ketones and more

Question
Dr. Fry,
   What causes a dog to have a high level of ketones in their urine?  My dog is diabetic and has been successfully treated with insulin for a little over 1 year.  I got her checked recently and her diabetes was still being managed effectively.  Can ketones indicate kidney problems?  What all is involved in treating kidney problems and how successful are these treatments?  Thank you for your help.

Answer
Ketones in the urine of a diabetic animal are the result of NOT being regulated.  If the body is unable to use sugar for energy, it will break down fat for energy and one of the by-products is ketones.  I would recommend having a urinalysis and culture done to check for underlying urinary tract infection as well as a complete blood count and chemistry screen done to look for other problems.  Some dogs who have diabetes will also have Cushing's Disease (over-production of cortisone) which leads to disregulation of the diabetes.  We do not see ketones in the urine of animals with kidney problems.