Simba was diagnosed with DKA. Vet thinks we're out of options. Help :(

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Eric and Simba, Dec 3, 2018.

Thread Status:
Not open for further replies.
  1. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    TL;DR: Cat has DKA and our only option seems to be a bank-breaking ER visit. This seems extremely urgent and we're out of options.

    Simba is the friendliest, most loving cat I've ever met. He's been my best friend for the past year and I'm getting desperate. If there's anything else we should be doing to help him, please let me know. This seems like something he should be able to get past, but the vet thinks we're at the end of the line here.

    Posting as many details as I think might be relevant. Sorry if the post is too long, and sorry if this is the wrong forum.

    We got Simba from the shelter last year. He was a 13 year old diabetic (but in remission). Since bringing him home, he had remained in remission for several months on a diet of Fancy Feast Classic Pate (4 cans per day). Early July, his glucose measured high (~3-400) on our home meter. Brought him to the vet & got him started on ProZinc insulin straight away (1 unit twice a day). Due to issues with that vet, we never actually got a real curve for him, or learned how to properly take a curve (big mistake, I know..) We spot checked occasionally and ended up raising his dose to 2 units.

    Fast forward a couple months (October?), we got him to a different vet who prescribed Lantus. They taught us more about BG curves & we finally started taking the measurements we should have a long time ago. He was on 1 unit for a week or two. He measured very high throughout the day of the first curve (400+ - spreadsheet here), so they had us increase to 2 units. Next curve at 2 units was even slightly higher. They wanted us to wait another week or two before taking another curve and deciding if we should increase the dosage. I was planning on doing it this past Friday, but...

    Thursday he threw up once or twice during the day and several times throughout the night. He tends to eat any garbage he can find, so this wasn't anything too worrisome. We got really concerned when he didn't eat his breakfast the next morning. He usually goes to town on it & finishes it immediately. So much that we've been giving him 1 of his cans frozen so he doesn't eat too quickly. He was also extremely lethargic (total limp noodle). Naturally, we brought him into the vet.

    The vet gave us a pretty grim outlook. After going over the possible causes, she took him aside for a ketone test. Came back as what she said was "bad, right on the cusp of REALLY bad". Gave us 3 options:
    1) Treatment at their facility, which involved fluid replacement/electrolyte therapy as well as further tests to try to figure out the cause of the DKA
    2) ER visit, where they would have some "faster acting" insulin with a higher success rate... but she said this would likely run us thousands of dollars and potentially not even save him
    3) Put him down...

    We left him with them that night (Friday), not knowing if he'd make it through the weekend. They said the treatment had a chance of a sudden heart attack. We brought them his Lantus vial for them to administer while he was there. Luckily, he made it through for us to pick him up and bring him home on Sunday.
    Results from the vet visit:
    -He got antibiotics (some type that should stay in his system for 7-10 days) for a UTI as well as pancreatitis
    -Gave him some anti-nausea medication (Cerenia)
    -Fed him some food (some higher-carb Friskies) - they said he completely devoured it, which is how he usually is
    -Gave him 1.5 units of Lantus one day, 2 units the next. Not sure about the rest of injections, as there should have been 4 total during his stay
    -His BG readings were around 300, which is better than he'd been doing recently
    -Fluid/Electrolyte therapy (they specifically said potassium)

    Brought him home Sunday afternoon. He seemed much better than he did on Friday, but definitely nowhere near his usual self. He ended up finishing his food overnight (took him at least 5 hours, when it would normally be gone in 5 minutes).

    Today, he still hadn't finished his breakfast by 6 PM. He normally gets feedings at 8AM & 8PM alongside his insulin injections. We gave him some canned salmon around 6PM, as I'd read online that something more pungent might be more appetizing. This worked a bit, but he still didn't finish it up. Also tried heating up his normal food to no avail. My SO was home, and she managed to get 2 readings earlier in the day (+3 and +6) and one PMPS. They were all 500+ (see spreadsheet). I picked up some ketone urinalysis test strips (CVS brand) and I was able to get one measurement while writing this. Looks like it's in the small to moderate range (attached pic).

    The vet thinks he's still in DKA and says our only options are to retry the therapy or to give up. They gave us a fluid bag (potassium chloride & sodium chloride) for sub-q injection at home, but he really hates it and we haven't managed to get the full dosage in. I'm not even sure what this is supposed to help.

    The whole situation looks dire. Took one more BG reading just now and it came in at 557. Is there anything short of a $3k ER visit that we can do? We don't want to lose him :(




    edit for more info:
    He's not eating or drinking much at all. I think we desperately need to get his glucose back down to normal levels ASAP but don't know how. The vet thinks he might be somogying and wants us to decrease his dosage to 0.5u for tomorrow. I don't think this is the case, as he has never actually measured at a low point since beginning insulin treatment. I think he needs a higher dose, but don't know how to be sure, don't want to make things worse, and don't want to go against the advice of the vet without good reason. However, it seems extremely urgent that we get him regulated ASAP. We are also planning on doing an extended curve tomorrow (measuring every hour) to get a better idea of what's going on.
     

    Attached Files:

    Last edited: Dec 3, 2018
    Reason for edit: additional details
  2. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Please contact DCIN (Diabetic Cats In Need)….they may be able to help with the costs. (it will depend some on how low our coffers are....we're really down in donations this year)

    If you have Facebook you can send a message HERE

    Or you can contact us through our website
     
    Jill & Jade likes this.
  3. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Thank you for the links. I don't know if I would qualify but I'll contact. Also hadn't heard about the Care Credit option before.
     
    Jill & Jade likes this.
  4. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Care Credit is great....and you don't have to have perfect credit to qualify so I'd definitely check it out.

    You'll usually get an answer within minutes
     
    Jill & Jade likes this.
  5. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    It looks like Care Credit asks for a specific hospital. My current hospital has said they feel unable to give him the treatment he needs given their supplies.
    Do you have any advice on choosing a good hospital that has experience with this kind of thing?
     
  6. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Any ER vet (that's open 24 hours) should be able to handle a DKA

    Unfortunately, it's a common complication of diabetes.....if they don't get enough food, enough insulin and have any type of infection/inflammation, that's the recipe for DKA
     
  7. Bubby & Ash

    Bubby & Ash New Member

    Joined:
    Mar 4, 2018
    My cat had something similar happen a couple of months back. Long story short, he went in for treatment of inappetance/vomiting with no ketones, had fluids and cerenia for a day, was sent home, still wouldn’t eat, developed ketones, went back in for 2 nights (IV, cerenia, syringe feeding, pain meds), came home with no ketones, STILL wouldn’t eat, went to different vet immediately with ultrasound. Diagnosed with pancreatitis, sent him home with meds. Once we had him on cerenia (half a pill a day), buprenorphine for pain (twice a day), mirtazapine for appetite (1/8 pill every other day) he rapidly improved and he’s fine now. He just needed extra support for pain and nausea at home after the ketones had been resolved. This is just anecdotal, it’s my only experience with this. Others probably know a lot more about this. I just hope that if you can get the ketones under control they’ll give you home meds to mitigate the pancreatitis. I think Bub was on all that for 5 days after his ultrasound and his numbers were a lot better with the pain under control. Big hugs to you.
     
    Bron and Sheba (GA) likes this.
  8. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I am sorry you are going through this.
    Iwould not decrease the insulin either. With DKA it is important that the cat gets insulin, gets food and the infection/inflammation is treated. Also fluids are very important to flush out the ketones.
    It is hard to treat DKA at home unless he is beginning to be on the mend. I would try and persist with the SubQ fluids if you are not going to take him back to the vet (which might be the best option)
    Itis important to get him to eat.....anything at this point. Have you given more cerenia? Or do you have some ondansetron as well. They can be given together for nausea/vomiting. If you don't have any ask the vetfor a script for some.
    Haveyou tried syringe feeding him?
     
    Last edited: Dec 3, 2018
  9. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    @Bubby & Ash I agree with all she has said and it is important to have pain meds for pancreatitis. It could take several days before Simba will eat properly as he is has a UTI, pancreatitis and DKA to deal with. Any of these will cause him to lose his appetite and feel pain poor love, Maybe the vet will give him another injection of cerenia.
    I would try dryfood if he won't eat anything else. Sometimes cats will start to eat dry again before wet when they have been sick. When Sheba had a bad attack of pancreatitis she wouldn't eat but she did start to eat small amounts of dry and I was able to switch her back over to the wet after a few days. I just put down 6 pieces for her at a time to start with. I hate dry but whenyou are inthe situation you are any food is better than nothing
     
  10. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Thanks for the replies everyone. We were able to retest his ketones again and it seemed worse than before.

    We rushed him to the ER and he is now spending the next few nights there. It's going to cost a pretty penny, but we should be able to manage it. If he's got a good chance, we can't put a price on his life.

    As of now, they're going to do an ultrasound to check his pancreas for abnormalities (to ensure the original diagnosis was correct, and that there are no further issues) and use more aggressive insulin to get his BG down immediately. They also seem much more willing to work with us than any other prior doctor.
    They mentioned pain meds for pancreatitis as well.

    I really do appreciate the stories and advice. It's great to know that you guys were able to get through your struggles.

    I'll keep this thread updated with info as it comes in.
     
  11. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Sometimes ER vets seem to work with us better than our regular vets.

    Prayers for Simba
     
    Beth and Herbert likes this.
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    So glad you have taken Simba to ER. You are right. You can’t put a price on his head. They are so precious. Sending prayers for a speedy recovery. :bighug:
    You are great mama and papa beans!
    Please keep us updated
     
  13. H.M. Victor (GA)

    H.M. Victor (GA) Member

    Joined:
    Jul 3, 2018
    Sending you my prayers for your Simba to pull through and recover :bighug::bighug::bighug:
     
    AlysonE likes this.
  14. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad you found a vet to help. Sending prayers for a complete recovery. Keep us posted
     
    AlysonE likes this.
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Hang in there! An ER clinic should be able to treat DKA. Yes, it's very expensive but they can get through it. I've been there twice with my guy. They won't necessarily be able to pin down an exact cause. A pancreatitis flare, some inflammatory bowel disease, etc. can percolate in the background and set it off. It can also happen with dental infection,, UTI, etc.
     
    AlysonE likes this.
  16. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Spoke with the ER vet a little while ago. They said he seems good, is eating and cleaning himself. Ultrasound showed no abnormalities on his pancreas, but he does have a fatty liver (I don't know much about what this means for him, but they said it can be normal for diabetics).
    They still haven't been able to regulate his BG though. His latest reading was 496. I think they've been giving him Novolin. Don't know much about that kind of insulin, but I think there's a forum for it here, so I'll take a look in a bit.
    They think he likely has some hormonal issue that is making him more resistant to insulin, but that he'll be good to take home. It sounds like they're going to try to get us Prozinc, as it's what originally worked for him at the shelter (2u BID->2u SID->0u (remission)). I'm not sure this will work, since he was on the 2u of Prozinc a few months back and didn't seem to respond to that either. He may just require a different dosage now, but I'm skeptical either way.

    Aside from that, my main concern is that he'll go back to not eating once he comes home. I don't know what we'll do at that point.
     
    Tracey&Jones (GA) likes this.
  17. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad he’s doing better! Fatty liver came from not eating enough. Ask the vet for some syringes in case you need to assist feed him. We can help you with him, just keep us posted.
     
  18. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I am so glad he’s doing well!
    I would ask to stay with Lantus insulin if Simba were my cat.
    Please keep us updated.
     
    AlysonE likes this.
  19. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Make sure you ask your vet for antinausea meds and appetite stimulant meds to have on hand. At the first sign of not wanting to eat at home, dose with antinausea meds (Cerenia or ondansetron). If that doesn't jump start him, give an appetite stimulant (mirtazapine or cyproheptadine). Giving subQ fluids can help with dehydration that adds to their feeling generally crappy.
     
  20. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    When you bring him home, get 2-4 cans of either Royal Canin 'Recovery RS' or Hill's A/D and a feeding syringe. If he won't eat, he's got to have food or he'll continue with fatty liver. You may need to syringe feed him for several days.

    Fatty liver or Hepatic Lipidosis is caused by not eating or not being able to convert the food to energy. The body begins to burn it's fat stores for energy causing 'ketones'. Ketones in the blood can cause the blood to become ph 'acidic' which is then DKA (Diabetic Ketoacidosis). This throws off all the body's electrolytes making it all worse. Lot of other 'stuff' in that happens in there but that's sort of a quick explanation. You are giving subq fluids with electrolytes to help flush the ketones out of the body, rebalance the electrolytes and return to body to a neutral ph balance.
     
    Bron and Sheba (GA) and Sharon14 like this.
  21. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    We had the same concerns when my cat had DKA.
    Ended up fitting her up with Esophageal Tube for several weeks to insure she eats and takes meds and has her insulin dose daily. Best explained by Dr. Pierson here.
    BTW, we picked our girl up after 24 h ER stay still with Trace (lowest) level of ketones and electrolytes being not good but stable.
    I was home back then and with intensive 24 h care for a few weeks it turned out ok, it was in 2017.
    My vet too was all sorrow and in very little option mood.
    @Eric and Simba
    How is Simba?
     
  22. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I agree you should get either the RS or A/D food from the vet. If you have to syringe feed mix the food with water. I use either a small food processor or even a coffee bean grinder to mix it to make it soupy.
     
  23. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    I'll ask them about syringe feeding and pick up some stuff for it - thanks for the tip. Last I heard, he's been doing okay.
    We should be able to pick him up later tonight. Fingers crossed that he's gonna seem a bit better & has a hefty appetite again.
     
    Tracey&Jones (GA) and Sharon14 like this.
  24. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Spoke with the vet just now. We'll be going to pick him up around 5 EST. They said he's been eating very well almost the whole time, so we'll hope that continues once he gets here. They agreed (after some bargaining) to send him home with some appetite stimulant in case of emergency. We still have some of the anti-nausea Cerenia from a couple days ago as well. They're also giving us some powdered potassium supplement to add to his food.

    @Lisa and Witn (GA) @Squeaky and KT (GA) ~~ Question about the RS & A/D food - why are these preferable to his normal food? Are these easier to feed via syringe? RS doesn't seem to be available without prescription, so I'd likely need to talk the vet into it. And A/D is kinda high in carbs at 12%

    His BG is still very high (near 600 last reading). They started him on 2u of Prozinc this morning, so we'll be looking to do a full curve on Saturday (after a full 3 cycles) and at least taking PS readings until then.
     
  25. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    They are more calorie dense and easier absorbed with additional vitamins and minerals to help with healing. PLUS they're both easier to mix to syringe feed. The Recovery is a lot better at blending to a good consistency plus most cats like it. Lower carbs is a plus. You CAN order it from Chewys .com but have to order a case. It's not for every day after healing as it lacks some long term needed nutrients so is considered 'supplemental feeding'. It's usually priced about the same as the a/d, it's just harder to find. Hills gives the vets a much better 'sales' deal...
     
  26. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Chewy says they'll require a script as well. I'll be sure to ask the doc when we pick him up. Thanks!
     

    Attached Files:

  27. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    He's home and seems SO much better! Way more energy, exploring, purring super loud.. :')
    Definitely seems we got through this.

    It's still going to be an uphill battle trying to get him regulated, but I'm so glad we have him back. With everything going on and the doomsayer of a vet we were dealing with, I was so scared that we were going to lose him. Seeing him back to normal is the biggest relief.

    Thanks so much for the advice and support, everybody. It really means a lot.
     

    Attached Files:

  28. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    So good to hear from you and that Simba is doing so much better!!

    He's such a handsome orange boy!! I have a special place in my heart for orange tabby cats....my very first kitten was an orange tabby. He was a Christmas gift when I was 7.....He had the ever-classic name of "Kitty"...LOL
     
    Jill & Jade and Eric and Simba like this.
  29. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    He was excited for dinner this time and gobbled it all up. Back to his normal self!

    PMPS BG was 305. That's the lowest number we've seen in months. It's probably somewhat deflated - he did receive a bit more insulin at the doc's today (Novolin) because of a high reading earlier in the day. Regardless, it's fantastic to see his numbers coming down from the 4-5-600s.
     
  30. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    You can also take the script to PetSmart if they have a vet's office in their store. Their vet will issue a prescription card so you can buy it any time at the store. This is very helpful when you cannot get to your vet's office before they close.
     
    Kris & Teasel likes this.
  31. H.M. Victor (GA)

    H.M. Victor (GA) Member

    Joined:
    Jul 3, 2018
    So glad to hear Simba's doing better!
     
  32. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Really good news! :smuggrin:
     
    Jill & Jade likes this.
  33. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I am glad Simba feeling better.
     
  34. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Bad news...

    After seeming good since he came back from the ER, he threw up around 6am today. We were able to get a urine ketone check around the same time and it came up Moderate-Large (40-80 mg/dL). Gave him Cerenia and Cyproheptadine around 7. Still only ate a tiny bit of food at 8. BG was close to 500. Gave his usual dose of 2u Prozinc anyway. Gave subq fluids around 9, got around 150mL into him. He has been drinking some water.

    My s/o is bringing him to the vet now. I don't know what they're going to say. We can't afford to keep putting him in the hospital.

    I'm running very low on hope for our little buddy here :(

    Tagged post as 911 in case anybody has more input, but I really don't expect much at this point...
     
  35. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I hope your vet can get him through this relapse. I think it's time to boost his insulin by a whole unit to 3 u. Hold that only 3 cycles or so and increase to 3.5 if he stays high. Keep that up until you see yellows and blues. This is much more aggressive dosing than we usually recommend but possible DKA is an emergency situation. What BG level was your vet getting him to last time in hospital? Was the vet using fast acting insulin to yank down BG? How was the 2 u dose determined? If you need to increase the carb level of his food to allow bigger insulin dose, do so. If that means giving dry food, do it. All the rules fall by the wayside right now.
     
  36. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Neither vet was able to get his BG down much. The first hospital said they didn't have the right insulin, so they used our Lantus. Second hospital used Novolin and said they still saw 5-600s. His first reading after he came home was 305. Lowest I think he'd been in a long time now.
    Not sure why they decided to start with 2u.

    Update from his vet visit just now - they flushed out some congestion, gave us more Cerenia, more fluids/needles for subq. Suggested increasing by 0.25u. I agree that this isn't the time to go slow, and we'll be bumping him up to 3. I understand that hypo is a serious issue, but we already have an equally serious issue at hand. We'll be able to monitor him closely while on the new dose.
     
  37. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
     
  38. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Keep us in the loop. I'm glad you're increasing to 3 u. His numbers are high enough that the risk of ketones is much much larger than the risk of dropping too low. That's a lot easier to handle at home with carbs, etc. As I said above, don't keep that 3 u more than 3 cycles if it doesn't produce anything below pink. Then go to 3.5 u for 3 cycles, etc. Those numbers must come down.

    You can post here or on the ProZinc forum or both. I'll be watching. Is Simba eating?
     
  39. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Here's info I gleaned from a lot of reading about post DKA here on FDMB:

    Post-DKA "at home" management:
    • food and insulin are key! More calories per day are needed to prevent ketone formation (give high carb/high calorie if you can)
    • feed food high enough in carbs to allow a high enough insulin dose to be given
    • this is not the time to try to get BG down into ideal ranges - settle for "OK" (yellows and high blues, very low pink max.)
    • appetite can/will be variable so be prepared to address nausea first and add in the appy med second only if needed
    • hydrate, hydrate, hydrate!
    NOTE: Cerenia can help with nausea but the human med ondansetron can work better. Some people use the two together for nausea because the drugs target different receptors. Ondansetron is the generic form of Zofran, a human drug for the nausea caused by chemotherapy. Zofran is very $$$. Ondansetron is not. You'd need a prescription from your vet to be filled at a human pharmacy. Nausea must be addressed before using appy meds.
     
    Tanya and Ducia likes this.
  40. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    He isn't eating much, but has eaten some. He seems extra heavy and I think he's full of fluids right now. He's been drinking a lot since he came back an hour ago.
     
  41. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Go easy on the fluids. It can be hard on the heart especially if there's any sign of cardiomyopathy. Once he's eating wet food, add water to each meal - 3 to 4 tablespoons.
     
    Tanya and Ducia likes this.
  42. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Noted. Thanks.
     
    Kris & Teasel likes this.
  43. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    @Eric and Simba


    extra calories are crucial with ketones in the picture, just as proper insulin dose.
    I found this syringes super convenient in case you'll need to assist feed.
    Best wishes for Simba and speedy recovery!
     
  44. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Sending many vines to Simba for making a full recovery.
     
  45. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    We did end up syringe feeding a bunch earlier. He's getting the rest of his food forced in right now. He did have a decent amount to eat today overall. Gave 3u Prozinc for his PM shot. Going to test around +4 before going to bed.
     
  46. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Give 3 u tonight and bump it up to 3.5 u tomorrow AM. Three cycles at that then 4 u, etc.
     
    Eric and Simba likes this.
  47. Bellasmom

    Bellasmom Well-Known Member

    Joined:
    Feb 12, 2018
    Eric and Simba likes this.
  48. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    My gf didn't feel comfortable giving 3.5 so he got 3 again this morning. Even with both cerenia and ondansetron, his appetite has been nonexistent. He's at least drinking a ton of water. We were able to syringe feed him around 70% of his normal food amount for yesterday.

    Ketone levels have been small to moderate every time I've checked. Gf said one measurement midday was high, but it had improved after that. BG readings have all been red/black. I'll make sure we up his dose by tomorrow morning if it doesn't improve.

    He's also dealing with a respiratory infection that they gave us Clavamox for a couple days ago. Both the respiratory issues and medication may be contributing to his inappetence.

    Between everything going on, he really has not looked good these last few days. Don't think he's gotten much sleep at all either.
     
  49. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    You have to be comfortable with the dosing you're trying. I really do think he needs those regular 0.5 u increases though. I know it's hard to trust someone on an internet forum. We're still here to help though.
     
    Bellasmom and Sharon14 like this.
  50. Bellasmom

    Bellasmom Well-Known Member

    Joined:
    Feb 12, 2018
    @Kris & Teasel, Kris is amazing, she helped me get bella out of the blacks and reds and now Bella is doing just great, I did everything she advised me to do, I wish u well and hope kitty gets better soon
     
  51. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Things aren't looking good. He hasn't eaten much of anything today and our only feeding syringe was destroyed by the dog. Our roommate is picking up another one now...

    Simba is having trouble walking. He stumbles a lot now. Ketone test came up with a clear moderate. He has lost another half pound, down to 9.5 now. I don't know how much longer he can last. We are considering giving up... He is miserable and is not showing signs of getting better.

    Do you think he still has a chance?
     
  52. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Unfortunately, the further along this path he goes the harder it will be to roll him back without a very expensive stay in a vet ICU. Only you can decide what course of action is open to you for any and all reasons from emotional to financial. Any decision made out of concern for a kitty's wellbeing is a good one. :bighug:
     
  53. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    We were able to get some food into him (~1.5 cans of fancy feast). He's still very weak and having trouble standing. BG came up at 386, but he didn't eat much beforehand so it's probably not very accurate. Going to give 3.5u at 8est tonight and try to get a bunch more food into him by then. Going to do my best to monitor him throughout the night as well.

    He is definitely miserable right now and I'm worried we might just be prolonging his suffering... I don't know when to say enough is enough. I feel like he still has a chance, and I can't give up on him while thinking I could still do more. This whole situation sucks :(
     
  54. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Well, you can decide to go with those 0.5 u dose increases for a little while if you feel you can get enough food and fluid into him. Keep the ketone testing going. If you feel brave, bump him to 4 u - nothing to lose really and it just might help. If he had dropped into blue mid cycle today I wouldn't have suggested that but he's got a ton of room to drop even with a 386.
     
  55. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    I think we're going to try 4u, & stay up to monitor him throughout the night. I'm afraid that we'll be out of time if we can't get him to a good level this weekend.

    I really appreciate everything you all have done for us. We would not have gotten this far without you. Thank you.
     
  56. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm glad to help. Increasing the dose might feel risky to you but the ketone risk trumps that. Keep getting food and water into him.

    Here's the basic problem:
    • not enough calories = body breaking down fat stores for energy = ketones as a byproduct of this process
    • not enough insulin = inability to get glucose from bloodstream into cells = cells using fat for another source of energy = ketone development as above
    • dehydration = increase in ketone concentration in bloodstream = feeling yucky = inappetance, nausea, etc.
    All of the above are connected. Having another infection or inflammation at the same time will make everything worse.
     
  57. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I think going to 4 is a wise decision.
     
    Kris & Teasel likes this.
  58. AlysonE

    AlysonE Member

    Joined:
    Dec 11, 2018
    I am really wishing you all the best and sending prayers for you and Simba.

    I also think going up to 4 is worth the risk.
     
  59. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    His PMPS just read 384. Pretty low for him. He didn't eat his normal amount of food today, so it's partially due to that. We're going to make sure he eats all of his food for the day (the lady is a better nurse than I).
    I think I am still going to give him 4 units despite the low reading. Thoughts? Going to give the shot soon.
     
    Kris & Teasel likes this.
  60. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    Just an observation...Clavamox absolutely destroys the appetite of several of our current crew of 6 cats. If possible, we usually go with a different antibiotic, although most can cause GI issues as well, but sometimes Clavamox is the best choice and we just need to deal with it until the course is over. Injectable Cerenia sometimes helps for appetite (and more so than the Cerenia pills in our experience). But Clavamox makes a couple of ours look and feel absolutely HORRIBLE - and that is just with an underlying infection and the Clavamox, not with diabetes and DKA piled on top!

    While Simba overall clearly has some serious issues, the Clavamox could be making it seem worse than it is. I am sure others can share their experiences/thoughts on it too.

    And similar to what @Kris & Teasel said...we don't know Simba, we can't see him...you know your buddy best and you are doing a phenomenal job, and any decision you make out of concern is the right one.

    Our best to you, you'll remain in our thoughts,
    Sandi.
     
    AlysonE and Eric and Simba like this.
  61. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    Just saw your update...since it sounds like you are prepared to stay up anyway, as long as you have enough strips and something high carb if he goes low, i would go with 4.
     
    AlysonE and Eric and Simba like this.
  62. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    4 units in. That's an awfully big amount of liquid. Fingers crossed for tonight.
     
  63. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    I know it seems that way, but the data you have so far shows that you have a long way to drop before you are in dangerous territory.

    Testing at +2 will be a good idea to let you see where he might be heading. I am in Eastern Time but I'll check in as long as I can.
     
    Eric and Simba likes this.
  64. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I think giving 4 u was the right thing to so. Get a +2 test this evening.
     
    AlysonE and Eric and Simba like this.
  65. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
  66. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    Ok, so you are still seeing a little bit of a rise in number as you have in the two nighttime cycles you've checked before now. That is pretty normal because the insulin isn't really kicking in yet, and this _probably_ means that you will have a safe and uneventful night with regard to BG.

    I don't know if you'll be up with him all night anyway to feed and monitor even if his BG is safe -- if that is your plan, you could always take a nap now and get up at +4 to test again so that you aren't totally wiped out tomorrow. I expect Simba to be safe for the next two hours.

    Edit to add: I'll set my alarm to check in on you then as well.
     
  67. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    We are planning on having one of us up to watch him pretty much throughout the night. I'll probably take a ~1hr nap before testing around 1:30 EST.
    Would you continue testing every hour after that? 2hrs? How low can he go before we should start with hypo treatment?
     
  68. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    No, I don't think it'll be necessary for you to test every hour. If the +2 had been lower than the Pre-shot, that can indicate it might be an active cycle, but his is a little higher.

    Below 50 is your "time to act"....but I don't think you're going to have to worry about that tonight.

    If you get a +4, I think that'll give you a pretty good idea if you need to continue to test tonight or not
     
    Eric and Simba likes this.
  69. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    So you don't yet really know what time he usually hits nadir (lowest point in the cycle), but it is normally between +5 and +7 for most cats most of the time. If your +4 is still, let's say...300 or more, you are likely safe not testing any more until AMPS if you need to rest.

    That being said, all data is good data, and the more you have, you'll start to learn when onset and nadir are, which helps you make educated guesses on when to test next based on what BGs you see, so that you aren't testing nonstop. Therefore, if you are up tonight anyway, you could test every 2-3 hours after that until the morning shot just for data gathering purposes. Or once you see 2 rising numbers in a row, there isn't much else to learn because you are probably then past your nadir.

    I'll see you around 1:30am.
     
    Eric and Simba likes this.
  70. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    Sorry, but I am really drifting off. I truly believe your BG is fine for the night based in +2 or I would force myself to stay awake. But folks in other time zones might be around.

    I'll check on you in the morning.
     
    Eric and Simba likes this.
  71. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Real sorry to say that we both slept right through the alarm...
    +6 came in at 437 - still higher than the previous 2 readings. Good news is he seems to have regained some energy/stability with those few extra hours of sleep.
     
  72. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    You probably all needed a good sleep
     
  73. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'd give 4 u tonight and go to 5 u tomorrow AM. It's too soon to know if he's a high dose kitty. He might just have a lot of glucose toxicity from being so high so long. If so, you'll reach a "breakthrough" dose that will knock him down. All the other health issues make it harder but don't give up.

    Is he eating?
     
  74. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    Agreed, that's good news. Sometimes everyone just needs sleep. I almost warned you in advance of how easy it is to sleep through them when you've been doing intensive care for multiple days :p

    It wasn't critical for you last night, but if it ever is critical for me to get up for a reading, I make sure to put my alarm across the room so that I have to actually get up to turn it off. That seems to help.
     
  75. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    He is not really eating willingly. Only took a few tastes on his own last night, nothing earlier in the day. The syringe is a lifesaver.
     
  76. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    You all are doing great with him.

    Hugs for everyone. :bighug:
     
  77. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Been testing every couple hours & his BG has at least been steadily decreasing since the AM shot. Numbers are still in the for now.
    Seems significantly stronger than yesterday, but still quite weak. Not falling over as much, was able to jump into the bathtub & land gracefully from jumping off the bed (which he couldn't do yesterday).
    Ketone levels are still around moderate. He's been drinking a lot (but only directly from the sink, not his bowl...) and we gave some fluids (~75mL) this morning.

    He still has 3 days worth of Clavamox left from the vet. His respiratory issues seem to have gone away (no sniffles or clicking sound) - are there any other indicators to look out for?
    We don't want to give it to him any longer than necessary, since it really does seem to be impacting him heavily. It looks like he's much more open to eating/drinking from his bowls when he hasn't had the pill in a while.
     
  78. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I would finish the course of clavamox
     
    JanetNJ and Eric and Simba like this.
  79. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Don't stop the antibiotic until it's gone altho' I understand it's hitting him hard. The length of time is just as important as the dose amount. Stopping it too early can let those few remaining germs rebuild. It can also cause that antibiotic not to work as well next time either. I've been guilty of that before, NOT good.

    I'm happy to hear he's getting better. One day he'll start eating again - he really will....
     
  80. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Need some dosing advice... His BG has been going down steadily the whole day.
    I should be giving his shot in the next 20 minutes or so but he's at a pretty low level (for him at least, considering he hasn't rebounded this whole day - 358). Worried that 4u may be too much.
     
    Last edited: Dec 14, 2018
    Reason for edit: additional details
  81. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    He's still way too high.

    I'd go ahead and give the 4U again tonight and test at +2....that should help tell us what he's going to do later in the cycle and how much you'll need to test tonight.
     
    Eric and Simba likes this.
  82. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    4 units in. Let's see where this goes.
     
    Chris & China (GA) likes this.
  83. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Moving in the right direction!
     
    AlysonE and Eric and Simba like this.
  84. Sandi&Maxine&Whispy(GA)

    Sandi&Maxine&Whispy(GA) Well-Known Member

    Joined:
    Oct 2, 2015
    Unfortunately, yeah I agree you should finish the Clavamox. I hope you didn't think I was trying to get you to stop early -- I wanted you to be sure to not make a permanent decision based on what is hopefully a temporary situation.

    I understand you are worried about the 4u, but your take action number of 50 is a long way away...and I mean that to be comforting, not discouraging!!! :woot:

    Maybe I should just stop talking now... :p

    358 for a pre-shot is certainly looking better, and once you get your next test, the info from last night should help you decide what additional tests to get tonight (if no one is on to help).
     
    AlysonE and Eric and Simba like this.
  85. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    I appreciate the input. I think things will be a whole lot easier once he's done with the Clavamox. The biggest problem right now is that he doesn't want to eat, so we have to force in the food & pills. It does seem like he's recovering slowly but surely.
     
  86. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Also, since the shot his BG has just been going up again as it did last night. Really strange.
     
  87. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Not unusual when you're not in the good dose range yet. It's a pattern that tells you he's still drifting in the "too high" range and there will be minor ups and downs in that range. Once you're seeing yellows and blues a clearer pattern *should* begin to emerge.

    I'd bump him to 5 u this AM if you feel brave, 4.5 u if you don't. Stay there for only three cycles then increase.
     
    Last edited: Dec 15, 2018
  88. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    He just walked over to the bowl and ate a bit of the Purina DM dry food all by himself! This is the first time he's eaten of his own accord in forever :D:D
     
  89. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I see you went to 5 u. Ignore those blacks. He could be rebounding from the pinks that were a 200+ point drop.

    Any urine ketone test results?
     
    Last edited: Dec 15, 2018
  90. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    One test around 3am. Came up small, maybe small-moderate. He's been at a solid moderate+ for a while now so this is definitely a drop.
     
    JanetNJ likes this.
  91. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    That's good news! :)
     
    Eric and Simba likes this.
  92. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    Got another ketone reading - small/small-trace!
     
  93. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    +6hr BG came up 600... is it normal to bounce back up for this long?
     
  94. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    All those blacks are basically the same BG level. High and flat is a typical bounce pattern. Try not to worry. Give 5 u tonight and tomorrow AM. Increase to 6 u either tomorrow night or Monday AM.
     
    Eric and Simba likes this.
  95. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    How are Simba's clinical signs: eating, peeing, pooping, moving around, demeanour, energy, etc.?
     
  96. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    You are doing an amazing job. Ah maze ing.
     
  97. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    He's still being syringe fed most of his food. Peeing/pooping in box, no issues there. He's been sleeping an awful lot.

    He has improved drastically over the course of the day yesterday. He looked barely alive on Thursday and is markedly better today:
    • He's got enough energy to resist syringe feeding a bit
    • Ketones have been decreasing
    • He is able to jump & land gracefully from several feet up (Thursday he would collapse if he tried)
    • He's still wobbly, but not as bad. He completely fell over several times on Thursday but has only lost his balance a few times since yesterday.
    • More responsive - wouldn't react to anything while sleeping, now he perks his head up some. Tail perks up some when petting him too
    • Sometimes goes for the DM dry food. He's had a couple bites over the past few hours without any prompting
     
  98. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Do you think you're getting more food into him lately? Increasing the calories is an important part of ketone treatment so if he's eating better now, that (along with increasing the insulin and hopefully getting whatever infection is going on under control) could be major factors in his improvement!

    Let's hope it continues!! You're doing fantastic with him!!!
     
  99. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    This is a very positive change! :) You're doing great.
     
  100. Eric and Simba

    Eric and Simba Member

    Joined:
    Dec 3, 2018
    He normally eats 4 cans of Fancy Feast per day. We've been getting him to eat around 3 of them per day since we started syringe feeding - not much has changed there. I think we managed all 4 yesterday. Despite him having a bit of an appetite now, he's not really eating an appreciable amount of food on his own.
     
Thread Status:
Not open for further replies.

Share This Page