? DKA help

Hello all,

My cat Jace has been in the ICU since Friday, and he is expected to come home tomorrow. I was wondering if anyone out there who has personally experienced this with their kitty could give me advice on what to expect when we get him home. I'm terrified that he will develop it again. It's a very hard thing to go through when you love your fur baby with all your heart and not to mention it is very, very tough on a college student's finances. Are there any things/signs I need to look out for? Ive never home tested and am thinking that now would be a good time to consider learning how to do so. I just want to be able to give him the exact care that he needs and hopefully prevent this from coming up again in the future. Of course, I will be getting as much information from the vet as possible but still feel better hearing from others who have experienced this before.

 

What insulin are you giving your kitty? I'm so sorry to hear he is in the ICU but it is the best place for him right now. I know how you feel about the finances as my cat Smoky has various health issues which so far add up to around $5000. Did you try posting on a specific forum: prozinc, lantus, vetsulin, for instance? There are quite a few members on here who have DKA kitties. Also, if you edit your title and include the prefix that has a question mark you may get more eyes on your post.

 

Welcome, sorry you have to be here, but glad Jace is doing well enough to come home. I don't have personal experience with DKA, so I'll tag @Meya14 who knows a lot about it. One of the most important things is that you make sure Jace gets enough calories and enough insulin to prevent another episode. Please pick up a meter and learn to test. Many of us use the Relion Meter from Walmart as it and the strips are affordable. While you're there, pick up some ketone test strips so you can test Jaces urine for ketones. If you need any help learning to test, please ask and we will be happy to help you.

 

He is currently on humulin 1 unit twice daily. I've read that humulin can be tricky with cats and haven't seen many people on here that use it. Hoping he can be switched to a different insulin after this. I should also add that he is very very skinny (6 pounds) and has been since his diagnosis. I haven't been able to get him to gain any weight back and he eats wet fancy feast classic varieties.

 

Is it humulin R or N that you are giving? Also, definitely home test. This will save you lots of stress and $ as it can prevent problems like hypos and DKA.

I'm assuming you are on humulin N. Unfortunately, this insulin wears off too quickly, and can allow time in the body without insulin. When the body doesn't have insulin, it breaks down fat for energy and ketones are the byproduct of this. You either need to give humulin N every 8 hours until your cat is better, or switch to an insulin like lantus or levemir. Note: The blood sugar isn't really a measure if the cat is recovering. We still test to prevent hypos and see if we need to add food and stuff, but you need to also check for ketons 1-2 times a day for a couple weeks. The ketone stips are urine dipsticks and are available at any pharmacy.

 

@Meya14 he is on the N. I did get an update from the vet this morning and she said she bumped him up to 2 units twice daily. She also mentioned getting him on Lantus but said that it can be very expensive. Although I would most definitely pay for the more expensive insulin than have this happen again.

 

Are you home testing BG? If not then home testing is a must.

 

A lot of the Lantus user order insulin from Marks Pharmacy in Canada, think I've seen $150 + S&H for 5 pens? Also, check on the Supply Closet thread
Will tag a couple members I've seen mention it @Chris & China @tiffmaxee

 

Lantus really isn't that expensive at a low dose. The pens have about 300 units depending on the type you get, and cost maybe $90 each. If your dose is 2units twice a day for example, this is only 120 units a month or about $36 per month. Although the manufacturer states to discard insulin after a month, Many people keep it much longer with no issues. Insulin remains active for up to 6 months or more as long as it isn't contaminated. My vet sells individual pens, but some pharmacies only sell them by the box which is about $300 up front but they last for over a year unopened.

 

@Larry and Kitties never home tested before but am definitely going to look in to starting that.

 

I used lantus which I bought from Mark's Marine in Canada. A box of 5 pens including shipping was about $169 and lasted a year or more. I strongly suggest you switch to it.

 

Update: Jace is home! He looks so much better but is a little sleepy. He slept all the way home and his first stop once inside after looking around was the water dish... hopefully this is normal. The vet said to keep feeding him his same wet food, but had me get a bag of dry science diet w/d. I was hesitant about the dry food, but she said that because he is so skinny that it's okay, just may give some false high levels next time his bg is checked.

 

I would not use dry WD. It's high carb and used for weight loss sometimes! Any regular low carb canned regular food is far superior. Look at the food list Lisa Pierson put together.

I'm glad Jace us home!

 

are you sure it's w/d and not a/d? a/d is the one for cats that need high calorie.... and you can get it as wet food.

 

@tiffmaxee & @JanetNJ im attaching pictures of the food and the hand out that the vet provided to me when she recommended the w/d. She said that only because he is so skinny that it wouldn't hurt him to have dry food out at all times. She did inform me that it will give him higher BG levels.. very confused now and scared to feed him this because of the mixed opinions!

 

W/d is for cats that need to LOSE weight, not gain.
http://www.hillspet.com/en/us/products/pd-feline-wd-dry


If you want a diabetic friendly dry that's higher in calories then go with young again zero carb or evo cat and kitten in the purple bag. Or just free feed low carb canned food.

 

Looks like the W/D is Hill's version of RC's Glycobalance. Either way the carbs are too high.

You should be able to put some weight back on him with the wet food diet, which can be left out. If you can't be home to give new wet food, you can freeze some portions with water added, set them out and they thaw out in a couple hours depending on the temperature. They even make automatic timed feeders with ice packs! Feed small portions of low carb wet food a few times through the cycle but take away all food 2 hours before preshot time so the reading is not food influenced. I know you have not started home testing and are looking into it . It seems scary at first but it has saved many a kitty's lives. No parent in their right mind would give their human baby insulin without checking blood sugar (BG) first. We are no different here , these are our fur babies.

If you want a good dry food, I am becoming a fan of Young Again Zero . You can ask for a free sample by e-mailing them and purchase online. Good food and testing supplies are still cheaper than an ER Vet visit and higher doses of insulin

 

Thank you all for the responses so far. I am not going to feed him any of the w/d. I'm going to stick to his 3 cans of fancy feast each day, which presents another question. Jace is always ravenous and devours his fancy feast in under about 2 mins each feeding. If I were to leave wet food out for him during the day to free feed, it would be gone in a matter of seconds.

My second concern is that Jace has been on a low carb diet for quite some time now. I've done a lot of reading on how diabetic cats on low carb diets usually need less insulin and can even go into remission. Jace is going to keep being fed this same low carb diet, and the vet just increased his insulin from 1 to 2 units. I'm just very confused. This won't hurt him, will it?

 

Well we increase in .25 increments. Increasing by a full unit might miss a good dose and could lead to a hypo. You might want to get a Pet Safe auto feeder that you can set to go off every couple of hours. You just don't want Jace to eat two hours before insulin so the number isn't falsely elevated by food. He devours his food quickly because of the high BG. The same thing happens when they drop too low.

 

Jumping from 1 to 2 units is kind of a big jump, Vet's seem to think in whole units where as most prefer to increase here by 0.25U or 0.5U. If he is still very hungry, there is a high chance his numbers are still high, or lower, since he was DKA. His body can't absorb the nutrients so his body feels starved. I know we keep telling you about home testing, it really could save his life and help you see his progress . While remission is the ideal outcome, don't make that your primary goal for him. We definitely want to see him better regulated so he does not have to end up back in the ICU. http://www.felinediabetes.com/fdmb-faq.htm#regulation

 

With DKA + skinny cat if you lower carbs and calories too much, you will increase the likelihood of another DKA episode, EVEN IF THE BLOOD SUGARS ARE NORMAL. This particular setup for DKA can be fatal as a skinny cat is much more fragile and can't bounce back as easy if he gets sick. Low body weight also makes it very hard to regulate diabetes as it can contribute to very wide swings in BS from very small amounts of insulin. This is called "fragile diabetes"

For a skinny cat that is just recovering from DKA, a *Moderate carb* (~10-12% carb) wet food will help to gain weight. Food should never be restricted if a cat is underweight. Never. Ever. Until the body weight is up, you can feed him as much as he wants. This means you will likely have to increase insulin. That is a good thing in this situation. Insulin's job is not only to lower blood sugar. Insulin has a lot of other metabolic functions (muscle growth, fat storage, energy use, cell function, electrolyte balance, etc). DKA is a sign these metabolic functions are disordered. Increasing insulin in response to greater food intake will help normalize his metabolism. This will make it more likely her diabetes will be well-controlled which is what makes remission possible.

DKA cats are susceptible to future occurrences so it's a good idea to monitor when anything changes in his diet or health status or behavior. Also, many cats we've seen here can have an initial recurrence within a week or two after the hospitalization, so you should test ketones 1-2 times a day for a few weeks to catch problems early.

 

thats the one I am using on smooch and she seems to love it along with Prozinc insulin, we are only 10 days into our journey of feline diabetes.

 

Is Smooch a skinny diabetic or is she bigger in size?

 

thank you so much. Do you have any suggestions for a moderate carb canned wet food? And should I still avoid dry at all costs?

 

well the vet says although she was 5.6 kg she was thin up her spine she is 14/15 years old, so fat thats why I am using the D/M hills prescription before this when I first got Smooch she was very thin but not diabetic just neglected so she was on hills prescription i/d as she was being sick all the time on wet food

 

Dry food is usually pretty high carbs, it can be useful for gaining weight, if you increase insulin. However, protein is important too to maintain muscle mass in older cats and wet food helps maintain hydration. The dry food might be too much at this point. In the case of a cat with anorexia or major illness, if dry is all they will eat, then that's what you feed. In the wild, cats don't really drink much water, most of their fluid intake is from the meats they are eating. I believe if you look at the "feline heath" forums list, there is a pinned post of the new food list at the top. This has a lot of different brands and the nutrition breakdown.