? Urine and ketone tests

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Billy the Kat Parent

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I finally figured out my signature and spreadsheet! Let me know if they look right, and thanks to those who offered help!

So in the whirlwind of stress and research and treatment, I just remembered that the vet requested another urine sample - because the first one got lost in the mail when they sent it to the lab. I don't even know what tests "the lab" runs that the vet doesnt, because they said his kidney was fine and gave him diabetes diagnosis and treatment plan without it. Maybe thats why the vet never said anything about his ketones besides that he had some? But the vet was also a "no need to home test" and "dry food is ok" type, so idk about them. So should we try to schedule an appointment as soon as possible, or get an at-home urine collection kit and try that first? The vet said collecting the urine would be free, but chant HATES car rides and im afraid the stress will mess with his bg. But making him pee on weird litter might be stressful for him or not work.

And good news, his ketone test showed negative!! But i wanna make sure, is it still valid if it may have accidentally touched the litter? Chant's other parent did the test, said he was very offended by it and left the litter box. So we don't want to do another test if we don't have to, especially coz i still get flashbacks from another cats stress induced litter box issues. Especially because they will test his urine anyway

So if he does not have ketones, is it more safe to skip insulin doses? We're very trigger shy, after shooting just a half dose and it made him go moderately hypo. And I still dont really understand ketones anyway, i looked at a few places on the fdmb, and i still havent found what level of ketones is dangerous, or how they relate to insulin or skipping doses. Any explanation or links are welcome, thank you!!
 
Billy the Kat Parent said:
I finally figured out my signature and spreadsheet! Let me know if they look right, and thanks to those who offered help!

So in the whirlwind of stress and research and treatment, I just remembered that the vet requested another urine sample - because the first one got lost in the mail when they sent it to the lab. I don't even know what tests "the lab" runs that the vet doesnt, because they said his kidney was fine and gave him diabetes diagnosis and treatment plan without it. Maybe thats why the vet never said anything about his ketones besides that he had some? But the vet was also a "no need to home test" and "dry food is ok" type, so idk about them. So should we try to schedule an appointment as soon as possible, or get an at-home urine collection kit and try that first? The vet said collecting the urine would be free, but chant HATES car rides and im afraid the stress will mess with his bg. But making him pee on weird litter might be stressful for him or not work.

And good news, his ketone test showed negative!! But i wanna make sure, is it still valid if it may have accidentally touched the litter? Chant's other parent did the test, said he was very offended by it and left the litter box. So we don't want to do another test if we don't have to, especially coz i still get flashbacks from another cats stress induced litter box issues. Especially because they will test his urine anyway

So if he does not have ketones, is it more safe to skip insulin doses? We're very trigger shy, after shooting just a half dose and it made him go moderately hypo. And I still dont really understand ketones anyway, i looked at a few places on the fdmb, and i still havent found what level of ketones is dangerous, or how they relate to insulin or skipping doses. Any explanation or links are welcome, thank you!!
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@Bron and Sheba (GA)
@Wendy&Neko
Previous post intro
https://felinediabetes.com/FDMB/thr...-symptoms-should-i-shoot.295568/#post-3219432

@Billy the Kat Parent
I see you said on your spreadsheet you said vet said he had ketones but didn't say anything about it
I would add that to your signature
 
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I just saw a great video today on how to get your cat used to grabbing a urine sample. It's OK if some litter touched it.
You might not even need an official "at home collection kit". There are other options for litter too, such as washed aquarium gravel or lentils, that do not absorb the pee, allowing you to grab it with a syringe per the video. More tips here: Tips to catch and test a urine sample

Billy the Kat Parent said:
So if he does not have ketones, is it more safe to skip insulin doses? We're very trigger shy, after shooting just a half dose and it made him go moderately hypo.
Click to expand...
I don't see where he went hypo. Normal in a cat can be in the upper 40's as well as those 50's. We just don't want cats on insulin going below 50. We also have doses we call 0.25 units or 0.1 unit that might just nudge him a little lower so he spends more time in normal green numbers. I'd like to see him get rid of those numbers in the 100's.
 
I can’t advise you on skipping doses but do have an opinion of the urine collection question. Many on this forum catch their cats’ urine. I’m in serious awe of them. I’ll bet you can do it if you’ve managed with the stick for ketones. I use no sorb, little black plastic pellets sold by my vet—I was worried my cats would be put off, and having two unrelated male cats anxiety over someone deciding NOT to use the box runs high—but each of them took right to it. My sort of OCD cat mostly was bothered there wasn’t as much litter as usual in the box but not enough to avoid using the box. Chewy sells a version that looks like sand but the urine puddles on top of it. That was my plan B. It’s a LOT easier than dragging them into the office
 
Diane Tyler's Mom GA said:
@Bron and Sheba (GA)
@Wendy&Neko
Previous post intro
https://felinediabetes.com/FDMB/thr...-symptoms-should-i-shoot.295568/#post-3219432

@Billy the Kat Parent
I see you said on your spreadsheet you said vet said he had ketones but didn't say anything about it
I would add that to your signature
Click to expand...
Diane Tyler's Mom GA said:
@Bron and Sheba (GA)
@Wendy&Neko
Previous post intro
https://felinediabetes.com/FDMB/thr...-symptoms-should-i-shoot.295568/#post-3219432

@Billy the Kat Parent
I see you said on your spreadsheet you said vet said he had ketones but didn't say anything about it
I would add that to your signature
Click to expand...
Thanks, will do!
 
Wendy&Neko said:
I just saw a great video today on how to get your cat used to grabbing a urine sample. It's OK if some litter touched it.
You might not even need an official "at home collection kit". There are other options for litter too, such as washed aquarium gravel or lentils, that do not absorb the pee, allowing you to grab it with a syringe per the video. More tips here: Tips to catch and test a urine sample


I don't see where he went hypo. Normal in a cat can be in the upper 40's as well as those 50's. We just don't want cats on insulin going below 50. We also have doses we call 0.25 units or 0.1 unit that might just nudge him a little lower so he spends more time in normal green numbers. I'd like to see him get rid of those numbers in the 100's.
Click to expand...


Thanks, I actually saw that video! I wanted to see if it would work, but his other parent who is in charge of litter box duty says that he squats too Iow. I think we will try a small package of the vet's non absorb litter or lentils

And I'm confused about what counts as hypo, i read on melissa and popcorns sticky about hypos that 40-60 was the moderately low range? And he was having weird symptoms that day both around 100 and 50-60. I know we can't know for sure but do you have a guess as to why he would have had those symptoms while in a range that should be safe?
 
SmallestSparrow said:
I can’t advise you on skipping doses but do have an opinion of the urine collection question. Many on this forum catch their cats’ urine. I’m in serious awe of them. I’ll bet you can do it if you’ve managed with the stick for ketones. I use no sorb, little black plastic pellets sold by my vet—I was worried my cats would be put off, and having two unrelated male cats anxiety over someone deciding NOT to use the box runs high—but each of them took right to it. My sort of OCD cat mostly was bothered there wasn’t as much litter as usual in the box but not enough to avoid using the box. Chewy sells a version that looks like sand but the urine puddles on top of it. That was my plan B. It’s a LOT easier than dragging them into the office
Click to expand...

Thanks, that makes me more confident in trying it! Here's hoping it'll work and we can save him the trip!
 
Is he on prednisilone all the time for his asthma or just for flares? If intermittently do you recall if he’d been on it when diagnosed with diabetes?

im assuming he’s on predisilone rather than Flovent (inhaled steroids) due to cost. (I had serious sticker shock the first inhaler and began to suspect that’s how Methos ended up in the shelter). If so, I’m going to put in a good word for Canadian pharmacies—still not cheap but not heart attack inducing and maybe worth considering —in case a change to inhaled might eventually get him off insulin. (Not a vet, just a suggestion to discuss w vet)
 
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SmallestSparrow said:
Is he on prednisilone all the time for his asthma or just for flares? If intermittently do you recall if he’d been on it when diagnosed with diabetes?

im assuming he’s on predict rather than Flovent (inhaled steroids) due to cost. (I had serious sticker shock the first inhaler and began to suspect that’s how Methos ended up in the shelter). If so, I’m going to put in a good word for Canadian pharmacies—still not cheap but not heart attack inducing and maybe worth considering —in case a change to inhaled might eventually get him off insulin. (Not a vet, just a suggestion to discuss w vet)
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He was on it daily until dx with diabetes and now he's just in it for flares. Yeah i cant afford the inhaler but maybe if it's cheaper, where would i start looking for it in Canadian pharmacies like are there certain websites? And how does the steroid effect if he can get off insulin?
 
Billy the Kat Parent said:
He was on it daily until dx with diabetes and now he's just in it for flares. Yeah i cant afford the inhaler but maybe if it's cheaper, where would i start looking for it in Canadian pharmacies like are there certain websites? And how does the steroid effect if he can get off insulin?
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Just to not hijack this I will send you a pm with info on Canadian pharmacies and I link to the one I used.

Nerd science warning!!! (And if still not clear just tell me and I’ll try a different explanation :) )
When blood sugar rises the pancreas releases insulin that helps the body use the sugar and tells the liver “no more sugar needed” Steroids make the body insulin resistant, meaning there’s insulin present but it doesn’t work as well as it should, so the liver ignores the insulin and the pancreas tries to increase production —just like a drug addict getting tolerant to drug levels this high level of insulin all the time makes the already resistant body even less likely to respond—a bad cycle ensues. I’m not a vet but I think cats are like humans in this regard: some non diabetic humans who are on long term steroid use (for autoimmune disease, asthma, herniated discs etc) can develop diabetes—often it resolves once the steroids are stopped. You still get steroids via the inhaler but at a much lower dose because it’s being delivered straight to the lungs.

the reason steroid do this is they are similar to cortisol, which is produced in the adrenal gland —more is released in response to stress, the purpose being a body under stress (back in the saber toothed tiger days) needed extra glucose (to run from tiger or survive the ice storm etc)—we often see high glucose levels in people who’ve been in accidents, and cats are notorious for having high glucose levels just from a trip to the vet— because the body doesn’t differentiate what kind of stress, it just thinks “ok more glucose needed”
 
Thank you i think i got it that was a great explanation! I alwyas appreciate knowing the science because it helps you remember and you also know it's not just a random opinion, i wish doctors and vets all explained things like this.
 
There is no hard and fast rule for a number that constitutes "hypo." There are cats that have symptoms of hypoglycemia even if their numbers are in the 80s, for example. A lot depends on what your cat's body is used to. There will always be cats that are outliers -- either they have symptoms if their numbers are higher than one would expect or don't have symptoms if in low numbers. My kitty dropped into the 30s and short of sitting and looking at me with a, "Mom, I need food." expression, she was asymptomatic. Your observations are important to guide your decision making.

One point for your consideration. I'm assuming you've read the Prozinc dosing information. If Chant's numbers drop below 90, you should reduce the dose by 0.25u. Given that Chant dropped to 54 on a dose of 0.5u, you could consider a dose of 0.25u.

From having been here for a long time, one thing I've observed is that we are very effective when it comes to warning people about the dangers of hypoglycemia. We're less good at helping people differentiate between low numbers and hypoglycemia. When we refer to hypoglycemia, we're talking about symptomatic hypoglycemia. As an example, with new members, we discourage shooting low numbers (e.g., below 150 - 200). Once you're comfortable with lower numbers, shooting low is fine. I would routinely shoot anything above 50. I was using Lantus and the mantra is, "Shoot low to stay low." This would not be a strategy for some of the other insulins.
 
Billy the Kat Parent said:
Thank you i think i got it that was a great explanation! I alwyas appreciate knowing the science because it helps you remember and you also know it's not just a random opinion, i wish doctors and vets all explained things like this.
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I’m not a vet nor an expert in this like the advisers and moderators around here but fwiw: from what I understand your kitty was on daily steroids for asthma (for some period of time). He was subsequently diagnosed with diabetes and the steroids changed to “as needed” and he’s been off of them. I think I read you’d also moved him to a low carb/wet diet? At any rate since that time he’s had many numbers that are too low for a beginner to shoot (and technically those numbers are in the normal range for a cat—I get that people around here may disagree but just as many protest that their non diabetic cat has BG of 50, I also believe no vet would start an asymptomatic cat on insulin if their routine panel had a BG of 100 or even 150)

I am NOT saying stop insulin. He should stay on it for now (although technically he’s been too low to shoot for about a week it looks like). Stopping or stayin on insulin is for your vet to decide annd it’s important he stay on it until discussed with vet. But I do think it’s worth showing your vet the numbers you are getting now that he’s no longer on steroids and see if he thinks at some point the insulin need should be readdressed,
with the question of whether his diabetes was caused by his chronic steroid use and if so when a trial off insulin would be advised.
 
The moderators aren't vets either!!

I do agree that a vet is unlikely to. start a cat that is in normal range numbers or has a normal fructosamin on insulin. We do have a protocol for tapering down insulin as a means of ensuring a cat is in a solid remission. In addition, it's not abnormal for a cat that may have experienced a steroid induced diabetes to go into remission quickly once the steroids are discontinued and a low carb diet is in place.
 
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