GA DKA feedback/guidance (Final update: RIP Mimi)

Some of you may remember me, my niece's cat, Mimi, was diagnosed with diabetes in the beginning of this month; I did start a thread in the old forum and got a lot of great advice. Due to time constraints and other things going on in my life, I had no time to make out a profile and spreadsheet for Mimi until today; I posted the links in my signature. As you can see in the spreadsheet, her numbers seem to be all over the place since we began giving her Prozinc and monitoring her BG. Its only been about 2.5 weeks, and we don't give her any insulin if her BG is less than 200. I am wondering if her erratic numbers is due to the fact that she is new to insulin? Or maybe need to adjust her insulin dosage? Any advice will be greatly appreciated.

And for those of you who remember my thread from the old forum, if you recall, she wasn't eating or drinking water in the beginning, but after a week of giving her the appetite stimulant, she began eating and drinking on her own; now she eats what we give her and is back to her normal self for the most part.

 

Hopefully someone else will chime in soon but I would suggest 2 things when looking at her profile and spreadsheet.

1) the dry food: their are only a few that are diabetic friendly and even then it is not recommended. High carb food can cause high numbers even if its only a couple pieces of kibble. Recommended diabetic friendly dry is Young Again zero carb, Stella & chewys freeze dried, EVO cat & kitten, and Epigen.

2) I would lower the dosage so you have 2 shootable numbers. That seems to be a problem right now. No dose a lot of times because she's too low then she'll shoot up, some of those numbers are probably due to bouncing as well. I would suggest maybe sticking with .5 units for a few cycles to see how that looks, even if she' really high come time for shot. Better to be too high for the moment than too low.

 

I agree with both points. I replied on the ProZinc forum with the same response.

 

Thanks for the advice. I started giving her 0.5 of insulin this morning.

 

Hi there. Its been a week since I changed Mimi's dosage to 0.5 units of Prozinc and quit giving her dry food. Her BG numbers look better than before, but still goes a little high at times. If anyone can take a look at Mimi's SS and give me some feesback, I would greatly appreciate it. Thank you.

 

Cutting the dry food really helped; look at the color shift from red pre-shots to magenta, then to yellows and blues.

There are 2 possibilities:

1) he might be higher because he is getting insulin he doesn't need, so his body is compensating by releasing some stored glycogen which converts to glucose. I say this based on how he responded when he was up in the 400s at pre-shot and then dropped like a rock with the insulin. If you're OK with it, you might see what happens with no insulin for 1 cycle and monitor how he responds to food. If he drops about 2 hours after food, you'll know the pancreas is starting to kick back in. Its an experiment.

2) or he might need a slight dose increase or to develop a sliding scale so you can shoot based on his new patterns; that'll take a little time to develop.

 

How would I go about developing a sliding scale? I'll try the no insulin for one cycle tomorrow.

 

You collect data starting from the dry food removal, as responses with the dry may be different.
You get nadir tests when you can to see how much drop you get from the pre-shot and dose.
By observation of these, you will see that at higher pre-shots, it may be safe to give a slightly higher dose and at lower ones, a lower dose.
You make another sheet and group together the similar pre-shots and doses, and start experimenting to see what works most optimally for your cat (Note: each cat is different, so the sliding scale for one may not work for another!)

If the glucose goes up mid-cycle when you do give insulin, that's another clue it may not be needed, or it could be reduced. I just have a feeling she's darn close to getting off.

Are you using U-40 syringes? You can do smaller doses (0.2 unit increments) with a U-100 syringe and conversion table, if you're interested.

 

Thanks for the info. I am using U-40 syringes and am interested in using U-100 syringes for smaller dosages.

 

U-100 means 100 units per mL
U-40 means 40 units per mL, ie, it is 40% of the concentration of a u-100 insulin.
When you use a U-100 syringe to measure a U-40 insulin, the markings need to be adjusted by 40% or 0.4, to calculate the U-40 dose.
Short version: each 0.5 unit marking on a U-100 syringe measures 0.2 units of U-40 insulin.
0.4 * 0.5 = 0.2 units of U-40
0.4 * 1.0 = 0.4 units of U-40
0.4 * 1.5 = 0.6 units of U-40
0.4 * 2.0 = 0.8 units of U-40
0.4 * 2.5 = 1.0 units of U-40
and so on.

 

Cool, thanks. How much slightly lower or higher dosage should it be? Like 0.2?

 

You've been giving 0.5 units.
Depending on how the no insulin cycle pans out, you can try 0.2 or 0.4 units if he's over 150 mg/dL on a human glucometer.

 

Thanks for the info.

 

Sorry for the delayed update. I was planning on doing the cycle with no insulin this past Monday (1/5), but Mimi sneaked into the kitchen in the morning and ate dry food, so her BG was over 500. I waited till Wednesday (1/7) to do the no insulin cycle. It seems she did okay, as shown on the SS. We feed her a 1/4 can of Friskies Classic Pate 3 times a day, morning, mid-day and evening. Take a look and let me know your opinion is. Also, I'm not giving her any insulin today to see if her BG numbers remain the same as yesterday.

 

Wow! That's quite a reaction to dry food. Now you know she will always need to eat low carb.

I think she still needs a little insulin. To be regulated, she needs to be in the mid 200s at preshot and in double digits at nadir (but above 50). remission numbers are between 40-120 on no insulin. I'd try .25 if you can eyeball it on your U40 syringes or .2 on the U100s.

 

Her numbers looked good today with no insulin, around the same range as yesterday. Tomorrow I'll start giving .25 of insulin and go from there.

 

Welcome back!

I was using the U-100 syringes for smaller doses for Hank which worked out very well.

I also switched Hank to 9 Lives wet food for lower carbs. I feed him flavors between 2-5% carbs according to the food chart on catinfo.org.

Of course, you should always transition food switching slowly for less stomach issues.

It's worked well for Hank.

Just a thought.

Keep tracking. You're doing great!

Kimmie

 

Thanks for the help. We didn't have to worry about switching her food, we were already feeding her Friskies Classic Pate before she was diagnosed with diabetes. We just quit giving her dry food and now feed her 3 times a day (1/4 canned wet food). I have another concern. Yesterday (1/9) we started Mimi on 0.25 of insulin and her BG numbers have been good, but since yesterday, we've been having to force feed her again, all 3 meals yesterday and this morning. She's not eating or drinking on her own and isn't acting like herself; she just mopes around all day and looks drowsy (the same way she was right after being diagnosed for diabetes and being treated for DKA). Not sure what this could be since she was doing so well and eating on her own, now all of a sudden going in the opposite direction. Anyone have any ideas of what is going on with her?

 

Are you testing for ketones? If not, I'd go out and get some ketone strips and test her. Cats do not always have to have high Bg numbers to have ketones.

The other possibility is that she is dropping lower at some time other than the standard nadir time. I'd get some numbers before and after that window. If she is on a roller coaster from yellows to greens, that may make her feel off. But I would test for keyones asap.

 

When lethargic, check glucose and ketones. Either may be associated with lethargy.
And it could be something else, too, so if neither of those seem like a problem, a vet visit is in order. I'm thinking you mau need to fatten that quarter unit dose a hair.

 

I'm not checking ketones, I'm gonna have to go buy some strips. BJM, what do you mean fatten that quarter unit dose a hair?

 

To fatten a dose, you increase it a smidgen, but not up to 0.5 units.
To skinny a dose, you do the opposite.

 

I did get strips, but so far have been unsuccessful in getting her urine. Besides that problem, she is eating on her own a little bit more; she eats some meals on her own, but other times only eats some and is forced fed the rest.

 

Oliver would never let us watch him pee. We'd put him in a room with a clean litter box filled with aquarium gravel. He'd just have to christen the clean box and we'd get our smaple without it soaking into the litter. I think there are special litters that test for ketones also, but have never tried them.

I'm glad she is eating better and feeling better. Her numbers look good. I'd be sure to monitor when you shot into a 170 or below. And be sure it is a rising number, not still falling.

 

My niece was finally able to catch Mimi urinating in the box, but by the time she got to her, she wasn't able to get enough urine on the strip; she missed the most important one, keatones. Some of the results were not normal, Mimi's protein was 30+ and specific gravity was 1,030. Everything else looked good, with the exception of Ket, Bil and Glu since she was unable to get enough urine. Should I be worried about the protein and specific gravity numbers? By the way, the multistix 10 sg strip was used.

 

My niece was finally able to get Mimi's ketones level, which is negative.

 

Terrific on no ketones. I wouldn't worry about the other stuff.

 

Mimi is back to just looking tired and sleeping a lot. Her ketones were negative last time it was checked and her BS numbers are good. We have been having to force feed her the last couple days. Any ideas of what is going on?

 

i don't know, but do you have any of the appetite stimulant she used before? Did you ever get an indication from the vet about her decrease in appetite? Any suggestion of pancreatitis?

Here is some info in it to see if the symptoms sound familiar:

http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

I do think it would be wise to get a curve to see if the +6 is her lowest point or if she is lower before or after that. If she is dropping low at some point, that could make her feel crummy.

 

The appetite stimulant was given to her just once in the beginning when she was newly diagnosed with diabetes. The vet said she wasnt eating because she was in DKA, so her body was in a manner of speaking, in shock. The vet only gave one weeks worth of the appetite stimulant. Besides the not eating, she does look lethargic and when I pull her skin, slightly dehydrated. She did throw up once a few nights ago, but hasn't since.

 

when did you last check for ketones? If not today,I think I would get a current test, just to be sure that isn't the problem. If you are concerned and she is not acting normally, maybe a vet visit?

 

Last ketones check was last Friday, Jan 16. I haven't been able to catch her urinate since then. I am going to take her to the vet, but her vet is closed on Wednesday and I work all day tomorrow; trying to find a coworker to cover part of my shift. If not, then I will take her to the vet for sure on Friday. I am concerned, but she still jumps from the bed to her cat post and vice versa and she isn't throwing up.

 

If she is acting better toward the end of the cycle and worse during the cycle, I'd definitely get some numbers and see if she is dropping at some point.

 

I took Mimi to the vet yesterday and they kept her overnight. I called this morning and over the phone told me she isn't doing any better. The vet said its DKA (BS was 298) and not pancreasitis, her enzmymes are fine. The vet said depending on how far I'm willing to go, either put her down or recommend a specialist. I'll be going later to go pick her up. Not sure what to do, I'll get a copy of her results and post later on.

 

You can do fluids at home, but managing the electrolyte disturbances from DKA are tricky.

 

Maybe prozinc isn't working? Would switching to another insulin maybe help?

 

I posted the lab results for Mimi; for the blood work, there is one test pending, and for the urinalysis, its still pending as well. I went to the vet already to speak with them in person and said that its DKA and that her liver and kidneys are not working right. He recommended keeping her for the day to give her more fluids and see what happens, but he couldn't guarantee anything. The options were: give her more fluids and hope for the best, take Mimi to a specialist and see what they recommend, or to put her to sleep. Mimi is going to stay for the day for more fluids and I'll be picking her up later on in the afternoon; after that I don't know what to do.

Financially speaking, I won't be able to afford to take her to a specialist (and its not guaranteed if the specialist can do anything); so far since Mimi first being diagnosed with diabetes this past December, I've spent close to $2000 already. Morally speaking, it feels wrong to decide her fate based on money and its my niece's cat, and its hard to see her hurt and cry; she was crying her eyes out when we got home from the vet. Also, its morally wrong to see a cat have to suffer like that, and if more fluids throughout the day doesn't work, then I think the best option would be to put her to sleep, even though it will make my niece very sad (she's had Mimi since she was kitten and she's her very first cat).

BJM, you said that fluids can be given at home, but its tricky with electrolyte disturbances from DKA. Do you have experience in this or have any literature? What are the success rates? If anyone else has any thoughts or recommendations, I would greatly appreciate it.

 

I attended most of the diabetes sessions at the Midwest Veterinary Conference last winter, including a discussion of what is needed to intervene with DKA. The complexity is why many cats remain at the vet for several days, or are euthanized due to the cost.

Here, when we have someone who has had a cat that went through that, or one that is showing more than trace ketones in the urine, we encourage fairly intensive monitoring, pushing fluids, syringe feeding if the cat won't eat, and in some cases, the use of Regular (R) insulin. It can be very intense nursing and there are no guarantees of success. There are supportive things which can be done for the liver and kidneys.

If you can post the lab results, we may be able to get feedback from folks who have dealt with this before.

Please go up to your first post in this thread, and on the right hand side find the little down arrow. Please click on that and change your title to DKA feedback/guidance, or something similar, so folks notice the topic.

I put a post over in Lantus to get you more feedback and thoughts.

 

I am so sorry to hear she is in DKA again. Hard, hard choices. You know how much you can afford in time, energy and money. And no, you don't want it to be so difficult for everyone that her quality of life is no longer there. Having said that, we definitely have cats surviving DKA, usually requiring stays in the ER or lots of supplemental support at home.

Only you know what is right for you and for her. And whatever choice you and your niece make will be the right one, because you will make it out of love.

 

Thanks for the help and support. I did post the lab results on the spreadsheets under the labs tab.

 

Ok. I see them.

bilirubin is increased
glucose is increased
potassium is decreased
sodium is decreased
Na/K ratio is increased
Chloride is decreased
Cholesterol is increased
Triglyceride is increased
Neutrophils increased
Lymphocytes decreased

 

Here's a stab at it:

When there isn't enough insulin, fat is broken down for energy. This may increase the cholesterol and triglyceride values. Also, the fat goes to the liver for processing, which can cause it to swell. This may make the bilirubin increase.

When the glucose is elevated above about 240 mg/dL, the kidneys start dumping the water with the glucose into the urine. The animal can become dehydrated, plus the increased urination may excrete a lot of the minerals. This may explain why the potassium (K), sodium (NA) and Chloride (Cl) values are off.

The values for neutrophils and lymphocytes indicate infection.

 

We picked up Mimi from the vet already, she doesn't look any better, we'll be taking her back in the morning for a re-check and possibly another day for fluids. The urinalysis results are back and posted on the spreadsheets under the labs tab; her ketones are 3+(high). We'll see how she does over night and tomorrow after getting more fluids. She does have an IV in place, so I'm going to ask the vet when we bring her back home tomorrow if they can keep it in (I work in a hospital, so I have access to fluids) so I can give her fluids at home.

 

You, Mimi and your niece will be in my prayers.

Kimmie

 

Ketones are a by-product of fat breakdown. You want to encourage fluid consumption.

 

Quick question: Mimi's BG was 105, most likely because she didn't eat much during the day at the vet; the vet said they did feed her a little bit of food. Should I give her a small dose of insulin? We did force feed her dinner.

 

Until and unless she is testing over 150 mg/dL on a human glucometer, I would not give insulin unless you can stay up, monitor her, and intervene if her numbers start dropping low.

 

Ok, thanks for the advice, I won't be giving her the insulin shot.

 

How is she doing today?

 

Last night she just wanted to be left alone, and she did urinate A LOT in the litter box. This morning she didn't look any better, and she was hiding underneath the bed. Her BG was at 157; we had to force feed her and she still looks dyhydrated, had to force her to drink water again. Going to take her to the vet in a few hours for a recheck.

 

My cat when he was diagnosed had severe DKA. Since my husband and I are both nurses, in order to save on costs, keep my cat happy, we chose to treat at home with the vets guidance. The main thing with DKA is the body is "starving" due to lack of insulin and burning fat which throws their metabolism out of wack and causes dehydration.

The key to treating DKA is Insulin + High carb foods + fluids + electrolytes + nausea control/appetite stimulant.

Ideally, you should NEVER reduce insulin during DKA especially if they are not eating, because lack of insulin is the cause. The body is not able to use carbs/protein as energy without insulin. The cat should be syringe fed every hour with high cal/higher carb wet food to maintain calories. Subq fluids (lactated ringers - which has electrolytes) and a potassium supplement given orally should be done at least daily, sometimes 2x/day depending on intake. You can do these at home, it's not much more complicated than learning to give insulin.

If she doesn't get the calories to stop her body from burning fat, the DKA will get worse. Insulin may need to be increased as well.

 

Just got home from the vet: Mimi got a appitate stimulant for 10 days, antibiotics and a litter of lacted ringers for three days via IV. Hopefully with all that, we'll see improvement. Also, when would be the best time to give her the fluids?

 

I just gave in the AM, it really doesn't matter, whatever is convenient. The fluid pouch absorbs in about 15 minutes, and really doesn't affect their movement or anything. Just be sure to shoot insulin in someplace other than the scruff for a few days after you stop the lactated ringers as it can decrease absorption.

You might have to give fluids for longer than 3 days if intake doesn't improve. As soon as my cat started eating again, I made a "soup" of wet food, extra water, and some dry food for carbs (carbs are OK in DKA), which gave him extra fluid too.

Keep feeding and giving insulin. If she goes low, better to feed more, than to reduce insulin. You might want to call the vet and get a potassium supplement orally as well, because the loss of fluids and insulin itself can reduce potassium and yours was already low. There is potassium in lactated ringers.

Try to keep a stable dose of insulin until she is better. Cats prone to DKA require a basal (constant) supply of insulin. Your spreadsheet has a lot of changes, holding of insulin which is not great for cats who are insulin dependent (prone to DKA without insulin).

Once she is better, you might want to ask your vet for a switch to lantus/levemir, as prozinc has a stronger peak and that might be why your numbers were swinging so much. Lantus/levemir are "peakless" or at least have much less of a peak.

 

Thanks for the advice. I figured she will be on fluids for more than 3 days. I will be giving her a higher carb food and trying the "soup" when she starts eating on her own. Right now she has an IV, the vet showed us how to hook her up to the fluids.

 

I tried giving the fluids through the IV, but I think the IV isn't working, her paw was swelling up. I'm going to give it subq. The rate I was told for the IV was one drip every 15 seconds. Would it be the same rate for subq? I tried calling the vet, but they are closed already?

 

Just what do you by

Who is giving the IV? That is not something you do at home. Sine times the IV catheter gets mis-inserted and the fluid goes sug-Q in the leg vice into a vein.
SubQ fluids are given as bolus, usually abut 50 to 100 ml in a couple of minutes

 

Mimi stayed at the vet over night on Thursday, so the vet put the IV in and left it in for home use. They did show me how to connect the fluids this morning when I took her in for a recheck. It was working fine then, but at home, her paw swelled up.

 

For subQ, hang the bag so you can see the bag markers, inject needle shallowly into her scruff. Open the roller about halfway, and let it run until you see the fluid left in the bag at the right measurement (ie. 50-100ml). Do you know the total ML you were suppose to run through the IV? Did the vet give you needles for subQ?

Remember to choose another site for insulin (maybe flank) for a few days after you stop subQ.

For her paw, put a warm towel around it. Ask the vet if you should remove the IV.

 

I'm new to all of this and don't have any real advice, but my cat's paw/foot was pretty swollen after her IV was removed Thursday. They said it was because she liked to tuck her front legs under when she laid down while it was in. It went down in about 24-36 hours.

 

She was supposed to get between 250-300 through the IV. I do have needles to do subq. Thanks for the video. I'll be calling the vet on Monday to give them an update, and to let them know about the IV.

 

You either gave the IV too fast or the end of the catheter slipped out of the vein.

 

I think the catheter slipped out the vein because the drip rate was already set at the vet this morning when they were showing me. When I connected the bag to the IV, it was dripping at the proper rate, 1 drip every 15 seconds, and then my niece noticed her paw swelling.

 

Split up the total then, give half in AM and half in PM. 300ml is too much to give all at once subQ. The fluid will move out of her paw as she walks around. Warm compresses help. Not a huge issue.

 

Is it the same kind of fluid for subQ as it is for IV?

 

Can be and usually is the same. However, things can be added to IV fluids like Dextrose which should not be given subQ. Common fluids that can be given both IC and subQ are LRS (lactated Ringer solution), 0.9% saline, Plamalite,and Normasol. Concentrations of saline higher or lower than 0.9% can be given IV but not subQ.

 

Its the same fluid, I just gave her 100 ml lactated ringer subQ. It was fairly easy to do, just had to keep Mimi from not moving too much.

 

Thanks Larry. Just wanted to verify that.

 

You're doing great!

I will continue prayers for all of you.

Kimmie

 

Is she eating, or are you having to syringe feed her? Try to aim for at least 6oz (1 can) of food/day if you can get it in her. More is better.

 

Still having to syringe feed her. The appetite stimulant hasn't worked yet; last time she was given the appetite stimulant it took about 3 days before she started eating on her own. Right now giving her 1/4 canned of wet food 3 times a day (5.5 oz can); that's all we can get in her. I'm hoping the appetite stimulant kicks in soon so I can give her the "soup" you mentioned @Meya14

 

Update: Mimi's BG this morning was at 187, her gums look more pink as opposed to looking yellow the last few days. Had to force feed her still. She does look a little better. @Meya14 She still has a fluid pouch; we gave her 100 ml subQ yesterday around 4pm and the fluid pouch is about half its size. I read that if the cat still has a fluid pouch, to not give her any more fluids until the body absorbs all the fluids. I'm holding off from giving more fluids subQ. Let me know if that's the right move.

 

Yeah, let it absorb. If you want, you can give the subQ on one side of the scruff, then to the other for the next dose if there is still a little left. You don't want too much fluid absorbing all at once if there is a large pouch left, cause you could overwhelm the kidneys. I'd check again at about 4pm and if most of it's gone, give the next dose. She should be urinating now with the feedings and extra fluids. Keep feeding, and you can add extra water to the food. Seemed as max got better hydrated and more active, the SubQ was able to absorb better. I think we did 2X a day for a week, and then a dose every other day for a week. He was better after about 2 weeks. The first week all his intake was force-feeding, subQ.

Fluid requirements for (normal, non-diabetic) cats is about 30-45ml/kg/day. So for example, a 12lb cat would need 163ml-244ml per day. I aimed for 300ml/day for max due to his size (16ish lbs) and due to increased fluid loss from DKA.

Consider getting an anti-nausea med with the appetite stimulant.

The less yellowness in her gums is a good sign, means her bilirubin is probably going down in response to the increased calories.

 

Please remember to give the insulin shot to your kitty in a different location than you are using for the subQ fluids. The fluids can affect the absorption rate of the insulin and you'll get wonky numbers.

 

On a side note, you may want to ask your Vet about testing her again/treating her for hypothyroid (her lab was low). Could be a reason she is prone to these episodes.

 

Mimi went downhill overnight. Yesterday she was livelier, looked more alert and took down her food/medicine without too much trouble. This morning, she looks lethargic, took much longer to feed her (it was MUCH tougher to force her mouth open to feed), groans when we touch her/pick her up, and her gums look yellow again. We did giver her fluids subQ yesterday and the fluid pouch absorbed in about 6 hours, much quicker than the day before. I gave her another 50 mL this morning, but had to stop because she was groaning and moving around. Not sure what to do; I was hopeful after she showed signs of improvement yesterday, now today she's going backwards. She does urinate, but we haven't seen her poop yet (unless she pooped somewhere else besides the litter box, she has done before). I'll be calling the vet later on this morning to give them an update, but I don't think they'll be able to tell me much. Any other suggestions?

 

I am not really very good with test results but I see that she has raised ALT but the other liver values are okay except for raised bilirubin. Could you ask the vet what this might mean.

I am wondering if she also have hepatic lipidosis or some other form of liver disease such as cholanghepatits/ pancreatitis. I feel intensive feeding is very important at this point and you need to find a way of getting a lot of calories into her. I would ask the vet for ongoing anti nausea medication and or an anti vomiting such as ondansetron or cerenia. So not just the appetite stimulant I think you already have.

What food are you giving? When my cat was very poorly and jaundiced I got hold of royal canin instant support sachets. I would then make one up daily and feed it to him over the course of the day in a syringe. First I got them from the vet and then online. This was before he had diabetes though. http://www.vetuk.co.uk/royal-canin-...n-convalescence-support-instant-sachets-p-254

If they suspect the jaundice is caused by liver disease then you might want to ask about destolit (called something else I think in the US) and antibiotics.

 

Final update: Mimi got worse throughout the day today. She became very lethargic, her gums turned more yellow, she was breathing heavy and she was just groaning whenever we touched her. We took her into the vet and the vet said there wasn't much else that we could do, we did our best. My niece decided to have Mimi put to sleep; she didn't want Mimi to suffer any longer.

It was hard to have to put her to sleep, much harder to see my niece cry since Mimi was her first pet. Even now as I type this, I hear my niece crying in the next room. Even though Mimi had a short life (she would have been 7 years old this spring), she had a wonderful life and helped my niece through a lot of hard times (my niece's therapist at that time recommend to get her a pet to help her get through some dramatic life changes).

Although it was only a few months of caring for a diabetic cat, I did learn a lot from this forum (and before Mimi became a diabetic, I had no idea cats could get diabetes). I am glad I came across this forum and I want to thank you all for all the support, advice and knowledge. I really do appreciate everything you guys have done. If I ever have family, friends, co-workers, or come across a random person who have a newly diagnosed diabetic cat, I will make sure to recommend this forum to them.

Once again, thank you guys so very much, words cannot express my gratitude.

RIP Mimi 01/26/2015

 

I am so sorry.
It's hard to lose them.

Fly Free Mimi.

 

I'm so very sorry for your loss.

Fly free little Mimi... land softly.

 

I am so sorry for the loss of your sweet Mimi-that's a beautiful picture.

 

I am so sorry to hear of Mimi's crossing, and my heart goes out especially to your niece.

 

Requiem aeternum, Mimi.

{{hugs}}

 

So sorry for your loss.

 

I'm so sorry for the loss of your beautiful Mimi.

 

I am so very sorry to hear that you have lost mimi.

 

Sending purrs and prayers for both ou you

 

My deepest condolences on the loss of your beloved Mimi.


Lighting a ring of candles, in memory of your sweet Mimi.

It's never long enough, 7 years or 17 years. So sorry that it was Mimi's time to cross over to the Rainbow Bridge.

 

I am so sorry. Losing a pet is never easy.

Fly free Mimi and watch over those who loved you.

 

I'm so sorry for your loss

 

So sorry

 

so sorry for your loss, sending deepest sympathy and prayers.
Suki and Crystal