Cat not improving...

Our cat Mayton has been hospitalized twice now. Every time he gets back he is fine, but soon after he starts eating less and less until he needs to go back to the hospital. We do everything the doctor says, following all of the insulin instructions, but he continues to get ill. For food we have tried DM wet and dry, different meat baby foods, boiled chicken, different flavors of fancy feast, tuna, and sprinkling parmesan cheese on the foods. He just came back from the hospital a week ago and he is starting to eat less food again. We have also tried appetite stimulants and anti nausea pills. We can't afford to keep putting him in the hospital for 4 days. Are there any suggestions on what could be causing this or other foods to try?

 

Do you test his blood glucose levels at home? What specifically was wrong with him when he went to vet and had to stay? what insulin instructions?

 

We do not take his levels at home, when we went yesterday it was in the 300s. He was hospitalized both times for ketoacidosis. They thought he had a kidney infection the last time but the test was negative. Yesterday they changed the instructions to 2 unit every 12 hours, before it was 1.5 units.

 

would it be possible for you to get a glucometer and test him at home, a lot of times the levels are higher at office due to a kitty being stressed. Also would be helpful if you could test for ketones at home as well.

 

@jayla-n-Drevon I am tagging a member that has been here a longer than me to get some extra eyes on your thread. Hang in there, the people here are very helpful and really know a lot about feline diabetes.

 

Thank you very much. We will look into to getting a glucometer and one for Ketones as well.

 

@Tricia Cinco(GA) & Harvey also would be able to give more insight than I can.

 

with Ketones you don't necessarily have to get a meter, you can, but you can also just purchase strips to check urine at pharmacy, it does involve some sneakiness on your part, watching to see when Mayton goes to litter box and following and sneaking a strip under his urine stream, or some people have been successful with putting some plastic wrap on the litter and catching some urine this way.

 

I am new here so I am not an expert but my cat just went through this( twice. Hospitalized)

He was only diagnosed two weeks ago but he wasn't eating. What meds are you giving him?
Once I stopped the meds he was on , he started eating. It seemed to not have a good effect on his appetite

 

Hi Mackenzie....I have only been at this diabetic stuff since July and really following this board since September and I can testify to the fact if not for the knowledgeable, caring people on this board Elmo would be very sick or worse. The biggest lifesaver has been testing at home, a minimum of before each insulin shoot , which tells you what amount to give. Your vet is going by the number taken at the office which due to stress may or may not be correct. My vet did not encourage or discourage home testing but due to encouragement of this wonderful message board my Elmo is doing well. I just wanted to encourage you to get a meter ASAP and begin testing and be ready for life saving info for your Mayton

 

He gets 1/4 tablet of Mirtazapine (appetite stimulant) every day and 1/2 tablet of cerenia (for nausea) once a day as needed.

 

Thank you for the encouragement! I definitely think tomorrow we will be going to the store to get one. Does it matter what kind you get? Is there a brand you recommend?

 

First breathe!
Most Vets do not understand what we do here. If you click on the lantus forum at the very top there are sticky notes to read. Start there. You will need to get some supplies and start testing him at home and give him insulin twice a day once prescribed. Please know that at the very beginning we were all over whelmed just like you.
He is not eating because he doesn't feel well when his blood sugar is high. 300 is to high.
To recap 1. Breathe 2. Lantus forum sticky notes 3. Get supplies cheap at Walmart. 4. you can do this!!

Welcome to the most wonderful place on earth you never wanted to be.

 

The cerenia was the issue for me.
It made him stop eating. It's happened twice now. They said at the hospital he was ok but both times he took it he stopped eating and then started again when I stopped it
I would check with your vet about this.

Also mirtazapine should not be given every day.
It should be a 1/4 every 72 hours.
I only know this because I have too much to my cat( the vet actually said the wrong amount)

How many days has he been on it?

 

Yes relion prime from Walmart for
10.00 and lancets for 2 .00 get thicker ones not thin. Meter strips lots 100 or
More. Keystone strips 3.00.

 

I use an alpha trak but many here use Relion, I believe, that you can get at WalMart. Someone with far more experience than I will be on here shortly and be able to give u as much info as ur caring kitty brain can handle . So excited for u to get the help this message board offers. They are the most caring, supportive group ever with tons of experience caring for diabetic fur babies . So glad u here

 

This past time he has been on them since Tuesday the 29th.

 

Just got this am reading .....

 

Hi
Welcome !
As you can see the members here are very happy to help so please ask questions.
As mentioned above home testing is critical.
Imagine if you had a small child that was diabetic you would never inject insulin without making sure it was safe. It is the same for a kitty. Knowing how to home test and having all the supplies will allow you to avoid a hypoglycemic event
Also increasing by .5 is a large increase and may cause your kitty to bounce
A bounce will occur if the blood sugar drops too low and then the liver kicks into overdrive because it doesn't understand what's happening and then the bg number will get very high and you will create a cycle of very high and very low blood glucose

The way to avoid this is to do small increases we recommend .25 in order to find the right does it is very easy to skip over the right dose by increasing too quickly
Getting midcycle test in is very helpful in finding and appropriate and healthy dose for your kitty
Many vets are not well educated in the management of feline diabetes, it isn't really their fault because they could never keep up with all of the diseases that are out there in the current information
Fortunately this group is very up to date and is very happy to share it with all of us
Not eating ....
Many of us use a drug called ondansetron or Zofran (same drug)
This is a pill for nausea and it works very well many of our cats depend on it
Some of us use ondansetron and cerenia together.
Some of us also use Mirtz and as also mentioned above it is given every three days one quarter of a tablet or even less
Most of the members here prefer cyproheptadine for an appetite stimulant
Most of the prescriptions are 15 mg and you give a very small amount tiny chip will do

If I was in your shoes I would try the ondansetron to see if nausea is the issue as you may not need an appetite stimulant
I am going to tag a few others who can give more insight and have much more knowledge than myself
@manxcat419
@Wendy&Neko
@Chris & China

 

Thank you this is very helpful! So with the at home test, do you adjust the insulin amount depending on the reading? Also is it recommended to do the reading before or after he eats?

 

What insulin are you using?....it makes a little difference in when you should test/feed depending on the insulin

 

Lantus U-100 insulin

 

Depending on if you choose to follow tight regulation or the slower method wil depend on your "no shoot number"
Both protocols are explained in the little stickies if you click on Lantus /Lev forum and then look for which protocol you're interested in or which one best fits with your schedule

It would be very helpful for you to set up a spreadsheet and if you need help with that you can send a private message to @Marje and Gracie

The no shoot for AT is 68
But we do not recommend you shoot anything you're uncomfortable with for the first time if it's a much lower number than you're used to without the guidance and help of one of the experienced members on the board
I think you are using Lantus -if that is the case we hold the dose for at least six cycles and a cycle is 12 hours so every day is two cycles
Here is where it is so important to have tests in between especially in the beginning so you know when your cat has an onset which is when the insuin starts to take affect and the nadir where it is at the lowest point
We adjust the dose based on the nadir NOT the pre-shot
What we are looking for is how low the dose will take your kitty.
My own cat has gone from almost 400 blood glucose down to 50 on alpha track in a matter of hours this is where it is critical to know your cats patterns and behaviors and always to have a canned high carb food and a hypo tool box just in case kitty goes to low.
(My boy is what we call a champion diver)
The protocols that we use our scientifically proven and written by veterinarians.
There is also a food chart that you can find in the stickies and there are many other foods you can try that are under 10% carbs
If indeed you are using Lantus it is important that you test feed and then shoot if your cat is not eating on his own you may need to assist feed and there is a video for that as well and the stickies
One of the reasons I have switched to using Levimer is because my boy likes to graze and with Lantus he would drop much too quickly and not eat enough - not to mention he is on a diet

 

I see @Chris & China is here
Your in great hands.
About a year ago she stayed up with me thru the night to make sure my boy was in safe numbers

 

And Chris & China did the same for me....saved Elmo's life during an all nighter ! Chris&China rock !!!

 

OK.....Lantus is an excellent insulin so that's half the battle

What most of us do is Test/Feed/Shoot.....all within about 5-10 minutes. You Test (to make sure they're high enough for insulin at all), Feed (to make sure they're at least willing to eat) and Shoot

It's important to take food up for at least the 2 hours right before shot times so that when you test, you get a number that's not influenced by food......then, depending on which treatment method you decide to use, you either shoot the same dose for a minimum of 6 cycles (Tight Regulation) or you hold the same dose for a week (Start Low, Go Slow)

If the dose you're currently giving doesn't get him where you want him, you increase by .25 unit.

As for the food, mirtazapine really isn't supposed to be given every day....it's usually prescribed every 3 days and giving too much can cause something called "serotonin syndrome" which can be very serious. There's more information in this thread about the problems with mirtazapine

I'd suggest trying cyproheptadine instead.....in some cats it makes a big difference which medication they get and how well it works

 

Here's some information on both the Tight Regulation Protocol and the Start Low, Go Slow method

It makes a difference on dosing advice we'd give you. TR is the only protocol that's been published in a veterinary journal so it has a lot of science behind it, but it requires you be able to test a little more often than SLGS. It also gives the best chance at remission. We've had cats go OTJ (Off The Juice) on SLGS, but it's much more common on TR because you adjust the dose more often in response to the numbers you're getting.

Some of the basic differences are:

TR...dose adjustments can be made as often as every 3 days (6 cycles)...this is most effective because if they're staying in numbers we don't like, we can increase more often
SLGS...dose adjustments are made once a week....this can be hard on the caretaker IF the cat is "stuck" in high numbers very long

TR...reductions in dose are given if they drop below 50 on a human meter, 68 on a pet meter
SLGS...reductions are given if they drop below 90 on either meter

TR...You'll want to get the 2 PS tests and at least one other test....preferably at least 2 other tests.....One somewhere between +4 and +7 on the AM cycle and a "before bed" test on the PM cycle...if you can only get 1, the "before bed" test is most important since most cats go lower at night
SLGS...You still must get the 2 PS tests in, and then do a curve once a week (testing every 2 hours for 12 hours or every 3 hours for 18 hours)

 

If you live in the US, I'd suggest getting to WalMart and buying either the Relion Confirm or Micro blood glucose meter......they're very popular here and the strips are affordable ($35.88 per 100).....there are cheaper "Prime" strips, but the Prime meter seems to give some people a lot of problems with error messages and it doesn't save any money if the strips are cheap but you have to use more of them due to errors!

The Confirm and Micro also use the tiniest sample size and that's important, especially at first!

You'll also want to get lancets, but look for "Alternate site testing" lancets that are 25-28 gauge....they poke a little bigger "hole" and are easier to get a sample from until the ears "learn to bleed".....as the ears get poked more and more, new capillaries will grow in and make it easier to get blood

You can also get Urine Ketone strips for usually less than $10......Here are some Urine Testing tips too

 

Thanks for all of this information! We're going to call our doctor tomorrow morning and ask their opinions on everything. As for the at the at home testing, my mom is going out of town tomorrow morning so it will just be me taking care of him this week. So the amount of times I can test his glucose will be limited since I have school. I will definitely look into to both of these methods and see which will work best.

Is testing for ketones important too? It was mentioned above a little.

 

Thanks for the tag @jayla-n-Drevon . I have to say I'm not sure I can add an awful lot of value on this one - not with repeated DKA episodes due to not eating. I will say there is usually some sort of infection involved in DKA, even if it's not kidneys - hopefully they ran blood work both times to try and pin down whether or not to give antibiotics. However, I would like to add to the call to do as much of the testing at home as you can - that way you can at least get a heads-up early when things are going in the wrong direction, whether that's high glucose levels or ketones starting up etc. I would definitely test for ketones with a cat who is prone to them. We actually managed to avoid a potential DKA with one of our cats (Roxi) just this week because we were home testing - she suddenly started running high and stayed there all day (got into some sugary, carby human food that had been dropped on the floor) and was just starting with very small amounts of ketones. We were able to get some sub-q fluids prescribed by our vet in an attempt to flush the ketones and hopefully dilute her glucose levels just a bit and she came back down within a few hours of getting them and the ketones cleared shortly afterwards. Honestly, she might have been OK without - I have no way of knowing for sure - but it's always worth being proactive where you can. Maybe your vet would be prepared to let you have a bag of fluids for days when it's needed? It's always worth talking to them about.

Because Mayton is clearly prone to ketones, I would agree that assist feeding so that you can give his shots may be necessary - you really don't want to skip a shot unless it's absolutely unavoidable. I find baby food is often the easiest to use for assist feeding - and it also avoids the possible problem of a cat taking a dislike to any flavor of food that you've used to assist feed as it won't be his regular diet.

It looks as though you've already got excellent advice from @Chris & China and @jayla-n-Drevon on most of this, but I hate anyone to feel like I'm ignoring them if I've been tagged even if I'm really only saying most of the same things. Just shout out if you have any more questions though - that's what we're all here for.

 

Here's something I wrote up for others that needed help with testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well.

When you're first starting, it's also important to use a lower gauge lancet, like 25-28 gauge. Most of the "lancet devices" come with 33 gauge lancets and they are just too tiny to start with. The bigger lancets (that are lower numbers) make a bigger "hole". As you poke more and more, the ears will grow new capillaries and will be easier and easier to get blood from...we call it "learning to bleed"

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

It's never too soon to start getting them used to "the routine" .....and it will make it a lot easier too!

 

I wanted to step in and reassure you that we all know this seems like an awful lot of information to digest and of course it is a lot of information to digest. I promise though it is truthful, honest, and great information to follow. My Shaak kitty had a glucose reading of 600+ when she was diagnosed. I was planning on just following the vets info. Then I decided to read up on it as I always do anything. I love to read. I found this website and while I thought in the beginning it was crazy stuff I decided well might as well give it a shot. several things happened, mainly three different times I avoided a hypo (low low blood sugar) because I was checking Shaak's BG at home. Those were really stressful times, at one point I was testing Shaak's blood sugar every 20 minutes for 3 hours at a time, but I had to, to be sure she was recovering from the low BG's. I was using a fast acting insulin because it was all I could afford, and I was diligent, constantly on guard for high or low numbers. At one point I was giving ONE drop of insulin every 12 hours because she began going into lower numbers, but not quite low enough to be considered in remission. However, that diligence paid off and after 7 weeks of insulin Shaak went into remission and has not needed insulin since. It has been almost 9 months now that she has been OTJ (off the juice, no insulin needed).

I am so glad I found this website and that I was willing to listen to them even when the vet was suggesting otherwise. Shaak got cystitis and the vet said it was because I was testing at home making her nervous and that I should stop immediately. If I had listened to that advice Shaak would most likely have died when she dropped below 50.

It's those low numbers you want though. You just want them without the need of insulin to get to those numbers. I know it seems terribly overwhelming, and I have a feeling you are pretty young and are going to have to discuss all we told you with your mom. I may be wrong, who knows, you might be in your 40's.

God Bless Mayton, you and your mom. Your in a good place.

 

*** 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.

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).

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.

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
.

 

More links with tips on how to encourage eating:

Persuading your cat to eat

How to stimulate appetite

Things I have found helpful:

- feed small, frequent amounts (the way Lantus works it supports feeding mini-meals). If you can keep getting a little food into Mayton regularly it can help break the cycle of nausea and inappetence.

- warm the food a little and add a couple of teaspoons of water to each feed to help with hydration.

- raise food and water dishes a couple of inches off the floor (helps avoid nausea due to reflux)

- mix food and water into a gooey paste and offer it to kitty on your fingers (helps with emotional reassurance and also warms the food a little).

- blitz up some freeze-dried chicken treats into a powder and sprinkle it over warmed food.

Sometimes if you can encourage a kitty to eat a little off your fingers and gradually entice them towards the food in the dish they will eventually eat the rest under their own steam.

If the anti-nausea and appy stimulants don't start to help soon it would be advisable to ask your vet about giving Mayton a feeding tube. Here is information from vet-authored site catinfo.org:

Feeding Tubes

It might sound/look a bit scary but tube feeding can be a great help in ensuring that a kitty gets enough food and fluids - and also can make for much easier and safer administration of insulin for diabetics.

Although low carb, wet food is normally the optimum food for feline diabetics, if a cat is having problems with ketones or recovering from DKA it may be more beneficial during convalesence to feed a slightly higher carb food so that enough insulin can be given safely to get the ketones under control. At times like this, the right food is the one Mayton will eat regularly and reliably. The route to resolving ketosis/DKA is:

- making sure kitty has enough CALORIES and fluids. (If Mayton will eat them, IAMS Max Cal or calorie-dense kitten food may help him get more calories each day while he's recovering.)

- making sure kitty gets enough insulin to be able to metabolise his food properly.

- identification and treatment of any underlying health problems that may be elevating BG, causing nausea/inappetence, etc.

NB: Home testing is pivotal in helping you to manage Mayton's insulin needs and keeping him safe. The sooner you can learn, the better - it will give you and your mom much more peace of mind and it will help you to optimise Mayton's path to recovery. We'll do all we can to help you both. Even though you can't test during the day, if you can get a test done before each insulin dose (with a little practice it only takes a couple of minutes) and another 'before bed' test each evening it would help you greatly to find out how Mayton is responding to his insulin and will guide you faster towards a dose that really works to help him.

Sending a little prayer for Mayton to get his full appetite back ASAP and some big for you and your mom. And when you feel overwhelmed, remember to take a few slow, deep breaths - it really helps. It's a bit of an uphill climb at the beginning but things will get better as you learn more.


Mogs
.

 

PS:

A clarification:

For cats recovering from DKA who may be fed a higher carb diet as part of their treatment during convalescence the insulin dose may need tweaking due to the carb load.

If you do a search on the Feline Health board (search box is in top right-hand corner on a computer display) for posts about 'ketoacidosis' or 'DKA' written by member @Meya14 you'll find some very, very helpful information on the special calorie and insulin needs of cats recovering from DKA; Meya is extremely knowledgeable about this. We do see cats here who recover from DKA and get back home only to slide back into it again, as seems to have been the case with little Mayton. Sometimes this is due to the treating vet failing to prescribe supportive meds for treatment of nausea and inappetence (so you're ahead of the game with your vets!) but the other very common problem is cats not getting enough calories in the food that they manage to eat and also problems with the balance between dietary carb intake and insulin dose to support proper metabolism. Meya does tremendous work here to help educate members about common DKA recovery pitfalls and possible means of avoiding them; her posts on the subject are an absolute treasure trove. I hope you'll find them helpful; I've learned a great deal about DKA and its treatment from Meya.


Mogs
.

 

PPS:

A timed feeder like the Petsafe 5 can help with mini-meal feeding. Timed feeders can be an absolute godsend for both sugar kitties and their guardians; can't recommend them highly enough.


Mogs
.

 

Yeah we have had automatic feeders since he was a kitty. He just isn't eating the food. He ate a little dry DM this morning but he threw it up later and now he won't eat anything. We're about to go to Walmart right now to pick up a glucometer and check his levels. I will send a follow up post with the results.

 

(((Mackenzie)))

Having personal experience of the worry of a fur baby who's having eating difficulties my heart well and truly goes out to you.



Great news that you're off to get a glucometer. While you're there, remember to pick up some ketone test strips, too, plus a variety of foods and perhaps some chicken breast to poach at home (it's very bland and he might be able to keep down some minced poached chicken and broth).

Knowing what's happening with Mayton's BG levels will help you both so much. Be sure to post for help with testing if you get stuck. We'll do all we can to support you.


Mogs
.

 

Okay so we got the Relion micro and some ketone strips. It took a lot of tries but we finally got enough blood for the reading. It came out to be 170. This morning we gave him 1.5 units before he threw up. That was at 7 am. Are these results good? Is the amount of insulin we are giving a good amount?

 

How long after the shot did he throw up? Good for you getting the meter! Can you test every couple of hours today while you are home so we can see how low he goes?

Could you set up a signature with info about the insulin, dose, and type of food, as well as any other pertinent information? Just click on your screen name at the top and click signature.

 

I got the story wrong. He ate a little dry DM then threw it up, then he ate a little baby food and we gave him 1.5 units instead of the 2 units. I set up a signature with information I think would be helpful.

 

Hi Mackenzie,

What a productive day you've had!

When you get a chance can you add that Mayton has had two bouts of DKA so that members replying to your posts will know that he has a history of problems with ketones. Also can you add the type of meter you're using so members will be able to understand the BG numbers properly. (Some members use human meters and some use pet-specific meters; the reference ranges for the meter types are different so having a note of the meter enables correct understanding.)

Big congrats on getting your first blood glucose test under your belts! That 170 on a human is not bad at all. How many hours after the injection was given did you get that reading?

Tip: When doing a test try warming the ear for quite a long time before doing the prick; it improves blood flow and makes it easier to get a sample. As you keep testing more capillaries will form at the test sites and it will get easier and easier to get a sample for testing.

Next step is to snag a urine sample so you can check Mayton's ketone status. You're doing great!


Mogs
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Okay I added it. We gave him the shot at 7am so it was about 5 hours later when we tested the blood. He usually pees when we try to feed him so I'm hoping I can get the sample around 6.

 

That was a good time to get the mid-cycle test in, Mackenzie.

We have a spreadsheet template that you can use to record Mayton's test results and share them here (see other members' signatures for examples). The spreadsheet will help you to learn and track Mayton's response to his insulin and it can help you and your vet to optimise his dosing. Here are links about how to set up a spreadsheet. If you'd like someone to help you set it up, just holler:

FDMB Spreadsheet instructions

Understanding the Spreadsheet

Typically insulin is given to a feline diabetic every 12 hours. The 12-hour period following each Lantus dose is referred to as a 'cycle' - so you have an AM and PM cycle each day.

To make sure it's safe to give the insulin a test is done before each dose. These are the preshot tests - AMPS for morning, PMPS for evening. Tests at other times are referred to here as mid-cycle tests. When posting test results here and recording them in a spreadsheet we use 'plus notation' - '+' followed by the number of hours after the injection was given. For example you did your first test today on the AM cycle 5 hours after the injection was given so today you've got the following data:

AMPS - (not yet testing)

AM+5 - 170.

When you get your BG test done before giving Mayton his evening dose of Lantus that will be today's PMPS test. If you manage to get a test, say, 3 hours after the evening dose, that will be the PM+3 value (and so on and so forth).

Good luck getting the urine sample. Some members manage to snag a urine sample by sneaking a ladle under their cat's derriere mid-pee! Fingers and paws crossed here for a negative ketone result.




Mogs
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You are doing well Mackenzie. Remember to breathe you can do this. Is the dry DM the only food Mayton eats? And how often is he fed?

Mayton is an interesting name, how did you come by it?

 

Well Mayton is very weird about food. He will eat something one day and not touch it the next. His favorites are the DM dry and chicken baby food, but he sometimes eats boiled chicken, trout fancy feast, or tuna. On good days he will eat breakfast, and snack on DM dry food whenever he wants (we have a little sitting out most of the time) and have lunch and dinner. So he gets breakfast, lunch and dinner with snacking in between if he wants. He hasn't been eating well though for the past couple of days.

Mayton got his name because its our family friends last name. They found him in their backyard when he was a little baby, but they weren't looking for any more pets at the time so they offered him to us and we took him in! So we named him after their last name.

 

Maybe leave out a selection of foods to let Mayton help himself to see if you can get him to eat a bit more. Try the finger feeding, too; it can make a difference.

Have a look at the link with the nausea symptoms. Is Mayton showing any of those signs?


Mogs
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Mayton has the loveliest little face!

 

We left out 4 different foods today for him which he didn't want. We also tried putting it on our finger, didn't work either.

Some of the symptoms did look familiar. He has a loss of appetite, he was drooling a little 3 days ago, playing with water (but he has done that everyday of his life haha), sniffing food and walking away, and licking the gravy off of food only.

Here is one of my favorite pictures of Mayton, he has these huge eyes that look so cute in this picture!

 

I wonder if maybe finding a grain free dry would help. My civvie (non diabetic) Tripper would vomit every couple of days. I always mentioned it to my vet. One visit we had to see an associate and he told me the dry would be like a sponge and swell in the stomach and when it built up cat would vomit. He told me to change to grain free. We did and the vomiting has for the most part stopped. If what the vet said is true or not I don't know but it worked. Just wish I could get her off the dry all together.

 

Yeah, we bought some grain free wet food that we have never tried before so if he doesn't eat his normal stuff we will try that.

 

Have you tried grain free dry?

 

aaah, he's so cute. If they're not eating I usually find the stinkier the food is the more likely they are to eat it. x

 

My two go-to options for a cat that isn't eating is either meat and broth only baby food (Gerber Stage 2 have 4 different flavors) or 9-Lives Tuna & Egg or Tuna & Cheese (both available from Walmart if you have one locally...not too expensive either). I don't finger feed because some of ours don't like taking food from anyone's hand, but I do put a little food on a teaspoon and give it to them that way...that sometimes seems to be 'special' enough to encourage them to eat just a little.

 

If that isn't just the cutest darn cat!!!! I love those eyes!

 

No not yet

 

What a cute boy you have! You've been given a lot of good advice from these great folks.

 

That really does sound like nausea....since he's already on the cerenia, I'd talk to your vet about adding the ondansetron along with it and see if it helps.

I'd also try the cyproheptadine instead of the mirtazapine after you've gotten the nausea under control....it's really not good to give an appetite stimulant if they're nauseous too....you know how you feel when you're sick to your stomach? The last thing you really want to do is eat so giving an appetite stimulant on top of feeling icky isn't a good idea

 

You might want to try it as long as your giving dry food.

 

He's just adorable! Reminds me of Puss in Boots from Shrek 2.


Mogs
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How has Mayton been doing poop-wise since he came home from the vet hospital?

I agree with Chris about Mayton showing classic symptoms of nausea and about asking your vet for ondansetron. I found it helped Saoirse much better for nausea treatment than Cerenia. If he isn't pooping properly also ask your vet about whether he might have nausea related to motility problems/constipation. (See my earlier posts for info on treatment for this.)


Mogs
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Update: he was eating a new food and then all of a sudden he threw it all up. when this happens do we give him insulin still or lower the dosage or just not give him anything? Also we tried to get a blood sample but after about 10 pokes we decided to just try again tomorrow because Mayton wasn't having it at all.

 

He had runny poop for just one day but since then it has been normal.

 

With the history of DKA, it's important that he get his insulin

Did he eat the food quickly and then throw it up soon afterwards? If that's what happened, it could be a "scarf and barf"....where they eat too fast and it comes right back up. If that's what happened, try spreading his food out on a flat plate instead of putting it in a bowl so it will slow him down when he eats

Can you syringe feed him if you have to? Might try giving a small amount (like a teaspoon or two) at a time and see if it stays down.

 

No he ate it slowly. We are calling out 24 our emergency vet to see what they suggest right now.

 

Wise decision, Mackenzie; I hope they can do something to help Mayton quickly. I've been through bad kitty nausea and I really feel for you both.

Sending prayers for things to improve very soon.




Mogs
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They said to take his glucose levels but we can't get any blood... me must have tried 20 times. We tried heating it, rubbing the ear, using a anti biotic cream to slick the hair down. We tried all over the ears and paws. Luckily he ate a spoonful of baby food and about 1/3 package of tuna so we are going to give him some insulin.

 

I'm very relieved to hear that Mayton has eaten something for you and that you're able to give him some insulin. Try to celebrate the small victories as you go along; it helps.




Mogs
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His ears will "learn" to bleed more easily over time. What also helps is to have 28 gauge lancets instead of the thinner 30 or 31 G type. The 28G are often labelled "for alternate site testing" or similar. If you use the rice sock method for heating his ear, it has to be quite warm and you might need to carefully cover/rub his ear with it for longer than you might think.

 

Yeah, we read that the 28 gauge is better after we bought the 30 gauge. When we went back to the store they didn't have any of the 28. We tried heating it with a damp wash cloth that was heated up and holding that over his ear. But we have tortured that cat way to much tonight so we will try again tomorrow morning.

 

Definitely make yourself a rice sock: old clean sock that has lost its mate, fill toe part with maybe 1/2 cup uncooked rice, tie above toe part or make a knot in the ankle part of the sock, nuke in microwave until it's very warm (but you can tolerate it on your skin), put over kitty's ear and rub in circular motions for as long as it takes to get the ear well warmed. I don't think they like the wetness of a warm washcloth and it won't hold its heat as long as a rice sock.

 

That explains a lot. My vets taught me to do similar with a big wodge of cotton wool and I had awful problems at first. I got on better with a plastic pipette containing warm water; more comfortable because it was dry, it wasn't bulky and it held the heat better. A small rice sock would also hold the heat better, too.

Here are some of my tips for home testing:

1. Smear a thin film of Vaseline over the test area then warm the ear thoroughly (can take much longer than you think in the early days).

2. Wrap a 1" strip of folded kitchen paper around your index finger then wrap the ear around the finger in a similar fashion.

3. Hold the ear and paper support in place with light-firm pressure from your thumb and middle finger so that the skin of the ear is taut. (Helps reduce head movements, too.)

4. Make sure the bevelled edge of the lancet is facing you then poke at a slight angle to draw blood sample.


Mogs
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Meya just posted a very helpful reply on another thread about DKA recovery. Here's a link:

http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-after-surviving-dka.169143/#post-1835133


Mogs
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Call your vet and ask if they tested potassium levels at the last hospitalization. A low potassium can lead to what is called paralytic ileus (slow bowel) and can cause nausea -with- vomiting. Most of the DKA cats I've seen here typically don't have vomiting, just signs of nausea. Low potassium can then be supplemented, and other medications for constipation/nausea can be added to increase motility. Bowel issues can be overlooked at times, but this is probably a frequent trigger for DKA for some cats.

 

Are you using the lancet device? or are you free-handing? The lancet device should be set on 3 or 4. You might have better luck free-handing.

 

Yeah we tried the device but free handing it was working better.

 

Morning Update: mayton ate super well! He ate almost all of his dry food. We got some blood from his paw as well. However I accidentally feed him before we took the blood so that might have changed the results. He ate about 15 minutes before the sample was taken. It was 404. Do you think they are that high because we feed him before? He is just about to get his full 2 units of insulin.

 

Good to see that Mayton is eating well today!! Testing 15 minutes after eating should not affect the reading, since it does take some time for the food to affect numbers. It is always best to test, then feed then shoot just to makes sure though

 

So it is probably high because he only got .5 unit last night?

 

What a very welcome update, Mackenzie! I'm so pleased for you all. Well done getting the BG test. Any joy with ketone testing yet?

Might be due to the lower insulin dose and the dry food might be carbier.


Mogs
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Oh yeah I forgot to say that I did the test and it came back negative for ketones!

 

Woot!

That's really good news, Mackenzie. You're doing a fantastic job.


Mogs
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Excellent news about him eating and you doing a successful ketone test! Keep practicing the BG pokes.

 

great job!!!
and another vote for ondansetron.... I don't know what we would do without it--

 

When we were on the phone with the vet last night we asked about it and they said they wouldn't change it until they did an evaluation on him. So we will have to wait at least another week.

 

Update: Mayton had been eating super well so he has been getting his full 2 units of insulin. I checked again for ketones last night and I was negative. This morning when we took his blood it was 536... which is pretty high. Is there something we are supposed to do to lower it?

 

It sometimes takes a while for those preshots to come down. So glad he's eating! Try to get some mid cycle numbers. Is he on all wet low carb food? Maybe you could add what he's eating into your signature.

 

He eats a 1/4 cup of dry DM. You need 2 people to get a blood sample from Mayton, he is very squirmy. So the only times we could take a blood sample is in the morning and around 9-10 at night.

 

Hi. I just scanned your thread this morning, and have to log off now to get to work. I also checked your spreadsheet.
I am so glad his ketones were negative. Keep testing for them a couple times a day if you can, while he's high and not acting normal (like the throwing up). He could be high right now, because he went lower the night of the 4th, as he was throwing up his food, even though you gave him a partial dose, and he could have gone low (for him) last night as well. He could be bouncing. Sending eat your food vines to Mayton.

 

He won't eat wet at all? I ask because the dm food is about 12% carbs. My cat loves dry so we got her young again zero carb food. You could ask them for a free sample.

 

So, considering that you've gone through DKA twice in a row, I wanted to talk about possible causes or risk factors. Basically, the ketones form due to fat breakdown in the body which can happen for multiple reasons. It's helpful to remember that while insulin lowers BS, it also allows cells to use glucose for energy. Without insulin, cells starve. Starving cells tell the body to burn fat so they can use ketones for energy (dangerous if this occurs for more than a little bit).

Infection: Infection causes the body to need more insulin to heal, if more insulin isn't available, the body will try to burn fat. Common infections are UTI, bowel parasites or infections, viral infections such as feline herpes, etc.

Too low calorie intake: You should look at a cat body chart and see where your cat falls as far as weight. Basically, if you can see the outline of the shoulder blades, your cat may be too thin. Any cat that is on the thin side and having issues with BS control or DKA should -NEVER- be restricted in the amount of food they eat. Low body weight makes "brittle diabetes" more of an issue, makes BS harder to control, and predisposes to illness. Also, not all calories are processed the same way, proteins and fats have a complex metabolism that relies on several enzymes that may not be present in certain illnesses. Carbs are a much simpler pathway, and may allow faster weight gain and glucose stabilization in skinny cats. Ultra-low carb diets in skinny cats may lead to DKA if prone.

Chronic Illness: Illnesses that make food hard to absorb should be considered as causes - pancreatitis, liver disease, IBS, bowel lymphoma, diarrhea or constipation, cancer, other GI issues. Also some illnesses cause higher metabolism or calories to burn - hyperthyroid, cancer, heart failure, kidney disease, parasites, etc. These should all be ruled out.

Too low insulin: Insulin is like air - a body always needs it to survive. Without insulin, cells starve, and metabolism goes haywire. The body makes some amount, but it may not be enough to allow the metabolism to remain normal. We -INDIRECTLY- monitor insulins effect on the body through BS tests, but that's not the only function of insulin. When BS is normal to low in response to insulin, there is actually 2 options to keep sugar at good levels - you can either reduce insulin, or increase food. The right choice really depends on the situation. Same goes for high blood sugars - you can either reduce food or increase insulin. It's good to think about the results of the choices in relation to the kitty's needs (ie encouragement or prevention of weight gain).

Dehydration: If chronic kidney disease, diarrhea, or heart failure are issues, dehydration can be the initial trigger. Balancing hydration in complex kitties really requires vet monitoring/lab monitoring.

 

Thanks for the information. I always try to leave food out for him at all times, he had been eating more than he has been for the past month which is really good. He has definitely lost weight. He weighs 11 pounds now and he looks skinny. We found him on the streets so we don't know what breed he is... but I think he is at least part Maine coon, he has a large structure. I think he used to weigh around 17 pounds. I'm going to try to test his blood by myself before he eats dinner. Hopefully I can get some.

 

So far the DM is the only one we can get him to eat consistently and enough of. Thanks for the suggestion I will look into it

 

Great job getting the spreadsheet up and running, Mackenzie; you're playing a blinder.

Great to hear about ketones being negative again and that Mayton is getting more inclined to eat sometimes without the assist. You're correct that you need to make sure he has some food on board prior to giving each insulin dose but, as you've observed, when the insulin starts kicking in it can give a kitty a bit of an appetite boost so they will eat more at that time. I think it's a good plan to leave food out for Mayton to graze.

At the moment if the DM is working well for Mayton then I'd suggest sticking with that; he's getting his calories and while he continues to eat regularly that will help the nausea symptoms to reduce (and hopefully disappear!).

With regard to testing is there any way that, in addition to the morning and evening preshot tests, you could get a test in at +3 hours after the evening dose every day? For the sake of one extra test a day during workdays it would give you a much better picture of how Mayton is responding to his insulin.


Mogs
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So sorry to hear about your kitty and his DKA. My own maine coon kitty, Ozzy, is also recovering from his first DKA episode (he was hospitalized a week ago) and it has been very stressful and heartbreaking. We didn't know he had FD prior. As you probably know, Maine Coon kitties are one of the larger breeds (and one of the sweetest IMO). My kitty used to weigh between 18-19 lbs and now is 15.3 lbs. When I saw your kitty went from 17 lbs to 11 lbs, it really stuck a chord with me and broke my heart. I know how much my cat's appearance changed (and so quickly) when losing weight and I can only imagine how shocking it was for you as well. I am praying that your kitty gets better and very quickly.

Ozzy has been home for about 6 days now and he is also not eating well. I learned a lot on this board already from the amazing members and now know that post-DKA nutrition is super important. We are unfortunately syringe feeding our kitty still to make sure he gets adequate nutrition. He will eat some on his own, but not enough.

I am also new to BG testing and have poked my poor Ozzy's ears more in the past few days than I'd like to honestly admit. I drove home from work today thinking there is NO way I am doing that to my kitty again tonight. But when I got home and saw he still didn't feel well and didn't want to eat, I just needed to know his numbers to I could make some sense on why he would not be eating still. I think someone on here mentioned that cats with high BG don't feel good and so they don't want to eat. I am just hopeful his insulin will start to bring his numbers down over the next few days and things will change. I am hoping the same for your kitty.

I really hope your kitty gets better soon. I'm going through the same thing so just wanted to let you know I understand your hardship, worry, stress, frustration...etc. I have hope for both our kitties, though. What another member told me is that they just really need our help to eat.

 

For Mayton we have never been able to get him to bleed in his ears... we use his paw pads and it works every time for us. It's not the best situation and he doesn't like it that much, but it's to help him. If you haven't tried it already I might. Hope Ozzy gets better soon!

 

Yeah I could probably get one in around 10pm.
This morning his blood test said "Hi" which means 600+ and we did it twice so we know it's accurate. The emergency vet said to keep his insulin at 2 units still which I thought was weird since his blood has few been high for the past 2 days. We gave him 2 units this morning and they said test it in 1 hour and if it his still high we need to go and get a curve at the vet.

 

With Lantus it usually does not start showing much effects until +2 or +3 with the peak effect showing around +5-+7, so it not surprising that the +1 test was still high. You can do a curve at home when you are available for the day. You would want to test at preshot and then every 2 hours for a 12 hour cycle. This will help show how well the dose is working and when the nadir (lowest number) is, which is good data to have. A curve done at the vets may not be as useful, since many kitties are very stressed with a vet visit and stay, which will cause the readings to be higher than they would be in a relaxed atmosphere. It may be that Mayton needs more insulin but until you have more data is is very difficult to make that call.


ETA Well done getting your spreadsheet up. It is such a valuable tool to have.

 

My dad took him to the vet for them to do a curve today since we wouldn't be able to until Saturday. We wanted to make sure we are giving him the right amount of insulin. He should be back tonight. Yeah