? What’s the best time to test for ketones? Does timing matter?

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I am curious as well. I just started checking blood ketone levels myself. I figured it would be best to test when the BGs are at their highest since that's when ketones would be most likely to show up. I haven't the foggiest idea if that's accurate at all, but I just go with it, haha. When I had my urine ketones strips, I just tested when I could catch him in the litter box. I didn't really think much more past that. :cat:
 
What meter are you using and what ketone reading are you getting? I don't see the number on the ss.

Also, why did you drop the dose from 2.5u to 1u?

The recipe for ketone formation is:
Not enough insulin + not enough calories + infection/inflammation/some other systemic stress

Under the circumstances (high BG and reducing dose by more than half) I would test a minimum of once per day.. I would mix up the times.
 
For other people to easily follow the history, here is your last post here: http://www.felinediabetes.com/FDMB/...ne-please-help-me-interpret-his-curve.193657/
andy
I agree with Sandy, not sure why you decreased the dose. He was starting to see some mid blues on 2.5 units, but looks like he needed an increase to 2.75 units. With that reduced dose I would definitely check ketones frequently. Doing that "reset" usually leads to higher numbers, which you are now seeing. And I've seen it also lead to ketones. How is Frosty's appetite? Is he still eating well?
 
I read somewhere on this forum that ketones start to register at 2.4 on a blood meter. I use the Novamax meter on Luna and she’s usually .2 - .8 when I test. I would be worried if I saw 2 on it. I’m not an expert but I think Frosty needs more insulin. I don’t know your reasoning for decreasing from 2.5 to 1 but I’d be testing for ketones several times a day now.
 
Wendy&Neko said:
For other people to easily follow the history, here is your last post here: http://www.felinediabetes.com/FDMB/...ne-please-help-me-interpret-his-curve.193657/
andy
I agree with Sandy, not sure why you decreased the dose. He was starting to see some mid blues on 2.5 units, but looks like he needed an increase to 2.75 units. With that reduced dose I would definitely check ketones frequently. Doing that "reset" usually leads to higher numbers, which you are now seeing. And I've seen it also lead to ketones. How is Frosty's appetite? Is he still eating well?
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Kittymama81 said:
I read somewhere on this forum that ketones start to register at 2.4 on a blood meter. I use the Novamax meter on Luna and she’s usually .2 - .8 when I test. I would be worried if I saw 2 on it. I’m not an expert but I think Frosty needs more insulin. I don’t know your reasoning for decreasing from 2.5 to 1 but I’d be testing for ketones several times a day now.
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He’s bouncing like crazy on 2.5 units and I’m tired of seeing numbers in the 500s. He was on that dose for 2 weeks without improvement. I kind of think his dose might be too high. It actually looks like his numbers are pretty similar on 1 unit as well as 2.5, which I don’t understand.

Looking back through my spreadsheet before we came back from vacation, I should have taken him off insulin because he hit below 90 multiple times, even on 0.25 units. Instead i went up to 0.5 because we switched syringes. When we got back and he tested at 150 at pmps I should have skipped that dose all together. I almost wonder if continuing to give him insulin while his sugars were lower cause all these crazy bounces, and now we are just all over the place. So I went back down to 1 unit to see if we could start titration the dose over again. I don’t know. Continuously going up just isn’t working, his numbers aren’t getting any better.

The only other thing is, I just got new lantus pens and I’m wondering if I should try a brand new pen. The pen I have now I’ve had since I got him. Maybe the insulin is bad? Or maybe he needs to be switched to s different type of insulin all together?

He’s eating and acting fine, just drinking a lot, but it’s also 100 degrees here this week.
 

Please read up on the two methods used here - SLGS. and TR and select the one that’s a good fit and follow it. No worries if you pick one and then decide the other may be best...you can always switch.

Ana and Frosty said:
He was on that dose for 2 weeks without improvement.
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Note that each of the methods have specific guidelines regarding increasing and decreasing dose. Holding an ineffective dose for two weeks invites glucose toxicity, which is likely what’s happened with Frosty.

Ana and Frosty said:
So I went back down to 1 unit to see if we could start titration the dose over again. I don’t know. Continuously going up just isn’t working, his numbers aren’t getting any better.
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Starting over is flirting with disaster if ketones are on the scene.

There is no starting over; only moving forward. A kitty needs as much insulin as needed to first reacquaint the body with normal BG levels and then keep them there long enough to support healing of the pancreas.

Regarding ketones ‘trace’ is a call to attention and since ketones can quickly develop from trace to large (exactly 24 hours in my kitty’s case) any reading above ‘trace’ warrants a call to your vet.
Ana and Frosty said:
Looking back through my spreadsheet...
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If it’s farther back than about 2 weeks it’s pretty much ancient history.
 
Luna bounces like crazy too. Some days she goes from high 400's to under 100 in three hours. I reduced her dose by .5 a while back and it didn’t work for her. She still dropped like a rock, bounced and also lost her blue’s and green’s. Dosing is based on nadir so I’d keep increasing until you see some blues and greens on a consistent basis. The first few months of Luna’s diagnosis she didn’t bounce and her numbers were great. I thought she was as heading for remission and suddenly out of nowhere it changed. It’s a never ending puzzle for sure!
 
I think it would be wise to give something with some efficacy behind it a solid try, TR, SLGS your vet's method, something, for a good month or so and get Frosty out of those yucky numbers. I know you tried both, but not for long enough to see results, he keeps going up and down and up and down (in dose) which compounds the problem. The beauty of this site is you don't have to reinvent the wheel and DIY your own dosing strategy. Many people have done that already and their mistakes are our good fortune because what doesn't usually work has been tossed aside and what does has been kept. Seeing good numbers in the beginning and then they go away isn't uncommon. Wondering if that lower dose was the answer isn't uncommon. Taking the dose back down rarely works, especially if you raised the dose incrementally from the beginning like you have. He just needs more insulin is all. The longer you wait, the higher the dose he will likely need to break through that glucose toxicity. Not to mention the dangers of ketones.

I hope you'll consider committing to something so Frosty can get sorted out soon. :)
 
So I actually posted here because I was looking for input about timing of ketone testing. I was not looking for dosing advice... and no one answered my question, but I got a lot of advice that I’ve already heard many times before. Soo... can anyone tell me if it matters when in the cycle you test for ketones and what the optimal time is?
 
Ana and Frosty said:
So I actually posted here because I was looking for input about timing of ketone testing. I was not looking for dosing advice... and no one answered my question, but I got a lot of advice that I’ve already heard many times before. Soo... can anyone tell me if it matters when in the cycle you test for ketones and what the optimal time is?
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You did get an answer from a member very experienced in dealing with ketones. Go back and read the post from @Sandy and Black Kitty
 
Ana and Frosty said:
What’s the answer? I don’t see it. Just questions and criticism about my dose. Absolutely nothing about whether timing of checking the ketones matters .
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She said to mix up the times of your ketone testing. Silver had ketones so high the meter read HI. Basically if they have ketones they have them and from what I've seen from Silver it didn't matter what time I tested. They were there.
 
Ana and Frosty said:
What’s the answer? I don’t see it. Just questions and criticism about my dose. Absolutely nothing about whether timing of checking the ketones matters .
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I don’t understand why you are choosing to view the responses you’ve received as criticism. You’re asking a specific question, when to test for ketones, but the answer is rooted deeper in that ketones are in the picture because something else is going on in the first place.

The people that take time out of their day to respond to these questions don’t typically just blurt out a generic answer without putting some thought in to it, without reviewing your posts and SS so that the information applies to your cat and your situation. If you choose to see that as criticism, that’s your prerogative, but please consider that people want to help Frosty and you and that’s why sometimes you get a more detailed response because your question branches out into a wider area of why ketones are there to begin with and there are some obvious reasons for the numbers being high. I feel it would be irresponsible not to mention that, what you do with that information is up to you.

Beenie’s response to your question, based on numbers and symptoms seems pretty reasonable. Sandy responded that under the circumstances, she advises testing once per day and mixing up the times. Ketones in the blood are there right now, ketones in urine were there some time in the past few hours and may or may not still be present. Any time a cat goes off his food, is acting out of sorts, losing weight, has high numbers or anything else funny is going on, those are all great times to test for ketones.
 
And believe me - to reiterate what Stacy is saying - I totally totally get it. I had the same temptations as you to start over. I would increase and increase and not see improvement. I'd get frustrated at the help I was offered as it didnt make sense to me. But you just have to keep on following the protocol you choose and keep going forward. Eliminate any other possibilities for numbers not going down: need for a dental; old insulin; (in my case - even expired strips). Keep going - you will get there and so will Frosty.
 
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