Dk(maybe a) in ICU (this is how we found out she is diabetic)

My kitty girl, Jake is in the ICU as of about 4 pm yesterday after being stabilized at our local vet (who recommended euthanasia). She's had a long history of mystery illness that seemed to come in a cycle- weight loss, heat seeking, lethargic, definitely ill but all blood/urine tests normal. The vet would always prescribe antibiotics and she would rebound until the next cycle. She has always been a small, soft ball of fur. As I posted in my intro thread, in late December she lost weight again. My vet thought maybe she'd acquired fleas (though no flea dirt) and affiliated worms from the kittens we'd adopted a year before despite continuous flea preventatives. She was given a new flea med that also treated worms and had her first application in early January. She seemed to perk up, but despite a hearty appetite she was not regaining weight- in fact she was losing it. The vet suggested I switch out the canned food I usually used (Evanger's Gone Fishin') for Friskies. He said it was the equivalent of McDonalds and should pack on the calories. She didn't seem to lose any more weight, but she was not really regaining. On Saturday night she was her normal self- she was chasing a ball, came when called- and told the other kitties she was Queen and would be leaving first from the room. She even stole from my roast chicken when I turned my back to the counter for just one quick moment! Sunday morning she refused her canned yummies...and had a dry heave. I thought maybe she had a sour tummy so did not push it. Monday morning she was heat seeking by the running dryer and refusing to eat. I started to alternate canned food and water every 15 minutes and force feed her. I did this for an hour and a half, then gave her an hour break and started again. She promptly vomited everything I'd gotten in her. My vet could see us at noon, and squeezed a urine sample out on the table. He dipped a strip in it and said sever ketones- treatment is expensive, you should euthanize. Her temp was 97, he weight down to 7 pounds from 9ish, she was constipated and not moving. He put her on a heating pad, gave iv fluids and 2.5 hours later called me to come get her for transport to the ICU. The hospital took her straight back and started tests and treatment. This is how I found out my skinny kitty is a diabetic.

The ICU said she had non regenerative anemia, elevated liver levels, severe dehydration, dangerously low potassium levels- the list went on and on. They said the original vet had given her an injected antibiotic. They indicated many of her issues might be the dehydration. They said they were running a blood gas to see if she also had the acidosis part of DKA. They said she would get an ultrasound of her pancreas today to see if she had concurrent pancreatitis (they said they it would not change treatment plan so they were not rushing this test). Her temp was up to nearly 98.

This morning I called and her blood sugar was down to 120 with a continuous IV drip (I never was told what it had been initially). Her potassium was still very low. The vet tech said she was a little more alert than when he had first taken over her care, but she is still quite ill.

I wish I could provide this treatment at home. I think she'd be so much less stressed if she was with us. She was a bottle fed baby found left behind when a hoarder's cat colony was rehomed. She has ALWAYS been with me since that time and I worry about her. She is now 8 and never spent a night out of her family home! (They did not do a very good job rehoming that colony- I now have 5 other cats all younger than her from the same hoarding place- I worry since the vet suggested Jake's diabetes is likely genetic that I will miss signs in all these inbred siblings of hers...)

I have no idea what to expect if she DOES make it home. The vet gave a really cursory overview of home maintenance. Both of my parents are type 1 diabetics, and my experience with them makes me feel like what she described for the cat is not very exact or scientific. I am very concerned. I don't even have a list of what I should be doing/buying to prepare her home for her return!

 

I'm sorry you're going through this, but you've come to the right place.

Some things you'll need for once she comes home:

1) A glucometer to test her blood sugar. The vet may suggest a pet only one, but you can use a human one just fine. If your parents are diabetic maybe ask if they have a spare one? If not there are some cheap ones you can get, depending on where you are. Testing strips and lancets for the monitor.

2) The vet will likely give you insulin and syringes to get you started. This should last you a few months and once you know what insulin she'll be getting at home, you can post in that specific subforum and people can help you there with the specifics of dosing.

3) Some low carb wet food. Friskies pates and fancy feast are common here, but there are other options as well.

There are several people here who have diabetic cats with pancreatitis, and they'll be able to help you manage that if you need to.

For now I'd say wait for the vet to make sure she's stabilized and to get a full workup of what her issues are. It can be very overwhelming at first, but it is manageable.

 

The Dr just called from the ICU with an update on Jake. She reported that Jake DOES have the acidosis part of the DKA and that it has not yet stabilized but they are working on it. She said her blood sugars have remained in the mid 100s (I have no idea if this is the target range) with the continuous drip. Jake's potassium continues to be very low. She said the ultrasound showed her pancreas to be unremarkable, but that her liver is bright and slightly enlarged. She felt that it was not alarming as an additional issue but felt it was consistent with uncontrolled diabetes. She said she felt that if we get the diabetes under control the liver issue should resolve- that none of her blood or tests said this was an actual liver issue of any other origin. She reported that the ultrasound also showed Jake has bladder stones. She said they do not appear to be causing a problem and so there is no need to do anything. I asked what causes these as we have always provided a really high quality diet. She said the diet may be great, just not great for Jake...so it seems like this is my fault as well She said they had withheld food over night in preparation for the ultrasound but would now start offering her food. She said once Jake starts eating regularly, they can start the long acting insulin (something that begins with a g...she said it was expensive- I don't know why these vets have to keep bringing up money- this is stressful enough!). She finished by saying Jake is "ok" but not where they need her to be to go home. She kept reminding me Jake has been there less than 24 hours and that this is a slow recovery process. We get to visit her this afternoon.

 

Here's a really good article about something called Pandora Syndrome that's poorly understood and might possibly be part of what's going on with your baby. How do I know? I have two, possibly three, of these kitties living with me, including my diabetic.

https://todaysveterinarypractice.co...ora-syndrome-in-cats-diagnosis-and-treatment/

 

Quick overview of what a post DKA kitty will need at home after discharge (I've been there - twice!):

• insulin in a sufficient dose to prevent ketone development (we can help you with that)
• calories, calories, calories - up to twice the amount that a healthy kitty might require (to prevent ketone development)
• food high enough in carbs to support a sufficient insulin dose
• water, water, water - add extra to wet food meals and give subQ at home if needed (not as hard as you might think)
• meds are essential! - antinausea, appetite stimulant (try antinausea first and add in appy stim if needed), pain meds, antidiarrhea meds (if that's going on) DON'T LEAVE THE VET CLINIC WITHOUT THESE!
• your patience - because it can take weeks before kitty is back to normal.

 

Just want to say that you shouldn't think like this. It's not your fault. You're doing your best for Jake and getting her help right now. You didn't know and you're not to blame for that. Diabetes builds over time and for many people it's hard to see that anything is wrong until they reach this point.

 

That is interesting to read! I think we do most of the things they suggest. We have 6 litterboxes (self cleaning..but we also clean them daily) in the finished basement, two on the main floor and two on the top floor, so 10 litterboxes for 6 cats cleaned daily. I feed them in the basement and the dog is not allowed down. Jake eats first in her own space, followed by our "feral" in her own space, and then the other four who only like to eat in a cluster together, though they have their own bowls. There are cat trees on each floor (we just added one to the basement) and window seats in all windows with cat cushions. They have cat cuddlers (little squishy sack like houses) and their own recliner, two per floor. They have three cat beds on the main floor and two upstairs and 6 in the basement. They also have open access to their crates and a large dog crate. There are toys EVERYWHERE and they all play with the toys and each other except Jake- she only plays with me or my daughter, which happens daily). We always had feliway plugins and then didn't for a few months but recently reinstated them. She has 2 favorite sleep spots and everyone knows them. The other cats won't even jump up to lay on the love seat cushion if she is on her favorite spot on the top back corner. They give her a pretty wide berth. I think we could do better about making them give her space and respect. She has never cared for other cats...she doesn't dislike them, she just has no interest in them. When she first came to live with us, our very working dog temperament GSD, Beast, really raised her and she took on a lot of traits of that dog. When he died she became just human focused- and only really on my daughter, me and my son if no one else is around. She actively dislikes my husband I wonder if her flares are triggered by the other kitties not respecting her boundaries....

 

The vet mentioned Friskies- I feel like I'd be permanently feeding my kitty McDonald's food! Is there something better? Do I cut out her verus dry all together? She was getting Evanger's Gone Finshin' for canned until the vet wanted me to try "junk food" to get her to fatten up. Are there good versus bad calories? What do I need to look for aside form calories? Do I need to worry about carbs like my parents do? If so, how many carbs am I looking for? Does she need to eat more often? Right now they get free fed dry and canned every morning. She's never been a big drinker which is why I push the canned. Do I need a special diet because of the bladder stones?

They said she was constipated? Should I be concerned? Is that a result of the dehydration?

The kittens we fostered a year and a half ago (who now live with us forever since I had 10k in ICU bills for them at 4 months of age- invested too much money and love to move them along as originally planned) had to have sub q fluids at home so I can handle that (i volunteered with a GSD rescue for years so acquired a lot of vet tech type skills...now learning them in cat style).

Will this be recurrent?

 

Friskies is cheap so it feels like junk food, but it's actually really good for diabetic cats. You are going to want to watch her carbs (<10g definitely, but <5 preferably) which both Friskies and Fancy Feast have. Just because food is more expensive doesn't mean it's better. I disagree with your vet that it's McDonalds and not good for the cat. Wet is also always better than dry, since even low carb dry will still have a lot more carbs than wet food.

Here is a good food chart if you want to compare nutrients: http://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

Eating more often is better as it keeps the blood sugar more even. This may be difficult with all the other kitties, but if you can do it many small wet food meals will be better than one big one.

Constipation can be caused by a lot of things, but more water does help them along regardless by rehydrating everything in there and getting things moving.

You'll have to keep her on insulin twice a day and check her blood sugar several times a day, but hopefully once she's regulated you won't have to go through about DKA episode like this.

 

Thank you for the food link. I am going to study it. I spoke to my mom today...I think if Jake is released she will likely go to their house. The Dr indicated she will need monitoring...I work during the day as does my husband. I am not sure the kids could handle when they get home from school...but my parents are retired....so we might make an isolation crate/room and work to get her dosing and food right before she comes all the way home...like a kitty rehab center. Since both of my parents are type 1 they might see signs I would miss....it's that or have them come over several times a day to check her, which doesn't seem like enough.

 

Friskies gets a bad rap but it's absolutely fine to feed a diabetic. Fancy Feast is popular here too.

 

FYI Welcome forum thread HERE.

 

Just a note, the insulin the vet is talking about is Glargine, or Lantus. It's a very good insulin and you can read about it HERE.
It is expensive here in the States, but many members buy it through Marks Marine Pharmacy in Canada.
http://www.felinediabetes.com/FDMB/threads/buying-insulin-from-canada.203498/
You do need a prescription and you should check the current prices:
MARKS MARINE
You can get the pens, and just use each pen as a vial with syringes so that you can fine dose as needed. A refrigerated vial can last up to 6 months, but you probably will not use all of it, as cats get much smaller doses than humans. I have read that the pens are a better value and last perhaps a year. Much better value for your buck.
Best wishes for Jake, and you and your family.

 

I was able to visit Jake tonight. They brought her out wrapped in towels. I held her and she purred- maybe from discomfort or anxiety, but I want to believe because she was happy to be with me. She didn't purr at all yesterday. We cuddled and then the tech said they had given her an appetite stimulant and were hoping I might get her to eat as she still hadn't. They brought a bowl of kibble and another bowl with fresh tuna, some sort of shreds in gravy and chicken baby food. She sniffed in the bowl direction but was not interested. I tried putting the chicken on my finger and bringing it near her nose, but she didn't even sniff it. I tried wiping a bit on her lips, her gums, etc and she did not even lick it off. I brought a feather of the fish to her and still no interest. She seemed distracted by all the noises of the hospital...and after a bit just tired. She stopped purring and began to tremble. I put her on the seat next to me and she tried to walk but was wobbly. It really scared me. I got the tech back to the room and she said she was going to go test her blood. She said they would keep trying to get food in and whisked her away.

It really scared me and made me very sad. I am so worried she's not going to recover. They said she has to start eating so they can do the long lasting insulin...they have been trying since this early am and nothing I'm more worried than I was before.

 

I'm glad you got to visit with Jake. It often takes a concerted effort to get kitty to start eating. If she won't eat, the hospital can install a feeding tube to get food in her. Are you going to be able to visit with her again today? Hopefully she'll take some food today. Check with the vets to see what meds they are giving Jake. I would think she needs some anti-nausea medication and probably an appetite stimulant. Sending healing thoughts to Jake and hugs for you.

 

Do check that they gave anti nausea meds before the appetite stimulant. Cerenia is a good one but some kitties respond better to ondansetron for nausea. It's a human drug for the nausea of chemotherapy. An appetite stimulant won't do the trick unless the nausea is addressed first. Also - some kitties do better with cyproheptadine for appetite rather than mirtazapine.

If it comes to a feeding tube, don't be afraid of that. It's less daunting to deal with than you might think (I've been there too!). It's an expensive intervention but can be the thing needed to turn kitty around. Cats are notorious for becoming anorexic. They stop eating for one reason but it then takes on a life of its own.

 

I spoke to the tech again this morning and he said she was asking for pets and head booping so I think she is feeling better. The Dr called me later and said they got her to eat about 4 bites of food (DM food).Her PH remains low as does her potassium but they hope that when she starts to eat they can get those levels corrected. The Dr said she is not normalizing, but improving. Her anemia (which was thought to be nonregenerative) is at 30% (also considered improving). Her blood sugar was 354 at last test- higher again, but they said it was because of food being taken in....so I guess that's good. I had a glucose meter from my diabetic parents to use at home and she said I needed an animal specific one so now I need to figure out where to get one ASAP! I also need to get U100 syringes and glargine insulin. They are writing scripts but I want to make sure I find the best pricing.
They scheduled me to visit tonight and asked I bring the food she likes- so I will...I am more hopeful than last night!

 

Glad to hear she has eaten a little on her own. Encouraging!
You do NOT need a pet meter. Pet meters are extraordinarily expensive to use and the strips for them are not readily available (have to be ordered through vet likely at a premium cost or through an online vendor). A human meter will work just fine. May I ask what brand of meter you have? Better to have one that takes a small blood sample especially when you first start testing. You will also need lancets and should get some that are Gauge 26 or 28. The smaller ones (Gauge 30/31) can make testing in the beginning more difficult. If you are in the US, Relion U100 syringes 3/10ml 8mm 31gauge needle with half unit markings are available at Walmart very reasonably priced and probably the cheapest. Glargine in the US is expensive but can be ordered from Marks Marine pharmacy in Canada. I'm just not sure what kind of delivery time might be involved. Better to buy the pens (again assuming you are in the US) as the 10ml vial will not be used up before it loses potency given the small doses our cats take. Some pharmacies will sell you one pen which is 3ml or 300 units of insulin so ask about that option and then you can order from Canada going forward.

 

Many members buy the Lantus (glargine) from Marks Marine in Canada: https://rxcanada4less.com/
http://www.felinediabetes.com/FDMB/threads/buying-insulin-from-canada.203498/
I have read that the pens are the best value as you will most likely be able to use all the insulin, as opposed to the vial which when refrigerated will only last about 6 months.

 

The vets insist on a pet meter because that's what they use, but it's not necessary.

 

She did say I would need U100 syringes- which my diabetic parents have on hand as they now use something different. They were also going to give me the one touch verio as they have a lot of test strips on hand. The vet said the pet meter would be calibrated to cats...so now I am worried about using the human one The vet said she would write me scripts for everything once Jakie comes home, but I feel so confused and overwhelmed. I get to see jake tonight...and the vet will still be on shift so I will try to ask questions. I asked my mother to come along when I do finally get to pick up- I figure since she is a diabetic she might to think to ask things I don't even know to consider....

Thanks for the pharmacy link. I am going to see what I can do to order from there.

 

Glad she’s doing a little better! The pet meter is more accurate, but most of us use human meters because they are much cheaper. If you feel more comfortable using the pet meter, maybe start with that then, when you get the hang of things and Jake is doing better you can decide if you want to switch.

 

The needles your parents used may be for larger doses of insulin than you will need for Jake and not have half unit markings as human doses of insulin tend to be considerably larger than those we use with our kitties and that would make fine dosing far more difficult and less accurate.

The One Touch Verio meter is fine. It takes a small sample of blood which is ideal.

The other thing you will need when Jake comes home is ketone test strips so you can check her urine for ketones.

Great idea taking Mom along when you pick up Jake. Always helps to have another set of ears, especially ones familiar with diabetes.

On a human meter, normal BG is between 50 and 120. The pet meter will read higher but as long as you know what a safe range is for Jake, the human meter will give you all the info you need to keep her safe and healthy. It's entirely up to you....we are familiar with both types of meters here although most folks use human meters and the documented dosing methods are based on human meter readings.

 

Sweetie, take a deep breath Jake is improving, that's wonderful. You do not have to worry about the meter, many of us use the human meters and strips simply because they are more available, and less expensive. You are probably going to be testing a lot when Jake gets home, for your peace of mind and her safety. Strips for the One Touch Verio are about $40 for 100 on Amazon. I just looked at Walgreen's website and 100 Verio strips are $109 Walmart.com has 100 strips for $49.90. Should be the same in the store.
Walmart also carries the U100 syringes with half unit markings, 100 for less than $15.
You are going to get through this, you have all kinds of love and support coming your way.

 

We visited Jake tonight and took some food with us. They bring her in the visiting room wrapped in blankets. Her nurse told us she is still very relaxed- the other nurses told her she should put her in a carrier because they have to walk through dog ICU but the nurse told them her family said she is a dog lover (this is very true). She said Jake seemed to relax as they walk through the dog area- I am happy they are trying to make her comfy.

Jake immediately crawled out of the blankets and onto my son's lap. after a bit she crawled over to my jacket on the bench next to him and settled in happily. I offered her the bowl of food and she turned her nose up. She has NEVER liked metal bowls and that is all they have there. I offered her some on the tongue depressor they gave me and still no go. We facetimed my husband and daughter. She perked up to my daughter's chat...and then one of our other cats came along and planted himself on my daughter's lap. I don't know if it was just a coincidence, but suddenly she wanted to eat the food on the tongue depressor. At home she loves to eat in front of the other kitties (she is fed first) and viewing her brother Marley seems like it did the trick (bonus that he is a talker and we could hear him as well as see him). She did not eat a lot, but she ate some!

Before she ate, the Dr stopped in to discuss Jake's progress. She said her blood sugars are still high, and that she will likely go home high as it will take time to find the correct dosing. She said the ph and postassium are still low. She then said that the kidney values (BUN and creatinine) were still skewing high. She said that while the bun was one outside of range the creatinine was still high at 30 ) though it had come down from over 90 just before that). She said that when they push fluids (and noted they were pushing them at the highest possible level) they expect the creatinine to go way down. She further stated that because creatinine is created by muscle and excreted by the kidney, when the cat is super skinny like Jake you would expect it to be low. She said that when you don't see it normalize with such heavy fluid load it may indicate some chronic kidney disease. She said they had missed a urine catch but planned to try to get one. She said if it was concentrated then there may be some room to push more fluid and think the levels would go down more, but if it is dilute they will likely have the answer. This is terrible news. I am so sad. I was hoping we would handling the diabetes, but now it seems like more, and maybe even worse!

She is also now fighting conjunctivitis. They suggested she likely had feline herpes dormant her whole life now flaring because of her overall stress. They are giving her antibiotic in her eye and keeping it clean.

So every time I think we turn a corner, it feels like more bad news is heaped upon us. They did say she may be able to leave around dinner time tomorrow, so at least there is that! She had told me she was going to have me leave tonight with the scripts but somehow that was forgotten before we left.

 

Consider Tiki Cat... I like their after dark line. I feed that along with fancy feast classic

 

Comfort and hugs. You know, she might respond so much better when she's at home and in "her" place. Everything at the vet is strange. Get as much ready as you can, before she comes home. That might help reduce some of the anxiety you are feeling right now. Then, a little less stress for you and family, and you can focus on the other things you need to.

 

If it turns out to also be ckd there are treatments and dietary changes that can often slow down progression and extend the quality of life... Sometimes for quite a few years.

 

A new Dr took over Jake's care today due to shift changes. The doctors were definitely different and it has made me a little less confident and not sure what to believe. Today's Dr seemed to have no real concern about the kidneys being an issue at all. She didn't have a lot to report during her call this morning and when I asked about items the Dr had mentioned the night before she kept saying I must have misunderstood. I had written down the lengthy descriptions to research when I got home so I was fairly certain of what the first Dr has said. I asked if she was still on track to be sent home around 5 and the new Dr had no idea that was supposed to be the plan. She said they had not repeated the urine test the other DR had said would happen the night before and that an important blood test was scheduled for 4 pm, results of which would not be ready before 5. I got another call about 30 minutes ago that if I wanted she could go home tonight, but that the nurse who does diabetic discharge was gone for the day so I would have to go back again in the morning for the training and info session. After some further discussion it seemed best to leave her overnight, let them step down her level of care and see if she remained stable.

I asked about home care and if they would be sending me home with the initial necessary supplies. They indicated that they would give her the morning dose, but that I would need to fill my scripts immediately as they have no insulin to dispense. I am now panicked trying to figure out where I am going to get a pet meter and other required supplies- I live in a rural area and imagine the local pharmacy won't just have this all in stock.

My father offered me a lantus pen until I get our own. I read correctly that this is glargine, right? Will the script I get be for lantus or will I need to ask for that? PANIC!!!

 

Do I need pet urine test strips?

 

Deep breathes! If your Dad has a Lantus pen then you have what you need. You DO NOT NEED a pet meter. The One Touch Verio will do just fine and give you all the info you need. We can help you with that.

It sounds to me like communications are a bit broken between vets but if you are in a rural area, surely the new vet knows a pet meter is not something you can readily obtain at any local pharmacy. The only other thing you need is ketostix, cat food and a baby syringe for feeding if Jake's appetite is still not great and he needs some assist feeding.

 

Yes, Lantus is glargine. The pet meter will have to be ordered so maybe start with the human meter. Be sure to have plenty test strips and lancets. As for the urine ketone test strips, no you do not need pet specific ones. You can pick up human ketone strips at any pharmacy.

 

My mother and father just stopped by with the One Touch Meter, 1000 test strips, Two gallon sized ziplocs of all sorts of lancets (they want me to decide which works for us then they will destash to us which ever one works best for us), 4 large boxes of alcohol swaps, and several types of U100 syringes. They brought over a lantus pen that is over a year old so when I go tomorrow for the training they can teach me how to draw doses out of the pen without wasting a usable one. I guess I will take all these supplies and see what they think I can use until I can get the scripts filled. My dad has 5 new pens he will give me if we can use them- he has switched to another product so those are now mine.

The vet hospital is about an hour away...so early tomorrow morning I will be off to get my Jakie Cat! I hope she will be as happy to come home as we are to get her back!

 

The syringes you need are the 0.3ml U100 8mm syringes.
If you can get the half unit syringes all the better but you do need the ones I mention above NOT the U100 0.5 or 1 ml syringes

 

Jake came home today. Our training appointment took about an hour and half. They told me that I am never to change the dose until directed by the Dr...and told me when to come right in and when to just call. I feel nervous that I will miss something again. The tech told me Jake's morning number had been 134 so they had decided not to give her any insulin. The Doctor wanted me to feed her in the evening and then call to discuss had she had been acting and they would decide on a dose.

We got home and Jake immediately came out of her carrier and crept around a bit. The other cats all went in the carrier and fought about not all fitting. She went up to her favorite spot on the back of the sofa. She settled in got lots of rubs and pets and took a good long nap. At 6 I woke her up with a smelly bowl of food- 1/2 a can of Friskies canned pate. She seemed to be voraciously eating when I brought it to her...but when I measured it out she really didn't eat much. She seemed to go right to sleep- a deep sleep after this. I called the vet and she wanted me to give 1/2 a unit, which I did- I think....It seemed to go in..the fur was not wet in the area and the needle was empty so I guess it went in..unless it was so small an amount I couldn't tell the fur was wet...STRESS. She said since the hospital was likely not particularly restful she may sleep deeply now that she is home. The Dr said I should only worry if she seemed unable to be roused or not alert. Since she perks when I call her name I guess she is ok.... We took her down to the main litter boxes but she just sniffed around and didn't do anything. The Dr had said she would be peeing all the time because of all the fluids they had been pushing but nothing had happened so I felt nervous. She walked up the stairs slowly so she was active. The tech told me we really never had to check the blood sugar levels this week (she has an appointment a week from today) but I just feel so anxious. We had roast chicken for dinner and she came along trying to beg some- so she is food oriented again which I suppose is a good sign. She is climbing on the kids, but mostly back in her favorite sleepy spot. Worried about her, I tested the blood. 2.5 hours after she ate/got insulin she is at 328. She got up a bit ago..got some water and came back t her sleepy spot. I hpe she will use the litter soon.

The Dr wants me to call in the morning when I feed her so she can decide on dosing. Should I test her blood BEFORE I feed? Will that help the Dr?

 

I forgot- they also gave me this potassium creme that I have to give to her 2x per day (1/2 tsp) that she does NOT like to eat. I am afraid if I mix it in her food she will not eat the food! They gave me meds for nausea and an appetite stimulant. I understand what to look for to know when to use the appetite stimulant- but how do I know she is nauseous?

 

I am glad Jake is home again with you.
I definitely don't agree with the vet that you don't need to be testing the blood sugars.
Please start testing the BSL (blood sugar level) now. Always test before every shot and about 4 to 6 hours after the shot to see how low the dose is taking her. It is really important to see what the BSL are doing following the DKA and to adjust the insulin accordingly.
Are you testing for ketones. It is really important you test every day at this point.
It is not really a good idea to skip doses after DKA..
Try and get Jake to eat as much as possible ....even little bits often is fine but she needs to eat following DKA.
Did they send you home with cerenia and / or ondansetron (for nausea) and an appetite stimulant?
I am going to tag @Kris & Teasel for you to help you.

ETA I see you have the antinausea and stimulant meds.
If Jake goes up to the food and sniffs it but won't eat/ or she just won't eat, then she is most likely nauseated.

 

I'm so glad Jake is home. I'm sure Jake is exhausted from being in the vet with all the strange activity and noises there. She is also recovering so she is likely going to sleep more than usual for a few days.

This is indeed a good sign. If she isn't particularly interested in her cat food or not eating as much as you think she should, try giving her some of the roasted chicken if there are leftovers. It's not going to hurt her as long as there is no onion or garlic on it. Remove the skin and give her some of the meat. Right now it's more important to make sure she is eating than it is to worry about the type of food she is eating.

Nauseated cats will often approach their dish, sniff, lick their lips and then walk away or just be licking their lips a lot without food nearby, possibly drooling. If Jake is showing signs of possible nausea, give her the meds for nausea first. Don't give her an appetite stimulant until you deal with any signs of nausea.

We advocate always testing before feeding the pre-shot meal, withholding food for at least 2 hours prior to testing for a pre-shot BG level. Assuming you are using the One Touch meter it will tell if it's safe to give insulin and yes that is something the vet needs to know. Dosing blindly simply based on behaviour isn't safe IMHO.

While I am glad they told you when to call and when to come in, I don't agree that a vet who is advocating not testing the cat's BG can direct you over the phone about dosing. It is absolutely necessary to be testing BG both before every shot of insulin having withheld food for at least 2 hours prior and also sometime in the middle of the cycle. As Bron said, getting a test 4 to 6 hours post shot will tell you how low the current dose is taking Jake's BG and also give you an indication of whether the dose needs to be increased or decreased. Ultimately testing is the best way to keep Jake safe.

You will be fine and we will help you look after Jake in the days ahead.

 

The vet instructed that Jake can ONLY eat the two meals as directed followed by the insulin. I wanted to give her the chicken last night, but it wasn't a meal time. They told me no snacks, no cheating. She is so skinny...I want her to eat! When I asked about testing the vet told me that constant testing causes the animal to stress and stress affects the rendering test results inaccurate. She said in fact they won't do a test every two hours for 12 hours straight day as they once did- they now do some frucaminise (no idea what she was saying despite saying it a dozen times) test instead. I have pretty much been awake all night watching Jake. I am worried beyond belief.

 

oh..and they suggested I get ketone test strips...no guidance on when or who to test...or how frequently.

 

If your cat is underweight and hungry, feed him. Just no food 2 hours prior to the preshot test so the number is not food influenced. My cat is not stressed at all by the bg test. I suppose any stress out could potentially cause is dependent on the cats personality. My cc literally purrs and enjoys the attention and extra cuddles.

 

Buy the Ketostix from the pharmacy and test daily at this point. It is a urine test.
You can feed Jake as often as you like except for the two hours before you give the insulin as we don’t want the blood sugar level to be good influenced before giving the insulin.
So the routine should be
Test the blood sugar and see if it is high enough to give the insulin.
Feed Jake
Give the insulin.
Then you can offer some food every few hours up until 2 hours before the next shot.
Test the blood sugar level at + 4 and + 6 if you can.
If you are unsure of anything please post here and ask for help.
Your vet is incorrect saying not to feed inbetween the shots. Jake needs lots of food to combat the ketones. If she asks for food please give it to her.
Constant testing DOES NOT stress the cat out and render the test results inaccurate. That is just total rubbish. If you give a small treat each time you test, Jake will soon come to associate the tests with food. My Sheba used to come running to me every time she heard me go into her testing kit as she knew she would get a treat. So please test.
The fructosamine test is an outdated test the vets still do that will give an average of what the blood sugars have been over the last few weeks. It does not tell you if it was high or low, if you should increase the dose. It just gives one number. If you are home testing you can see hour by hour if you have the correct dose and if it is working. And you are keeping Jake safe.
So please test the blood sugars and feed her often. Your vet is not at home with you, Jake is your cat and you are paying the bills.

 

I tested her blood this morning- she has absolutely no issue with the process. She doesn't respond to the ear prick or even the rubbing the blood to the surface. She's always been rather accepting of anything I do to her. Her number was 374. I phoned in as the Dr had instructed me to do last night. Shift change- new Dr, new nurse. They seemed annoyed I was calling at all and told me to stick to the one unit protocol. I didn't even speak to the Dr so did not get to report the numbers I tested...I don't think this Dr even read the case or notes from the Dr that wanted me to call. SO...1 unit it is.

Jake had a good appetite. I usually feed the cats in the basement kitchen, but I prepped Jake's food in the main kitchen. She heard me tap her bowl and was right there in a flash. I took her back to her soft spot on the sofa to eat knowing I would need to do meds and wanting her to be comfy.. She wanted NOTHING to do with the potassium cream- that's essentially 2 doses now rejected. She ate her food and after eating about half of what was offered she settled into a sleepy state....then I moved the bowl closer and she ate more. She had to stop and do some serious grooming...then she ate almost the rest of the contents of the bowl! Normally she eats her food all up, rather quickly and goes on her way...it seems feeding time is going to take longer now. I gave her the insulin and she had no reaction to that stick either. She only got annoyed when I needed to put the cream in her eye for the eye infection.. She's snuggled in her sleepy spot, grooming intermittently. I have seen no movement to the box yet...but assume she may have gone when I was trying to sleep- I did see her hop down for a bit and I know she went in the kitchen...maybe she went to a box from there. My husband found her headed to the laundry room and directed her right on out. I feel like I woke up every time there was any movement- and with me sleeping on the sofa to watch her the other cats were very interested, so there was a lot of movement keeping me up. I thought they would just sleep in my bed as do when I am there- they still had my husband after all...but the change in routine had them stalking about and trying to find a comfy place on me on the sofa (it's big not not enough for ALL these giant furballs to lay on me!)

One note about another kitty, Luna. She has been all out of sorts since Jake came home. She is just walking around growling...not at anyone or anything...just growling as a matter of course. She skipped breakfast as well. She will get over herself I am sure...but could this impact Jake? Will it stress her? Should I isolate Luna so she does not disturb the recovering patient?

 

She doesn't have to eat the whole thing right away. As long as she eats some and has a willingness to eat, let her graze.

1 unit twice a day is a good recommend starting dose. Good job getting that test!

Cats smell weird to other cats when they come back from the vet. Give it a few days.

 

I’m so glad to hear Jake is doing well! You’re doing a great job with her. Many vets recommend twice a day feeding. I think that came from the days when the harsher insulin’s were used and no home testing was done, it insured the cat had plenty food on board to combat any low Preshot numbers and the fast acting insulin. If the vet is worried about stress, think how stressful being hungry in the middle of the day and not have food! She needs the nutrition and calories to help her heal.

 

I think the vet today has given you an out not to ring every day for instructions. The people here can guide you with the dose if needed.
I’m glad she is eating better. That is very good.
If you can get a mid cycle test that would be very helpful. Sounds like she is a real sweetheart.
Yes cats like routine and the minute they don’t, they are looking out why. I can imagine it would be very uncomfortable on the lounge with several cats. They always like to be very close or on top of you!

 

Oh no- she is at 403! What should I do? She ate from 6-6:30 am and got 1 unit right after. It is now 11:30 am and it went UP!

 

Don't panic. It's a number and Jake is more than one number. You are just getting testing data now, and as you get data you are going to be able to see a pattern. Is she feeling ok, is she eating? I read your more recent posts about her homecoming and how she was eating. Good advice from Sharon14, Bron & Sheba and JanetNJ. Lantus is a depot insulin and a little goes to work right away, but a little is tucked away for use later. It's possible that her BG dropped and since her little body is used to high numbers, the liver released glycogen to compensate, and the 403 could be a reflection of that process.
So, get your signature up so we can all see her info with your posts, it only takes a few minutes:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters)
I know you are tired and feeling very overwhelmed, but take a few deep breaths. You have Kiddos..children, and you probably faced a few crises with them, right? You are a veteran! You are a mom, you know how to do this.
We are going to need to see the testing numbers you are getting now, without having to page back through each post. The spreadsheet is a wonderful organizer, you enter the insulin dose and amount, the BG test numbers and you can enter feeding times, amounts etc in the comments. It's color coded so that BG numbers within certain levels are different colors, and you can easily see the highs, lows and in betweens.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
This spreadsheet is linked to the signature and all the information is then viewable to advising members.

 

Thank you. I tried making the updates and the spreadsheet. Should I be doing anything about this high number? She decided to take a walk upstairs and hang out with my daughter- her very favorite human in the whole world. She's just snoozing on my daughter's bed after a bunch of petting and head bumping. She spent her time before that snoozing and grooming, occasionally walking around the ground floor.

 

I see the signature and the spreadsheet, wonderful! There really isn't anything to do about the 403 BG, just put the number in the appropriate cell in the spreadsheet..however many hours after the insulin shot. Sounds like she's acting fine, and being with your favorite human being is the best! She's probably going to snooze a lot, she's had some harrowing adventures! Just keep an eye on her, test her before her injections and maybe a couple of times in between. Notice how much she's eating and excreting and get the ketone test if you can. You are doing everything you need to be doing..except maybe taking care of yourself. You have to do that yanno, Jake doesn't have thumbs and can't open those cans!

 

In the next few days, start reading the information in the Lantus forum: http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
Then you will begin to understand how Lantus works, and you can begin to follow a protocol for effective insulin treatment. Now, there is a lot of information there, so take it slow and don't be shy about asking questions in that forum. Lantus is an excellent insulin for our sugar cats and there are very experienced and knowledgeable members who will help you every step of the way.
I relied on those members when we first arrived and they helped me immensely. They provided correct insulin and testing instructions, and with that help and the diet change he went off insulin.
Here is a link to some very important information about hypos. It's just something every sugar cat parent needs to know about. You may never need this information, but being prepared is the best defense:
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/
It's rather like having a first aid box in the home, and knowing how to handle the emergencies that can happen to humans.

 

I was just putting away groceries and Jake came in looking hungry. I took the advice here and gave her about a table spoon of chicken breast I shred up for her. She gobbled it up...looking for more. I am too anxious to give her more. I saw her at the dog's water bowl about an hour ago so she is drinking.

 

Up to 436. Tested before I fed then gave her the one unit of insulin

 

i just called into the vet to see what to do..they had to take a message and see who could get back to me I am feeling panicked. She was hospitalized for DKA- we never knew she was diabetic...it came out of nowhere- I am so afraid she is going to crash like that again and end up back at the ICU or worse...dead. I feel like I need to know where she is at all times...I can't sleep..I need to check her....

 

If you get a blood ketone meter it may help you monitor ketones easier so you aren't just waiting for her to urinate. It may help you feel less anxious and more in control. I got mine on amazon.

 

Take a deep breath you’re doing a great job with Jake. It’s very scary at first, especially with all you’ve been through. It sounds like she’s feeling pretty good and has a good appetite. I think Janet suggestion for a blood ketone meter is a good one. That way you can test any time and not have to wait for her to pee.

 

95 this morning before eating and insulin