Dice Cat - Recently Rx'd and DKA

Hello -
My name is Amy and I have a very sweet 14yr old boy who was newly rx'd with diabetes. He received his rx last Wednesday and we started a 1 unit AM - 1 unit PM ProZinc schedule per our vet's instructions. Our boy must have been too sick or not getting the right dose b/c by Sunday he needed emergency vet care for 3 nights, DKA, they treated him with fluids and meds and got him acting like himself again. He is home now with us and his ProZinc has been adjusted to 2 units AM - 2 Units PM. He is eating again, less water drinking, much less of a food maniac (begging for food 24-7).
I am now a worry wort.
Is he eating enough, is he laying around too much
Is he getting sick again
He is not back to his normal behavior, although he is nothing like he was Sunday.
I do have an appointment next week with an internal med cat diabetes vet to keep finding good adjustments for him to be healthy.
How much should I worry if he's eating, not drinking as much, but sleeping/laying down a bunch?
Its the sleeping/laying down a lot that has me worried.
Also how much should he be eating? He eats wet food, always has. Merrick chicken pate and tiki cat chicken and egg
Thank you for your help, Amy

 

Updated my signature line

 

DKA is nasty and it can take quite a while for a kitty to feel normal afterward. Was he checked for any sort of infection while he was in hospital? The usual recipe for DKA is not enough calories + not enough insulin + some source of infection or inflammation. UTI and/or dental problems are near the top of the list.

I've been through DKA twice with my kitty and these are the essentials once he's back home recovering:

• a high enough insulin dose
• enough calories
• excellent hydration - via subQ if necessary
• antinausea meds if he won't eat enough
• appetite stimulant meds if antinausea alone isn't enough.

 

Kris thanks for the reply
He was checked for infection, no infections. They did treat him with bunches of fluids and antibiotics, they said they did the anti-bodies just in case.

All the points are great,
how do I know if he is getting enough calories? He is currently eating his food.
Do I feed him more than his normal?

The laying around worries me the most, lethargic. This is expected?

 

Feed him as much as he'll eat in several small meals. Aim for maybe 50% more food than his normal intake if you can manage it. Wet food is best and you can add as many tablespoons of warm water to it as he'll tolerate to make "soup" - good way to keep him hydrated.

You should test for urine ketones at home. Go buy some human ketostix at your pharmacy. Here are some ways to get it done:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

Lethargy is common post DKA. Human diabetics who have had it say it feels like a Mack truck hit them. If you're thinking of testing his BG at home and setting up a spreadsheet like we use here, now is a good time to start.

Was he sent home with antinausea meds? He might still need those. Cerenia is the usual one.

 

Amy, sorry I don't have any experience with DKA and so I can't offer any advice there. While you are here, however, it might be a good time to set up the spreadsheet so that members can see the insulin shot/dose times and the BG tests you are getting. It's a great tool for detecting patterns with the insulin to see how that's affecting Dice. He's a charming little guy and I am wishing the best for him.
Here is a link to the spreadsheet instructions SPREADSHEET and a link to understanding the spreadsheet grid GRID
If you have any difficulties getting it set up, holler, we have members who can help out.
Please check out the FAQs forum. There is an index with valuable information, plus a discussion about DKA that might be helpful:
http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

 

Kris - the vet so far has recommended to only feed him when he gets his two shots (twice a day)....but I can up his food and the suggestion to add water, I can do that too. great tip

About the ketone strips, if I test and find ketones what then? More DKA treatment?

I will and can start a spreadsheet with BG readings. Our guy is way chill, always has been. He's so good with all the new poking and prodding. bless him.
I am comforted to know that DKA lethargy is common, it's honestly what has me worried the most. He's generally sleeps, but not like this.

No Cerenia sent home, I can call and ask about it. Thankfully he is eating, but I will panic if he doesn't. It would be great to have this on hand.

 

thank you all for saying Dice is handsome, we think so, but are very partial

 

Sorry for over posting...
I just talked to one of his vet's (he has emergency vet who treated DKA, and family vet)
Emergency vet Rx'd only feeding twice a day with shots
Family Vet thinks he should eat more often

Conclusion, for now we have landed on feeding him more in his twice a day feedings. I will add the water

Again (sorry to keep saying this), he is literally zonked out sleeping all day with no energy. The family vet agreed, DKA recovery, but also his weight loss contributing to this sleeping. Please someone tell me again is this normal?

His family vet seems to not sound very hopeful he will come out on the other side of this due to being 14 and such a quick onset of diabetes. He seems to think it is the end.

 

Hi Amy. I did not use ProZinc for my kitty so I can’t comment on the dosing, however, I did look as your kitty’s picture and see that he doesn’t look overweight. I was wondering whether he has always had a long face/lower jaw? At times it can be a sign of Acromegaly if it sort of became longer over time, which could explain his diabetes. I could be wrong, it’s only one picture. Could you maybe post more photos of his face? Tagging @Wendy&Neko since she has experience with Acromegaly cats.

 

The DKA has knocked the stuffing out of him and the weight loss can be from diabetes. Most kitties will gain weight or at least stop losing as their BG level is better controlled.

 

He is an Ocicat, his face has always looked this way. I always thought it was the Siamese in him He is Not over weight, he is underweight. It's sad

 

ok thank you for the reassurance, he did have the stuffing knocked out of him. I am so paranoid

 

Our kitties can come a long way back!! Take a look at China's Profile …..you'll see a big difference in when she was first diagnosed and after she'd been treated for awhile (with the help of the great people here!)

 

She is looking so healthy.
Our Dice boy is just as skinny as her before picture.
It’s interesting you feed many small meals and no meals before insulin.
The vet has advised us only feed 2x a day and insulin right after. He said without food dice could react to insulin and it could even kill him.

 

Hi and welcome I am so sorry you are dealing with a sick kitty and DKA at the moment.
There are some terrific people here on the forum who have DKA experience and have helped many kitties back to health when the vet had all but given up.
Yes, you do need to feed before giving the insulin but I would feed several time a day because it is important Dice gets lots of food at this point. It is better for the pancreas as well to have several small meals instead of two big ones. My Sheba was very thin when diagnosed too but she got back to the stage where I had to watch she wasn't putting on any more!
Dice is very handsome and regal!

ETA. I think you must have misunderstood someone saying they don't feed before insulin. We withhold food for the two hours up until the preshot test so that the test is not food influenced but then we feed before we give the insulin. Does that make sense?

 

Welcome Amy! I had a similar issue with Coco when she was first diagnosed - not with the DKA, but with the feeding schedule. My vet advised to feed only twice a day, but Coco only nibbles and wasn't getting nearly enough food. She was hungry to the point she dug through a trashcan looking for food. It was pitiful and I felt like the worst cat momma ever. After that awful incident, the vet agreed that having several small meals or even free feeding was best for her. I'll do whatever it takes to make sure she eats.

 

Just like with human diabetics, more frequent, smaller meals are better for our sugarcats!

Now with some of the older, harsher insulins, it was a lot more important that they eat a "normal amount" before they got the insulin so that when it "hit", there was food on board, but with the newer, gentler insulins (like Lantus, Levemir and ProZinc), you just need to make sure they're willing to eat.

What we recommend here is that you don't feed for the 2 hours immediately before shot times (so you get a Pre-shot reading that's not influenced by food)….then Test/Feed/Shoot.....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....usually all within 5-10 minutes.

The newer insulins usually take 2-3 hours before they start to "kick in", so you have time for kitty to graze some without worrying about them crashing.

 

Hello thank you for the reply. I have now heard from many of you to feed several times (and add warm water so he gets enough fluids). I can feed a small 3oz can at noon. I will start with this in addition to his 5.5 ozs at night.
Yes the stopping food two hours before for reading does make sense. Then of course feeding before shot, always.
Despite the sleeping all day (hard sleeping) dice still has an appetite. (His dinner is at 8) I’m grateful.
Your kitty kins avi is adorable
Feeling more positive with support here.

 

With all this feedback I am tmrw going to add a small meal mid day. He will eat it (at least right now fingers crossed) and really needs to eat as much as possible. Thank you for sharing.

 

This post is extremely helpful to explain it all. We were being hawks watching him eat it all (sometimes takes 20 mins) then shoot, then if any was left over removing. I now feel more confident not to do this.

 

tonight I added 1/4 cup water to 5.5 oz pate, he ate half of it and drank all the liquid. He also ate about 1.5 oz of rotisserie chicken (plain chicken breast) I think we are winning. now he is sleepy again, like stone cold tired.

 

<-- this guy is currently recovering from DKA as well. He was diagnosed November 30th & spent time in & out of hospitals for the week. He was extremely sleepy/lethargic for maybe 10 days after coming home and didn't want to eat at all (he usually screams for food like it's his job as well). He has recovered tremendously in that time, and is still gradually improving today.

It's worth noting that certain medications can also take a toll on him. He was on clavamox, cerenia, and ondansetron. Side effects of these include nausea, lethargy, weakness, diarrhea, fatigue, loss of appetite, headache, dizziness... Ironically, Cerenia (used to treat nausea) can induce inappetence. (PS - I'm not suggesting that you should take him off of any medications that he might be on, just bringing awareness )

 

Aww I am so happy for the recovery I am also relived to hear a similar story. My guy was on several anti bodies (although he had no detected issues, they advised treating as an extra precaution?, which was ok with me). Cernia for appetite, ampicillin and a couple others.
Your guy looks like a sweetie. I’ve not met a fur friend that I don’t love.
Thank you for sharing a similar experience, it’s helps me not panic and over react. My dude needs me thinking clear.

 

When does an insulin like Prozinc ‘kick in’ if he gets a shot at 8pm and 8am what would a healthy curve look like? Tmrw we will try first reading.

 

Sure thing. I got a ton of support when I came here for help as well. Paying it forward a bit is the least I can do

 

@Kris & Teasel @Rachel

 

Unfortunately, every cat is different. If you haven't already, you should set up a spreadsheet to track his glucose levels. It's helpful to have historical data to look back on and identify trends.

I'm sure the other folks will have more to say. I wouldn't want to give any incorrect info.

 

I’m going to start Testing tmrw. Have the kit, need to pull trigger. Downloaded spreadsheet. He’s a chill man. Vet showed how to use back leg paw pad.

 

Good luck with beginning testing Amy. The testing is really important and it's going to help you a lot. Make sure you have "alternate site" 26 or 28 gauge lancets, the paw pad is quite a bit thicker than the ear site (also more sensitive I have read)
Would you tell us why did you decided to paw test instead ear test? Pardon if I have missed information in the previous posts. Have you decided on a testing station and have you begun desensitizing Dice and getting him ready to test? Low carb treats before and after work pretty well for most of us, and don't forget your treat too!

 

Sounds like a plan. If you want to get a curve done, it's generally recommended by the folks here to get a test every 2 hours or so, starting with one right before his shot. You'll probably start seeing his level go down a bit around the +2 mark and bottom out around +6. Again, this is different for every cat (and can even differ from day-to-day for the same cat depending on eating habits, stress, and more).

Also to echo what @Idjit's mom said - testing on the very outer edge of the ear is usually preferred over the paw pad. Fewer nerve endings (and in the event that it's uncomfortable, he doesn't have to walk on it).

 

Lots of good testing tips here: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

The emergency vet where he stayed for 3 days suggested the paw, they suggested the back paw and showed us how they did it. I have studied the ear draw site 'you tubes'. I am open to either. Ear seems scary, didn't think of paw being more painful. Still have yet to do our first test. Want to get my husbands support and help the first times. Tonight before his night shot should be good.

 

Thank you for sharing more super helpful info and tips

 

Most of us were anxious and stressed at the prospect of testing BG, often more than giving the injections. I promise you - it gets much, much easier over time. Have a look at that testing link I posted above.

 

Here is how we are today so far
AM Food - ate about 1oz of wellness chicken pate and 1oz of rotisserie chicken (plain chicken breast) - regular 2 units - drank some water
Mid Day (first time we are feeding mid day) - ate about 1oz of rotisserie chicken, drank water

LOTS and LOTS or hardcore sleeping continues...
Some pee in box this AM, but not excessive

 

Looking now (at the link) and I did go so far as to download the spreadsheet on my PC thankful its easy to understand how to use

 

@Kris & Teasel you mentioned anti-nausea meds. He is eating, but not everything (see above, today he's wanted to eat maybe 3-4 ozs of food in total). When would you give something like anti-nausea?

 

He should probably be eating more than that in a day - 6+ ounces at least. I think it's a judgment call. He's still in DKA recovery and needs calories. Did your vet prescribe anything? Cerenia is often used but the human drug ondansetron (brand name Zofran for the nausea of chemo) is a good one for many kitties. Some people give the two together because they target different receptors. If antinausea meds alone don't get him eating better then an appetite stimulant can be tried. Mirtazapine is one but some kitties act strangely on it. Cyproheptadine is a human antihistamine that can work well. I used ondansetron and cyproheptadine for Teasel at home post DKA this past June. They worked quite well.

 

@Kris & Teasel Vet did not RX anything. I'll call right now and ask

 

Idjit's "Dad" and I do Idjit's tests together. Dad holds and I "poke" and use the meter. It works out well for us, he's a bit too big, too strong and wiggly for me to handle by myself. But, we are both retired and can be home for testing time. You will find what works for you. I would say the greater percentage of members test on the ear, and would use paw testing only if there is a problem with the ears. It's a little difficult at first to get the blood drop, but the more you ear test, the more capillaries develop, and the ears bleed more readily. Practice and patience win the day. Throughout the day(s), if you are able, take him to the testing station, offer a treat, massage his ears, maybe use a warmed rice sock on his ears and around his head, then offer another treat. Then, hopefully, he will accept this as a pleasant experience. http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
Poor little guy, he has been through the wringer, wishing you all the best going forward.

 

@Kris & Teasel The vet just gave me a cernia maropitant 10mg injection for tonight. He also gave me mirtazapine for appetite.

 

Are you doing the Cerenia injection yourself? The injectable often works better than the oral. I've read here that it can sting though so be prepared. Try that first to see if it gets him eating better. Maybe hold off a bit on the mirtazapine. Sometimes that's a once every 3 days formulation. It can work well. Some kitties become a little odd and more vocal but I wouldn't worry. It's called "meowzapine" for a reason.

 

Yes doing injection ourselves. Vet said he mixed it with b12 to make it sting less? We will give this shot tonight and hold off on the appetite. I’ll post progress. Your advice prompted me to try these things to do thank you!!

 

OK. I wasn't aware of the moderating effect of the B12. When Teasel had Cerenia injections they were done by the vet in clinic. He didn't react. I'm glad to help. I know how fragile a kitty is in the time at home after DKA.

 

Actually B12 injection stings. Coby had pancreatitis a month ago and B12 for appetite stimulant. The vet tech warned me to hold Coby tightly while he gave the injection.

 

Updates
Must continue practicing with bg draw. Two attempts unsuccessful. Watching the videos will keep trying.
Gave 1/2 of cernia injection as half squirted out. Poor kitty, we are amateurs trying. Picked up another injection from vet for Sunday. We will do better with this one.
He’s eating about 2 ozs per meal. Yesterday got in 3 feedings so total 6oz maybe. Will be giving meowzapin (used this acronyms Kris shared yesterday) today. Still very very sleepy.
Feel sad for him.
He did poop decent size solid. He’s drinking good water amounts after meals.
Any tips with feeding the pill? Tried sneaking in food this am, but he’s finicky. Don’t want to mess up what he is eating.
He starts with his Merrick or wellness then we can coax him to eat more rotisserie chicken breast.

 

We are still having ups and downs...
Gave another cernia injection this morning per vet, did get him yesterday to take 'meowzapine' pill
Eating maybe 1 to 2 oz per meal 3x a day; mix between wet food and rotisserie chicken. He really likes the rotisserie chicken. I may try some baked chicken tonight, to create chicken juice.
He's not drank much water today.
He continues to sleep a ton, he especially sleeps after eating.
Got one BG reading last night at 511 (not good right). Will go get a different lancet pen per advice here. His ears just don't bleed like the videos. I also will practice on myself, when blood drops are forming, I cannot seem to get the strip to suck up the blood like the videos show
It's so sad to see him like this, I do not want him to suffer and it seems like he is very uncomfortable.

 

That BG is very high. The 2 u dose should go up but we like to see a spreadsheet of data to give the best advice. Would you be willing to set it up?
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Are you testing for urine ketones at home? Very important. He's still at high risk.

 

What dose are you giving?

You might want to make some bone broth....a lot of us use it to help get more fluid into them as well as it's really good for sick kitties to get some nutrition into them.

Make sure you're touching the blood drop against one of the little black spaces on the side of the strip. (that's another reason I don't like the AT...it's just easier to "suck up" from the end of the strip in my opinion)

If you have the spreadsheet set up, you need to put the link to it into your signature. We're very data driven here and really depend on our spreadsheet to give you the best advice.

 

I’m scared too but will go higher.
No not ketone testing. I know you advised it. If we find ketones what would we do? Go back to vet? Can’t afford another big visit. Anything to do at home?

 

Vet gave 15 mg and spilt it into 4th. So we gave approx 4.x mg yesterday.

bone broth..Ok I can do this, thank you thank you

AT reader: Ah!! I was trying to get it to suck up from front.

spreadsheet: as soon as we can get readings I’ll enter them into spreadsheet and attach.

 

First thing is to get the BG testing conquered. We don't recommend dose changes without that in place.

Re ketone testing: again, you need to know what you're up against. If it's negative, great. If trace, increase the water in wet food meals and syringe more in. Anything above trace, call your vet for advice. Like BG level, you need to know what you're dealing with.

 

@Kris & Teasel i literally just practiced on my own thumb the bg testing. This was good for me to do as I found out it really doesn’t hurt that bad. Helps me know for him. I’m going to try the lancet device instead of free hand. Warm the ear. Maybe wrap him in a towel.

 

That's great! We all found the testing daunting at first. You'll figure out ways to help you at the start.

 

There are a lot more nerve endings in our fingers than are in the edges of a cat's ear. Most of them just object to the fact that you're fooling with their ears at all, but if they get a special treat each time (doesn't have to be food....can be special cuddles, grooming, play...whatever the cat really enjoys), they quickly learn that if they let us fool with their ears, good things come right after!!

The Lord knew what He was doing when He created the cat. If you've ever had an un-neutered Tom, you know that they get into a lot of fights....and the edges of their ears get a lot of the injuries.

 

@Chris & China I found this at fresh thyme. Ingredients are water, chicken broth made from bones, and sea salt. Cooking chicken thighs in the bone broth in hopes that it all has higher fats and nutrients.

 

My sweet boy has a tiny tear in his ear from where he tussled with his brother in kittydom. Why do they always bite each other’s ears!?

 

I know!!…..but at least there was some planning when they were created so if their ears were going to get beat up a lot, it wasn't going to cause them a lot of pain!!

It's better if you make your own when you can.....most stuff designed for humans has a lot of salt and that's dehydrating. I can't find any nutritional information like how much sodium it has

 

Able to get 2 readings today (attached spreadsheet), he's been high today and due for 2 units at 8:00 EST.
@Chris & China and @Kris & Teasel thoughts on what we have been able to read?

 

Congrats on getting those tests! The readings are high-ish. I'd increase to 2.25 u next dose. You have to eyeball that on your syringe to the best of your ability. I know you're working hard on getting a testing routine going. Do your best to get a BG test before every shot - no food in the 2 hours prior so the number isn't inflated by food.

 

Increasing tonight’s shot by suggestion. A rice sock and lancet device instead of hand holding a pin really helped.

 

I knew you'd figure out what works best for you.

 

It literally came down to figuring it out or losing him. Got 2 good draws behind us today and aiming for 3 tomorrow. This board and your advice are lifesavers. I would have given up or gone crazy by now.

 

We've all been there ...

 

@Kris & Teasel he's coming down and today we got glimpses of his normal personality! We are going to do another reading before bed. He's also eating more on his own, today we got in + 10oz

 

Hey Amy.....not sure what you've done with your spreadsheet, but it'll help if you'll use the same one we all do.

We have the links to our in our signature and it color codes automatically. It's a Google document, not an Excel sheet.

I just don't want you to get into any trouble …..it takes time for us to download the Excel spreadsheet and it's not color coded so it will take us more time to offer you help....and we wouldn't want that time to cause you any problems with Dice!

If you need help, feel free to ask me. I set them up for lots of people.

 

@Chris & China I saved it to my pc and reattached. Looks like you guys are using google sheets I’ll modify and tag you with questions appreciate the help.