Home care after DKA??

Alice went into DKA Friday night. The emergency vet kept her for 3 nights. Now we are waiting at my busy regular vet's office for her to stay just until 6pm (central time) to help keep her stabilized. I don't know what to do after that. I took pictures of all her records and notes from the emergency stay and I will post those on this thread too.

How will I need to care for her at home? Can I learn to do subcu fluids myself? My regular vet is not equipped for overnights so for the moment I'm just here to get her back on her IV for the rest of the day, and see how her sugar is and go from there.

 

ER vet pages 1-4

 

Your vet can show you how to give sub-q fluids at home. Lots of us have done it ….it's just one more thing to master and I'm sure you can do it!

 

How often should I check her BG when she is home? I can set alarms and check all night and I will if I should. How often should I check for ketones? (I will get test strips today.) How will I know if she needs subcu fluids?

Does anyone keep a short-acting insulin and use it at home ever, for emergencies? Is that a thing?

I'm starting to have trouble thinking straight. The last few days have been a psychotic blur of this most of all but lots of other things. I need a schedule. Or something.

 

I've been through DKA twice with Teasel. I wouldn't wish it on anyone ...

Here are the basics of recovery treatment at home:

• kitty needs calories - up to 50% more than normal - to prevent ketone formation from metabolic breakdown of body fat and muscle (you might have to syringe feed)
• during recovery wet food should be high enough in carbs to support a large enough insulin dose to prevent ketone formation - maybe mid range carbs (10 - 15%?)
• insulin in a large enough dose and do not skip a dose - ask for help in deciding on a lower dose if PS is lower
• hydration is very important - add extra water to all wet food meals and/or give subQ fluids in amounts appropriate for the kitty (be careful if there are cardiac issues - ask the vet)
• use meds as needed: 1. antinausea/vomiting (Cerenia or ondansetron); 2. appetite stimulant (mirtazapine or cyproheptadine) if anti nausea meds alone aren't enough; 3. diarrhea meds if that's an issue (metronidazole or tylosin)
• test urine for ketones at least once a day for the first week home or so

Know that recovery can be slow and it could be weeks before your kitty is back to normal.

 

@Kris & Teasel that was perfect and I needed that list just like that. Thank you so very much.

My god it was terrifying and no I wouldn't wish it on anyone else either.

Now I need to know if she can safely switch insulin from NPH to Lantus now? Later? (I posted on the Lantus etc group).

 

I just called the vet and her BG was in the 600s but she had just eaten a bit ago. Sigh. They are administering 2u Novolin N and will recheck in 3 hours. Apparently they gave her a little of their dry Purina DM and I about flipped. I have NO idea about the carb content of the dry. But she also had some of her Fancy Feast 2% carbs. (1.5oz)

I feel so lost again.

 

I think the dry DM is about 14% carbs. Don't worry about carb level right now. Getting her eating consistently is far more important so whatever that takes, do it. She also needs to be well hydrated. Adding extra water to wet food meals (if she'll tolerate it) is an easy way to do this. When Teasel was very ill a year ago I added 4 Tbsp of water to every meal and he was fed 4 meals a day, so 16 Tbsp daily. That's equivalent to 240 mL or close to 1 cup of water extra per day. I also gave him subQ fluids a couple of times but the water added to food was my main approach.

It's critical that you have an at home pharmacy of meds when she comes home. Antinausea meds top the list. Cerenia is good for vomiting and somewhat for nausea. Ondansetron is better for nausea. Treat for nausea first. If that doesn't get her eating, add in the appetite stimulant. Mirtazapine is usually the vet's first choice but I gave Teasel cyproheptadine - less likely to cause side effects like agitation, yowling, etc.

I think it would be better if they start her on Lantus while she's in hospital. It's action is much different to that of Novolin (slower onset, needs to build up in her system over a couple of days). They might be able to find a ballpark dose for you to try when she gets home. The Lantus forum people can help you with assessing/adjusting the dose. It'll be important to NOT skip doses once she's home, even if her appetite isn't 100%. You'll need advice about that too.

 

Well my vet closes today and I don't know about funding any additional hospitalization. So I suppose for now keep her on the Novolin N while stabilizing her?

 

I have cerenia and mirtazapine from Friday before DKA happened that I had picked up. She is choosing to eat on her own and she has been since sometime late Saturday. Ondansetron is expensive but I'll ask about it when I pick her up. Thank you.

 

Anything else to add on a supply list?

 

Do you have good syringes to help assist feed? http://www.felinediabetes.com/FDMB/threads/syringe-assisted-feeding-video-and-tips.144367/

And some yummy soft pate easy to syringe? Sometimes kitty will go for all meat babyfood, but it's not a complete meal for long term. Royal Canin Recovery or A/D from the vet syringe easily. Tikicat Velvet Mousse pounches are also nice and soft. Worst case, add a bit of water to her normal food to make a nice mousse texture. Problem is that some cats develop a food aversion to whatever they ar syringe fed, so getting an alternate flavour can be a good idea. Once had a hepatic lipidosis kitty that took 6 weeks before he'd eat chicken again after I syringe fed the Recovery for a couple weeks.

I have heard ondansetron at Costco (generic brand) is much cheaper. In Canada where I am, even the generic is a ridiculous price. Fortunately your kitty's dose would be just a portion of a pill. Do you have a good pill cutter?

 

I have a friend that is a nurse. I'm sure she has some things like pill cutters lying around!
I have one giant syringe for feeding, I'm going to ask them for another when I pick her up. She didn't like it when I tried Friday. But she IS hungry and does want to eat again, so far.

 

She is home.

BG on freestyle @ 9:30PM (30 min ago) was 403, it has been slowly climbing, from 356 @ 6:45PM, and within the past 30 minutes I've been trying to help her eat and drink more. A few minutes ago she seemed to start breathing just a little faster and acting a little spacy as she lies down. Am I obsessing? Or should I test again?

 

Vet has advised 3U Novolin N every 8 hours but it's only been 6 hours.

edited to add: Nevermind, I don't know, I just thought she was acting a bit odd for a minute. Now she is up and grooming and I need help on how to keep her from trying to remove the bandage wrap thing covering up her IV port. She has been very insistent about tugging on it a few times. I want to know if I can nap for an hour.

 

Glad she’s up and grooming. Not sure what to tell you about the port, but you do need to rest. You have to take care of you so you can take care of Alice. Set an alarm to wake for her next test/shot.

 

Yes....remember, you have to take care of yourself too or you won't be any good for Alice

It's probably fine to go ahead and remove it now anyway unless your vet specifically told you to leave it on for some reason. It usually only takes a few minutes for the blood to clot so you can safely remove the wrap

 

I can't get a blood sample for a BG test. Alice is purring and responsive. Hungry and accepting freeze dried chicken in exchange for ear punishment. Going to feed more. Maybe she isn't hydrated enough to bleed?

So do I shoot?

 

Sorry I haven't experience with dosing Novolon N.
To check hydration pull up the scruff of the neck. It should fall back fairly quickly if hydrated. Also feel the gums. If they are slippery hydration is probably ok but if tacky may be a bit dehydrated.
It is best not to skip a shot with DKA in the picture. Can you try and test again?

ETA did they tell you the last test for ketones result at the vets and have you been able to test at home yet for ketones?

 

Were you able to try again to test? As Bron said you don’t want to skip insulin after DKA. Since she had climbed to the 400’s @+6, and was eating, she was probably high enough to shoot anyway. Did the vet give you subQ fluids to give her? Unless there’s a reason not to, such as heart trouble, I’d ask about that.

 

Update: my phone is broken now so I'm having trouble checking and responding

But I did give her 3u NN at midnight

7am her reading just said high so I gave her 3u NN an hour early. +1 after her meter read 495.

Driving her to the vet in a min to see if she needs her port out or more IV fluids and I will get a subq lesson while there.

 

Today while at the vet she read as "high" on her meter again so we gave her additional novolin N.

+3 from that she was reading down to 305. About to test and shoot.

She is SO tired now. I'm sure I would be too, but its breaking my heart I cant fix it.

Need to try to check for ketones again when I can get another pee but she was negative last night and this morning.

 

You are fixing it! By testing, feeding, giving shots, fluids, testing for ketones, and giving her love and comfort. You’re doing a great job. It can be slow going at first, but you’ll get there!

 

There are meters that you can get that measure both ketones and BG from a blood sample. Different strips for the different jobs, but a few members here use them.
Keto-Mojo and Nova Max combo are a couple that come up in a web search.
And Sharon14 is right, you are fixing it. I know you are tired and worried, but you are doing so well.

 

Thanks. I cried at my vet yesterday.

I am sleep deprived, the house is disgusting, I have 4 other fur babies that need me too, and I am broker than broke.

BUT at +3 just now Alice was at 227 and I never see her that low. Ever. She is eating on her own. She's still a bag of bones though. I know that will take time.

We are just being really aggressive st this point with the NPH at 4u 3x/day and more in emergency highs.

I think I forgot to mention, one of the ER vets said the little mass on her belly she has had for months is possibly a mammary gland tumor. I need to start thinking how I can get additional diagnostics because generally we all expect there may be another underlying condition causing or exacerbating her diabetes. Her Lantus will be coming soon too and I'll be glad to see if this regulates her better.

Anyway, all I care about for now is seeing her in the 200s for the first time! <3

 

Oh and as for the meters that test both BG and ketones, I assume the strips and meters are pricier? :\ Is it more cost effective to just use ketone strips?

Also as far as ketones go, she's getting a lot of food but not "too much" and her sugar is improving a LOT. Would her ketone risk be much lower now?

Oh and will her antibiotic hurt her appetite.

 

There are different prices for the combination ketone and glucose meters, the Keto-Mojo looks like about $50.00 - $60.00, the Nova Max Plus looks like between $30.00 and $40.00. The ketone strips are more expensive, yes. It looks as if they are around $2.00 per strip, in boxes of 10 strips.
If you are able to get a urine sample and test with the ketone urine dip strips you are using, that's much more cost effective. I think some members use the combo meters because it may be very hard to get a urine sample from their cats.

I'm sorry I can't offer input on your second and third questions. Hopefully someone who can will be along soon. I'm sorry you have had such a bad time, and hope you can lay down and rest more today. You are taking care of the other animals, and the house stuff isn't going anywhere (I've been waiting for years for that to happen!) Take care of yourself, so you can take care of Alice and the other fur kids. It will all get taken care of eventually.

 

Sort of but you still want to be checking at least once a day for awhile. It's a lot easier to treat if you catch it early...but it's good that she's eating well and her numbers are better!

It may....some antibiotics cause some kitties to be nauseous so be aware of that. She NEEDS to eat, so we don't want anything to cause her to feel bad and not want her food. Also, you should put her on a probiotic to help keep her from getting diarrhea from the antibiotic. Lots of people use the Probiotics from WalMart or any pharmacy. You can get capsules you can open and sprinkle on her food

 

Yes it is - Walmart's Relion dip sticks are just $6 or $7 for 50ct.
With recent DKA it is better to test multiple time a day - and I know how fast these dip sticks go.
Dip sticks are not as precise as blood ketone meters but does the job - it'll let you catch any ketone development early.I'd stick with strips for now if $ is an issue.

Some reported that AB (I think Amoxicillin/ Clavamox were mentioned more often than other) affected the appy temporarily. My cat was ok on it.

You certainly doing everything needed to keep ketones at bay - foods, water, insulin and AB. Just keep doing what you doing. Ketones can develop very quickly - sometimes in a day. Sometimes with cats who are well regulated and below 200.
Alice is in vulnerable situation right now - just out of hospital but your latest updates sound very promising.
I hope she recovers quickly!

 

Woot!!! Go Alice!

 

Guys she just tested at 148 on her freestyle. I am thrilled. But I am still supposed to shoot 4u now. Thoughts?

 

Also this was her strip test at 12:30 today when she missed the box again and I got a straight stream into a cup again. Lol. (Also urine is more yellow today than yesterday which is less hydrated.) Since these sticks my nurse friend gave me test all this other stuff, can anyone tell me if any of it is relevant?

 

Her WBC count was practically off the chart high when she was in the hospital. So if I can glean any additional health info from the rest of what these test for, I want it. She needs all the data I can get.

 

Cassandra, I suggest you begin a new thread with the title that you need dosing help so that your last three posts are going to get the attention they need faster. OK?

 

I did start a thread to ask about whether or not to shoot. And I called my vet. Is it easier for people for me to have more posts or a single post with more information? Generally, I mean.

 

This was a different issue that you needed addressed right away and it's very possible that someone that could answer would not have seen it right away on this thread you began Monday.
You can begin a new thread every day, and link the previous thread for continuity.
To do that you highlight the address above the thread, in this case: http://www.felinediabetes.com/FDMB/threads/home-care-after-dka.212964/#navigation, copy it and paste into the new day's thread. Then write your new message.

 

Okay. Thanks. I'm having technological issues so it's been difficult to use the forums these past two days. I can make new ones next time too.

 

If you need help with linking the previous post, ask someone and they can plug it into their response. You are in a different time zone than I am and I have been a slugabed lately to boot, or I would offer to look in first thing in the AM and help. You are perking around and I am still snoring. I am not a reliable source first thing sadly.

 

Haha. If you knew how little sleep I've had.... the time zone no longer makes a difference. I'm not even in time anymore I'm such a zombie. You're fine. My phone is broken and only half sort of working and I'm having trouble navigating on someone else's. And I'm too tired to brain much. I keep trying to nap between feedings and checks and I can't because anxiety. Yay. :b

Thanks for taking the time to respond.

 

Oh sweetie, I am sorry you are so tired and stressed. Try to relax, Alice is doing better and you need to be healthy to continue what you need to do. It's been a rough road for you both, but I am seeing a light at the end of the tunnel, can you see it? I wish I lived next door and could bring you a cup of tea or some homemade chicken soup. I would even do your dishes.

 

That's thoughtful, @Idjit's mom , thank you. I'm needing to work out a schedule I think. Feed what when, test when, take a break or nap when, shoot when... I need to straighten her shelves up too. I'm a bit worried about her hydration and haven't tried subq fluids yet but I have a bit of a bag left from her hospital visit. Nervous. That needle and my tiny wisp of a girl!

 

Here is the wonderful video tutorial How to Give SQF - that's how we learnt it.
It is intimidating to think about it but actually doing it is much easier. You mentioned a nurse-friend earlier - is there any chance she/he can spent time with you helping for the 1st time? It'll take less than 10-15 min for the two of you. Ringer's Lactated Solution (RLS) not only provides hydration but restores some of the depleted by DKA electrolytes and is crucial to the recovery. I know how exhausted both of you are but it really important to get it going daily. Additional bonus - hydration does help with appy and general well-being.

We were doing the same here in 2017. If you click on Ducia's SS and then the 2017 Tab at he bottom of the screen you'll see in the Remark Section records as to what was done. Ducia was fit w/feeding tube but the rest is just like what you are doing for Alice right now. I recorded all foods by time and portions, meds, water orally and via SQF - all in there. Take a look, maybe it'll help you to figure out something for yourself and Alice.
(And no, you don't have to test as often as I did back then and you do not need to stay up as I did - don't let it scare you! I was a wreck and could not sleep at all. Please make sure you do plan your naps, rests , etc - looking back I regret that I exhausted myself to the degree where I was not the greatest help for Ducia. )
Wishing you both the very best and speedy recovery for little Alice.
@CassandraCatface

 

@Tanya and Ducia , thank you for the supportive reply. I am just as much a wreck, or was, but each half day or so I see her perk up a smidge more and I'm feeling more hopeful. I am exhausted and I hurt and until last night I think I had only 12 cumulative hours of sleep in 5 nights, but I got a nap and an extra full cycle of deep sleep last night! I hirt everywhere but I know, if I just keep going it will get better and she and I will both be able to rest more readily and comfortably.

I do want to see if my nurse friend can help. Our schedules are weird. It helps to hear its nor as bad as I am thinking. My partner is a CNA and has also been getting to know what she needs, and her hand is swifter than mine with the pokes.

She's doing confusingly well though. 300s pre shot and 100s in between, right now.

 

I just want to share ... I’m new and just found this thread and I’m so glad I did because it’s SOO validating! I’m 2 wks post-DKA and completely, totally exhausted!! It also helps to see what folks are advising and what you did is what I’m doing. I’ve learned on the fly because post-hospitalization, vet hospital did not advise me at all what to do. Principessa just kept crashing, each time stopping my heart, it is so terrifying. How is your kitty doing now? Kind regards, Princi & Lee

 

@Starfiregirl if you are needing assistance with post DKA care, please start a thread and we will be happy to help you.

 

Note that there are different times specified for reading the various test pads on the strip.
KETones read after 40 seconds, GLUcose after 30 seconds. The pads change color with time as well as with the concentration of the parameter being read. For KETones, the pad darkens (higher ketone level) with time. Thus, you have to read/compare the color of the pads with the colors on the vial at the time specified.
The LEUkocyte (white blood cells) pad reads 99+% false positive for cats and thus should be ignored.
The SG (Urine specific gravity) pad is not really accurate but it may be OK for determining trends.