Ketones? *photos of test*

I finally got my ketone test strips and used them tonight. From what I can tell, it looks like we are looking at TRACE amounts. What do you think? If so, what does this mean?

 

Hi, I would say trace but the impact of that I can't say really. I haven't had a keytone issue so am not sure on the protocol. You may want to post into the Lantus forum so more eyes will see this post. May be change your title to include the question mark, so experienced eyes will see the question.

 

Yes, it might be trace. One thing you can do immediately is add enough warm water to every wet food meal to make a stew. The extra hydration is essential He also needs calories so don't stint on the feeding. The third essential is enough insulin and it seems as though he could use a small increase. Can you eyeball 3.25 u?

Keep testing for ketones and if there's anything over trace get him to the vet right away. Ketones can build fast and the sooner treatment is started the better.

 

Do you suggest a repeat of the subq fluids tomorrow? I did 100cc's today because he's not drinking and eating as much due to the URI. I'll try making the warm stew tomorrow morning.

Also, should I be testing for ketones multiple times a day (if possible) or is it just once a day? Or once every few days?

I think I can eyeball the 3.25, but my morning staff might not be able to. To be determined...lol. I gotta get this kitty into a home!

 

He is beautiful. Sorry cant offer advise, just cheering section.

 

Something you can try is to fill a syringe with colored water as a guide for your staff to replicate.

 

This could be trace but the colour differences are very close for negative and trace. Did you do the reading at the correct time. With the Ketostix or Ketodiastix the reading is done at 15 seconds. If you leave it longer it may continue changing colour but the correct reading is the change at 15 seconds. To be on the safe side you could do several readings the see if the results are the same. I also have done a ketone test on myself to get an idea of how the colour changes, since I KNOW I do not have ketones.

 

Not eating and drinking as much is a sign that more ketone testing is needed. Could you manage twice a day? If he's really agreeable, three times. Do time the test for 15 seconds because the strip colour does keep changing.

I like the idea of making a reference syringe with coloured water so others can give the 3.25 u. Good plan going forward for when you can't be there.

I don't want to be alarmist but I've been through an episode of DKA with my guy and it's scary and expensive to treat. The triggers are/can be:

• infection/inflammation
• eating less
• dehydration
• insufficient insulin.

 

Now I'm freaked out about DKA. He's now drinking more on his own. Ate the rest of his dinner overnight and ate maybe 1/4 of his breakfast. It seems like he actually has an appetite but can't really smell his food very well due to the congestion. So he'll eat a few bites and then have a sneezing fit, and then get over eating. He's acting like he's got more energy than the last few days and is jumping to different levels and using the scratching post. I have not been able to get any more testable urine but have put an plastic liner in his litter box and just a handful of litter and I'll check it often.

I'm not understanding why his +3 is still so high since it's usually when he drops to normal range. I have been unable to go in early (7am) every day to do his AMPS test, due to my other morning obligations. We are a few days over the 30 day mark for the Humulin so maybe it's not as effective anymore? I now have the PZI and hope to start it tomorrow. I'll be able to get AMPS and curve testing throughout the day for the next three days.

 

Have you tried warming his food up for a few seconds? Might help the aroma get through his stuffy little nose better

 

I use those same strips and end up with the same color you got every time, I call it "neg-trace". But if you look at the color even before using, they resemble more towards trace than negative. I guess a good comparison would be test yourself and see how it reads (if you don't have ketones!)

 

@Yong I just heated it up a bit and got about another 1/4 of the food into him!

@Bronx's dad Thanks for the heads up! Although I felt weird doing it, I just tested myself and it was pretty clearly in the negative zone. My color was lighter than what I got for Rusty so his is definitely in the trace zone.

 

I'm not sure if this is really a 911 but I don't know. Looks like we've moved up to small . This lighting makes it look close to moderate but it's definitely the small. Is this like a get him to the vet NOW kind of thing? He's actually got more of an appetite today but isn't drinking very much. I did another round of 100cc fluids an hour or so ago. Not sure what to do?

EDIT: Just called the local emergency vet and explained the situation. The tech that I talked to consulted with the vet who thought it didn't sound like an emergency situation that I'd need to rush him in for because he's still eating on his own and is acting okay but to monitor him closely tomorrow.

 

I'm not sure what to say about taking him in or not... Keep testing the urine as often as possible. If they go up, I think he has to go in.
Sending healing vines.

 

It's possible the fluids you gave him - if I'm reading your ss right, he's had sub-q tonight - may help to flush the ketones somewhat. The one time Roxi started with trace ketones, we were able to get them back down with sub-q (obviously with agreement and prescription from our vet). It would be worth testing him again as soon as you can...if they're coming down he might well be fine, but if they're still increasing I would definitely take him to the vet. I've always been told to go straight to the vet for anything higher than trace, and our vet knows that I do know how to handle most situations.

 

Just checking-- that reading was taken at around 15 seconds? The colors can darken further over time.

That said, I agree with everything April said-- the subQ is the best thing you could have done, getting some more fluids into him to flush the ketones, but keep a close eye on how things develop.

 

The subQ fluids are very helpful. I still vote for vet attention because I can tell you from direct experience with my guy that they can go downhill fast. Full blown DKA is life threatening and requires several days of very expensive ICU treatment. My opinion ...

 

I second the vote for a vet visit. If it doesn't help, it can't hurt. With him being above trace ketones...it can get bad fast. And cats CAN develop DKA even when eating...

 

Any updates?

 

I'm in my way to the shelter now and will taking him to the vet. My plan was to start him on PZI today. Not sure what to do about his Insulin? Give it? Hold off on the switch? Go forward with the switch? Let the vet do it?

 

I don't think I'd start a new insulin with this going on, but see what the vet's assessment is.

Hope he's doing OK. Ketones are scary.

 

I agree...I'd probably wait on the switch until you've seen the vet and gotten things under control...but ask the vet for advice on that too. Please keep us posted!

 

At the vet now, they are taking him back to take blood and urine. Will keep you updated!

 

Update: His ketones are now at Trace levels. They are sending the blood and urine out to get the full senior work up and I'll have results tomorrow. She felt he was sufficiently hydrated and thought his numbers (I provided the spreadsheet) actually looked good. She thinks anything between 200-300 is okay for a diabetic cat. I told her I'd rather see numbers from 150-200 and she looked at me funny. Lol.

Overall, she didn't feel as though he was nearing DKA. I asked if I should continue fluids and checking urine for ketones, she said it wouldn't hurt. Of course it won't hurt, it will help prevent!

 

I'm so glad you took him in. Better safe than sorry. We all disagree with the vet about a good number range. Keep checking for ketones and giving fluids. Did she address the insulin switch or the dosage?

 

I've still got some major concerns as he has just vomited, is acting nauseous when it comes to food, and at +4 is still 506. He hasn't eaten a thing since last night. I think I'm going to need to force feed now and I'll go search for that link. The vet wanted to keep him on the Humulin N for now (she said 3-4 units) and to not switch it up quite yet.

I've just called the vet to give them the update of the vomiting, continuing to not want to eat, and the continued high BG. I'm not sure what to do at this point. Poor guy

 

Sending healing vines

 

Keep up the ketone testing. You can give subQ fluids and try syringe feeding anything that can be pureed and sucked into a syringe. Adding the vomiting/inappetance to the mix of infection, high BG and "small" ketones earlier makes his situation even more worrying. I hope the vet isn't dismissive.

 

Ketones are now at Moderate and things are getting worse. Back to the emergency vet (a different one might I add). Let's hope this one takes it seriously...

 

Do not take no for an answer at the ER-- "Moderate" ketones are an emergency situation!!!!!!!

 

Make sure the ER vet does the blood test for ketones. Kerones in the urine show up much later than ketones in the blood.

Prayers sent for you

 

Absolutely refuse to take no. Any vet worth their salt should know they need to handle this.

Sending tons of healing vines.

 

Hope this Vet takes it more seriously than the other. More healing vines for Rusty

 

Crossing fingers that this vet takes it very seriously and gets aggressive treatment under way.

 

Sending Healing Vines and Feel Better Vines to Rusty. I hope they can get those ketones down and gone. Fingers crossed.

 

UPDATE: Rusty has been hospitalized and I am MUCH more comfortable with this vet and their office. She's actually a board certified Critical Care Specialist and knew just what to do. She listened to me intently and agreed that this was indeed serious. We will take it day by day and I'll update as I know anything. It's not going to be cheap that's for sure. I was able to get a good chunk of the funds authorized by the higher ups and I'll send out a fundraising email to our donors to try to pull in the rest!

I'm so glad I finally went and just bought the ketone strips at the drug store instead of waiting for them to come from Amazon (who delayed the shipping)!

Thank you all for helping me to recognize the symptoms, advising, and the positive thoughts!

Rusty is a pretty special cat who I've gotten to know and love over the last few weeks. He deserves a chance, I sure hope he pulls through.

 

Glad to hear he is in good hands now . Please give us daily updates if you can!

 

So glad he's getting the help he needs!!

 

I'm very relieved that Rusty is getting the care he needs now. Please keep us posted on his progress.

 

How is Rusty doing today?

 

He's doing "okay" today. Still not eating on his own (they have been syringe feeding) and as of this morning his ketones were still Moderate/Large. No more vomiting. His blood sugar is being kept in the 200's using Humulin R and he's on continuous IV fluids. They are due to test his urine for ketones again about now, so hopefully that shows improvement. They will definitely be keeping him another night at least. His overall bloodwork was "uneventful" and showed pretty normal organ function. She was surprised to see his electrolytes at almost normal levels and his potassium even a tad high. Hopefully we see some more improvement in ketone and appetite soon!

What kind of lasting effect can DKA have on a kitty?

 

Thank goodness you took him in last night and this place actually knows how to treat ketones.

Sending lots more prayers and healing energy

 

They can recover with no lasting effects. However, when he's back home he needs insulin, hydration and calories. You might have to feed higher carb food in order to give high enough insulin doses to keep ketones at bay. If they develop ketones once they can be more prone to do it again.

 

So Rusty will be staying another 24 hours. He's now eating on his own but ketones are at Large. They are switching him to a continued release Insulin because the other just isn't bringing his BG down enough. He'll see an internist tomorrow to talk about a possible ultrasound to see if there is something going on in the abdominal cavity that's causing this insulin resistance. They aren't convinced it's the URI alone. He's shown no symptoms of IBD or Pancreatitis so I'm worried about cancer possibly? Not sure how much more we can afford. This is heartbreaking

 

Come on ketones, you've spent enough time in Rusty! Get out!

 

DKA therapy usually involves the use of fast acting "R" insulin to pull BG down but it doesn't last very long. When you say "continued release" insulin are you referring to Lantus or Levemir? These are known as depot insulins and do have a sort of time release effect. I really hope they can figure it out.

 

Oh dear...I hope they're able to figure out what's going on. Please keep us updated.

 

Poor Rusty... I'm glad he's started eating on his own again already, that is a good sign that he didn't go too far along the DKA road. He is a fighter. Just gotta get rid of those ketones...

 

Thanks for all the support and well wishes everyone!

His appetite is continuing to improve and so is his demeanor. They will do another big blood/electrolyte/ketone test in the morning

@Kris & Teasel I guess I misunderstood what they were saying. So they have just changed the method in which the insulin is being given. He's still getting Humulin R. They were first doing it intramuscular and now will be doing it CRI (continuous rate infusion) which is given through IV and released in continuous small doses...I guess?

I hope for good news in the morning!

 

I understand now. I think that's part of the treatment my guy had when he had his DKA a year ago.

 

Glad to hear his appetite and demeanor are improving! This is such a scary thing, and it's such a relief he's at the vet getting the care he needs!

 

Morning update is a positive one His ketones are gone! He was negative this morning, the CRI worked very well for him. They want to switch him to Lantus, rather than then PZI like we planned. As soon as his BG is high enough, they will give him his first dose of Lantus and keep him another night (in boarding rather than ICU) and keep an eye on what that does to his BG. If all goes well and the ketones are still neg tomorrow, he should come home then!

 

Fantastic news! Make sure to ask them for specific feeding recommendations for post DKA (calories are essential) and many here have recommended going home with both anti nausea meds and an appetite stimulant.

 

Hooray! So glad to see this update! Go Rusty!

 

How is Rusty doing?

 

Well, I'm on my way to pick him up after five days at the vet. They said he's perky, hydrated, eating well, but his BG is still all over the place. They currently have him on 6 u's of Lantus and that isn't keeping his BG from getting into the 700's! This morning he was neg for ketones. They want to dispense the Lantus and the Humulin R (as needed). That will be interesting to figure out...

I think we've decided to hold off on the ultrasound (for $$ purposes) because he's not showing any symptoms for what they usually look for in those (pancreatitis or IBD).

Here we go!

 

Whoo-hoo!

Good luck with the Lantus. Get as many BG tests as you can, particularly in the beginning-- there are a lot of factors at play here. When you get a chance, could you put some notes in your signature about the DKA, the insulin history, and any other important info you can think of? Especially if you start posting in the Lantus forum, where there are lots of folks who won't be familiar with Rusty's story, it will save time and help people help you.

So happy he's doing well (other than the BG's, but one step at a time)!

 

I'm glad Rusty is coming home and negative for ketones Yay!

Please keep the R insulin in a separate container in a separate part of your refrigerator than where you keep your Lantus, and never take the two vials out at the same time. R insulin is very powerful and fast acting, and you never want to get the two insulins mixed up and accidently give the Lantus dose of R. That would most likely be an immediate trip to the ER. I would highly encourage you to have someone with experience in using R from this forum "be with you" help you when/if you start using it. You will need to test every hour for at least the first 4 hours when giving R to see how he does. We usually start with a dose of like 0.1 (1 tenth) to 0.25 (1 quarter) of unit of R and test a lot for it's duration. Hopefully, you'll post in the Lantus forum soon.

 

I'm so glad he's doing better! Yes, - do go to the Lantus forum where the experts can assist.

 

Rusty is doing GREAT today! He's super alert and active. Eating and drinking. his numbers are even looking pretty darn good without the use of R insulin! Because it's important to keep him eating, he's been getting dry food that's grain free but not as low carb as I'd like. He's not super interested in the wet food lately but will go for the dry without issue as of now. I think I'll need to get some of the EVO kitten (because the YA is too expensive, given recent events, lol). I haven't tested for ketones today but I will if I can catch him peeing.

Once I get a chance, I'll update my signature with the details and say hello in the Lantus room! Thank you all again for the thoughts, advice, and support! This is no walk in the park!

 

I get evo from jet.com at a reasonable price.... Esp when I make a big order and the price comes down. The young again lasts a long time. With 5 cats eating it am 8 lb bag lasts 3 weeks. It could easily last 2-3 months with a single cat.