*** LONG POST ALERT ***
Hi Mackenzie,
I'm really sorry to hear about the hard time Mayton has been having; he's an absolute
dote! I understand that this must be very hard for you and your mom, too.
I see other members have already clued you in on how much help learning quickly how to home test blood glucose levels will be to you and Mayton. I've included a lot of information below about other things which might help you both. I'm not trying to overwhelm you further, just trying to put key links in one place so that you can find them easily and read through them at your own pace but I do recommend you read the first link about DKA plus the one about nausea symptoms and treatments ASAP because this seems to be what you need help with right now.
Is testing for ketones important too? It was mentioned above a little.
It is very important to test regularly for ketones in
all diabetic cats but
for a cat prone to DKA it is of critical importance to test once (or preferably twice) every day. You can test urine using ketone test strips (e.g. Keto-Diastix, Walmart Relion ketone strips) or using a blood beta ketone (BBK) meter (same method as for glucose testing but with a special meter). The test strips for the meter are a bit pricey BUT testing this way is more predictable and manageable as you're not reliant on catching a urine sample. With your current situation it might be very much worth considering getting the meter because it can detect ketone presence sooner than urine testing (and therefore make treatment response faster and less expensive in terms of vet bills). If you are urine testing, some people find it handy to place some plastic food wrap on top of the litter in the box - ideally in one of your kitty's 'favourite' spots in the box - and this should enable you to catch enough urine to perform a test.
For information, if a trace ketone result is obtained you'd need to call your vet for advice on how to proceed. A result higher than trace and you'd need to bring Mayton to the vets
- ETA: immediately - so that they can treat him to flush out the ketones and hopefully prevent him going into DKA again. Here are some useful forum stickies about DKA to help you learn more (good idea to bookmark them for easy reference):
Are you testing your cat for ketones? If not, do it!
DKA and Blood Ketone Meters Sticky
Newly diagnosed and unregulated diabetics may have problems with neuropathy, a problem affecting the nervous system. It can cause problems with walking and also gut motility problems (gastroparesis). B12 methylcobalamin supplementation and effective insulin therapy help improve neuropathy-related problems. Zobaline is a methyl B12 supplement suitable for diabetics (no sugar in the tablets - available online).
He gets 1/4 tablet of Mirtazapine (appetite stimulant) every day and 1/2 tablet of cerenia (for nausea) once a day as needed.
As already suggested, alternative meds to ask about are:
- ondansetron for nausea (generic is cheaper than the branded version, Zofran). As Jayla comments, it can be given alongside Cerenia. Here's a useful post about this (including dosing often used for an average cat - c: 10lb weight):
http://www.felinediabetes.com/FDMB/...ast-yesterday-help.166040/page-3#post-1796242
- cyproheptadine for appetite stimulation. It is gentler in action than mirtazapine (and, as mentioned above, doesn't carry risk of inducing serotonin syndrome). Small doses of cyproheptadine (1/8 - 1/4 of a 4mg tablet for a 10lb cat) can be given every 8-12 hours. I found it gave me much finer control over when and how much to stimulate Saoirse's appetite at times when she needed it. When used in conjunction with the ondansetron it seemed to settle her GI system better, too (cypro is an antihistamine so I think it may have soothed her system a bit).
Note that when nausea is present, appetite stimulants aren't really effective on their own; anti-nausea support needs to be in place first. Here is a very helpful link about how to spot and treat nausea:
Nausea and inappetence - symptoms and treatments
(If the link doesn't work straight away try again later; sometimes access to the above site can be a bit glitchy.)
Other things to watch for include whether or not Mayton can smell his food properly (cats won't want to eat if they can't smell their food properly). Also if Mayton suffers from constipation that can also cause nausea (and sometimes vomiting, possibly with watery diarrhoea leaking around a 'stuck' stool). If that were at the root of the nausea problem then the normal anti-nausea meds won't work until the constipation is resolved. Diabetics can have gut motility problems leading to constipation. A day or two's treament with metoclopramide (Reglan) can help boost gut motility (not suitable for long-term anti-nausea treatment in cats as they don't have many of the receptors it targets for nausea management and also metoclopramide can have bad, potentially irreversible, side effects if used for long periods). Helpful information on feline gut health and constipation can be found at:
www.felineconstipation.org
A course of B12 injections can be a big help to cats with appetite/digestive system problems.
I will say there is usually some sort of infection involved in DKA ...
Following on from April's note about infection, other disease processes such as inflammation can also contribute to development of DKA. Checking for and treating any underlying illness/infection/inflammatory process would reduce the risk of a kitty throwing ketones.
Because diabetics are more vulnerable to infection and inflammation (plus they may need longer treatment courses than non-diabetics because they may heal more slowly) and that can increase the risk of DKA, especially in cats who are not eating enough and are not yet well-regulated. Good things to ask your vet to check for if not done already are dental problems (diabetics are more vulnerable to oral health problems like gingivitis) and also pancreatitis - many diabetic cats have issues with chronic pancreatitis as well. Clinical signs of pancreatitis include nausea, poor appetite, abdominal discomfort (cat may crouch in a tense 'meatloaf' position after eating or become withdrawn/lethargic). If your vet offers SNAP fPL tests you could get an on-the-spot yes/no indication of whether pancreas inflammation is likely to be present. Spec fPL is another pancreatitis blood test which gives a numeric indication of the severity of any inflammation but it needs to be sent to an external lab. Here is a link to a very helpful resource. Although its main focus is on pancreatitis there is a lot of very helpful information on treatments for nausea, inappetence, and pain (pancreatitis can be very painful and flares may resolve quicker when appropriate pain relief is given).
IDEXX Labs Pancreatitis Treatment Guidelines
Also, as others have mentioned above, it is important to check for any urinary tract issues (dilute/sugary urine can make diabetics more vulnerable to UTIs).
More to follow ...
Mogs
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That 170 on a human is not bad at all. How many hours after the injection was given did you get that reading?
Fingers and paws crossed here for a negative ketone result.
