HELP!!! Time is running out - cat has DKA! :(

Discussion in 'Feline Health - (The Main Forum)' started by Chloe'sMom, May 14, 2015.

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  1. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Hello all- I found this forum after researching what if anything I could do for Chloe from home. She is 12.5, a diabetic for 2 years and as of Monday started acting very odd. The vomiting started before that, when I changed her food (back to wet) last week. It persisted and I noticed bile and thought her tummy was just upset with the wet food. Well, Monday she didn't eat much and so Tuesday I took her the vet (new vet - new city, etc). They weren't able to extract any urine from her bladder so they did a serious of blood tests and thought it might be fatty liver disease. Gave her some anti-nausea meds, and an appetite enhancer and fluids under her skin and said for me to try to get her to eat as much as possible. By this point it was probably 12-24 hours of POSSIBLE not eating. The rest of Tuesday and into Wednesday she didn't eat and barely would drink. I know her habits as a diabetic and this is NOT normal. She is small, but eats like a bear. I took her to the emergency vet on Wednesday AM when she was super lethargic and acting so odd. Found out that it was her appetite enhancer making her eyes weird, but that she was lethargic from DKA, etc. They suggested to keep her over night so that they could get IV fluids and insulin going for her. $1000 later (plus the $300 from the other vet) and we just couldn't afford to keep her there anymore. I picked her up around 2pm (against the ER vet's wishes - and they suggested home would be hospice-like care) and we've been home the last 3.5 hours and she is sitting staring out the back patio, which is GOOD. She has been just staring out into space a lot. 30 mins ago I just fed her 15ml of plain pedialyte and 7ml (most I could get in her) of cat food gravy. I'm desperate. I don't have the $5000 or so to keep her overnight for days on end and I'm afraid I'm going to lose her!!!! Any advice? I've reached out to the vet I took her to on Tuesday and I'm just waiting for them to contact me with any ideas of how to get her eating and maintain her insulin.

    I'm open to suggestions from people that have had a cat with DKA. Please and thank you!
     
  2. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    You have a rough road to travel. We'll give you the best information we know.
    Ketones form as a by-product of fat breakdown for calories. this happens when the cat cannot use the glucose from food that has been eaten.

    1) In order to monitor your cat, you must get an inexpensive human glucometer, such as the Target Up and Up or the WalMart ReliOn Confirm, matching test strips, and lancets (alternate site testing ones are best as they are 25-28 gauge and easier to get blood for the test). Check You Tube for videos of the process.

    2) fluid intake - offer plenty of fresh clean water, add some to the canned food and mix well. This helps flush the ketones out.

    3) food - right now, anything she'll eat works. Plain baby food with nothing but meat and water works, and is easy to syringe. You must get the food in


    4) insulin - what insulin do you have? How much are you giving?
     
  3. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Thank you BJM. I have a glucometer and just spoke with another vet (there is a group of them) in our practice and she advised of syringe feeding which I had done since Chloe isn't eating on her own. I've given Chloe about 25 ml total or so of food in the last 2-3 hours. Vet recommended only 1 unit of the insulin. Lantus is what we have. We're desperately trying to save her. And while the money for the MedVet Emergency vet 24/7 care is not readily available to us, we are doing our best. Apparently the vets while helpful, are surprised we're willing to do so much.

    BJM, are you in Columbus Ohio? I am too - ironically. We have been treated at the Easton Animal Hospital and at MedVet in Worthington. I'm praying she makes it through, though we have been told that it would be unfair to keep her much after 24 hours if she hasn't improved. :'(

    Thank you for your help and any other suggestions is appreciated! What are your thoughts on Pedialyte?
     
  4. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    Yes, I am in Columbus. Plain Pedialyte may be OK; the most crucial electrolyte needed is potassium, as the insulin uses it to work. Did the vet do blood work and test the potassium levels? You may need to take her in for testing that and general blood work tomorrow.
    I'm in NW Columbus. You?
     
    Last edited: May 14, 2015
  5. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    See my signature link Secondary Monitoring Tools for testing dehydration.

    I sent you my phone #. Look up in the upper right.

     
    Last edited: May 14, 2015
  6. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    BJM - thanks! I appreciate your kindness. Have you had or known of anyone to get their kitty out of the DKA state? And Pedialyte has potassium, which is good. Yes, vet checked and I'm actually trying to remember - it may have been a little low and they supplemented before I picked her up from the ER. I wish I had thousands to have them care for her there... :(
     
  7. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    She is still purring when petted so I'm hopeful that she is still somewhat alert to know that I'm there. She is on Mirtazapine to stimulate appetite which so far the last couple of days has not worked. Forcefully feeding her is the only way that I've gotten nutrition in her. She has licked a few licks of gravy once or twice, but that is about the extent of it. I don't like how the Mirtazapine has made her feel/look. She's so groggy so it's hard to tell if that is the DKA or the drugs. The vet that is at the practice we go said that she thinks it could be either way, but knowing that Chloe exhibited these behaviors the other day when on it, makes me think it's the meds: large pupils, odd behavior (splashing water around, sitting in her water bowl, etc). I know she feels sick and I think that drug is making it worse. For now, we have been recommended to syringe feed her and get her peeing those ketones out. That is the ONLY way she will get better is to eat and get those ketones out. I know it is unlikely, but I'm still remaining hopeful. Any advice and thoughts are so welcomed. And thank you.
     
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    Toward the bottom of this article is information on financial help. Care Credit is a resource many people have used. DKA is very difficult to treat at home given the need for monitoring electrolytes and titrating insulin.
     
  9. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Jul 18, 2011
    Can you give her subq fluids at home, too? That would help flush the ketones and keep her hydrated. You might also ask about trying Cyproheptadine instead of Mirtazapine. It doesn't make kitty as wild-eyed and it works better for some kitties than Mirtz. Be careful not to syringe too much food too fast - it might make Chloe throw up. Space the feedings out a little. Use a food that is high calories, but watch the fat content, as that can also upset the tummy. My Cinco was in DKA when we first took him in. That was 4.5 years ago. Sending you lots of prayers and good thoughts.
     
  10. Ann & Tess GA

    Ann & Tess GA Well-Known Member

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    Jan 7, 2010
    Food, fluids and enough insulin are important for DKA. It happened w/ Tess about 2 months ago when she wasn't eating. She was at the ER for 2 nights on an IV drip w/ R insulin. When we got her home we gave sub-cutaneous fluids every day and got R insulin to use as a bolus to bring high numbers down. Her improvement is amazing, bright eyed, alert, eating well even demanding it in the morning! She has also gain nearly half a pound back. So yes they can come back from DKA. The fluids have been really important in her recovery.

    Good that your vet is suggesting syringe feeding. Your vet should be able to set you up and teach you how to give sub-cutaneous fluids at home. Talk to your vet about getting R insulin to use as a supplement. You can get R insulin at Walmart pharmacy for about $25 (anywhere else it's over $100, they have a special deal w/ the maker) and no prescription is needed. Advisors here can help you work out a scale on how much and at what point to use it. The ER vet thought it a good idea, but recommended 1 unit, we usually only give her 1/10th of a unit!

    I just saw Tricia's post, you can get the Cyproheptadine at Costco pretty cheaply and the Ringers for sub-q fluids too.
     
  11. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Here is a good information post on DKA/ketones. It's going to be helpful for you to have a good understanding of what's going on in her body so you can understand how to help her.

    At the bottom of that post are some links to posts that have info that might help you where another cat was dealing with ketones.

    Sending healing thoughts to Chloe. And yes, many cats do recover from DKA, but it's a very serious situation.
     
  12. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Jul 18, 2011
    If you are able to get the sub-q fluids and want to give them at home, here is a WONDERFUL video on how to do it, made by our own Marje and Mike, starring the adorable Gus.
     
  13. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    If you are able to check her sugars and post here, that would be very helpful. DKA happens due to not enough insulin (amongst other things) and you need to be able to safely increase insulin to reduce those ketones. Increasing insulin could cause her to go low if you are not testing. Ketone strips will help you track if she is improving, and you can buy these over the counter at most pharmacies.

    For feeding, try to get in her one 5.5oz can of food and 300ml of water a day. Syringe feed every 2 hours or so, you may need to do this around the clock for a couple days. For calories see if you can get Iams Max Cal from your vet. You can ask your vet to show you how to do subQ fluids at home, it's not much harder than giving insulin once they show you. Your cat will need electrolyte labs, because if potassium is low this will prevent recovery.

    What dose of insulin was your cat on prior to the DKA?

    I'd ask for an anti nausea instead of the mirtazapine, in DKA usually nausea is the barrier to eating. You may have to taper the mirtazapine in order to get rid of it.

    Cats can and do recover from DKA, but it's a marathon for a few weeks. More food and more insulin is the key.
     
  14. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Wow, thank you everyone. I have a log of what I've been doing and she was last syringe fed at 9:45pm. I'm setting my alarm for every 30-60 mins to keep an eye on her. I've given her pedialyte too. I gave her 1 unit of insulin around 7:30 per vet's orders. Now the emergency vet thought she should have stayed with them, but the cost was just so high. We can't afford thousands. I'm ashamed to admit that. But her home vet group is trying to help - however they suggest that if she isn't better tomorrow, that we consider euthanasia.

    Just checked her glucose and it was an alarming 332. And that is after the 1 unit at 7:30. I wasn't expecting it to be so high!!! I'm about to syringe feed her again. Since she has been home (2pm) she has urinated only 3x plus once in her carrier on the way home. I'm giving her water and pedialyte regularly. I know this will be a long night and I'm thankful for all of you for help!

    I did ask for the Cipro, but it seems these vets like to use the Mirtazapine. I don't plan to give her any more if I can help it. I think more anti-nausea may be good?

    Her syringe food is a can of Fancy feast seafood with a packet of kitty gravy and water. I have small 3ml syringes and I try to give her 12-15ml each time but it's getting harder and harder. It is weird to watch her with the food on her face. Normally she would be cleaning herself. I'm trying not to get scared, but she seems like she is in just a lethargic state. I'm willing to do all I can. Thankful I work from home and can monitor her. With this though, work has been put on the back burner. I'm not ready to lose her yet, but I don't want her to suffer either!!

    I don't have anything to check her ketones. I know that is why she is not eating. Poor thing has slowly lost over 2# since September when she has a similar, but much milder, episode with the emergency vet. Please keep sharing ideas and at 1am I'm doing all I can! Now for more syringe food.
     
  15. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Oh and she was on 3 units 2x a day before - but I had taken her off last week as her glucose was in the 180s and she was eating low carb foods - which are preferred. I feel this catapulted this DKA, but the vet seems to think this has been and issue for a while. I've now learned that I have to ween things, not cold-turkey it.
     
  16. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    I don't really have a good idea about her pattern of sugars, but if you are at 3U a week ago, and now 1, she probably needs an increase. If you could check the sugars every 2-3 hours tonight and post in the am, I'd feel more comfortable saying increase by 0.5ml, but see where she's at first. 180s are good numbers, you don't need a reduction if you are in this range when testing from 6-10hrs after the shot. Low blood sugar in a cat is 50s and below.

    She's not going to be better by tomorrow, DKA doesn't work like that. It takes at least a week, sometimes 2 for them to start acting better and eating better. Low potassium and dehydration can contribute to the lethargy. Ask about testing the potassium and getting potassium powder to add to the food you are feeding. My cat Max was very sick with DKA when he was first diagnosed. He was like a limp rag the first couple days. Took about 2 weeks, but now he is fine with no lasting effects. The potassium, subQ fluids, syringe feeding, and cerinia (anti nausea) were are critical to his recovery.
     
  17. Linda and Scooter & Jack

    Linda and Scooter & Jack Well-Known Member

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    Nov 9, 2012
    No advice from me just a huge welcome and a note to let you know that you have found the place where plenty of former DKA kitties have recovered and Chloe can to. You do not have to euthanize her. Just hang in there and keep posting so folks can help you.
     
  18. Deanna & Billie

    Deanna & Billie Well-Known Member

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    May 10, 2014
    I don't have experience with DKA but I just want to say I think you're doing a great job of being there for your girl, and I'm sending lots of vines your way. The experienced people here are very knowledgeable about these issues (more than a lot of vets), and you are getting a lot of good advice. I would keep doing what you're doing and try everything people have suggested. We are pulling for you.
     
  19. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    The odd thing is that at home before this, she was at 180-183. They had her on an IV and insulin CRI and now she's spiked. Not sure why. It could be because she now has food in her system. She had food in her system when it was in the 180s too. Vet had said that if she had 10-15ml more of syringe food in the AM that she was ok with 1unit then too. I will check it again in a couple of hours. I just fed her about 12-13ml of the food/gravy/water mixture. She was pretty good this time, but towards the end, she starts spitting it out a bit. I'm trying to give pedialyte every so often because I know it has potassium too. I will ask about the subq fluids, more anti-nausea (they gave her cerenia the other day at the vet -not ER), Cipro (though they'd said it wouldn't work any better than Mirtazapine) and thing others mentioned above.

    I agree, she may not bounce back right away, but I'm fearful I won't have vet support unless she is at least somewhat better tomorrow! I'm willing to do all I can. The last few days have been s nightmare and I've cried more than I can remember. I am willing to fight for her if she is!
     
  20. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Thank you!!!!! I hope I continue to get vet support - I just need my Chloe to do better tomorrow otherwise they are pulling for euthanasia.
     
  21. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Thank you! You all have been so supportive and I am soooooo grateful. You have no idea at 2am how this just makes me feel. Thank you thank you!!!!
     
  22. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    I took a screenshot of my iPad so that you all could see my beautiful Chloe! At 12.5, I'm hopeful there is a lot of life in her yet!
     
  23. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    The mistake vets make is to pull back on insulin when a cat stops eating or is eating poorly. Often this can trigger even worse appetite and DKA. With ketones, any reduction in insulin will make the body produce even more ketones. Of course, you want to make sure a hypo doesn't occur as well. You can mix honey or syrup into her food to keep her sugars up if needed in order to give more insulin. And test BS at least every 4 hours.

    If she doesn't get enough insulin to change her metabolism back to normal, the DKA won't improve.

    Good luck at the vet. Make a list of supplies you'd like to have at home and see if they will give them, after that, it's possible you are on your own (and FDMB will still be here) if your vet doesn't know how to treat DKA.

    If your home vet won't give you fluids/anti-nausea/potassium and test for it maybe the ER vet would be willing to do this.
     
  24. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Ok. I wonder now with her higher glucose levels if she needs more. I wil mention it to them tomorrow! I know they know how to treat it, definitely, but I think that they think she is beyond repair to some extent. She has high ketones - checked again Thursday morning. But - sounds like we can manage them. Also, she was not eating etc at the ER and when boarded or any other time at the vet, she is so extremely stressed. I think with their guidance and with her at my home, we can do this. Good thing, my vet group is only 1/2 mile from my house! My home vet is way more receptive to home care than the ER, but I found out that they are colleagues and well, they worry that Chloe will be in more pain or unable to come out of this with home care. However, the home vet said that DKA can be cured 60-70% of the time, but she said it's with careful management, which is hard to do at home. I will keep trying!!!!!! Thank you!!
     
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  25. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Hopefully that made some sense at 2:30 with a loss of sleep!

    Meya- do you have recommendations for how much I should feed her/give pedialyte and how often? She just urinated again which is good!!!
     
  26. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    Your goal is one 5.5 or 6oz can a day. So split it up every couple hours so she doesn't get too nauseous from it, however your schedule allows, maybe every 2-3 hours. 300ml of fluid is the goal, but that includes fluid in wet food, so if you get close to that you are doing good. If you can get your hands on any IAMS Max Cal, that would be helpful as it is very high calorie.

    Make sure the pedialyte doesn't have xylitol in it because it damages cats kidneys.
     
  27. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    That is not their decision to make and they shouldn't try to force you into it. They can advise, but they can't make you euthanize your cat. And only giving her 24 hours to recover from DKA isn't very realistic on their part. As long as you can give her the care she needs - food, fluids and insulin - and are prepared to put the time she needs each day into helping her recover then they should be prepared to at least let you try even if they don't necessarily approve. Good luck discussing it with them. :bighug:
     
  28. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Thank you manxcat. I appreciate the support. They were just worried she would be in more pain etc.

    The pedialyte I'm giving is the infant unflavored. It appears to be free of that. I read that flavorless was best.

    http://pedialyte.com/products/liters#unflavored
     
  29. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    And thanks Meya. Just checked glucose again at 4:20 and it was 251. So it came down a little. Going to continue to monitor.
     
  30. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    6:55am and Chloe's glucose is at 222. She's urinating every 4 hours or so. Wondering if I need to up her pedialyte or water more? She's been tired too and I have tried to give water, pedialyte or food every 1-2 hours.
     
  31. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    You're doing a good job of helping Chloe. My kitty J.D. was a DKA survivor. He had it when he was 11 and lived to be 20.
    Good luck at the vet today. I hope you get all the supplies you ask for. Keep getting the food and the fluids in.
    If you get R insulin, you will need to test a lot, so have plenty of test strips and have someone experienced with R here, help you and guide you. Vets seem to only be used to 1 unit increments. When I used R, I did 1/10th unit.
    You can buy ketone test strips at the pharmacy today.
     
  32. missMeows

    missMeows Well-Known Member

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    Apr 4, 2015
    I'm not knowledgeable with DKA but just wanted to say you're doing a great job and are in good hands with this community. Been thinking of you and Chloe all night and am rooting for you both!
     
  33. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Thanks Dayna! I'm trying to get a list of things together to talk to the vet about today. So, this helps too.
     
  34. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Thanks
    I so much! Hubby came in before work and thought she looked a bit better. Still very groggy and she's very lethargic still, but we are hoping and praying for the best!! I'm being optimistic and we are on board to help her all we can.
     
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  35. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Here's my list for the vet- do I need anything else? :
    R insulin
    Larger syringe for feeding
    Iams max cal food
    Test for potassium
    Potassium powder - or ask if pedialyte is ok
    Subcutaneous fluids for home
    Cerenia
     
  36. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    The R insulin might drop the sugars too fast and needs to be titrated pretty tightly. IMO It's better to leave the R to the vets where she can get a constant IV with dextrose. Others here might feel different. You can increase the lantus and that should be able to eliminate the ketones. Most vets won't give R for home use, but it is available without a perscription at pharmacies. I'd try some lantus increases before I jumped into R.

    Here's where we are at for people following:
    7:30pm - 1U (was on 3U twice a day a week prior)
    1:17am(?) - 332
    4:20am - 251
    6:55am - 222
     
  37. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    Her blood glucose levels (BG) may be elevated if there's an infection. Infection/inflammation elevates BG. An antibiotic may be needed.

    If you're feeding "kitty gravy" (you mentioned this above), that may be elevating BG, as well. Frankly, calories are very important in combating DKA. The MaxCal is a good option since it's calorie dense.

    Cerenia or ondansatron will help with nausea and/or vomiting.

    Please do not add potassium without having blood levels drawn. Too much potassium can cause almost immediate diarrhea (and hence, dehydration and further electrolyte imbalance) and can cause massive cardiac problems. It's not a trivial supplement. Phosphorus levels are also affected by DKA. You need electrolye panels drawn.

    If there is any way your vet can trim costs and help you out with this, it may be safer to have your kitty hospitalized. I know it's expensive-- I went through this with my cat at the time she was diagnosed. There's no easy way for you monitor electrolytes at home. The typical regimen is for a cat to be getting a basal insulin (like Lantus) coupled with a fast acting insulin (such as Humulin R -- it has several other names) while on a dextrose drip and while getting fluids. These are not things you can do easily at home.
     
  38. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    Jul 19, 2011
    First - HUGE HUG! Yep DKA stinks! You're not going to be able to bring her potassium levels up much with the pedialyte. It can keep it level where it is but can't increase it much. I'm glad you're having the potassium level checked....
     
  39. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    The prescribing information
    http://products.sanofi.us/lantus/lantus.html#section-16
    for Lantus includes
    LANTUS is a long- acting human insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. (1)

    Important Limitations of Use:

    • Not recommended for treating diabetic ketoacidosis. Use intravenous, short-acting insulin instead.
    R is the best. It can be give subQ. If you use small doses it is safe to use. Lantus really is not suitable since it acts slowly.
     
  40. Linda and Scooter & Jack

    Linda and Scooter & Jack Well-Known Member

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    Nov 9, 2012
    actually I do. The wonderful folks on here stayed up all night with me and guided me to save my Scooters life one night. I know how wonderful and affirming it is to find this place.
     
  41. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Hello all - just a bit of an update. Busy morning and early afternoon and we've been ALL over the board here.

    Quick update from the vet: gave 200ml subq fluids and sent me home with enough for 800ml more for 4 more days. He didn't feel the need for potassium or to check it even - saying that the fluids should be enough and that the pedialyte would supplement also. Came home around noon after buying ketone strips from CVS and got settled. We had given her 1unit of Lantus at the vet and he didn't feel comfortable with giving the R insulin as it would be more difficult to maintain, etc. He said her temp was lower - giving him concern and the whole time he had a look of great concern on his face. This obviously made me question what the heck I was doing. I shared info with hubby who also wondered if we were being futile with our efforts. He gave her a shot of Cerenia and recommended that I stick with the Mirtazapine - not what I wanted, but he preferred it. I don't plan to give her more at this time. He gave me a Royal Canin high calorie food and larger syringes that I mixed with a tad bit of water and gave Chloe about 45ml of food, or approx 1/8 of the can (large can). He said we need to try to give 1 can a day like mentioned above. He listened to her heart and lungs and said that they sounded good, no raspy breathing, and then lifted her skin to check hydration. Being off of fluids she obviously was a bit dehydrated. He just left it with: that if she was to get worse, that we wouldn't make her suffer any longer.

    Hubby was concerned with her when he came home for lunch and saw how out of it she was. She even smells sick; it's sad. We have the food as I mentioned above and he was very solemn with her with worry and then left to go back to work. Fifteen mins after he left she was sitting at the back patio (I have the screen door open for fresh air) and then suddenly she was sitting partially in the door track - very odd. I've tried to open the door to let her roam, but she's had no interest. This time however- she went outside! She sat on the back mat in the sun and seemed very content. Then, she started acting a bit more like herself and even started sniffing around, cleaned her face for a few seconds (I've not seen this behavior in DAYS) and even was curious enough to go down one of the steps and look around. She is very wobbly - obviously very sick still, but she was interested in looking around. She partially fell into me, so I'm glad I was sitting there. She would've toppled down the stairs. Then, about 20 mins later, we went back inside and when the dog passed her to go in, she cried at her in normal fashion. Her cry is weak and she sounds sick, but it was nice to see her annoyed by the dog. lol

    She then urinated and I saw how dark yellow her urine is! It is concerning, but she hadn't urinated since 6:43 this AM - so several hours. (She was stressed at the vet even though I tried to get her to go). I used the CVS ketone strips and either something is wrong with them, or something else is wrong with her, because they read out at "trace" amount of ketones. That doesn't make sense! I went onto check her glucose - she had 1 unit of Lantus at 11am- and her level was the lowest ever that I've seen - at 155. I've been giving pedialyte and water trying to keep her hydrated. She's resisting the syringe more which is good in some ways (she's getting more feisty like herself) but bad in others because it's harder. She's way more alert now that the Mirtazapine is wearing off and I'm hopeful again. What a roller coaster! Just checked her glucose at 3pm and it's now 162. And wow, I could see a lot of veins in her ears this time! I'm not sure what to think of all of this? I know the Mirtazapine is a goner - she's becoming more and more like herself, but I can't get her to drink out of the faucet (her preferred method lately) or bowl. I'm having to use a syringe. In some ways we're getting so much better, in others, we're the same or worse. Thoughts?!
     
  42. Chloe'sMom

    Chloe'sMom Member

    Joined:
    May 14, 2015

    I understand - and while I agree based upon the text, my vet didn't want to prescribe it. Her glucose is down a bit, and the ketone strips say trace, but I'm fairly certain those strips have to be wrong. I tried 5 of them to be sure, but I'd be amazed if she's pulling out of this already... Doing all I can in the meantime!
     
  43. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    If you wish, I can come over for a bit this evening and give you a hand, or a break so you can get some rest for an hour or two. Look in the upper right corner of the screen. There should be a red blip over your inbox. Click on that. I sent you my phone #.
     
  44. missMeows

    missMeows Well-Known Member

    Joined:
    Apr 4, 2015
    My fingers, and kitties toes, are crossed hoping that this is a good sign!
     
  45. Chloe'sMom

    Chloe'sMom Member

    Joined:
    May 14, 2015
    f
    Thank you for the offer! I told hubby he might need to do the night watch tonight, lol! :)
     
  46. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Maybe check out
    RASCAL Animal Hospital
    Reviews online are average.
    They are on the northwest side, west of 270 and Tuttle Mall.
     
    Last edited: May 15, 2015
  47. Chloe'sMom

    Chloe'sMom Member

    Joined:
    May 14, 2015
    Ok, folks, I'm worried. I know there are highs and lows, but I'm hoping someone can tell me if this is normal? Her glucose is managed right now about about 152-162 for the last few hours. She hasn't drank anything on her own since 6:55am. I've either been giving her pedialyte here and there or syringes of water. Hubby went out to get new ketone strips to verify against the others, but she hasn't urinated in a few hours (1:47p) either. She's now wanting in the windows (they're open) and she's more her feisty self when giving syringes. Gave pedialyte at 2:14 pm, 2:45 and 5:30 (after a long night, I ended up zonking out a bit longer than I wanted to).

    She just had about 25ml of pedialyte but again, no interest in water bowls or faucet. HELP? What should I do????
     
  48. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    When the glucose is well controlled, and the food being given is wet food, the cat tends not to drink very much. This can be OK.

    Check for dehydration:
    1) Gently lift the skin at the scruff of the neck and release. Does it immediately snap right back down, or does it stay pulled up and s l o w l y return to where it was? If it snaps back, good. If it stays pulled up, or tented, then there is moderate to severe dehydration.
    2) If #1 was good, now check the gums. Lift a lip and gently press your finger on the gums. Notice how they feel (moist, sticky, dry?). Remove your finger and watch. The pressure gently pushes out the blood; releasing that, the area should pink right back up if hydrated. It may stay blanched or pale and slowly turn pink again if slightly or moderate.y dehydrated. Also, if the mouth is dry/sticky, the cat may be mildly to moderately dehydrated.
     
  49. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    BJM - Thanks for the info. Good to know!

    It take about 1 second or so to go back down. I checked just below her collar and then removed her collar and closer to the back of her head, it took 1-2 seconds. I will check gums in a few moments.

    I called vet with worrisome when Chloe urinated at 5:50 and then sat in it. I know she's weak, even though she's shown several signs of improvement today. During that call the vet shared that he would prefer NO ketones and that we should continue with the fluids. The tech/assistant spoke to me the most and said that this can take 1-2 weeks. (As I've read here) During our phone call, Chloe had her first BM since Monday! Now it did take her a while, as she was constipated, and the feces looked a bit odd in comparison to what she normally has, but I'm pretty sure that's because it had been compacted. I shared Chloe's glucose over the last several hours of 155-162-152 and she was so thrilled she said that she would share these things with the vet. She gave me hope and thought that for us to continue to syringe feed Chloe through the weekend was not irresponsible. I told her I am SO glad that I didn't listen to that MedVet Dr (no offense to him) and euthanize Chloe. I told her that I had to do everything in my power and home care was part of it.

    Already I'm glad that I continued to push on and try all options. I hope that I can get Chloe to eat and drink on her own, and maybe the constipation was part of the reason why she wasn't, but while I know we are not out of the woods yet, I will continue to push forward with renewed hope and strength in hopes that I can save my precious Chloe!!!
     
  50. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    There's a web site for everything!
    Feline Constipation
    Miralax or generic, 1/8 teaspoon, may help soften things up by drawing water into the GI tract.
     
  51. Chloe'sMom

    Chloe'sMom Member

    Joined:
    May 14, 2015
    BJM - her gums are light pink and a little sticky. Sounds like she might be moderately dehydrated. I will try to continue to push syringe fluids. She is getting more feisty with them, but she needs them!
     
  52. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    You might also "Mom cat" her and take a warm, damp washcloth and stroke her down with it, like a mom cat grooming her kittens. Its a soothing thing for many cats.
     
    Last edited: May 15, 2015
  53. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    Hang in there, you are doing your best for her, and I hope she starts to improve. SubQ fluids can really increase energy/alertness, so I imagine they increase comfort for a cat as well. I thought I'd share:

    I have an acquaintance who is a type 1 diabetic and I was curious about the experience that a cat might be going through during severe DKA. This friend of mine had been diagnosed about 10 years ago, and had gone through DKA herself twice, very severe the first time. I asked her what it was like. She said the thing that she remembers most is that she was so thirsty. She said for the most part she was too out if to care a lot about what was going on, but remembers feeling nausea and extreme thirst. She denied that the experience was painful at all, but said she was to tired to move, and just very out of it. I think it's helpful to hear someone's take, because our cats can't speak for themselves.
     
  54. Chloe'sMom

    Chloe'sMom Member

    Joined:
    May 14, 2015
    Thank you Meya. She definitely has improved today. It's been slow, and up and down, but she's really returning to herself. She's even rubbing up on my laptop here as I type, which is normal Chloe!!! Now she has quite a bit to go since she's not eating or drinking on her own, but we see the death slowly disappearing. I'm sorry to describe it that way, but that is what we felt like we saw - death on her. It was scary, frightening and overall more than what I could handle. I cried as though she was already gone because I really had thought I lost her. We are certainly not out of the woods yet, but I feel that she is gaining more and more strength. Tonight she's been sniffing my food (last hour only) and that hasn't been happening. She's had two BMs now and we are thrilled. The syringe feeding is so exhausting for myself, husband and of course Chloe. We're hoping she starts eating on her own soon. Earlier when I called the bet and talked to the tech she was so thrilled to hear how Chloe was doing and she's even improved more since then. She was eager to share the news with the vet Dr himself. I'm thankful for everyone here because truly, I think that we would've had a different outcome. Like I said to the vet tech - I'm SOOOOO glad I didn't listen to the ER vet and put her down. She may not recover fully - we're hopeful still that she will, but these extra couple of days are SOO worth the trouble, lack of sleep and even expense. We're a family of 4 and we intend to keep it that way as long as possible! :)
     
  55. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    What are you feeding?
     
  56. Mogmom and Goofus

    Mogmom and Goofus Well-Known Member

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    Dec 9, 2014
    I've just read every post since your first one and more than once I could feel the tears stinging at the back of my eyes. I so hope for all of you that Chloe recovers, it sounds like she's on the right track. I've suffered thru many sleepless nights with rescue kitties that were sick with distemper, it exhausting, not just the lack of sleep, but the fear of losing them. Chloe is very blessed to have you all for her owners. Best wishes!
     
  57. Chloe'sMom

    Chloe'sMom Member

    Joined:
    May 14, 2015
    Things have been going good until I woke up at 1:30 and checked her glucose after her one unit of Lantus at 9pm (late due to getting her food and water) and her glucose level was all the way down to 43!!!!!! I'm freaking out. I'm giving her Karo syrup and now even shooting small bits down her throat to save her. She's crashed down to 38 and finally is starting to climb to 59. Do I feed her now or not? She's gotten more dehydrated so we're giving syringes of water constantly. She won't drink on her own. We have been fighting this far we can't lose her! I'm praying one of you is awake and can assist!!!!
     
  58. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    Yes, please give her a little more food - it would be better if she was just a little higher - I'd like to see her in the high 60s or 70s at least before you see what she can do without more food. Unfortunately, you could be in for a long night - you're going to need to see rising numbers even after the food she's already eaten and whatever she eats now wears off. Oh - what type of meter are you using? Just to make sure I'm giving you the right information!
     
  59. Chloe'sMom

    Chloe'sMom Member

    Joined:
    May 14, 2015
    manxcat I'm using a human Bayer glucometer. I've given her about 1-2 ml of karo and some water via syringe - she isn't drinking on own and I'm holding her right now. I can't tell if she's shuddering from numbers being low or purring. Hubby thinks she is shuddering. I'm so scared. We are so nervous and he wonders if we need to let her go? I didn't expect a drop like this....
     
  60. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    OK - I just wanted to make sure you weren't using an Alphatrak or I'd have needed to adjust the number range I was thinking in.

    You can get her through this. If you can check her levels again in about 20-30 minutes. And if you can get a little more water into her that would be good too. Don't give up on her yet - that drop means the insulin is working...a little too well maybe, but working and insulin is part of what she needs to get through the DKA.
     
  61. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    Oh, and believe me, I know you're scared. Make sure you take some deep breaths - you're going to get through this. Just keep on with what you're doing - once you get the next test we'll know whether she needs more karo or whether she might start holding higher numbers on her own. :bighug:
     
  62. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    manxcat, something to note - two different ketone test strips show trace amounts of ketones. (We bought two sets when one showed trace, we thought they would be higher). talked to vet and they said that even trace was too much. Chloe is still not eating or drinking on her own - but have no idea quite how many ketones she had from ER, except that they said "high". I'm hoping this therapy is working, yet why is she not eating or drinking? I will give food now. Thank you for helping me. Will post momentarily.
     
  63. Chloe'sMom

    Chloe'sMom Member

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    manxcat we started at 43, then she went to 38, and then went to 45 with karo, and last was at 59. Having trouble getting blood as she is a bit dehydrated. I have the subq fluids, but she was given 200ml last at around 11:30 yesterday morning. I was waiting until tomorrow (later today) at the same time to give. I think I will just have to keep shooting water down her??????
     
  64. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    No ketones is definitely what we want to see, but if she's down from "high" to "trace" that's good progress. It does sound as though what you're doing is working - I know it's difficult but you are seeing results. If she won't eat on her own, if you can assist feed her just a small amount that would be good. :)

    And yes, I would go with getting a little more water into her if you can too. I don't think I'd try doing subq while she's running low - I think getting some food and water in at this point is more important right now.
     
  65. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Ok, no food given, but literally at 2:39, I just checked again and it is at 111. So we are climbing! I have NOOOO idea how long she was in those lower numbers though. Can she have permanent damage???
     
  66. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Vet said to get vet ketone strips tomorrow. I'm using the human ones from Walmart at CVS. I'm afraid that the ketone strips may be inaccurate?
     
  67. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    Those are the same ones I used for Rosa when I was testing for ketones - and the same ones most people here use I think. I don't think there's much difference between the Walmart ones and the vet ones apart from price!
     
  68. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Should I still administer food now that she's higher? She last ate at 8:30/9pm or so.
     
  69. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    If you can get her to take a little food, yes please. The higher numbers you're seeing now are going to be influenced by the syrup and that doesn't last long in a cat's system. How many hours is it since her last insulin shot?
     
  70. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Oh and her eyes are dilated somewhat. She's not on any Mirtazapine or anything other than the Cerenia at 11am. Still pretty lethargic, but definitely more herself this evening than we have seen in days (minus this late night hypoglycemic episode)
     
  71. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    She's probably feeling a whole lot better overall with the ketones down a long way and her BG more under control. It will take her a while to get all the way back to normal though - getting over DKA isn't going to be instant. She's not in the danger zone right now at 59 - we just want to make sure she stays above 50 for the rest of this cycle.
     
  72. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    As of 10 mins ago, she's at 111. I'm giving her some gravy, but as hubby mentioned, we don't want to push her in the other direction either. Should we still opt for food at 111?
     
  73. manxcat419

    manxcat419 Well-Known Member

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    You could give her a little low carb food if she'll have it. I wouldn't give any more carbs for now - you need to find out if she's going to be able to maintain those higher numbers once the karo wears off.
     
  74. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    How long does it take for the karo to wear off? Vet sent us home with Royal Canin Recovery RS food to give her calories. Right now we're just giving her Simply Nourish seafood bisque gravy. Should we trying the Purina DM diabetes food, or the Recovery? Thank you for your help - we just really want to give her the right thing.
     
  75. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    We just don't know why she's not interested in water on her own now. The Mirtazapine makes her loopy, but at least she was infatuated with water to drink and play.
     
  76. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    When her numbers are lower, she won't be as thirsty - the crazy water drinking is one of the symptoms of hyperglycemia so the better her numbers are, the more you should see her drinking reduce. It's important with recent DKA that she stays hydrated though, so if you have to syringe some water into her, that might be the way to go for now. Not a whole lot, just little bits here and there.
     
  77. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Ok quick update - just had an accident where she had very loose stool -diarrhea (consistency of like stew or thick cheese sauce - sorry I know that's gross) and peed. Had to give her a bath. Her urine is still a dark yellow, which I'm not sure why. I've been so used to almost clear the last couple of years with the diabetes. Should. This be a concern? At least she's had 3 stools tonight. I'm not sure what to think of all of this?!?!?
     
  78. Chloe'sMom

    Chloe'sMom Member

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    So not all is lost in the fact we have to syringe water? Hubby worries she's too far gone when she's not wanting water. Again so used to her drinking so much. Thank you again!!! Cleaning her up now and mess in litter box. Haven't gotten to hardly any food at all. Trying not to traumatize the poor thing.
     
  79. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    Sorry, missed your message about the karo - it should be wearing off by 2 hours out at the most...probably a little less. What you need to make sure is that she can maintain her number above 50 all that time. You really need to check her at 30 minutes, 30 minutes and then an hour starting from when she last had karo (assuming her numbers don't drop low again at any of those tests). Sorry - I know that probably means an all-nighter for you but I'll check back in with you to make sure you're doing OK.

    Don't worry about it being gross - we have 6 cats here...I've dealt with just about every type of kitty accident there is! Cat's urine, under normal circumstances, is very concentrated. As long as she's not straining, she should be fine.

    No, having to give her water is fine - she's probably still out of routine too from everything that's happened in the last couple of days. None of the cats here really drink water now they're on wet food. I have a huge bowl of fresh water out for them every day but it's usually barely touched.
     
  80. manxcat419

    manxcat419 Well-Known Member

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    If you find she's keeping her numbers up without food, that's fine too - though you will need to keep assist feeding her for the DKA until she does start eating on her own of course. But for the purposes of the hypo, if her numbers stay up without food that's fine. :)
     
  81. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    Oh, and no - she's not going to have permanent damage from this. My Rosa was down in the 30s a couple of times and the 40s relatively often and she's absolutely fine. It's worrying at the time but the good thing about home monitoring is that you know when they're heading into the risk zone and you can deal with it before it turns into a problem. You caught the low number and did all the right things - she didn't lose consciousness or have obvious hypo symptoms. She's going to be fine. What you're doing now is monitoring to make sure she stays up in good numbers but well out of the danger zone. You'd know if she'd been symptomatically hypo enough to cause instant and permanent damage.
     
  82. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Ok great. I didn't check this last urine for ketones as she went straight on to the litter. Shortly after she peed - more like immediately after she had the diarrhea episode. She just now jumped up onto the bed on her own accord with me and she's getting some strength which is great. I'm right about the diarrhea or loose still so I will call the vet in the morning and ask if I should be more like immediately after she had the diarrhea episode. She just now jumped up onto the bed on her own accord with me and she's getting some strength which is great. I'm right about the diarrhea or loose still so I will call the vet in the morning and ask if I should be of a concern. She snuggled up to me right now which is great but back to the whole glucose level I'm not sure exactly what to do I'm going to check in just a few moments and I will reply back thank you.
     
  83. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    Awww - she must be feeling better if she jumped up on the bed with you. :) Enjoy your snuggles with her! I agree on checking with the vet about the diarrhea just to be safe - with the DKA, I wouldn't leave anything like that to chance. Let me know what her number is when you check her and we'll figure it out from there. :)
     
  84. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    Did you manage to get another reading yet? I'm expecting the start of a bounce at her next reading, but you'll need to know for sure before you leave her and get some sleep.
     
  85. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Omg! I am serious right now- Chloe is eating on her own!!!!!!!!!!!!!!! This episode tonight is just a roller coaster but she is seriously eating some of the dry kibble hubby got out for her. It's not ideal, but her eating is key. I cannot believe this!!!!!!!
     
    Lori & Lulu and Meya14 like this.
  86. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    That's great news! I'm so happy for you that she's eating on her own - she really must be feeling better!! :D :D I wouldn't worry too much about WHAT she's eating, just that she IS eating! Oh and with dry kibble out, if she's at a decent number now she should be fine for a couple of hours at least until you test her next. :)
     
  87. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    I started to do another reading when I observed her going after the kibble - a last minute effort idea of hubby since he knows she likes it. Will do a reading right now!
     
  88. manxcat419

    manxcat419 Well-Known Member

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    Sounds good :) Well done hubby! You've both done an amazing job with her so far - and tonight too!
     
  89. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Ok did a reading and it's 53!! vet said to do karo syrup if below 80. What do I do!?!! The roller coaster continues....
     
  90. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    Ouch! OK, you don't want her going back under 50 tonight. I'd give a couple of drops of karo - the dry kibble takes a bit longer to get into their system. And another test in 30 minutes - sorry, I was hoping to be able to let you get some sleep around now.
     
  91. manxcat419

    manxcat419 Well-Known Member

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    I'll check back in on you at your next test time. :)
     
  92. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    30-mins and at 60. That was with karo mixed with a little bit of water. I'm going to give her more straight karo.
     
  93. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    I think that's a good idea. And then test again in 30 minutes - she's not making this easy for you tonight. You're doing great by the way - you're doing everything right and she will come up and level out...it's just taking her a while.
     
  94. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Read that you give 1ml per kg of weight and she is about 3kg right now. We had given approx 1.5ml of 75:25 karo:water and just gave her 1/2ml of straight karo. Will check again in 30.
     
  95. manxcat419

    manxcat419 Well-Known Member

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    I have to admit I didn't know that calculation - I just gave "a bit" when I needed to...not very scientific! ;) Hopefully that extra 1/2 ml will bring her up a bit more. I'll check back with you in 30. :)
     
  96. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    5:20am - 77 glucose. :/
     
  97. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    Ok she is coming up but only slowly. If you can get her to eat just a little that would be good. Let's see how she does with just food and no more karo this time - we don't want her numbers carb influenced heading into her next shot time if we can avoid it. Though if she drops again we might not have much choice.
     
  98. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    Oh I did give 1/2ml karo. Oops. She just urinated which is good. Trying food now.
     
    Jeanne likes this.
  99. manxcat419

    manxcat419 Well-Known Member

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    That's ok. If necessary you can delay her next shot by an hour and work the time back over the next couple of days. Let's see where she is in another 30 minutes.
     
  100. Chloe'sMom

    Chloe'sMom Member

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    May 14, 2015
    No interest in food at the moment. Seems to want to cuddle with me now though. I'm sure she's exhausted with the glucose roller coaster, accident, bath and now this again. I will check again in 30
     
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