7/7 Tigger PMPS=452+testing positive for ketones - need help

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Tigger's Friend

Tigger's Friend

Member Since 2013
Of course I was gone all day today from Noon till 7:20, rqare for us. Tigger started out with what appeared a normal Lantus day - AMPS/307, +2/276, +4/233, so I thought he'd have a good day while we were gone, & possible go into the blue. We left the cat door open & he was outside when we got home, but seemed fine. His PMPS was 452 - v. high for him - only the 2nd time he's been above 400.

His appetite was good - ate 3/4 can Wellness. After his insulin dose I decided to test him for ketones with the Nova Max - I've been able to get some fresh catches in the last week & he's been negative. However, his urine glucose ever since he's been diagnosed has been pretty much at +2 - +4.

The first ketone test came up .6, the high end of normal. I tested again 5 minutes later (same ear) & it was 1.1. Now I'm freaking out.

Tigger's breath smells fine. He acts fine.

I did a control with both the Relion & Nova Max & they both test normal.

What should I do at this point? I have sub-q fluids - is that recommended for DKA at this level?

Did I test too close together for the ketones? Why would I get 2 such different numbers in just a few minutes? How often should I re-check at this point? Should I call the vet in the AM if he's still at 1.1? Trying unsuccessfully to not freak out. Tigger's +1 BG is 382, so it's already come down 70 points.

I was also going to increase Tigger's Lantus tomorrow AM (Day 8) to 1.25 units, but now I'm totally confused - any advice on the dose would also be appreciated. Thanks, sorry I'm so freaked.

Also, I read that Vitamin C can cause a false negative for ketones. I am giving Tigger Maxiguard for stomatitis, which contains citric acid. Citric acid is not Vitamin C, but does anyone know if it will cause a false positive?

Thanks for any advice!!!!!!!!!
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Suzanne,
Let me try to find someone who can help. I used a NovaMax to test Bob for ketones, but he never showed any after I bought the meter. This a blood ketone test, right?
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Suzanne

Is there any way to test him again although blood ketone strips are expensive. If you tried the control solution, do they need to be coded? Any way to test urine ketones?

I definitely think his dose needs to go up to 1.25u. We would not normally hold a dose this long.

Any possibility of any infections? UTI, dental issues?
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Thank you, Marge.

The NovaMax is a blood ketone test. I have 10 ketone blood tests left, so will test again & re-post.

I first tested him with the Nova Max several weeks ago & got a .3, which is normal. With the NovaMax, 0 - .6 is normal. .6 - 1.5 is a warning range & above 1.5 is an immediate issue.

Tigger hasn't urinated inside yet, so no way to use a urine dipstix for ketones at this point.

I always add water to his canned food, & he ate well tonight. I may give him some tuna water. Can also do sub-q, but he doesn't feel dehydrated. Will go do a BG & ketone & report back.

I was trying to Google Citric Acid & Ketones, as it appears Vitamin C supplementation can provide a false positive. Can't find anything.

Thanks re. dose increase. I thought I had to hold it the first 7 days on Lantus due to the depot, and he seems to have been bouncing the few times he went under 200.

Thanks again, for your time & input.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Suzanne

I understand. I have a NovaMax. Sometimes when you do one test right after the other, the meter reads quite differently. I have no idea why. Even though ketones can progress quickly, it shouldn't be that quick. So if you wait a bit and then retest, we should get a more accurate test. I hope.

If he is reading .6 again, I would give him fluids and call the vet first thing tomorrow. I don't know about the citric acid.

On the initial dosing, it states:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Click to expand...

After the first four cycles, he was high and flat so I would have raised him sooner. I would suggest that if he stays in pink and yellow (or higher), raise him .25u every six cycles until he starts showing blue and then slow down. If his nadirs go from yellow to pink, increase by .5u.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

OK: +2 BG = 275, down a whopping 177 points from PMPS of 452.

Ketones per NovaMax blood monitor = .7, above the normal range of 0 - .6 I think this is better territory.

Skin test is showing good hydration, & Tigger historically has somewhat dilute urine, from the excess drinking & the water I add to his canned food.
I'll give him some tuna water, which he loves.

He has had a dental infection from the stomatitis previously (4/18/13) & a dental on 5/15/13. A vet visit 2 weeks ago showed his mouth is doing great, so I doubt there's any current infection.

However, the Maxiguard oral cleansing gel the vet prescribed has Vitamin C - I thought it was citric acid, but a different site, & the manufacturer's site states it is Vitamin C /Ascorbic Acid: Active Ingredient(s): Deionized water, zinc gluconate, ascorbic acid (vitamin C), methylcellulose, taurine, methylparaben, propylparaben, F.D.&C. blue no. 1. May also contain zinc sulfate.

I'm positive I read that the Nova Max Plus can give a false positive with Vitamin C supplementation, but it didn't give the concentration & I can't find the site - am checking the Nova Max Plus literature now. Am still checking. i think this may be a contributing factor.

What do you think?

Thank you for the input re. dose increase. I will go ahead & start 1.25 u tomorrow Am.

Thank you very much for your prompt replies - you are all amazing - I'm still worried, but am feeling there is a link here with Vitamin C & an increase or false positive, which, if so, would be beneficial for all to know when testing for ketones.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Cats throwing ketones aren't necessarily dehydrated. It's great that you add extra water to his food.

Be careful on the tuna juice. Even if the can says "in spring water", many companies are now putting vegetable broth in the juice and vegetable broth can have onions and soy....both of which are bad for cats. So check the fine print on the ingredients.

I would be sure and get a +4. If the +2 is much less than the preshot, it is likely to be an active cycle.

I hadn't read that about the Vitamin C but I prefer to be cautious when it comes to potential ketones.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

I found this, but it's for urine ketones. Not sure if it applies to blood ketones?

False positives
This may occur in non-diabetic (as well as in diabetic) patients:

Positive test result but 'no' ketones:
Some medication:
Levodopa, for example Sinemet®
Phenazopyrazine
Valproic acid
Vitamin C
Dehydration
Click to expand...
http://www.patient.co.uk/doctor/urine-ketones-meanings-and-false-positives
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

This makes it sound like you would get false positives if testing urine that you wouldn't get when testing blood. It sounds like that is the reason they recommend testing blood.

Reasons for ketone blood testing:
Accuracy - Certain medications can give false readings when testing with urine. Levadopa taken for Parkinson's or Restless Leg Syndrome can cause a false negative result. Ace Inhibitors such as Lisinopril can cause false positives when using urine tests containing nitroprussides. Highly colored urine as when taking Pyridium (for painful urinary tract infections - turns urine purple) can cause a false reading as well as using a medication called Depakote. Urine can be inaccurate due to sitting in the bladder for an extended period or remaining in the ambient air for a long time. Urine concentration can cause inaccurate results. Menstrual blood in the sample will cause inaccuracy. Excess ascorbic acid or Vitamin C can cause a false positive result. Urine test strip reagents lose potency when exposed to air; bottles of strips open for 90 days can cause inaccurate results. Blood strips are individually wrapped in tin foil packaging.
Click to expand...

http://community.diabetes.org/t5/Re...s-Is-Blood-or-Urine-More-Accurate/td-p/301786
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Hi Carl, thank you, I am finding the same, that it is with urine testing.

However, the Nova Max informational insert does state that there is no interference with a concentration of 20 mg/dl ascorbic acid. I doubt the small dab of oral gel we're using would cause a higher concentration, but to be sure i'll contact the manufacturer & see if they'll give me the concentration.

Marge, Since Tigger is at .7 now, shouold I give him sub-q (if so how much) or just tuna water?

Thanks so much to you both -I'm not spinning so much now - I know it's late, I appreciate your staying with me & researching information.

I kept forgetting to add my previous condo: Tigger's 7/5 Condo
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

shouold I give him sub-q (if so how much) or just tuna water?
Click to expand...

I think if you've done this:
Be careful on the tuna juice. Even if the can says "in spring water", many companies are now putting vegetable broth in the juice and vegetable broth can have onions and soy....both of which are bad for cats. So check the fine print on the ingredients.
Click to expand...
and it look okay, then tonight, the tuna water should be okay.
I'd check ketones again in the morning. And if TIgger is still flirting with high normal, call the vet and ask how much fluids would make sense to give him.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

If you don't want to give fluids tonight, I'd be sure I was adding alot of extra water to his foods.

50mls of fluids is 10 tsp. that's a reasonable number to get into him mixed in food.
 
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Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Thank you, Carl, that makes sense.

I'll check Tigger's +4 in 30 min. & afterwards do tuna water. It's Trader Joe's, unsalted, just tuna & water, 0 carb, so I think we're good.

I'll report back in 30 min.

Thanks again, Carl & Marge.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Just got Marge's post. Thanks, & thank you for the additional dosing information. I tend to err on the side of caution, so it really helps me to have the dosage supervision.

I'll wait till the +4 - if we're still dropping like a cannonball I'll do tuna water in food. Otherwise, I may break open the fluids & give him 50 ml. He's a big cat, Maine Coon type, so I doubt that would hurt him. He'd probably feel better with sub-q too, but he acts just fine - we're playing right now.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

OK, Tigger's +4 is 210, so he's slowing down, but maybe he'll see some blue tonight. Wow - 452 - 210 in 4 hours - what a ride! Hope he doesn't zing back up for the AMPS nailbite_smile

Somehow I missed a trip to the litterbox, but I tested the lukewarm clay patty for ketones anyway - negative, but I don't really trust the testing method.

I'm going to do sub-q, 50 ml. Prepping it now.

Thanks to all!
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Ok....please let us know what his ketones are in the morning.

I'd just grab a before bed test and if he's flat or higher, I'd call it a night.

Good night, Suzanne. Paws crossed for negative ketones tomorrow.
 
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Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Thanks, Marje,
Tigger's +5 is 230. He's really hungry, so he's getting 1-2T chicken in 3T liquid.

I'll do ketones around 8:15 tomorrow. Paws crossed. Hope he doesn't rocket back up for the AMPS.

New dose will increase by .25 to 1.25.

Thanks again for pulling us through tonight.
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Tigger's Friend said:
The first ketone test came up .6, the high end of normal. I tested again 5 minutes later (same ear) & it was 1.1. Now I'm freaking out.
Click to expand...

i wouldn't panic nor go overboard thinking tigger is throwing ketones or going into DKA. :-D
3.0 is approximately when blood ketones start showing up as "Trace" on urine strips.

another member, sharyn/fiona, did extensive comparisons between blood ketone reading and ketone readings on ketostix. here's some of her comments:

Precision Xtra Readings for Cats

**'Normal' for cats is 0.0-0.3 (Fiona's normal is 0.1, D & Shadow's normal is 0.3)

**3.0 is aproximately when ketones start showing on urine ketodiastix strips at a trace - at least that is the case for Fiona.

**As BG's go down so will ketone levels (in most cases). If I can get Fiona's BGs under 250 for even a couple of hours her ketone level will go down.

**Other than being DKA at dx, the only other time Fiona has had ketones above 1.0 was when she had some kind of infection. The first time (Aug 2008) was occult and we never figured out what it was but four rounds of different ABs finally took care of it. The second time (Dec 2008) was tooth problem even though she had an extensive dental in April '08. She had a pocket behind a canine and a broken tooth. Neither of which could be seen by the vet until she was under.

**Other cats get elevated ketones for other reasons, too high BGs for too long, etc...



granted, sharyn's comparisons were done with Abbott's Precision Xtra Blood Ketone Meter, but blood ketone reading indications are the same with the Novamax meter as the Precision Xtra according to what's posted on childrenwithdiabetes.com:

32b0193e-14e1-4fc0-b7f3-b7970e7e29a9_zps41b6a89c.jpg



if i were in your shoes i'd definitely call your vet to ask for advice, be watchful (you want to catch any trend upwards), and continue testing for ketones as you have been, but please don't panic!
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

i'd like to amend my post. :-D

in the hours since i posted, kirsten of tillydiabetes.com was kind enough to email two of the latest scientific studies concerning measurement of ketones when using a blood ketone meter. these studies provide an up-to-date interpretation of when a blood ketone concentration of DKA is more likely to be present: 2.4 and 2.55.

Measurement of β-hydroxybutyrate in cats with nonketotic diabetes mellitus, diabetic ketosis, and diabetic ketoacidosis. - published March 2012
and
Point-of-care β-hydroxybutyrate measurement for the diagnosis of feline diabetic ketoacidaemia. - published in June 2012


evidently, we've all been struggling with what to do with the information from obtained from blood ketone meters.
i'd like to personally thank kirsten for passing along the latest information!
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Thank you Jill.
My bookmarks just increased:-)
Great info!
 
Re: 7/7 Tigger PMPS=452+testing positive for ketones - need

Thank you, too Jill & Kirsten - I read the info & bookmarked it, too.

No word from the vet's office yet - my vet is gone all week. Tigger's back up to 1.1 but acting normal, so I'm giving extra liquids & holding off on more sub-q till I hear from the vet, hopefully soon.......
 
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