Tested for ketones today.. trouble?

[pevsfreedom]

Hello I tested Luna for ketone's today (first time ever),

she read 1.1 mmol/l which is 19.8 mg/dl,

according to this site:

http://www.diabeticcatcare.com/DCCCOK/Ketones.htm

she's at a small-moderate level. She's showing no symptoms of anything and is acting normal. She's had level's be too high for awhile now (BG wise). I should add she did vomit this morning, just spit. She is known to eat dumb stuff like plastic and hair ties though and throw it up, though nothing came up this time. Her appetite is fine.

What do I need to do to get this under control ASAP? We started giving her 2 units as opposed to 1 yesterday and got her under 250 (@ nadir) for the first time in a long time. Today at +3 hours for some reason she jumped from 340 pre-shot to 370. I started the 'tight control' protocol yesterday, should I just keep doing what I'm doing and watch for symptoms to develop?

 

[Shiloh & Rhonda (GA)]

I don't have any dealings with ketones, but my understanding from reading here is that anything above a trace is trouble. @BJM ?

 

[pevsfreedom]

That's what I've heard though like I said no symptoms are present. I'm sure this has been a problem for months since we only recently found out she came out of remission (and stopped relying on vet to tell us her BG levels).

 

[BJM]

Ketones are a by-product of fat breakdown for calories. As long as the cat has insufficient insulin, fat breakdown will be needed to keep the body functioning because not all glucose can be used.
The problems come in when more ketones are produced than the body can handle, causing an acid build-up and flipping into ketoacidosis. Also, if enough fat breakdown is happening, it can overwhelm the liver, causing it to swell and seriously, sometimes fatally disrupting digestion.
Do whatever you need to do to get your cat to eat, (even if it is high carb) and adjust the insulin to match it as closely as possible also, keep your cat well hydrated to flush the ketones out. If possible, add 1-2 tablespoons of water to the canned food.

 

[pevsfreedom]

Thanks for the info. She's eating normally and drinking lots of water like usual. I already add water as well because I heard it helps prevent UTI's.

I take it as long as she's eating/drinking/(totally) normal I have nothing to worry about besides watching out for any symptoms while trying to lower her BG levels? Thanks.

 

[Meya14]

You do also want to do the increases rather quickly to get the insulin to a level where ketones stop forming. Per the tight regulation protocol, you should be increasing every three days if BS is still elevated at the nadirs. In her situation, I would definately do 0.5U increases (and not 0.25U increases) until you see some response in the nadirs and a lower ketone level.

 

[pevsfreedom]

You do also want to do the increases rather quickly to get the insulin to a level where ketones stop forming. Per the tight regulation protocol, you should be increasing every three days if BS is still elevated at the nadirs. In her situation, I would definately do 0.5U increases (and not 0.25U increases) until you see some response in the nadirs and a lower ketone level.

What kind of #'s do ketones stop forming, is it the ~220-250 area? I'll most likely increase on Saturday to 2.5 (from 2). Thank you.

 

[Meya14]

Actually, it confuses a lot of people but the BS number is somewhat independent of the ketones forming. Insulin has a few functions in the body. One is to lower blood sugar during times when there is too much. This BS is stored as fat. The other function insulin has is to allow the cells of the body to use glucose as energy. If you don't have insulin, your body will burn fat for energy when it should be burning glucose.

BS and ketones may be tied together in some cats (as BS is often an indicator of not enough insulin), however, sometimes, the BS can even be in the normal range, and yet the metabolism issues aren't corrected. This can happen with anorexia, concurrent illness, or when fed an ultra low carb diet. Some cats are the opposite, and a small amount of insulin can prevent ketones, but that amount is still not enough for normal sugars.

For these reasons, the BS should not be the only measure for gauging the insulin in a cat who has ketones recently. You should test ketone levels daily until she is clear of them, then ever few days for a couple weeks. After a couple weeks, if everything else is good, you can reduce the testing.

 

[BJM]

Thanks for the info. She's eating normally and drinking lots of water like usual. I already add water as well because I heard it helps prevent UTI's.

I take it as long as she's eating/drinking/(totally) normal I have nothing to worry about besides watching out for any symptoms while trying to lower her BG levels? Thanks.

Uh, no.

Drinking lots of water indicates the lack of glucose regulation.That plus the ketones indicates your cat is at increased risk of become ketoacidotic. DKA is expensive to treat and may be fatal.

Watch for the whites of the eyes turning yellow and/or the skin turning yellow (jaundice) as it indicates the liver is having problems and may develop hepatic lipidosis where it shuts down. This, too, is expensive to treat and may be fatal.

Continue testing for ketones as Meya notes. Continue working the dose of insulin per protocol to get the glucose controlled. Be sure to touch base with your vet and keep him/her in the loop.