Newly Diagnosed After Surviving DKA

Hi All- My name is Joanna and my sweetheart 8-yr old Maine Coone Tabby named Ozzy was jut recently diagnosed with FD. We found about out his diagnosis after he was hospitalized last week for 4 days because he was in DKA. We had been concerned about his weight for awhile and had decided to put him on a diet about 6 months ago. We switched him to a half wet half dry food diet and we did notice that he started loosing a little weight but we thought this was normal because he had been eating less dry food and less calories overall. What we did not know, is that he probably already had diabetes at this point and his weight loss was obviously contributed to FD and not to the new diet we had him on.

If he had not been on a diet, we would have taken the weight loss as a serious indication and taken him to the vet. We love both our kitties dearly (we have another 13-yr old happy healthy tuxedo kitty named Figgie) and they are both part of our family. To learn that our beloved Ozzy had diabetes and was in critical condition in the hospital was absolutely heart breaking.

We now have had Ozzy home for 4 days since the hospital intervention and he is working on his recovery. I have been trying to find out as much as I can about diabetes and I am most particularly interested and hopeful in finding ways that we can reverse his diabetes. We now have him on wet food only. Since he is still recovering, he is not eating much, only about half his daily calories throughout out the day and only eats about .5-1 oz of food at each sitting. Our vet said this could be due to all the other medications he is taking including antibiotics and potassium supplementation.

His second day home, he seemed to start showing signs of improvement. But yesterday he looked really dumpy and laid in the same room and didn't really move around much. It was so hard for me not knowing if his sugars were high and that's why he felt awful or if it was due to all the meds he was on. I finally broke down and brought home a glucometer and tested his sugar. It was 348!! I immediately called the vet and asked if we should give him insulin, even though it was 4-5 hours before his next dose. He is on 2 units of Vestulin insulin 2 xs a day. We were told to only give him half his shot if he eats half or less than half of his food, so we had only been giving him 1 unit twice a day for the last couple of days. The vets office said not to give him any more insulin until his next dosage time and still to only give 1 unit if he does not eat much. They also said his sugars will be high until he is regulated and that we will only worry ourselves sick if we continue to home test. Doesn't part of regulating him include trying to keep his sugars in normal ranges? We wouldn't let our human family members walk around feeling dumpy with a BG of 348, so why should we let our fur babies?

We have been looking online at a lot of research and found the website YourDiabeticCat.com and learned about the protocol outlined by Dr. Hodgkins. We felt nervous about going against the vet's advice and gave him 1.5 units of insulin anyways (still less than the 3.5 units recommended by Dr. Hodgkin's protocol) and tested him again in 1 hour. His BG went down to 158 and within 20-30 minutes he was already looking like he felt better.

This morning he woke up with a BG of 206 and we fed him but he did not eat much. My husband dosed him with the 1 unit we were recommended to give him, but we are not sure if he actually injected him correctly (we are still learning - it's only been 4 days) because his fur was a little wet right after. I tested his BG 90 mins later and it is now 292. I am hesitant to give any more insulin because I am really not knowledgeable about all this and I definitely don't want to overdose him, I know the insulin has peak times and maybe it hasn't kicked in all the way yet. We have decided to wait about 6-8 hours and give him more if his numbers are still high. Do you think this is the correct thing to do? Or should we just wait 12 hours and give him the dose the vet recommends (1 unit if he eats half his food or less) even if his numbers are in the 300's again? Do you dose insulin based on how much a cat eats or based on his BG levels? I didn't see anything in Dr. Hodgkin's protocol that referenced insulin injections on how much food the cat eats, it was just based on BG readings. But maybe her protocol is based on cats who are eating normally and not ones who were just released from the hospital with life threatening DKA.

Sorry for the long introductory post - we are just confused and have been worrying ourselves sick over our poor sweet kitty.

I am interested in hearing about your thoughts related to Dr. Hodgkins protocol and success stories, and also if any of you went against the advice of your vet.

Thank you for reading and I look forward to learning a lot about FD from all of you!

For any of you who are interested in learning how much a 4-day stay in kitty ICU in a 24-hour vet hospital costs to treat DKA, it was $4800!!! All the more reason to treat FD before it becomes serious!

 

Adding some more background and more questions-

I have been trying to look up info on this board related to DKA and how other's cats have recovered. It seems that making sure my kitty is getting a lot of calories is important. When I called the vet to give status on Ozzy, I let them know that he is eating on his own, but not very much food. He is supposed to eat about 8.25 oz of food a day but he has only eaten between 3.5 - 4oz a day for the last 3 days. I asked the vet if we should continue to syringe feed (he was syringe feed for about 18 hours in the hospital but immediately started to eat on his own with his first meal at home) and they said, "no". They thought it was better that he is eating on his own. Since Ozzy is still not getting enough calories, should we syringe feed him in addition to him eating on his own. I just feel awful since we have to give him other medicines by syringe 6 xs a day right now (anti nausea, antibotics and potassium 2xs each a day. he also gets an appetite stimulant every 3 days). The vet sent us home with A/D urgent care food which is supposed to be high in calories, but he doesn't eat much of it. He has eaten a few different foods over the last 3-4 days but mostly just likes tuna right now. Obviously tuna doesn't have many calories.

The second day after Ozzy was hospitalized, his ketones were negative but they said his blood was still acidic and they were working to get it down. He entered the hospital with 3+ ketones. I am worried that he could develop ketones again. The vet wanted to keep him for another day or so but I know my cat was so traumatized from the whole experience that he was not eating and I knew he would resume eating as soon as he got home, which he did. They also did an ultra sound on Ozzy and had to shave his belly. I know he was completely traumatized from this entire experience. Somehow along the way, he ripped off a back toe nail so it seems he put up quite a fight during his whole ordeal.

Vet said he has some fatty liver and it was red on ultra sound but that could be from the FD and not eating. His liver tests were actually normal as so was his pancreas. He did have some signs of irregular shaped (they said "bumpy") kidneys. I am not sure if this is related to how much he has been urinating since having high BG or if it could be normal for a cat that is 8 years old.

I am about to do another BG test here in 30 mins (6 hours from the insulin shot we gave him this am - or improperly gave him if my husband did not inject it correctly). Ozzy has been sleeping most of the day but when he is awake, he is more alert than he was yesterday. I will try to get him to eat more right after we test him. If his numbers spiked up to the 300+ level again, we may decide to give him a small dose of insulin (since we may not have administered it correctly this am) and then check again in an hour. Any maybe another small does (after testing) at his 12 hour normal dosage time. Any advice from any of you in the next hour or so would be GREATLY appreciated! I see some folks are reading my post but no responses so far. Please reply!

BTW.... Ozzy still seems very weak and lethargic. How long should we expect him to be this way as he is recovering after being released from the hospital from a DKA episode? When should we be concerned and take him back to the hospital?

 

Welcome to - as many say here - the best place you never wanted to be! You've made some good decisions already in switching completely to wet food and buying a glucometer to test his BG. Please repost your message on the main health forum where more people will see it. My first piece of advice is important: please don't stray from an every 12 hour insulin dosing schedule right now. It's very early in Ozzy's treatment and you haven't yet established what a good dose is for him or how he responds to Vetsulin. We can help you get there safely.

 

Repeat of my important advice: do not give Ozzy more doses of insulin outside of the 12/12 regular dosing schedule. It's not safe to do so. You need more help and guidance on what to do about all the concerns you've expressed. Please repost on the main health forum.

 

Hi, Joanna. Welcome to you and Ozzy Pawzbourne; great name!

You've done very well to start home testing; it is far and away the best thing you can do to keep Ozzy safe on insulin and improve his regulation.

URGENT WARNING: DON'T GIVE INSULIN AGAIN UNTIL 12 HOURS AFTER THE LAST DOSE!!!

Even if you did give a fur shot earlier you have no way of knowing how much insulin got into his system and you could easily overdose Ozzy!!!

The +6 test would be very helpful.

More to follow ...


Mogs
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Hi Joanna and Ozzy and welcome to FDMB. I am sorry you have been through DKA ....yes it does cost a lot to treat once it gets serious.
Firstly....it is great you are testing the blood sugars! That is really important. We recommend you test before EVERY insulin shot to see that it is safe to give the insulin. Vetsulin is quite a harsh insulin so you need to make sure he eats before the shot. He should start eating more once he starts to feel better. Also test about 4 to 6 hours after the insulin to see how low it takes the blood sugar. Make sure you have some honey or Karo on hand to give if the Blood sugar drops too low....below 50.
Are you feeding low carb wet food....10% or less. Higher carb food will raise the blood sugar. Here is a link to lists of suitable food
http://www.felinediabetes.com/FDMB/threads/links-to-various-food-charts.169055/

I would strongly recommend you buy a bottle of ketostix from the pharmacy to test Ozzys urine for ketones. Ketones in the urine is what will lead to DKA. I would test daily for the time being until he is well again. DKA can happen when there is not enough insulin, not enough food and fluids and an infection .....so it is important he gets his insulin, eats his food and drinks plenty as well as the antibiotics. If you are testing the urine you will be able to see if ketones reappear in the urine. Just either collect a specimen if you can or stick the stick under the flow of urine and follow directions on the bottle as to how to read the result.

We do not follow Dr Hodgkins protocol here on the forum or recommend it.

If he does not eat all the food at once you can still keep offering him the food throughout the day except for the 2 hours before testing for the insulin dose as food can influence the result. It is important he gets enough food each day after having had DKA

 

Quick question: do you have ketone test strips at home? You need to monitor Ozzy's pee for ketones at least once a day (twice would be better).

More to follow ...


Mogs
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Thank you for the responses!

No, I don't have ketone strips. Where can I get them and how do I test urine from a litter box? I'll go get some today if I can buy them OTC.

I will follow the advice above and not dose him again until his 12 hour dosage time.

Thanks!

Joanna

 

You should be able to buy them from any pharmacy. I am in Australia so can't direct you in the US but I am sure any pharmacy would have them. Try putting a small container or large spoon under Ozzy after he starts to wee or just stick the strip into the stream of urine.
I see you have posted in the health forum so I will copy this post to that.

 

Welcome and sorry to see that Ozzy has had such a rough time with the DKA. You have got a lot of good advice already and the people here are very experienced and can help you with your journey through FD. One comment...the members here do not follow the Hodgkins approach and even for those on the other site that do. it is not intended to be used with Vetsulin.

 

Also posted on the Health Forum

http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-after-surviving-dka.169143/#post-1834979

 

You can get ketone test strips (e.g. Keto-diastix) at pharmacies or at Walmart (assuming you're in the US).

 

This is what you want to test for ketones
or

 

FAO members reading this thread:

Discussion has now moved to the following thread on Feline Health:

http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-after-surviving-dka.169143/

To avoid duplication and confusion, please post replies to the above thread from now on.

Thank you!


Mogs
.