Ketotic smell

Hello all,

My diabetic kitty Ephalba has been stabilized on 1 unit PZI once per day for a couple months now. She (and all my other cats to the woe of my bank account) eat only grain-free Wellness. Her blood sugars have been consistently been 215-230 before her evening shot and I have not done a bg curve (testing is pretty traumatic on her and me and I haven't gotten up the courage). Right now she has a fairly strong acetone smell on her breath but it's the only symptom of ketosis I've seen. Her appetite is excellent, she's cleaning herself, usual activity level and no noticeable recent weight loss. I did miss her shot last night because I got distracted and then fell asleep on the couch. :YMSIGH: I am of course out of test strips but I'm going to get more this afternoon so I can't test right this moment but likely within the next couple hours. Will ketosis reflect in bg readings anyway? She had the same smell on her breath a few weeks ago and I called the emergency vet but they said not to worry if it was the only symptom I was seeing. Since it's happened again, I thought I'd post here and ask the collective experts. Thoughts?

much thanks,

Nicole

**edited to undo 911 tag, emergency over!

 

It may or may not show in the BG's. However, this is something to be concerned with and you need to deal with so that it doesn't become full blown DKA,

Typically fluids need to be administered via an IV drip, if you are not set up for that, then I suggest you contact an ER vet, tell them what is going on and see if they will help you with your cat.

Once you learn how to administer fluids yourself, you most likely can take care of this on your own, however, until you know how to do this, you need to get your cat treated as soon as possible. Especially as this is not the first time you are smelling the acetone.

Additionally, only giving insulin once a day (Even PZI) is typically not enough for the cat. Most cats require insulin twice a day (BID) and the numbers you are averaging 215-230 is high enough to warrant insulin BID.

And you really must learn to home test and get over the fear that you will hurt the cat.

Please contact the vet now about your cat.

 

Hi Nicole,
I'm not usually an alarmist type but I don't know why anyone would tell you not to worry about an acetone smell on your cat's breath.
I have a ketone prone kitty and when I DO smell acetone, that's when I know that I SHOULD start to worry.

You need to have either ketostix or ketodiastix and you need to do a urine test on your cat. If there are anything above trace ketones you need to get your cat to a vet. You know all of the proper terms(ie ketotic, ketosis;etc) so this leads me to believe that you know how serious this can be. The bg may or may not reflect the status of ketone activity so that's why you need the ketostix. Most cats don't get ketones if bg is below 300 but there are some who do so you can't go by bg.

If you smell acetone , there is some ketone activity and that really is the bottom line. Ketones require Insulin and fluids, and food, the amount which can only be determined by a vet professional.

If you haven't gotten the stix yet, please do so and let us know what the reading is. better yet, if it's higher than trace call a vet and keep us informed on what's going on.

 

Thanks to both of you for the input. I talked to the emergency vet and they still feel she does not need to come in. The vet thought it was likely her insulin needed to be increased to twice a day and said I should call my regular vet tomorrow and take her in. I checked her bg and it was at 230 so I fed her a bit and gave her 1u. I'll check again in an hour and a couple more times tonight. They told me to bring her in if there is any lethargy or she doesn't eat, etc.

Caryl, I've thought about doing the urine test, but I have five cats and I'm not sure how I'd manage it. I wish there was a way to check for ketones that didn't involve urine. I suppose I could have a special box for it and lock Ephalba in the bathroom and wear earplugs!

Hillary, I'm not afraid of hurting her but she is so wiggly and has tried to bite me so it's not the easiest thing to do. She also bleeds A LOT most of the time even if I apply pressure for while. I have to test alone in the morning (husband is around at night test) and I just can't manage it on my own. I'm determined not to give up though!

 

There is a meter that has strips both for glucose and ketones. It is the Precision Xtra meter. Here is one link for it:
http://www.amazon.com/Precision-Xtra-Bl ... B001EL30TM

 

Okay, hour after eating and shot bg is down to 173. Acetone smell not as strong, but still there. I'm going to keep checking and take her to the vet when they open at 7:30 tomorrow.

 

I'd never heard of these--the strips are really expensive, but it would be a good option for periodic testing. Thanks!

 

If she's down to 173 I'm sure it's not serious also but it's always better to err on the side of caution, know what I mean. Just call your vet in the morning The acetone smell will probably be gone if she keeps going down as it the ketones take longer to leave the body than to h\get there. If you can, try to syringe water into her mouth,that should help.

I have the precision xtra for when I just can't get urine and have gotten boxes of 10 strips for as little as 22.00 on ebay. that little meter does come in handy!

Good luck, Nicole!

 

I ended up taking her to the vet because I just didn't want to worry--it would have kept me up all night. Her ketones at the vet were +1, so not in the danger range, but they gave her IV fluids to make sure she was stabilized. I guess peace of mind had a $193 price tag tonight :smile:

I'm definitely getting the meter that reads ketones because it could save me a lot of money and stress. Makes me wonder why the acetone smell was SO strong though and her ketones weren't higher though.

 

Hi Niki, I'm glad you took her in. Are you going to see the regular vet tomorrow? I hope all is well for you both, but the only time I can smell the acetone is when my cat has DKA. The bottom line is you never want to smell the ketones, ever. Please keep us posted but you will need to check her again in the morning.

Best,
Pam & Layla

 

Glad you did go...Like I said, I can usually smell acetone before there is anything to really worry about. When the Precision xtra meter is reading 0.3 I can sometimes smell it. I consider those of us that can smell it early very lucky...right? So we shouldn't take it lightly.

Again, Glad you went, and the meter is great to have around when you need to get a reading in a pinch :razz:

Caryl

 

That 193 may have saved you 1500 and a very sick cat. I'm SOOO glad you took her in! I'm also glad you are going to twice day shots. She sounds very easily prone to ketones. I think you will really need to keep an eye out on her.

 

Ephalba went to the vet today and they did a fructosamine test on her to get a picture of her bg for the past couple of weeks. I'd not heard of the test before the vet so hopefully it's actually useful and not a waste of money! I'm also going to do a curve this weekend so between those two pieces of info we should have a pretty good idea if we need to adjust her dose but I'm thinking it's likely. No ketone smell today, so that's good news, and she's gained 1/4 lb in two months, so I'm happy for that as well!

 

So how about determining the root cause of the ketones so your cat doesn't get REALLY sick one of these times?

 

If you're not doing it already you should try mixing small quantities of water in with all of her moist food. We always mix at least a spoonfull or two of water in Yittle's moist food - depending on your cat's preference you can go for smooth puree - soup textured. We usually aim for chili textured here - soft puree with a few chunks because thats what Yittle prefers. The added moisture will help keep the cat hydrated and help with ketones.

 

Just catching up and glad that you have things under control and are getting a better understanding of what's going on.

Yes, that $193 was well worth it. Going forward, if it happens again, depending on severity of course, you very well may be able to handle this at home, you just need to be supplied to do that. The regular vet can provide the sub q fluids and instructions.

I asked Caryl to post here as she has a ketone prone cat and knows that smell and has handled this several times for Alex. So, feel free to reach out to her for more information about home treatment, etc.

Glad that you are now insulin dosing twice a day as that is really important for cats - unlike humans they need insulin more often.

So what else can we help you with?

 

So, I got the fructosamine results back and it was 471. Vet said that indicated the diabetes is being managed well, but my research is showing the number should be below 400. Any thoughts on this?

To clarify, I'm not currently shooting twice a day, only 1u at night--the vet felt the result was good and wanted to wait until after the curve before making any changes. I'm a bit nervous about this because my instinct says to add 1 unit in the morning, but I don't want to end up with a hypo kitty either. What complicates matters is that it's pretty tough to get morning numbers too since it's just me and my dear sweet cat won't hold still for me enough to do it. When we do manage morning numbers on the weekend when my husband can hold her, they are usually right around 200, often between 175-200. Evening number have been reliably 215-230.

I'm doing a curve on Saturday. I think I have the general principles . . . do our usual morning routine, then test every two hours for at least 12 hours. Is that right?

Thanks again for the support--I'm feeling braver lately in dealing with all this and it's starting to feel more manageable. I'm also feeling a bit more positive about the diabetes diagnosis. While we were feeding high quality for dry (Wellness regular and core), four out of five kitties are now on low carb wet (working on the 5th but she is uber stubborn!) and I feel fortunate that we made a change while our cats are relatively young. It might sound a bit sappy, but Ephalba's sacrifice could have saved the rest of our herd from lots of health issues.

 

I'm glad you are feeling more in control.

Regarding a curve - see the link that provides information on how to do a curve and what you are looking for. Curve information

While this link is geared toward lantus and you are using PZI - the information about curve is the same regardless of insulin.

I'm not a PZI user so cannot offer advice whether you should add a second daily shot. I suggest that you visit the PZI forum PZI Forum

and post there about your question.

What I can tell you is that generally speaking, cats need insulin every 12 hours, as they metabolize it faster than humans.

OOOOH I sure know about stubborn cats holding out for dry food. I too used high quality dry food and when I switched to wet - Maui learned to eat it, but my other two, would refuse to eat at all if I didn't give them kibbles.

You may want to read Dr. Lisa's page on transitioning cats from dry to wet - she offers several tips and suggestions on how to do it that may be helpful for you:

http://www.catinfo.org