Diabetic Ketoacidosis Kitty--Need Advise

Hello,

Bear was diagnosed with diabetes about a year ago. We have had a pretty successful route thus far. Insulin started off at 2 units, 2x a day and increased over the year to 4, 2x daily. She has had various fructosomine tests and been boarded at the vet several times, so the vet has kept a close eye on her. On 4/29, I took Bear to have dental work done. She was given Convenia for an extraction, which I didn't know about until after they administered it. The fructosomine indicated we needed to increase the insulin. This came somewhat as a surprise to me because I had not noticed the water drinking being excessive. We increased the insulin, per the vet, to 4 units in the morning and 3 in the evening. To make a long story short, over the past month since the dental work, the drinking increased, and we increased the insulin to 4 units, 2xdaily over the past week. Last night, I came home to find a kitty who could barely stand and kept vomiting---it seemed to come out of nowhere. The glucometer read 564! Kitty was taken to emergency vet last night. Diagnosed as diabetic ketoacidosis with a 700 glucose reading. The emergency vet is giving her fluids, insulin, etc. The vet Finally got her blood sugar down to 274 approximately 24 hours after we took her. My question is three- fold:

(1) The vet stated she is still not eatting, but this is not a big problem to them because she is receiving IV fluids. When should I be concerned that Bear is not eatting? Does that sound normal that the vet is ok with her not eatting?
(2) I read some of the other information on convenia that was on the boards. If anyone has any other information on convenia as it relates to this situation, let me know. The vet indicated that the dental work could have been a trigger for the ketoacidosis because it may have stressed the body, and I could not help but remember the convenia. I thought it was a 2 week antibiotic, but the drug information said "Convenia may persist in the body for 65 days," and I don't quite understand that disparity. Also, if she had been allergic, what then? If you take a pill and are allergic, then you stop taking the pill, but how does that work if you receive a long lasting injection?
(3) Also, if it took the vet 24 hours to get the blood glucose levels down, then I don't why, if the insulin is not effective now, that it will be later. Can someone explain?

Thank you,

Cami

 

(1) The vet stated she is still not eatting, but this is not a big problem to them because she is receiving IV fluids. When should I be concerned that Bear is not eatting? Does that sound normal that the vet is ok with her not eatting?

Eating is usually very important and most of the time the vet/techs will feed via syringe, but I've had vets postpone the food in order to get my cat stabilized. If she's been in the hospital 24 hours now, then I would suggest it is time to discuss food with the attending vet.

(2) I read some of the other information on convenia that was on the boards. If anyone has any other information on convenia as it relates to this situation, let me know. The vet indicated that the dental work could have been a trigger for the ketoacidosis because it may have stressed the body, and I could not help but remember the convenia. I thought it was a 2 week antibiotic, but the drug information said "Convenia may persist in the body for 65 days," and I don't quite understand that disparity. Also, if she had been allergic, what then? If you take a pill and are allergic, then you stop taking the pill, but how does that work if you receive a long lasting injection?

I can't help you with the covenia theory on dka. There is a thread on this page but I'm not sure it mentions DKA. Going forward, when Bear gets better, you can tell your vet to not give covenia. My cat went into dka twice after receiving a rabies vaccine but no one seems to think it had anything to do with it - but of course, I do.

It sounds to me as if Bear's glucose was not well controlled, so maybe that, combined with the dental infection, played a bigger part in the dka.

(3) Also, if it took the vet 24 hours to get the blood glucose levels down, then I don't why, if the insulin is not effective now, that it will be later. Can someone explain?

Sometimes they will put a cat on an insulin drip, but it sounds as if your cat is getting her normal insulin. What insulin are you using, and is that the same insulin you took with you to the ER? Also, I would like to confirm that Bear is attended 24/7 ER - vets and techs on the premises?


I'm sorry your Bear is so ill, but give her some time to recover.

Best,
Pam & Layla

 

Yes, Bear is at a 24/7 facility with vets on the premises. She was on PVI insulin, but she is receiving an insulin drip at the ER vet. Thank you for the response!

 

Cami,

I'm glad she is at a 24/7 facility - it makes a difference. When Bear goes home I would urge you to start hometesting her glucose before giving insulin. You can use a human glucometer, and get the reading by giving a little poke in the edge of the ear. This is much better than a fuctosamine because you get the daily values.

You might discuss switching insulin with the vet too. If you've been on PZI for a year without control, you might want to explore Lantus (glargine) or Levemir - both human insulins.

Keep us posted on your sweet Bear, and be sure and get some rest.

Pam & Layla

 

Dosing by fructosamine tests is a recipe for disaster - it does not tell you how high or low your cat is going inbetween shots, only the average, so in reality your cat could be doing horribly but have good numbers.

So you have a cat who may have been poorly regulated plus had an infection...this is a prime opportunity for ketones to develop. Antibiotics sound required but covenia seems to have the potential for problems but there is nothing you can do about now.

In the short term, she needs to be stabilized and she absolutely needs to eat. But once you get her home, you need to be testing her blood glucose levels yourself to determine what dose she really needs. And make sure that you are testing her urine for ketones religiously until she is better regulated.

I'm sorry you guys are going through this, but we can help you!!

Jen

 

This may sound very naive, but I did not know I should have been testing with a glucometer until she became very ill. I thought based on her behavior and fructosomine levels that everything was pretty good. We ran out frantically and bought a glucometer when she appeared very ill Wednesday right before the emergency vet. Talked to the vet today, and he said he is afraid she is getting fatty liver syndrome. He said she is not eatting. I said she gets that way when boarded, and the solution when boarded is force feeding and/or feeding her "junk" cat food. He said "within the next 24 hours...he would make a decision about this..." I told my husband I do not want to wait 24 hours. He works near the vet, and he is going to them with cat treats, fancy feast, tuna, and demand that they find a way to get food in her. What do you think? This is such a helpless position because I am Bear's only advocate, and I believe in fighting for her health, but I also don't want to look like a moron and tell the vet what is right when I obviously don't have a fraction of the training on such a severe issue. The only thing I DO know is that fatty liver is time-sensitive, and we are on a time clock here, and I don't understand why they would offer her one type of food (KD canned) and nothing else.

Cami

 

I don't understand either; from what I understand once fatty liver develops things get way trickier and feeding tubes are involved. She should be on an appetite stimulant and be syringe fed on a frequent basis! I'd take the treats in asap and demand that if she doesn't eat those that they start syringe feeding immediately.

As for the hometesting, we'll help you with that later ok?

Jen

 

Cami, I do not understand why they are not syringe feeding her at this point. You and/or your husband need to discuss this with the vet asap - the longer they wait she will get HL.

While feeding tubes are nothing to be afraid of it seems very odd that they are not trying to avoid HL.

I've had both with Layla - and they fed her around the clock. The last time, they couldn't feed until she was stabilized so she did get HL, they inserted an e-tube.

If she will eat crunch food - kitten chow, etc., then let her eat.

Hang in there.

Pam & Layla

 

My husband is there now and texting me. He said the vets were force feeding her and apparently the liver enzymes are not so bad at this point. He said they are baffled that her labwork is improving but that the cat is almost unresponsive. He said they are considering brain damage. She is in his lap now, and he said she licked his finger a few times (he had food on finger). It scares me when vets say "baffled" because that means there is something going on that is not addressed. This may have no signficance, but when I found the vomit before the emergency vet visit, some of it appeared to have catnip in it. I am not even sure it was hers because we have a lot of cats, but I assumed it was since she was vomiting so much. I have to wonder if the catnip could have done something? I know it is a long shot, but that is about all I've got now...

Cami

 

Catnip shouldn't do it, honestly...

I really hope that she improves soon!

 

Cami, what is the ketone level? Recovery from DKA takes time, so even when the numbers are starting to go back into the normal range, it may take a little longer for her mind/body to catch up with the bloodwork.

 

Per the vet via my husband, the labwork itself should show a normal "healthy" cat. Says she should be up and walking around and is not. Says ketone was in "normal" range. Vet doesn't know why she is not eatting and unresponsive. Does it sound normal that ketones would be normal in about 44 hours? He is afraid that the acidic system may have caused central nervous system damage. My husband said she would get up and tried to walk around and then would act like she was sleeping and unresponsive.

Cami

 

what are her electrolyte levels?

 

Each cat is different, but with mine, it usually took some time once the ketones cleared for her to act like a cat. So, even if she is ready to go home in a day or two, she still might sleep a lot when she gets home.

How are the glucose levels? Have they done any testing - what makes them think it is neurological? Did she have a seizure in the hospital?

 

Hi Cami

Where are you located? Is this a specialty hospital or your regular vet? Do you know her potassium, magnesium, ionized calcium, and phosphorous levels? Is she acidotic? My guess is an electrolyte problem, and these need to be treated quickly. Is she on antibiotics? Did they send out a urine culture? Did she have an abdominal ultrasound? Was she tested for pancreatitis? How much has she eaten (volume)?

If your vet is at a loss, I would look into transferring her. If you can get her to an internal med specialist that would be best. Complications from DKA can be severe and must be aggressively prevented.

 

My home is 45 mins from the hospital. My husband visited her today. I have spoken to them on the phone an average of 3x a day. They do blood work every 4 hours. I have not seen specific numbers on the tests since admittance. I would not know the context of most of these numbers without googling, which I can obviously do if you all think I need to look at a specific level more closely. Blood glucose was 176. The vet said the numbers (ie, ketones, blood glucose, and about thirty other levels, etc) as of this afternoon are finally "normal" and that the abdominal ultrasound revealed nothing unusual, and he doesn't understand why she is not more responsive with positive numbers. He is at a loss. Kidney function was 1, and he said high end of normal was .9. This is a hospital in Marietta, GA, and an internist is working closely with the kitty. The vet was afraid that her system was so acidic that she had received damage, and he said she could have an undiagnosed brain tumor. I think he is just saying "brain damage" becuase the tests do not point to anything definitive. He said he was worried about the kidneys earlier but that the blood work came back ok. I personally do not think she has had brain damage. I think she is not rebounding as he would expect, and he doesn't understand it. She is a very slow cat and always has been. She is quiet and likes to lay about, and she walks slowly, etc. She is not a mewer. That was how she was when we got her before she had any illness at all, and she has remained that way for 8 years. I wonder if he does not comprehend how slow she is, and he is interpretitng her lethargy as being maybe even more out of character than it is perhaps? My husband said she tried to walk, licked food off his finger, and responded to her name but kept wanting to go back to sleep. He said she seemed to see and hear.


Cami

 

you need to ask about her electroylytes; they should be able to tell you

 

Vet just called...said creatine has tripled, they think she is in kidney failure. HELP!!! Is creatine tripling enough to determine kidney failure? WHen am I giving up hope too fast versus making my baby suffer??

Cami

 

Cami, cats in crisis like this may experience very high renal values. It is difficult to determine whether or not it is truly due only to the kidneys or if it is due to the kind of issues that complicate DKA. Are you able to speak to the internal med specialist yourself, preferably in person, to get an idea of where things really stand?

 

I really appreciate everyone's feedback. Unfortunately, as of 3AM, Bear did not make it. She went into renal failure. The vet is not sure if there was underlying kidney disease that kicked off the ketacodisos or if the DKA and treatment taxed the kidneys and caused the renal failure. This has been very, very upsetting, and I appreciate everyone's feedback. I felt good about the treatment that Cobb Veterinary Emergency provided. I have attached one of my favorite pictures of Bear. Thank you for your kindness.

Cami

 

OH Hun I am so sorry for your loss, Bear was a beautiful girl and she was truly loved. Kind of eerie though as I was just cleaning out some old files of our computer today and ran across something I wrote years ago for my first Maine Coon kitty when she passed.

I think it is probably fitting for your beautiful Bear as well.

Oh hear me! You who walk upright to serve me.
I am the Goddess Bast, who of old was also called Bastet, Pasht and many many other names.
In Egypt they worshipped me and built temples to me. And I remember.
But sit not I on some heavenly throne but curl beside you purring.
I am the velvet shadow that brushes your leg
I am the flash of emerald eyes the spy you from under the hedge.
I am the embodiment of all things feminine.
I am the gentle mother who sings her children into the world
I am the mighty huntress stalking my prey.
I am the fierce fighter defending my young.
I am the graceful dancer
And when you leave this world it will be I,
Who will lead you to the bridge that we may cross
TOGETHER!

Bigs of hugs

Mel & Muse

 

oh cami, I am so sorry for your loss. sometimes things are just out of our hands. you did good by your baby. may you remember all the good and happy times you had together. fly free bear and soft landing on angel wings. ((((cami and hubby)

 

(((Cami)))

I'm so sorry for your loss.

Fly free sweet Bear!

Pam

 

I'm so sorry for your loss. wings_cat

 

So very sorry...

 

Im so sorry for your loss, you did all you could for bear and she knew that. She is beautiful .....

 

Such a beautiful girl. I am so very sorry for your loss.
wings_cat

 

Everyone, you are very kind to me, and I appreciate it. Thank you so much.

 

I am so very sorry for you and your family's loss of your beautiful Bear.

~M

 

I'm so very sorry for your loss.

 

What a beautiful kitty! I am so sorry for your loss. May you be comforted by all of your wonderful memories of the times you shared with your precious Bear.

 

Our deepest sympathy over the loss of your beautiful Bear.

 

((( Cami )))

I'm so sorry you've lost your Bear. Fly free, pretty girl.

 

Dear Cami,

I'm so sorry to hear about your most precious Bear. She will always be a beauty in our hearts!

Please accept my profound condolences and deepest sympathies. And, please know she will forever own her own special place in your heart.

Much love and countless gentle hugs,
Deb and Nikki, who was kindly sent by Giz who forever whispers in my heart...


Solace

From the silence of your pain I heard my name
and on the wings of light I have come
to see the sadness in your eyes
that cry without tears.

Can you see me? I am here.

I will always be near you
to calm your shattered heart
and to make you smile at the memories.

Do you feel me, perhaps a soft brush of fur?

You ache to believe it's real
but you are afraid to hope.

You brush away a strand of hair
But it was I, whispering.....

I am only here for but a moment;
The silver thread gently quivers.
I will leave behind my love in a dream.

When you awaken, and without really knowing why
Your heart will know at last
That it is all right, for now
to say good-bye

Copyright © Lisa Carmel Singer Printed with permission