? 4/9/17 Sprocket AMPS 417, 3.25u, +2.5/301, +7/209.PMPS/247, +2/316.Ketones, UTI, ear infection

http://www.felinediabetes.com/FDMB/...2-pmps-318-furshot-2-489.176018/#post-1935906

He ate well till 3am.
6am he looks nauseous and doesnt want to eat. Had a few bites. Gave 3.25 units.
Syringing famotidine & giving liquid cyproheptadine.
Hope it helps.
Can't seen to read anything on last post after midnight for some reason.
Suggestions?

 

Try to get some extra water into him as well, and (of course) a ketone test asap.

Glad the insulin got in him for sure this morning! Now we just have to let it do its work.

 

Also: I hope you got some rest last night!

 

Ya but now we may end up at ER. Just gave liquid cyproheptadine (appetite stim) & syringed famotidine.
5 mins later he vomited
Last couple of hours he drank alot and bowl was moved around like last time he had ketones.

 

I won't lie, I'm worried about the signs so far, but let's give him a chance until you can get a ketone test.

Can you syringe a bit more food, with some extra water into him? Just a little bit, since he might vomit.

 

He just peed. Trace ketones.
I think my reg vet may be open a few hrs today. Let ms look

 

OK, now we know what we are dealing with. Trace isn't too bad, but we need to get it moving in the opposite direction.

On the positive: he was eating well until 3am, so he's got some food on board from that, and he now has insulin on board. We may be able to nip it in the bud without another ER trip with food and fluids-- when was the last subQ fluids he had?

 

Yesterday at 2:45pm est. 70 ml

Doni put 911 flag now?

 

Does he usually get fluids every other day or every day? Does he have any heart conditions that you know about?

If your regular vet is open this morning, best thing is to call for advice when they open. I think, if he's at trace and now has insulin plus at least a little food, some subQ fluids might be enough to flush out anything developing and get him back on track, but if he's normally on a less-than-daily schedule I am unwilling to suggest it at the moment because I know Sprocket has a mix of health conditions. Others here may be more familiar with Sprocket's case and/or have enough experience with ketone management to advise differently.

Other than that, just keep trying to get some more food into him and cross fingers while we wait for the insulin to onset.

 

Yes he has gotten fluids daily for 2-3 weeks now.
Last we went they said he had heart murmur.

 

Have you found out if your vet will be open this morning? If so, how long until you can call?

 

I can leave a message n they check n call back

 

I would leave a message for your vet, then. Tell all that he has vomited and has trace ketones and you want to know about fluids, and can they work him in today.

Is he eating this morning? I would only feed him in extra small meals, and let him rest in between to digest and hopefully not throw up.

It is probably a good idea to look into getting a blood ketone meter.

 

I meant, with ketones, you still want him to eat lots of food, just with the vomiting to break the meals into smaller portions and then feed them more frequently.

 

He had few bites of wet food. He looked nauseous.
Then we did shot n gave meds. Then he vomited.
I have fluids at home but will he need more to go to vet?
I usually give 100ml a day. Yesterday he got 70ml

 

Thanks for stepping in, Dyana! From what Darnell has said, Sprocket ate well up until 3am last night, but has been nauseated this morning, so it's pretty recent.

Darnell, I think you can take the 911 down for the time being. Plain fact is, there aren't that many people online at the moment, so it's not gathering any extra eyes, plus I think you'll want to save it for a really time-sensitive crisis. We're not quite there yet-- we're working hard to stop the crisis in its tracks!

 

Do you have some Ondansetron for the nausea? Or any Cerenia for the vomiting?

Also, when you get a chance, can you change the Subject Line on your other post this morning to "DUPLICATE" and the Moderators will delete it, then you won't run the risk of having two confusing posts running at once.

 

I didnt know it posted twice.
I syrnged him famotidine then he threw up 5 mins later.
I have cerenia here.

 

Have you fed him since he threw up, and did it look like he threw up food, and was it all of his food?

 

No I haven't. He doesn't do well with stuff being shoved in his mouth.
He vomited the meds. It was liquid & looked like the powder.

 

I think we're at +2 right now, or pretty close. Although we're all laser-focused on ketones right now, it'd be great if you could get a BG test in to see how he's doing with that (and update the spreadsheet when you get a chance ).

 

I don't know what this is referring to

I'm glad he has his few bites of breakfast food still in his tummy.

 

I think that's 'cause I was suggesting trying a little syringe feeding to try to get a little more food in him and get ahead of the vicious circle of inappetance-ketones. But if Sprocket really hates it, probably better to hold off until he's truly not eating at all on his own!

 

I haven't syrnged food or fluids. He drank some water
He ate at 3am
I gave insulin at 640am. Est

 

I notice that you had his calories eaten in the Remarks section on his spreadsheet for the past couple days, but not yesterday. Did he eat his normal 500+ calories yesterday?

 

Yes about 460 calories. About 15 oz wet food.

 

Thanks. And how much has he eaten so far today?

 

A few bites.
Found a reg vet to see him as emergency. @35-40 mins away but not ER prices.
ER place close if need be.
Will keep ya posted

 

He needs to eat to keep the ketones at bay. I would try to feed him a few teaspoons of food, every half hour and see if he keeps it down.

 

Good luck! Keep us posted.

 

I will. 301 for 9:01am bg +2 4

 

Has he eaten anything since the few bites of food he ate at AMPS?

 

I agree with Dyana, the biggest need now is to get him eating. If you are going to this vet, have them administer some good anti-nausea meds like ondansetron to get him going. Unless his ketone readings have spiked up from "trace", I don't think he's going to need full hospitalization at this point, we just need to get him over this little blip-- get him eating, maybe get some more fluids into him to make him feel a little better and help flush out the ketones.

 

UPDATE. Darnell is with Sprocket at vet. He has a UTI and ear infection. He has been on antibiotics for a long time so I question if it's contributing to infections like this needing good flori. He has a high white blood cell count too. The vet is giving fluids, convenia and cernia. The vet said to offer food when he gets home. The vet said at PMPS if he is above 260 give insulin and if below DON'T give insulin. She will check back soon. BG is 150 at + 3.

 

UPDATE.
Darnell said vet told her to wait till 5 pm to feed unless BG goes down.

 

I do NOT understand this instruction.

The infection at least solves the mystery of how he developed ketones so quickly on one missed shot and 4hrs after a good meal...

 

Not enough food + not enough insulin + an infection is what causes DKA. What is the vet saying about the ketones?

 

Darnell says urine strip says trace and Urinalysis says +2 ..

 

Darnell said if he has a low BG he can't have insulin.

 

Doesn't that just complicate the ketone issue?

 

OK, but why withhold food until 5pm??????

 

The vet said withhold food so his stomach will feel better at 5 pm

 

If he eats some food then his BGs would come up. To fight ketones, you need to fight the infection and get enough food into them to give them as much insulin as safely possible.

 

Someone (@rhiannon and shadow (GA) , I think) was speculating on an earlier thread that the type of antibiotics being used may not have been properly targeted on the underlying infection, and that was the reason for the repeated DKAs in a short span of time.

 

I am agreeing here but more than one vet said ok for antibiotic. Gave convenia for uti.
Antibiotic causes diarrhea which is causing UTI.
Not helping as much as I think they are.

 

Some probiotics to put the good bacteria back in the system, given a few hours after the antibiotics (which kill both the good and the bad bacteria) might help her gut and the diarrhea.

 

Right, but I think the issue was the type of antibiotic being used-- some are good for UTIs, some are good for ear infections, some are good for wound infections, etc. etc. The "wrong" antibiotic for the job is better than nothing, but might not be able to completely clear an infection, which could explain the cycle Sprocket has been in.

 

Good point about probiotics-- it might help turn things around.

 

He has had antibiotics almost every day already. Put in food in AM & PM meals.

 

Here are blood tests and notes from vet

 

I wonder what +2 ketones on the urinalysis means?
I hope it's +2 in mg/dL and not +2 in mmol/L.

 

I would try Cerenia instead.
Does Sprocket vomit white foam/or food liquid with white foam?
If yes, then it is acid related and Fam is appropriate I was told.
If not then I would give Cerenia a try.
I cancelled Fam for Ducia since there was to foam in her vomit.
Please run this by experts on the Forum
Ducia takes 1/4 pill of Cerenia every 24 hours. But don't know the proper dosage for Sprocket.

 

Eeek! I wonder, too. There's also that top line of "+" markings, if that's part of the reading it would imply mmol/L

 

Looks like clear fluid when he vomits.
He was on cerenia until tuesday. Vet said stop for now.
They gave him cerenia today and covenia. I posted his test results and vet notes above.

 

You're home now?

I need to sign off soon, but I'm still questioning the vet's instructions not to feed until 5pm-- I feel like something must have gotten lost in translation, it's really important that Sprocket be eating small meals of whatever you can get him to eat.

 

Also, when you get a chance, please update the spreadsheet-- especially with this starting to be a long thread, it will make it easier for any new people to jump in and see what is going on.

How are you and Sprocket doing?

 

I just put in his bg i just took
- 209
I posted the test results and vet notes above.

 

Gave some wet food about a tblsp with water & fortiflora. He took a few bites. Walked away. Walked around a few times. Had a few bites and sat down now. Hopefully take a little nap.
Then feel like more food later

 

Good move giving the forti! I hope he'll get used to it because with the amount of antibiotics he is taking the fortiflora is good for him.
And I like his numbers today, too.

 

Thanks Nan for remembering what I said.

I'm glad you have confirmation now of the other infection. I suspected there had to be more issues.
Unfortunately the convenia won't really fix that, it is for bacterial skin infections. Vets like the injectable solution especially trying not to pill cats.
Doxycycline would have been a better choice for a uti. Clavamox makes kitties tummys feel worse. ( altho' some cats do tolerate it)


I would call that vet back and ask for a prescription for the ondansetron to address the nausea. ( take the prescription to a human pharmacy)
and while you are out, grab some kitty milk and baby food ( if sprocket likes those)
The other thing that can help with nausea but not bg numbers, is to boil some rice and see if he'll drink a little of the cloudy rice water.
It might help settle his stomach. It's just a carb though and might raise numbers but eating is more important right now.
That's why you need a good nausea medication.
Cats that are nauseous just don't want to eat, even when they are really hungry.

 

Update: he had 1.75oz wet in 2 feedings with probiotic capsule powder & fortiflora. Had a nap.

Usually famotidine is good for him.
What's the difference between the anti nausea meds?

I posted the lab results above.
& vet notes.

He has some bacteria in his urine.
He has had soupy poopy on n off but when not soupy it was soft. He did scoot on rug too to clean up something stuck.
Sure that didn't help.

Now that this has happened. Will his dose change since we are not sure how much he will eat?
Or if his bg will be lower cause he hasn't eaten much today.
And if it is,& I shoot same dose, if he goes low later. What if he won't eat the food?

 

Will he eat treats or even dry food? It's better if you are able to shoot the full dose (within reason - depends on the blood sugars) or just a slightly reduced dose (3/4 or so of normal). Skipping doses like the vet recommend is a sure fire way to end up back at the ER. If he is only eating a little bit at a time, you can add something higher carb (honey, dry food, treats) to each meal so it raises BS so you can give the insulin. It's important that you monitor the sugars really closely, as your kitty likes to give you hypo surprises.

The diarrhea is probably preventing him for absorbing calories as well. And if it was a GI infection from the longer term use of antibiotics, this could also prevent him from recovering. Generally, when they are having issues with diarrhea when getting ABX, they should be getting metronidozole (flagyl) as well to address the GI infection/dysbiosis. +2 ketones is Moderate. Cats usually have a lot of nausea by the time they have moderate ketones. And the ketones have increased since the home test. This is worrisome. You need ondansetron or cerina (anti-nausea) medications to help eating. Anti-acids like famotidine don't help this kind of nausea because it occurs in the brain (not from acid in the GI tract). Cyproheptadine is an appetite stimulant and is more for long-term anorexia, rather than short term nausea.

 

Also his potassium is on the lower side of the range (not dangerously so) you may want to ask about supplementation.

 

When he has not been nauseous, he wants to eat with appetite stim. Before I had cut the dose in half but after last ER we went back up. The cerenia didn't seem like enough with antibiotic for nausea. As soon as I started famotidine he was better to eat. It seems to help with antibiotic but he has to take it.
Antibiotic seems to be causing the issues with diarrhea in first place. I wonder if he really needs that one anymore.
Usually he will eat the zero or evo dry but been trying not to give u less he needs it for keeping bg up or if its most of what he will eat like when he was at ER.

So will I be able to get rid of ketones with fluids every day but more than 100ml?
Or what else?
Bg in a few mins

 

247.
Shot timeframe
Ate 1.5oz wet food
Dose? 3.25 stay or 3?

 

I want to offer some suggestions on the diarrhea/gut concerns that might help Sprocket. There is an excellent post on IBD kitties here that gives directions for giving probiotics to cats. It also has a section on Saccharomyces Boulardii, a beneficial yeast.

The link is good and I'd encourage you to read it. The short version of it is that you can buy S. Boulardii at a local health food store, or a section of a regular store if they have supplements - it's very common - and you can give it every 2 hours to stop diarrhea in a cat. It is a "non-colonizing" yeast, meaning that it works when you give it but it doesn't grow in the cat's gut, so if you stop giving it the effects are over. There are some cats that are sensitive to yeast, so if it increases diarrhea stop giving it. We've had good luck with it, however. You can open the capsule and mix it with food.

Here is a bit on probiotics and S. Boulardii that I just wrote last night for Bronx's Dad here.

Also, I would reconsider giving Fortiflora - or at least give a look at this link regarding its ingredients. We used to give it a lot but since I read this post I switched to human probiotics. If I wanted to use it as an appetite-stimulant, I'd smash up some dry food (or freeze dried meat) and use those as a topper instead of Fortiflora.

Sending you a lot of virtual support. I sure hope Sprocket feels better soon. We've had good luck with Cerenia. ​

 

Just saw your question about dose.

I would stay at 3.25u - my reasoning: he's on the rise from the nadir of this cycle, with ketones present you want to get as much insulin in him as is safely possible, and you are awesome at monitoring him.

 

I didn't see an answer to what to do if he won't eat and his numbers drop.
you can always rub honey on his gums, tongue, or even use your finger with honey on it , and rub it into his anus. ( that's what you would do if you
were on the way to the E.R.)

 

Don't fret about too low of carbs right now. You want to give him enough insulin to keep the ketones down. Getting ketones to go down isn't about getting blood sugar down, it's more about getting insulin in there so he is able to absorb the food and stop burning his fat for fuel. So although it seems counter-intuitive, sometimes, we have to add carbs in order to give the larger doses of insulin without fear of hypo. You can mix dry food with water to make a "soup" and help with hydration. You can even syringe wet food mixed with honey every 1-2 hours if he starts to go low. Because you cat is still having issues with ketones, it indicates that the insulin dose is not quite high enough to normalize the metabolism. I agree give 3.25 if you can monitor closely.

The subQ fluids can help with flushing out the ketones as well and preventing dehydration, however, in a cat with cardiac issues (murmur) I would used carefully per vet recommendation as sometimes you can cause swelling and fluid in the lungs if too much fluids are given and the heart/kidneys can't handle it.

 

I also agree with the 3.25 dose, because of the ketones. He needs the insulin.
I used Ondansetron for nausea and sometimes Cerenia too. And Cyproheptadine for an appetite stimulant.
Wishing ketones be gone, for Sprocket.

 

Uggg!! I can't win! I am not good at monitoring exactly. I am a mess!! I can do the bg test now but he is getting not so patient with that. After when he goes into 100s it freaks me out!
One doc said years ago he had a heart murmur then she said that for all 5 cats. Other vets listened and agreed to he didn't. This is first vet in 4 years to say it so idk exactly. He was purring at same time too.

I gave 3 units. I am afraid to do 3.25 cause he hasn't eaten alot, has not had appetite stim, no guarantee he will continue eating if his bg goes down early to give more food. Tummy tender. Plus I am not calm to do the balance at under 100 bg.
I know he needs insulin to reduce ketones but if he stayed in mid 100s for a low, wouldn't that still be ok?
I can't syringe him with no help. He won't take it. He freaks out big time! He was abused as baby so he doesn't like to be held down.
So TR is not good for him.
I am alone at home most of time. I have 3 friends that know how to help with subq fluids but 1 he is iffy with.
So I can't just syringe feed him.
This dose decision is so insanely scary to me. I don't want too little or too much.
For 8 days he stayed steady with numbers but he didn't have enough insulin or food so now he has more insulin and food but now has infection.
So ain't I doing something right?

 

(((Darnell))))

You are doing MANY things right! Sprocket is SO lucky to have you helping him!!

You're being given a ton of information and some of us are contradicting others. It can be very difficult in your shoes, to figure out whose advice is best to follow. I can say that if my cat were in Sprocket's place, I would want Meya helping me. She works with adult diabetic patients and has helped many of our DKA/ketone kitties get better. I never dealt with ketones with punkin, so don't have that experience. When a cat develops ketones, they are metabolizing differently than normal. The reason for more insulin is to change that cycle and return it to normal. I'll let others explain that better than I can.

See how he does tonight and you may want to go back to 3.25u in the morning. Don't reshoot anything now - just let it go.

 

Darnell, you're doing great! This is a very stressful situation, and you are hanging in there!

I think we haven't quite figured out where the infection(s) are coming from, although I do think it's possible that something has been hanging out at low levels with occasional flares the whole time. I hope the latest round of antibiotics is effective, but please read Rhiannon's posts above when you get a chance about different antibiotics and their uses. It may be as simple as just that you haven't been prescribed the right antibiotic yet.

I agree with Meya about just feeding him anything he's willing to eat at this point-- find something that he finds tasty even when he's feeling a little yucky, and don't worry about things like carbs. Dry food, baby food, treats, tuna, deli meat-- it's all on the table for the moment! What's really good is that he's still eating something, so you just have to get him to keep it up.

Adding, because Julie+Punkin just posted, I will second the recommendation to follow Meya's advice, 100%. If ever one of the rest of us says something that seems to contradict what she's saying, go with her take.

 

Or ask more questions!

Each of us has a particular experience and no one will be offended if you don't take his/her advice. Your job is to collect as much information as you need to make a decision for yourself.

 

I can't make a decision for myself. This is driving me nuts!
I have never been so stressed in my life. So many opinions. Then I feel guilty when I chose wrong! But I cant handle going so close to low. But he keeps getting something so he won't stay steady.
It takes so long for these posts to go through. Its hard to post, wait, give meds, feed, read& figure out who to listen to. Plus typing that I can barely type proper words so it takes longer.
All within a half hour from bg to shooting.
Fb pm is faster currently. So if someone can do that so it takes away a few steps for the short timeframe would be great.

I am losig my mind. I feel like I am killing him.

 

I know that you are overwhelmed, and I wanted to tell you that you are doing a fine job. It's just a very complicated health situation that you are in right now. For right now, don't stress too much about TR or protocols and all that. Those are really for well cats, not sick cats, so it's not worth stressing about. Also, don't feel bad about going with your gut at times. You know your schedule and abilities best, and you gotta do what you gotta do.

Having DKA resolve and come back is common, and it simply means that something is not right with either the insulin dose, the food situation, or there is an underlying illness that needs to be dealt with. So we can help you work on all those things. DKA happens a lot to diabetic cats unfortunately. We've had many recover and were just fine after they figured out the feeding/insulin/illness issues. It takes a good 2 weeks at least to recover, so hang in there.

As I mentioned in my post on the thread earlier, the more insulin you are able to get in him safely, the better. To do this, you can increase carbs to raise blood sugars. In people with DKA, we actually give them an IV of sugar water, and insulin. We basically put sugar directly into their veins so that we can give larger amounts of insulin. You may have to ask the vet for more anti-nausea and a medication called flagyl if the diarrhea continues. Feed anything that your cat will eat. Doesn't matter what really. What matters is getting the insulin in, trying to increase it slightly if we can, and getting those infections gone.

 

well....
let's breathe.

you are doing great.
as long as his numbers are above 50. He's not too low.

Keep exploring for things he might eat, even if it isn't diabetic friendly.
If he'll eat a piece of bread, that's calories..... and that will also keep him from going low.

 

I have been giving fancy feast pates. He used to eat proplan too but i was told to stick to less variety.
All under 5% . Should I give higher?

 

I would aim for about 12% at the moment, but if he's not eating that well, just give him anything. Set out dishes of all kinds of food, wet, dry, temptations treats (ie. kitty crack), etc.

 

So what do I do for dose in am? I am on eastern standard time. Western Massachusetts.
If I feed higher carb then give what dose?

Everyone is saying feed low carb so why the higher? Just to get more insulin in?
For how long?

Here is where confusion comes in...
Should feed low carb to get right dosage. So I do that now & he keeps getting ketones.
I been feeding him @400-500 calories under 5% carbs. 4-5 cans of fancy feast .
He was eating alot of gravy before this all happened.
So do I just feed med carb for a few weeks to get him out of danger?
Or is that how to regulate for him since he is now so ketone prone?

 

I would test about 2 hours before the test time. If under 250, then feed a highcarb meal at 2 hours before test time. Then check again at test time. If over 250, give 3.25U and monitor closely. If under 250 at test time (200-250), if you are able to feed another round of high carb then give 3.25, if he won't eat more, then continue with 3U. If he is below 200 at test time, ask here what you should do.

Ideally, we want to stick with 3.25 or even get up to 3.5. So use the food to get to a comfortable blood sugar level so that you can give it and not worry.

Low blood sugar is only dangerous when you start to get below 60-80. So you have a lot of wiggle room. Ideally, we want to see DKA kitties in the 150-250 range at all times. The range is different for healthy cats because we need that wiggle room and higher sugars for safety in DKA.

Try to get another ketone test tonight if you can (or did you already?) and get one tomorrow AM if possible.

 

Ya. I just got a ketone test and it says negative. So not sure if the strips are working well.
He peed like a long time too. I wish I had timed him. I swear it was like a minute he was peeing.
Although tonight I noticed he was sitting peeing and last couple of days he was peeing a little vertical. I wonder if that makes a difference?

So this procedure you wrote here. Is that forever? Or just to get him under control for awhile to allow his body to heal from ketones?

 

This is only for your AM dose for tomorrow. There are too many variables going on right now that it's really day by day.

 

Hang in there, Darnell. Things are harder and different now because of the ketones. You're on the right track to getting him better. I'm celebrating the negative ketone test tonight!

We can't give any advice via personal messages, either on Facebook or here on FDMB. It's a rule for the safety of the cat and the protection of the person giving advice. Advice has to be given in public view so that anyone can see it. No one would want to make a mistake and hurt a cat because of it, and one can lose their membership here on FDMB if they violate that rule.

There are a couple of features that might be helpful to you though:

1. On this page, at the top right, there is a little spot that says "Watch Thread." If you click on that, you can choose to get emails whenever anyone replies.

2. Somewhere at the top of the page, near the website address, is an icon that looks like an almost complete circle with an arrow on it. That is a refresh button. It will reload the page you are on and if there are answers, they will show up. I have a little Asus netbook, so if you have an Apple it will no doubt be in a different spot, but I think the symbol will be the same.

Hope you can get a good night's sleep!

 

the peeing a long time shows the uti. I hope he doesn't have crystal issues.