Ketoacidosis--Please help!

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Lauryn Harriman, Mar 2, 2020.

  1. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    Hi everyone,

    My husband and I have had a very rough day. We have been treating our cat for diabetes for 10 months now. He went into Ketoacidosis last April--he was truly on death's doorstep--but we were able to save him by taking him to the vet and having them treat him for 3 days and $3500... 10 months of twice daily insulin injections and apparently we are here again. I should say he was doing magnificently before this slip (healthy, beautiful coat, etc).

    He had been acting off for the past few days and we were finally able to get him in today. He truly is not where he was the first time we went through this with him. He is still responsive and a bit feisty (his personality is full feisty/sassy), and I truly was not expecting to get this news today. Her recommendation was to either pay $1800 more in care (which we can't afford) or that it may be time to say goodbye. He has a UTI and they want to do numerous tests, manage glucose, ketones, electrolytes, IV fluids, Vitamin B, etc.

    Honestly, I was resigned that we were going to have to put him to sleep, but I just found this message board today and I'm really hoping there is something we can do at home to treat him. He is eating and drinking on his own. He does not seem like he has given up. Before I found this forum I asked that we get the prescription for the antibiotic he needs at least--I think I was still really really hopeful and just kind of praying for a miracle in my own way. This is such a horrible call to make especially when you are making it because of money.

    Through this amazing website I have seen a couple threads where people have pulled their cats through this on their own, and frankly we want to give it a try even if it doesn't work I want to give what I can to help him survive (even if we don't have the money this time around).

    SO
    Can someone talk me through this? Give me a list? Tell me what to ask the vet? Etc? We are a bit at a loss and know nothing about this, but we want to give it all we've got!

    Thank you in advance for anything you can help with!
    Lauryn (and Ramesses the tuxedo cat)
     

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    Last edited: Mar 2, 2020
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  2. Sharon14

    Sharon14 Well-Known Member

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    Welcome, sorry it’s under these circumstances. As you know the best place for Ramesses is at the vet. DKA is very serious. Do you have the antibiotic? He needs that, SubQ fluids, lots of calories (AD food is good for that. It’s easy to syringe if necessary) and insulin. I have no experience with ketones, so I hope as others wake up, they will be around to give you more info. Where are you located?
     
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  3. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    Hi Sharon,


    We don’t have the antibiotic, no, but we’ll have it in the next hour. We decided to at least pay for that ten minutes before closing time and we live thirty away.

    He is ravenously hungry which is an improvement from yesterday. He wouldn’t eat for the vet. But has been interested in food ever since he’s been home. I just don’t know how much to feed him without triggering the diabetes. Can I feed him more food and insulin without messing up everything? I’m out of my depth if I’m being honest.

    my husband did give him pedialyte last night and he has been drinking a TON of water.

    We’re in Portland, Oregon USA.

    thank you for your help!
    Lauryn
     
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  4. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Food is medicine for him now. So is insulin. They are your best weapons against ketones; cats usually get into their worst trouble when the ketones make them feel too lousy to eat (vicious circle), so the fact that Ramesses wants to eat right now is wonderful!!!!

    Clarification: is he in actual DKA or is it just high ketones detected at the vet?
     
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  5. Lauryn Harriman

    Lauryn Harriman Member

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    I believe he is dka, sadly. They gave him nausea meds yesterday and he ate a lot of food on his way home from the vet. He is still interested in food and has been asking for it for the last 15 hours since. We gave him some tuna water to encourage the fluid which he loved. He is upbeat and his wide-eyed semi cranky self.
     
  6. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Well... that is really surprising (in a good way!), usually by the time they get to DKA, they are in really really rough shape. Let's hope that either it's a misdiagnosis, or an extremely mild version (numbers juuuuuust blipped over some borderline). Normally, DKA does require fairly intensive vet care. If he's still active and eating on his own, and is about to have an antibiotic on board, it might be possible to bring him out of this with home care, but I don't want to sugar-coat things.

    Tagging @Sandy and Black Kitty , who has had some experience with DKA recovery, hopefully she will be available to offer some insights.

    In the meantime, the "recipe" for ketones/DKA in a diabetic is: not enough food, not enough insulin, and some triggering stress (like the UTI). The first and third are being addressed with food and (soon) an antibiotic, now we need to worry about making sure he's getting the insulin he needs.

    What kind of insulin do you use, and what dose? Do you ever home-test his blood glucose, and if not, would you be willing to learn to do it?
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

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  8. Juls and Billy

    Juls and Billy Member

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    Did they test his ketones? It sounds like they have not tested his ketones yet. You can test them yourself. Many members here test ketones with inexpensive ketostix you can get at the pharmacy. They test urine. You have to catch him when he's peeing, because the urine needs to be fresh. I think it would be a very good idea for you to get a test. I can't help wondering if his symptoms could be from the infection rather than ketoacidosis, or if his ketones might not be horribly high, as your cat doesn't seem quite his normal self, yet does not have major symptoms.
     
  9. Deb & Wink

    Deb & Wink Well-Known Member

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  10. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Hang in there and hang in here... I

    Can you tell us about his insulin therapy? What insulin are you giving your cat? How has he responded ?

    Are you checking his urine or a blood for the presence of ketones? This is your first line of defense.

    The way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.




     
  11. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    Hi again everyone,

    so he definitely does have Ketoacidosis, but they did say we caught it very early (unlike last time). I ordered the litter to collect a sample and we bought the tests to both check blood sugar and the ketones. We’ve been rushing around trying to do and get what he needs. We started the antibiotic this morning and have tested his blood sugar once. It was “high” about two hours after eating and after his insulin (I gave him the insulin to him right after he finished eating).

    we bought the nausea meds and the sub-Q fluids so we are about to start that. Typically, he takes one unit of vetsulin twice daily. He has been consistent and doing amazing until recently. The last curve we had our vet draw looked “beautiful.” That was back in mid November.

    we bought the ReliOn strips and blood test. We’ve been adding some tuna water to his water to encourage him to eat. Guys, we are shooting from the hip here, but honestly whatever we can do is better than nothing because we have been planning to put him to sleep tomorrow. I don’t want him to be in pain or feel like we are torturing him, but I want to give it all we got.

    How much pedialyte should we be giving him? Does anyone know? I’m not currently having to force-feed him. He ate about 85% of his food this morning.

     
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  12. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    We just tested his blood again and it’s at 564. So it’s down, but not a lot.
     
  13. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    We just started tracking his blood today. We use vetsulin. And he’s currently on one unit twice daily.

    He tested as “high” this morning (10:30).

     
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  14. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    How many hours after the shot did you get the 564?
     
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  15. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020

    I gave him a shot at 7:45 when he ate 85% of his food. Got the “high” rating at 10:30. Then let him eat the last 15% of his food and gave him another insulin shot. We got the 564 rating at 12:30.

    I will be the first to say I don’t know what I’m doing, but I figure that if I’m getting a “high” rating he probably needs more insulin. Please tell me if I’m wrong...
     
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  16. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Some good news for you: vetsulin is a pretty good insulin to be using to recover from DKA, because it is fast-acting and can bring numbers down quickly (later, there are some other insulins that might be better for him longer-term, but let's get past this crisis first). The question now is dose, whether 1U is right for him right now, and that will probably take some discussion back and forth, and some more data from blood glucose tests. Congratulations on getting your first tests, by the way-- amazing job to get that up and running so quickly!!!!

    Because we're all in different time zones here, we have our own way of telling time, in hours since the shot. So for today, what you have for BG data would look like:

    AMPS (morning pre-shot BG): no data
    +2.75: "HIGH"
    +4.75: 564

    We also use a common spreadsheet template to record data-- you can see that most of us have links in our signatures to our cats' spreadsheets. They're really helpful, not just for you to keep track of data, but also it means anyone giving advice can see your cat's history at a glance.
    FDMB SPREADSHEET INSTRUCTIONS

    Probably more insulin is needed, but let's wait for some of the more experienced DKA and/or vetsulin users to weigh in before deciding on the next shot. And let's see where his BG is at the next shot time, in case there are surprises.

    We recommend getting a BG reading before every shot (to see if it's safe to shoot), and then more as needed to monitor between shots. You will probably be testing fairly frequently right off the bat in this situation-- DKA recovery is pretty much jumping in the deep end!-- [ETA: I also missed that you had given a second shot! Ignore the following advice and keep testing this afternoon!] but I think you can give him a break the rest of the afternoon with him so high.
     
    Last edited: Mar 2, 2020
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  17. Deb & Wink

    Deb & Wink Well-Known Member

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    And a second dose of insulin on top of the first dose means you want to test more.
    You have given 2 doses of insulin, within the space of 1 hour and 45 minutes of each other.

    How many units of insulin the first time at 7:45? How many units of Vetsulin, insulin the second time? at 10:30?

    Does this look correct? Need to know the dose of insulin given at +2.75 hours
    AMPS (morning pre-shot BG): no data 1 U vetsulin
    +2.75: "HIGH" ? U vetsulin
    +4.75: 564
     
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  18. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Hi and welcome. You are getting lots of great advice.

    Are you offering food frequently?
    Food is like a medicine with ketones and DKA and it’s very important that your kitty (not sure if his name, did I miss it?) is getting 1 1/2 times as many calories per day as he would normally get.
    What are you feeding?

    At this point it doesn’t really matter if the carbs are higher than normal.. the most important thing is he is eating and eating more than he normally would.
    It is GREAT he is eating on his own and hungry. That is a big plus!

    If you can get the spreadsheet up and running we can help you with the insulin dosing as that is just as important as food. You will need to test before EVERY SHOT and again DURING the cycle to see how low the insulin is taking your kitty.

    How much subQ fluids did the vet say to give?
    Did the vet ok giving the sub Q fluids?
    It is important to give the subQ fluids in the scruff of the neck and the insulin in a different spot away from the subQ fluids site. Also give the subQ fluids AFTER the nadir (the lowest part of the cycle... usually after +6 of the cycle).

    Do you have some higher carb food and honey or karo at home as you will need those if the blood glucose level drops low?

    Also check for urine ketones twice a day at this point... very important.

    Sounds as if you are getting well organised and have caught this early. keep posting and we will do our best to help you through this.
    Bron
     
    Last edited: Mar 2, 2020
  19. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    That's correct.

    It looks like this:
    AMPS (morning pre-shot BG): no data 1 U vetsulin
    +2.75: "HIGH" ? 1 U vetsulin
    +4.75: 564

    I'll look at the spreadsheet and try to get it updated.

    Thanks!
     
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  20. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Just seeing you gave a second dose of insulin during the same cycle.
    This is not advisable. Please don’t give a second dose of insulin during the same cycle.
    As Deb said you will need to test much more frequently and make sure you have some of the high carb food and honey available in case of low numbers. Dont wait til the numbers are low to get the supplies. Get them now.
     
  21. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  22. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Just a reminder with Vetsulin you want to test, feed him, then wait 30 minutes and then give the vetsulin.
    It can be a good idea to feed your cat 20 - 30 minutes before giving insulin. This ensures there is food on board for when the insulin starts to work. So, the sequence would be: 1. Test BG. 2. Feed. 3. Wait 20 - 30 mins. 4. Give the insulin shot

    I'm really praying that he is going to pull through, :bighug:
     
    Last edited: Mar 2, 2020
  23. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    Spreadsheet is updated. See signature.

    Just tested 5 minutes ago and he's at 552.

    Understood on the extra insulin. We won't do it again. We have honey on hand in case the BG gets low - thanks for the tips.

    For what it's worth he when he was first diagnosed he was on 2U Vetsulin 2x daily. The vet reduced it to 1U after about 2 months of treatment because it made his numbers too low. He has always been on vetsulin.

    The doctor did OK subQ fluids. 200mL today, every other day which we will be starting.

    We are taking him to the vet tomorrow for a check-in to see if there's been any improvement.
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

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    You may need to up the dose of insulin, to get the BG levels down.
     
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  25. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Re the sub Qfluids.
    200 mls in one go is a lot!
    I think if the vet said give them on alternate days, you would be much better giving 100 mls daily. That would be better for flushing out the ketones as well to have a daily lot of subQ fluids. Remember to give them after the nadir.
    What do you think @Wendy&Neko
     
  26. Deb & Wink

    Deb & Wink Well-Known Member

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    Besides having the SS (spreadsheet) link in your signature, there is some other useful information that will help us help you better.

    Go to your user id profile.
    Add to your "Signature", your first name and cats name age and sex. diagnosis date, insulin used, meter used for testing.

    In fact, I think you want to increase the dose of insulin tonight. With DKA, you need to get those BG levels down as well as keep your cat hydrated and well fed. Are you able to home test during the night time? Even setting an alarm could be helpful.

    Please let us know the most recent BG levels. And how long it will be until you will need to do the pre-shot BG tests. And give the PMPS dose of insulin.

    Hand feed if necessary. Get extra calories in your cat. Forget about the carbohydrate level of the food for now.

    Food and plenty of it is more important. Plus fluids to flush out any ketones.
    When did you do the last urine ketone test?
     
  27. Lauryn Harriman

    Lauryn Harriman Member

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    Thanks- we've been hand feeding and giving some pedialyte, tuna-water, and free access to water.

    We haven't done a ketone test ourselves but we will soon. Just got the strips so we'll be doing that soon-ish.
    Gave the 200mL per the vet's recommendation at around +6.5. He took it like a champ but looked like a hunchback for a short time.

    BG is at 570 as of +8.5. Pre-shot would be in 3.5 hours. PMPS dose is usually 1U, but i imagine we'll need to up it given the BG results we've seen today.

    My husband can do some night shift BG monitoring to keep things on track.

    Thanks again everyone...
     
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  28. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    The vet should be the expert on this, I'm not. Amount of fluids is usually based on size of cat. Another issue with 200 mls is having the cat stay still that long to give that amount! And you do want to make sure there is no heart condition going on.
     
  29. Deb & Wink

    Deb & Wink Well-Known Member

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    You might consider upping the dose to 1.5 to 2U of Vetsulin.

    Not sure which would be better for Ramesses.
    There are risks with a higher dose of insulin.
    But there are also risks if he is not getting enough insulin, that the DKA and ketones could get worse.

    With those very high BG levels, there is very little risk of hypoglycemia with taking the dose up to 2 U. But the risk is still there.
    Vetsulin is one of the in-and-out insulins. So the effects rarely last more than 12 hours.

    Be sure to give the dose of insulin as far away from the fluid injection site as possible. That is so the fluids do not interfere with the insulin absorption.

    Took another look at Ramesses SS. His BG levels really have not come down at all during this AM cycle. Not even with the 2nd dose of insulin. We need to get his BG levels out of that black color range and down more quickly.
    I suggest 2 units for the Vetsulin for tonight's dose in the PM cycle.
    I can't stay up that late to help you. Your PM injection time is in the middle of my night.
     
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  30. Juls and Billy

    Juls and Billy Member

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    I'll be up until around 3pm EST. I'll keep an eye out. I agree with Debs advice to up to 2 units 2x a day. I don't know much about DKA, but I'm happy to check in and try to help. Sounds like you have all the good DKA advice already!
     
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  31. Bandit's Mom

    Bandit's Mom Member

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    sorry - just saw this because of the time difference. nope, Bandit didn't have DKA.
     
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  32. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    PMPS is HIGH.

    Waiting 10 more minutes before doing 2 units. We'll give that a shot. Seems like he definitely needs more insulin. We'll check on him during the night.

    Thanks team for all the help. I'll keep the spreadsheet updated for our kitty.
     
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  33. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Have you managed to get the ketone test yet?
     
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  34. Lauryn Harriman

    Lauryn Harriman Member

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    Yes, we literally just got it. It’s at 5 (trace). Looking up what that means. But my husband is checking again because that seems too good to be true.
     
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  35. Lauryn Harriman

    Lauryn Harriman Member

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    The second strip is the same and he is looking sassy again.
     

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  36. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    That’s really good news.
    We have to keep checking the ketones twice a day still, to make sure they are not increasing.
    Keep up the feeding as much as he will eat, the antibiotic, fluids and monitor the BG levels during the cycles so we can see what the insulin is doing.
    Well done!
     
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  37. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Congratulations on your first successful ketone test!
    Do not let 24 hours go by without at least one Ketone test, preferably two. My Black Kitty once went from negative to large in exactly 24 hours. Any reading above “trace” warrants a call to the vet.

    I can’t comment on dosing as I don’t have any experience with vetsulin. I will say that finding the right balance of calories and insulin to bring enough food energy into his cells is key to stopping his body from breaking down its own protein and fat stores, the byproduct of which is ketones.

    You are going to be in a state of somewhat intensive care until your kitty gets on the other side of this.
    Hang in there and hang in here :cool:
     
  38. Juls and Billy

    Juls and Billy Member

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    I think Deb had a good plan with the dose increase. You need those levels to start coming down. Huzzah about the trace ketones, but as others have said, keep testing. You are taking great care of Ramesses!
     
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  39. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    We just tested again and the reading is still at “high.” Even with two units. Not sure what to do but keep an eye on him and check him every two hours. I’m hopeful with the ketones though. We’re going to the vet tomorrow, so I’m hoping they’ll have insights and see his state as hopeful.
     
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  40. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    There is nothing you can do about the BG at the moment. Just keep feeding and giving oral fluids and test the urine when you get the opportunity.
    I am not a Vetsulin user so can’t help there. Hopefully @Deb & Wink will be around before the next dose.
     
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  41. Sharon14

    Sharon14 Well-Known Member

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    I’m so glad Ramesses is feeling better! I hope his BG comes down soon. What antibiotic is he on? It usually takes a few days for that to really kick in, and when it does that should help with the BG number. You’re doing a great job!!!
     
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  42. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    BG has been High all night. Going to try for a urine sample in the next hour-ish to check the ketones again. He still has an appetite though.

    He's on Clavamox, 2x daily for antibiotic.

    Should I stay the course with the 2U for the AMPS insulin dose? Or should I consider upping a bit? I expected his BG to dip below HIGH at some point last night but it didn't.
     
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  43. Deb & Wink

    Deb & Wink Well-Known Member

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    IF the AMPS BG test is also too high, you will need to increase the dose. You are going to need to up the Vetsulin insulin dose again for the AM dose. I'd suggest you increase from 2U to 3U.

    You will need to monitor very closely. Suggest testing every 2 hours minimum. Frequent BG tests are absolutely essential when you are trying to treat DKA. Since you are trying to treat DKA at home, those tests are even more essential. Absolutely critical.

    How old is your insulin vial Lauryn? When did you first pierce the rubber seal on the stopper? Date when that was done? Do you have the 10ml vial or the Vetpen?

    Are you thoroughly mixing the Vetsulin? Vetsulin changed their directions for prepping the insulin for withdrawal back in 2013. They now say you have to shake the vial to mix the suspended particles in well with the suspension liquid. Are you doing that? And then you have to wait a bit for the foamy part or air bubbles to subside, and then roll the vial a little bit to mix gently once again, if you had too much foam. Are you doing that?

    Prep for Vetsulin PDF document

    If BG's are still in the black color coded range on the SS (spreadsheet), you will need to increase the next dose also. The PMPS dose may need to increase from 3U to 4U if you do not start seeing any lower BG readings. We want to see BGs reading down in the RED or PINK or YELLOW colors. Even lower would be good.

    It is also possible to dose Vetsulin more frequently than every 12 hours. We do not know what the duration of Vetsulin is for Ramesses. That makes it more difficult to suggest what you can do. For many cats, Vetsulin lasts 8-10 hours. You could dose more frequently, but I'm not sure how often. It could be dosed every 8 hours. It really, really depends on how Ramesses body is reacting to the dose.

    And if the antibiotic is helping him. Plus how good his appetite remains.
     
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  44. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    I see from the SS that you are using one of the Relion meters. Get plenty of test strips for it, 150 to 200 test strips would not be too many right now.
     
  45. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    Vetsulin is a 10mL vial. It's probably 2 months old and we first pierced the rubber in mid January, probably January 20th. So, the shelf life is ok, but technically we should replace the bottle because it's been more than 30 days since the first puncture.We typically start a new bottle every 4-5 weeks, it's possible this one perhaps has lost some effectiveness.

    We have been mixing according to the instructions you mentioned.

    When we see the vet today we will grab a new bottle and ask about the dosing.

    Ketones are negative! Appetite is strong. Personality is back.
     
  46. Lauryn Harriman

    Lauryn Harriman Member

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    Mar 2, 2020
    AMPS is 588. Feeding him now.
     
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  47. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Well, better than "HIGH"! Let's hope that means he'll start coming down now (esp. with the antibiotic just starting to take effect, hopefully).

    Always good to check on the status of the insulin when getting these kinds of numbers. Sounds like yours is OK, though.

    Hooray!!!!!
     
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  48. Deb & Wink

    Deb & Wink Well-Known Member

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    I think your insulin is ok too. Wanted to check though.
     
  49. Juls and Billy

    Juls and Billy Member

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    Huzzah for the negative ketones! Keep being awesome, you'll get those BGL down.
     
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  50. Lauryn Harriman

    Lauryn Harriman Member

    Joined:
    Mar 2, 2020
    BG is still high. We did 2.5 units. I was admittedly really nervous about overmedicating him. Ugh. Maybe we should have. I'm checking him hourly now to see where we end up. Seeing the vet in six hours.

    Please continue to send good vibes. Still hopeful, but worried about when the clavamox will start working and getting us where we need to be. May take another urine sample before the vet just to see where we're at. He is ravenously hungry.. I'm feeling bad that I can't feed him all the time. Anyway, we're truly doing our best. He is now pretty feisty about all the poking which I take as a good sign.
     
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  51. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Feed him as much as you can. I'm not a ketone expert, but everyone says the treatment for ketones is hydration, insulin, and food. Diabetic kitties don't utilize food as well as non-diabetic kitties, and they often need much more food than a normal cat ( sometimes twice as much) since much of the calories are going straight into the litter box. With Ramesses' high BGL and other issues right now, if it were me, I'd feed him every single time he asks for food and leave food out for him while you're out of the house. Low carb wet food won't raise his BGL. All you need to do is pull any uneaten food up 2 hours before when you do your pre-shot test. That way he'll be hungry enough to eat when he gets his insulin, and the pre-test number won't be bumped up be recent feeding.

    Just a question-- you aren't trying to make him get by on only 2 meals a day, are you? Too many vets suggest this (I know my vet did, but I ignored him because I used to be a diabetic myself.) Like all diabetics, cats often do better on many small meals a day rather than two big ones. And when the time comes, having food available will help Ramsses if his blood sugar drops too low. Cat's naturally get hungry when their blood glucose drops, and that can keep them from getting a hypo reaction.
     
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  52. Lauryn Harriman

    Lauryn Harriman Member

    Joined:
    Mar 2, 2020

    Great question! Yes we were. They told us not to let him free eat, but we were trying to find a balance between not free eating and letting him eat when he complained.

    we’re headed into the vet now, so hopefully she can help/give us different food. All we have is the low carb dry food at the moment.
     
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  53. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Okay, here's my opinion, and it's something a lot of members here follow. First, there is no need to feed any prescription food from the vet. All you need is low carb canned food. There's a food chart here. Many members feed Fancy Feast Pates. My Billy went into remission on Fancy Feast Pates. I'm going to post this now, hoping you'll see it before you buy expensive food from the vet.
     
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  54. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Next, I want to address the two big meals thing. I highly suggest you ignore the vet on this one. Even if your kitty is overweight, now is not the time to limit food. Feed him any and every time he is hungry. Especially now with the DKA. I didn't limit Billy's food at all when we were getting him regulated, even though he's a fat boy. Many small meals help the body regulate blood sugar and keep it on more of an even keel. Worked for me when I was briefly diabetic, and absolutely worked for Billy too. As I said, just withhold food two hours before pre-shot test.

    I also would like to know what kind of dry he's been eating. Is it a prescription dry? Our vet's office sent us home with Hills M/D, which is high carb and horrible for diabetic cats. I ended up giving it back, unopened, and I was angry at the vet for a hot minute for prescribing it. Interesting fact, the vet told my sweetie we should feed a low carb wet diet, it was the tech that sold him the exact opposite.

    If you didn't see my above message in time, it's up to you if you want to feed any food they might have suggested. Let us know the brand of food and we can help with the carb content and see if it's a good choice. Any unopened food can be returned to the vet, I imagine.
     
    Last edited: Mar 3, 2020
  55. Briere Fur Mom

    Briere Fur Mom Well-Known Member

    Joined:
    Sep 19, 2019
    One member that I can think of that's dealt with DKA w/i the last 6 months would be @For_Luna . I haven't seen them on in a lil bit but, they do check in every now and again. I wonder if they couldn't offer you some additional advice. Sorry for being nosey:oops:
     
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  56. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Please, please feed Ramesses multiple times during the day and night. Only feeding before shots is old thinking and definitely not the way to treat DKA. Don’t follow your vets advice if he advocates only feeding twice a day.

    The reason ketones develop, simply explained, is when there is not enough food and insulin and the body can’t use the carbs, for nutrients so the body starts to break down proteins and fats and that produces ketones. So getting food/calories and plenty of it, into Ramesses is so important as we need him to be using the carbs in the food for energy not the fats and protein that will form the ketones.
    Please reread sandy and black kitty’s post several posts back as it explains it well and she is very knowledgeable about DKA and it’s treatment.

    You are so lucky that Ramesses is hungry and willing to eat. Many DKA cats won’t eat and need to be syringe fed for days.

    I hope the vet took some blood to check how the DKA was going.
    Please let us know how the vet visit goes.
     
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  57. For_Luna

    For_Luna Member

    Joined:
    Jan 24, 2019
    I'm sorry you're going through this. We had Luna at the animal hospital for 12 days and got every piece of bad news possible, and she still made it through. It sounds like you have everything covered.

    You know what caused the DKA come on; the UTI.
    You have antibiotics.
    Your cat is eating and drinking.
    You caught it early.

    Keep testing BG and ketones. If something looks off, call your vet. Our first sign was Luna stopped eating and just looked different. Unfortunately, we caught it really early and her blood test didn't show any signs of infection or DKA.

    Call your vet 100 times if you have to. We had to learn to be annoying. The vet's office will have to deal with it.

    Listen to the advice on this board but listen to your gut too. You know your cat.

    I'm sorry I can't be of more help. By the time our vet figured out what was going on with Luna, she needed to be hospitalized. We didn't do much treating on our own.

    Please message or tag me if you have any questions. I hope everything works out for you.
     
  58. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Please, please feed Ramesses as much as he wants. He needs the food to combat the ketones from developing further and the more food the better.

    In fact right now, I would not worry about carb content, canned versus dry. Or any of the "normal" suggestions we give to diabetic cat owners. Whatever and whenever he wants to eat, feed him.

    What did the vet say at Ramesses visit today?

    p.s. He needs more insulin. You have GOT to bring those HI BG readings down ASAP.
     
  59. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    If you want a happy medium between free feeding which is fine or the 2 meals the vet tells you. Try feeding every 3-4 hrs AROUND the clock. You don't have to tell vet.

    But those numbers need to come down. You might need different insulin. Subq fluids can also help with ketones. You can do them at home. Try kitten wet food, higher in calories but still under 10% carbs. Also Fancy Feast Savory Centers beef or chicken flavor. Cats really seem to love these.
     
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  60. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    A short acting insulin like the Vetsulin, an in-and-out type insulin, is better right now than a long acting insulin like Lantus or Levimir. Takes too long to build the "depot" when a cat is in DKA.

    Agree with everything else Olive & Paula said.
     
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  61. Lauryn Harriman

    Lauryn Harriman Member

    Joined:
    Mar 2, 2020
    Hi everyone!

    I wanted to give you a little update. Rammy is up .6 pounds. He was at 11.3 Sunday, and is now at 11.9.

    The vet was super impressed by the progress we made and was really positive. She said the BG will come down it just might take a bit. She said not to up the dosage because it will accumulate and the antibiotic will kick in.

    Anyway, it was super positive. THANK YOU all! I'm hoping all is up from here, but I'll keep you all updated!
    Lauryn
     
  62. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Don't understand why the vet thought the dosage would "accumulate". Vetsulin, being an in-and-out insulin, is used up in the cats body and does not last beyond 10-12 hours.
     
  63. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Vetsulin doesn't accumulated. She's confusing it with lantus. I'm not sure your vet knows a whole lot about treating diabetes. We want to get your cat out of those scary black and red numbers. Your dose is too low. Cats dosage needs change. So glad you are home testing now.
     
  64. Lauryn Harriman

    Lauryn Harriman Member

    Joined:
    Mar 2, 2020
    hi Janet!

    sorry guys! It’s me not her. Honestly this whole thing has been extremely extremely draining and I totally wrote that out wrong. It’s not her, it’s me hahaha. This is all not my forte so explaining what she said is suuuuper hard.

    She wants me to send his numbers to her and she will advise accordingly. And she wants me to do a couple full curves for her so that she can tell where he’s at and tell me how to adjust his insulin, so I will be emailing her throughout the week. She does know a lot about diabetes. I’m the one who doesn’t. But there is some syndrome that apparently can tank a cats blood pressure fast and kill them, and she wants to be safe and avoid that at all costs.

    On another note, the urgent is still negative for ketones, and the antibiotics seem to really be kicking in! His numbers are trending down which is great! I’ll keep you posted again later today!
     
  65. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    We'd appreciate that very much. We worry about members when they disappear and wonder if they and their cat are ok. Especially worrisome if the cat is sick, like Ramesses.
    I think you mean taking a cats blood glucose down very fast? Is that correct? It's called hypoglycemia. With those high black range BG numbers, Ramesses is no where near hypoglycemia. Not even near hypoglycemic numbers in the red, pink, yellow, blue ranges you see on the spreadsheet. It's when a cats BG (blood glucose) levels drop below 100 (<100) and then much lower, <50 that we become concerned.
    Good that the urine is still negative for ketones. Things are looking up.

    Ketones can develop very quickly, so if a cat has ever had ketones, like Ramesses has, then we suggest you test for ketones daily. Always. To catch the situation as early as you can, and avoid DKA (diabetic ketoacidosis).

    Improving symptoms with him on the antibiotics could have helped with the ketones also.
    Would you be willing to update your spreadsheet, so we can see those lower numbers? Is Ramesses down in the blue or green color coded numbers today?
    Understood. Take your time. Reread what our responses were. It's a lot to understand and can take some time. We can help with that.

    Keep asking questions. Think of us as an adjunct resource, sharing knowledge with you that you can then share with your vet. Having a support group like this, as well as your vet can be very useful to diabetic cat owners.

    ECID. Every Cat is Different, Every Caregiver is Different, Every Cycle is Different.

    Keeping our paws crossed here that Ramesses continues to do well and get better and eats more.
    p.s. Prozinc, Lantus, Levimir are the preferred insulins for cats. You might want to see if your vet is aware of the
    (2018) AAHA Diabetes Management Guidelines for Dogs and Cats

    See page 4, left hand column in that linked document. Vetsulin is recommended for dogs, not cats.
     
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  66. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi @Lauryn Harriman how are things going with Ramesses?
    I haven't been around for a few days, so just catching up?
    Would love to hear an update if you have time.:)
     
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  67. Lauryn Harriman

    Lauryn Harriman Member

    Joined:
    Mar 2, 2020
    Hi all,
    I know it's been quite awhile... I apologize for that and I want you all to know that we deeply appreciate the time and support you provided for us. There's been a lot going on in our lives with a separate family emergency (even before the pandemic thing!), and because of all of these factors, we stepped back from the forum and we were consulting with our vet predominately for treatment direction.

    This is actually her husband now, (Bob) and I'm stepping in to pilot the home treatment. Ramesses had plateau'd but never really got much better than last time we spoke.

    We have been working through things with our vet as best as possible, and even got a second opinion from another vet but they basically reiterated what we were already told. They were concerned about increasing his insulin dosage too quickly, so we were incrementally creeping it up by .5U each week. They were concerned about a Somogyi overswing if we increased too fast. I think overly concerned IMO.

    They are very nice and capable vets, but I don't think they are experts in diabetic felines...So I wanted to give you all an update:
    • His BG levels never really got below HIGH, hence the lack of updates to the spreadsheet. We've never been able to make a curve because of this.
    • We finished the antibiotic treatment and he seemed a lot better - 1 course of antibiotics.
    • He still has an appetite and is eating normally.
    • He drinks and pees a ton still.
    • We were on Vetsulin and maxed out at 2.5units 2x daily.
    • We are administering subQ fluids at home every other day. 200mL per vet's recommendation. It really helps hydrate him.
    • The vets think he developed a resistance to Vetsulin. We just switched to Lantus yesterday, and I got one of those pens. He's on 2U 2x daily. Too soon to see how well it's working.
    • He's lost 1lb in the last two weeks, he's down to 10.5 lbs.
    • His ketones are back at "trace" now, so we're looking potentially at DKA again if we don't manage it.

    Has anyone switched from Vetsulin to Lantus on the forum? Is it really a 1:1 dosage shift, or should we be upping it?

    Personally, I want to up it because I'm sick of seeing the "HIGH" BG. But I understand that Lantus works a bit differently than Vetsulin, so I do want to be careful.

    Probably not going back to the vet at this point. We have little left to lose and we're just thankful for any of the time that we have left with him. He's a sweetheart.

    Thanks all! :bighug:
    Bob
     
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  68. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Bob, I'm very glad to hear from you.
    It may take time but if he has recovered from the DKA we can hopefully get him back to good health.
    I'm glad Ramesses is eating well. Continue to feed him as much as he will eat. He needs at least 1 1/2 times as much as he would normally eat at the moment to keep the ketones at bay.

    Continue to test every day for ketones. Are you testing with urine testing or a blood ketone meter?
    With the swap over of insulins and the trace reappearing, it would probably be prudent to be testing for ketones twice a day. Could you do that?

    Yes, lots of people have swapped from Vetsulin to Lantus. It is normally a swap to the same dose..
    However Lantus is a depot insulin and it can take 5 days for the depot to fill initially so you need to stay with the same dose for the drop to fill and stabilise.
    Also are you using the Lantus pen which only goes up in 1 unit doses?
    What you need to get is some insulin syringes ...do not use the Vetsulin syringes..asthey are the incorrect type.
    You can buy some suitable syringes from Walmart if you are near one.
    They are called Walmart ReliOn 3/10 U-100 30 or 31 gauge 6 mm or 8 mm insulin syringes with 1/2 unit markings. They are $12.58 a box of 100. If you can't get that brand there are other brands such as Uticare, Carepoint, Sure Comfort and B/D.
    Make sure they are the above type and make sure you only get ones with 1/2 unit markings on them.

    Please try and maintain the SS now as we rely on that to help you even if it is only highs. I know how dispiriting that can be but hang in there, post every day and we will stay with you and help get this boy better!
    Make sure you are testing before every shot and try and get a test in about 1/2 way through the cycles.

    Are you feeding multiple times during the day as well as before the shots?
    What are you feeding him?
    He is probably losing weight because he is unregulated and the nutrients are not being absorbed.
    I will speak to a couple of others about his insulin dose.
    Looking forward to hearing back from you Bob.
    Bron :stop:
     
    Last edited: Mar 17, 2020
  69. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Switching insulin leaves a ketone prone kitty vulnerable. If he were mine I would increase to 2.5u with the next shot.

    when my BK was heading towards his second episode of DKA I was guided by an FD guru on how to use Humilin R (R for short ) a fast acting non depot insulin, along with Lantus.

    The idea is that R will help you keep a ceiling over how high the numbers go while you are climbing the dosing ladder to a good Lantus dose. It also gets more insulin into the picture which is critically important when battling ketones.

    Note - It’s not advisable to attempt to add R to the mix without the guidance of someone who has experience.

    I believe it can help. Let’s see what others think.
     
  70. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I agree with Sandy that increasing the dose to 2.5 units Lantus is needed. I would do this at your next shot as more insulin is needed to keep the ketones at bay. This is so important.
    Also Sandy's idea of using R insulin to help bring down the BG is an excellent idea.
    However, as Sandy said, you would need guidance from an experienced user of R insulin to do this and this can be organised if you would like to do this. We would hope to get Ramesses out of those black numbers.

    I think it would be better if you started posting over on the Lantus page now that you are using Lantus and where you will get more experienced Lantus users to help you.
    Here is the link. Put 'post DKA kitty' in your subject line to alert people. I will watch for your post.
    http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
     
  71. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    My girl switched from Caninsulin (Vetsulin is just a rebrand) to Lantus. We should have switched at the same dose, didn't and took forever back to where we should have been. Ended up going higher in dose. I was lucky I wasn't dealing with ketones. That's my long winded way of saying increase to 2.5. If there is any way you can get later tests in every PM cycle, say at least +2, we'll be able to help you increase the dose faster. He needs to get out of those Highs.
     
  72. Lauryn Harriman

    Lauryn Harriman Member

    Joined:
    Mar 2, 2020
    OK. Thanks everyone. He's been on the glargine 2.5U for about a week now. Still "HIGH".

    No ketones though! I am urine testing.

    Still feeding him dry Royal Canin Glycobalance. He loves it. Open to other foods though if switching might help.

    I posted here:
    http://www.felinediabetes.com/FDMB/threads/post-dka-kitty.227503/
     
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  73. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Glyco balance is about 25% carb. Diabetic cats should eat foods under 10 percent. This may be why his numbers have not come down yet. Definitly change foods.
     
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