Ketones Keep Rising!!!

[pablo'smom]

I’m finally starting to see decreases in Pablo’s BG but his ketones have started going up again. He was 0.1 mmol/L on Thursday afternoon then 0.3 yesterday after and now this morning about 14 hours later he is 0.6 using KetoBM blood meter. I’m not sure what to do and I’m terrified he’s going to go DKA again. He is finally eating normal and his stool has improved (not back to normal but not liquid diarrhea). He is only allowed FF pate split into 2 meals both right before his insulin. For the last 24 hours his BG has been below 300 when we were consistently sitting in the 300s. Is there anything I can do to get the ketones to go back down? I’m so worried.

 

[Sienne and Gabby (GA)]

One thing you can do is to add water to his food. If he's still experiencing loose stool, he's likely dehydrated so additional water, low sodium broth, etc. will help. Water helps to dilute ketones.

I would also feed Pablo as much as he wants and as often as he wants to eat. It is not necessary to feed a diabetic only twice a day. Most of us feed our cats several small meals. With a cat that's prone to ketones, you want to increase the amount of calories they are consuming. Pablo should be getting roughly 1.5 times the amount he was typically eating pre-DKA.

S. boulardii is a probiotic that is wonderful for dealing with diarrhea. You would add 1/3 of a capsule to Pablo's food.

 

[pablo'smom]

I have been giving him probiotic and it’s helping his stool a ton. It’s finally having shape and he is only going once a day instead of multiple episodes. His vet has me giving him protein throughout the day (bland chicken or turkey breast) to get calories and protein in with no carbs. Hopefully tomorrow his levels are better. He has been drinking water and peeing but I’ll try to get more fluids in him. Also we are going to do 1.5 units of insulin now.

 

[SmallestSparrow]

I understand your concern (I have ketone anxiety and worry over evey test and Methos hasnt had DKA. So good for you testing and if you follow the good advice of @Sienne and Gabby (GA) you are on the right track: fluids food and insulin all are key.
That said, ketone meters have limits in accuracy. I found this for yours (I think):
https://keto-mojo.com/help-docs/tips-for-glucose-ketone-testing-accuracy/

Because these meters are designed to roughly show risk, the lower numbers have a wide variance in accuracy. For numbers below 2.0, the “real” lab number is within 0.3mmol 90% of the time, and within 0.5mmol 100% of the time.

I know. I was shocked at similar results for the Precision Xtra. I still test. I still worry. But fwiw 0.1 could really be as high as 0.4 or 0.6, while 0.6 could be really as low as 0.1 according to mojo’s accuracy info. Do I still freak out at 0.6? Yep, and I feed him xtra and push fluids. But I also reassure myself numbers that low are reminders to be vigilant but aren’t a reason to panic (yet)

edit: read the link. Besides accuracy data it lists things that can falsely alter results. Good luck !

 

[SmallestSparrow]

I’m also going to say Methos’ results can vary a lot even in a day. I know if I test first thing in the am before insulin, esp if amps is high his ketones will be higher than if I test closer to nadir or even just at +2 after he’s had some food and water. YMMV of course. I can’t help myself and will test if BG is high even knowing I will freak out. But sometimes I just wait to later in the day so I’m less stressed.