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DKA recovery

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Hettie, Sep 6, 2019.

  1. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    I had to take my boy to the ER on Monday afternoon and they said he was in DKA. He was there about a day a half while they gave him fluids and got his BG under control but then developed a fever that wouldn't respond to antibiotics. After 4 days, we just couldn't afford to keep him there and the vet was out of ideas as to why his fever wasn't going down on the antibiotics. blood tests showed elevated ALT and bilirubin. So I brought him home last night and the vet suggested to try a different antibiotic, which we started him on last night- I took his temp this morning and it was normal 100.4. His temp has been stable all day, but his BG has gone back up to the 600's- they told me to start him out on 1 unit (his 'normal' dose was 3). He still isn't eating on his own, and has an NG tube that I feed him through and give meds and liquids. He's still lethargic. I'm worried he's going into DKA again. I don't have a ketone tester. He is due again for his next shot in about 20 minutes - the vet said to give him 2 units ,but I feel like it's not enough.
     
    Last edited: Sep 6, 2019
  2. Hettie

    Hettie Member

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    Dec 27, 2018
    I should also note that we switched him from the Prozinc to Lantus about 2.5 months ago.
     
  3. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
  4. Hettie

    Hettie Member

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    Dec 27, 2018
  5. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    I am sorry this is happening, too. I don’t know enough about some of the details you mentioned, either. My Alice survived a DKA hospitalization back in April. All I can say is that her recovery was slow for awhile and then suddenly she was doing much better. I see you just updated a comment with numbers so going to take a look.....
     
  6. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Do you know what they gave during hospitalization? Was he on a drip or did they give lantus as well?

    If no one answers, I’d be inclined to just continue giving 1 unit for this cycle until someone with more experience chimes in.

    It’s good you’re able to feed via NG tube. Keep that up as calories is part of the solution to ketones.
     
  7. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    The gave him the "short acting" insulin - I don't remember the name but they gave it every 4 hours.
     
  8. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    I’m wondering..... with Lantus being a depot insulin, if there’s a way you could gain some regulation with an insulin that acts differently....? Just a thought.... When I used NPH one of the only beneficial things was that I had much more specific control in the moment. I don’t think 1u makes any sense at all with those numbers and what your dose used to be.

    Agreeing with Crista it is good you have the tube. How much are you able to get in him? If you are capable of getting food in him then I don’t see why there would be a reason for a higher dose to be a dangerous thing—calories and insulin are critical in DKA recovery, and I personally would rather have to give higher carb I think while in the depths of DKA, than not give enough insulin.
    Others with more experience than me need to chime in, though.
     
  9. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    R is what it is often referred to as. Just R. Humilin R or Novolin R are brands I think?
     
  10. Hettie

    Hettie Member

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    Dec 27, 2018
    Yes, the 'humilin' sounds familiar - I'm pretty sure that's what they called it.
     
  11. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    In certain situations, owners have given their kitties lantus + a short acting insulin like humulin R. I don’t have experience with that and someone that does will have to guide you if that becomes an option.

    Although I suspect since Max was on 3.25 units before he probably does need to go back up. But again, I’d wait for the experts.
     
  12. Hettie

    Hettie Member

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    Dec 27, 2018
    I'm giving him 75 cc every 6 hours - It's the Royal Canin renal support liquid stuff. He hasn't been throwing up and seems to tolerate pretty well. The vet said that I would expect to see his numbers elevated from the liquid since it has more carbs.
     
  13. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Have you posted in the health forum? Perhaps there is someone there that can help too.
     
  14. Hettie

    Hettie Member

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    Dec 27, 2018
    No, I didn't post there...but I will.
     
  15. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
  16. Suzanne Burton

    Suzanne Burton Member

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    Aug 9, 2019
  17. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    Okay, I've never dealt personally with DKA.

    Link to Financial Aid. http://www.felinediabetes.com/FDMB/threads/financial-help-links.131190/ (some of the links may be outdated).

    You can measure ketones with urine ketone strips. Most pharmacies carry them. Here is how to use them: https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

    A blood ketone monitor is good to have if your cat is shy in the litter box. It measures ketones in the blood.

    Also read this link on DKA: http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

    DKA = not enough insulin + not enough food + an underlying infection or condition.

    It is important that you get enough food on board. The Royal Canin Renal Support D, E, and F run between 16% and 23% That is considered high carb and probably one of the reasons why you are seeing high numbers.

    It is also important to get enough water on board. Did the vet give you subq fluids to give at home? Are you adding water to the food? Ketones need to be peed out.

    Did you give 2 units tonight?

    I apologize for the quiet night on the board. It's usually not this quiet.

    Tagging @Tanya and Ducia who has experience with DKA.
     
  18. Kate & Toby

    Kate & Toby Member

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    Aug 23, 2019
    Hi, I'm so sorry to hear this, I know what you are going through as have been living the DKA rollercoaster for a few months now.
    As the others have said, fluids, calories and insulin are the key to ridding the body of ketones, and time. My vet also told me to go to 1unit, we were back in DKA within a week, I'm no expert by any means but just wanted to say I understand and send you my very best x
     
  19. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    If you can test frequently, have lots of high carb food around, can get food in him, I would give his original dose. Buy urine ketone test strips and test at least twice a day while he is high. Make sure he is hydrated to flush out ketones. Do you give subq fluids?

    Looks like you shot 2 units tonight, can you test 2 or 3 hours later?
     
  20. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    @Hettie
    Hi,

    hang in there - you were dealt a very rotten card but you are neither a 1st one to get it nor will you be the last one.
    It is tough but manageable.

    When discharged from the ER hospital - did Max receive any written plan of treatment?

    Such as a schedule of medication, sub Q. fluids, length of antibiotic course & dose?..etc?
    Can you share it? It is a good point to start, in most cases anyway.

    Basically , as other suggested above - food, water (arch important) and proper insulin dose is what wards off the ketone's recurrence.

    Post DKA my cat Ducia was fit with Esophageal Tube - we could feed up to 20 ml per session every 3 - 4 hours - day and night do the total caloric intake was about 250 Kcal (1.5 can of Friskies Pate 5.5 oz).

    I do not have the full picture of Max's illness in my head but your vet's advice on lowering the dose of the insulin just past DKA is rather odd.

    You r today's PMPS is high. It is the 2nd dose of Lantus at home.
    Can you take the +2 test and post it here?
    Can you also note in the SS as to what you have fed and when?
    It is important to take in the food influences when assessing a dose.
     
  21. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Hi everyone -thank you for the replies. I'll try to respond to all of it in one message here:

    The discharge instructions were as follows:
    -prednisolone: 1ml once daily
    -doxycycline: 5ml every 12 hours. (he was on clavamox for the two days prior)
    -metoclopramide: 2.75 every 8 hours
    -75cc Royal Canin Renal support liquid diet every 6 hours
    -flush tube with 5ml of water after medication or food (I was not instructed on sub-Q fluids)

    They said to feed him through the tube until he starts to eat on his own. The other medications above will be given until Monday, then we will reassess his progress.

    PM dose of Lantus was at home (2 units given) and I am monitoring every 2 hours- feeding was at the same time as his PM shot
    his +2 was 584
     
  22. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    Why?
    It is a steroid medication, the well known high glucose causer, why was it prescribed? @Hettie
     
  23. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    https://www.royalcanin.com/uk/cats/products/vet-products/renal-liquid
    "Formulated to support renal function in case of renal insufficiency: high quality proteins and restricted levels of phosphorus. Contains EPA + DHA and antioxidants.
    Very high energy density which provides daily energy requirements in a reduced feeding volume.
    Complete and balance liquid diet to support nutritional restoration and convalescence of dogs and cats requiring assisted enteral nutrition.
    The synergistic antioxidant complex helps neutralise free radicals.

    Milk and milk derivatives, cereals, oils and fats, vegetable protein extracts, minerals, derivatives of vegetable origin. Source of protein: low-lactose milk, caseinate, soya protein concentrate.
    Vitamin A: 3330 IU, Vitamin D3: 320IU, E1 (Iron): 30mg, E2 (Iodine): 0.3mg, E4 (Copper): 1.8mg, E5 (Manganese): 2.4mg, E6 (Zinc): 28mg, E8 (Selenium): 0.15mg.
    Guaranteed analysis: Crude ash: 0.9%. Crude oil fats: 5.5%. Moisture: 85%. Protein: 7%.
     
  24. Hettie

    Hettie Member

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    Dec 27, 2018
    They said it would be short-term to help him feel better overall and hopefully get him interested in eating, but the vet did say it would cause BG to go up, but that we'd compensate with insulin.
     
  25. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    what is the reason to Rx it in the 1st place?
     
  26. Hettie

    Hettie Member

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    Dec 27, 2018
    She said it would help him feel better overall and maybe get him interested in eating on his own.
     
  27. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    this "diagnosis" sounds like fine kettle of fish.
    The steroids are the nukes of the Pharmacy world - it is given as a last resort. Never as what if it start the appetite.
    What was wrong with Max that he had to go to the most dreaded med?

    The things that we were done at home for our post DKA girl was mostly food 250 KCal/ 24 at least (super important - the calories X 1.5 times the reg amount)), water - up to 100 ml subcutaneously in addition to the watered wet food, and all of the meds on time - that is vet determined (amount/ volume + frequency= food intake).

    I strongly suggest that you find out why you r cat was given the most dreaded med, the Pred.
    Other than that do keep giving enough insulin and food to help the situation. The Black numbers in your SS are scary. I hope you 'll find a way to help it.
     
  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi and welcome. I am so sorry you are going through this. :bighug:
    You have been getting good advice.
    I agree with Wendy.......I would increase the dose back up to 3 units ( his normal dose). You can always give higher carb food to bring up the BG if needed.
    Do you have higher carb food at home if needed?

    Also he needs more fluids then he is presently getting I think. Can you ask the vet about subQ fluids.?
    In the meantime I would give some extra fluids orally via the feeding tube. Just 10 mls hourly would help.

    And I think he should eat more often than every 6 hours.
    I'm surprised the vet didn't suggest Hills A/D food. Can you ask about that?

    And I think it is really important you are testing for ketones so you know how Max is at any given time.
    Can you go out and buy a bottle of Ketostix from Walmart or a pharmacy?
    You just need to collect a urine sample from Max and dip the test strip in, wait 15 seconds exactly then read it against the colours on the side of the bottle.

    Keep asking questions. We are all happy to help and support you. Cats with DKA take time to recover and need lots of nursing and support from their carers.
    You are doing a really good job with Max and it is great you have reached out to us for help and support.
     
    Last edited: Sep 7, 2019
  29. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    update: I took Max to our primary vet this morning as he started having diarrhea last night and this morning. They gave him some sub-Q fluids and showed me how to give it at home as well. I have increased the amount the of water I'm giving him through his tube. He still doesn't seem interested in eating on his own, but I do have some high carb wet food if he will eat it.

    I'm in the process of getting him set up so I can test his urine or blood for ketones.

    Thanks everyone for the advice and support.
     
  30. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018

    Is the Hills A/D food a liquid? He isn't eating on his own yet, I'm just feeding him through his NG tube which is very tiny and only allows liquids.
     
  31. Kate & Toby

    Kate & Toby Member

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    Aug 23, 2019
    Hi Hettie, it's not a liquid it's a very smooth paste/pate which goes well in a syringe, but can be watered down even further. It's a complete rRestorative food with all the essential nutrients. If you need a liquid, I have also used liquivite who are super fast at delivery, again a complete food and totally liquid. X
     
    Hettie likes this.
  32. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

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    Jul 23, 2018
    sorry, no great advice, just some support - :bighug:
     
    Hettie likes this.
  33. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    Hettie, you are getting lots of response and help now, would you please remove the 911 from your thread title? That red 911 beacon increases our heartbeats a bit and gets the adrenaline flowing whenever it shows up. :)

    Thanks me dear, and take good care of yourself as you take good care of Max.
     
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  34. Justin & Sebastian

    Justin & Sebastian Well-Known Member

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    Feb 1, 2019
    DKA can take a while to recover from. Sebastian had his feeding tube for about two weeks until he started eating on his own again.

    Definitely get ketone testing strips, they'll help get you ahead of any issues.

    Dose seems very low for that high of BG, but since it's Lantus it will take time to build so you don't want to increase too much too fast. I would strongly suggest introducing some R as it can help get things down in the meantime. Most people here will act like it's one of the scariest things on the planet but as long as you are careful with it, it works great. You can get it over the counter, Walmart is the cheapest I've heard. Start with a very small dose, like a drop, and then test every hour to see the effects. Don't give more than one dose a cycle and try to not overlap the lantus cycle, i.e. try to give it between +4 and +8, since it's on about an 8 hour cycle and that way you won't be doubling up on nadirs. Do a dose size for two cycles or so so you can confirm the effects and then increase as necessary until you start to see movement. Again, take it slow because there's a pretty find line between when it works and when it doesn't and if you give too much it'll really move. You can look over Sebastian's spreadsheet to see the effects. I've been using it for the past week or two at various dosages and you can see pretty clearly at what point it starts to work and by how much. If you do decide to go the R route, let me know and I can offer you a little more direct guidance.
     
    Hettie likes this.
  35. sandscout

    sandscout Member

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    Apr 27, 2018
    Justin what is “R”?
     
  36. Justin & Sebastian

    Justin & Sebastian Well-Known Member

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    Feb 1, 2019
    Novolin R or Humilin R, a fast acting insulin.
     
  37. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Hi Hettie
    While R might be an option for you to try, I would definitely not use it without the guidance and help from someone like @Marje and Gracie.
    You would be using two different insulins with different nadirs and in the beginning you need someone to stay with you to guide you through it until you understand the effects the combination of the two insulin have together.
    Please don’t just look at someone’s else’s SS who has used it and think that is enough help. While it will give you an idea of how it works, ECID and will react a bit differently.
    In the meantime I would look at increasing the dose of Lantus if the BG are still in the black and red

    ETA I’m so glad you got some subQ fluids done and can do them at home. And great too on getting the ketone testing sorted. That really important.
    I hope the diarrhoea settles
     
  38. Justin & Sebastian

    Justin & Sebastian Well-Known Member

    Joined:
    Feb 1, 2019
    That's a long wait for a train that doesn't come. I had to figure it out on my own because there's no one around here regularly who uses it.
     
  39. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    That’s not really true Justin.
    You are lucky it worked out for you but I would not suggest someone else try it without supervision.
     
    Marje and Gracie likes this.
  40. Justin & Sebastian

    Justin & Sebastian Well-Known Member

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    Feb 1, 2019
    I made multiple attempts to get supervision. One person eventually said they would help but then disappeared. So it is true, I lived it.
     
  41. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Justin, You may have successfully used "R" on your own up till now because there was an issue finding someone to help you learn how to use "R" with Lantus but that doesn't mean it's appropriate or safe to suggest others use it without some experienced help. As a Registered Nurse who understands the physiology of diabetes and pharmacological action of insulin very well I would never have tried using "R" with my IAA kitty without someone experienced using it for cats to teach me the ropes. You are lucky to have managed Sebastian safely up till now but what worked for you isn't going to work for everyone else. I had no intention of using my girl as a guinea pig and I don't think it's appropriate to be suggesting others do so without specific instruction for their cat. When using "R" it's important to know when to use it and even more important to know when not to use it.
     
  42. Justin & Sebastian

    Justin & Sebastian Well-Known Member

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    Feb 1, 2019
    Well every cat is different and I don't think it's fair to Hettie and Max to not lay out all the available options and let her make her own decision. Personally I'd feel more than a little guilty if I knew about something that could potentially save her cats life and didn't say anything. But whatever.

    Best of luck Hettie, hope you're able to get the help you need.
     
    Hettie likes this.
  43. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Justin, I know you have good intentions and want to help Hettie and Max but using R is a specialist area and needs a very experienced person to say that is the way to go and for them to guide you with dosing.
    At this point it has not been established that R would be the best option for Max. He may just need an increase in Lantus or we might find that R is needed. It is not something which should be jumped into without discussion..
    Getting some tests in for ketones will help with decisions.
    I agree wholeheartedly with @MrWorfMen's Mom comments. I am also an RN and understand diabetes well.
    I would always defer to the experienced R people for any decisions and for them to guide the carer through the process.
     
  44. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I AGREE.

    I FULLY UNDERSTAND and AGREE with ALL that's been said in this thread regarding the use of R.

    However, we currently have a problem on this board, specifically in this forum. We do not have experienced users who can be around enough to guide others in the use of R as a bolus.

    So do we not mention R -OR- do we mention R and encourage the caregiver to
    • find help?
    • speak to their vet?
    • search the board for R instructions given to others?
    • ask 5 million questions?

    R use has become rare in recent years. I bet you'd all be surprised if i told you that when I started here in 2006 most Lev users also used R because the onset of Lev wasn't until generally +4 or+5? There wasn't any exclusive little club of R users.

    I do not want to minimize the dangers of R use, or as was pointed out, when not to use R can be just as important or even more important than when to use R, BUT there are times when it may need to be brought up for the sake of the cat.

    That said, I honestly do not think using is crucial to Scout's treatment/recovery at this time. However, I do agree with exploring the subject with the caregiver. It's something she may want to discuss/pursue with her vet.
     
  45. Justin & Sebastian

    Justin & Sebastian Well-Known Member

    Joined:
    Feb 1, 2019
    Thanks Jill, that was the point I was trying to make. I don't disagree that it should be supervised by an experienced person, the problem is they don't exist. And I definitely wasn't trying to suggest someone just look at my spreadsheet and wing it from there. I mentioned that if she did decide to use it, ask me for help. I hardly consider myself an expert on it but at the same time, if you need an experienced user and it's a question of life or death, I'm pretty much the only option right now.

    I also agree that it shouldn't be this exclusive little club. I've had tremendous success using it with Sebastian and it seems a little silly that such a tool is being overlooked so much. Obviously we don't want to be carefree with it but we need to find a middle ground.

    I'll defer to you all on whether it should be used in this case since you do have more experience with a wider variety of cats. It just seemed to me, having a DKA cat myself and it being mentioned previously how important it is to keep the BG low, and knowing that Lantus is slow acting, dose increases are relatively slow to occur, and Max is possibly on too small a dose, it seemed like the right option. I'd be interested to know why you don't consider it a good fit right now.
     
  46. Justin & Sebastian

    Justin & Sebastian Well-Known Member

    Joined:
    Feb 1, 2019
    Get yourself a little blender. When we had to feed Sebastian the A/D through the tube I got a Magic Bullet and I would just blend the pate food up in it and then put that in the syringe. Worked really well, never had a clog. Also pro tip: a caulk gun makes it WAY easier on your hands. Trying to squeeze a whole 80ml syringe at once was killing my hands until I had the idea to try it out.
     
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  47. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    @Wendy&Neko @Marje and Gracie @Sandy and Black Kitty

    @Justin & Sebastian - I beg to differ. There are people experienced with R here on the Board. Everyone here has a life outside of FDMB. Several of those who are experienced with using R have been away or dealing with events in their lives. If you read Jill's post, she noted that the experienced members are here but aren't around 24/7. The people exist but I doubt you took the time to figure out who they are or tagged them.
     
    Marje and Gracie likes this.
  48. Justin & Sebastian

    Justin & Sebastian Well-Known Member

    Joined:
    Feb 1, 2019
    Are you being serious right now? I've made dedicated posts asking for R guidance, as recently as about a month ago. We even had a whole big thread about it with Jill involved. Maybe look at my post history before you go running your mouth about something you know nothing about and calling me a liar.
     
  49. Justin & Sebastian

    Justin & Sebastian Well-Known Member

    Joined:
    Feb 1, 2019
  50. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Hattie, I have a ketone meter I can send you. Send me your info via PM and I will get it in the mail to you tomorrow.

    My Gizmo was hospitalized 3x's with pancreatitis and was put on steroids as a last resort that put him in FD. Don't give up. They can recover but it is a long, slow road. My heart breaks for you and Max. He reminds my if Gizmo in your avatar. He never had a feeding tube but I did have to assist feed with a feeding syringe.

    Fortunately Gizmo never had DKA, but he had numerous health issues we managed with FD. Did your vet test for pancreatitis? Did they give any nausea meds? Pain meds? Is this vet you have used for a long time and have a repor with Or some one new?

    Is he showing any interest in eating on his own? I always gave Gizmo the opportunity to eat on his own before I forced fed. Are you giving any water via feeding tube?

    What did he eat before Diabities?

    Besides the Hills and Royal you might try Weruva BFF Play patés (Petco carries them). They are very loose and could be watered down and fed through the feeding tube (I think). They are ~5% carbs.

    https://weruva.com/brand-summary/b-f-f-play/
    https://weruva.com/nutrition-landing/bff-play-ni/
    Chicken Checkmate
    Chicken & Turkey Topsy Turvy
    Chicken, Duck & Turkey Take a Chance
    Chicken & Beef Best Buds

    :bighug::bighug:
     
  51. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    That's not what I said. I said,
    "Crucial", meaning very important, of the utmost importance, of great consequence, of the essence, critical, high-priority, preeminent, paramount, all-important, essential, vital, vitally important, indispensable, mandatory, urgent, pressing, compelling, necessary, needed, required, or requisite.

    IMHO, at this time, the use of R is secondary to getting the basal dose brought back up to speed. In other words, I have no idea why the vet, or any vet, would reduce the basal dose to 1 unit. Currently, the dose is back up to 2 units, but it took a 3.25u dose to pull BG numbers down to green less than 2 weeks ago. It'll likely take the same or more to do it again. Just my opinion... atm, the basal dose is what's of utmost importance. Then we can add a bolus if necessary.
    I see where you're coming from, but (1). I don't think it's a question of life or death and (2). with all due respect, you being the 'only option' scares the heck out of me. A few weeks ago someone asked me to look in on your 'decision-making'. My response, verbatim: "I have NO idea what the reasoning is to support the decisions he's making. His only saving grace is that he does test a lot, so he can intervene if necessary."... and that's HUGE. A HUGE plus. Anyone who knows me well knows I have always said one increases their responsibility for keeping their cat safe whenever choosing to deviate from the norm. And that's what you've done, Justin. My hat's tipped to you in that respect.

    OTOH, I don't think you have a good or working grasp of what I guess one could call 'the basics of using R'. It's impossible to pass that along when teaching someone else if you don't have it yourself. Scary.

    I think it's time to take the conversation between you and Sienne down a notch or two immediately. While I get the level of frustration coming from all 'sides', that tone isn't the least bit helpful and is coming very close to becoming disrespectful. Stop. Desist. Or this thread will be shut down.

    @Hettie
    How are things going today? Please don't let differing conversations deter you from posting. We're quite a passionate bunch. How can we help? If it would make you feel more comfortable, go ahead and start a new thread if you'd like.
     
  52. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Hi firstly belated welcome from George and me.

    I'm so sorry Max has been having a hard time of it lately. How's he doing? I see that he came down from black to red yesterday, and saw some pink last night. How are his numbers today?
    The problem you are likely experiencing is one of a depot that is not altogether full, that and the higher carb food are likely contributing to the higher numbers. It may take a few days to see the full effect of the dose. If his numbers are still consistently high you may need to move a little quicker with the dose, but in order to fast track safely you would need to keep up the tests in both am and pm cycles, so you can be sure that you are not missing any lower numbers.
    If he remains in pinks or higher for 6 cycles on this dose I would take him up to 2.25u.

    He has been quite bouncy so a PS in the red doesn't necessarily exclude him from having seen green earlier int he cycle.
    Do continue with checking BG midcycle both in the am and pm cycles, this was discussed when you first switched to Lantus, you've been doing a great job at getting all this data in over the last few days, keep up the good work. It's really important to look at the nadirs (midcycle testing will tell you how low the dose is taking Max) when deciding on dose. When deciding on changing dose, with Lantus/a slow acting depot insulin, there is a basic question you ask yourself
    'How low is this dose taking kitty?'
    The answer to that governs your dosing decision, and how often you ask yourself that question and reassess the dose is governed by whether you are following the TR or SLGS dosing methods.
    So if kitty is nadiring in the normal range, you would hold the dose, see if he keeps on getting there, ignoring bounces and high PS. If nadirs are not low enough you would increase after 6 cycles (TR) 1 week (SLGS).
    That said with DKA in the picture, it complicates matters especially if kitty is not getting enough calories.
    Looking back through the numbers on Max's ss there have been some unorthodox dosing decisions, it seems like you may still have a 'prozinc head' on.



    I also feel that I want to comment on the usage of 'R' (sorry to hijacck your condo Hettie)
    I agree with Jill, that it may not be necessary at the moment, first see how his BG pans out now he is home. It may be worth considering if you find that he is staying high and increasing lantus doesn't get his numbers moving, or if it becomes apparent that you could use R to help manage his bouncing, but it's to early to make that call at the mo IMHO

    I've been on the board for 4 years, and my experience has been that those with R experience have been more than willing to give up their time and share their knowledge/experience with those in need, tagging across the timezones to help kitties on the other side of the world. But it is only natural that these volunteers (many who no longer have FD kitties of their own any more) take some time out from the board, so if you are considering it's use do shout out, if tagging folk doesn't work (sometimes the tag alerts don't work) try a PM.
    R is a powerful tool, and needs to be used with care and judgement, if you're unable to get help here, perhaps speak to your vet, manu are familiar with it's use.

    I agree with Sienne, and think you are being very unfair, the people you are mentioning here in this post I know for a fact have been 'helping' you even though you may not have been aware of it.
    Did you not get a response straight away, just when you wanted, perhaps.....
    But I've read through and contributed in many of Sebastians threads, at times I have posted information which it seems you choose to simply disregard, and not even acknowledge. Wendy, has for example, with regards the use of R repeatedly said to you that you should avoid overlapping nadirs of Lantus and R, and advised against shooting R at +2 since this risks the L and R nadirs overlapping and causing a steep drop which will trigger a bounce....... she has also offered other advice, which is not taken, and that is your prerogative, but it is unfair to say that you have had no help, that is not true.

    Should CG be aware that R can be used to help stabilise a kitty, of course they should, but I'm not convinced that it was an appropriate suggestion at this particular point.
    I don't think that if I had been using R (and not with the most auspicious start) for just a couple of weeks that I would be offering to guide someone else on it's usage, I'm not sure that I would be able to say I had enough experience to take all the factors into consideration and keep their cat safe, and that is paramount when giving even the smallest snipit of advice. 'Do no Harm' must always be in our mind when offering advice.

    What I would perhaps say is 'R has been working well for me, perhaps you want to explore if R would be appropriate in your particular case, try asking a question about it in the thread title and see what folk with more experience than I think?'

    One difference here is that Max has a feeding tube, so CG is able to get food into her cat, something you were struggling to do, DKA is not just about the insulin but about getting enough food into the cat and treating infection/inflammation.
    Also Sebastian has IAA, Max has not as far as we are aware, certainly his numbers don't suggest that. Sebastians numbers and history made a number of us suspect there was some sort of issue there.
     
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  53. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Thank you so much for the offer, but I did get a ketone tester ordered yesterday. I got one that tests blood, as I think this will be easier for both of us.

    They did all sorts of blood tests and 2 ultra sounds to try to find out where the inflammation/infection was. Unfortunately, it didn't show anything definitive. The ultra sound didn't show anything wrong with his pancreas but his blood results showed something going on with his liver and they were worried it was liver cancer. But he seems to be responding to the new antibiotic, so I don't suspect cancer.

    He is on anti-nausea medication and a steroid, but no pain meds. He has showed some interest in his wet food and has been drinking a bit on his own too, so we have seen some improvement in the past couple of days. I'm still giving him the recommended amount of food through his tube and additional water as well.

    The ER vet was new, as it was during the holiday so our primary vet was closed that day and they were not equipped to take on cats that need overnight care, so we kept him at the ER. The ER did send updates to our primary vet during the course of his stay and I've been on the phone with him almost everyday, so he knows what's going on and is providing advise.

    Prior to his diabetes, I was feeding him a dry kibble - I think 'Natures Recipe' was the name.
     
  54. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018

    Thank you for the offer to help - I really do appreciate it, but I'm already feeling a bit overwhelmed right now to add in another insulin at this time. I have increased his Lantus, and will continue to monitor/increase as we go.

    I ordered a blood ketone tester, as I think this will be easier for both of us.
     
    Last edited: Sep 8, 2019
  55. Tina Marie and Jan

    Tina Marie and Jan Member

    Joined:
    Jul 24, 2019
    Hettie, I'm here just rooting for you and Max. I adore the picture of him on you getting all that love.
    I'm glad you increased his dose this morning. Progress is being made, keep up the good work:bighug:
    I have five civvies too! And one drooler.
     
  56. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Initially, none of the tests they did (blood, urine, ultra sound) showed anything definitive as to the cause of his inflammation/infection, but something was going on with his liver. The new antibiotic seems to be working, as he's been showing some improvement in the past couple of days. We are now doing sub-Q fluids and I'm giving him extra water through his NG tube.
     
  57. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Just saw that you shot 2.5u this morning,
    Was that vets advice? or did you decide to given the amps?
    Just trying to understand your thinking.

    Given the dose he was on prior to DKA, it's probably ok.
    Why did you stop giving insulin altogether on 8/28?
    But ideally you would want to hold onto this dose till the depot builds, and stabilises as you will not see the full effect till that happens, if you take the dose up too quickly you could end up with his numbers crashing once the depot catches up.

    With Lantus that usually means taking the dose up (if the numbers warrant it) every 6 cycles, by 0.25 (or 0.5u if numbers warrant it), in some instances you may also fast track a cat, usually that would be 0.25u every 4 cycles (if numbers warrant it, and you would want someone with experience to help you with this)

    Glad you are seeing some improvement. Sending more healing vines his way.
     
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  58. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    I hadn't thought of that, but that's a great tip! My hands are killing me already!
     
  59. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    When we went to the vet yesterday morning, the vet recommended I go up to 2.5 if he was still high today.
     
  60. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    A thought for you when you check in with your regular vet...

    A steroid can be given to treat pancreatitis.-- or any inflammation but steroids don't typically help with infections. If you can check your paperwork/labs, is there a Snap fPLI or Spec fPLI? These are tests that are specific for pancreatitis. If Max wasn't eating well (which I suspect he wasn't given the feeding tube), there was likely a risk for liver involvement (i.e., hepatic lipidosis or "fatty liver") as you mentioned. If that's the case, just keep doing what you're doing to get food into Max. It's helpful for his liver and for keeping ketones at bay. I would encourage you to ask the vet what the steroids are treating. The steroids will cause higher BG numbers and while it's not high numbers alone that cause ketones to develop, they are one ingredient in the recipe.

    (FYI - if you have copies of Max's labs, there's a tab on your spreadsheet where you can enter the values. This allows us to track what's going on, as well.)
     
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  61. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    He seems to be improving slowly. Seems a bit more interested in his own food (mostly just licks the gravy) and drinking some water on his own. I'm able to give him sub-Q fluids now as well.
     
  62. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    When we first switched to Lantus, I did try to follow the protocol as instructed on here, (increasing slowly and holding the dose), but occasionally I'd get a low number and get nervous so I take it back down :nailbiting:
     
    Last edited: Sep 8, 2019
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  63. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    I'll try to get a copy of those today and post them.

    When he was first admitted, his temp was low, and they couldn't even get a reading on his blood pressure. So they put him on a heating pad and started fluids right away and other supplements b/c his potassium, calcium and electrolytes were out of normal ranges. After two days there, he wasn't interested in eating and started getting a fever, so that's when they put the NG tube in. I talked to our primary vet yesterday about taking him off the steroids, but he said to keep him on it for now because it can help with inflammation and increase his appetite so we can try to get him eating/drinking on his own.
     
  64. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    You did mention that information in a previous post. I'm sorry for not recalling. The vets point about the steroids and appetite are on target. It's a balancing act! With the electrolytes being off, it does sound like DKA may have been in the picture. You're doing a great job handling all of this. My kitty was pretty sick at the time she was diagnosed and it's a lot to handle. the learning curve for FD all by itself is huge. Please let us know how we can best help.

     
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  65. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    I know it isn't ideal food for feline diabetes but you might try it to see if it will get him eating on his own. The sooner he is eating on his own the better.

    Glad you got the meter. Just so you know, it will take a larger "drop" of blood than your glucose meter and will take a bit longer to give you results too. The strips are about $1 each so just wanted you to be aware :):bighug:.

    Do you have copies of all the labs? They will also give a summary paper on discharge. Some here have experience on reading these. Just FYI.

    Feel better Max and eat yur fudz :cat:

    Hattie, please keep posting and giving updates. This place helped give me two additional good years with my boy. We are all here to help. Even if it is just to lend emotional support and give encouragement :bighug:
     
  66. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    @Justin & Sebastian I’m not MIA. I’ve been out of the country and am just back home. As @Gill & George said, many of us experienced with using R have lost our FD kitties and still come here to help but we do have lives that we are getting back to living fully. I might not check in every day for tags but everyone can reach me via PM and I’m always happy to help as long as I’m in the US.

    @Hettie I haven’t had a chance to look through everything or even Max’s SS but, if at some time, you decide to use R, please send me a PM and I’ll post in Max’s condo and help you. I don’t have any plans for travel in the immediate future and I’ll slowly be getting back on the board but, as one of the few very experienced R users left, I will likely have a bit more time now than some of the others so just PM me in case I miss a tag and I’ll be happy to help you with R.

    If you get a copy of the labs, please let me know. I’m early well versed in reading them and am happy to help.

    Many vines that Max will start to improve.
     
  67. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Thank you. I'll try to get copies of his lab work and post here later today. He does seem a bit interested in his own wet food - just licking the gravy mostly at this point, but it's better than it was a few days ago. He is also more alert and engages me when I walk in the room.
     
  68. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Thank you. I'm already a bit overwhelmed with everything so I probably won't try adding the R at this time. I'm monitoring his BG on the Lantus and we increased it this morning to 2.5, so I'll just continue to monitor and increase slowly. I'll probably hold him at 2.5 for a while.

    I'll try to get copies of the lab work and post later today.
     
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  69. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Understandable, we all feel like that, it take time to get learn kitties patterns on Lantus and get comfortable with those lower numbers.
    Going forward we can help you with that if you post regularly. We can look at the numbers and depending on the situation (ie if you can be available to monitor, have supplies, kitty is eating etc) we can help you make a plan that will gradually get you shooting lower, step by step, and within your comfort zone and help you achieve those lovely flat curves Lantus is so well known for.

    I'm so glad he is showing positive signs, paws crossed you continue to see improvement.
    sending vines.:bighug:
     
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  70. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    We were out of town for the weekend and I'd left him before for a couple of days and was fine (also confirmed with the vet on this prior). I know it's not ideal and I feel terrible now that he wasn't getting what he needed but it seems he had something else going on prior to us leaving which created the perfect conditions for DKA. He was acting normal and eating/drinking before we left, so I had no reason to suspect anything.

    We'd try leaving him at a pet resort in the past, but he'd get so stressed that he'd stop eating. Then we tried a pet sitter to come to the house and he attacked her and started hiding every time he saw her. When I told the vet my dilemma re the pet resort, he said, if it's only a couple of days, it's probably better to just leave him at home so he's eating and not stressed, than not eating, stressed, and not getting insulin :(
     
  71. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    IMO, the prednisolone raised the amount of insulin my cat needed. So the amount of insulin needed for Max may be more.

    And it's GREAT that Max is licking some food! Anything he wants to eat right now is good food, even if it's HC.

    When Max is better and when you're ready, we're happy to help guide you through the protocols here. I know the sudden lower numbers are scary but we're here to help and you're testing so well at home that you're keeping Max safe.

    :bighug::bighug::bighug::bighug:
     
  72. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    :(
    You had no reason to suspect that it would be an issue, many have made that same choice and not had a problem. :bighug::bighug::bighug:
    Have you got any cat loving friends/neighbours nearby?
    We have a friend/neighbour nearby and she got to know George first, he either stays with her or she comes and stays at our house. George gets very stressed with cars, and the cattery, though fantastic, didn't feel comfortable giving insulin. My neighbour learnt to shoot by coming round and doing it with me first, and then we did a reduced dose so she didn't need to test so much.
    Although George is in remission now he still stays with her as he's quite senior (approx 20yrs old) and the hour journey in the car to the cattery would be stressful for him, plus he's become super good friends with our neighbour, so I think he now enjoys his time with her.:) Though he did draw blood the first time she had him:eek:

    If you could find someone like that perhaps that would be an alternative.
     
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  73. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Yes, our neighbor comes over to check on them and scoop the litter box, but she's not comfortable giving injections (which I understand), and she works so her schedule is a bit wonky. She was coming to the house and reported on Sunday morning that everyone was doing well...so I guess it was sometime between Sunday morning and Monday morning that things took a turn for the worst.
     
    Last edited: Sep 8, 2019
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  74. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Had you thought to check with any of the vet techs at the vet's office? They often pick up extra cash by pet sitting.
     
  75. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Perfect. I didn’t expect you to add R now but just wanted to toss out the offer if it becomes something you feel is warranted. Several of us here can also help you with information on whether it’s a good idea or not if you get to that point.

    Very happy to help you with labs when you get them.
     
  76. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Yes, I did ask a while back, but there wasn't anyone that lived close or could do it at the scheduled time. I'll ask again though...maybe there are some new people there.
     
  77. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    update: labs, exams, ultra sound results are attached.
     

    Attached Files:

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  78. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
  79. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    It there's any way you can enter the lab information on the "Lab" tabs of your spreadsheet, it would be very helpful. It will allow you to compare lab data over multiple dates if it's on your spreadsheet.
     
  80. Justin & Sebastian

    Justin & Sebastian Well-Known Member

    Joined:
    Feb 1, 2019
    It's getting a little old, you people treating me like an idiot. We said basically the same thing but you want to quibble over semantics and act like I'm so stupid I don't know what the word "crucial" means instead of just trying to be helpful and answer my question? You're acting like a child. Ridiculous behavior, especially for a moderator.

    Scares me too. I don't want to be responsible for another cat's life with my limited experience.

    I've adopted this attitude after repeatedly being let down by the advice I get from the so-called "experts". No one bothers to explain anything they're suggesting, so I can't trust it and can't learn from it. The majority of time, at least in my case, I get the impression that the "experts" are only taking a quick glance at the colors on my sheet and making snap judgements based on that. They don't look at the actual numbers, the rise and fall trends, the extra info like diet or medical complications. They just give some general statement that really doesn't apply. And I've gotten some downright bad and contradictory advice. @Wendy&Neko told me the other day "If we didn't see it, it didn't happen" in regards to not seeing greens, even though I was seeing literally 100-110 on either side of a testing gap, and suggested a dose increase. That statement is complete nonsense and downright dangerous. Meanwhile, I saw @Gill & George respond to @Beth 73 that he was hesitant to suggest a dose increase because there were some lower numbers on either side of a gap and they could have gone lower. Two completely contradictory statements from long time users that are constantly referred to as experts. So who are we to trust when the "experts" don't even agree?

    EDIT:
    I suppose it never occurred to you to actually ask me about it instead of talking about me behind my back? Probably could have avoided all of this if you would have brought your concerns to me and we could have discussed the problems like adults.

    I don't disagree. Just think it's a little funny you say that after opening up your response with an extremely disrespectful insult to my intelligence.

    Thanks for answering my question. As to the rest, see above for my explanation on why I often don't follow the advice you guys give.

    Why are you guys acting like I'm disparaging you for having a life? I'm not, I get it. People said there were plenty of experienced R users around, I said there wasn't, because after multiple attempts I never got the dedicated support I was told I needed. That's it. No judgement on the reason they're not here. Just stating that if you're trying to find dedicated support, it's not around right now. Maybe it will be now, since it seems some people have come back into town since my original posts.


    So yeah, as much as I don't want to, I'm thinking I might need to leave. You guys are attacking me and insulting my intelligence left and right when all I was trying to do is help. I'm not getting much help anyways since, as I said before, most of it is contradictory and/or doesn't make sense with what's actually going on with my cat. I have been enjoying connecting with some of the newer users and trying to support and help them and don't really want to lose that, but if I'm going to get attacked every time I try and help, it's not really worth it.

    You guys might want to take a step back and examine your behavior. You have a serious "experts" club problem going on right now. Most of the advice you do give doesn't give any explanation, so people don't learn, and comes across as very judgmental and scolding rather than supporting. I know I'm not the only person who feels that way.

    And @Hettie , I'm extremely sorry your thread got hijacked like this. I'm pretty sure you know I was just trying to help and this has just spiraled way out of control. Best of luck getting Max better. I was in your exact position before and I know how difficult it can be but guarantee you it is something you can recover and come back from, Sebastian is living proof of that.
     
    Last edited: Sep 9, 2019
  81. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    @Justin & Sebastian
    I can't believe how incredibly rude you have been to Jill.
    Jill works tirelessly on this forum, giving her time freely, to ensure everything possible is done for FD cats.
    It is her responsibility to make sure things run smoothly and the advice is correct. It is a huge responsibility which she does admirably.

    This board is not run by paid people but by volunteers. If you read the literature it says there are no experts here.
    It is a peer reviewed board where everyone can see others people's advice and help and if they don't agree with it, they can say so.
    But it needs to be said in a civilised manner.
    I have to say that your responses to all this looks typical of many of the responses seen on social media where people can remain anonymous and say whatever they like and be as rude as they like. That type of behaviour is completely unacceptable on this board!

    I have been on this forum since early 2015 and was lurking for months beforehand that.
    Most advice given, certainly by experienced people, is very considered and with explanations given. And many of the newer members give lots of support to others as they learn the dance. We all want to help and teach others so they in turn can help. And most helpers do look carefully at the SS before helping.

    Personally I think it is you who needs to step back and take a good long look at your behaviour.
    And you need to apologise to Jill, who does a great job keeping this the most democratic, lifesaving and (normally) civilised board there is, and you also need to apologise to all the wonderful helpers that give up their time FREELY to help and educate others so that FD cats can live a good life.
    ETA
    @Hettie i apologise for hijacking your thread.
     
    Last edited: Sep 9, 2019
    Reason for edit: ETA
  82. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    @Hettie

    How is Max doing today? :bighug:
     
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  83. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    He's doing a little better. He ate a few bits of his dry kibble this morning and licks at the wet food and has started grooming himself again a little. He's still having diarrhea but I'm giving him extra fluids and sub-Q fluids so he doesn't get dehydrated. His BG numbers are still high, I think as a result of the steroid, but I don't want him going too low since I'm not sure how long they want me to keep him on those - I hope to have an answer on that this week.
     
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  84. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    I was able to get a blood ketone meter - I just tested him and got 0.4. Is this "normal" or should I do something? His BG is still high at 2u - I'm thinking I should go back up to 2.5...but I worried the high numbers are a result of the steroid and when he goes off them his numbers will go way low.
     
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  85. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Here is an excellent post on DKA and ketones, http://www.felinediabetes.com/FDMB/threads/ketones-diabetic-ketoacidosis-dka-and-blood-ketone-meters.135952 0.4 is fine for ketones, 2.4 is when you need to start being concerned. And good news on the low number tested. :)

    I also like that spot of yellow on the spreadsheet last night. I think the increase in Lantus will be fine. You can think about lowering the Lantus dose if his numbers get a lot lower (greens). You will be tapering off of steroids, not stopping them right away so there shouldn’t be a sudden change in insulin needs overnight. Getting his numbers down a bit in the meantime will be easier on him.
     
  86. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Good to know! thank you!
     
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  87. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Nice to see that sunny yellow.

    FWIW Given that he was on 3.25u before this DKA episode, it is unlikely that 2.5u would be too much insulin for him even if you took him off the steroids all in one go, and as Wendy has already said they will usually taper them off so that should give you time to adjust dose if necessary.

    That all sounds promising.

    Hope this clears up soon I know how distressing it is to see liquipoo when you go to clear up the LB, George recently had bad tummy and I can't tell you how happy I was when he finally made a solid deposit.:) I'm glad that you are able to keep him hydrated with the sub q's that will help him a lot.
     
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  88. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Excellent! You are doing wonderful.
     
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  89. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Hettie

    I hope Max is doing better today and gaining strength. I did look through his labs and the other paperwork. It looks very consistent with a cat with DKA and electrolytes out of whack. I would imagine as he starts eating and recovering, you’ll see the calcium, Phosphorus, and potassium come back into normal ranges.

    The thing that concerns me is the jump in his liver enzyme levels. The first test, his ALT was very, very mildly elevated and his TBIL as well. Two days later and most of his liver values are substantially higher. His ALT at 562 is now more than just even a moderate increase. The ultrasound did indicate liver abnormalities but the radiologist really didn’t give you any good specifics. I find it interesting that a needle biopsy was recommended because most specialists will say those are hit or miss. There are other tests they can do, considering the elevation in GGT and TBIL (like a bile acid assay) if the numbers don’t come down altho the radiologist did not note any gallbladder or bile duct issues. Usually, an obstructed bile duct is easy to detect on ultrasound.

    Breaking it down:
    ALT is often increased due to any insult to the hepatic cells. However, ALT has a short half-life and so when the insult desists, the ALT can return to normal. Lots of things can cause this to increase like triaditis, cholangiohepatitis, even intestinal issues.

    GGT is usually increased if there is a bile flow obstruction but steroid use can also increase the GGT. GGT is not typically increased due to hepatic lipidosis.

    TBIL or bilirubin can also be increased due to obstructions in bile flow; because his ALP is normal, in his case, an elevated TBIL would not indicate hepatic lipidosis.

    I’m hoping they will recheck his liver enzymes this week and see which way they are trending.

    I see you are in Phoenix and have seen Dr. Bailey. I know her; she used to be here in Tucson and I had to take one of my cats to her as she was the recommended IM specialist.

    Have she mentioned rechecking his labs or any concern about his liver?
     
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  90. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    He is doing better. Thank you for looking at those and providing feedback. They didn't mention anything about a bile acid assay, but I will ask about that. I believe the plan is to recheck his blood panel when we go in next week for a follow-up.

    Are there particular tests for triaditis and Cholangiohepatitis? They didn't mention these conditions specifically. I'd really like to find out what/where the infection/inflammation started so I can know if this is something that might reoccur so I can monitor.
     
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  91. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Because his gallbladder and bile duct did not seem abnormal on ultrasound, they are probably not concerned about the bile acid assay to see if there is a physical obstruction. That’s why I say see where his numbers are and if they are still high or increasing, there are other things to do besides a needle biopsy. The bile acid assay is just an example.

    There are no tests for triaditis or cholangiohepatitis. Diagnosis is usually based on symptoms and liver panel numbers. For some reason, the radiologist didn’t comment on his intestines to see if there is any apparent issue there and he also indicated the pancreas was normal. Normally with triaditis, we’d see pancreas, liver, and small intestine inflammation. With cholangiohepatitis, it would be inflammation of the liver and biliary ducts and, again, he didn’t address the biliary ducts at all. But, my own kitty had similar but less increases in her liver values and was diagnosed with cholangiohepatitis after an ultrasound. Her gallbladder was normal as was her pancreas.

    I hope that helps a little. And keep in mind, I’m not a vet and so I’m,not trying to make any dx. I’m just offering you information to discuss with the vets so you are better informed. A lot of times, when our kitties are so sick, we just don’t have the focus to even know what to ask so that’s all I’m offering. I like to give the full gamut of potential issues understanding that some...or none...might not exist but you have some basis to ask questions.
     
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  92. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    How great is that!

    @Marje and Gracie you at such a blessing to all of us on this site :bighug:

    @Hettie you might see if you can get some Hills a/d from the vets (rx diet). It is for recovery (same as the Royal) and it is a "go-to" of last resort for many here. It was what got Gizmo eating on his own a few times. It is like kitty crack:cat::D. If you can get it, warm it just a bit before trying to feed it.
     
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  93. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Thank you, Lizzie Boo :bighug::bighug::bighug::bighug::bighug::bighug::kiss:
     
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  94. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    I'm going to get some of the Hills a/d tonight...fingers crossed.
     
  95. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    @Wendy&Neko
    @Gill & George
    @Marje and Gracie

    I talked to our primary vet yesterday about tapering off the steroids - he said to give the same dose, but give it every other day and then we can start to reduce the dose given every other day....is this typical?

    I was expecting to just reduce the dose over the next several days. I'm a bit nervous about starting and stopping the steroid since I'm not sure how his BG will respond to the changes.
     
  96. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    There are different ways to taper the dose. You aren’t really stopping it. If you think about it, giving a half dose every day is basically the same as giving the full dose EOD. The main thing is that the dose is tapered and not just cold turkey stopped.

    From a Veterinary Partner article written by Dr. Brooks:

     
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  97. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    Thank you!
     
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  98. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    You are most welcome!
     
  99. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    How are you and Max? Took a peek at the SS. Glad you increased and pleased to see pink! :bighug:
     
  100. Hettie

    Hettie Member

    Joined:
    Dec 27, 2018
    He’s doing better- he’s been eating on his own a bit more ( I was able to get some of the Hills a/d) and grooming himself. I’m still supplementing with the liquid diet. We are in the process of tapering off the steroids and he has a follow up appointment on Tuesday with our primary vet to recheck blood panel and possibly remove the feeding tube. I’m thinking it might be time to bump up his insulin to 3u though...
     
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