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?

 

Copying this important post from your welcome thread

http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-after-surviving-dka.169137/#post-1834980

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.

↑
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.
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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I have copied this from the introductory forum
http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-after-surviving-dka.169137/#post-1834980

 

Me again.

As others have already mentioned we don't follow the Hodgkins protocol here and it's not meant for use with Vetsulin. (Note: when my Saoirse was first diagnosed I did look at that particular protocol but I wasn't comfortable with it; too aggressive and risky for my taste.)

Here's a link to FDMB's general guide for Caninsulin/Vetsulin users:

FDMB C/V Guide

Typically insulin is given to a diabetic cat every 12 hours. It's tricky in the early days to get one's head around how the insulin works but regulation is a gradual process. It's not a case of just giving more insulin if numbers are high; BG levels can't be 'forced' down by a higher dose of insulin. Ozzy's body has got used to running in higher BG numbers so when the Vetsulin starts lowering BG levels Ozzy's body needs to gradually relearn how to use insulin and glucose properly. Giving too high a dose of insulin could result in either:

a) an overdose leading to hypoglycaemia.

b) release of counter-regulatory hormones and dumping of stored glucose from the liver which will drive BG levels UP, not down. (The body has got so used to high numbers that when it detects a lower BG level - even if it's in a healthy and safe range - it can respond as though the cat is in danger of becoming hypoglycaemic and it then makes adjustments to increase BG levels to protect itself from what it incorrectly perceives to be a 'threat' to the cat's life.)

Regulation is achieved by way of a gradual process. Kitty is started on an initial dose low enough to be safe (determined by BG testing). The starting dose is held for several days while the body gets used to the new insulin and starts using it to better utilise glucose for the body's normal metabolic functions. Home testing before each dose will tell you whether it's safe to give the dose and additional mid-cycle tests will help you to track the effect of the dose and how low it takes the BG when the insulin is at peak effect (nadir BG). After an appropriate number of days a curve is usually run. If necessary the dose is adjusted by a small increment (typically 0.25 IU). The new dose is held for a number of days with home testing to monitor safety and efficacy, then it's rinse 'n' repeat until the kitty becomes well-regulated or goes into remission.

Vetsulin typically starts to really kick in from about +2 hours after the dose with the most powerful effect between +3 and +6 hours after dose admin (this is when the amorphous fraction of Vetsulin is at its peak period of effect). There is another 'kick' from the crystalline fraction of the insulin between +7 and +10 hours after the dose. These are statistical averages and individual cats will have their own pattern of response (plus a given kitty may have day-to-day variation in response - hence the value and importance of home testing!).


Mogs
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Just completed the BG test. Here are Ozzy's numbers for today:

• 9:15 am - 2o6 - 1 unit of vestulin given after he ate a small amount of food this am.
• 11o am - 292
• 3:50 pm- 330

If you recall, we think we might have given a fur shot of insulin this morning instead of injecting it under the skin. His numbers never went down. We will still follow the advice and not give his next dose until the normal time frame tonight. Actually, the vet said we can give it an hour earlier each night until we get from 9:30 pm to 7 pm which will be our normal time from now on.. 7 am and 7pm. So he will get his next dose at 7pm tonight. He has only eaten a few oz of food today. Should we give him his full dose of 2 units at 7pm or just 1 unit since he did not eat a lot of food?

Tomorrow is my first day back at work and I am gone from my home for 12 hours. I will only be able to test him, give him all his meds and put down food for him then his insulin dose before I go to work. I am concerned that he doesn't eat much, only about .5 - 1 oz at each sitting and for the last 4 days we have left food out for him to eat throughout the day. He is supposed to get 2 units if he eats more than half of his food. I am only going to give him 1 unit in the am if he eats anything- BUT...what number should his BG be for me to go ahead and give a dose? This am he was 206 but he did eat throughout the day yesterday (still no more than 4 oz) and then at midnight and again at 5:30 AM before I tested him at 9:15 am and his BG was 206. I will leave some extra wet food out for him in a few spots but I know it won't last for more than a few hours so I know he won't be able to eat much. Hopefully he will be hungrier when I get home from work and will eat more.

 

Critter Mom and Tuxedo Mom- thanks for the advice on the ketone test strips. I will go pick up a box and figure out how to get Ozzy to pee on them! Hah! Sounds like an adventure. I am not sure he will be up for it but I'll try my best. Ozzy also shares his litter box with his brother Figgie, so I know I need to make sure to follow him in there to make sure it's his urine. I do want to note that Ozzy is drinking less water and peeing a lot less today than he was the last couple days. I hope that is a good sign.

All the ketones were out of his urine on Tuesday, and we brought him home from kitty ICU on Wednesday (it's now Sunday for those of you who may read this on a different day). What are the chances he has developed them in his urine again? Could that happen in 4 days time? What do we do if he has? Please don't tell me we have to take him back in for hospitalization. Not sure how we are going to pay the initial $4800 bill from this week, I can't fathom another one. And... I don't really want to take my kitty back to the torture chamber. What can I do at home if he has trace amounts to avoid another vet hospitalization?

Ozzy's one-week check up is tomorrow afternoon, we got it moved up from Wednesday. Probably because we have called the vet's office over 10 times in the last 4 days since we brought him home. What questions do you think we should ask the vet in our follow up visit? They are going to do another round of blood tests and we will be sure to ask to check his ketones and potassium then as well as his WBC (they were elevated in the hospital and he is now on antibiotics).

Thanks everyone who has responded. This has been a VERY stressful week for me. I have never worried so much in my entire life over anything and it is so kind and comforting just to have others not only share their knowledge and advice, but just make me feel like I'm not alone.

With the proper treatment...when should I expect Ozzy to start feeling better and acting more normal? And eating normal? He is still lethargic and weak. It's been 8 days today since he was hospitalized - 4 days in ICU and 4 days at home.

 

You can give Vetsulin a bit earlier than the 12 hours, since it is an "in and out" type of insulin. As long as the numbers are going up you can adjust back an extra hour or so earlier. Vetsulin tends to be a faster acting insulin which means that you would want to have a decent meal on board about 1/2 hour before shooting. When first starting off it is suggested that you do not shoot under 200 until you have more data on how he responds to the Vetsulin and you are able to do a test of two after the shot.. Vetsulin usually starts acting at about +2 hours after the shot and has a peak effect between +3-+5 hours after the shot. When doing the preshot terst, make sure he has not had any food for at least 2 hours before testing so that the reading is not influenced by food.


ETA As far as not shooting under 200 in this case with having had a DKA episode it would be best to be able to give some insulin unless the numbers are very low. To prevent another DKA attack you want to make sure there is insulin on board to keep the numbers down, tht he is eating well and there are no infections. There have been a good number of kitties in here that have been through DKA and as long as they are monitored carefully they have done well.

If you have any question about what dose to shoot you can post on here after the testing while he is eating and get some feedback from others.

 

Ketone development usually arises from the following:

- lack of sufficient calories

- lack of sufficient insulin

- infection or other systemic stressor/disease process/inflammation

The key to successful recovery is to identify and treat any underlying illness (has your vet checked for mouth/urinary tract/pancreatitis issues?) and to make sure the kitty gets enough calories and insulin to enable the body to use glucose as an energy source to support metabolic functions. Keeping the kitty well-hydrated is also critical as this helps the body to flush out any ketones that may be produced. As you've seen, a huge problem is that many kitties in recovery don't have much of an appetite so anything you can do to help Ozzy to get sufficient calories is key to a successful recovery, otherwise he'll be at high risk of developing ketones and going into DKA again. In an ideal world it is best for a kitty to eat under their own steam but there are times when they do need help. Syringe feeding can be stressful but he needs the food to enable him to recover. Giving small amounts of food very frequently can help but you do need to give him a decent amount of food about 30 minutes before each insulin dose to make sure he has enough in his system for when the Vetsulin kicks in. It's great that you're home testing because it will help you to make sure Ozzy is in safe numbers.

Other calorie-dense foods to try are IAMS Max Cal and also kitten food. At the moment anything you can get Ozzy to eat and keep down is the right thing to feed him, even if the carb content isn't ideal; calories are the most imporant thing right now. Given that you're administering the appy stimulant once every three days I'm assuming it's mirtazapine. It might be worth trying cyproheptadine instead. It has a shorter half-life and you can give it up to 3 times a day (1/8 to 1/4 tablet for a 10lb cat). It might give you better control over appetite stimulation for Ozzy. Also if Ozzy's only being treated with Cerenia at the moment for nausea do ask your vet about treatment with ondansetron as it has helped many, many cats here suffering from nausea problems, my own Saoirse included.

I posted a good bit of information on nausea, inappetence and DKA on another thread earlier today. Here's a link to the thread:

http://www.felinediabetes.com/FDMB/threads/cat-not-improving.169098/

There are many very helpful links in my posts on that thread. Also I strongly recommend you do a search on this board for posts containing 'ketoacidosis' or 'DKA' by member @Meya14; she's highly knowledgeable about DKA and gives sterling advice on how to help a DKA kitty make a strong and successful recovery - including food and insulin guidelines specific to a DKA kitties special requirements during convalescence.


Mogs

 

My kitty was hospitalized for DKA at the end of March this year. He was in the ICU for about 3 days on IV getting fluids, electrolytes and fast acting insulin to get his BG down. He was very sick but, luckily, began eating on his own in hospital. It took him a few weeks to get his strength back. I'd say that you can expect Ozzy to take a while to get back to his normal self.

 

Ozzy has been through a lot over the last week so it's understandable that his energy levels are low but the lethargy is very much something to keep a close eye on. In addition to the stress from the DKA and hospitalisation the lethargy could in part be due to Ozzy's body getting used to the 'foreign' insulin. That said, some cats do find the action of Vetsulin quite hard on their systems because it can produce quite a significant swing in BG from the highest to the lowest level in the cycle. It helps to keep a daily journal of clinical signs and be sure to update your vet frequently during the early days with this information. (Note: if the lethargy persists other insulins are available which may agree better with Ozzy but it is early days.) At least with your home testing you'll be able to monitor BG to make sure that he is in safe levels.

If at all possible it would be very helpful to you if you can get BG tests at +3 and +5 hours after Ozzy's insulin dose tonight (sleep loss is not uncommon in the early days of treatment - especially when dealing with complications ); on the assumption that his levels are OK tonight it should give you some bit of peace of mind that he'll be OK while you're at work tomorrow. Given that Ozzy's not eating very much be sure to leave food out for him in the hope that he'll graze during the day.

Re tonight's dose Mary Ann (Tuxedo Mom) has given you good advice in her post above. If you're in any doubt about dosing be sure to call your vet for advice.


Mogs
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Re ketone testing, if you get 'trace' then call the vet for advice. If you get higher than trace you really need to get Ozzy back to the vets immediately so that they can give treatment to flush them out of his system and prevent another episode of DKA.

Given that you've got two kitties sharing the litter box can I recommend you consider getting a blood beta ketone (BBK) meter? They work the same way as a glucometer. The strips are pricey but because they enable you to check ketones 'on demand' and can also detect presence of ketones earlier than urine testing the benefits can very much outweigh the costs (easier on kitty, too!)

I'm about to sign off now (I'm in the UK) so I'll close with some of these for Ozzy's wonderful but very stressed mama:




Mogs
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Do you think that Ozzy could be dehydrated at all? Dehydration can cause lethargy and weakness.
To test for dehydration you can lift up the skin on the back of his neck and let it go. If it springs back he is probably not dehydrated. If it goes back slowly he could well be dehydrated. Also feel his gums. They should be wet and slippery. If they are tacky, he is probably dehydrated. If you think he is dehydrated he may need some subcutaneous fluids from the vet.

 

So, some pointers for aftercare of DKA:

Feeding: Most cats will need 200-300 calories a day, main coon being a generally larger cat will probably need closer to 300 calories, aim for this amount. Calorie counts are listed on most food packaging. If your cat isn't eating this much, it's important to start intervening (syringe feeding or other means) to increase intake. Poor intake = Burning fat, which is what leads to increasing ketones. This is usually equal to 1-1.5 large 5.5oz cans. If your cat will eat dry food, put it out. Whatever he'll eat, treats, pure sugar, whatever, let him have it. You can always adjust insulin higher which is kind of what we want to decrease ketones. If you have to syringe feed, do it as soon as possible. Try and aim for small amounts of food every 2-3 hours at least.

Blood sugars: During recovery you want to aim the sugars a little higher than "normal", or aim for about 150-220ish. Too low and it's usually because kitty isn't eating enough. So for BS <150, instead of reducing or withholding insulin, try to feed some high carb stuff. This might even mean mixing honey with wet food or dry food, or syringe feeding. Consistently over 250 means insulin needs to be increased. Increase by 0.25U and see what happens in the next 24-48 hours. Try to keep doses stable, a sliding scale protocol will increase the chances of too low insulin which can increase ketones. You might have to increase a few times during recovery.

Ketone tests: Check them at least once, better twice a day. Ketones can develop VERY rapidly in < 24 hours.

Fluids: Ask your vet to show you how to do subQ fluids at home, this can make a great difference in relieving the lethargy and nausea that can happen with dehydration. Oral fluids should be about 300ml/day, this includes the amount in food. Most 5.5oz cans have about 200ml give or take. So try to replace at least 100ml extra orally.

Nausea: Nausea is the main barrier to eating. Ask your vet for an anti-nausea if you don't already have one.

Potassium: Potassium levels can go very low in DKA. This can lead to weakness, poor appetite, nausea, and heart problems. Call your vet and check what the levels were and if you need to get a supplement. If you do subQ fluids this is especially important. Also, get this retested in about 3-4 days if possible if he's still lethargic.

Recovery: Most cats won't eat on their own in the first week and require some amount of feeding support. Once they are eating some amount on their own, and insulin levels are increased to a sufficient amount, they should continue to improve and be generally back to their baseline after 2 weeks or so, minus any bumps on the road. In a study I read on DKA in cats, cats that got DKA as their initial presentation prior to diabetes diagnosis had a much higher rate of recovery, probably because there isn't an underlying infection or other illness triggering, just lack of insulin.

Weight loss: In the future your kitty is going to be at higher risk for DKA, if you decide to try a weight loss diet at some point or any time you reduce insulin, you should test for ketones.

 

Thank you so much for everyone that has responded. I really appreciate all your support and especially the time you have taken for your own personal busy lives to help me better understand the situation my kitty is in and how to help him. He is still not eating well today so I am going to go with Meya 14's advice and give him whatever he will eat - including dry food which I was really trying to avoid. But if that will give him the calories he needs to get him through this episode, then we will try it.

 

ok, just tested Ozzy's blood sugar again, it's now 344. So it has consistently gone higher through the day and I am also now confident that we gave him a fur shot this morning because his numbers NEVER came down today after the shot of insulin and only consistently rose. Poor Hubby- he feels so bad!

We just put down some dry food for Ozzy. I actually feel awful about this. I will see how much he will eat. Dry food is his favorite, and also what got him here. I know we can diet him off of it once he starts to get better.

 

With the dry food, it helps increase water too if you make a "soup" out of it, so you kitty is still getting fluids. Also, I would consider increasing your dose after tomorrow if your numbers are still above 250 at all readings. Check in wth people here, then consider to increase each dose by 0.25U. I would ask your vet about the subQ fluids too, made a huge difference when my kitty had DKA.

 

Ozzy's BG was 206 this am but we don't think we injected his insulin properly this am (his fur was wet at the spot of injection) and his numbers never came down at all after 4 times of testing his BG today.

We did put down some dry food a few moments ago but he only ate a few nibbles. I then decided it was time to intervene so we could give him some insulin (especially since we don't believe he got a proper dose this am) so we force fed him 1 oz of the vet prescribed high calorie A/D urgent care food. I mixed some up with some water and we put it in a syringe and force fed him. Hubby was not very happy about this. He is not doing the research I am and is just concerned about Ozzy's numbers. He keeps thinking that if his numbers are high, we need to give him Insulin. So on top of dealing with my very sick cat and trying to understand the best way to heal him, I have to deal with Hubby who is not doing the research and going off of what his Type I diabetic male cousin does with his own diabetes. Tried to explain that this is not normal diabetes because we are dealing with post-DKA and the nutrition is the most important thing to get his liver working properly. I will wait about an hour and then try to get him to eat some more (sometimes he will after he has had insulin) and if not, then we are going to try to get another 1 oz into him with the syringe. He is at about 5.9 oz of food today. Needs to be closer to 8 - 8.25 for his 15.6 lb frame. He used to be 18-19 pounds before the diabetes.

Regarding dehydration - the first few days he was drinking a ton of water and peeing a lot. I have noticed both taper off in the last 2 days. Since he is very weak, I will pick him up and carry him over to the water bowl to make sure he gets some water and he will usually drink some when I do. I tried the 'pulling back his fur at his neck" and the skin seems to return to normal and his gums feel wet not tacky from what I can tell. The great thing is I have my other non-diabetic healthy cat to do a comparison to.

Speaking of my other cat - that is a whole other issue. Like I need more issues to complicate things. My other kitty (a tuxedo name Figgie) has always been a very jealous cat. He is very jealous of the attention that we have been giving Ozzy since brining him home from the hospital. Now we do try to give him some extra love and attention but it doesn't seem to be enough for him. Also, he is not eating as much as he normally does. I think he sees the crazy routine and syringe feeding of the meds we are giving Ozzy and is super jealous. I don't need two sick cats. Other than him eating less, his behavior is normal. I am a little concerned because Ozzy came home from the hospital with a sneeze and for the first 2 days, I saw what I sore were watery eyes at least on 3 or 4 occasions. I was concerned he might have contracted a respiratory illness in the hospital, especially due to his weakened immunity. The sneezing and water eyes have seems to pass and he is currently on antibiotics. I am just worried for Figgie too. Don't want him to get sick, too. We are keeping a watchful eye on both kitties at this time.

 

BG i hour after 1.5 units of vestulin insulin and some food - 292.

 

I agree with all that @Meya14 says. She is very experienced with DKA.
Don't feel bad if you have to feed Ozzy some dry food to get him to eat; and have to syringe feed him. As meya14 says the most important thing is to get him to eat one way or another. You can worry about the low carb food once things get back to normal..
If hubby is concerned, get him to read meya14 post ....she explains it well. And tell him not to feel bad about the fur shot.....we have all given them!
If Figgie is getting jealous try giving him a treat each time you do something for Ozzy.
You are doing a great job looking after him...it will get easier

 

Headed to the vet in the next 2 hours to take Ozzy in for his check up appointment. Any questions you folks think I should ask the vet?
Thanks for all the great information yesterday. I have a pretty long list of questions already based on many of your comments above that I am taking with me!

With the help of the syringe feeding 2xs yesterday, Ozzy ate 7.7 0z of food (just shy of the recommended 8.25 oz) which is the most food he has eaten in a day in over a week. We are really working on his nutrition today and the upcoming days. I'm just PRAYING there are no ketones in his urine when we see the vet today.

 

Also, what BG levels should we be aiming for this early on?

Here are the two tests I was able to do before I left for work this morning:

• Pre-shot: 346
• 1 hour after 1.25 ml shot and about 2 oz of food: 269

We made sure he has kept eating as well. His appetite seems to pick up after he gets insulin. Makes sense I guess because I'm sure he feels pretty crappy with such high numbers. If he didn't eat more food again on his own within 30 minutes, we were going to syringe feed him another 1oz - 1.5 oz of food to make sure he had enough in his system to work with the insulin. His regular dose is supposed to be 2 Units but he has not eaten his recommended number of calories per day to be able to give him a full dose yet. My Hubby has been calling me every hour giving me progress reports and it seems Ozzy has been eating every few hours. He took his 1/4 pill appetite stimulant today. I'm hoping he will eat his whole day's worth of calories on his own today without syringe feeding, but I'm not putting too many expectation on him. We will help him eat more if he needs it.

Ozzy is supposed to get 2 units of vestulin after breakfast (for approx. 4.125oz of food) and 2 units at night for same amount of food. Since we can't get him to eat over 4 oz at breakfast yet (and that is a REALLY large amount of food to syringe feed), we have been making sure he consumes at least 1.5 oz to be able to give him half his insulin. We then make sure he eats again right after, which he usually will. if not, we will syringe feed. But now that we are trying to get him to consume his entire day's calories in many small meals, are we now not giving him enough insulin? We can't give him his full dose unless he eats more than half his breakfast calories in his first meal. I don't want to give him his full dose since I can't monitor him during the day to make sure he eats more food to keep up with the insulin intake.

My Lord- how did you all figure this out and not go crazy with worry. I know insulin is very dangerous and it makes me crazy giving my kitty insulin and then leaving my home and not knowing how he's reacting to it; and I worry he could go into hypo and I won't even be there when the insulin peaks. How long does a hypo episode lasts before you need to be there or it's dire?

I will be testing him RIGHT before we go to the vet's office today. I want a comparison between the vet's blood monitoring and my cheapy $9 Wal Mart Relion Prime Human BG monitor so I can see how much disparity there is between the two methods. I will definitely report back what I find.

 

Re your questions about feeding and insulin.....if you go back and read @Meya14 main post, you will find she has the answers to most of your questions. If I were you I would print off her answer so you can refer to it easily.
When increasing insulin it is best to go up in 0.25 unit increments so as not to miss the best dose. If however he has ketones in his urine this might change and the vet will guide you..
Good luck at the vets.....we will be interested how it all goes

 

I think your best bet is to work up slowly to that 2U dose by increasing by 0.25U and waiting 2 days in between each increase to let you see what that is doing to the blood sugar. Vetsulin has 2 peaks and the peaks are steeper than an insulin like lantus, so the risk of hypos is slightly greater. If ketones are continuing to decrease then slow and steady increases are the right way. If ketones increase then maybe a faster insulin increase might be necessary. Insulin dose isn't based on food alone, dehydration, fat burning, and liver can increase BS in a cat even without eating at all. You still need the insulin, even if a cat isn't eating. It helps to think of insulin as a hormone necessary for overall metabolism rather than just one that lowers blood sugar, that's really only one of it's effects.

 

Posting an update after coming back from the animal hospital tonight:

I was frustrated that after we waited an hour for our scheduled appointment, the girls behind the desk finally told us that our vet had left for the night and they did not know what blood panels our vet had wanted to run. I was able to convince them to at least run his ketones which they did and another vet advised on some additional blood tests to run, including a blood gas and CBC. We went home with a $350 vet bill. I guess be careful what you ask for.

We were happy to learn that Ozzy is still negative for ketones. Yay! I also asked them to check for dehydration and he is not dehydrated either. The vet tech who took him back also worked with him while he was hospitalized and mentioned that he was frisky and growled at her during his exam so she could tell he felt better compared to a few days ago. Hubby stayed home with Ozzy today and also reported that he seemed the best today so far.

These are Ozzy's BG levels for today: 1.25 Units Vestulin
Pre-shot insulin levels this am: 346
1 hour after breakfast time insulin: 269
9 hours after breakfast time insulin: 311
10 hours after breakfast time insulin and AT THE VETS (stressed) surrounded by barking dogs: 411
2 hours after his dinner time insulin: 281
4 hours after his dinner time insulin: 267

I will not be able to get mid-cycle BG levels until this weekend because I am at work all day. I am curious how low his numbers go when the Vestulin peaks. I know it's still really early on and there is missing data for mid-cycles, but I don't think the levels above are ideal. I know some folks suggested increasing at .25 U every couple of days, but I am not home in the middle of the day to test to see how low his numbers go, so this makes me nervous. I won't be able to try this until this weekend so I can monitor him closely. Also, are you folks doing this on your own, or with instructions from the vet?

Does anyone think we should consider changing insulins down the line? I have heard a lot on this board as well as in researching vestulin that it is a harsh insulin. I am worried that I may overdose my cat, maybe not now, but in the future because the peak times of his insulin are always when I am at work or in the middle of the night. I think I might feel more comfortable with an insulin that is more stable. When we were at Walmart this weekend, their pharmacy tech mentioned they sell insulin for cats. I want to talk to my vet about our options this Wednesday when he is back in the office. Anyone have any thoughts about getting Walmart insulin? Also, does anyone know how long vestulin lasts in the fridge? I thought I read somewhere that it is only good for 28 days. One bottle costs me $70, so if it really only lasts 28 days, I would like to consider another more affordable option.

I also wanted to see if anyone has any tips on how to get a blood draw on the first ear prick? I have literally pricked my kitty over 20 xs in the last 3 days trying to get the right technique down to get a drop of blood to test. I feel AWFUL! To be honest, most times it doesn't seem to bother him, but today he seems a little better demeanor-wise and he flinched a few times and I felt like I hurt him. Also yesterday, I swore I actually punctured the lancet right through his ear (they are very thin as you all know). After doing ear pricks for 3 days now, I have decided that I hate it and I hate making my kitty bleed. I know it's important in managing his diabetes, so any help on how to make this a quick easy and ONE TIME process for each test would be greatly appreciated.

Thanks!

J.

 

Many caretaker's here get their human Lantus and Levemir insulin from this Canadian pharmacy
https://rxcanada4less.com/
Much more affordable that getting in the USA. YO still need a prescription to send to them.

 

It can take a couple of weeks for the ear to learn how to bleed. Here is a link to some good tips to help you.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
I think both Lantus and Levemir are excellent insulins for a cat if you are thinking of changing. They are not as harsh as vetsulin and last 12 hours.

 

I made my cat's test times into cuddle times and now he actually comes running and purs the whole time I'm testing him. He usually isn't allowed on my bed unless I'm testing him, so it's fun for him I guess. The trick is to be very consistent and make a habit out of the process.

As far as insulin dosing, my vet had me call in each week my blood sugars and then she'd give me the new dose. My kitty had severe DKA when first diagnosed too, so she was checking up on him as well. After a month or two, she pretty much set me free, and hasn't asked for numbers or anything. When we come in to see her she just asks what dose he's currently on and how his sugars have been. Some vets like to micromanage tho.

 

Posting an update for today:

We are back at work and gone from our house all day. We have given Ozzy 1.25 U of Vestulin both am and pm today. His pre-shot BG this am was 300 and his pre-shot BG before dinner was 301. I recognize these are still really high numbers but we are taking it one day at a time. A little victory is that his BG numbers are a little lower than the last two days pre-shot.

Can anyone share with me what your cat's BG levels are pre-shots and while doing a curve once they were regulated? Should they still be close to 300? What should be our goal here numbers-wise? Our vet is a hospital vet and we have not been able to talk more with him about this and the next steps or long term goals. I am expecting a call back tomorrow from him. I am also thinking of going to a regular vet that can give us more individualized attention vs a hospital vet. Ozzy and Figgie have not had to have much vet care over the years (just check ups, shots, flea tx, etc) so the hospital vet 1 mile down the street was always easiest. Since we are going to need regular and long term care for Ozzy with his diabetes, it make more sense (probably for our pocket book too) to see a regular non-hospital vet.

My biggest concern right now is that Ozzy is still not eating well on his own. Part of me thinks he is just pissed with me for everything we have put him through and the constant shots and ear pokes, but I know the real truth is he is still recovering from his traumatic ordeal. Last night the hospital called with his blood tests results from earlier in the evening and said his WBC were normal and his potassium was normal. The vet originally thought he might have a UTI because his WBC were elevated when we admitted him and with onset DKA and diabetes, they assumed this was the case. But his urine culture actually came back negative. We decided to stop the antibiotics and potassium supplements for one day only to see if his appetite would return. I read that both these meds could upset his tummy and make him not want to eat. But this am and pm he still has no interest in food and we keep having to syringe feed him.

Usually after we give him his insulin and a little time goes by, he seems more interested in food and will eat on his own. Hubby is convinced that he has no appetite when he has BG is the 300s (pre-shot). Hubby thinks we should give him his insulin first and then try to see if he will eat on his own and if not, then we will syringe feed him. I said no, I know he needs food to work with the insulin. We would never give him insulin without making sure he has food in his system, but I can see Hubby's point. We don't wan to have to syringe feed him forever! This morning was very stressful and I have to admit I was really frustrated/mad at Ozzy because he wouldn't eat. We can't go on line this forever. Do you think Hubby has a point with Ozzy not wanting to eat with high BG levels? Since your cat became regulated, what are his/her pre-shot numbers? For background, Ozzy has been home from this hospital post-DKA for 6 days now.

Regarding nutrition: I know post-DKA, getting a full day of calories is very important to get the liver to do its job again and not have kitty digress back into DKA. Our kitty is supposed to eat around 8.25 oz per day. We haven't even been able to give him the vet recommended 2 U of insulin a day because he does not eat more than half his meal at each sitting. The first few days home with him, we brought Ozzy mini-meals throughout the day to try to make sure he was consuming enough calories. Now that we are back at work, we are not able to do that. Should we just be force feeding him all 8.25 oz of his daily calories? For those of you who may not have had the joy of syringe feeding your cat- that's a LOT! If Ozzy will only consume 1 oz of food on his own at each sitting (which is the case) , is that enough to give him a dose of insulin?

I have to admit - after almost two weeks of stress, worry, and concern - I am getting really exhausted with this. I still have hope for Ozzy though and I love him dearly. I guess I just needed to vent a little. I am sure all owners of diabetic cats can related on some level. Thanks in advance to responders.

 

I don't have the experience with DKA that other like @Meya14 have, but I have to think that 8.25oz is a lot of food to get any cat to eat in one day....especially one that's not feeling very good.

I'd think about concentrating on foods that are high calorie and get as much into him as you can....Like AD and Recovery foods that are calorie dense

Have you gotten him any Ondansetron for nausea??

The stuff WalMart sells isn't good for cats at all...although they might try to tell you it's the same as Lantus, it's not and acts totally differently. If you're considering changing from Vetsulin, I'd go with the Lantus or Levemir and buy it from Marks in Canada....a 5 pack of Lantus pens is about $150 plus shipping, but for most cats, that's enough to last up to 2 years of treatment so it breaks down very cheaply by the month.

This will get better, we promise!! I pierced China's ears so many times when we first started that I joked that I should just buy her some diamond stud earrings!! You'll develop a feel for it though, and it IS true that the more you poke, the more new capillaries grow into the area which will eventually make it easier. I think I could just look hard at China's ears at this point and they'd bleed!

Once the ear is really warm, try poking twice in the same place and then "milk" the ear to bring the blood up.......and after you've tried 3 times, take a break and try again a little later. Cats pick up on our stress pretty quickly, so when in doubt, walk away.

Have you considered getting him an auto-feeder? It opens up 5 spaces where you can leave food down for him and you program it to open when you want it to. The PetSafe 5 is a favorite around here

Wishing you and Ozzy the best and hopes that he continues to fight his way back!!!

 

To answer the above recent questions:

1) Ozzy is on AD recovery food right now. We force feed him through a syringe. I also give him anything else he will eat on his own. Our vet said he needs 1 1/2 cans of AD food a day (which is 8.25 oz). Meya 14 said the same and quoted our vet exactly on oz requirements.

2) Ozzy is on anti-nausea meds. 2xs a day 15-mins before breakfast and dinner. He also takes an appetite stimulate every 3 days. Not sure how much both of these are working though since he's still not interested in food. I decided to give his appetite stimulant tonight (due in am) to see if he'll wake up hungrier. Fingers crossed.

3) Have considered an auto feeder in the past then freaked about what would happen if we left for a few days on vacation and the electricity or something went out. Actually, we put down 3 days worth of dry food for both our cats over the thanksgiving holiday (they normally eat half wet and half dry) and I believe this is one of the things that kicked Ozzy's DKA into full gear. He was obviously struggling with diabetes (that we didn't know about) and then the stress of us being gone for 3 days and him most likely gorging on his 3 days worth of food in about 18 hours (those of us with fatty cat maine coons know what I'm talking about) probably took him over the edge. I am still interested in a feeder, but I have read a lot about the fact that you should NEVER feed a diabetic cat dry food again. Anyone else still feed dry? If it is at all possible, our goal is for remission from FD. If we have to put him on a strict wet food diet to do so, we will and are committed. I don't think auto-feeders work with wet food. Do they??

 

yes....the people who use them here use them with canned foods....you can either just plop it into each bowl, or you can add an ice cube to help keep it fresh (as well as add more water) or you can freeze the cat food into small "pucks" that will take a little time to melt, but will be fresh when the door in the feeder opens....I think you can also put an ice pack on the bottom to keep things cool

 

Generally, your goal is to have AM and PM preshots in the mid 200s and the mid-cycle (nadir) number in the high double digits or low 100s. If/when you find a dose that produces these results consistently over time then your kitty is regulated. The challenge is getting there and it can take quite some time. Also, the dose that keeps them there can fluctuate over time. That's why we call it the "sugar dance".

Lack of appetite is a challenge for sure. Syringe feeding that amount of food is very difficult. I'd post another question on the forum for advice on how best to use the antinausea and appetite stimulant meds for best effect. What meds are you using? There are people here with a lot of experience who might have suggestions.

This isn't safe with a fast acting insulin like Vetsulin. Ozzy must have food on board before giving his insulin. You know this of course - I'm just verifying it.

Cats are tricky. They stop eating because they feel ill or have been very ill like Ozzy and the inappetance takes on a life of its own. That's why I'm suggesting that you ask for meds specific advice. Some meds work best in combination and some meds work better for some kitties but not all. You need to ask for others' input.

Sometimes, if the lack of appetite persists to the point where syringe feeding isn't enough and the kitty is at risk of developing complications from lack of adequate food (such as hepatic lipidosis) a feeding tube will be recommended. A tube is surgically inserted into the neck and down the esophagus and liquified food is syringed into the outer end of the tube as needed. This sounds awful but isn't nearly as bad as you think. It can be just what a kitty needs to get back to eating normally which, of course, makes them feel better.

Achieving regulation can take a very long time. Some cats are easy and many are much more difficult. It's a journey and we can help you. You're still new to the game and all of this will become more routine. Your confidence will grow.

I have syringe fed cats and it is difficult. I hope you get some good advice on meds for appetite and I've given you a heads up about a feeding tube. I have no idea if/when your vet will suggest it but don't be frightened if it comes up. Unfortunately, I can't advise on what amount of food Ozzy needs to eat before giving him his insulin.

Believe me, we ALL understand how you feel. Vent as much or as often as you need. This will get easier over time.

 

With Vetsulin kitty should eat 30 minutes prior to getting insulin. Vetsulin is fast acting and food needs to on board before the insulin starts to work.

You can use an automatic feeder that runs on batteries so you don't have to worry about power failures. You must remember to put new battery in regularly. I didn't, batteries died feeder didn't open. After that I used rechargeable batteries and put new ones in every month and the day I gave the flea spot treatment as a reminder.

 

Excellent tip, Paula.


Mogs
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Guess who is eating again and pretty much looks like he is back to normal?? OZZY! Yay! We are so excited! He started eating again yesterday- as in biting and chewing his food instead of licking it. He has eaten a good portion of his food for last 3 meals and waits in the kitchen by his bowl for his nummies like he always did! And he is even back to trying to steal food from his brother Fig's bowl too!

We got a full report from the vet this week on Ozzy's recent blood work and his numbers are all back to normal with the exception on one liver enzyme that was elevated during his DKA episode (the vet said he wasn't too worried then) and has improved over the last week. We expect it to return to normal as his liver heals and vet said be is not concerned. Ozzy's potassium levels, blood PH, and WBCs are all also back to normal so we no longer have to give him antibiotics or the potassium supplements. Since he is eating again good on his own, we have also discontinued his anti nausea and appetite stimulants as well! All he is on is his insulin! We are soo happy that we don't have to torture him by constantly shoving food and meds down his throat with a syringe. My hubby gets an award for that though- he was a PRO!

Thank you for all the wonderful advice, tips, concern and love we have received from all of you on this board. I truly believe you helped me heal my little buddy and me too! I was a wreck!! I will be posting a separate thread on post-DKA advice we received from the vet who answered a ton of my questions for other's who might need the same advice in the future.

Now we are on the road to regulating Ozzy with his insulin. He has been handling the shots so well that I have been suprised! Today I am to do a full blood glucose curve at home and I was so excited to give him his first shot. I got him right after breakfast when he was all relaxed and cleaning and grooming the last bits of his savory food flavors off his cheeks and paws and guess what!!?? I think I gave him a FUR SHOT!! Damn! He wasn't laying flat like I usually try to get him before the shot and he got up to run off...I did what others have said and sniffed him and felt for wetness on his fur and there was a little a faint bandaid smell and a tiny amount of wetness so I have probably ruined his chances of a glucose curve today! I will check his numbers again in 2 hrs and if they are not going down- will have to try again tomorrow. Don't want to have to poke him now too many times unnecessarily. He actually hates it and sometimes cries and tries to paw at his ear. I know it definately hurts him!

My hubby nicked name Ozzy after Ozzy Osbourne- and now he totally looks like a tough little kitty with his shaved tummy and paw. He has a new nickname around the house- the "Five Thousand Dollar Cat"!! Another reason to try to avoid DKA!

 

Wonderful, wonderful news, Joanna. I am beyond glad for all of you to hear of Ozzy's great progress. Isn't it a thing of joy to see one's kitty eating properly again! Be sure to give hubby an extra-special FDMB gold star for services to kitty nutrition in the face of great adversity.

Tip: in the event that you see Ozzy showing any signs of nausea it tends to be much better to give a dose of anti-nausea medication sooner rather than later; if nausea is tackled quickly it's less likely to lead to a cycle of inappetence. Also be sure to keep monitoring for ketones going forward; it's much more important to do so for ketone-prone kitties.

Keep eating your fudz, Ozzy and keep your mama happy! (And stay away from bats ... )




Mogs
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Critter Mom- thank you so much for your comments! Even though I don't know you, you personally have helped me tremendously through this super scary ordeal and gave me a lot of comfort. I really appreciate you!!!

Regarding the nausea- is it likely to return? I was hoping we were out of the clear now?
Also, how often should we be testing for ketones?

I checked Ozzy's +2 hr BG and it is 152. That is his best number we have seen since we starting testing. It looks like things are going in the right direction. Curious to see his 6 and 8 hr readings to see how low his numbers go. Guess I didn't give him a full fur shot like I thought. Wondering how much of the actual 1.5U went in him though. Will do another curve next weekend when I am home all day with him. I really really hope we can reverse his diabetes. Mostly for him but I am blown away at how expensive insulin is and we are on one of the more affordable ones. Any reason to switch him off vestulin that we should consider??

 

I'm very glad that I was able to help and reassure you a little, Joanna. I know from first-hand experience how utterly terrifying it can be to be trying to help a sick kitty; it's so difficult when they can't speak to us to tell us what's wrong and what helps. I, in my turn, have received an unbelievable amount of help, support and comfort from other members here since I became a member. I very much welcome chances to pay forward because the members here have been incredibly kind and generous to me and mine.

Try to get a +4 reading for Ozzy as well if you can, Joanna, as that's when the strongest fraction of the Vetsulin is usually working at peak effect (although nadir time may vary from cat to cat - and also from day to day for the same cat!).

Per Meya's recommendations about BG levels for kitties recovering from DKA she advises that a nadir around the 150 mark (human meter) is a good level. It might be an idea to print out a copy of her post on DKA aftercare so that you can refer to it easily for day-to-day guidance.

Nausea can wax and wane; even batch-to-batch variations in a kitty's regular food can trigger a tummy upset. All going well Ozzy will be past the nausea stage now (anti-jinx) but you now know that he is a ketone-prone kitty. Inappetence can lead to an increase in ketone production so it's safer to learn to spot signs of nausea quickly and, if necessary, to intervene with supportive meds earlier rather than later so as to reduce the risk of him going off his food and going into ketosis again.

Again because he's ketone-prone, it's safer to check Ozzy for ketones as part of his regular monitoring routine regimen as you go forward. For the time being it's advisable to check ketones at least once a day for the next few weeks. When you and your vets are confident that Ozzy has made a solid recovery it should be OK to check for ketones a couple of times a week. Blood ketone meters really are a godsend for doing quick and easy ketone spot checks and are well worth considering (plus they can give an earlier warning than urine testing).

Re insulin prices, it might be a good idea to post a separate topic asking for money-saving tips on Vetsulin. Certainly you can get Lantus (and, I think, Levemir) massively cheaper in Canada than in the US (many, many members here have been buying their Lantus from Marks Marine Pharmacy in Canada for quite some time now). For the time being you're probably best keeping on with what you're doing - stability is king right now. Your BG tests will grow to a body of data which will show you how Ozzy is responding to Vetsulin. When you have more information you'll be able to see how well it is working for him or whether another insulin might be worth considering. If you can record Ozzy's data in an FDMB spreadsheet we'll be able to see it and perhaps offer input on how he's doing.

Here are the links you'll need:

FDMB spreadsheet setup instructions

Understanding the spreadsheet

If you get stuck setting it up just holler and we can find someone to help you get started.

When you're setting up your signature it would be great if you could also add the type of insulin and type of meter you're using plus a note advising that Ozzy has a history of DKA (helps members replying to your posts to give more helpful responses!).


Mogs
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