? Managing Ketones At Home

Katie & Benny

Member Since 2025
Benny has been through another tough week this past week.

On Monday, he was acting a little sleepier but still relatively normal, always eager for his food and behaving better than he had been. He went to the bathroom and I decided on a whim to check his ketones. I used a keto-diastix strip and the ketones show up dark purple for Large ketones. I was in shock because I never did an at home test that showed up positive before. From here on, it was a night of sitting in the ER, being referred to a bigger emergency hospital because Benny has anemia and ketones, and being admitted for the second time in less than two months for DKA and anemia.

It turns out, the anemia was from over testing on Benny’s blood. Since the last hospitalization, Benny has had blood tests multiple times in the week and he is just so small right now and so unregulated that his body has no time to regenerate those cells. I was relieved this wasn’t a more serious concern as the first ER worded this finding as possibly being something “more sinister” going on that no one had found yet. He received IV fluids, went through three chest taps because a Freestyle Libre was attempted to be placed and it punctured his lung (please don’t even ask about a Freestyle Libre because it’s not happening after this experience), and very thankfully discharged from the hospital December 11th after 3 days in hospital.

We are heading into day 3 since Benny has been out of the hospital and my biggest worry right now is that his ketone tests are showing up as Large again. We have contacted his new internal specialist and she recommended putting Benny back up to 2 units again from 1.5 that he has been on since he was discharged on the 11th. She honestly didn’t seem that worried that his ketones were back so quickly because we did say he is acting fine. Benny once again is acting pretty normally, just still pretty tired but definitely not extremely lethargic, no vomiting, no diarrhea, no heavy breathing. He is eating his food as ravenously as usual and his glucose is staying within the 300’s which I know isn’t great but is better than what he was working with before. Benny is getting between 300-350 calories a day, sometimes a bit more.

I was supposed to get a blood ketone meter in the mail today but unfortunately it did not arrive so I am still working with the urine test strips for now. Biggest question, what can I do to try and get these ketones down at home? He always eats all of his food so that, luckily, is never a worry, I am making sure he is drinking water to try and flush out the ketones, and we have made the increase from 1.5 units to 2 this evening. We are doing an at home glucose curve tomorrow and sharing results with his internal specialist who so far is very collaborative.
 
I am so sorry you're going through this. The only thing I was given and told to do at home was subq fluids. Did they at least send you home with that? You can buy them at most vet clinics or chewy. You need to be careful not to overload them though, AND be sure he doesn't have a heart murmur. If so, it can still be given, but much less as to not overwork his heart.
That's all I know, but hopefully someone will come around with more knowledge to keep you both out of the ER.
Best of wishes
 
Sorry to hear Benny had to go to the hospital since you last posted. Here is the link to your last post here, which we include to make it easy for people to see what happened previously: AMPS: 375, +6 382, +9 352, 1.5Ul for Benny’s Dinnertime Dose?

Did they find any infection or system inflammation in Benny when he was in hospital? The formula for DKA is not enough insulin + not enough calories + infection/inflammation. At this point, he should be eating 1.5 times his normal calories of food. I'm glad to hear he's got a good appetite. Spread those meals into several small meals a day and night. If he's a grazer, that also works. Add lots of water to his food as well, as much as he'll tolerate, to try to flush out the ketones. Keep testing those ketones daily, or even twice a day.

I'm glad you increased tonight. Going forward, you shouldn't decrease the dose unless you see him going too low. Don't keep changing the dose around. Lantus likes consistent dosing for several days so the depot can build.
 
I am so sorry you're going through this. The only thing I was given and told to do at home was subq fluids. Did they at least send you home with that? You can buy them at most vet clinics or chewy. You need to be careful not to overload them though, AND be sure he doesn't have a heart murmur. If so, it can still be given, but much less as to not overwork his heart.
That's all I know, but hopefully someone will come around with more knowledge to keep you both out of the ER.
Best of wishes
Thanks for the reply, Tyleete

We were not given subq fluids to take home. He also does not have a heart murmur. This was confirmed by a cardiologist about 2 weeks ago.
 
Sorry to hear Benny had to go to the hospital since you last posted. Here is the link to your last post here, which we include to make it easy for people to see what happened previously: AMPS: 375, +6 382, +9 352, 1.5Ul for Benny’s Dinnertime Dose?

Did they find any infection or system inflammation in Benny when he was in hospital? The formula for DKA is not enough insulin + not enough calories + infection/inflammation. At this point, he should be eating 1.5 times his normal calories of food. I'm glad to hear he's got a good appetite. Spread those meals into several small meals a day and night. If he's a grazer, that also works. Add lots of water to his food as well, as much as he'll tolerate, to try to flush out the ketones. Keep testing those ketones daily, or even twice a day.

I'm glad you increased tonight. Going forward, you shouldn't decrease the dose unless you see him going too low. Don't keep changing the dose around. Lantus likes consistent dosing for several days so the depot can build.
That’s a relief to hear we made the right move of increasing his dosage tonight. In the hospital they did not find any infection, they are thinking he may possibly have some GI issues but nothing confirmed which is why we now have some Royal Canin Protein in his diet. During this glucose curve today we are going to give him some smaller meals to hopefully keep him consistent. His food is already pretty wet but I’ll make sure to add some extra water to work on flushing the ketones. He attacks his food all at once so no grazing for him!

I will make sure to post his glucose curve data once we complete that today.
 
Oh boy, what a week for Benny, I’m glad he’s home now and appetite it good, fingers crossed it stays that way. The really important factor in treating post DKA at home as Wendy mentioned is hydration to help flush ketones, which includes making sure each feeding has extra water, making it as soupy as he will tolerate, and the extra calories are key. In order to get 1.5 times more calories, you could also try the Hill’s a/d or Royal Canin Recovery, available at the vet, since those both have more calories per can, and a lot of cats love the taste of it. Plus, it’s very smooth if you need to assist feed. And of course, keep monitoring for ketones and watch for signs like diminished activity, lethargy, not eating, vomiting, and ketone odour on his breath. Hope the increased insulin helps as well, if you have any concerns with lower preshots down the road, please post, it is is critically important with cats who have had DKA that you do not skip insulin.
 
Oh boy, what a week for Benny, I’m glad he’s home now and appetite it good, fingers crossed it stays that way. The really important factor in treating post DKA at home as Wendy mentioned is hydration to help flush ketones, which includes making sure each feeding has extra water, making it as soupy as he will tolerate, and the extra calories are key. In order to get 1.5 times more calories, you could also try the Hill’s a/d or Royal Canin Recovery, available at the vet, since those both have more calories per can, and a lot of cats love the taste of it. Plus, it’s very smooth if you need to assist feed. And of course, keep monitoring for ketones and watch for signs like diminished activity, lethargy, not eating, vomiting, and ketone odour on his breath. Hope the increased insulin helps as well, if you have any concerns with lower preshots down the road, please post, it is is critically important with cats who have had DKA that you do not skip insulin.
So far Benny is doing well today with the soupier food today which is good! He’s definitely sick of me bothering him for his glucose checks but I’d much rather have that than him being so lethargic he’s not interacting with me at all. I’m updating his spreadsheet as we are going today and his numbers are showing a rise in glucose around 10am which definitely fits his energy level at that time lately. He just kind of hunkers down and sleeps through that high glucose then becomes a little more active through the afternoon.
 
I think you’ll be ok to hold off on more ear pokes until PMPS, but if you can continue with ketone tests and if you don’t mind adding the results in the remarks on your SS, that would be excellent, since I don’t see any since Dec. 12th. So very glad he’s happily eating, let’s look at that as a major win :bighug:. Which Royal Canin prescription food do you have?
 
We are doing a glucose curve today so we will have three more checks today to complete the 12 hour curve. I test his paw and he has always been incredibly easy with that. We have Royal Canin PR which is the select protein wet food. He was started on this food while he was hospitalized at UPenn Vet Hospital to help with possible GI issues that we will be looking at soon. I’m giving him about 75% Fancy Feast and 25% Royal Canin because the Royal Canin is quite soft and he did get some very soft stools from it. His stools are back to normal since I started giving him more Fancy Feast again. I think we just need a slower introduction to it. We have never had trouble with him eating ravenously so we feel very lucky for that! I will add his ketone readings to his spreadsheet!
 
Apologies, I just saw the part about the curve for the vet in your original post after I posted as well as finding the proteins diets that are on the food chart. I had wanted to see what those foods had for calories, since the FF naturals appear to be fairly low in calories.
 
@Christie & Maverick The Royal Canine PR seems to be about 149 calories in a 5.1oz can. We are calculating Benny to eat around 300-350 calories a day and we’ve been hitting just above 350 since he was discharged on the 11th. He does get some freeze dried chicken and a churu as a snack through the day as well.
 
Don't be discouraged by Benny's numbers today. He is probably seeing what we call "New Dose Wonkiness". We don't know what causes it for sure (maybe depot rebalancing), but when it happens it is in the first 2-3 cycles after an increase. Anyway, it's not representative of what the 2.0 units might be able to do for him when the depot is fuller. But it does make for a curve that won't tell you much.
 
Don't be discouraged by Benny's numbers today. He is probably seeing what we call "New Dose Wonkiness". We don't know what causes it for sure (maybe depot rebalancing), but when it happens it is in the first 2-3 cycles after an increase. Anyway, it's not representative of what the 2.0 units might be able to do for him when the depot is fuller. But it does make for a curve that won't tell you much.
So far his numbers are as we expected and they are giving us a better idea of his “high” times. All we can hope for is better numbers as he receives more injections. We had this curve planned out with the specialist and then the ketone levels have forced our hand to make that increase last night. I am still making myself quite nervous trying to check for his ketones to lessen. How long can it take to see a change in his ketones?
 
Sounds like his ketones have come down a little bit below high? As the depot builds and his numbers go down, the ketones should come down some more.
 
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