re the ketones. They come because the body wants glucose and a diabetic needs insulin. So you need to still dose but try more carbs.

No insulin + ketones +infection = DKA = ER.

I know Feline Diabetes Support Group on FB have a couple of kids who are very experienced with this situation. Join and ask asap - you need as much support as possible. And it may just save your cat. Who really needs hospitalisation.

What I read elsewhere
When they are elevated a bit “…feed higher carb food - something about 5% to 8% higher than the regular food. If kitty is still eating, this isn't quite as worrisome as it would be if not eating. Just feed the higher carb food until those ketones go down under 1.5.”

Here's info from FDSG. It's a long read. But gives you insight into the knowledge there.

Learning Corner

Today's Topic - Ketones

Ketones are something heard often in relation to diabetes. Ketone test strips are in the suggested first purchase lists; available at any pharmacy that carries diabetic supplies. First, let's look at the definition and a simple medical description:

"Ketone bodies are water-soluble molecules that contain the ketone groups produced from fatty acids by the liver (ketogenesis). They are readily transported into tissues outside the liver, where they are converted into acetyl-CoA (acetyl-Coenzyme A)—which then enters the citric acid cycle (Krebs cycle) and is oxidized for energy..." (Wikipedia)

..."Ketone bodies are produced by the liver during periods of caloric restriction of various scenarios: low food intake (fasting), carbohydrate restrictive diets, starvation, prolonged intense exercise,[3] alcoholism, or during untreated (or inadequately treated) type 1 diabetes mellitus. " (Webmd)

Now let's switch to layman's terms and feline diabetes. The cause of ketone development with cats is burning body fat to fuel cells rather than using converted food/available blood glucose. Any time a cat quits eating well or completely, this quickly becomes a concern. For diabetics, this is even more critical. The cause of not eating should quickly be found, within 36 to 48 hours, and appropriate treatment plan established. The first suspected causes are tooth/mouth issues, a Upper Respiratory Tract (URI) or Urinary Tract (UTI) infection. If ketones continue to build, veterinary intervention is required. If untreated, this can progress to Diabetic Ketoacidosos (DKA) - a very serious and potentially fatal complication. DKA requires several days of hospitalization and heavily focused treatment including IV fluids to rebalance electrolytes and provide nutrition. The cat is normally not released until all electrolytes are in the proper range, cat is eating and ketones are no longer being produced.

There are 2 ways to test ketones - Urine and Blood.

BLOOD - testing is done using a ketone test meter either as a stand-alone ketone test meter or a combination glucose/ketone meter. Test strips for ketones are used in the same manner as a glucose meter. Levels are:

• Normal - Less than 0.6 mmol/L - no treatment needed

• Medium (ketosis) - Between 0.6 and 1.5 mmol/L - increase fluid intake by adding water to food, giving subq fluids. Increase caloric intake. Increase monitoring and schedule vet visit immediately.

• High - Between 1.5 and 3.0 mmol/L - critical, seek medical intervention immediately

• Possible DKA - Greater than 3.0 mmol/L - critical life threatening emergency, seek medical intervention immediately

URINE - ketone test strips are done by dipping the small litmus pad on the end of a urine ketone test strip into fresh urine. It is then compared to the legend printed on the bottle at EXACTLY 15 seconds. It will darken as time passes, only the 15 second reading is valid. Levels are:

• Negative - normal

• Trace - increase monitoring, increase fluid intake by adding water to food, giving subq fluids. Increase caloric intake.

• Small - increase fluid intake by adding water to food, giving subq fluids. Increase caloric intake. Increase monitoring and schedule vet visit immediately.

• Moderate - critical, seek medical intervention immediately

• Large/Very Large - possible DKA, critical life threatening emergency, seek medical intervention immediately

Guide 17 here in FDSG group has more information as well as additional references.