the word canine in there?) was developed for dogs. Cats do well with Levemir, Lantus, and Prozinc. It sounds like you can just go buy insulin at the pharmacy in Canada without needing a prescription. If you can, I'd get the Levemir.
 
You're correct in that he was off insulin for a couple of months with no testing being done. He began to show the same signs that he did originally in January - lethargy, not eating well, not grooming - so I brought him in to find out his bs was again high as were his liver values. He was in hospital for a couple of days on fluids and they increased the dose while he was there, starting at 1U 2x/day and I believe up to 3U 2x/day. I brought him in for bi-weekly bs tests.
Again, if I'm remembering correctly, the dose was increased pretty much every time I went in. It would go from 3U am and pm to 4U am and 3U pm, to 4U am and pm, etc etc up to the current 10U am and 9U pm.
I noticed a drop from mid-30's to mid-20's when I switched from the prescription diabetic food to the friskies/fancy feast, but I'm not seeing any lower numbers with the increase from 8U 2x/day.
I feed him 10:30am, 5:30pm, and 10:30pm, giving him equal amounts of food each time.
As I'm not working tomorrow I'll be able to do a curve. Should I test every 2 hours? Every hour?
 
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