The FDMB's Ketone mini-FAQ
this information was compiled by Fawn with the help and experience of the FDMB collective

Note: this is essential information on ketones, something that all caregivers of sugarcats should test for regularly.  This information is a brief overview of ketones and how to monitor for their presence.  For more detailed information consult your vet and/or visit: http://petdiabetes.org/ketoacidosis.htm.  Please understand that the presence of ketones in your cat’s urine demands a call to your veterinarian immediately. This information in now way is intended to replace the guidance of your veterinarian or to replace the immediate medical care your cat may require.

Through discussions at the FDMB, it seems that many vets fail to warn clients about the dangers of ketones and do not stress the need to regularly test the urine of a diabetic cat for the presence of ketones.  Ketones are a waste by-product caused when the body must burn fat for energy.   If ketones aren’t monitored regularly, they can develop into diabetic ketoacidosis – a very serious, sometimes fatal condition.

Ketones will usually show themselves when the cat doesn't get enough insulin or food, or the right combination of both.  Not enough insulin/food means that the body cannot metabolize its own glucose for energy, so it starts to burn stored fat for energy to keep the body going.  Ketones can also appear if the cat has an infection. Since many diabetics are prone to urinary tract infections regular testing for ketones is important even if your cat's glucose levels seem to be managed. Ketones should be tested regularly (most folks do it at least once a week).

Important times to be extra vigilant in testing are: 

• ·     when you skip a shot or reduce your dose – for  example, if you are testing for rebound, if your cat's BG went too low on the dose he is getting, or if you get a low preshot, especially if the low pre-shot was caused by your cat eating less than usual

• ·     if your cat has very high BGs – to clarify, high BGs alone do not cause ketones and it is possible to have ketones without high BGs; however, high BGs can mean your cat is not getting enough insulin and the lack of enough insulin can cause ketones.

Testing for ketones is just as important as monitoring glucose levels whether you test glucose via urine or a glucometer.  If you have difficulty obtaining a urine sample please post for advice on the FDMB as there are a lot of people that can offer suggestions. Test strips can be found at any pharmacy. Be sure to put the date on your bottle, strips expire after 6 months.  Here’s a picture of the keto-diastix a lot of folks in the US use:

Here’s a link to a page that compares various urine test strips so you can see if the strips you may be using now to monitor glucose also detect ketones, http://www.hocks.com/urinetest/stripchart.htm.

Don't ever assume that because your cat has never developed ketones that it never will. Also please don't assume that if your cat's glucose levels are low you don't have to worry about ketones. It can't be repeated enough: Ketones can be caused by not enough food, not enough insulin, or an infection.

ANY TIME YOUR CAT DOES NOT WANT TO EAT OR HAS VOMITED OR JUST PLAIN DOESN'T "LOOK RIGHT" TEST FOR KETONES RIGHT AWAY! Ketone levels can go from trace to moderate very quickly and by the time symptoms show up (vomiting, loss of appetite, lethargy, fruity or acetone smell to breath, etc.) your kitty is already in danger of developing Diabetic Ketoacidosis (DKA). The mortality rate for DKA is very high and requires aggressive treatment by the vet.

A simple quick test can mean the difference between a short $100 hospital stay with fluids or a 5-day agonizing event costing you thousands of dollars while your precious baby's life hangs in the balance. If for that reason alone, TEST TEST TEST!!! Do not attempt to treat ketones at home, you need your vet to rule out a possible infection.

Why "NO FOOD=NO SHOT" can be dangerous. This is fundamentally correct advice, but you must understand that it is also an invitation for ketones.  Keep a variety of items on hand to tempt your cat to eat - don't worry if it's healthy at this point - YOU MUST GET YOUR CAT TO EAT! Keep meat babyfood (without onions) on hand to syringe feed if you must, because skipping food and skipping shots is nothing to play around with. This is particularly dangerous with a newly diagnosed cat that doesn't feel well and doesn't want to eat.  No one is suggesting that you disregard your vets advice - only warning you that ketones are a definite worry and you must make every effort to get your cat to eat and to test for ketones. If your cat won't eat and appears ill and you can't get a urine sample, you must get your cat to the vets so that they can obtain one for you.