Ketone Testing, Trouble getting regulated

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pevsfreedom

pevsfreedom

Member Since 2015
Hello all, I had a few questions for Luna the diabetic cat (as she's known around these parts),

I want to start testing for Ketones to be safe then sorry though I've noticed no symptoms.

1) How can I test her for ketones (urine) if we have 3 cats? I've had Luna for over a year and have never once seen her in the litter box. She's very sneaky. Is blood testing an alternative? What's the avg. cost for ketone testing at the vet (if anyone knows, my vet wouldn't give me an answer over the phone oddly). Also, if she does test (positive?) for ketones, is that an emergency? Does testing just say 'yes/no' in terms of ketone presence?

If I buy the stuff and test her, and she HAS ketones, is there anything to be done other then watch out signs of DKA? She's acting fine and has been since starting insulin.

2) We're giving her 1 unit of Lantus twice a day. I checked her a bit ago at +4 hours and she was 340. I've read about conducting BG curves to adjust doses? Anyone have more info on this? I'm sure she needs MORE insulin, but how much more?

3) How many times should she be tested a day? Once before eating, once immediately after eating, and once at +6-9 hours? Or is just once before and once 6-9 hours later ok? I'm trying to force myself to test her more, which I've been getting better at.

Thanks all.
 
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To Luna's mom (or dad?). At least before each shot, you need to test. Then at the 5-7 hour mark, and at least before you go to bed. I would say four at a minimum. Some of us (me included) become serial testers, as the more information you have about how the insulin is working for Luna, the better you can decide on her doses.

Do you test/shoot/feed, in that order?
 
Shiloh & Rhonda said:
To Luna's mom (or dad?). At least before each shot, you need to test. Then at the 5-7 hour mark, and at least before you go to bed. I would say four at a minimum. Some of us (me included) become serial testers, as the more information you have about how the insulin is working for Luna, the better you can decide on her doses.

Do you test/shoot/feed, in that order?
Click to expand...

Dad here. And thanks for response. What we've been doing is basically test, feed, shoot after a few minutes, then test a few hours later. We haven't done curves yet as I'm still learning how to stab my cat and make her bleed on a daily basis. She's not regulated though, at +3 and +6 today both readings were 340-344, which is odd, because +0 she was also 340.

She's been losing weight, though she was 4 or 5 lbs overweight when we got her. Low carb diet. Etc.
 
I take it she is a new cat? And hi, Dad! Test/feed/shoot is normally what I do. I shoot while Shiloh is eating. Sounds like she is having a flat cycle, which is good, she is not up and down. But lower numbers are obviously better. How long has she been at 1 unit?
 
And there are meters that you can buy that test ketones in the blood. Not familiar with them myself. But I"m sure someone else will be along soon that can advise about those.
 
Thanks. We've had her for about a year. We gave her either 2 or 3 units for a few months (I forget) and she went into remission almost instantly after we swapped her diet from dry food to low carb wet food. We found out a few months ago she fell out of remission.

She's been at 1 unit for a few months now. I haven't been testing as regular as I should, and upon doing some reading about high BG levels I'm going to do a lot better. I think I want to get her 1.5 starting tomorrow, because 340 is pretty high up there.

How often should I do 'curves' to see 'what's up' with her averages and all that? Thanks again for responses. I see you got your cat regulated very quickly from your spreadsheet.
 
What insulin are you using?

Here are some Urine Testing Tips to help with the ketone testing. Anything over a "trace" is an emergency and requires veterinary assistance. Sometimes if caught early (at "trace") we can help you manage it at home, but ketones are dangerous and need to be taken seriously.
 
Shiloh & Rhonda said:
And there are meters that you can buy that test ketones in the blood. Not familiar with them myself. But I"m sure someone else will be along soon that can advise about those.
Click to expand...

Yeah I found one that wasn't too bad, $18 + the strips (10) at $30 or so. I just am not sure if the test will really show me anything.. I mean I'm sure she has ketones for being over 300 for so long, but from what I've read if I get her regulated (and she doesn't show any symptoms of DKA) then the ketones will 'go away'. I could be wrong. I just don't wanna worry over it if there's nothing to worry about!
 
Chris & China said:
What insulin are you using?

Here are some Urine Testing Tips to help with the ketone testing. Anything over a "trace" is an emergency and requires veterinary assistance. Sometimes if caught early (at "trace") we can help you manage it at home, but ketones are dangerous and need to be taken seriously.
Click to expand...

Lantus. Good info, thanks. I have 3 cats and this one is very sneaky with her litter habits, would I be better buying a blood testing kit (for ketones)? I'll get on that. What entails 'home management' of ketones?
 
Dad, I normally do a curve about every one to two weeks. On the weekends when I am off. As you can see, I'm really new here, so I try not to give dosing advice.
 
Most of us can figure out our diabetic cat's peeing pattern well enough to get a sample "mid-void" (I've never been able to though...China's a "private pee'er...LOL) I've always had to giggle when I think of chasing a cat around the house with a soup spoon trying to stick it under them at just the right moment!

Another option is to put your cat in a bathroom until she produces for you. Have you ever tried the Breeze litterbox? It has non-absorbent pellets and there's a tray underneath where you can collect the sample too (usually there's a pad in the tray to absorb the urine, but you don't HAVE to use it)

Yes, you can use the blood ketone meter if you can afford the strips, and actually it's better since ketones show up in blood long before they show up in urine.

As for testing, the BEST thing you can do is always test before shots to make sure they're high enough for insulin and then on the AM cycle, get at least a mid-cycle test (like 5-7 hours after the shot) and at least a "before bed" test on the PM cycle to make sure it's safe to sleep without setting an alarm. Most cats go lower at night.

Lantus dosing is based on how LOW it takes them, not the pre-shot tests, so it's important to find out where her nadir is (nadir is the lowest point in the cycle). Depending some on your schedule, there are 2 protocols we use here for Lantus. The Tight Regulation Protocol gives the best chance at remission and it CAN be done with a full time job with a little creative thinking! Dose adjustments can be made as soon as every 3 days to get them to the "best dose" as quickly as possible.

The other protocol is the Start Low, Go Slow method, where dose adjustments aren't made as quickly and have some different parameters for when dose adjustments are made.

You'll need to decide which one is best for you and your sweet kitty
 
I get more then a giggle, I get a strong urge to NOT chase my cat hoping for a urine stream! :) Seriously though in over a year I've never once seen her use the box, she's very sneaky.

We also have 3 cats, which makes things harder I guess.

I decided to buy the ketone strips, 10 for $25 I believe it was.

How often should I be testing for ketones? One website said once a month as long as no symptoms are present.

Luckily I work from home so I have plenty of time to get this right hopefully! Thanks for your long answer I really appreciate it. Also one last question, how often do people get fructosamine measured at the vet? It costs like $180 and I'm not sure if it's necessary if home testing?
 
Ketones occur from the change in metabolism if a cat is either not getting enough food, enough insulin, or is sick. Normally, the body uses sugars for energy, ketones form when fat is utilized from fat stores. Weight loss can contribute to the development of ketones.

The reason why they are such a problem is that they can lead to anorexia and dehydration very quickly, and these are very hard to correct in a cat without expensive treatment.

The best prevention is good hydration, enough insulin to control BS, and early intervention with symptoms or infections. Symptoms include poor appetite, signs of dehydration, lethargy, signs of concurrent infection, changes in litterbox habits. Not all cats are ketone prone. It's more common in recently diagnosed cats, cats who have a history of DKA, or cats with infections.

If blood sugars are not <250 at all times then there is greater risk of complications, so ketones could be checked more frequently. Due to the weight loss, if feasible I'd test at least once a week. DKA can develop in a matter of a day or two, so you have a better chance of intervening early with weekly checks. Check if you notice changes in symptoms as well. When ketones are caught early enough (before the cat stops eating), increasing fluid intake, increasing calories, and increasing insulin can help to eliminate them.

If you are monitoring blood sugars daily and keeping track of them, fructosamine won't really give you any information you don't already know.
 
Thanks for that. She shows none of those symptoms, despite weight loss, but she was overweight to begin with and lost 3 lbs over about 8 months. If ketones ARE present, then basically you just treat that before it gets worse? It's a slightly confusing subject to me.

I thought as much about fructosamine, thanks.

Does anyone have a clean spreadsheet to share with me so I can better monitor? I can't find any templates anywhere!

Thanks everyone this forum is so helpful I'd be lost without it.
 
Here's "How to create our spreadsheet" that includes the template we use.

If you still have trouble, let us know

If ketones are present, whether it's an emergency or not depends on what level they're at. If they're at "trace", we may be able to help you handle them at home. If more than "trace", it's an emergency and you need to get to a vet
 
Two ketone test meters are:
Nova Max Plus
Precision Xtra
On the average, ketones will be detectable in the urine about 5 days after they show up in the blood.
On the average, ketones will be detectable in the blood after about 2 weeks of sustained high glucose, insufficient insulin, and infection.

Note: average means that some may be detectable earlier or later than the specified time period. All things considered, a blood test is going to find ketones faster.
 
So in essence if trace amounts show up, and she's constantly above 300, she needs more insulin (to treat ketones/high BG levels)? I'm planning on giving more starting tomorrow. Thanks. I got the Precision Xtra.
 
If there are no signs of infection and calorie intake is sufficient, then the usual culprit is lack of insulin. There are some metabolic/GI issues that can cause ketones too (hyperthyroid, diarrhea, etc) so if ketones were to increase or persist, it is important to rule other things out too.
 
BJM said:
Following the Lantus protocol you are using, you adjust the dose.
Tight Regulation
Start Low, Go Slow
Click to expand...

Thanks I just found those today and am going to follow the tight regulation schedule starting tomorrow.

Meya14 said:
If there are no signs of infection and calorie intake is sufficient, then the usual culprit is lack of insulin. There are some metabolic/GI issues that can cause ketones too (hyperthyroid, diarrhea, etc) so if ketones were to increase or persist, it is important to rule other things out too.
Click to expand...

I've heard a couple times today about caloric intake. How does one really come up with the right number for this? I follow the instructions on the can and she's eating exactly 1.5 cans of 5.5oz low carb wet food a day. Doing this she went from 14.7lbs to 11lbs in about 8 months which is a much healthier weight. She seems 'satisfied' throughout the day, though she's a FIEND for food.
 
When cats lose weight too quickly they can develop problems with fat accumulating in their liver. I'm not sure how quick cats can safely lose weight, but >4lbs is quite a bit. Cats who are unregulated will lose weight because they don't have enough insulin to store fat, and end up urinating out a lot of calories worth of sugar. Until blood sugar is in a more normal range, her caloric needs are going to be higher than a non-diabetic cat. For this reason, IMO, feeding as much as she wants of low carb food would be what I'd do. It's hard to calculate how much extra an unregulated cat's needs are, and this type of weight loss is not really healthy. Much of the weight loss that occurs with uncontrolled diabetes is muscle mass in addition to fat.

A very rough estimate for an average sized cat is about 250 calories a day. This really all depends on the cat (diabetic control, activity level, size, other illnesses). Most foods will list the calorie content on the packaging. Typically, 5.5oz cans are from 130-180 calories each, so 1.5 cans sounds close. As she becomes better regulated, she will utilize calories more efficiently and may start to gain weight, so you may have to reign in the feedings.
 
She typically is fine until about an hour before normal feeding time, then she whines for food like crazy. I suppose I need to probably feed her more then since her levels are so high? I might bump it up .25 cans extra each meal to 2 cans/day. Thanks for the info. I'll know more as I test her more. Wish I started sooner.
 
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