Diabetic Cat & Infection - Spiraling Quickly

Hi everyone,

New here! And I am in dire need of help, unfortunately.

Some background:

My cat is a 10 year-old female, recently diagnosed (month and a half ago.) Her name is Bootsie. Initial bg was really high at 520. She's currently on 1 unit of ProZinc twice daily.

I don't test her bg at home. The vet said it was unnecessary for me right now, and that I could look into it when Bootsie starts to show signs of good regulation. After perusing this forum today, I see that's probably bad advice, but I can't go back in time.

She's had a few vet visits since her diagnosis. The first was good and showed a lot of progress from her diet change (wet only, friskies pate) and starting insulin. Bg was 250 at the vet. The second not so good, her bg was elevated (320) and fructosamine showed fair to poor control (420.) It's been a bit of a rollercoaster for me, but I was happy because through it all, Bootsie was still showing signs of great improvement (way less drinking and urination, more energy.)

In the last couple of days, however, Bootsie's condition has really taken a (random and sudden) turn. Two days ago she suddenly lost her appetite and stopped drinking water. She became very lethargic and listless.

I took her to the vet immediately the next morning and they discovered that she had an infection of some sort and was running a fairly high fever (104.4.) Her bg was also high at 300, and she was of course dehydrated from not drinking. The most disturbing news was that her urine showed ketones.

The vet gave her subcutaneous fluids and a shot of penicillin and B-12. She also instructed me to give her her insulin ASAP. For the ketones, she said that I could leave her for hospitalization, or monitor her at home and bring her in tomorrow for hospitalization if her condition doesn't improve quickly. They also planned to run a urinalysis later in the day (never heard back on that.)

The problem is that Bootsie's condition has not really improved at home. She's still acting lethargic and will hardly eat or drink. She's just been mostly laying around, though she did walk a bit and jump on the couch and bed a few times to get some attention from me. I managed over the course of the entire day to get her to eat about a quarter can of tuna, but that's it, even after presenting her with three other flavors of food she likes, and even mixing them with hot water and adding Parmesan cheese. And she hasn't been drinking at all.

What should I do? I know that to help her, I'll have to take her back to the vet tomorrow. But I truly and honestly cannot afford to hospitalize her there. It would cost me $5-600, and that's in addition to the $200 I already paid for her visit today. And I cannot afford to take on any more personal debt via care credit or other financing. And my vet doesn't offer a payment plan option. They just recommend care credit.

What should I do? I'm really scared for Bootsie. She's been my little buddy for ten years now, I've had her since she was just a tiny kitten. I don't want to put her down, but I can't afford to treat this. And I know she's at risk for DKA now, which I definitely can't afford to treat if it gets to that point.

I could afford and manage the regular diabetes treatments, but I didn't think something this big or bad would happen so soon. Any ideas on why she would so suddenly have a catastrophic incident like this? What could be causing her infection? The vet seemed to have no idea, except maybe UTI.

I hate that money is a consideration here. If I had limitless funds, I'd of course do every test, every treatment available to get Bootsie healthy again. To the bitter end. But I don't, and it makes me feel like a totally inadequate and unloving caregiver to my cat, and she doesn't deserve this. I feel like a horrible human being for causing her to suffer and not get the treatment she needs.

 

Please contact Diabetic Cats In Need (on Facebook)

In the meantime, get her to eat anything you can, even if it's high carb. You can increase the insulin as needed, but it's important to get calories into her. Here's a video on Assist Feeding too


The "recipe" for DKA is Not enough insulin + not enough food + infection/inflammation

 

Thank you for the reply! How do I get her to eat? I've tried several different flavors that she likes. Didn't work. I tried microwaving them to increase the smell. I tried mushing it up with hot water. I tried Parmesan cheese. And I gave her tuna. The tuna seems to be the only thing she's even mildly interested in, but she's not even eating that now!

I don't have any feeding syringes to try and force feed her. Is there any other device I could use? I also don't have a blender. I tried putting some tuna on her paws/fur to get her to lick it off, but she just shakes her paw and flings it away.

Any other ideas I could try?

Also, thank you for the recommendation. I will try contacting them ASAP.

 

Actually, that organization seems to only be willing or able to help with food, supplies, and insulin. I can afford those things. The issue is the high cost of hospitalization. No one is going to help pay for that. I'd have to pay out of pocket, or through credit. I literally don't have the money to pay out of pocket, and I really, really can't add additional debt.

 

I'm a case manager for DCIN....we do help with kitties in crisis, although it's kind of late for me to be able to get in touch with the person that handles it.

Try anything....even kibble if you have to. Sometimes if you offer food to them on your finger or from a spoon they'll eat for you.

 

If you can get to a WalMart, get some urine ketone test strips. Anything over "Trace" is a medical emergency and DCIN can help with treatment costs.

Here are some Urine Testing Tips

 

Thank you for replying! I've been trying for the last few hours to get her to eat. I've put out her old kibble as well, which she hasn't touched.

The good news is that I just decided to sit on the ground with her near her food area, and she came over and ate a few mouthfuls of tuna. She's been doing that on and off throughout the day. It's not a lot, but she is still trying to eat voluntarily.

I'll try your method next.

 

Even if I already know that she has more than trace ketones in her urine? The vet confirmed this earlier today, but she isn't (or at least wasn't) DKA. According to the vet, anyway. Although she was pushing hard for preventative hospitalization immediately. I couldn't say yes because they'd expect immediate payment I wouldn't even have had time to apply for care credit if I wanted to.

I really wish I'd had a few months to save for this kind of thing. I really didn't expect it.

 

That's good!!

It doesn't take long to go from trace ketones to full blown DKA....it can happen very quickly.

At the very least, if she's not vastly improved by morning, she needs to go back to the vet. Please send a message to DCIN. If you feel this is an emergency, there's a phone number you can contact when you message DCIN.

Push as much fluid and food into her as you can and make sure she gets her insulin.

I'm sorry but I have to get offline for tonight. I have to take my 88 year old mom to the doctor in the morning and have to be up and out in 4 1/2 hours.

 

Thank you so much! I'll contact them immediately.

And yes, I'll continue trying to get her to consume some more food and water. At least until I go to sleep for a few hours, since I'm going to have to take her first thing in the morning. She will certainly get her insulin.

Good luck with your mom, and thank you for your help!

 

Just a quick FYI....you can apply for Care Credit and get an answer immediately. I've applied to them in the past and immediately got how much I was approved for and access to my new account number.

If your vet works with them, they can also help you apply.

 

My vet does accept care credit. My issue is that I don't want to add to my already critically huge debt load. And I mean CRITICALLY huge. But in a moment of panic over my cat, I actually did apply earlier today. It told me that for some reason my application couldn't be processed immediately and that they may either need more time, or I may need to provide more information. I'll have to call them in the morning if I really decide to go this route.

Again, thank you for the information.

 

How's Bootsie this morning?

Been worried about her all night

 

Bootsie's condition was unchanged this morning. Still hadn't eaten much or had anything to drink. She actually urinated outside of the litter box, too.

I talked to my vet and worked out a price reduction for day hospitalization which isn't too bad. And I got a care credit line. So Bootsie's currently being treated at the vet hospital. She'll be getting IV fluid today and tomorrow, meds for pain and nausea, and they're running another blood test.

I hope she's okay. I know she doesn't like being at the vet, so she's probably incredibly stressed. But at least I'm getting her some treatment.

 

None of them like being at the vet, but it's the best place for Bootsie right now.

Getting those ketones flushed out is the most important thing so she can come home soon!

 

So Bootsie is back from the vet. She's fine, much more alert. And she's eating more now! She's actually acting like she's hungry!

Turns out she has pancreatitis. The vet said it could be chronic, but we don't know yet. I really, really hope it's not. It will be very difficult dealing with the cost and management of flare-ups like this on a frequent, or even semi-frequent basis.

But I'm glad to have her back and looking so much more lively!

I forgot to ask the vet this, but do any of you know whether her diabetes still has any chance of remission? Does the pancreatitis affect that?

 

there is always a chance for remission, it is up to you now - your care for her FD=her success.You will find a lot help here.

Yes, p-titis does affect this.

 

Here’s a link to some great info on dealing with pancreatitis going forward. It’s pretty common in diabetic kitties.
In case the link doesn’t work you’ll find this in the Health Links forum.

http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

Glad Bootsie is feeling better!

 

That's great news!!!

Hopefully she'll continue eating well for you and you can get the pancreatitis under control so she's back to 100% for you soon!

 

I'm glad to hear that there is still a chance for remission. How exactly does the pancreatitis affect it?

 

Thank you!

 

Yes, she's eaten about 3/4 of an entire can of food since she's been home. And she's drinking freely from her water dish, too.

Thank you for the well-wishes!

I'm due to take her in again tomorrow morning for a half day of fluids. I'm glad, too, because while she's definitely more alert and mobile, she's still kinda disinterested in her toys (could be because they left the catheter in, haha.) I'd like her to be 100% again.

 

I agree with all of the above. You have to remember that high BG will make her not feel good as well as having an infection. Just keep doing what you are doing and home testing is a must.

 

Oh, thank GOD. I was in tears reading this because DKA took my baby Dweezil 2 weeks ago.

So the high BG and pancreatitis plus not eating made the ketones but it wasn't full on DKA. So relieved.

Phew

 

If you see this in time, ask your vet about whether it makes sense for you to be administering fluids at home in the future. You can't do IV, obviously, but you can do subcutaneous at home, and it'd probably be cheaper than having to bring her in for fluid therapy. Fluids help not only for ketones, but also for pancreatitis flares.

I don't know if anyone knows what exactly causes pancreatitis in cats, or how it relates to diabetes. My vet described it as a stressor (in both directions): diabetes stresses the pancreas and makes it prone to pancreatitis, and the pancreatitis stresses the cat, raising blood glucose in a diabetic. Remission is possible even with pancreatitis, though a later flare can cause them to drop out of remission.

Glad to hear that she's eating and drinking on her own now! That is an excellent sign!

 

Yes, I will definitely be home testing from now on. I've got to learn and get the hang of it, and get Bootsie used to it (she can be very uncooperative sometimes), but it seems like the only way I can have more control over the outcomes (and costs) of caring for her.

 

I'm so sorry to hear about Dweezil! You have my greatest sympathies.

That was my biggest fear with Bootsie. I'm glad she recovered in time before that happened.

 

Thank you for the information! Is it terribly difficult to administer subcutaneous fluids?

I'm glad that remission is possible. It gives me something to aim for, rather than just thinking that my goal is to keep her relatively healthy until the next crisis, which is way more depressing.

She was doing less well this morning. She was a little lethargic again and only ate a bit of her food. She did drink a bunch, though, which was encouraging. She's currently getting more fluids and meds at the vet.

I'm worried that she'll be fine when I bring her home today, but that she'll backslide again tomorrow. They're giving me pain and appetite meds to take home and administer as needed, but it's still all so up in the air.

 

Not terribly difficult, no. It does help to have a non-squirmy cat. Here's a video that shows how it can be done, with lots of detailed instructions: How to Give Subcutaneous Fluids (Video)

Glad she's getting treated at the vet now. Pain meds are good-- often that's the worst effect of the pancreatitis, if you can address pain they do a lot better.

What appetite med did they give you? They can be helpful, but word of caution: if the reason she isn't eating is because of nausea, appetite meds aren't going to help, so watch out for signs of nausea (lip-smacking, approaching food then turning away). Hopefully the pain meds and fluids will do the trick on her inappetance, though. Often, once you get them eating (and can address the pain), they'll continue along on their own.

 

Thank you for the video! It's a little overwhelming to think about having to do that right now, but I guess if it comes to it, I'll do what I have to do. Do I get the supplies from my vet? I want to start thinking about being prepared in the future.

So yesterday they gave her buprenorphine for pain, Cerenia for nausea, and mirtazapine for her appetite. The vet said they're going to send me home with all three of those.

The last few days, during the periods where she hasn't been eating, she was definitely showing all of those signs of nausea! This morning, too. She ate a bit because it looked like she really wanted to, and she was acting like she was excited to get food, but then she did the lip-smacking and walked away after a few bites. Guess nausea is the cause. Thanks for informing me, now I will know what to treat her with if she's acting like that again.

 

Aha. That's good to know-- sounds like she's not really having a problem with appetite per se, then. Hopefully the other treatments help with the nausea. Another anti-nausea med to consider if the Cerenia doesn't do the trick is ondansetron (it works by a different mechanism), but fingers crossed she'll have the same positive response as she did yesterday!

 

Not 100% certain but I do believe Ondansetron and Cerenia can be given together, since they do work by different mechanisms. Might not hurt to ask your vet about it.

Here is the recipe for the Liver Shake, supposed to be irresistibly delicious and packed with great nutrition. Of course, if kitty is nauseated, this will not help and should not be offered until nausea has passed. I have never personally tried this but it gets rave reviews.

 

Thank you everyone for your support! I've had Bootsie home from the vet for a full 24 hours now, and other than being mad at me about the vet visits and the oral meds, she seems to be doing okay. She's a little weak in the leg where they had her catheter, and still not 100% overall, but she's a night and day change from where she was when I created this thread. She's eating heartily and showing a lot more energy. She even played with me a bit today!

The only thing I'm really worried about at this point (other than a recurrence) is her drinking. She's definitely not drinking a lot. She's drinking small amounts, but nowhere near her previous levels. I'm hoping this picks up soon like her eating.

 

If her BG numbers are lower, she will drink less. Are you testing at home? If not, what were her numbers like when the vet released her?

 

I only just this weekend went out and bought supplies for home testing. Hadn't been doing it before. I'm still in the process of learning how to do it, so I haven't really managed to get a real reading on my own yet. But her last reading from the vet was 235. She had been drinking roughly 4oz of water before this episode, and now she's hardly drinking much at all. She'll lap at the water for a few mouthfuls here and there, but it's not making a big dent in her water bowl.

I'm also a little concerned because it looks like whoever did the testing at the vet didn't do a good job...she has a hematoma on her ear where they stuck her.

As far as testing on my own, I'm currently struggling with Bootsie's suspicion and resistance; between the meds and the poking attempts, she is running like crazy from me and hiding in places where it's not easy for me to get to her. I always stop trying after that, because I don't think it's really worth it to terrorize her further. This evening, for instance, she wouldn't even let me give her the pain med. I tried four different times, and the one time I was able to hold her down, she hissed and swung at me, and then ran away again. I can't do the burrito trick because she knows it and avoids any towels she sees. She's on to me. I don't know what I'm going to do about testing. I'll have to devise a different strategy, I guess. She just really hates being poked and prodded, and she's extra sensitive to it after her recent extended vet stay.

Luckily she's eating more and acting more energetic now, so I'm not too worried about the pain med. The vet said to give it as needed. And she loves tuna so much that I was able to give her the cerenia pill by dissolving it in there. Bootsie completely cleared the plate.

I'll see how she does tomorrow and attempt everything all over again. But I feel like if I try any more too soon, she's just going to get even more jumpy around me. I feel bad that she's started to run from me on sight. It's not until I coo at her and sit down that she comes back for petting.

 

Following your thread...how is your kitty doing?