HELP! Cat has DKA and I need advice - NEW THREAD

Discussion in 'Feline Health - (The Main Forum)' started by Laudie, Jul 13, 2018.

  1. Laudie

    Laudie Member

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    Hi all,

    Just continuing on my last thread so I can continue getting advice for these next few weeks. I appreciate all that everyone has already done.

    A short background for those who don't want to read through the old thread.

    Took our cat in on Sunday to the vet and admit him for 48 hours to treat for DKA. Vet sent him home after he started eating. Bandit has not eaten on his own since being home Tuesday night but we have been syringe feeding him as much as we can and trying to ensure he gets insulin. We've also got Cerneia and some anti-stimulant we are giving him in the mornings as well as sub-q fluids.

    I'm keeping his spreadsheet up-to-date as best I can.

    Old thread if you want it
    http://www.felinediabetes.com/FDMB/threads/help-cat-has-dka-and-i-need-advice.198202/#post-2218302
     
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  2. Djamila

    Djamila Well-Known Member

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    Okay, so picking up where we were on the dosing....:)

    If you and your husband are around and comfortable getting frequent BG tests, and if Bandit is tolerating the BG testing well, you can consider trying 8 hour injections. This can get tricky though, so consider carefully. You need to be very consistent about the 8 hours. If you get off schedule, it can really mess up your day/sleeping schedule. You'll want to give one injection right as you go to bed, one first thing in the morning, and one in the afternoon - halfway between the other two. You'll need to be able to maintain that schedule for at least a week, two is better. In between each injection, you'll need to get at least two mid-cycle tests. The reason for two is that you need to know the number is either flat or rising before the next injection. If the number is still falling, then giving the injections this close together can get dangerous.

    The benefit of TID (three times/day) injections is that you can hopefully get the numbers down and hold them down better. The downside is that it's exhausting and requires a lot of monitoring. While you're doing it, it will take over your life. Given that you're dealing with DKA, it could be a helpful approach, but again, it will put a strain on you and DH, and care-giver burnout is a real thing. You need to do what you can both commit to and sustain. TID doesn't need to be forever - you can switch back to 12-hour shots, but it's best if you start it that you sustain it for a bit and not go back and forth between the two approaches.

    If that seems like too much, then you can stick with two shots/day and we can increase the dose as quickly as we can while still keeping him safe. You'll still need to be doing at least two mid-cycle tests, but on this version, there aren't as many cycles (a cycle is the time between two injections). The downside of this is that prozinc doesn't always last 12 hours, so there is a little more up and down in BG values. The upside is that it's much more sustainable and doesn't take over your whole life to the same extent.

    So talk it over with DH and let us know which scenario seems most realistic for the two of you, then we can talk about how to adjust the dose.

    If you see this in time (I know it's almost your shot time), I would suggest going to 2.5u this morning. As long as you are able to syringe feed successfully, you can keep getting calories in him and keep him safe.
     
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  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    My vote would be to increase the dose to 2.5 u right away but stay with BID dosing. There are several reasons I suggest this: if you're giving meds you have to track those times, if syringing food/water you need to keep a schedule for those as well, and added to all that are dosing times and testing times. That's already a lot to track and schedule. There might be more BG ups and downs with BID but it's more manageable in the critical couple of weeks ahead. You could go with the recommended method for fast-tracking ProZinc dosing by increasing as often as after every three cycles to get the BG range down as quickly and safely as possible. Feeding higher carb food (10-12% or so) for now is what I'd do because it gives you a cushion against lows.

    I agree with Djamila's advice of getting at least two mid cycle tests to follow his progress. One at +2 or+3 can give you a heads up if he's about to dive and another in the +6 to +8 range will give you an idea of the effectiveness of the dose. How low it takes him if the key to assessing that.
     
    Last edited: Jul 13, 2018
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  4. Laudie

    Laudie Member

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    We talked it over and are going to stick with dosing at 12 hours. We'll see how he does over the next week and re-evaluate. If we need to try TID we will. Also I did see this before we dosed so we are going to give 2.5 :).
     
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  5. Djamila

    Djamila Well-Known Member

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    I think that's a good choice. TID is great, but I know it's more than I could handle! So in that case, you'll want to follow what Kris was explaining about fast tracking the increases. You'll want to increase every third cycle. So stay at 2.5 tonight and tomorrow morning, then move to 3u tomorrow night, assuming that the numbers you're seeing allow it. If the mid-cycle numbers are above 200, go for the increase. If they dip below 200, we'll need to re-evaluate. Kris' suggestion of getting a test at +2 or +3, and then again at +6 or +7 is exactly right. If your schedules don't allow that, go with what you can do. The middle of the cycle is the most important because that's when most cats are the lowest, and that's the number we need to see. That earlier test helps you catch a low before it happens which is important for safety at this point since you're just beginning to collect data and we don't know Bandit's patterns yet.

    By the way, great job getting your signature and spreadsheet set up so quickly! That's really helpful!
     
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  6. Laudie

    Laudie Member

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    Thanks for the advice! DH said he can try and test at the +2-3 hour mark and the +6-7 hour mark so hopefully we are successful with that :)
     
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  7. Djamila

    Djamila Well-Known Member

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    Also, I'm hoping someone can chime in who knows more about this than I do: I know there is an order and timing that works best with the anti-nausea and appetite stimulant meds. I believe the cerenia should be given first, but not sure how far apart, and how long before food is given? Can someone clarify that?
     
  8. Laudie

    Laudie Member

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    The vet I spoke to said just give him both in the morning but I don't know what order. Today I gave him the cerenia about 20 minutes before the entyce.
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'd start with Cerenia. It can take a little while to kick in so maybe give it an hour or two? At that point give your appetite stimulant. I'm not familiar with the one you have (Entyce). I doubt if giving them closer together as you did is a problem. What you don't want to do is give only an appetite stimulant. Once Bandit is eating better, continue the Cerenia. Many cats will keep eating without an appetite med if the nausea is well controlled. Did your vet say how long you could give Cerenia? Vets used to say a certain number of days on it then take a break for a couple of days. I think that advice has changed and many people give it daily as long as its needed. Maybe other members can be more specific about this.
     
  10. Laudie

    Laudie Member

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    Well my normal vet admitted she isn't a specialist but she was like "keep giving him the cerenia and fluids every day he isn't eating on his own".
     
  11. Laudie

    Laudie Member

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    I think the positive takeaways from the last few days are that he has not rejected the food we try to give him and he has not vomited any of it up (and he was vomiting everything up before we took him in). He's also walking around a tiny bit but I can tell he still has the will do go about the house like he used to, he just doesn't have as much energy.
     
  12. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    That's great!
    Did your vet mention anything about his potassium levels? If his potassium is low it could account for trouble with walking and lack of energy. Low potassium is common in diabetic ketoacidosis...
     
  13. Laudie

    Laudie Member

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    I do remember them mentioning it while he was at the emergency vet. We did buy the unflavored pedialyte. Should we try and force him to drink some of that?
     
  14. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Ask your vet. He has the results from the latest blood work/labs.
     
  15. Olive & Paula

    Olive & Paula Well-Known Member

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    Cerenia can be given every day. There is no need to take a break. Depending on the dose you are giving now, it's may be possible to increase it.

    Cerenia is best when given 1 hour before eating. In relation to appy stimulant I do not know.
     
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

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    When DKA is being treated in hospital potassium chloride is often added to the fluids that are given IV. I don't know how this can be addressed at home. Maybe you could call your vet for advice? This isn't something you''d want to give on your own because it could cause a dangerous electrolyte imbalance. This is where treating DKA by the simplest means of home support is tricky.
     
  17. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Re BG numbers: getting them down from black and red is the goal but you don't need to shoot for low blue and dark green right now. Maybe try for mid 100s? I'd also feed slightly higher carb food for now to support an effective insulin dose that gets you to mid blues.
     
  18. Laudie

    Laudie Member

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    At this point I'm shooting for yellow but once we get there then I'll shoot for the blue :)
     
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  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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  20. Laudie

    Laudie Member

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  21. Djamila

    Djamila Well-Known Member

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    How is his ketone level today?
     
  22. Laudie

    Laudie Member

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    Ketones were back in the small range. He did make his way outside but is so far under the steps we can’t get him to test his blood right now
     
  23. Laudie

    Laudie Member

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    The potassium levels for him were at 2.9 before he left (slightly below average she said). They did say if he wasn't eating we should try another stimulant but we spent good money on the stimulant we are giving him so I don't know...
     
  24. Djamila

    Djamila Well-Known Member

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    Ketones do cause a loss of appetite, and low potassium can be contributing to the problems. I would ask your vet about potassium supplementation, and then a plan to monitor that so it doesn't go too low or too high. Pedialyte can help with hydration and from getting worse, but isn't enough to help him recover if his potassium is low. If your vet isn't sure on this, it might be worth a call to the emergency clinic. They are sometimes better versed in treating DKA than a regular vet's office.
     
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  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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    It was one of the moderators, @Jill & Alex (GA), who made me aware of this link. It's a really good summary.
     
    Last edited: Jul 14, 2018
  26. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I'm glad Kris gave you that link. It contains a lot of helpful info.

    How have things been going today? How is Bandit acting... how much has he eaten... is he moving around normally? Is he eating on his own at all?

    I'm having Internet connection problems. If I can't get back, the answers to those questions will help others help you.
     
  27. Laudie

    Laudie Member

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    Well I was taking his blood and realized the meter was calibrated to a 36 and it should be a 37 and my husband said he might have accidentally hit it yesterday or today so now I hope the readings aren't terribly off but we took it at the correct calibration now and it's still very high so I'm going to continue doing the 2.5 units.

    Bandit is more active today but still very lethargic. He got up and walked to different places in the house and outside but not very far at once. I think this is good for his spirit though. Still not eating on his own but a few times it seemed like he opened his mouth on purpose for the syringe. And he got probably another 30mL of the can of friskies pate mixed with water. Should we try and get more food in him? That's probably about 50 mL of food total for the day counting breakfast and dinner.
     
  28. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Sounds good.
    I had my meter calibrated incorrectly for about a week and a half once. It didn't seem like it made much difference so I wouldn't worry about it now. You might want to note it on your spreadsheet. The important thing is it's correct now.
    I agree. I'd worry more about him if he weren't moving at all. However, if he's still not moving around much tomorrow you might want to think about bringing him in to check his potassium levels. It's usually a good idea to have that done 3 - 4 days after the first check anyway.
    It's a good idea to feed approximately the equivalent of one 5.5 oz can or two 3oz cans in a 24 hour period. When Alex wasn't eating I attempted to give her 10 - 12 ten mL syringes of blended (almost whipped) food without water mixed in over 24 hours. I don't like to "force" feed. I prefer to make up syringes ahead of time and then feed frequently over the course of the day and night (while I was up). You may have to work up to that amount.

    How are you and your husband doing with all this? Caring for our kitties can be exhausting. I hope you can manage some rest in-between caring for Bandit.
     
  29. Laudie

    Laudie Member

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    I guess I'm wondering what the equivalent of syringe mL is to the oz in the can.

    My husband and I are doing pretty good actually. It's a tag team effort when I'm here and Bandit is so chill he makes it fairly easy. I try and wake up and give him the Cerenia and fluids before DH wakes up and then when he gets up he gives the stimulant and food and injection. And it's the weekend so we'll both be here the next 2 days!

    As for potassium levels, as much as I would love to do it again it's $121 for the test which is a lot more than I'd prefer to spend if I can avoid it.
     
  30. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I'm sorry. My Internet continues to drop my connection. It's frustrating! Not sure if or when this will post.
    I wish I knew. I didn't use water when blending food for syringe feeding. Water made it too messy. I'd get 10 - 12 ten mL syringes per 5.5 oz, so roughly 5 mL = 1 oz... if I guestimate using a 5.5oz can divided up into 11 10mL syringes. Again, that's without water added to the blended mixture.
    Oh good. It's definitely easier with two!
    Ouch! That's a lot! Hopefully he'll be even better tomorrow so it'll become a moot point.

    I'm sorry. I've been trying to post for the past 15 minutes or so. I'll have to catch up to you tomorrow...
     
  31. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    That doesn't sound right. I'm terrible at math!
    Maybe someone who's good at it will figure this out correctly.

    Without water, I'd get 10 - 12 ten mL syringes per 5.5oz canned food.

    Roughly, how many mL to an ounce?
     
  32. Chris & China

    Chris & China Well-Known Member

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    1 ounce is 30cc's (or 30ml's)
     
  33. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Yes, one fluid ounce = 30 cc's or 30 mL's.

    However, that means when I blend a 5.5 ounce can of food (sans water), twelve ten mL syringes would yield only 4 ounces of food at best. That doesn't compute considering I started with a 5.5 ounce can of food.

    I think the problem in using that math has something to do with an ounce of weight (as in canned food) isn't the same as an ounce of fluid and there isn't any standard conversion between weight and volume unless you know the density of what you're measuring (according to Google).

    Yes, I'm confused and may be waaaaay off, but here's what I do "know":
    Blending a 5.5 ounce can of food (sans water) yields 10- 12 ten mL syringes. Less blending = 10 ten mL syringes. More blending = 12 ten mL syringes (mousse consistency). My goal was to feed the equivalent of one 5.5 ounce can or more a day.

    :confused::D:confused:
     
    Last edited: Jul 13, 2018
    Reason for edit: fixed typo
  34. Laudie

    Laudie Member

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    That's why I was confused but that makes sense based on what you "know" from experience. I'll factor in the water and try to get him about 110-120 mL of food. So probably more like 140 mL per day.
     
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  35. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If you have an immersion blender it works really well to convert a can of food to a thick mousse. If needed you can add two or three tablespoons of warm water to make blending easier. That doesn't dilute the food much. If you put the whole can of blended food in a separate container and draw from that you can track your progress as you get through the can's contents. It's hard to convert the ounces in the can to volume of blended food. As Jill pointed out, there's a difference in fluid volume ounces and weight ounces. Some foods are more dense than others so there's more weight in a smaller volume and vice versa.

    As you do this with one can you can see how many 10 mL syringes are in that can for that type of food with the 2-3 Tbsp of water you added to blend it - or not.
     
  36. Olive & Paula

    Olive & Paula Well-Known Member

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    Can't help with food conversion. Totally dunce when if comes to calculations.

    How is bandit? How you holding up?
     
  37. Laudie

    Laudie Member

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    Not eating again today and his blood is so high still ugh. But we got probably 45mL of food/water into him this morning. He's fighting it a little more so I'm taking that as a good sign. We'll leave a variety of food out for him today to see if he eats it. He has some hiding spot in the backyard because we spent 30 minutes looking for him last night and my husband stayed awake and kept checking. Eventually he turned up though ha
     
  38. JanetNJ

    JanetNJ Well-Known Member

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    he's still so high. Do you all think it's time to go to 3 units? @Kris & Teasel
     
  39. Olive & Paula

    Olive & Paula Well-Known Member

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    Any chance you can keep him in? You don't know what he might be getting into.
     
  40. Laudie

    Laudie Member

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    We could try but he loves the fresh air.
     
  41. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, increase to 3 u this evening. He's had 3 doses of 2.5 u and you can increase according to established ProZinc guidelines after 3 cycles. If three cycles at 3 u don't get him to yellow at least , increase to 3.5 u after that.
     
  42. Rachel

    Rachel Well-Known Member

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    I second this. You want to increase every 3 cycles while he's this high. It's imperative to get that BG down soon. Have you checked for ketone levels today?
     
  43. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Are you feeding higher carb food right now? You need a higher insulin dose to get his BGs down and the extra carbs add some leeway there.

    Try to get a urine ketone test as often as you can - more than once a day if you can.
     
  44. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    LRS (Lactated Ringer's Injection, USP is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment in single dose containers for intravenous administration. It contains no antimicrobial agents.)

    is a better way to fight the electrolyte imbalance and to hydrate a patient.
    Administered SQF a home.
    Dose/ frequency is cat dependent.
    We did 100 ml/ 24 h and then 75 ml for an underweight <7 lb cat.

    LRS is available in human pharmacies w/ Rx. Less then $20 w/ lines.
    @Laudie


    ETA: I mean that Pedialyte won't do it for you.
     
    Last edited: Jul 14, 2018
    Reason for edit: clarif.
  45. Laudie

    Laudie Member

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    Thanks everyone. We haven’t been able to get ketones today. He hasn’t gone in his box at all. His spirit is so much better when he is outside so I’m letting him hang out in the back.

    We did go up to the food with slightly more carbs but are going to try and give him the low carb for dinner. I’ll up the dose to 3 units since his low is only at 380.
     
  46. Laudie

    Laudie Member

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    Good news is that Bandit has the energy to hop the fence to the front. Bad news for him is that he’s lost his yard privlages :joyful:
     
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  47. Laudie

    Laudie Member

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    Ketones were at trace tonight! We still had to feed him and I really don't want him to become averse to the food but he isn't eating on his own. Sugar is still very high but we were able to give him the low carb FF and I'd say we got him about 3/4 of the can and gave him 3 units. We'll see where his levels are a bit later and tomorrow morning.
     
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  48. Djamila

    Djamila Well-Known Member

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    One way to keep that from happening is to only force feed with the other foods, and keep the food that you want as his regular food away from him right now. That way he doesn't start to associate it with being sick.

    So good to hear ketones are at trace tonight!

    Fingers crossed we can get him out of those black numbers soon!
     
  49. JanetNJ

    JanetNJ Well-Known Member

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    You are doing an awesome job!!!
     
  50. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Trace ketones - much better! Try to get as much water into him as you can, if not with his syringed food then by syringing water alone often.

    We're all rooting for you and Bandit! :bighug:
     
  51. Laudie

    Laudie Member

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    He showed more interest in food today! I thought he was going to eat but ended up backing away. But PROGRESS yay! He also started fighting us so much more when we were syringe feeding which shows more energy but also since he's not eating is making it more difficult ha.

    And his morning number was MUCH lower than yesterday. We did give him about another 3/4 of a 3oz can for breakfast but it was a mid-level carb can so I went ahead and gave 3 units. I'll keep testing his blood throughout the day.
     
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  52. JanetNJ

    JanetNJ Well-Known Member

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    Have you tried putting FortiFlora on his food
     
  53. Djamila

    Djamila Well-Known Member

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    Oh wow! I love seeing that AMPS! It's still way too high obviously, but so much better than it's been! Fingers crossed he has a good cycle today.

    I second Janet's suggestion of fortiflora. It comes in little packets - you can buy a box off Amazon or from a vet - you sprinkle a little on top of the food and it often entices them to eat. Other possibilities: nutritional yeast (sold in most grocery stores - often in the bulk section), Parmesan cheese, tuna water (not oil), bonito flakes (also off Amazon, Asian section of the grocery store, or some pet food stores sell them as treats), or crushed up kibble. Heck, at this point, you can just try giving him kibble to see if it will entice him to eat on his own. Getting him back on food is the most important thing, and you're doing sub-q fluids, so dehydration wouldn't be as much of a concern.

    Hopefully his hint at being interested in food will just keep growing.
     
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  54. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think the recommendation would be to give 3 u tonight and then bump him up to 3.5 u tomorrow AM.
     
  55. Laudie

    Laudie Member

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    @Kris & Teasel yea at this point I'm just so perplexed. He was looking so good this morning and now he isn't decreasing! I even just checked again, hoping it would have decreased, and it didn't.

    FYI I did buy the FortiFlora and it will arrive on Tuesday.
     
  56. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, I understand how discouraging those numbers are. Just continue the methodical increases after 3 cycles at a dose. It's not unusual for the BGs to be up and down when you're not yet at the good dose range. The DKA also makes them more volatile in their response to insulin because it messes with their physiology. It's very early days in his recovery. Hang in there!
     
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  57. Djamila

    Djamila Well-Known Member

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    If you can, try to get a test before bed tonight to see if he budges at all during the evening cycle. It's unfortunately not uncommon to have a cycle like you saw today at this point. Try not to get too discouraged by it. DKA is a slow recovery, and this being his second round of diabetes, it often takes longer for them to respond to the insulin than it does during the first diagnosis.
     
  58. Laudie

    Laudie Member

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    We actually just gave him his shot and I'm about to hit the sack but I'll try and get up a bit earlier than normal and get a test right when I wake up...that would probably be about +8
     
  59. Kris & Teasel

    Kris & Teasel Well-Known Member

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    How is Bandit this morning?
     
  60. Laudie

    Laudie Member

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    He's doing about the same. He didn't show interest in food again so we had to syringe feed him again. He is fighting it so much though it's becoming difficult. I'll take this as a good sign. He finally pooped just a little which makes me happy too and he was apparently moving around a lot more last night. He even purred when my husband came to bed (which he did before he was sick and hasn't done it since). I upped his dose to 3.5 today as well
     
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  61. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You're doing what you can. Get as much water in as you can too. Try for a urine ketone test today. Bright side: a red pre shot BG is better than a black. Is he still getting Cerenia and Entyce? It's possible he might do better with mirtazapine or cyproheptadine as a appetite stimulant.
     
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  62. Laudie

    Laudie Member

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    We are still giving cerenia and entyce and sub-q fluids. I'll give my vet a call today. Oh and we tested ketones last night and it looked negative to us!

    I'll see if DH can syringe him some water or pedialyte today at different points in the day.
     
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  63. Djamila

    Djamila Well-Known Member

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    Take a look at post #44 where @Tanya and Ducia posted about Ringers. Is that what you're using for the sub-q? That may be better than just adding water as he needs to get his electrolytes back into balance. Hopefully Tanya (or someone else with experience in that) can clarify if that's accurate.
     
  64. Laudie

    Laudie Member

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    I'm just using the normal sub-q fluids from the vet.

    @Tanya and Ducia can you explain the Ringers more?
     
  65. Kris & Teasel

    Kris & Teasel Well-Known Member

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  66. Laudie

    Laudie Member

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    Oh I have the ringer's one! She told me 100 but I've been doing 150
     
  67. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'd ask your vet about exceeding the recommended amount of subQ fluids. In cats that have a cardiac issue (diagnosed or not) the extra fluids can put a strain on the heart (congestive heart failure). If you want to increase the added fluids above the 100 mL subQ you can syringe in extra by mouth. It doesn't affect the heart the same way.
     
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  68. Laudie

    Laudie Member

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    @Kris & Teasel she told me anywhere from 100-200 was technically fine. The first time I got fluids they told me to do 150 so that's why I went up
     
  69. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's fine then. I wasn't clear on what your vet had recommended.
     
  70. JanetNJ

    JanetNJ Well-Known Member

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    Your cat weighs 14 lbs so that should be ok just make sure the last ones given have been absorbed.
     
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  71. Laudie

    Laudie Member

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    Jul 11, 2018
    @JanetNJ I'm waiting 24 hours between administration
     
  72. Laudie

    Laudie Member

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    Made it to the yellow!
     
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  73. JanetNJ

    JanetNJ Well-Known Member

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    Whooohoo!
     
  74. Laudie

    Laudie Member

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    Jul 11, 2018
    The vet just gave me an earful though because she said I need to stop forcing him to eat and she was saying he cannot be on 3.5 units because spot testing the glucose doesn't show you the whole picture and blah blah blah. And she said he really needs to go get rechecked to see if it's inflammation of the intestines or pancreatitis causing this appetite loss but I just can't afford any more tests so sorry it's just not going to happen.

    Now that his ketones are gone from the urine I feel more comfortable not feeding him for 24 hours so we'll try and leave food out and only give him half the normal dose of insulin we had given him (so I'm thinking I'll give 1.5 units tonight).
     
  75. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I am concerned about your vet's advice. A lack of calories and a lack of insulin are leading contributors to DKA. If you withhold food and reduce insulin, there is potential for Bandit to fall back into that again. You've seen his ketone level decline and his BG start to lower using your current approach. I don't understand why your vet would want you to change directions at this point.

    I am not an expert in DKA. I've never dealt with it myself. So I really hope that some of our more experienced folks will chime in and share their thinking in case I'm wrong. This just doesn't sound like a good idea to me. Maybe revisit that link that Kris shared in post #19, and some of the info that was shared on your original thread (the one that was closed).

    @Jill & Alex (GA) @Tanya and Ducia @Kris & Teasel @Bobbie And Bubba I'm not sure who else to tag with this?

    Now back into an area in which I do know a few things: It's so great to see that yellow show up today! I just wanted to give you an idea of what to expect next. Because this is the lowest number Bandit has seen to date, he will most likely be back up in the blacks tonight, and maybe tomorrow. When the BG drops lower than the cat is used to, the liver will dump glucose into the blood. It takes a couple of cycles to clean that out. So this process isn't exactly linear. You'll have a good cycle, and it will often (though not always) be followed by a couple of higher, flatter cycles. So if that happens, try not to worry. It's just part of the process. Sometimes a cat gets lucky and will have a few good cycles in a row, but that's less common this early in the game. It happens more as they get closer to being regulated.

    Assuming that's what happens, and if you want to keep going with this approach, you'll keep the 3.5u dose for three cycles, and then do the next increase. If Bandit gets another good cycle before it's time to increase, we might reconsider that.

    As far as eating, it's really okay to try anything at this point. Does Bandit have a kibble he likes? Treats? tuna? really anything - you just want him to remember that he can eat on his own again.
     
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  76. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I agree with Djamila.

    Many vets discourage "assisted feeding" because they feel it creates food aversions because of the stress/pressure involved. They prefer that the kitty is given meds for nausea and appetite or, in a more extreme situation, has a feeding tube installed. Whether a food aversion develops from assisted feeding depends a lot on the cat. It's done often by a lot of people with good success.

    Re inflammation: vets want to know the cause of the DKA. It can be from infection or inflammation (eg. pancreatitis, inflammatory bowel disease, etc.). There's an expensive blood test for pancreatitis that can give an indication of whether it's the problem but it's not foolproof. As far as IBD goes, the gold standard test for diagnosis is biopsy of various locations in the digestive tract. An abdominal ultrasound can show thickening of intestinal walls and that's an indicator. All these tests are expensive and some very invasive so many owners opt to treat the symptoms (meds, fluids, etc.).

    Re insulin dose: it needs to go up in the methodical way we've recommended. Vets like to have doses held a longer time and sometimes have the idea that around 2 u is the highest dose a cat will need. Doing the pre shot tests and a couple of mid cycle tests daily will tell you how well a dose is working better than a weekly curve either done at home or at the clinic.
     
    Last edited: Jul 16, 2018
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  77. Laudie

    Laudie Member

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    Jul 11, 2018
    I've already done the blood test at the beginning of June when he first got sick (before DKA) and he had signs of pancreatitis. I got the ultrasound done 3 weeks later after he was feeling better and it showed nothing out of the normal with the exception of slight thickening of the intestinal walls). I don't really see what the point is in taking him in, spending another $1,000, and having them tell me exactly what i know already.

    Re Insulin Dose: I'm really thinking of following what the vet says for 24 hours. Especially since he doesn't have ketones in his urine. If this doesn't seem to help him then I'll continue treating how we've been discussing on here. I'm so conflicted....:(
     
  78. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I agree with Djamila. I would not fast him for 24 hours or decrease his insulin. The recipe for DKA is not enough food plus not enough insulin plus an infection or other stress. I had to syringe my kitty J.D. I bought a case of Iams Maximum Calorie (333 calories in a 6 oz can) before they stopped making it. I can send you some cans if you like.
    You don't really want to syringe the food he normally eats as that may cause him to think of that food as the stressful syringe feeding.
    And your vet saying that spot testing won't give you the whole picture is bizzare. That's how we tell how the insulin is affecting him.
     
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  79. Laudie

    Laudie Member

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    Jul 11, 2018
    Thanks for the offer but we have lots of cans of food we can feed him. She said he needs to be tested every 2 hours to get a clear picture because he could be going much lower than I am showing with my tests...even though they are 3 hours apart.
     
  80. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    I'm so sorry you're feeling conflicted. It is really hard to decide if you are going to follow your vet's advice (with their degree on the wall), or a bunch of crazy cat ladies on the internet. When I first got here, I was really unsure about what to do, and who to listen to, and what would be best for my cat. Please know that we are here for you no matter what. We will always give you our best advice, but at the end of the day, Bandit is your cat, and we will respect and support you no matter what. You're dealing with some complex, difficult, and stressful things right now. Know that you are not alone and that we understand how hard this is. :bighug:
     
  81. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes to what Djamila said. We're here to help and support whatever you decide to do.
     
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  82. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    Oh boy! With all due respect, your vet's advice is absurd. Like the others, I have huge concerns about following this latest from your vet. Yes, determining an underlying cause is the way to go, BUT you aren't the first and won't be the last who cannot afford all the diagnostics to figure out exactly what is going on. Many of us treat symptoms for any number of reasons. Bandit needs to eat. He needs whatever amount of insulin he needs to pull his numbers down to get him over this hump. Chances are, it won't be forever.

    I agree 110% with everything already said and strongly urge you to reconsider. No ketones. BG numbers are coming down slowly, but surely. Looks to me like Bandit is currently headed in the right direction.

    If you have doubts, please get another opinion.
    YES to this! Every one of us understands what you're going through because we've all been there in one way or another.
     
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  83. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015

    PS what your vet is describing with the every-two-hour tests is called a curve. They are helpful, especially for people who work all week and can only get mid-cycle tests on the weekend. They are also used by vets because the vet can't test the cat day to day and must get as much info as they can on a day when the owner has brought the cat into the clinic. You and DH are testing enough to have the information you need at this point. We do often recommend that people do curves around here, but I see no need for one for Bandit right now. You're doing just fine on your data collection.
     
  84. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Well, would you look at that yellow at +7!! I really hope you reconsider dropping the insulin dose when you've just seen the benefit of the recent increase.
     
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  85. Laudie

    Laudie Member

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    Jul 11, 2018
    So assuming the cat didn't have DKA but had pancreatitis, how would you treat?

    And also how would you treat thickened intestinal walls if that was all he had?
     
  86. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Pancreatitis treatment is aimed at relieving the symptoms so meds like Cerenia for nausea/vomiting, an appetite stimulant if needed, fluids if dehydrated from vomiting and/or diarrhea and pain meds.

    The thickened intestinal wall is from inflammation. If minor it isn’t treated but if it’s worse then steroids can be used to decrease inflammation.
     
  87. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    One does not exclude the other. The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses. Pancreatitis would be considered a systemic stressor/illness. DKA likely developed as a result of the p-titis if Bandit has p-titis. These are symptoms of P-titis Marje has listed in her "Primer on Pancreatitis" (copied and pasted):

    "Symptoms
    Cats with pancreatitis, even when severe, often present with non-specific clinical signs. In one study of 40 cats with severe pancreatitis the following clinical signs were reported:
    • lethargy (100%)
    • anorexia (97%)
    • dehydration (92%)
    • hypothermia (68%)
    • vomiting (35%)
    • abdominal pain (25%)
    • a palpable abdominal mass (23%)
    • shortness of breath (dyspnea) (20%)
    • loss of muscle coordination (ataxia) (15%)
    • diarrhea (15%)

    In diabetic cats, BG levels often increase possibly in response to pain but also inflammation."

    Treatment consists of much the same as treating DKA: fluids, pain management, addressing nauseousness, making sure the cat eats (including via syringe or feeding tube if necessary), appetite stimulants, antibiotics (if bacterial infection is present), antacids, supplementing with Zobaline and/or SAM-e, and sometimes giving steroids. This is all explained in detail and better than I ever could in Marje's p-titis document linked above.

    The insulin dose is increased accordingly. Marje also mentions close monitoring is crucial because as kitty gets better, it's likely BG numbers will drop and insulin needs will decrease. This can happen quickly.

    Please read through the document. Reference materials are included at the bottom.
    I'm not well-versed on this subject so I will step back and hope others will respond.
     
  88. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Thickening of intestinal walls is often indicative of IBD. General home treatment for IBD, if it's not severe, is good quality food (often raw diets are recommended, but not required) and probiotics. As mentioned, steroids are sometimes used when it's more severe. They do complicate diabetes treatment though, so we tend to avoid them when possible around here. It's not always possible to avoid them though and when needed, we dose around it.

    My kitty has diabetes, pancreatitis, and IBD. So it's possible that there is more than one thing that contributed to the DKA for Bandit. But please know that all of these things are treatable and manageable, especially since there is a lot of overlap in the treatments - what works for one, works for the others to some extent. It's just a matter of learning about them. Right now it probably feels like you're being blasted with a fire hose of information. Just take it little by little.
     
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  89. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I hope you try the 3.5 u dose again today - if you're comfortable doing that. It's always your call. It resulted in a much nicer BG at +7 yesterday afternoon and the lowest PMPS yet. That 308 is very close to being yellow. This morning's PS will likely be high because of the lower dose last night so don't be alarmed.

    Is he eating anything on his own?
     
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  90. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Just checking in. I’m curious to see Bandits BG this morning. I know it seems like we’re all throwing info at you but it’s because we really care about the kitties in here. They and their beans become part of our family.
     
  91. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Please continue to check for ketones. It's more important than ever given the reduced dose.
    Hope Bandit is feeling better and eating on his own...
     
  92. Laudie

    Laudie Member

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    Jul 11, 2018
    Hi all,

    I 100% appreciate all of the information! I'm super happy to read through everything. He did not eat last night or this morning but showed some interest in a temptations treat today so we'll see what happens tonight at dinner time. We are leaving food out for him. We left some of a new can of cat food he hasn't had before as well as some canned tuna and the temptations and some kibble. I also will be getting the FortiFlora today so I'll add that into some food.

    We checked his ketones around 10 and still negative! I think if he is still at negative later then I feel ok skipping one more meal. Especially since he BG hasn't skyrocketed yet and the 1.5 dose seems to be bringing him down a little.
     
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  93. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    Yay for negative ketones!

    I would not skip any more meals, but that's up to you. Cats can not go long without food even if they aren't recovering from a recent dx of DKA. They can get fatty liver disease from too much reduced calories or too much fasting. This latter is also serious. I am only coming from my experience of making sure my cat J.D. had the calories he needed when assist (syringe) feeding. The specialist vet I went to said to try for 220 to 280 calories a day, and that's what we did.
    I am guessing you are trying to fast him to see if he will eat on his own if he is hungry enough?
     
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  94. Laudie

    Laudie Member

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    Jul 11, 2018
    The vet was very adamant I stop force feeding now because there are lots of studies that say cats will become food averse and stop eating even if they are hungry. So I'm just trying to give it a little of time considering she is the expert but I won't do more than tonight.

    And yes we are trying to get him hungry enough to want to eat and not be averse to his food.
     
  95. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I would say that if he doesn't start eating some food on his own soon you might have to revisit the syringe feeding issue in spite of what your vet says. The danger of developing hepatic lipidosis is real. The alternative to syringe feeding is to have a feeding tube installed. It sounds much worse than it is and can be a life saver. Anorexia in cats is a strange condition. It can start for one reason (DKA, etc.) but then takes on a life of its own and continues unless there are significant interventions. At the very least I'd call your vet to ask about the threat of hepatic lipidosis (fatty liver).
     
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  96. Laudie

    Laudie Member

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    Jul 11, 2018
    Ketones have been checked 3 times today and negative each time!

    Levels are a bit high still but look way better. Here's to hoping he eats tonight
     
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  97. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Very glad ketones are negative.
     
  98. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Hi there and I am so sorry you are having these issues with your baby. I agree with everything that everyone here has said. Eating is paramount with a kitty who is throwing ketones. My ex- vet ( ex the optimum word here ) told me to not force food either because of food aversion blah blah blah but as Jill gave you the recipe for DKA event to happen: Not enough insulin, a systemic stress or illness, and in appetence. So, please keep trying with the food.

    Whenever Bubba goes off his feed ( he is normally a pig so when he does, he is sick or in pain !) I can usually get him to eat baby food. All meat , either chicken or turkey or ham . If Bandit is eating you can get the required insulin in him to bring down the numbers. Also ,I have sprinkled oregano on his food which has gotten him to eat ( sounds weird but it works)

    And as others have said, add water to each meal he does eat as it helps to flush ketones if they form.

    Good luck with Bandit. I know how very upsetting it is when our kitties don't feel well and they won't eat. Sending you lots of good appy vines! ( vibes, we call them vines on Lantus and Levemir forum)
     
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  99. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Let us know if the FortiFlora tempts him. Did he actually eat one of the temptations on his own?
     
  100. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    That's fantastic!!! Undoubtedly the sub-q fluids are helping. Please remain vigilant about testing. Things can go south quickly... especially with a reduced dose and without food.
    That's most likely because he hasn't eaten.
    Kris is on point with her comments. Please reconsider. Feed Bandit if he's not eating well on his own...
     

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