Tigger's home from the hospital..questions!

We brought Tigger home tonight after 3 nights in the hospital, following DKA. They said he was doing well, eating, and his BG had come down. So we were sent home and told he'd need his food and insulin around 7pm. (He had also been given an appetite stimulant which lasts 3 days). So we bring him home..and he won't eat! He took about one bite according to my husband. So his discharge instructions said that if he missed a meal to give him 50% less insulin, and if he missed the second meal to call them. So I gave him 1 1/4 units of Lantus,(his prescription is 2.5u). I did call them just to make sure that they had not fed them and it turns out they did feed them at 4 PM! I'm not sure how much they give him or how much he ate though. so I'm assuming that's why he didn't eat anything at 7. Now I'm worried that he won't eat in the morning and we'll have to take him back! We're already up to $3300 so far . I guess I just thought he'd come home and he'd be back to his old self. Does this sound normal? it's just scary to me because since he was diagnosed last year he's always been ravenous and not until his DKA this week ,had he not eaten.( They had him on a Humulin drip at the hospital and now he's on Lantus. He been on Vetsulin until now). Maybe it's just all the changes?

 

You might have to assist him in eating, Carol. Right now Tigger doesn't know which end's up..and he's scared. When cats routine is upset, they often stop eating.

Try spoonfeeding, or putting the food on your finger? Or puree it and let him taste it on your finger or a spoon. Smear it on his lips so he has to stick out his tongue to lick it off.

Tigger has been under a lot of stress..he's just gotten used to the noise of the hospital and now he's been brought home. To a cat, that's like an alien abduction.

Perhaps he's afraid of someone grabbing him up and taking him back again. Lots of reasons he might stop eating after coming home.

Don't give up. You may have to work at getting him to eat. There are several videos on YouTube concerning feeding ailing cats who don't want to eat, or syringe feeding them. Cats are wierd..they shut down very easy and half the time their logic is a mystery to us. So you must assist them, sometimes for a long time. Then, all of a sudden, they'll start back on their own. Sometimes.

One thing for sure..your vet is right that if Tigger is not eating for more than a day or two it can be life threatening. Find a quiet place with no distractions....Lay down paper towels or a sheet, all over, put on an apron, and get ready to have food flung everywhere. Even a few bites is a victory. Be sneaky..even if it means playing "Here comes the airplane...vrrrooom!" It can be like feeding an eight month old a new food...protest, protest, or utter distain. Or perhaps it's a control issue, like that of young women who are anorexic..the only thing they can control is whether or not they eat?

I don't think cats connect not eating, with getting sicker. They don't get it.

 

Things that have helped Bama in the past: raising her food dish, holding the bowl up to her face while she eats, putting the food dish in front of wherever she is sitting, feeding her small amounts off of a spoon, pureeing the food with water to make a lappable soup

I had to syringe feed Bama for a few days after her pancreatitis flare. It is messy but she handled it pretty well. Here is the FDMB page on syringe/assist feeding. http://www.felinediabetes.com/FDMB/threads/syringe-assisted-feeding-video-and-tips.144367/
I used this video for reference when preparing to syringe feed.

 

Oh, thanks so much Jeanne! Your post is exactly what I needed to hear!! And the funny thing is, right after I read it, Tigger went over to his bowl and started eating! Hooray! We've let him nibble on it all evening..he keeps going back for more! It's a can of FF ocean fish. Vet said it's basically the same thing as the prescription diabetic food. Anyway, thanks so much for your support...it meant a lot!!

 

He did very well this morning with his food. Almost one whole can of FF! So I was able to give him his insulin. Question: how much food do they need to get down before you can safely give them their shot? A few bites? Half a can? ????thanks!

 

The more you can get into him the better. If you can get half a can down, that would be wonderful! Just watch his numbers (sorry, just had to say that) and if he starts tanking, give him some med. carb or even high carb if they go that low. After his DKA, it's better right now to have enough insulin and have to feed a higher carb food than not enough insulin and low carb....

HUGS and HUGS

 

For me personally the "number" I use in my head is one ounce. Which is what I give him from his treat chicken if for some reason (read he puke up breakfast after I gave him his shot just before I needed to leave for work), I need to make sure he is going to eat it and most likely keep it down. (The food eaten was and experiment that was not repeated so I never knew why he puked). But half a can sounds good too.

 

For cats recovering from DKA, you want to be able to get them to eat at least one 5.5-6oz can a day of a higher calorie food (~200 calories). Ask your vet if they can give you some cans of recovery food (Iam max cal or royal canin recovery), or find an over the counter higher cal food (wellness and evo foods are high cal). If your cat isn't able to eat this much on his own, you really do need to syringe feed. Lack of calories will cause the ketones to come back.

If you are getting the calories in her, you should be able to safely give the insulin. If you could, take the blood sugars every 3-4 hours and post them here so we have a better idea where her BS is at so we can help with insulin. If possible, you want to be able to give him the full dose or near the full dose. If this means increasing carbs or mixing a little honey in the food, do that. Feeding higher carb food is ok at this point so that you can give her all the insulin. Not enough insulin is what leads to DKA.

Hydration: It's important that you get him to have enough fluid intake. a 5.5 oz can has about 150-180ml water. He needs to have about 300ml a day including what is in the food, so keep an eye on how much he is drinking.

Ketones: The real measure of improvement in DKA is through testing the ketones. You can buy the urine strips at any pharmacy. Please test 2x a day, as ketones can increase very rapidly and you want to catch that early.

Appetite: If he continues to have a poor appetite, call your vet and ask for an anti-nausea in addition to the appetite stimulant. They work in different ways, and the anti-nausea works immediately, most cats with DKA have nausea issues. The appetite stimulant usually takes a week or two to start working.

 

He ate his morning meal...about 3/4 of a can of FF. Gave him his 2.5 u of Lantus. Then he keeps going back and nibbles on the rest..by lunch it was practically gone. Still looking around for food! But that was when there was still a little FF left in his bowl!? Wants to go outside so badly (he's partly an outdoor cat), but we're keeping him in because he's such a hunter. Vet said that would mess up his BG. He did drink from the sink earlier, and I assume he's had a little water from his bowls..but not a tremendous amount. He was over 300 this morning, but we had only given him a 1/2 dose of insulin last night. I tested him at +6, and he was in the mid-200 range. Wishing it were lower..they got an 89 at the vet! (pet meter). This is so frustrating! We can't have another DKA episode..my husband wouldn't put out the money . So far we're up to $3300. So he ate enough to get all of his insulin...so no need to give a high calorie food? I don't have his numbers up on here yet.
Thanks for your suggestions!

 

If he's eating, you can stick to his normal food, but don't restrict his food. If he eats all of it, open another. Let him have as much as he wants. The goal for blood sugar should be a little higher >150, so that you don't have to skip or reduce any doses. If he's lower than 150, that means he needs a little more carbs, and NOT a reduction of insulin for the time being.

Since he got DKA in relatively low numbers (200s), it's very important that you get the urine strips and test for ketones. BS alone is a very poor indicator of how the recovery is going.

Sometimes it helps to switch the flavors of food, because the nausea they had earlier can create a distaste for the food that was fed when he felt ill.

 

Glad to hear Tigger is out of the hospital and starting to do better. We've been going through the same thing with Whitey and it's hard. The expenses, the stress, the anxiety etc. The one thing I can say is listen to @Meya14 . She has helped us immensely. We've had a lot of good advice and support from all members as usual but she's really gone out of her way to help witIh advice on Whitey's DKA and he's steadily improving. I would give you advice but I don't feel qualified and other than to tell you what has been working right for Whitey (which I've been updating in his thread).

 

Yes, I agree...Meya is very helpful and informative! I have a question about testing for ketones..I haven't done it yet but if I do and he tests positive for ketones, then what? Back to the vet and we go through which we just went through the last three days and cost tons of $$$$? It's freaking me out to think that that could happen again? He's been on low-carb food since he was diagnosed last year, he's been getting regular insulin shots, I don't know what we did or didn't do the cause the DKA to happen, and that's what scares me. Now we've switched insulin but I don't know that's going to be enough or if it will make any difference at all. I home test at least twice a day. What more can I do to make sure this doesn't happen again??

 

Catching the ketones early is the best way to avoid the inpatient vet bills. When you catch the ketones at a trace or smalll level, sometimes you can adjust insulin, adjust feeding, and possible visit the vet for subQ fluids and a simple check up and your cat will improve very quickly and not need inpatient.

Identifying the cause is important too. The 3 most common causes I see here are:

1. Infection
2. Under feeding
3. Skipping insulin too often especially if sick, or poor overall glucose control.

To understand what happened with your cat, it will be really helpful for you to get preshot tests, and also tests in between the shots so you know how low your cat goes as well. People on this board can help you figure out dosing then and help you get the BS better under control. Lantus is a MUCH better insulin for DKA prone cats, so that switch is good.

The test is a urine dipstick that are about $10-20 for a pack of 50. You can find them at almost all pharmacies over the counter by where they have the diabetic supplies. You want a fresh urine sample when you test, the easiest way is to wait until they get in the box to go, and then place a little bowl or something similar right under them to catch it. http://www.amazon.com/Ketostix-Reag...=UTF8&qid=1455257740&sr=1-8&keywords=ketostix

 

He just tested at 290 2 1/2 hrs AFTER his pre-dinner test of 221 and his shot! Why is he going up and not down? I'm so stressed out over this. He's eating...but still leaving a little food in the bowl which is SOOO unlike him! Could it be because he was just switched to Lantus in the last 48 hrs??

 

Lantus works a little different than the other insulin you were on. It doesn't create the larger swings up and down, but rather brings down the entire range. The lowest point is about 6-8 hours after you give it. It's not unusual to go up a little after giving if he just ate as well. I'd try and get tests between 6-8 hours after and see where he's at.

 

Thanks for this. You've given me an idea of how I might help Saoirse while she's like this.

I know ECID but could you maybe give a stab at how long it takes for gravy from a higher carb food might nudge numbers up, Lyresa? (Looking at Hill's i/d Chicken flavour pouches.)


Mogs
.

 

I really, really feel for you, Carol. Saying a prayer that Tigger will start eating OK as soon as possible.




Mogs
.

 

When Hannah gets into scary numbers, I feed FF Gravy Lovers... a couple of teaspoons. It takes just about 30 minutes for her BG to rise approximately 60 points, so it works pretty quickly.

 

Ketones are a result of the body burning the wrong 'fuel' for energy. Instead of using the food, the body begins using it's fat stores....like putting bad gas in your car and it smokes. To use the food correctly, there must be enough insulin on board. If this continues, the body's ph balance becomes 'acidic', the electrolytes are totally out of balance - Ketoacidosis.