Can someone tell me how to test for ketones?

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emchic

emchic

Member Since 2012
My cat, Zoozey, is at the e-vet recovering from a DKA. He was diagnosed in Jan, and we've maintained his BG with diet until last week. He'll be getting Lantus twice a day, 2U. I have no experience with BG home testing (though the vet is going to walk me through it today with the meter I bought), and she's going to show me how to give intramuscular shots because he's lost a lot of muscle mass and apparently that's more effective. He was ketonic on Sunday when I took him to the e-vet, so I want to be able to check his BG and ketones so that this never happens again (he was very very close to death!)

So, how do I test for ketones? From what I've read I can test with either blood or urine. Which one is easier?
 
Hi,

My cat Bob was also treated for DKA, and I can certainly understand your wanting to make sure it never happens again. Scary stuff for sure.

The urine testing is much easier and cheaper that the ketone meter and strips. Basically, you just buy urine test sticks from the diabetic section of the pharmacy. (Look for Ketostix). Then the trick is to catch kitty in the litter box while he's peeing. You just stick the ketostix in the urine stream, it'll change color if ketones are present in the urine, and there's a graphic on the box that will tell you what the color means.

http://www.walgreens.com/store/c/ketostix-reagent-strips-for-urinalysis/ID=prod19769-product

Home testing is not hard for blood glucose either. Many people have trouble at the start, but after a couple of successes, it's not big deal.

The part about "inter-muscular shots" concerns me though...
My cat, Bob was given IM shots the whole time he was on insulin, so yes, they "work". I don't know if they are more or less effective. The thinking is that shooting IM versus Sub-Q changes the absorption rate of the insulin. I can't say for sure, because Bob only got sub-q shots for a couple of days, and then IM shots for 10 weeks, so I can't compare the rates of one way over the other.

The concern, to me, is the type of insulin (Lantus) and the method of giving insulin. Bob was on PZI insulin, which works totally different than Lantus. PZI is a shorter duration insulin, and the way it works inside the body is not the same as Lantus. I know PZI worked okay that way. But I don't know if anyone here has experience with giving Lantus that way. It may not be a realistic option.

I'm going to post a question on the Lantus forum and ask some of the more experienced people there to come here and give you some feedback. They may also help in evaluating the 2u starting dose, which is "higher than normal" for a starting dose. But every cat is different, and there may be good reasons for your vet to prescribe that amount to start. The DKA diagnosis, for instance.

More people will chime in soon. Welcome to the Board!

Carl
 
Oh, I could have mentioned...
I used a meter to test for Ketones on Bob, because it was next to impossible to intrude on his litterbox privacy so the stix weren't a good option for me. The strips are outrageously expensive though. You can get 50 stix for the price of a half dozen of the ketone meter strips.

I used the Nova Max Plus, which can be used to test both BG and ketones.

Carl
 
Not only are the strips rather expensive for the blood ketone meters, but they tend to need a considerably larger blood sample than when you're testing for glucose.

For example, the FreeStyle Optium meter that I have tests for both; it needs a 0.3μL blood sample for the glucose test strips, but a massive 1.5μL of blood is required for the ketone tests.

It seems that most meters which test for both glucose and ketones share this drawback.

ETA: According to its user guide the NovoMax meter that Larry has linked to above only needs a 0.8μL blood sample for its ketone testing (and a 0.3μL sample for glucose testing), so that meter definitely seems to be the one to go for judging by sample size alone. The link below enables you to gets free NovoMax meter - I'd go for it; even if you do end up using the ketodiastix on a more regular day to day basis, it is still very useful to have a blood ketone meter available for more precise testing.

Free meter:
http://www.novacares.com/free_meter.php

User guide:
http://www.novacares.com/downloads/Nova ... nglish.pdf

H
 
Zoozey likes his privacy when using the litterbox, so, alas, I think it might be difficult to use stix to check his urine. He shoots right out of the box if I come near him while using it. He's coming home from the e-vet tomorrow and she warned me that his BG readings are going to be all over the place for a bit because he's been so incredibly sick. So today she discussed the signs of ketosis with me so I'll be more aware if there is a next time. But still the thought of checking BG and ketones every day is scary, but as I suppose that will fade the more I do it and the more I become aware of diabetes.

And Helene thanks for the link! I filled it out and hope to get a meter in the mail soon. Do you guys check for ketones every day? If so, how many times? Carl, is it even economically feasible to check his ketones on a daily basis with a meter instead of stix?
 
There are a few ways to get a urine sample for ketone testing:

Stalk the cat to the litter box and stick a cup or long handled ladel under the tail to get a sample.

Use a Smart Cat box: http://www.felinediabetes.com/SCB/SCBindex.html Or use the cheap alternate method: Temporarily replace the regular litter with fish tank gravel. After the cat has used the box, tip the box to pool up the urine into a corner, and dip the test strip into that. Make sure to use a clean litter box. Litter residue will affect the test strip reading.

You can use either KetoStix or KetoDiastix urine test strips. KetoStix only tests for ketones with KetoDiastix tests for both ketones and the presence of glucose. All diabetic cats have some amount of glucose in their urine so the urine glucose reading isn't important.

To get a ketone reading via blood, you need a blood gluocse meter that will also test for ketones. The Precision Xtra is one brand. It uses two separate test strips, one for blood and one for ketones.

I've never heard of giving insulin via IM injection. There is a difference in absorption rate between IM and the more common subQ injections. I think IM injections are absorbed faster while subQ are slower.

Blood glucose testing isn't as scary as you think it is :smile: It takes many people a little while to get the hang of doing. Once you've gotten a routine down, testing takes less than a minute to do. Some cats may need lots of treats (low carb for diabetics) and praise to get used to being tested.
 
Squeem, the vet gave me a great explanation for giving IM injections and absorption rate was part of the reason. What that explanation is, I don't remember. I think it had something to do with the fact that he's so emaciated? I think. I've been given so much info the last few days it's hard to keep everything straight.

I just like the idea of testing ketones through blood better than urine, but I'm not particularly thrilled about the expense of blood testing for ketones regularly. I also have three cats, so getting a read on what's been left behind in the box could be difficult. I just have a lot of newness in this situation to get used to. I realize now how lucky I was to live insulin free for 10 months.
 
Carl, is it even economically feasible to check his ketones on a daily basis with a meter instead of stix?
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I think that once he comes home, you'll need to check daily. The strips for my meter, the NovaMax Plus, ran about $3 each? You can sometimes find a good deal on them on Ebay, but not regularly. The more you buy, with any strips, the less per strip it will cost you. Here's a link to Amazon, and it looks like they are charging under $3 per strip on a box of 10.
http://www.amazon.com/Nova-Max-Plus-Glucose-Monitoring/dp/B0050Z48IU?tag=felinediabetesfdmb-20

For me, at the time, it was economically feasible (barely). I know the vet charged more than $3 a test, and they were using ketostix, not a meter. But then again, they charged $10 or more for a BG test using a strip that cost less than fifty cents too! I'm thinking I was being ripped off. :shock:

Carl
 
Welcome, Barbi.

Carl asked a few of us who are regulars on the Lantus board to stop by. I can think of only one other member here who was shooting IM. It is not typically how an insulin injection is given. IM injections of Lantus typically speed up absorption. However what you may gain in absorption, you lose in duration. In other words, a dose will not last as long if it's given IM. If your vet is concerned about Zoozy's numbers being all over the map, I would think that duration would be important.

The other concern I would have is a practical one. Most cats barely notice a sub-q injection. My cat doesn't blink when I give a shot. (She has her head in her food bowl which may have something to do with it.) If you're giving an IM injection, this may not be the case. It may be easy for the vet to suggest an IM shot twice a day but your vet has techs there to help. If you are the sole caregiver, this might prove to be more challenging.
 
It may be easy for the vet to suggest an IM shot twice a day but your vet has techs there to help. If you are the sole caregiver, this might prove to be more challenging.
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Sienne brings up a good point. I was blessed to have a very mellow cat with diabetes. Had he not been cooperative with just about anything I ever did, things may not have gone so smoothly. Bob got his shots in the big muscle in the top of his hind legs (what you would call the hamstring in a human). The shots are a little more complicated, because after you put the needle in, you need to draw back a little to make sure you aren't in a vein or artery. With one hand holding his leg, and the other holding the syringe, I had to learn to manage to draw back and shoot with only one hand, using my left hand to hold his leg still and stop him from "escaping". The first few shots were sort of stressful for both of us. I did learn to give sub-q shots at first, and even to someone who'd never used a needle, that was much easier than an IM shot. I was also the sole caregiver, so having someone else help wasn't happening.

If there's any way your vet can see to have you do sub-q shots, I'd try that option first. Not only will it be easier and less stressful for everyone involved, but it will also allow the insulin to act "normally".

Carl
 
Sienne, This is a valid point. I'm racking my brains and trying to remember what she said about the reasoning behind the IM injection. I will make sure to ask tomorrow when I pick him up at the e-vetand let you guys know. I think she recommended IM shots because she wanted the Lantus to absorb more quickly when his numbers are high. She may have also said something about IM injections because he's lost so much muscle mass. He should weigh 12-13 pounds, but he weighs 9 and he lost an entire pound last week. I could be wrong. Does that even make sense? I'm so tired and sleep deprived right now that everything the vet told me is running together.

I've given him a couple of subq shots and he barely noticed (but he was still severely DKA at the time, so that might be why). Carl, thanks for the suggestion. I'll make sure the vet watches me give him a subq shot. When I had him home on Saturday afternoon/Sunday morning, it was scary--he was so sick and lethargic and I think it scarred me a little. Thank goodness I found this message board. Now I realize that my regular vet sent him home when he wasn't stable enough to go nor did they provide me with enough knowledge or instruction on how to care for him. I just hope I get used to this new routine quickly because right now it seems scary!

I'm going to try but some ketostix and see if I have any luck, but I think in the end it's going to work better if I use a meter. I just don't see him cooperating with a urine check and I never ever want to see him that sick ever again so I'll definitely be checking his ketones daily especially these first few weeks at home.
 
I'm going to try but some ketostix and see if I have any luck, but I think in the end it's going to work better if I use a meter. I just don't see him cooperating with a urine check and I never ever want to see him that sick ever again so I'll definitely be checking his ketones daily especially these first few weeks at home.
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Make sure and reread what Squeem suggested about less invasive methods of using the stix above... I've read several people say they use the aquarium gravel trick.

Carl
 
I'm all for trying the aquarium gravel. Has anyone had success using the aquarium gravel or the smart box with multiple cats (one diabetic, the other two not)? If so, what did you do? Right now I clean out both of my litter boxes once a day. Would it help if I cleaned them out more than once a day?
 
I think what people with multiple cats do is keep the diabetic cat in one closed off room for an entire day with a litter box, food and water, and toys. That way you know for sure that the urine in the litter box is from the diabetic cat.
 
I have a shy litterbox cat.
I vought a cheap small litterpan
1 bag of gravel (multicolor- lol looks like fruity pebbles but it was under 2.00 a bag)
I leave bast in the bathroom with watery food and box after his am shot. I check after an hour and see if he went. I read the pee should be used within an hour on the ketone strip. If he didn't go I do a glucose check (well, he is there...) and leave another hour. Just remember to have a towel or blanket on the cold floor.

For cleaning- we have a deep sink in the laundry room. Pour the gravel in a collender (get a cheap one at the thrift store- you don't want to use it for food) and "wash off" the rocks. Wash out the pan and let dry. In a hurry? Use a hair dryer to dry (may have to put it in a pillowcase so the gravel doesn't blow all away).
 
Thanks for walking me through it, Misty. Honestly, this is something that's got to be done. I don't ever want him to go into DKA like that ever again. He finally left his cozy place in my bedroom this evening and came and sat with me in the living room with the other cats. I have never been so excited to have a cat sit on my couch. Seeing that made all of the money I've spent (and will spend paying off my $3800 vet bill) worth it. It's fantastic to see a cat that was so so sick start to come to life again.
 
I also learned if Bast is whining and clawing at the door- he isn't hurt - he has to pee and doesn't want to use the gravel box. If I don't let him out- he WILL use it. then i give him a treat.
 
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