Advice on CT Scan

M

Melissa&Moka

Member Since 2026
Moka had an appointment today for a CT scan but her ketones were too high when they did the preliminary blood work. This is especially frustrating to me because I had emailed them multiple times about her ketones being high and they told me to not worry about it until she isn't eating. I wish they had told me if her ketones were too high with my home testing to not even bring her in.

My internist is now telling me I have to go to another internist to get her diabetes stabilized before she can get a CT scan. Has anyone else had this issue?

I'm just so confused and angry. Her diabetes isn't stable because of the acro, but I can't get a CT scan for radiation/surgery until she is stable... it's a really annoying chicken and egg situation.

Does anyone know what I can say to this new internist to try and get things moving? I am so tired of trying to advocate for my cat to be disregarded and dismissed. The internist today even suggested euthanizing Moka, because this process is going to be long and expensive.
 
What is the purpose of the CT scan? Is that the place you were going to get surgery or radiation therapy? When Neko had CT scans, it was the day before her radiosurgery. No need to get it done before then. What was her IGF-1 number? What is her insulin dose?

I would ditch today's internist if they are suggesting euthanasia - that's crazy! :mad:. Neko had a good 4 years after her SRT, just the last few months were hard.

I agree that getting her to a point where there aren't ketones before anaesthesia is a good idea. Would you like help with dosing to get Moka in better numbers faster? How often re you home testing her for ketones and what are the typical values?
 
My internist said the next step after the echo cardiogram was a CT scan so I scheduled with them, I didn't realize it wasn't to map out the tumor and that it was just to verify that there was one and that Moka would probably need another one for mapping - I wish that was clarified before scheduling this CT scan (I swear vet care feels like a scam sometimes).

Her IGF-1 number was >1200 - I didn't get an actual number back.

I test her ketones at least once a day when I can and it ranges between 0.8 and 2.8, usually higher around insulin shot times and lower mid-cycle. The highest I saw was 4.8 after we decreased her insulin from 5 to 2 units after the first internist appointment where they suspected a somogyi effect. I have contacted them multiple times about her high ketones but they told me to not test so much and to look for clinical signs of DKA and to only test every 10 days.

She has been at 5 units for the past week, but I'm increasing to 6 units at the request of the internist. Her numbers throughout the day are usually low to mid 300s, and the nadirs I've been seeing are high 200s and usually right before her PMPS. I know acro kitties can increase insulin every 6 cycles but I get a little nervous because the internist insists that it takes 7-14 days to really see the effects of a new dose.

I've been referred to a new internist that has oncology on site, and where she would likely get SRT (I'm going to opt for SRT if I can, surgery seems to have too many risks). I also have a spreadsheet but I am slow to fill out numbers sometimes.
 
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Your vet is not the first to ask for a CT scan to confirm. Over 1200 is enough evidence to say acro. Sometimes I think they just want to know for sure. I got so I asked my vet the question "what would we do differently with this information?". Plus with an acro, best to limit unneeded anesthesias. Good to hear you are got a cardiogram too. Even if they don't see anything, it's good to have a baseline.

Somogyi is very rare in cats. The Somogyi theory was based on a study of humans, almost a 100 years ago, on fast acting insulins. And not published in a peer reviewed journal. It has been debunked in cats on long lasting insulins like Lantus where home testing is done. But that last part hasn't been spread widely in the vet community.

With our dosing methods, should you follow them, at her size of dose we'd increase by 0.5 units at a time. Do you have U-100 syringes with half unit markings? The smaller increases makes the faster increases less scary. The Tight Regulation protocol that allows increases every six cycles does depend on you getting at least 4 tests per day, the two preshots and one other per cycle, as a safety mechanism. So you know you aren't missing any lows. Tonight, when you see a cycle where they start high and slight down to start the next cycle, would be a good time to get a test in before you go to bed tonight. Especially since you increased the dose tonight.

You can go ahead and link the spreadsheet in the signature, so you don't have to include it each time in your posts.

Ketones can increase very quickly, I've seen them go from trace to high over the space of a day. Testing every 10 days is not enough. You should test whenever in higher numbers. Neko was easy to urine test, so I did that.
 
Thanks Wendy! And I agree, I don't want her to go under anesthesia unnecessarily, which is another reason why I'm so angry that this CT scan wouldn't have got me closer to treatment really. I'll be better about doing evening readings. I do have U-100 syringes with half unit markings and will go back to follow TR and do 0.5 unit increases going forward.

I usually do blood ketone tests when I do glucose readings, I haven't seen any urine ketones with the strips which is why I have been defaulting to blood ketones. Should I test multiple times a day for ketones as well? She varies a lot throughout the day.
 
I think you can test for ketones once a day, unless you see something high on the first ketones test of the day. Once you get to an insulin dose where the ketones test are consistently low, you can slow down how often you test for them.

The 0.5 unit increases are when they are between 5 and 10 units and not seeing anything under 100. Think of the size of increase as a percent of the total dose. At 10 units we'd move to the 1.0 unit increases.
 
Last question, should I continue with the 6 units I've given today or reduce to 5.5 and go from there?
 
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