NEW MEMBER - Suki - Can't Control Ketones

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Becca & Suki

Member Since 2026
Hello everyone! I hope this is the right place to post. My 15 year old cat Suki was diagnosed around a month ago, fructosamine at 451, main symptoms were excessive drinking and urination with lethargy and low appetite. We're based in the UK.

She's been started on ProZinc 0.5U, monitoring with a human meter (VivaChek Ino). Once diagnosed we switched her to low-carb wet food (Sheba Fine Flakes in Jelly - around 2% carbs). What I noticed from the get-go is that her appetite just wasn't there. She'd be lethargic during the day, eating and drinking very little, then perk up and night and eat a lot more. A few days into treatment we ordered a ketone blood monitor (GK Dual) and realised she was having ketones. Messaged the vets immediately who weren't concerned. From that time we were never able to get on top of the ketones (they'd be high at insulin time, lower during the day, but never gone). We added extra carbs to try to buffer her system however it only helped temporarily, and then her BG readings would be erratic the next days. We had a few no shoot numbers and at that time she stopped eating completely and went into mild DKA. She came home from the hospital a few days ago with a clean bill of health and an appetite stimulant (mirtazapine) but since then WE CAN'T CONTROL THE KETONES.

What we're doing now:
- ProZinc 1.0 (had to up to 1.25 this morning as ketones were 1.6)
- Higher carb food (anywhere from 13.5% - 19%) with appetite stimulant to try to get her eating MORE and to be able to tolerate more insulin, although I'm unsure what level would be most appropriate

I am at a loss for what I should be doing here. The vet surgeons sent her home with a "give her 1.0U and whatever food she'll eat". She's horribly lethargic, clearly uncomfortable. I desperately need help to prevent her going into DKA again. Any advice or suggestions I would be so, so grateful for.

Her SS: Suki - UKFD SS HUMAN METER Template
 
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@Suzanne & Darcy can help you with ProZinc.

@Bron and Sheba (GA) @Wendy&Neko @Sienne and Gabby (GA) can help with the ketones.

I know there are UK members here but not sure how active they are. @Elizabeth and Bertie might be around occasionally.

Here's some info on dealing with ketones: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones I think you basically feed whatever the cat will eat for now and make sure she stays hydrated and keep a close eye on the ketones and blood glucose levels.
 
Becca & Suki said:
Higher carb food (anywhere from 13.5% - 19%) with appetite stimulant to try to get her eating MORE and to be able to tolerate more insulin, although I'm unsure what level would be most appropriate
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Feeding carbs is not the way to go. This is only going to increase BG and that causes ketones to rise. .

What kind of numbers are you getting on your blood ketone meter. I am very familiar with high ketones as my boy had high ketones for a long time (post DKA) and I could not usually get the vet to take them seriously!

You need to feed a lot of low carb food and keep him well hydrated by watering the food if he tolerates it and sub-q fluids at home if you can. And we may need to increase insulin. I will take a look at your spreadsheet. Doing different doses all the time usually leads to erratic BG numbers.
 
Those ketone readings I see on the spreadsheet are not super high, however, I am very concerned about the lethargy and lack of appetite. Was Suki checked for a urinary tract infection or other possible infection? How are her teeth? Has she had any antibiotics recently?
 
Suzanne & Darcy said:
I do understand that you need to keep him eating. Do you have appealing foods that are low carb?
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This was my fear but from what I read the initial thing to do with ketones is get carbs in. We have lots of low carb food in that she likes, and with the appetite stimulant she'll eat. Our problem has been that she only licks up the gravy but doesn't eat the chunks, so we're going to start pureeing so the food is mostly gravy now - hopefully this will get the calories in. It's infuriating that vets don't take this seriously! Suki is drinking plenty and we add extra water to her wet food every time (especially now as we're going to be pureeing). No UTI found or other infection, her teeth have been looked at by quite a few vets and no problems found. She had some antibiotics at the hospital but kept vomiting them up when we got home, so the vet said to stop them as no infection was present in the bloods.
 
I'm sorry that your boy also suffered with this! I feel like we can't get stability right now and I think that's exactly what Suki needs. My gut feeling is the lethargy is coming from the ketones as everything else was checked at the hospital - ultrasound showed nothing in the organs, bloods all clear, urine sample and culture the same.
 
If we're going to get her back on low-carb food, should I transition her slowly? I'm worried that suddenly changing will then cause a BG drop and the insulin will be too much and potentially hypo her.
 
Becca & Suki said:
with ketones is get carbs in
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It's not so much carbs as calories, she needs to be having more calories, particular if she's lost weight.

The balance is
1) enough insulin
2) enough hydration
3) enough calories

Do you have a spreader set up with her blood glucose levels?

To some extent of she has no appetite, whatever food she eats is what's good for her, but if that's high in carbs the insulin dose has to go up accordingly. Ideally we want her eating well and lower carbs.
 
Gill & George said:
It's not so much carbs as calories, she needs to be having more calories, particular if she's lost weight.

The balance is
1) enough insulin
2) enough hydration
3) enough calories

Do you have a spreader set up with her blood glucose levels?

To some extent of she has no appetite, whatever food she eats is what's good for her, but if that's high in carbs the insulin dose has to go up accordingly. Ideally we want her eating well and lower carbs.
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Yes, I think our problem has been the calories and not getting enough in. She has an appetite stimulant now which is really helping but she only like the gravy of the food so we're trying to puree it all now. I have her spreadsheet here: Suki - UKFD SS HUMAN METER Template
 
Becca & Suki said:
If we're going to get her back on low-carb food, should I transition her slowly? I'm worried that suddenly changing will then cause a BG drop and the insulin will be too much and potentially hypo her.
Click to expand...
Yes. If she is eating all medium to higher carb food, you can gradually make the change back to LC food. It shouldn’t take more than a few days 3-5 days though— depending on how she does with the switch. If you are monitoring her BG you can keep her safe.
 
Suzanne & Darcy said:
Yes. If she is eating all medium to higher carb food, you can gradually make the change back to LC food. It shouldn’t take more than a few days 3-5 days though— depending on how she does with the switch. If you are monitoring her BG you can keep her safe.
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We'll keep monitoring as closely as we can. What dose of ProZinc do you think would be reasonable to keep her on for now? Since coming back from the hospital over the last few days she's been on anything from 0.5 to 1.25 - I'd really like to stabilise the dose for her little system to settle but obviously with changing the food back to LC I desperately want to avoid a hypo situation, while keeping ketones under check of course.
 
Becca & Suki said:
We'll keep monitoring as closely as we can. What dose of ProZinc do you think would be reasonable to keep her on for now? Since coming back from the hospital over the last few days she's been on anything from 0.5 to 1.25 - I'd really like to stabilise the dose for her little system to settle but obviously with changing the food back to LC I desperately want to avoid a hypo situation, while keeping ketones under check of course.
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Looking at her numbers today, I think you can keep her at 1.25 units. You have plenty of room for her numbers to go down and, as long as you are monitoring and making the changes over the course of a few days, you can keep her safe. If you feel more comfortable, you could go with 1 unit and see how it goes. You have been feeding around 13.5 percent carbs, you said, so that’s considered medium carb and isn’t as bad as 20 percent or super high carb kibble (which is oftentimes 35-40 percent carbs.) Hopefully, that means the change in BG won’t be as dramatic (but we are hoping to see lower BG.)
 
Suzanne & Darcy said:
Looking at her numbers today, I think you can keep her at 1.25 units. You have plenty of room for her numbers to go down and, as long as you are monitoring and making the changes over the course of a few days, you can keep her safe. If you feel more comfortable, you could go with 1 unit and see how it goes. You have been feeding around 13.5 percent carbs, you said, so that’s considered medium carb and isn’t as bad as 20 percent or super high carb kibble (which is oftentimes 35-40 percent carbs.) Hopefully, that means the change in BG won’t be as dramatic (but we are hoping to see lower BG.)
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Halfway through the day she's decided she doesn't want her 13% and will only eat her 8% food so I think to be safe I'll go for a 1U, trying to get a little more of the medium carb in here and there to help the transition. Thank you for all your help today, Suzanne!
 
I wouldn't worry too much as long as you're doing wet food the carbs get out of the system pretty quick, kibble is much higher and dependent on the cat it can take a few days, which can be tricky to judge, with the carbs in wet you're looking at a couple of hours, they will affect the insulin cycle of course, usually shortening the duration and seeing the Nadir's higher. It's important to get enough insulin and as much food as possible.

The other thing I forgot to mention is that it's important to address any infection or inflammation as often its a combo of not enough insulin, not enough calories and infection/inflammation.

So keep an eye out for any signs of infection/inflammation, that's why Suzanne was asking about her teeth and othe common issues
 
Gill & George said:
I wouldn't worry too much as long as you're doing wet food the carbs get out of the system pretty quick, kibble is much higher and dependent on the cat it can take a few days, which can be tricky to judge, with the carbs in wet you're looking at a couple of hours, they will affect the insulin cycle of course, usually shortening the duration and seeing the Nadir's higher. It's important to get enough insulin and as much food as possible.

The other thing I forgot to mention is that it's important to address any infection or inflammation as often its a combo of not enough insulin, not enough calories and infection/inflammation.

So keep an eye out for any signs of infection/inflammation, that's why Suzanne was asking about her teeth and othe common issues
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The hospital cleared her for any infections so I'm hoping we're all okay in that department! I didn't know though that wet food carbs clear much quicker than kibble - Suki was on 18% kibble for about a day and half when she first came out of the hospital (it's all she would eat) so I'm a little worried her numbers right now might still be being affected by that.
 
Becca & Suki said:
The hospital cleared her for any infections so I'm hoping we're all okay in that department! I didn't know though that wet food carbs clear much quicker than kibble - Suki was on 18% kibble for about a day and half when she first came out of the hospital (it's all she would eat) so I'm a little worried her numbers right now might still be being affected by that.
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She’s been home from the hospital for five days so the dry food influence is gone. It doesn’t last that long. High carb wet food will only raise BG for about two hours. But you have only been feeding MC, but still that will influence BG for about two hours.

Still, when making food transitions, it’s always right to be monitoring BG carefully as you are already doing.
 
Have you changed the spreadsheet? I am to read it. You need to change the sharing so that it's is "anyone with the link". Also best to put the link to the spreadsheet in your signature, so it's there all the time.

A ketones level of 1.6 is not a red alert, though you'd like it lower.
 
Hi and welcome to the forum.
I can’t read the spreadsheet either.
If Suki is not eating she may need an antinausea medication such as ondansetron. This should be given before the appetite stimulant.
How often are you offering food?
 
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