DKA newly diagnosed diabetes, seeking help

velveteenrabbit

velveteenrabbit

Member Since 2026
Hello everyone,

Mister had been much sleepier over the weekend than usual, he would get up to eat and use the litter box but otherwise just wanted to be in his bed. I started to get concerned so I ordered a ketone meter. I tested Mister's blood ketone using a Keto-Mojo yesterday and it came back 4.6mmol/l. I rushed him to the local vet and they really didn't seem that concerned. They actually kind of laughed at me when I told them I had tested him at home. They administerd sub-q fluids and tried to convince me to purchase a bag of Hills Glucose dry food and told me the FF pate and Tiki Cat I was feeding him was no good. They wanted me to up his Vetsulin dose from .5u to 2u. They made no mention of DKA or wanted to run any tests. I left and brought him home in order to give him his insulin dose as it was time, and opted to give him 1u. I then took him to an emergency vet. There they ran blood tests. No signs of infection, no pancreatitis, electrolytes looked good and his ketones read 3.4 on their meter (they said it was a similar meter that I had used) They also gave him a cerenia injection and some oral antibiotics. They gave me about 10 days worth of sub-q fluids to administer at home. I could not afford an overnight stay unfortunately and will not be able to for right now so I am very nervous about this. His spreadsheet is up to date. Can someone please offer insight into what I need to be doing to help him get these ketones flushed out? I have a food chart but I feel overwhelmed with information and would so appreciate if someone could let me know some safe options. He's a little underweight as it is and as you can see from his spreadsheet, his BG has remained pretty high. I'm just in tears, I hate seeing him not well. He is up and moving around this morning a little more, appetite is good. I'm mixing water in with his food as much as he will tolerate. I guess I need some reassurance. I think about him 24/7. I am able to be home with him at all times right now but eventually will need to return to work as I'm riding out my funds by being home. Thank you all so much for your support and for reading this far. Oh also at the emergency vet I got him a prescription for Lantus as I have wanted to switch him since learning more about it. Would love to hear thoughts on this.
 
There's some info on DKA here: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones Members who have experience with DKA will be able to give you more detailed info.

Lantus is a good insulin to use. I'm not sure if you should stay with the same Vetsulin dose when you start Lantus given that your cat has ketones. Other members can advise you on what dose to start Lantus on.

Lantus is U100 so you need to use U100 syringes. If you are using U40 syringes with the Vetsulin (most likely), you need to put those syringes away so you don't accidentally use them. Post them on the Supply Closet or offer them to Diabetic Cats In Need.
 
squeem3 said:
There's some info on DKA here: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones Members who have experience with DKA will be able to give you more detailed info.

Lantus is a good insulin to use. I'm not sure if you should stay with the same Vetsulin dose when you start Lantus given that your cat has ketones. Other members can advise you on what dose to start Lantus on.

Lantus is U100 so you need to use U100 syringes. If you are using U40 syringes with the Vetsulin (most likely), you need to put those syringes away so you don't accidentally use them. Post them on the Supply Closet or offer them to Diabetic Cats In Need.
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Thank you so much. Yes I’m concerned about his dose, I know that the insulin is critical in helping with ketones and I don’t like seeing his numbers stay mainly in the 300s. Its been so difficult thinking my decisions could hurt him or save his life and up until last week I knew none of this so I’m not very confident yet. I would love someone with experience or background to help instruct me on dosage.
 
@Bron and Sheba (GA) I was told to reach out to you. My boy isn't feeling well at all. He's been hiding under the bed all morning. He's still eating. I want to try to give him his sub-q fluids, but he just had some around 4pm yesterday so I don't know if I need to wait the full 24 hours. It's killing me to see him like this.
 
Dyana said:
I don't know if this helped Jackson, but when he showed ketones, I changed his food from 2 cans a day to 3.5 to 4 cans a day, and added lots of water to his food.
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Thank you for this, gives me hope. I'm pretty much doubling mine's food today as well. I only have low carb options at the moment, I was told to try to stick to 8-9% for ketones. I'll have to pick some up today when I go pick up his Lantus.
 
What helps to combat the ketones is calories, you want at least 1.5 times his normal calories. That is a separate number from carbs. Not sure the 8-9% makes any difference. Make sure to add plenty of water to his food.

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.
 
He weighed 10.08 at vet last night.
Only 2.5 hrs, it is 1:30pm here now. He just got up and ate again. Thankful his appetite is good. If he continues to do ok I may hold off until about 3:15-3:30. Also in case it takes me awhile to be able to get it. I’ve never done this before and he isn’t happy about needles. He’s also more on edge today than usual because he spent all day at the vet and then emergency room last night.
 
Hi
I’m sorry your boy is unwell but you are doing well looking after him.
Keep going with the extra food, sub Q fluids, and testing daily for ketones.
While Lantus is a better insulin for cats, I would not swap over to Lantus yet while he has ketones. This is because Vetsulin is an ‘in and out’ insulin which means the full dose you give works straight away.
Lantus is a ‘depot’ insulin which means it takes five days for the initial dose to work fully. With ketones in the picture you can’t afford not to have the full dose of insulin working every dose.
Once he is well free of ketones you can swap over to Lantus.
Does this make sense?
It is food (calories), insulin and fluids that help combat ketones.
Can you put each ketone test result into the SS please for us to see? Thx😀
 
Bron and Sheba (GA) said:
Hi
I’m sorry your boy is unwell but you are doing well looking after him.
Keep going with the extra food, sub Q fluids, and testing daily for ketones.
While Lantus is a better insulin for cats, I would not swap over to Lantus yet while he has ketones. This is because Vetsulin is an ‘in and out’ insulin which means the full dose you give works straight away.
Lantus is a ‘depot’ insulin which means it takes five days for the initial dose to work fully. With ketones in the picture you can’t afford not to have the full dose of insulin working every dose.
Once he is well free of ketones you can swap over to Lantus.
Does this make sense?
It is food (calories), insulin and fluids that help combat ketones.
Can you put each ketone test result into the SS please for us to see? Thx😀
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It does make sense! I upped his dose to 1.25u (Vetsulin) tonight and I will wait to switch him over until we are past this. Thank you so much, that was a very helpful explanation. Unfortunately I wasn't able to get all of his fluids in him today, but I learned from my mistakes and will try again tomorrow. I did get about 40-50ml. Also adding water to his food. He seems to go through waves, sometimes hiding under the bed, other times he's out walking around and friendly. I know he's stressed a lot over the constant tests and shots and especially the fluids today. I will update his ketone test when I take it in just a bit. Edit: I may try to give him the rest of his fluids before bed tonight. is it ok to give it after his insulin if I wait a couple of hours?
 
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Do you have some honey or karo and some high carb food at home in case the BGs drop low?

While giving the sub Q fluids, do you think he would eat a few little treats or some food to distract him?
 
Bron and Sheba (GA) said:
Do you have some honey or karo and some high carb food at home in case the BGs drop low?

While giving the sub Q fluids, do you think he would eat a few little treats or some food to distract him?
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I do and I just finished putting my kit together. Labeling the tops of cans, putting everything in a little clear tote box. Feeding syringes, medium carb food and caro so far. With a print out sheet of instructions. Trying to be as prepared as possible. I’m checking his BG and ketones now so will report back in a few minutes. Edited to add that I don’t think I can give him treats while I do it unfortunately, it’s just me by myself so it’s difficult to hold him while also controlling the tube/needle and monitoring the bag. He’s feisty, he will try to scratch and get away so I have to almost sit on him. It’s not fun for either of us :(
 
Bron and Sheba (GA) said:
As you increased the dose of insulin this cycle and he had had 40 to 50 mls subQ fluids already today, I would be inclined to wait until the morning unless the ketones have increased somewhat.
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His BG is 269. Ketones are the same as when I tested yesterday, 4.6. My spreadsheet is up to date now with that information. If there’s a clearer way for me to record the ketones please let me know. Thank you so much for your help. I’ve been so worried about doing the wrong thing.
 
The ketones are fine where you put them in the SS . Otherwise you can start a column for them.
Are you offering lots of meals during the day and evening? Smaller meals often is better than a few larger meals. And it’s good you are adding water to them.
When doing the sub Q fluids, if you just put the treats in front of him just before inserting the needle, will he eat them?
Apart from the ketone test itself, Red flags for you to look out for regarding the ketones progressing in the wrong direction are lethargy, not wanting to eat, vomiting, diarrhoea, excessive thirst or peeing.
Keep up the great job you are doing with him!!
 
Thank you so much. I am feeding quite a few small meals between his regular breakfast and dinner. Those 2 are bigger. Then I break up cans of pate basically every few hours. I’ve added a little bit of medium carb along with his low carb since the ketones as I was told that would help. Sometimes he finishes it sometimes he doesn’t but he always eats and I’m so thankful for that. He had his lowest number tonight after this new dose, I heard to look at patterns more so rather than the number itself but this is a good sign wouldn’t you say?
 
It isn’t necessary to feed the higher carb food unless he is refusing the lower carb food. The most important thing with ketones is the cat eats… and any food is better than nothing. It is calories, not carbs which need to be increased. But if he’s happy eating low carb food, I would feed him that.
But keep in mind that if you swap back to low carb food, and you have increased the dose of insulin… the BG could drop lower.
Getting him into lower BG numbers is what we want to happen but we need to keep him safe while doing this.
 
Thank you for this!! It’s been 90% low 10% med today only so with his numbers back in the 300s already by the +5 hour I’ll go back to low carb tomorrow. He seems to just stay in the high 200s to mid 300s :(
 
You are doing a wonderful job managing Mister's diabetes! It doesn't sound like your vet is quite up to speed on some issues (e.g., food!) -- you were wise to have Mister seen at the emergency vet. Despite the expense, if he were my cat, I'd feel much better having labs run, getting an "official" ketone test, encouraging fluids, etc. You did good.

Ketones are frightening. Keep checking levels. If Mister is getting fed up with being poked, remember you can use urine ketone test strips. As others have mentioned, getting calories into your cat is essential. Feed him as much as he wants. Wendy's suggestion of feeding 1.5 times as much as he typically eats is a good way to gauge food intake. Adding water to his food is also a very good strategy.

I agree with Bron that sticking with a low carb food is what I would recommend. Ketones can develop if there's an underlying infection/inflammation along with your cat not getting enough insulin and enough calories. If you're feeding a higher carb food, numbers will be higher and you will need more insulin. I also agree with Bron that I'd stick with the Vetsulin for the time being. When starting Lantus, it takes 5 - 7 days for the dose to stabilize. The pharmacology of Lantus is quite different than Vetsulin - Lantus is a depot type of insulin. What that means is that every time you give a shot, a small amount is deposited as microcrystals in the fat tissue. Those crystals slowly dissolve but once the depot has fully formed, there is always overlap between the cycles. This is what gives Lantus its gentle action and its long duration. However, with ketones, you want to be sure that your cat is getting enough insulin. Until the depot is established, there's a bit more variability in the insulin level.
 
Sienne and Gabby (GA) said:
You are doing a wonderful job managing Mister's diabetes! It doesn't sound like your vet is quite up to speed on some issues (e.g., food!) -- you were wise to have Mister seen at the emergency vet. Despite the expense, if he were my cat, I'd feel much better having labs run, getting an "official" ketone test, encouraging fluids, etc. You did good.

Ketones are frightening. Keep checking levels. If Mister is getting fed up with being poked, remember you can use urine ketone test strips. As others have mentioned, getting calories into your cat is essential. Feed him as much as he wants. Wendy's suggestion of feeding 1.5 times as much as he typically eats is a good way to gauge food intake. Adding water to his food is also a very good strategy.

I agree with Bron that sticking with a low carb food is what I would recommend. Ketones can develop if there's an underlying infection/inflammation along with your cat not getting enough insulin and enough calories. If you're feeding a higher carb food, numbers will be higher and you will need more insulin. I also agree with Bron that I'd stick with the Vetsulin for the time being. When starting Lantus, it takes 5 - 7 days for the dose to stabilize. The pharmacology of Lantus is quite different than Vetsulin - Lantus is a depot type of insulin. What that means is that every time you give a shot, a small amount is deposited as microcrystals in the fat tissue. Those crystals slowly dissolve but once the depot has fully formed, there is always overlap between the cycles. This is what gives Lantus its gentle action and its long duration. However, with ketones, you want to be sure that your cat is getting enough insulin. Until the depot is established, there's a bit more variability in the insulin level.
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Thank you so much for such a thoughtful explanation. I appreciate all the information I can get right now, sometimes it’s hard for me to dig through everything and know what I need to be focusing on. I’m worried about his BG remaining high even after upping his dose, with the present ketones. I cannot afford another emergency vet visit for at least a week. Do you think I will need to go up again tonight? He is eating wonderfully, and he does have more energy today. I can still tell he’s not feeling the best, but he’s up and moving more, spending time in his catio. I’ve been so relieved for that.
 
velveteenrabbit said:
He seemed to have a little more energy today. He was still sleeping most of the day. Appetite good.
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I’m just waiting to hear from a couple of other experienced members.
It looks like his dose is due now. Is that correct?
I’m glad he is seeming well. That is early good.
Can you put into the SS what time you gave the SubQ fluids please?
 
I haven’t heard back from anyone yet but I know the dose is due now and I don’t want you to be late giving it as insulin is so important in the fight with ketones.
Given that he is eating well and seems generally well, I would stay with the same dose for now.
Can you test for ketones later in the day again please?
If you think he will eat a bit more, I would offer him a bit more.
Are you happy with this?
 
velveteenrabbit said:
Do you think that going to 1.5 would be safe? I am able to monitor him tonight. I just worry about the ketones increasing. And yes I can test again
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You only increased the dose 24 hours ago and we generally don’t recommend increasing earlier than three days.
I know the ketones are a worry but he is eating well and doesn’t have any of the red flags that we need to worry about. If he was unwell, lethargic and not eating I would say to increase the dose but he is doing well apart from the ketones.
Keep up the sub QFluids, extra food with some water in it if he tolerates it and keep monitoring the ketones.
Keep posting with updates. I will be watching for them. It’s only 9.30 am here.
I will talk to my colleagues about him.
 
I stayed with the same. Thank you so much for being here with me through this. It’s scary knowing that the shots I call could help or hurt and there’s so much I’m still learning. I’ll keep you updated. He’s eating a little bit now ❤️
 
I’m sorry none of us Bron reached out to responded by the time you needed to shoot. We are in different time zones and may not be around to respond if the shot time is close.

At any rate, if his BG stays high 200s to 300s during the PM cycle and are still up there by shot time tomorrow, you can increase to 1.5u every 12 hours based on his ketone levels. Vetsulin is an in/out insulin and not a depot insulin like Lantus so we have more leeway on increases if we need to.

If you increase, please be sure you can be there to monitor and you have HC food/syrup to steer his numbers if the BG drops. Be sure to post here if you have any questions about whether to increase or not.

On another subject, you are using a spreadsheet that a FB group pirated from us and which can be glitchy when linked on our site. You don’t want glitchy if working lower numbers. We’d like you to switch to our SS. If you need any help, send me a private message and I can transfer data from one to another.

Keep up the extra calories, water, and subq fluids.

We are glad you found us.😊
 
Marje and Gracie said:
I’m sorry none of us Bron reached out to responded by the time you needed to shoot. We are in different time zones and may not be around to respond if the shot time is close.

At any rate, if his BG stays high 200s to 300s during the PM cycle and are still up there by shot time tomorrow, you can increase to 1.5u every 12 hours based on his ketone levels. Vetsulin is an in/out insulin and not a depot insulin like Lantus so we have more leeway on increases if we need to.

If you increase, please be sure you can be there to monitor and you have HC food/syrup to steer his numbers if the BG drops. Be sure to post here if you have any questions about whether to increase or not.

On another subject, you are using a spreadsheet that a FB group pirated from us and which can be glitchy when linked on our site. You don’t want glitchy if working lower numbers. We’d like you to switch to our SS. If you need any help, send me a private message and I can transfer data from one to another.

Keep up the extra calories, water, and subq fluids.

We are glad you found us.😊
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Oh I didn’t know about the spreadsheet, I will work on switching them tonight. Thank you so much for getting back to me, I feel good about moving forward like that. I’ll be home with him until further notice so definitely monitoring him close. I also set alarms to wake up every so often at night until I get him more stable. His BG is following the same pattern so far tonight but his ketone test just now came back at 3.5. I’ll test again in the morning but hopefully that is right and they are going down. His behavior has been much better today than yesterday.

I am so glad I found you all, too! More than I can ever say. Last week I felt so alone and scared, getting varying opinions from vets, overloaded with information online. I’m just so thankful this place exists and the sense of community and support is so strong. I appreciate all of you (and so does Mister)
 
velveteenrabbit said:
Oh I didn’t know about the spreadsheet, I will work on switching them tonight. Thank you so much for getting back to me, I feel good about moving forward like that. I’ll be home with him until further notice so definitely monitoring him close. I also set alarms to wake up every so often at night until I get him more stable. His BG is following the same pattern so far tonight but his ketone test just now came back at 3.5. I’ll test again in the morning but hopefully that is right and they are going down. His behavior has been much better today than yesterday.

I am so glad I found you all, too! More than I can ever say. Last week I felt so alone and scared, getting varying opinions from vets, overloaded with information online. I’m just so thankful this place exists and the sense of community and support is so strong. I appreciate all of you (and so does Mister)
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Great news on the ketones!

Bron and Sheba (GA) said:
Thanks @Marje and Gracie for replying to Elizabeth and Mister.
That’s great news tbr ketones have dropped to 3.5. Keep up the good job you are doing!!😀
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You’re welcome, Bron. 🫂🫂
 
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