3/26 Smokey Not Really Eating, Vomited 3 Times

So tonight Smokey seems to be having some tummy trouble... This morning he didn't finish all his food. His BG has actually been pretty good the last few days, as seen on his SS.

But tonight he vomited in the living room twice, and then just now, he vomited two more times. The first two times were watery with what looked like dog kibble remnants. The second pair of pukes were totally liquid, and were clear-brown-yellow color. He's now laying in the sunroom, where it's cool.

Should we be worried at all? He's been doing really well on the 0.75 IU dose of Lantus, though we haven't gotten a curve yet. He's drinking water normally.

 

Have you been testing for ketones?
The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

If he's not better in the morning he may need to be seen by a vet.

Edited to add:
Signs of diabetic ketoacidosis

• Drinking excessive amounts of water OR no water
• Excessive urination
• Diminished activity
• Not eating for over 12 hours
• Vomiting
• Lethargy and depression
• Weakness
• Breathing very fast
• Dehydration
• Ketone odor on breath (smells like nail-polish remover or fruit)

 

We have not. We have a bottle of Ketodiastix from a few years ago from his original DKA episode. Can they still be used?

 

No, you'll need a new ones. They expire "x" amount of days after opening. It should say on the canister.

 

Shoot. Okay.

I'm having really bad anxiety now, as we don't have the funds to pay for DKA emergency treatment a second time. And he's not acting like he did during his first episode. I'm just praying he maybe got into the dog food...

 

I’m pretty sure the expire 6 months after opening them.
May I ask why you haven’t been shooting when he is in the blue?

 

We haven't been shooting because the SLGS post says not to give insulin under a certain number. Or did I read it wrong?

 

Minor update: Mom checked our doggy's bowl and his kibble was all gone! Her door was also open, and Smokey's brother also threw up earlier. We may have the culprit on our hands.

 

Hmm, that's interesting that they both vomited.
I wonder if the kibble has become moldy at all. It's more common than you'd think.

SLGS: You may want to re-read these three sections in the SLGS sticky:

• How to handle a lower than normal preshot number
• If the preshot number is far below usual preshot numbers
• If the preshot number is near usual preshot numbers

There are guidelines within the protocol that could eventually have you shooting on preshot numbers greater than 90 mg/dL.

 

I believe you are also due for another curve.

 

We will go get new Ketostix in the morning and start testing, but I have a sneaking suspicion Smokey was grazing. He's been a life long free feeder, and had only been on a feeding schedule since he was diagnosed a few years back.

I will reread that section, thank you.

 

You're welcome!
Hope he's feeling better soon!

 

Update: He is very lethrgic this morning, and wouldn't even have a Temptations treat. And his third eyelid is showing. We called the vet and will be taking him in, though they said his specialist is no longer working there.

I feel like I'm going to faint. I'm having flashbacks to 2016 to his first DKA episode... I don't know what to do... I know the ER staff will recommend euthanasia.

 

Oh!!!! I'm so sorry.

Don't assume the worst. If this is another ketones episode, you're catching it relatively early, and sometimes in that case it doesn't need much intervention to get them back on their feet. And he may still just be reacting to getting some bad (moldy?) dog food. You don't know until you go in. And by bringing him in quickly, you are doing exactly the right thing for him.

 

Thank you so much. We are so scared right now. His last DKA episode he became bony before the episode. This time around he's still pudgy, so here's hoping it's not full blown DKA...

 

First things first. Can you get the keto stix and test? Next thing is hydration. With vomit there is loss of fluid. How is his hydration? How about Smokey's brother? If food is the culprit is he lethargic at all today?

 

Adding: it sure does sound like the trigger was the kibble, but another thing you might ask about given the symptoms might be pancreatitis, especially if he was showing any signs of abdominal pain. Treatment is similar to that for a ketones episode itself (fluids, appetite/anti-nausea meds), except with the addition of pain meds, which can be key to getting them feeling better.

Keeping fingers and paws crossed!

 

Might a sign of stomach pain be sitting in the loaf position alot? He was doing that alot last night.

Also, his hydration had been good. He hasn't been drinking tons of water like during his last episode, but he's been drinking a little bit. His normal amount.

 

Good luck today at the vet. You are doing the right thing to have him seen. By any chance does your dog food have corn in the ingredients? A while back my vet RX a higher fiber dry food for my boys. They both got sick and threw up and had diarrhea for a day. Corn was one of the ingredients. Now, I know better that a cat doesn't eat corn! Keep us posted.

 

Yes, the meat loaf position indicates they are in pain /and or do not feel well.

 

Yep, that's the classic sign. Could still just be stomach upset from that kibble, but I'd definitely at least get the SNAP test for pancreatitis (immediate yes/no answer), and if funds permit consider the Spec test (gives a more quantitative result indicating severity, but has to be sent away so it takes a while to get the answer).

Poor little guy, hope he's feeling better soon.

 

Please don't assume the worst. If it's ketones, early treatment by the vet is best. If it's full blown DKA early treatment is still best. I don't know why the ER vet would recommend euthanasia. It could also be an attack of pancreatitis from dog kibble overdose. That stuff is a lot higher in carbs and could set it off.

Meanwhile, syringe extra water into him if necessary and don't skip insulin. Syringe in baby food or other pureed food and ask for advice here on insulin dose. The fact that he's a good weight right now works in your favour wrt DKA.

 

Corn is the third ingredient in the food!

We're at the ER now. He doesn't look happy, though his third eyelids are also showing, making me anxious all over again.

 

Please keep us posted on how Smokey (and you) are doing.

 

love light and healing

 

Please keep us in the loop.

 

Update: BG is 255, going to test blood gas and test for ketones.

 

Sending some healing vines....hope Smokey recovers quickly.

 

Update: He is in DKA, his ketones are at a Large level. They need a deposit of 2250, but it could be up to 4000 when all is said and done.

 

Ugh. Feel better soon Smokey!!

 

My brother is going to start a YouCaring fundraiser to help pay for this stay. Will share the link when it's online!

 

So glad you took him! Keep us posted.

 

The doctor said that according to their more accurate glucometer, Smokey's BG is actually over 400. That is quite different from 255... I'm a bit puzzled by it, to be honest.

 

That is quite concerning.

Are they using an AlphaTRAK? Or is this from a blood test? I use the same meter you use and my cat has been to the vet a handful of times since becoming diabetic, I always try to test at the vet and with the same venous blood they take from her if I can to compare the lab number to my (human) meter and it's always been quite close in both low numbers and really high ones. I would investigate this further and make sure you have a fresh battery in your meter, non expired test strips that are stored in proper conditions (lid closed, within the temperature range on the strip bottle, low humidity etc.) Please also note, regardless of the expiry on the test strip bottle, they expire within 3 months of opening.

Have you tried testing yourself or another cat in the house (non diabetic) with the meter? Do you have control solution for it?

I hope Smokey is feeling better soon.

 

I'm so sorry to hear Smokey is in DKA. I know hospitalizing is rough both emotionally and financially, but it's the best place for him to be right now.

Starting a YouCaring fundraiser for him may help. However, members must obtain approval from our board administrator, Robert and Echo, prior to posting links to fundraisers on the FDMB. Click on his name and then send him a private message/start a conversation with him asking for approval. In the meantime, I believe fundraising links are allowed in the FDMB Facebook group.

By all means, do check to see if your meter is working properly. Although, the difference could just be vet stress. Alex once went from 71 at home right before getting in the car to go to the vet. Her BG was measured (by the vet) at 300 when the vet saw her! I tested her with my meter and came up with a number close to the vet's results. I tested her as soon as we got home and she had already dropped 100 points. She hadn't had insulin that morning and yet she dropped to 147 @ +24.

Let us know how things are going.
Sending positive thoughts...

 

Your vet is probably using the Alphatrak 2 meter which is specifically for dogs, cats, etc. You are using a meter specific to humans. There will always be a difference between a human meter and one specifically calibrated for animals. I have used both and in comparison, the AT2 is always higher, and in my testing comparisons, it is from 50 to 100 + points higher than a human meter. The human meter I have tested for comparison is the Relion Meter, equivalent to your Glucocard meter.

Wishing you the best for your sweet Smokey!

 

Update: Vet called. One of his kidney values is slightly elevated, which is expected. His bilirubin level is high thight, so she is concerned about obstruction or severe pancreatitis. I haven't told my mom yet. I'm a slight mess right now.

He's going to have an ultrasound to see what's going on.

 

Hang in there! An ultrasound should help.

 

I second Jill's "Hang In There!" Prayers and vines sent!

 

Sending vines and prayers from Florida

 

Fingers crossed ...

 

No update, just that my anxiety is through the roof. My mind keeps assuming the worst, that he's obstructed.. I'm seriously hoping it's pancreatitis.

 

Many, many hugs and prayers from us!

 

Update: He had the ultrasound. No obstruction, though his gallbladder is a bit distended, the vet said it's due to the pancreatitis. It could potentially become an obstruction, but right now it is not. When she checked his blood work again a few hours ago, it improved slightly. Ultrasound also showed a little more changes in his kidneys, but that's not a surprise or a concern right now.

 

Glad to hear it isn't an obstruction, sorry about the pancreatitis. Healing vines to Smokey, I hope he's on the mend and back at home with you soon.

 

Sending more healing vines for Smokey

 

Update: His bilirubin went back up from 3.something to 5.something. I have a feeling it's just part of the pancreatitis, though still fingers crossed it won't become an obstruction. This morning he walked around his cage and drank some water, but still won't eat. When I spoke to the vet at around 1 PM, she said she was going to place a triple lumen central line so that he's not being poked every few hours. His phosphorus level was low, so he's on a supplement now. Not surprised, since that happens with DKA treatment. We're still nervous wrecks, but I feel like at this point it's just a very nerve-wracking waiting game. The doctor also said his heart rate is back up at a normal rate, so that's very good.

On a side note, we're not pleased with the financial end of things. The ER doctor required a $2250 deposit yesterday, but had a lower deposit approved. We only had to put down $1500, and lucked out when my mom was approved for a $4800 credit from CareCredit. Last night, however, the doctor said we need to complete the rest of the deposit by paying another... $1500?!?! What the heck?! We feel like they're starting to nickle and dime us, and we didn't even tell the doctor we had CareCredit! The front desk girl told her! And the doctor threw it in my mom's face last night when she questioned the deposit being higher than originally. She was like, "Well, you were approved for $4800 of CareCredit!"

Seriously disgusted with the veterinary system right now with regards to money. It's absolutely horrendous. We now have put $3000 on the new CareCredit account, and it's only been 24 hours. I'm pretty sure DKA treatment is not THAT expensive. His first episode only cost us around $2000, and he was in much worse shape!

 

Holy moly, that's an outrageous thing to say!!! CareCredit isn't a gift, it's debt you're going to have to pay back!!!!! With that kind of attitude, I'd be afraid that they are just going to keep charging you right up to that limit, because "you can afford it". Gah!

That said, you don't have much choice in matters right now-- the vet is where he needs to be until he's in better shape. I don't know enough to be able to critique some of the treatment decisions being made, maybe others will, but I have a couple of questions:

1) what is the current ketone status, is he still in DKA?
2) if there's pancreatitis in the mix, he should be getting some kind of pain meds (unless contraindicated by something else)-- is he?

It is great news that he's walking around his cage and drinking!

 

Yes indeed it's outrageous! :O

I know, the only other ER around here is the VCA, and they DEFINITELY won't be cheaper, lol!

He still has ketones and is still in DKA, but his hydration is MUCH better today. Still flushing the ketones out.
I believe he is getting pain meds.

 

Vines that Smokey continues to approve.

That vet....man....that just.....beyond words.

 

What makes it so outrageous? I understand it involves meds, staying several nights and tests, I’m just wondering where the big expenses come from, I see cats on here with it and everyone has stated how expensive it is to treat, geez

 

It's pretty much round-the-clock intensive care for a bout of DKA, with treatments (short-acting insulin, fluids, etc.) being constantly readjusted. And there are lots of tests being done the whole time to monitor the condition. Beyond that, though, because DKAs are usually triggered by some other health problem, you have to find and fix that at the same time as you are doing the intensive care. It can add up very, very, quickly.

But then, as with everything else, there's a lot of variation among vet practices in terms of just what they choose to do, and how much they charge. You are pretty much assured a large bill with a DKA, but exactly how much, you don't know until you're deep in it.

 

Thanks for explaining

 

Everything is expensive at the vet. Even an ultrasound is $600 for what exactly? Xrays are $175 for a picture. Good luck with Smokey, glad to hear he is getting the help he needs!

 

Teasel was in my vet clinic's 24/7 ER ICU for three days during his DKA in March of 2016. Final bill (rounded up) was $2700 CAD.

 

How is Smokey doing this am

 

I think the most expensive item on our 24H ER stay when in DKA was th e"nursing (billable) hours - just like Nan said :constant monitoring, dextrose drip, rapid acting insulin, syringe feeding, etc. They also, me think, mark up med supplies pretty high. (at least they do in California).

Sending healing vines and support and hoping very much to hear good update soon. @Rusty & Smokey

 

UPDATE: His bilirubin doubled and is now 10 or so. BUT. He ate three times today! We visited him just now and he looks awful, but I'm having a feeling he looks worse than he is. He is still definitely not out of the woods yet, and his ketones are still high, but that's not unusual, the vet said. If his bilirubin doesn't lower tomorrow, she will perform another ultrasound just to make sure he's not developing stones, though she won't charge us the full 360 for it, only 200. He was weakly yelling at us when we were there, so that's good haha. He's also been complaining when being handled for care and such, so that's promising.

 

Happy to hear Smokey ate today!
Food is like medicine for problems with the liver. Encourage Smokey to eat as much as possible.

 

His liver is actually fine; the bilirubin is from his gallbladder due to the pancreatitis. But still, food is medicine!

 

They're closely entwined. Bilirubin is produced when the liver damages/destroys old red blood cells. Liver damage is known to cause the body to produce more bilirubin than it's supposed produce. Elevated/extreme bilirubin is associated with an increased risk of symptomatic gallstone disease.

 

Ahh I see. Yeah, the vet said he's at risk of developing stones. So the fact he's eating is even more good news than we originally thought, yeah?

 

It was definitely so for my Ducia - we could not confirm at the time whether or not she had pancreatitis($$$) but eating improved her liver and high bilirubin values.
Did the vet mention the current/ latest BG level?
How long ago since the hospitalization?
I am a bit concerned with ketones being at Large .. but she is the right place to tackle it!

 

His BG has been very stable. He's been in the hospital since Tuesday morning. He is improving, though very slowly and slightly.

 

@Rusty & Smokey How is Smokey today?

 

He's much brighter than he was yesterday! Ketones are now Moderate, though his bilirubin went up a tiny bit, but is no longer doubling. He didn't want to eat earlier, but that's normal. His electrolytes are now at normal values. The vet decided not to do another ultrasound, since it's pretty certain that the bilirubin being high is just from the pancreatitis.

 

Thanks for update!
Hurray on the Moderate ketones - big step forward!
Fingers crossed he'll recover quickly.
Please keep us posted on his progress.

 

UPDATE: So yesterday when we visited, they asked for $600 more to bring us up to 75% of the high estimate, which was given as 4700 MAX. Today, a different ER doctor is on, and she's saying as of 8 AM, our bill is now AT $4800, and that they need EVEN MORE money. We're going to try and fight this, because this is just completely unethical at this point.

As for Smokey, his bilirubin is now at 4, his ketones are still Moderate (though the doctor for today said moderate to large, and acted surprised when my mother corrected her...), but he ate and pooped! And he's no longer hooked up to a central line. Happy news!

 

Hooray for eating and pooping!!!! That is fantastic news!

Do you have that high estimate in writing? I'm not sure how binding something like that is (I wouldn't be surprised if they put a clause in about "reserving the right to increase this amount at our discretion"), but it's worth looking into. I would also ask for documentation of every. single. charge. on whatever bill they give you. It is not encouraging that you are getting different totals depending on who is on duty at the time, that suggests a certain looseness in the billing practices (though there was the overnight in between, but that's a pretty big difference in 12hrs when nothing special seems to have happened!).

 

We got an updated treatment plan from the ER doc who has been with him since Tuesday, and it shows the high estimate at $4700. The ER doctor on shift today is a different one, and is saying that our bill is now UP TO $4800, and that we need to leave even more money.

They haven't given us an actual bill yet listing every charge. They only do that on discharge, and they do not bill later. They require money up front.

 

Arrrgh, that is very frustrating. This is out of my league and experience, maybe others can weigh in with opinions on how to deal with this. You want to keep a good relationship with the vet while Smokey is there, but this is very tricky when the treating vet has changed over.

How is the staff in general? The fact that Smokey is eating on his own is such a good sign, he must be at least a little comfortable with them.

 

The doctor we've dealt with all week will happily be back on shift tomorrow, so that's good. But yes, very frustrating!

The techs are fantastic! And the ER doctor we've had has been great as well. It's this billing crud that's bothering us.

 

UPDATE: When we visited yesterday, the doctor Smokey had been seeing had called in sick, so we had another doctor, who has been AWESOME. She is VERY willing to work with us on financial arrangements for paying the rest of the bill, and has been VERY nice. Yesterday, his ketones were negative, and his bilirubin came down to 2.1, and he was no longer yellow! Happy news!

Today we went to pick him up, but missed a call from the doctor. He had a hypoglycemic episode and she wanted to keep him just overnight to make sure he's all good before springing him loose. She suspects the SoloStar pens are formulated differently than the vials of Lantus, even though they both have the exact same ingredients. An interesting thought that we may consider. He was gobbling diabetic kibble, and was even violent in taking it from my mom! lol The doctor will call in the morning, and hopefully we can take him home tomorrow. Thanks everyone for your well wishes and support! <3

 

Quick update re: Lantus SoloStar

I managed to find the pharmacological information for Lantus, and the SoloStar pens lack an ingredient that the vials have: polysorbate 20, which is an excipient and stabilizer. I printed the segment of the information containing the formulations for the vials and pens and will show the doctor tomorow. I felt I should share on here. I think that's a pretty critical ingredient that the SoloStar pens are missing! It helps facilitate drug absorbtion and it stabilizes suspensions (in this case, the insulin).

 

Hooray for Smokey!!! Though, that's a bummer about the hypo and not being able to come home immediately. Hope that all clears up soon and you can have your little guy back home!

I'm not sure about the hypothesis about the pen-vial difference. Maybe when you see your vet, ask how long the vial had been opened? The insulin does lose effectiveness after a while, and there's a large amount in a vial so they may have been using it for a long time. What dose did they have him on?

 

Actually, they had us bring in his pen to reduce costs. So they were using the exact container of insulin we've been using. They had him on the SLGS starting dose of 1 IU, which made his BG plummet. At home, we had him on 0.75 IU, which directly contributed to the pancreatitis flare up and subsequent DKA episode. So they are giving him his insulin from home, rather than their own insulin there. It's very frustrating! 0.75 IU was too little, and now 1 IU is too much! What the heck?! Vet suspects he may just be hypersensitive to the insulin at the moment while his pancreas settles down. Let's hope it's just that, and that he doesn't need another change in insulin!

 

Hope he feels better soon

 

Oh, OK, I misunderstood, thought they'd switched from vial to pen and then gotten a hypo.

He may very well be more sensitive to insulin for a while. Glad you home test!

 

I'm really glad to hear Smokey is doing so much better.

FWIW, when Gabby was diagnosed with DKA -- probably close to 10 yrs ago -- the ICU cost was estimated to be around $1000/24 hrs. I think I ended up putting $3000 down but did get some of that back.

 

I am glad to hear Smokey is better now and coming home.


Scrutinize that bill! Jones ended up in the ER for breathing issues and not eating (never found out the issue) - 3 days ER in oxygen cage - $2800 CAD. The nursing hours was the most significant amount. I noticed they only charged that over the night time hours vs. the day hours, however the 12-16 hours charged each day added up. And I was lucky as his IM vet is part of the ER hospital - his time was not charged once he took over the case.

 

Teasel's 3 day stay in my vet hospital's ER ICU for DKA in March 2016 was $2700 CAD.

 

So we brought Smokey home today! He is on a half unit of the Lantus. He's been very sleepy, though not lethargic, if that makes sense. We called the vet and asked, and she said that's normal, though we can't help but be nervous wrecks! lol He's in his pumpkin house and has been there since we got home, and he's due for BG check, food, and then insulin at 8:15.

What are your experiences? Have your kitties been pooped when they first came home after a DKA episode?

 

My Rufus was at the vet for 6 hours for dental (anesthesia) and and ultrasound. He was pooped for the rest of the day, and most of the next!

 

When Teasel had his in March 2016 it took him a couple of weeks to get back to normal. He was very tired.

 

My cat has had 3 DKA's in a year. I thought she was going to die because she was so lethargic, but shortly after the vet got fluids into her, she came to life again. Actually, a similar thing happened to me many years ago. I got food poisoning and couldn't eat or drink for 3 days. Finally, after going to the hospital, they put an IV of liquids in my hand and presto! I felt normal again after only about an hour. I had been dehydrated.

 

Just now reading this thread. How is Smoky doing?
As to the charges, you're very lucky the empathic vet came back! I understand why they want money up front, but I do not understand why, after taking so much money from one, they insist on more, meanwhile withholding treatment until they see yet more cash. This can, of course, result in the animal's death.
I know others will disagree, but under the circumstance, and I have experienced such, I think it's close to malpractice. The animal ERs are way out of control.

 

@srk4cats
@Kathy and TiTi

This is an older thread. Sadly, Smokey has crossed the bridge: http://www.felinediabetes.com/FDMB/...ay-vet-says-too-hard-to-regulate-help.193607/