Treating ketones

velveteenrabbit

velveteenrabbit

Member Since 2026
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Treating my newly diagnosed diabetic kitty for present ketones at home.

I was supposed to get new Keto-Mojo test strips today to test Mister’s blood ketone level but I got a late delivery notice from Amazon. They should be here tomorrow🙏. He got into some high carb wet food last night (not very much but enough to spike his BG) so I was so curious to see if that affected his numbers but it will have to wait until tomorrow. He is doing good today, you wouldn’t really know anything was wrong with him other than he’s a sleepy boy.

Continuing with Sub-Q fluids and small meals throughout the day. Sticking with his 1.75u Vetsulin dose tonight. I was happy to see it brought his higher than usual number (425) down quite quickly this morning (wondering if he hadn’t gotten into that food, would it have brought it down so much?)

I just wanted to update everyone. I appreciate you all checking in on us. It helps me so much to know we have support. I hope everyone has a blessed day/night.
 
@Staci & Ivy (or anyone else familiar with giving Sub-Q fluids) I had to give Mister his fluids later in the day yesterday and will need to give them at an earlier time today. My question is, is it safe to administer fluids if it’s not quite at the 24hr mark? Today I can either give them 2 hours early (22 hours after last time) or wait longer and give them before I go to sleep. I would prefer to do it earlier if it’s safe to do so. Today will be his 6th day on fluids for ketones. He is 10lbs 2 oz and gets 100ml a day.
 
velveteenrabbit said:
@Staci & Ivy (or anyone else familiar with giving Sub-Q fluids) I had to give Mister his fluids later in the day yesterday and will need to give them at an earlier time today. My question is, is it safe to administer fluids if it’s not quite at the 24hr mark? Today I can either give them 2 hours early (22 hours after last time) or wait longer and give them before I go to sleep. I would prefer to do it earlier if it’s safe to do so. Today will be his 6th day on fluids for ketones. He is 10lbs 2 oz and gets 100ml a day.
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I’m not sure about the timing of giving fluids.
I see Wendy said the below in a previous post (good to keep in mind)
Before giving more fluids, check around his body to make sure there aren't any squishy lumps that could be fluids that hasn't been absorbed yet. How much fluids did he get yesterday? Too much fluids is not good.

@Marje and Gracie @Sienne and Gabby (GA) can you address this question about giving fluids and timing?

You can also use the prefix ? In your title and put “fluids question” in the title to get some attention and answers.

You’re doing such a great job! Keep up the good work 💓🥰
 
I think it depends on how far off the 24 hour mark you are. Probably within the hour is fine. I did a quick search and the point was consistency rather than exact timing. If you're not sure and want expert advice, see if you can call a local vet emergency and if someone can answer your question.
 
Thank you all! I actually don’t feel any lumps even now, but I’ll call the vet just to make sure. From what I’ve been able to gather “less is safer than too much” so I may give it to him at his regular time (2 hours before the full 24 hours, or 22 hours after last fluids) and give him a little less than 100ml to be safe. Especially if his blood ketones are continuing to go down. The test strips will be here soon!

I’m learning so much from this place and from the wonderful people here. Going to sit down and drink some tea and finish reading through the beginners guides. I appreciate your helpful responses❤️
 
@Bron and Sheba (GA) Hi Bron :) I’ve been doing some reading on DKA and I see a lot of people talking about giving their cats electrolytes. I did have Mister’s tested on Monday and everything looked good, should I still be concerned about this or incorporating them into his diet/water somehow? His ketones were down again today, 1.8 now. And still doing okay symptom/behavioral wise. He definitely doesn’t have as much energy and sleeps more but I wouldn’t call him lethargic like he was on Sunday. Just wondering about the electrolytes now.
 
That is great the ketones are down to 1.8
How is his appetite?
The only person who can check the electrolytes is the vet and he will tell you if any supplements are needed. If they are all normal then you don’t have to do anything. Just continue the subQ fluids as directed by the vet.
 
Bron and Sheba (GA) said:
That is great the ketones are down to 1.8
How is his appetite?
The only person who can check the electrolytes is the vet and he will tell you if any supplements are needed. If they are all normal then you don’t have to do anything. Just continue the subQ fluids as directed by the vet.
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His appetite is good. He eats 99% of what I feed him, which is small amounts every 2-3 hours. I noticed just now that he has soft stool, not diarrhea but not firm like normal, do you think this could be from the Tiki Cat Stix I give him during his fluids? He’s also on an antibiotic, Veraflox.
He did seem to sleep more today but like I said in another comment I’m not seeing lethargy like I did over the weekend. His BG is still high. Would you recommend increasing to 2u tomorrow? I started to worry about insulin resistance but his numbers have gone down after most of his shots, just not always by very much (spreadsheet is up to date. About to test him now too) thank you Bron.
 
With Vetsulin, we follow SLGS but because he’s had ketones, we want to be a little more aggressive to de some better numbers so I would increase to 2u in the morning and let’s see where he is after 4 cycles.

Note: this is custom dosing just for Mister based on ketones being present recently. Other members should not follow dosing advice.
 
Staci & Ivy said:
Can you give a good probiotic since he’s having soft stools? (Not fortiflora which doesn’t have enough strains to be effective).

It could be from GI upset caused by the antibiotics.

You can also use S. Boulardii to help with soft stools or diarrhea.
Here’s some information:
How to Use S boulardii for diarrhea
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Will look into getting this today! Thank you. Edit: have the Farrow brand coming today, thankful for Amazon Prime. I’ve only noticed it once, but will keep an eye on him. I appreciate you sending me that link, very helpful!
 
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velveteenrabbit said:
Will look into getting this today! Thank you. Edit: have the Farrow brand coming today, thankful for Amazon Prime. I’ve only noticed it once, but will keep an eye on him. I appreciate you sending me that link, very helpful!
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I’m not familiar with that brand probiotic.
Agree about Prime 🙌
Here is the link for S. Boulardii
https://a.co/d/0ckhcNCN

I’ve used it and it’s very helpful 🥰
 
velveteenrabbit said:
Mister’s ketone test came back 0.6 tonight🥹my sweet boy he’s fighting so hard!
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You jumped the gun on increasing the dose.😉 Remember I said “after four cycles” we would reassess. We don’t “chase” numbers here.

I would talk to your vet about prescribing Lantus and you could buy a pack of five pens. Don’t buy a vial…it’s more expensive. When we see steady lower ketones and BGs trending more yellow, we can start Lantus. What do you think?
 
Marje and Gracie said:
You jumped the gun on increasing the dose.😉 Remember I said “after four cycles” we would reassess. We don’t “chase” numbers here.

I would talk to your vet about prescribing Lantus and you could buy a pack of five pens. Don’t buy a vial…it’s more expensive. When we see steady lower ketones and BGs trending more yellow, we can start Lantus. What do you think?
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I almost posted here this morning too but I was already ~15min past 7 :( So that means today is 2 cycles, right? (By tonight I mean) so remain 2 full days at a dose?

I have a prescription for Lantus! The emergency vet wrote me one last Monday. I was planning on switching him over after I had read about the differences, but then with his ketones was recommended (it may have even been from you, I’m sorry my brain feels like mush lately!) to stick with Vetsulin until they went down. So that sounds good to me, too.

From what I’ve been able to gather, it’s relatively simple to make the switch is that right? Please correct me if I’m wrong- he will start on the same dose? I’m hoping his ketones will continue to go down, I’ll keep posting updates. He’s still doing well, more energy it seems today too. Let me know what you would recommend as far as how long until I start the Lantus. I just have to find a pharmacy. Thank you so much.
 
His ketone test came back 0.9 last night. He really hated the tests yesterday, usually he does good even though he growls and lets me know he doesn’t like them, but yesterday he grabbed my arm and ankle after he wiggled away from me to really let me know. I feel so bad poking him all the time. It does seem he is more his usual self, so that is good. Do you recommend I continue with 2.25u for today and what about tomorrow morning @Marje and Gracie ? Can someone help me better understand what I’m looking for? I guess with every cat being different it’s hard for me to know how much is too much of a drop too soon or what the goal is other than treating the ketones right now. I learned about bouncing and mainly have focused on reading about Vetsulin but I’m also very much looking forward to getting him on Lantus when the time is right. Thank you all for your help. Bron and Staci and Marje and everyone who has stepped in, you’ve already helped me more than I can even say, and even just having some peace of mind knowing there’s a whole corner of the internet with information and support. When I left the vets office after he was diagnosed I don’t know that I ever felt so scared and alone. Lastly, a picture of him from yesterday (taken right after his subq fluids so he’s looking a little shocked😆)

Edited to correct my tags, time for another cup of coffee.
 

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velveteenrabbit said:
His ketone test came back 0.9 last night. He really hated the tests yesterday, usually he does good even though he growls and lets me know he doesn’t like them, but yesterday he grabbed my arm and ankle after he wiggled away from me to really let me know. I feel so bad poking him all the time. It does seem he is more his usual self, so that is good. Do you recommend I continue with 2.25u for today and what about tomorrow morning @Marje and Gracie ? Can someone help me better understand what I’m looking for? I guess with every cat being different it’s hard for me to know how much is too much of a drop too soon or what the goal is other than treating the ketones right now. I learned about bouncing and mainly have focused on reading about Vetsulin but I’m also very much looking forward to getting him on Lantus when the time is right. Thank you all for your help. Bron and Staci and Marje and everyone who has stepped in, you’ve already helped me more than I can even say, and even just having some peace of mind knowing there’s a whole corner of the internet with information and support. When I left the vets office after he was diagnosed I don’t know that I ever felt so scared and alone. Lastly, a picture of him from yesterday (taken right after his subq fluids so he’s looking a little shocked😆)

Edited to correct my tags, time for another cup of coffee.
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Glad Mister is doing well!
How are his poops, still improving with the S. Boulardii?
I see you noted improvement on your spreadsheet 🥰
Let’s see what Marje says about dosing and when you should switch to a Lantus.
(She is probably still sleeping now in her time zone).
Any pharmacy should be able to fill your prescription.
You “should” be able to get either a vial or a package of five pens for the same price.
Hopefully it should only cost you $35 for either one.

You can always look at something like GoodRx and use a coupon from them if your pharmacy gives you a hard time about pricing.

It should not matter that it is for a pet, as you are not using any insurance.
Sometimes you have to check with different pharmacies to find one who will honor that price as they are not the brightest. ***usually a pharmacist is more helpful when a clerk can’t figure it out.
I use my local pharmacy in my grocery store and they honor the $35 price.

I like a pack of five pens personally, but you can certainly use either.

With SLGS which you should be following with Vetsulin, you would hold the dose for seven days, although I think Marje may have you increasing possibly sooner than that as long as Mister isn’t going too low (under 90).
***But make sure you check with her before giving an increase.
Here is a link to the SLGS protocol with lots of information and instructions
Please keep posting with any questions, we don’t want Mister to be overdosed!
Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

Info - Sourcing Insulin More Economically
 
I have been looking for this link! I knew I saw it when I first found this forum and I wanted to bookmark it, thank you!

He is definitely improving, the last 💩 I saw around midnight had form to it again so I think we are getting there. He doesn’t mind the S Boulardii being in his food either which is a relief.

Thank you for the information on the pharmacies. I have several in my area so I will keep trying if the first one doesn’t honor it. Out of curiosity, is 5 pens equal to the amount in a vial?
 
velveteenrabbit said:
His ketone test came back 0.9 last night. He really hated the tests yesterday, usually he does good even though he growls and lets me know he doesn’t like them, but yesterday he grabbed my arm and ankle after he wiggled away from me to really let me know. I feel so bad poking him all the time. It does seem he is more his usual self, so that is good. Do you recommend I continue with 2.25u for today and what about tomorrow morning @Marje and Gracie ? Can someone help me better understand what I’m looking for? I guess with every cat being different it’s hard for me to know how much is too much of a drop too soon or what the goal is other than treating the ketones right now. I learned about bouncing and mainly have focused on reading about Vetsulin but I’m also very much looking forward to getting him on Lantus when the time is right. Thank you all for your help. Bron and Staci and Marje and everyone who has stepped in, you’ve already helped me more than I can even say, and even just having some peace of mind knowing there’s a whole corner of the internet with information and support. When I left the vets office after he was diagnosed I don’t know that I ever felt so scared and alone. Lastly, a picture of him from yesterday (taken right after his subq fluids so he’s looking a little shocked😆)

Edited to correct my tags, time for another cup of coffee.
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Glad he’s doing well. Is he eating enough calories? Right now, we want him to have 1.5 times his normal calories and you should be adding water to his food to keep him hydrated even if you are continuing subq fluids. You don’t need to add a lot but some helps.

First, we need to do a little housekeeping. As soon as you start the Lantus, please change the insulin type on his SS to Lantus and we usually insert a red line across the SS to separate when you made the change. Be sure to change on an am cycle.

Also, do you think you will be able to do TR? It is much better especially for DKA/ketone cats but a prerequisite is absolutely no dry food. Please let us know and then enter it on the SS.

Lastly, if you could please update your signature so we actually have the info we need at a glance. It should look something like this (feel free to copy)

Mister & mom, Elizabeth | dx 4/26 | Vetsulin | ReliOn Premier meter | SLGS | LC wet food | history of ketones
Mister’s Spreadsheet

You’ll want to update any changes to insulin, method of regulation, food, or add any other medical issues.

You’ll have four cycles of 2.25u of Vetsulin done if you start Lantus tomorrow morning. I would start him at 2.5u Lantus provided you can be there to closely watch and monitor. While Lantus usually needs several cycles to build the depot, I have seen a few cats that responded quickly. If you can’t be there to monitor closely, I’d start him at 2.25u and we can give him four cycles at that.

Watch him closely for signs of ketones and keep up on ketone testing, extra calories, fluids, etc as long as vet approves you continuing those. I would not give more than 100 mls subq even if a vet tells you it’s ok unless you’ve had an echocardiogram done and it’s been approved but, honestly cats rarely need more than 100 mls/day subq.

I will not be around tomorrow until late in the day your time as I’m out the door here at 6:00 am and don’t have time to check the board. So…if you want to wait until Thursday to start the Lantus, that’s ok, too.

Questions? I hope he continues to do really well.
 
Marje and Gracie said:
Glad he’s doing well. Is he eating enough calories? Right now, we want him to have 1.5 times his normal calories and you should be adding water to his food to keep him hydrated even if you are continuing subq fluids. You don’t need to add a lot but some helps.

First, we need to do a little housekeeping. As soon as you start the Lantus, please change the insulin type on his SS to Lantus and we usually insert a red line across the SS to separate when you made the change. Be sure to change on an am cycle.

Also, do you think you will be able to do TR? It is much better especially for DKA/ketone cats but a prerequisite is absolutely no dry food. Please let us know and then enter it on the SS.

Lastly, if you could please update your signature so we actually have the info we need at a glance. It should look something like this (feel free to copy)

Mister & mom, Elizabeth | dx 4/26 | Vetsulin | ReliOn Premier meter | SLGS | LC wet food | history of ketones
Mister’s Spreadsheet

You’ll want to update any changes to insulin, method of regulation, food, or add any other medical issues.

You’ll have four cycles of 2.25u of Vetsulin done if you start Lantus tomorrow morning. I would start him at 2.5u Lantus provided you can be there to closely watch and monitor. While Lantus usually needs several cycles to build the depot, I have seen a few cats that responded quickly. If you can’t be there to monitor closely, I’d start him at 2.25u and we can give him four cycles at that.

Watch him closely for signs of ketones and keep up on ketone testing, extra calories, fluids, etc as long as vet approves you continuing those. I would not give more than 100 mls subq even if a vet tells you it’s ok unless you’ve had an echocardiogram done and it’s been approved but, honestly cats rarely need more than 100 mls/day subq.

I will not be around tomorrow until late in the day your time as I’m out the door here at 6:00 am and don’t have time to check the board. So…if you want to wait until Thursday to start the Lantus, that’s ok, too.

Questions? I hope he continues to do really well.
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Yes I think he is eating enough calories, I was trying to count them (rough estimate) the first day but he doesn’t always finish his bowl so that became a little tricky. Now I just feed him a little bit every 2-3 hours, and he always eats at least most of it. I also feed him at least once during the night. His breakfast and dinner (before shot meals) are always 1 can and then the rest are smaller meals. No dry food. I’m still labeling cans but so far his food is 6% carbs or less so this is all low carb also.

I’m always home with him unless I run short errands like groceries or something so TR is doable! I will educate myself more on it today. Also can update my spreadsheet/signature today as well, thank you for that I’ll copy your example :)

I have the prescription for Lantus but haven’t filled it yet, so I can do that tomorrow and be able to start him Thursday morning. There’s several pharmacies near me so I don’t think I’ll have an issue there having multiple options. Thank you so much for taking the time to walk me through these things, sending you a virtual hug! Will update soon.
 
velveteenrabbit said:
Yes I think he is eating enough calories, I was trying to count them (rough estimate) the first day but he doesn’t always finish his bowl so that became a little tricky. Now I just feed him a little bit every 2-3 hours, and he always eats at least most of it. I also feed him at least once during the night. His breakfast and dinner (before shot meals) are always 1 can and then the rest are smaller meals. No dry food. I’m still labeling cans but so far his food is 6% carbs or less so this is all low carb also.

I’m always home with him unless I run short errands like groceries or something so TR is doable! I will educate myself more on it today. Also can update my spreadsheet/signature today as well, thank you for that I’ll copy your example :)

I have the prescription for Lantus but haven’t filled it yet, so I can do that tomorrow and be able to start him Thursday morning. There’s several pharmacies near me so I don’t think I’ll have an issue there having multiple options. Thank you so much for taking the time to walk me through these things, sending you a virtual hug! Will update soon.
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That all sounds good and that gives you another day to watch his ketones. Remember initially, we will hold the doses longer on Lantus so we can fill the depot unless he starts showing ketones; then we will go to “Plan B”. So yes, read up on the protocol so you can ask questions.

I’d also like you to start posting in the Lantus forum once you start Lantus, ok? There are a lot more experienced eyes there. We do have posting guidelines so please read those and post accordingly as it’s a busy forum and we need to be able to keep track of everyone a little closer.

And always ask questions. That’s what we are here for.
 
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