Help please!!! Blood ketones 0.9mmol/L and BG 506 or 28.1 at +3

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Alana & Fatty

Member Since 2020
Hiya,

I am starting to freak out ... of course it's late. At +3, Fatty's blood ketones are at 0.9 mmol/L. They were at 0.4mmol/L at +1.5 and 0.6mmol/L at AMPS.

I took him to the emergency vet when they were at 0.6mmol/L a few months ago, and the emergency vet (and my normal vet) said they don't check blood ketones, only urine. His urine ketones tested neg at the emergency vet and they charged me over $400 to basically say he's fine.

I don't know what to do. He ate 3hr ago and got 100ml subq fluids 3h ago.
 
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Is this on a blood ketones meter? If so it’s nothing to panic about. Up to 2.4 is a trace. He’s not in ketoacidosis. After that it’s more pressing problem. So make sure he’s eating and drinking. Add extra water to the food. Check him a few times tomorrow because we want to make sure he’s safe. I do think you need to go back to 1.25 u. This will also help with the ketones.
 
Hi Janet,

Thanks so much for your words of wisdom. It is a blood ketone meter, yes. I was rereading all the bookmarked ketone posts I have and saw the 2.4 number and wasn't sure if that was mmol/L or mg/dL. My urine ketone strips say trace is 0.5mmol/L (5 mg/dL) so I was confused. I just rechecked and he's at 0.7mmol/L on the blood meter and neg in the urine strips ... gave him some soupy food too and he's eating and stuff normally. I called the emergency vet (as I do) but remember last time they told me he was fine and charged me $400, so I am trying to be calm. It's hard. I am not a calm person, haha.

Dose increase tomorrow for sure. THANK YOU!
 
Hi Janet,

Thanks so much for your words of wisdom. It is a blood ketone meter, yes. I was rereading all the bookmarked ketone posts I have and saw the 2.4 number and wasn't sure if that was mmol/L or mg/dL. My urine ketone strips say trace is 0.5mmol/L (5 mg/dL) so I was confused. I just rechecked and he's at 0.7mmol/L on the blood meter and neg in the urine strips ... gave him some soupy food too and he's eating and stuff normally. I called the emergency vet (as I do) but remember last time they told me he was fine and charged me $400, so I am trying to be calm. It's hard. I am not a calm person, haha.

Dose increase tomorrow for sure. THANK YOU!
No problem. I mean do keep an eye on it.... you want to keep it from creeping up, but for now it’s not dangerous.
 
It won’t show up for cats on the urine strips until 2.4. Blood meter pick it up sooner than time. Kind of like how the glucose don’t go Into the urine until it’s around 250.
 
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I mean do keep an eye on it
Luckily (?) I had to pull an all-nighter anyways to grade some assignments, so I have been checking very often. He's been at 0.1 the last two times I checked (at +7 and +9), and I've been giving him Fancy Feast soup to get his BG down (much lower carb than his normal) and his hydration up. He loves FF and doesn't get to eat it because he's on this dang renal food, so he's happy about that.

Trace on your urine strips is 0.5 for people, not cats
Ahhh. That makes sense. Does that mean ... forgive my tired brain ... if anything showed up on the urine tests, it would already be in emergency zone?
 
Trace on your urine strips is 0.5 for people, not cats. It won’t show up for cats on the urine strips until 2.4.
Hi @JanetNJ are you sure about this? I thought a trace was a trace on the urine strips and was the same for people and cats. I'm confused.
upload_2021-5-5_7-37-48.png
 

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Luckily (?) I had to pull an all-nighter anyways to grade some assignments, so I have been checking very often. He's been at 0.1 the last two times I checked (at +7 and +9), and I've been giving him Fancy Feast soup to get his BG down (much lower carb than his normal) and his hydration up. He loves FF and doesn't get to eat it because he's on this dang renal food, so he's happy about that.


Ahhh. That makes sense. Does that mean ... forgive my tired brain ... if anything showed up on the urine tests, it would already be in emergency zone?
no ... it's not an emergency unless it's over a trace. at a trace it's just something to be aware of and work at eliminating. Over a trace you would want to go to the vet for some fluid therapy
 
Hi @JanetNJ are you sure about this? I thought a trace was a trace on the urine strips and was the same for people and cats. I'm confused.
View attachment 60786
it is.. I worded that poorly and wasn't clear... the readings on a blood ketone meter and urin strip are different. so in other words it will show trace on the urine strip (5) when it is about 2.4 on a BLOOD meter. Does that make sense? minute ketones show up on a blood meter before a urine strip. So it won't even show a trace on a urine strip unless it's around 2.4 on a blood meter. ok i think that makes more sense. hahaha I'll edit my other comment.
 
dMXpb8k
so in other words it will show trace on the urine strip (5) when it is about 2.4 on a BLOOD meter.
So, urine strip 5mg/dL and blood ketone 2.4mmol/L? I'm in Canada and my blood meter only reads mmol/L but my urine strips have both mmol/L and mg/dL, where 0.5mmol/L or 0.5 mg/dL is "tract."

xbrZOGA

I found this article (http://www.diabeticcatinternational.com/knowledge/ketones/) somewhere on this board ... and this is what I was looking at last night (and have saved as a screenshot in my phone). This one says blood ketones at 1.6 is bad news -- or am I still confused? Looking through the ketones posts I see that many of us are wondering what the heck is going on here, haha. And of course this happens at night when my freak out senses are heightened! :blackeye:

weruva wet foods for cats with diabetes and kidney disease
Thank you for this (again) -- maybe it's time to revisit this idea. I was having a hard time finding them in Canada and was thrown off by the high protein content (from what I understand, Fats needs about 35% protein DMA), but I'm going to investigate again.

You are all angels!
 
I found this article (http://www.diabeticcatinternational.com/knowledge/ketones/) somewhere on this board ... and this is what I was looking at last night (and have saved as a screenshot in my phone). This one says blood ketones at 1.6 is bad news -- or am I still confused?
You didn't find that on this board, but on another board. This tells you the research of blood ketone meter readings in cats (vs humans):
The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:

Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdf
Measuring ketones - JSAP_Zeugswetter - 2012.pdf
 
Ah, okay -- thank you for these articles. I am keeping an eye on them again today and so far they've been at 0.5 and 0.2. I increased his insulin this morning but his numbers are high and flat, so hopefully they will begin to come down sooner than later. In the meantime, cat food soup!
 
Ah, okay -- thank you for these articles. I am keeping an eye on them again today and so far they've been at 0.5 and 0.2. I increased his insulin this morning but his numbers are high and flat, so hopefully they will begin to come down sooner than later. In the meantime, cat food soup!
Good preshot tonight.
 
I may be all wrong about this, but I think there’s a problem with the advice being given here. Actually, I think there are two problems.

First, my reading of the two linked articles doesn’t suggest that “ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter.” They say that DKA doesn’t show up before 2.4 mmol/L (or 2.55 in the second article).

In the present study, a cut-off value of 2.4 mmol/l revealed 100% sensitivity and 87% specificity for the diagnosis of DKA in cats, which is similar to the cut-off value in human beings.… In cats with a β-HB concentration < 2.4 mmol/l, DKA is very unlikely. (Weingart, p. 298)

A a-hydroxybutyrate concentration of >2·55 mmol/L had a sensitivity of 94% and a specificity of 68% for diagnosing ketoacidaemia. (Zeugswetter and Rebuzzi, first page)

The second problem is that there seems to be no distinction made in this thread between mg/dL and mmol/L. The image of the ketone strip bottle above is mg/dL, which would suggest that a reading of "2.4" is barely above "trace," but these articles both clearly reference mmol/L. This chart from the Wikipedia article on Ketonuria shows the correlation between urine test strips, mg/dL and mmol/L:

upload_2021-5-8_7-27-8.png


Confusing mmol/L readings for mg/dL readings could lead to tragic consequences. (And now the chart from the DCI website referenced above starts looking pretty spot-on.)

I’m in the US and I bought my ketone meter off Amazon. It reads mmol/L. It says so right on the screen. For kicks, I looked at the first 4 blood meters that came up in an Amazon search, and the results were as follows:

KetoMojo -mmol/L KetoSens – mmol/L
KetoBM – mmol/L KetoDoc – mmol/L​

(But please don’t take this as gospel folks. If you have a blood ketone meter it's up to you to determine for yourself how it reports results.)

I’m tagging the forum administrator and some moderators with the hope that someone will take a closer look into this issue (which I believe stems from an erroneous statement at the bottom of this sticky) to ensure that the advice being given on this critical issue is well founded in science and safe.

@Robert and Echo
@Marje and Gracie
@Sienne and Gabby (GA)
@Wendy&Neko
 

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I'd tweak that dose up to 1.5

Just seeing this now -- I gave him 1.2 this morning but am definitely thinking he needs an increase. 1.2 seemed to be working fairly well 2 weeks ago and now it's ... not ... doing ... anything ......... :mad::mad::mad:

In the present study, a cut-off value of 2.4 mmol/l revealed 100% sensitivity and 87% specificity for the diagnosis of DKA in cats, which is similar to the cut-off value in human beings.… In cats with a β-HB concentration < 2.4 mmol/l, DKA is very unlikely. (Weingart, p. 298)

I'm similarly confused about all this stuff (as y'all may have noticed by my frantic posting). I am inexperienced and not an expert here, so take this as you will, but my understanding from these articles is also that DKA is almost certainly present in kitties when blood ketones readings are at 2.4 (2.55 in the other article) mmol/L. But there wouldn't be a hard line between not-DKA and DKA, right? I mean there is a diagnostic line, but, say, 2.0 mmol/L on a blood meter still seems pretty not good.

I'm in Canada and my urine strips are in both mmol/L and mg/dL. I cannot seem to directly insert a picture, but ... and this is *not* my picture, thank God, but the strips look like this, with both sets of units: https://www.google.com/search?q=ket...=1280&client=firefox-b-d#imgrc=AS5p9QC0angDFM

So, on my urine strips, 5 mg/dL is 0.5mmol/L is trace. My vet said that I should call her for anything *above* trace -- that said, I have yet to get a urine strip reading, possibly because that 0.9mmol/L blood reading didn't stick around for very long. I don't know.

Anyhoo, this is not meant to start a riot or doubt anyone -- I'm just not sure what to think, and I think a couple of us are also like ... huh?
 
Just seeing this now -- I gave him 1.2 this morning but am definitely thinking he needs an increase. 1.2 seemed to be working fairly well 2 weeks ago and now it's ... not ... doing ... anything ......... :mad::mad::mad:



I'm similarly confused about all this stuff (as y'all may have noticed by my frantic posting). I am inexperienced and not an expert here, so take this as you will, but my understanding from these articles is also that DKA is almost certainly present in kitties when blood ketones readings are at 2.4 (2.55 in the other article) mmol/L. But there wouldn't be a hard line between not-DKA and DKA, right? I mean there is a diagnostic line, but, say, 2.0 mmol/L on a blood meter still seems pretty not good.

I'm in Canada and my urine strips are in both mmol/L and mg/dL. I cannot seem to directly insert a picture, but ... and this is *not* my picture, thank God, but the strips look like this, with both sets of units: https://www.google.com/search?q=keto diastix colour chart mmol/L and mg/dL&tbm=isch&ved=2ahUKEwi8qYPH9bzwAhUTB6wKHXJfB6kQ2-cCegQIABAA&oq=keto diastix colour chart mmol/L and mg/dL&gs_lcp=CgNpbWcQA1DzugJYy9MCYPrYAmgAcAB4AoAByQOIAYMXkgEJNS43LjMuMS4xmAEAoAEBqgELZ3dzLXdpei1pbWfAAQE&sclient=img&ei=MACYYLzREZOOsAXyvp3ICg&bih=698&biw=1280&client=firefox-b-d#imgrc=AS5p9QC0angDFM

So, on my urine strips, 5 mg/dL is 0.5mmol/L is trace. My vet said that I should call her for anything *above* trace -- that said, I have yet to get a urine strip reading, possibly because that 0.9mmol/L blood reading didn't stick around for very long. I don't know.

Anyhoo, this is not meant to start a riot or doubt anyone -- I'm just not sure what to think, and I think a couple of us are also like ... huh?
I'm glad the ketones came down. :)
 
Sigh. I wonder if he's having a bit of a panc flare? I buped him up and he's sleeping happily beside me but. these. BGs. are. nuts.
 
You're at a low dose still. I'd bump up to 1.5. Hold it for a few days and if not enough go to 1.75. Is he eating ok
 
He's eating well! I don't actually think it's panc ...

I just .... I just slapped myself on the forehead. Normally I give him freeze dried shrimp, tuna, chicken, or turkey on top of his food. On the afternoon of May 6th, when his BGs started going high and flat after the dose increase, I started giving him liver on top of his food. You know, the organ that stores glycogen. I checked the carb content of shrimp, tuna, chicken, and turkey, and all are 0-0.2g of carbs per 100g (obviously he gets way less than that). Liver is almost 4g per 100g.

:banghead::banghead::banghead::banghead::banghead::banghead::banghead::banghead::banghead::banghead:

No wonder he likes it so much -- it's like I've been giving him ice cream, gummy worms, cotton candy, and maple syrup on top of his dang "health" food.
 
I'd tweak that dose up to 1.5
I gave him a fat 1.25 this morning as I am giving him a mix of low carb Fancy Feast soupiness in with his normal renal food and withholding the liver.

I am hesitant to jump up to 1.5 today as when I tried 1.25 before, he dropped fast and I had to fight to get his BG even stable for 6h (it didn't go into the greens, but I couldn't get it to budge) -- but if he needs 1.5, I will not hold the 1.25 for the full SLGS week -- maybe just a few cycles.

Ketones are zilch. I am checking like a person possessed and running up my landlord's water bill by leaving the bathtub tap running for him. He has two water fountains but the tub has a certain je ne sais quoi! :D
 
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