? Help please -- ketones 0.4mmol/L [repost from PZ forum]

[sorry for the double-post -- I'm not sure if anyone will see it in the PZ forum).

Hi folks,

My dear cat Fatty and I have had a majorly hard time managing his BG since a high-carb renal food experiment/mess. He's transitioning off it but his BGS are still high. Wondering -- I used to use the dipstick ketone sticks, but have recently started using a FreeStyle Precision Neo ketone tester that checks for blood ketones.

We just got a reading of 0.4mmol/L. I've only been doing this for a few days but in the past his readings have been usually 0.1mmol/L. Any thoughts? The paper insert in the meter says under 0.6mmol/L is normal but I can't find what's okay for cats. He's at 1.75h after insulin and his BG is 25.4mmol/L or 457 mg/dL.

He has been eating well (last meal was 1.75h ago) and otherwise seems fine, maybe a bit lethargic, but he's been battling high BGs and CKD and panc for 6 weeks so nothing that seems alarming, though I am watching him like a hawk now.

 

Hi

Been using the Abbots B Blood Ketone meter since 2008.
As soon as the Bg is 22 mmol and higher it's starts the critical movement of the unbroken- down long-chained Fatty Acid which are the B Blood Ketones. Above 0,3 in B Blood Ketones are not good. As it also directly sets the pottassium flooding into the cells, and mainly into the brain cells. Do you have an ER Animal Hospital you can call direct with all the data, and your recourse?

 

Thanks for replying -- I just called them and they can't advise over the phone. I am going to recheck now and I think I will take him in.

 

I checked his ss. You were on 2 units. That was Good. With Pancreatitis all bgs goes hey wild, but you can't lower from 2 units without risking his B Blood Ketones and DKA.
Since you are experienced since before with start in 2017, you can give him a 0,5 unit nib closing the 12 hrs gap, until you properly raise insulin back up to 2 units.

Rooting for him and you.

 

Thank you Ann. Took him to the clinic and am waiting outside ...

 

Don't worry about the 0.4 reading. From this post: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

When do ketones show up on a blood ketone meter such as the Nova Max Plus or Precision Xtra Blood & Ketone meters?

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

 

Thank you Wendy!

Well folks, better safe than sorry. I took him to the vet (not our usual because it's Saturday night) and she said he looked good, his urine ketones were negative, and she wasn't sure if the blood ketone meter was appropriate/reliable for cats. Fatty has had so much going on (including this ongoing BG mess) that one little thing sends me dragging him to the vet. He was probably quite content sleeping in the laundry.

He's home now and his BG is down to 14.5/261. I gave him Fancy Feast (instead of higher carb renal food) at +7.5 to try and give his BGs a break tonight. Urine ketones negative at home too.

I am going to get a new vial of insulin Monday -- he's had this one since December 21, so maybe it's funky. Or maybe it's time to try a new one.

Thank you all!

 

Glad things are OK!

Rather than suspecting the insulin, I might look at the insulin dose. Not sure why you dropped back an entire unit after seen greens on the 20th. We typically would reduce by 0.25 units.

 

I reduced his dose so much because I switched his food from a 50/50 mix of 40%/20% carb (both renal foods) to just the 20% carb renal food which he had been regulated on at 1.0. I am very much in the learning stages here and I wasn't sure how much he would drop from that diet change, but I think his high BGs are closely related to the high carb renal food (not surprisingly).

The vet tonight suggested giving him 1.5U tomorrow morning (4h from now).

 

Good kitty lords. AMPS was 17.3/311, gave him breakfast (2 tbsp 20% carb food but withheld the 1.2 tsp of 40% carb), 1.0U. +3 is 9.2/166. I will feed and retest frequently -- when he dropped into the greens last week, he was at a similar level at +5 ... kind of nervous about the speed of this drop.

Fatty! You're a total freak!