Was frustrated, now is ketones have spiked! in over my head!

had posted this under frustrated could you view SS but I now have a bigger worry!
This morning Payne tested small on the urine ketone strips, where she had none for two weeks.

Her AM pre-shot BG 247 and at +7 257 (3 u ProZinc 1 u Novolin R bid )but on the ketone monitor
her ketones have popped!
We figured her baseline on the monitor was 1.5 (healthy,showing no signs on test strips) but
taken at +7 her # was 3.8. She seems okay, usually when she runs high her eyes get glassy but
are not. Is the monitor telling me where she is going? and that will show up in the strips
later?

When she had an attack 2 wks. ago we gave her SubQ's and 1 unit Novolin, which turned her
around, what should I do? I have a call into vet but this is Davis She doesn't seem
dehydrated at all. I can't seem to get ahead of all this .....
Nancy and Payne

 

Re: Was frustrated, now is ketones have spiked! in over my h

Probably time to get to an ER vet. My cat had DKA last year. With keytones that high I wouldn't try to treat this at home. Some other readers may have some suggestions but this sounds like an emergency. Sending good wishes and purrs!

 

Re: Was frustrated, now is ketones have spiked! in over my h

The ketone strips aren't old are they? If they're too old, that could cause a false reading (over 30-60 days old, opened I believe). If they're not old, and it's showing ketones, I'd try to get ahold of a vet ASAP.. regular or ER vet. Ketones can turn ugly very fast. :sad:

 

Re: Was frustrated, now is ketones have spiked! in over my h

I agree with the others, ketones can definitely turn ugly quick. I'd be heading to an ER vet if possible.

 

Re: Was frustrated, now is ketones have spiked! in over my h

I just got ahold of Carolyn & Spot, and she really thinks you need to head to the ER Nancy.. Hoping you're already on your way!

 

Re: Was frustrated, now is ketones have spiked! in over my h

Carolyn's @ the store right now, so can't check in here.. but she says she definitely thinks you need to head to the ER (if you haven't already!) & is also concerned about the efficacy of your PZI.

 

Re: Was frustrated, now is ketones have spiked! in over my h

I talked to the vet and he said to give her 1u Novolin, that was an hour ago and her
ketones are dropping fast ..... what causes this? nothing has changed. It hits like a
bolt out of nowhere!

Thank God for this list that has taught me testing, testing, testing, you are really kind
people to help newbies chart these waters. This is the second time we have been able to
help her at home, if only I had known all this the first three times, maybe she
wouldn't have gone into DKA 3X.

But we have made progress and I am looking forward to what you will teach me in the
future, thanks!
Nancy and Payne (feeling better)

 

Re: Was frustrated, now is ketones have spiked! in over my h

Oh good, Nancy, I'm glad you talked to the vet. I do agree thought that the ER may end up fast being the best place for her for the very reason you gave - it's come on fast out of nowhere.

I'm sorry that you guys are having to deal with this but really glad that she has you and that you found this place.

 

Re: Was frustrated, now is ketones have spiked! in over my h

Ketones can come on really fast from what I have read. Sometimes they seem to just need more insulin - it may be that with her #s creeping up on this PZI dose, she got ahead of it and the ketones came back. From what I have seen, if you aren't hitting blue #s on a PZI dose, often it seems like their insulin needs go up, like they get stuck in the higher #s and need more insulin over time to keep compensating (someone made the analogy somewhere that it's like a drug addiction - they keep needing more to get the same effect).

As I understand it (no ketone expertise, just from what I have read on the board), ketones come from some combination of too little insulin, not eating enough, and infection. And maybe some predisposition to getting them (? not sure).

Anyhow, hopefully others can help you understand it better. There is some info on it I think in the Pet Diabetes Wiki if you haven't already read all that.

Glad she is doing better! Did they tell you what to do from here to stay on top of the #s? Hopefully some peeps can help you figure out the doses/timing to get more insulin in her safely, moving forward.

((((hugs))))

 

Re: Was frustrated, now is ketones have spiked! in over my h

Nancy, I have a very ketone prone kitty(I have seen ketones more times in the last year than I care to remember) and the same thing happens to me with the meter. I don't like the meter. Everyone seems to thinks it's wonderful but I only use it to see IF Alex has ketones. I was sent a second meter by Abbott because i thought mine was broken because I did side by side tests with the meter and urine sticks and the meter read 4.0 and the sticks read trace. With the new meter as well. Then the numbers went down very quickly on the meter but were still trace on the sticks. There is something not right about that.

And you are thinking what I am...if 1.5 indicates trouble...and your kitty had 3.8, he really shouldn't have been able to walk...should he have? Same with Alex. With a reading of 4.0, actually he should have been in DKA but he wasn't. He was fine. I don't trust the meter, and in my opinion I don't think it works so well for cats. I was going to discuss this with Abbott but I think they would have hung up on me! I would rather stick a ketodiastick in litter that was freshly urinated on for an accurate reading.

I take ketones very seriously and I have seen my cat very sick from them. I have done a ton of research on this as well. If your cat is showing trace to small amounts of ketones and is acting fine...there really is no need to panic. As long as he is eating, getting insulin and if you can give subQ fluids, trace-small ketones should flush out pretty fast. UNLESS there is something else wrong (ie infection, etc). On the other hand, if your kitty is acting like he doesn't feel well, not eating and or vomiting..you need to get to a vet when ketones are present.

Again, I will repeat that ketones can be very serious...but they aren't always. I say if the stick says trace, it's trace. Don't panic if it's not darker pink or purple, but start treating for ketones immediately.

Hope this helped a little ....

 

Re: Was frustrated, now is ketones have spiked! in over my h

I thought the discrepancy between a blood reading and urine stick reading is that ketones show up in the blood before in the urine, which potentially has a several-hour delay? So in theory that would make the blood reading more accurate than the urine - urine might show trace even if the ketones have actually spiked, just due to timing of urine production? And conversely the urine reading could be high even once the ketones are resolved, as they would be residual I would think for a while in the urine even if they are out of the blood system...? Meaning that overall the urine reading would be less accurate.

I don't have direct ketone experience, so just commenting on what I have read combined with what makes sense to me. Of course if the meters are faulty, that's something different. Hope they gave you your money back if that is the case!!!

 

Re: Was frustrated, now is ketones have spiked! in over my h

I know...I've read it too. And that may well be true. But we ALWAYS have to take into consideration that these meters were not designed for kitties. If they say in the insert that 1.5 is when you should start being concerned, and Nancy is getting readings of 3.8, and I had 4.0. THAT'S HIGH!!!! our cats should have been VERY sick. Not once has Alex ever turned even deep pink when he had one of those readings so no, it hasn't been a sign of what was to come.

I can't explain it, I can only tell you about my experience with it about 12 times in the last year. And that's what made me start relying more on the stix again. Another thing is that it takes a while for ketones to leave the body. When Alex has been DKA, seriously sick, the stix have remained darkish for a day or two after he started to feel better and the subq's were still needed to flush them out. How is it possible that with a shot of insulin blood ketones go from 380 to 105 in 2 hours? If they are there ...they don't go away that fast. Certainly not that high a number.....

 

Re: Was frustrated, now is ketones have spiked! in over my h

Exactly. There are other people on the board w/ very ketone-prone kitties and they rely heavily on the Precision Xtra. Sharyn/Fiona is the one with the most experience (that I know of) - I'll send her a PM and see if she'll stop in.

 

Re: Was frustrated, now is ketones have spiked! in over my h

I see Sharyn posted to you on a previous thread. She's been around here for several years and is very trustworthy. She also has a lot of experience with R. Here is the information she posted to someone else: viewtopic.php?f=9&t=30967&p=320400#p320400

 

Re: Was frustrated, now is ketones have spiked! in over my h

Thanks Heather, as opposed to me being untrustworthy. And with no experience with ketones? Is that what you're trying to say? I wish I had no experience with ketones....

Why don't you explain why the ketones( which were so high on the meter) went down so quickly when it takes a long time for them to leave the body and they leave via the urine but they never showed up in the urine????

And by the way.Carolyn(&Spot) asked me to come post on this thread...I didn't even know about it. Just so you know that some people do think my opinion is valuable.

 

Re: Was frustrated, now is ketones have spiked! in over my h

Sharyn AKA as the Precision Xtra Queen on the old board. ;-)

In my experience of using Precision Xtra 3+ years, sometimes at 3-4 times a day, it is more accurate that urine strips. The first test I did on Fiona showed 7.6, urine strip showed none because she had been on IV fluids at ER. Blood is real time, urine is possible hours old. At 7.6 Fiona was walking, eating, etc... She wasn't that sick.

When she gets to 3.0, I start using R if needed and pump her full of fluids either via tuna juice. Continuing to eat is very important. Even if she doesn't seem dehydrated, fluids help flush the ketones out of her system. On Fiona, she doesn't show on ketone positive on urine test strips until she gets to 3.0 on PXtra.

Ketones would drop as soon as Fiona would go below 250. The lower and longer she stay below 250, the lower the ketones would get. I don't know what "from 380 to 105" that Caryl mentioned means so I can't explain it. Sometimes if she had an infection we had to go lower than 250 to see a ketone decrease.

If you look at our ss from Aug 2008 forward you can see ketone (BBK) readings in the Remarks section. On 8/29/08, she went from BBK 5.8 to .09 within hours. Since she kept eating we treated her at home.
https://spreadsheets.google.com/ccc?key=0AspCGYp5HCuNcFNjb2pMWnRva1E3dm9QSllsS2llQXc&hl=en

Normal for cats is 0.0-0.6. I collected data from PXtra users on the old board. Fiona's normal is 0.1. I don't believer that 1.5 would be Payne's baseline. That's a little high so something is going on. 1.0 has me testing at least once a day and keeping a close eye on the ketones.

I completely trust the PXtra and it gave me my life back because I could test anytime. Fiona was very ketone prone at the beginning. You'll see by our ss, that I was a testing fiend (primarily because I had no data). Hope this helps.

Don't forget Fiona has IAA, so when you see ridiculous amounts of R later in the year that because of her condition.

 

Re: Was frustrated, now is ketones have spiked! in over my h

I meant to say 1.5. as a random number. Nancy said that the meter registered 3.8 and shortly after giving R the ketone number went all the way down(I just picked 1.5). And the urine strip showed nothing. I have had that happen to me too many times to be comfortable. How can I get a trace reading on a urine strip and a 4.0 on this meter and never see it go higher on the urine strip? What exactly does that 4.0 mean? Alex wasn't acting sick. He was eating. Within a few hours his reading was down to 1.6 or something like that....was not a precursor of things to come. I reacted the way that Nancy did when I first saw that. Well I wasn't upset..just confused. Then it happened again and again. So I just don't have any idea what the numbers mean. Does it mean that 4.0 is trace for Alex? Or somewhere in that area. Because I've also tested him and gotten 0.0 when he was totally negative.

This is all just MY opinion..that it's easier to use a strip. When all is said and done, we're talking about a matter of hours difference and if kitty has ketones they're going to show up on the strip as well. Heather just likes commenting every time I say I don't like it. I make a comment, I know she won't be far behind. But I'm allowed not to like it. I didn't say "Don't use it". I'm allowed to prefer seeing what's always been the standard way of testing for ketones. I'm secure with that. Like I said...I use the meter to see IF Alex has ketones...but not to what degree since I can't figure it out. I'd still be curious to know how a cat can have ketones that didn't show up on a ketone strip (like with Nancy's cat tonight)..how can that be possible?

 

Re: Was frustrated, now is ketones have spiked! in over my h

Sorry Caryl - "trustworthy" was probably a poor choice of words. "More experienced" might have been a better choice - you've been doing this for about a year now; Sharyn has been doing it for several years. Additionally, Sharyn has tracked the blood ketone readings for several cats on this board in an attempt to better understand those measurements - the only person I trust more than Sharyn on ketones is jojo.

I do think your reasoning about measuring blood ketones vs urine ketones if faulty, and that is why I I state my opinion on this every time you state your opinion.

My understanding...
Blood is real time...it's circulating through your body. If you measure ketones (or glucose), what you see is what's actually happening. Urine is a waste product - it's been put in the "trashcan" of the body (bladder) and it's just sitting there waiting for a trip to the litter box. That trip to the litter box may be hours later so it's very possible that blood reads high and urine reads nothing (because it hasn't made it through the kidneys yet) or blood reads nothing and urine reads high (because you've brought down the bgs and cat is actually safe, but the urine hasn't been excreted yet). The blood is the "real" measurement; urine is the measurement that has built up over several hours. I assume kidneys make urine on a somewhat continual basis...therefore, urine ketone levels would be "an average" of all the urine produced over the time that it's produced; additionally, when you stuff them with fluids, you would be diluting the urine ketone measurements).

You've done a good job in managing Alex's ketones over this past year. You've done a great job at keeping him out of trouble. You're advice on what to do when ketones are present is sound. But, saying that urine ketone measurements is more accurate or even as good as blood ketones measurements is the same as saying urine glucose measurements are just as good as blood glucose measurements (and we would NEVER tell somebody that). While you've certainly learned to deal with "old data" I just don't think you can say it's as accurate.

My opinion.

 

Re: Was frustrated, now is ketones have spiked! in over my h

 

Re: Was frustrated, now is ketones have spiked! in over my h

Thank you, Heather but I've done a GREAT job in managing Alex's ketones. I learned a LOT from Carolyn and even more from Alex when it comes to ketones. When Carolyn started helping me she insisted that I test with strips only and that is the truth. I think that when you have dealt with ketones as many times as i have you learn to know 'accurate' pretty quickly. One year for me, two years for Sharyn..I'm still dealing with them...does it really matter who started first? I'm sure that Sharyn understands the value of the meter..I don't get it. I know instinctively (not by readings of either the meter or the stix) that my cat is in ketosis before I use either one MOST of the time. Data counts for a lot..but not everything. And your analogy is not a good one. MOST people still do use ketostix for themselves and their pets, they don't use urine glucose measurements for diabetes(except some people for their pets) which I agree would be inaccurate. However, they would both show a person to have diabetes. The number system on the ketone meter is very confusing. I don't mind if you want to discredit everything I say but I have a cat that throws ketones when you look at him the wrong way and he is doing very very well (thank GOD). I came on this thread because Carolyn asked me to. She knows that I know what I'm doing. I know how to help someone who's dealing with this. But if every time I try, I'm going to be embarrassed..and made to feel like someone else can do it better...then I guess there's no point in my even trying.

When I understand how the blood ketone numbers work, I'll recommend it. beige, pink , magenta and purple I understand.

 

Re: Was frustrated, now is ketones have spiked! in over my h

I'm not sure what happened today with Payne's ketones, that is to figure out tomorrow.
But I would like to thank EVERYONE, regardless of what side of the monitor/strip coin you
fall on .... you gave us your time and your life experience opinions, that makes me feel
very blessed.

Speaking of blessed, right now Payne is sprawled out on my older boy's bed,
as far out as she can go
and like my child, he is all to the side almost falling off! I should take a picture. But you
have all helped us get her to this point. A cat that has had DKA 3X in 7 wks. and even
though it started today, we were able to keep her home, sleeping in a bed. But believe
me, had she showed ANY signs of high Ketones we would have been in emergency.

To Sharyn, thank you for coming over and giving me your opinions. I hope you will
continue to be there for us newbies. (can't remember the last time I was a newbie??)
We newbies ....
need everyone's experiences, regardless of where you are coming from. Sometimes we
hear information and it makes no sense but someone else explains it and CLICK, we
are there. So I value you ALL, stay and teach me. (even if you want to bicker
Nancy and Payne (if a cat could smile

 

Re: Was frustrated, now is ketones have spiked! in over my h

Morning Nancy, glad to see you are still reading between the lines to get the info you need. ;-) I did in fact send Caryl last night, i thought you would like to speak with an active member who had a very ketone prone cat. Caryl has an unusual talent, she can actually smell the ketones, which is extremely rare. I do not know when this became a ketone competition, but I would consider anyone with actual persistent ketone situations to be quite experienced, and as we all know, much can be learned from differing tx approaches.

Now since Payne is back to throwing ketones I want to make sure you saw what I said yesterday about your basal insulin dose... The R use is no substitute for the basal insulin. Its only a tool to aid in removal of ketones. Please talk to your vet about the prozinc dose, it's too low if the ketones are back.
((((hugs))))
..C

 

Re: Was frustrated, now is ketones have spiked! in over my h

Using a longer acting insulin (basal insulin) and a shorter acting insulin to more rapidly reduce BG is used to manage human diabetics who are prone to keytones or BG spikes. Lantus and levemir are long acting insulins. Humulin R is short acting and is usually used only when BG is over a certain number. In humans they usually have a sliding scale that determines how much short or mid acting insulin based on the BG level. This can also be applied to cats as I see several board members do use both types of insulin.

I just wanted to clarify to some other readers that using a multiple insulin system is more complex. I just didn't want any readers to get the idea they can give their cat extra lantus or levemir and treat keytones or DKA themselves. If my cat starts throwing keytones I would not try to treat it my self. When human patients have keytones over a trace level, they are sent to the ER as a precaution.

I would agree that blood measures are more accurate than urine strips. I don't have any experience with the meter you are discussing so I really can't comment on it. However keytones are keytones wether it was prodced by a human, cat or dog. So it shouldn't matter. The meter should read the levels the same. Wether that particular meter is reliable or not is a question I can't answer.

This is a good example that each cat is different and sometimes things can change rapidly esp. dealing with keytones. When my cat was first diagnosed I wanted to do a dual insulin system because I was concerned high BG would trigger keytones. I got resistance from my vet (naturally) and when I mentioned it once on this forum I also got some crticism because it was outside the standard twice a day longer acting insulin Tx advocated here.

The good news is that Nomad has not had any keytones. For eight months. Infections can also trigger a crisis. Hopefully Payne will stabilize like Nomad did. The first four months I had him I felt like I was subsidizing my vet hospital. LOL

 

Re: Was frustrated, now is ketones have spiked! in over my h

"In conditions associated with acidosis, urinary ketones are tested to assess the severity of acidosis and to monitor treatment response. Urine ketones appear before there is any significant increase in blood ketones;[2] therefore, urine ketone measurement is especially helpful in emergency situations" http://en.wikipedia.org/wiki/Ketonuria

"Acid-base balance is critical for maintaining the narrow pH range that is required for various enzyme systems to function optimally in the body.4 Normal blood pH ranges from 7.3-7.4."

Mishka is ketone prone and has had DKA several times, especially when I first adopted her 7 years ago. Mishka can also throw ketones ranging from trace to max and still act fine, no vomiting, eating and playing well, and then come back up negative. If she doesn't eat, she goes to ER and I don't even bother with the testing. She goes! The first thing I want to know is her blood pH which will tell me whether she is in true DKA or just throwing ketones. Having ketones does not mean DKA.

"At low levels, ketones can be detected in the urine (ketonuria) before they are found in the blood (ketonemia/ketonaemia)[37]."
http://petdiabetes.wikia.com/wiki/Ketoacidosis

I test Mishka's urine only. I keep a ladle and plastic cups handy and catch the "liquid gold" as I call it every chance I get. She is also more apt to show problems in the 100's, never high numbers. She has never ever even hit the 400's in the years I've had her. Other than one time where she did end up with Acute Pancreatitis, no reason has ever been found as to the reasons why. No URI, no UTI, dentals are done every 6 months because of FORL. When I first adopted her I understood the reasons for DKA....weight loss of 10 1/2lbs. (obesity) before I got her, vaccinated 3 days before I got her, never started on insulin before I got her and those first 3 months were a battle. She is my 4th diabetic, Vinnie is my 5th, and out of the 5 I've had, the only one that has ever thrown ketones. I truly believe some cats, no matter how high, will just never throw them, and some cats, even with good numbers will throw them.

Ketone bodies are three water-soluble compounds that are produced as by-products when fatty acids are broken down for energy in the liver and kidney. They are used as a source of energy in the heart and brain. In the brain, they are a vital source of energy during fasting.

The three ketone bodies are acetone, acetoacetic acid, and beta-hydroxybutyric acid, although beta-hydroxybutyric acid is not technically a ketone but a carboxylic acid. (The Precision only tests for beta-hydroxybutyric acid)


Ketone bodies are produced from acetyl-CoA (see ketogenesis) mainly in the mitochondrial matrix of liver cells when carbohydrates are so scarce that energy must be obtained from breaking down fatty acids.

Acetone is formed from spontaneous decarboxylation of acetoacetate. In a corresponding manner, the levels of acetone are much lower than those of the other two types of ketone bodies. And, unlike the other two, acetone cannot be converted back to acetyl-CoA, so it is excreted in the urine and exhaled (it can be exhaled readily because it has a high vapor pressure and thus evaporates easily). The exhalation of acetone is responsible for the characteristic "fruity" odour of the breath of persons in ketotic states.


Ketosis and ketoacidosis
Any production of these compounds is called ketogenesis, and this is necessary in small amounts.

But, when excess ketone bodies accumulate, this abnormal (but not necessarily harmful) state is called ketoacidosis. Ketoacidosis can be quantified by sampling the patient's exhaled air, and testing for acetone by gas chromatography.[1]

When even larger amounts of ketone bodies accumulate such that the body's pH is lowered to dangerously acidic levels, this state is called ketoacidosis.

 

Re: Was frustrated, now is ketones have spiked! in over my h

That's exactly how I treat Alex...except that I can smell when he has them 98% of the times which, although I HATE it when my cat smells like a bottle of nail polish remover, it is a big help. If he is not eating..he needs more help than I can give him, and there is a difference between ketosis and DKA.

 

Re: Was frustrated, now is ketones have spiked! in over my h

Wow, what an awesomely helpful post Hope, thank you so much!

 

Re: Was frustrated, now is ketones have spiked! in over my h

I agree Carolyn. It's what I was taught. It explains the process perfectly. While everyone thinks that ketones all show up in the blood faster, low amounts actually show up in the urine faster (but I didn't want to say that last night). And that's when we really want to catch them..at low amounts.

Before you can successfully treat ketones you have to understand them and this post IS excellent! Thanks again, Hope :razz:

 

Re: Was frustrated, now is ketones have spiked! in over my h

Thanks for the reality check Hope. It really helps to have the actual info/sources. Turns out my understanding/logic was wrong, so I'm really glad to have that corrected!

On a board note, it is really rewarding to see tension evolve into calm discussion and statements that clarify the facts. Kudos to everyone here for clarifying your viewpoints and keeping it from turning into a locked thread. It warms my heart. :YMHUG:

 

Re: Was frustrated, now is ketones have spiked! in over my h

This has been a VERY helpful discussion!!!
Today is a good day for Payne, she is active and
more on top of things. We were unable to get a urine strip yet today, although the whole
family has been on litter box duty! The only reason I got the ketone monitor was for days
like today, (she is shy in box) just as a backup.

We just tested her blood and her BG was 232 +4 and the ketone monitor was 0.5 which
means her base is lower than we thought. (remember we JUST got the monitor)

I don't have the ability to smell ketones, not sure if I would want? but I can tell in a
second by her eyes. I will try to get her picture up but one thing at a time, she has
the biggest eyes.

I still need eyes on my SS, she was on ProZinc 45 days Thanksgiving but is still on pred &
tylosin, which I think messes with BG? I would like to get out of the 300's and touching
the 400's glucose #'s!

This list, all of you are a wealth of information!! now if I could just absorb it all in a
nanosecond! Thanks to all and somehow I miss the bickering :lol:
(just kidding

 

Re: Was frustrated, now is ketones have spiked! in over my h

If anyone really wants to get into this topic, Harrison's principals of Internal Medicine has a whole chapter on it!! My brain just iced over since I haven't read a lot of this since graduate school. There are three types of ketones. The serum meters and urine sticks test these in different ways at different points in time. They had a discussion of how the values can differ. There is a whole chain of sequences that lead to metabolic acidosis incuding changes in the liver, osmotic dehydration, PH change, etc. For treatment of humans in DKA, it recommends both blood and urine chemistries be monitered. I liked the concluding note "without such a record therapy tends to become choatic".

Too complex for me to deal with at home. I have concluded if Nomad shows high values on either measures for more than a few hours it is off the ER vet we go!

 

Re: Was frustrated, now is ketones have spiked! in over my h

I think it's highly possible you've got a dual problem going on Nancy.. I suspect you need less R, and am just about positive you need a nice kick to your prozinc dose. I would actually recommend a full half unit increase *to the prozinc only*, but I want you to talk to your vet about this. When you do this, you're going to have to heavily monitor, because that R is going to bring Payne down hard and fast. It's already doing it, so with an increase in basal dose (the primary insulin) you will want to monitor and remove some R from the picture. One thing that might help you to know is that since R is such a short duration insulin, it's perfectly ok to shoot it twice during a cycle. Many of us who use R have done that to help the basal insulin along a lot. This could be of assistance to you in learning to reduce your R, ie: if you were to bump prozinc, and reduce your R by 1/2u, you could then intervene at +6 or so with another 1/2u if ketones were to develop, or if the dose was not coming down sufficiently. This is something you are going to have to plan out, as I am truly worried he needs more prozinc.

EDITED TO ADD: **important info I failed to mention** do NOT shoot R twice in less than 6 hours or a very dangerous situation could develop. If you know the nadirs of your insulins, it will help you to know better what to expect. Please get a couple of +1 and +2 tests so you can more clearly see when the R is hitting the hardest.

 

Re: Was frustrated, now is ketones have spiked! in over my h

I did a search on urine vs. Blood testing for ketones. I must qualify first that this is for human diabetics but it is probably also applicable to feline diabetes. AMA, Web MD and American Diabetes Association all say blood test are generally more accurate. Two sites also say blood test will probably pick up excessive keytones before urine sticks or tablets. So I stand by my original position on blood probably being more accurate. Check out these web sites yourself: Americandiabetes.com/ketones.htm. And. Diabetes.webmd.com/keytones-14241. This was a good discussion and got me researching topics I haven't covered in a while. I have a feeling this blood vs. urine screening is still open for debate- read up and reach your own conclusions.

 

Re: Was frustrated, now is ketones have spiked! in over my h

Please explain to me how the meter works ...I mean how the numbers correlate to the colors on the ketostix. I bought it to use it but I can't because i don't understand the numbers. I know what the pamphlet says...but obviously that's not how it works. Because anything over 1.5 should be in the magenta purple range from what I've seen...the only chart I've found. And like I've said. Alex has had trace ketones and a 4.0 blood ketone reading. Last night Nancy had 3.8 and a small amount in the morning on urine stick...

Someone please explain it to me....because I really would like to know what a high reading means if it is never followed by a high reading on a urine stick...it is not enough to know where the ketones show up first. You have to know how the tool you're using to detect them actually works or what good is it? I have no idea and i'd like to learn. Seriously.


http://www.childrenwithdiabetes.com/d_0n_030.htm

 

Re: Was frustrated, now is ketones have spiked! in over my h

Caryl,I clicked on the link you gave for Diabetic Children. That site also says that the blood is more accurate and may detect ketones faster.So I am confused too because you gave a link that supports my point of view! The Wiki site does take a different point of view so even the info.sources out there disagree. The blood keytone meters only give a number value like blood glucose meters. If it doesn't help interpret or explain the results then I hear your point that it might not be useful to you.

If you have used the urine strips and they work for you,then that is certainly your decision. I guess the readers can explore both methods and see what might work for them.

If I do find good info.on how to interpret the meter numbers I will post again. I know blood ketone levels in humans that are 4.0 or above means the person is at increased risk of developing DKA.The values in cats or dogs would probably be similiar so I will try to do some more research.

 

Re: Was frustrated, now is ketones have spiked! in over my h

Caryl, how about doing an experiment. You have the time to stalk the litter box, the nose of a bloodhound, and a cat that will produce ketones at will (kind of...just give him the look).

Let's copy all relevant parts of this thread to Think Tank. Get help from "science" and "medical" people in creating an experiment (cause the strips are so expensive that we can't experiment often). Then, on a day you think he'll read positive, start measuring things ("aroma" & blood) each hour and each litterbox trip. Maybe start the process at the moment he pees and then track? Or the moment you smell ketones? I don't know - this is where we need the medical people. Do you smell ketones before the urine will show positive or when you smell ketones you know the urine will be positive?

If you want to do this experiment, and if we can get some input from the medical people about what should occur when and the best way to do the experiment, I'll check out e-bay and send you some strips.

 

6 of one, 1/2 dozen of another....ketones, ketosis, etc.

I remember Mishka's Critical Care vet, now at Davis, when I mentioned using the Precision, he said it only measures for one of the acids. I have always relied on ketositx and Mishka's overall attitude, eating, and 5 P's. If she doesn't eat, I don't care if I get a negative, she goes in. That's Mishka. Below is a bunch of things I have been reading and thought I would put it all out there for others to read. Very confusing, very controversial as to whether urine is the best indicator or blood testing at home. For me, I want to know the blood pH that only a vet can give me along with her electrolyte readings. Remember when reading the info below that " ketosis merely means that our bodies are using fat for energy" and a lot of people dieting will measure and look for ketosis happening.


Urine test strips and some assays for serum ketones may underestimate the degree of ketosis because they detect acetoacetic and not β-hydroxybutyric acid, which is usually the predominant ketoacid

Ketones will only show on the test when there are more in the blood than are being used by the body, once fat is converted it can not be converted back as a result excess ketones become a waste product and show on the test.

Hypernyms ("beta-hydroxybutyric acid" is a kind of...):

acetone body; ketone body (a ketone that is an intermediate product of the breakdown of fats in the body; any of three compounds (acetoacetic acid, acetone, and/or beta-hydroxybutyric acid) found in excess in blood and urine of persons with metabolic disorders



Because most urine tests measure acetoacetic acid, and not the most commonly found beta-hydroxybutyrate acid, it is possible to have ketones present and get a negative urine test result.

Further, it's also possible to have high levels of beta-hydroxybutyrate acid, get a negative urine ketone test result, but to have the test turn positive as the ketosis improves, due to the tests' measuring acetoacetic acid and not beta-hydroxybutyrate acid


Question: What is Ketosis?
Answer: A lot of people are confused by the term "ketosis." You may read that it is a "dangerous state" for the body, and it does sound abnormal to be "in ketosis." But ketosis merely means that our bodies are using fat for energy. Ketones (also called ketone bodies) are molecules generated during fat metabolism, whether from the fat in the guacamole you just ate or fat you were carrying around your middle. When our bodies are breaking down fat for energy, most of the it gets converted more or less directly to ATP. (Remember high school biology? This is the "energy molecule.") But ketones are also produced as part of the process.

When people eat less carbohydrate, their bodies turn to fat for energy, so it makes sense that more ketones are generated. Some of those ketones (acetoacetate and ß-hydroxybutyrate) are used for energy; the heart muscle and kidneys, for example, prefer ketones to glucose. Most cells, including the brain cells, are able to use ketones for at least part of their energy. But there is one type of ketone molecule, called acetone, that cannot be used and is excreted as waste, mostly in the urine and breath (sometimes causing a distinct breath odor).

If enough acetone is in our urine, it can be detected using a dipstick commonly called by the brand name Ketostix (though there are other brands, as well). Even though everyone is generating ketones continuously, this detection in the urine is what is commonly called "ketosis."

The higher the concentration of ketones in the urine, the more purple the sticks will turn. The Atkins Diet, in particular, advises people to monitor ketosis as an indication of fat burning. Other reduced carbohydrate diets don't pay much attention to this, or aren't low enough in carbs to make much of an impression on the sticks. (The latter type of diet is sometimes called a "nonketogenic" low-carb diet.)
Why do some people think ketosis is a bad thing?
There is an assumption that if a body is burning a lot of fat for energy, it must not be getting "enough" glucose. However, there is no indication, from studying people on reduced carbohydrate diets, that this is the case (though there is usually a short period of adjustment -- less than a week, in most cases). Although it's true that our bodies can't break fat down into glucose (though, interestingly, they easily use glucose to make fat), our bodies can convert some of the protein we eat into glucose. Indeed, this works well for people who don't tolerate a lot of sugar, because this conversion happens slowly so it doesn't spike blood glucose.

A dangerous condition called ketoacidosis can develop in those with type 1 diabetes, and it is sometimes confused with normal ketosis. The body usually avoids this state by producing insulin, but people with type 1 diabetes are unable to produce insulin. Even most people with type 2 diabetes who inject insulin usually produce enough insulin of their own to prevent ketoacidosis.

 

Re: Was frustrated, now is ketones have spiked! in over my h

My understanding is when the PH becomes effected and the potassium/sodium balance is compromised, then ketosis becomes ketoacidosis. Once that happens, it creates another whole chain of metabolic events. You are right that a certain level of ketosis is not considered abnormal. It is a matter of degree and a lot of other variables. Many other conditions can cause ketacidosis besides diabetes-starvation, chronic alcoholism and physiological stress.

I guess right now we have two camps-the blood ketones and the urine ketones (sounds almost like a musical group).I think the fact that everyone is so passionate about this is probably good.It means we are all concerned about the welfare of our sugar kitties and go the extra mile to also take the time to test for keytones.

I can easily get serum keytone criteria for people;Haven't found it for felines yet but it is probably similiar to humans (aka beanies).If anyone else finds it, let us know. One groupie of the blood ketones signing off for now!

 

Re: Was frustrated, now is ketones have spiked! in over my h

Jan, I wouldn't classify it as ketosis.......that is not the same. There is ketonuria.......ketones in the urine. Ketoacidosis is the DKA condition and is usually termed DKA based on blood pH.......how acidic the blood is.

 

Re: Was frustrated, now is ketones have spiked! in over my h

Wow! I haven't been a groupie for awhile! I am not in either camp yet but this latest discussion
has only confused me more ..... I think some cats are prone to ketone problems and you have to stay
on top of it, however you choose to do so. Once you are able to detect the ketones then you
can take evasive actions to avoid DKA. I realize that the discussion is which detects earlier but
remember guys, us newbies are trying to follow along! when you get TOO technical you lose us!! At
least my dictionary is getting a work out!

Payne is very good today! AM BG 297 and no ketones! (on strip covering my bases I am so thankful to
all of you for the input! Spoke with my vet today who FINALLY received her SS (my screw-up) and
he would like me to do a 2 hr. all day curve tomorrow, he didn't even say bring her in! maybe this
will work out. Thanks to all!

 

Re: Was frustrated, now is ketones have spiked! in over my h

Hi Nancy,

However you're testing...I'm glad to hear that Payne is doing well! Ketones are crappy and it' IS best to stay on top of them. I'm lucky because Alex smells before they even show up on anything. It makes me nauseous, but it sure is easy for me to know when I have to 'get to work'..so to speak! :roll:

 

Re: Was frustrated, now is ketones have spiked! in over my h

Nancy, there really isn't any "camp" on this ketone discussion. As you have read, there are two versions as to when they show up in urine and blood. My first clue with Mishka is not eating but I also catch "liquid gold" when I can just as a precaution. I'm glad Payne is doing well today. I honestly believe you would get different theories even from vets. We all know our own cats and what works well for each individual. You are on top of it with Payne, same as the rest of us that have kitties that can throw ketones and IMHO, just for the hell of it sometimes :roll:

 

Re: Was frustrated, now is ketones have spiked! in over my h

Ketosis is the process by which the body utilizes fat as alternative energy source.this produces the three types of ketones we have discussed.Ketosis turns into Ketoacidosis when the ketones are high enough to lower the PH and begin to effect other processes like the potassium sodium balance.Diabetic Ketoacidosis DKA is one type of Ketoacidosis.Like I said earlier, there are also other causes of Ketoacidosis. For example, alcoholic ketoacidosis and starvation ketoacidosis. Ketouria just means there is ketones present in the urine.I didn't mention ketouria in my last post.

The idea of posting this on the think tank is a good idea. I don't want to take up any more space on Payne's post debating this. I am glad Payne is doing better.Look at all the views we got on this topic! I didn't think keytones could be so exciting!

 

Re: Was frustrated, now is ketones have spiked! in over my h

I wasn't debating it anymore and as I understood it, either was Hope..."Do what works for you...as long as you're comfortable with it" is what i think we were both trying to say. No one was ever debating over what caused ketones as far as I can see. Or ketouria. I prefer to think of it as trace ketones. BTW does your kitty get them? ketones I mean? If not, You will be very well prepared if he does :lol: (G*d forbid)

 

Re: Was frustrated, now is ketones have spiked! in over my h

Just to answer your question,my cat went into DKA when I first found him last october.his BG was 520 and he was also very underweght.so I think probably both conditions played into it.He also had two close calls where keytones were very high but the PH and other blood chemistries were not very effected yet .Since he gained weight and is more regulated now, he hasn't had any ketones above trace level

I am a health care professional and work in several care facilities.Diabetes isn't my speciality but I did have to take biochem and physiology in graduate school.Many of my patients are diabetic and I have a coworker who is a Diabetic RN that talks this stuff all day.So sometimes I get more education on this than my brain can hold LOL

My explanation for those terms is correct.If someone wants to disagree with the medical text books I got it from I guess they are entitled to do so.This thread is just about unraveled so that's why I took it to the think tank ;-)

 

Re: Was frustrated, now is ketones have spiked! in over my h

I was never questioning your accuracy, Jan. Not for a second. I never delved into it so thoroughly and my kitty gets ketones often...so I was just wondering.

 

Re: Was frustrated, now is ketones have spiked! in over my h

This has been an interesting thread but I'm back to the subject, I'm frustrated!!
what causes the ketones to rise? I know there are a million reasons but on a day to day basis,
where nothing has changed? Payne had an elevated
ketone reading on Saturday and I nearly panicked but here we are again .....

This morning she showed trace on the urine strips but 3.3 on the ketone monitor, with AM BG 387.
NOTHING has changed! We are especially careful to have continuity. Shots 12 hrs. apart, urine
checked for ketones 2X a day, food under 5% carbs, treats raw/dried protein. We leave no food
out, clean our dishes as soon as we're finished.

I am doing a curve today and her +2 was down to 219 and 257 +4
(she is on ProZinc 3u & Novolin R 1u bid)
she is also on pred and tylosin sid and is suspected of having IBD and an infection? we are only
diagnosed (8 wks.) and some tests need to be re-done when she is stronger. As soon as my son gets
home I will do the ketone monitor again. My vet doesn't want to do anything yet because of the
curve and the fact she SEEMS fine, is eating/playing/sleeping .....

So? with decent BG #'s and NO outward signs, what causes a cat to have a rise in ketones when
nothing has changed, especially her behavior and looks? (plus she doesn't SEEM sick to me)

Nancy and Payne (wondering what all the fuss is about and trying to swat the fish

 

Re: Was frustrated, now is ketones have spiked! in over my h

I looked at your spreadsheet. While you are still working to control everything going on, perhaps Payne's requirements for useable glucose aren't being met, hence the breakdown of fat & resultant ketones. Perhaps the insulin doses need to go even higher.

I wonder if the prednisone is increasing the metabolic rate somewhat and that is exceeding the available glucose handled by the insulin being given. (I've always been much higher energy on pred, and hotter)

That being said, I'm too new at this to make dosing suggestions.

 

Re: Was frustrated, now is ketones have spiked! in over my h

Caryl, I never thought you were challenging my info. If you think I am bad, my coworker who is the Diabetic RN probably dreams about ketones I don't have a lot of time to write tonight (good for the rest of you ).I am going to post the main questions we noted on Think tank. If nothing else I ca argue with myself LOL

 

Re: Was frustrated, now is ketones have spiked! in over my h

Nancy,
Thank goodness it's only trace ketones you're seeing. I'm only going to comment on the urine stix because i have no idea what to make of the meter reading. While Payne's numbers are occasionally low enough not to worry about ketones(and even below 200 they can occur), in general, she is up there in the risk area and hasn't stayed down long enough to eliminate the risk of ketones. I'm always worried about Alex. When he has 2 days of no pink..I feel like dancing. Payne has been going up in to the 300's every day. I would think about doing what Carolyn suggested the other day and get more aggressive with her basal insulin. You've been at 3U for ages. Hasn't your vet suggested an increase? You need to bring her whole curve down...no matter what her higher numbers are caused by she clearly needs more insulin. Not of the R variety... If the R was just acting as a booster and keeping her numbers down, that would be one thing...but it appears as if you need more basal to do that. That's how it appears to me. IMO :?

 

Re: Was frustrated, now is ketones have spiked! in over my h

Thanks for the thoughts! on the curve, I am at +10 and she now has no ketones on the stix which is all
I can deal with.
you can check SS but her #'s today have been .... shot 312, +2 216, +4 257, +6 314, +8 306, +10 312 ....
I agree she needs more PZI which is why I'm doing the curve today, vet wanted to see that before we did
anything. What is weird, if she doesn't get the R, her ketones start going up, almost immediately.

The ketone stix are new, we changed out just to make sure. I'm sure the pred plays a part in the high
#'s, what part who knows? And actually her #'s today have been decent, for Payne, who wishes I would
just leave her alone for awhile. :lol:

Should I keep the curve going as long as I can? I might be able to get to a PM +4 but I get up really early
when the markets open, so that is probably the latest. Thanks everyone and my vet is training very
nicely, is even impressed that I can do a curve, me too
Nancy and Payne (who is looking for good hiding places .....)

 

Re: Was frustrated, now is ketones have spiked! in over my h

Typically a curve is one cycle, so from one 12 hour PS to the next. I'm not sure how the R affects the curve philosophy though. Personally, I'd stop after the next PS, get some rest and give her ears a break. Great job on getting the data!

If you are shooting the R at the same time as the PZI, at some point (on another day) I would think you might want to do sort-of a mini R curve, something like PS, +1, +2, +3, +4 (or whatever the R experts suggest). I don't know R though, that is just what makes sense to me.