Back on the juice and has ketones

[Yvonne & Leo]

Leo was in remission for a good while but now has numbers up in the 400s and ketones this time around. I feel like his insulin doesn't seem to be working very well or maybe I'm just not giving him enough. It isn't expired and has always been kept in the fridge. It is our original pack from 2022 but doesn't expire until 2026. I'm not sure what to do. He eats great and isn't vomiting or anything.

 

[Marje and Gracie]

Yvonne

I’m sorry you all have to be back but why do you think he is showing ketones? You state it is 0.5 on a blood ketone meter but recent studies show ketones show up in cats at between 2.4 and 2.55 on a blood ketone meter. See this post on DKA, ketones, etc. If he’s eating great, active, drinking, those are all good signs.

It looks like he’s getting some action from the insulin since he’s getting down below 200 and even 100.

For cats coming back from remission, you’ll need to be more aggressive with dosing. That means you should increase his dose to 1.25u. He’s been at 1u nine cycles and hasn’t been routinely getting into good nadirs.

 

[Yvonne & Leo]

Yvonne

I’m sorry you all have to be back but why do you think he is showing ketones? You state it is 0.5 on a blood ketone meter but recent studies show ketones show up in cats at between 2.4 and 2.55 on a blood ketone meter. See this post on DKA, ketones, etc. If he’s eating great, active, drinking, those are all good signs.

It looks like he’s getting some action from the insulin since he’s getting down below 200 and even 100.

For cats coming back from remission, you’ll need to be more aggressive with dosing. That means you should increase his dose to 1.25u. He’s been at 1u nine cycles and hasn’t been routinely getting into good nadirs.

I say that because I use a novamax plus blood ketone meter and the highest it has been so far is 1.1. I have never heard of ketones not showing up on blood meters, in fact I have been told you usually find out about ketones much earlier by blood than urine and blood is more accurate.

I will raise his insulin to 1.25

 

[Marje and Gracie]

I say that because I use a novamax plus blood ketone meter and the highest it has been so far is 1.1. I have never heard of ketones not showing up on blood meters, in fact I have been told you usually find out about ketones much earlier by blood than urine and blood is more accurate.

I will raise his insulin to 1.25

Ketones do show up on blood ketone meters but, for cats, they are not indicative of DKA until the blood ketones are 2.4 or above. In my earlier statement, I was using information from Jill which she got from Dr. Roomp who provided this information to us.

I would keep a very close eye on him; be sure he gets extra liquids in his foods and he is eating extra food. That might help with ketones. At 1.1, perhaps you are looking at trace or a little more. But if he stops eating or starts to eat less, doesn’t want to drink, shows any lethargy and the ketones are creeping above 1.1, you should get him to the vet immediately.

Good luck with the increase.

 

[Sienne and Gabby (GA)]

I want to reinforce what Marje said. It doesn't sound like Leo's level of ketones is dangerous but ketone levels can change quickly. Getting as much water/fluid into him as possible, making sure he's getting enough calories, and being on top of his blood glucose numbers and insulin are important. Marje also gave a good run down of any behaviors to keep a watch out for.

Hopefully, your diligence is paying off and his numbers drop back down and the ketones disappear.

By any chance, had you scheduled a vet visit? It's often helpful if a cat has fallen out of remission to get the kitty checked out by your vet. Something simple like a dental issue or UTI has been known to cause a cat to go back into diabetic numbers.