Newly Diagnosed and DKA Urgent

Hi,
My name is Liz, My cat Toby was just diagnosed as diabetic. He is 7 years old best guess, I have had him 5 years. I noticed Monday morning he was not standing up or walking on his back legs. He didnt seem in pain and acted fine outside of that. My vet wasnt in the office so I dropped him off at a previous vet I have been to. I have his labs but it all looked good other than his glucose was 376. Vet tried to get a urine sample but wasnt able to. She suggested starting him on prozinc but would have to order it. I was able to get him into my regular vet today she didnt want to start any insulin until we tested urine and/or fructosamine. We were able to get urine from him and his urine glucose was 1000 with ketones at 15. she mentioned doing a urine culture as well as a protein/creatinine ratio since we had the urine. Not sure I will do that. She uses vetsulin and that is what i will start him on for now anyways. One unit every 12 hours. Im going to work on a glucose curve at home at some point but right now we need to get his glucose under control and get him walking again. He isnt much interested in eating right now and will nibble on some wet food does anyone give mirt or cypro to help with appetite? Anything else I should do right at this moment? Oh and he eats canned friskies, no fish. prior to now he ate a very small amount of earthborn holistic but he likes canned.
Thanks
Liz

 

Hi again

With so little blood glucose data, To determine how critical the DKA Diabetes Keto Acidosis is, it would be so helpful for both yourself, us and a vet, if you can home test the blood glucose at these hour times

A.M in a.m before the a.m insulin shot

+ 6 hours after

P.M in p.m before the a.m insulin shot


Is that something you can do?

It is needed both to get a grip of the right insulin dose, the blood glucose levels and the ketones.

I'm worried that he is in critical DKA with the 15 urine value and because he doesn't eat either.

 

Hi Liz
You have put DKA in your subject line....did your vet say that your kitty has DKA or just ketones?
If Toby has DKA he should be at the vets on a drip getting treatment. It is very difficult to treat DKA at home.
This is not an illness to treat lightly as it can quickly turn deadly.

It's really important if there are ketones in the urine that Toby is eating well.
Food helps keep the ketones away. If possible he needs to be eating about 1 1/2 times as many calories as he normally does.
So you need to get some cerenia or ondansetron ( both antinausea medication ) from the vet. Don't give an appetite stimulant if your kitty is nauseated. Treat the nausea first.

It is also really important that Toby is getting his dose of insulin each 12 hours.
Are you home testing the urine?

You need to be testing the urine at home for Ketones at least every day. You can buy a bottle of Ketostix from Walmart or a pharmacy for around $10. You collect a urine specimen then dip the test strip in and compare it against the colours on the side of the bottle in exactly 15 seconds. Anything above a trace needs vet attention..

The first thing you need to do is establish whether Toby has DKA or ketones. THIS IS VERY IMPORTANT.

Please keep us posted as to how Toby is progressing.
Best wishes.

 

She did not say he had DKA but she said she was glad I brought him in because of the ketones. I already have all those meds for my other cats. He doesnt act nauseous but I can give cerenia. He was just diagnosed today I dont have all the home testing stuff until I can get it tomorrow. He isnt peeing much because he holds it since the neuropathy keeps him from walking to the litter box. When I put him in the litter box he doesnt go. He went tons at the vet when they did the uA because he had been holding it. I will have to ask her in the morning she said high ketones can develop into DKA she didnt say he had DKA. I will update more tomorrow
Thanks
Liz

 

Yes my vet and I discussed home testing. Im not able to get a monitor until tomorrow. She was concerned about the ketones but felt we could
get a grip on it with starting the insulin tonight and touching base tomorrow. He eats just not as much as normal. he ate some this morning and he
ate a little tonight before his shot. That is why Im thinking of some mirtazapine in the morning to stimulate his appetite. I dont think it would
effect his glucose

 

Hi Liz,
If there are ketones in the urine and he has been diagnosed with diabetes, I would get the insulin started as soon as possible.
Ketones form when the body starts using fat for energy instead of carbohydrates. The way to combat this is to make sure Toby is getting his insulin and getting enough food. Those are the two most important things. Fluids are also important as well as monitoring daily for ketones in the urine.

If Toby is not eating he is probably nauseated. Cats with ketones are often nauseated.
I would try him with a cerenia tablet and see if that helps..

I am so glad you are going to home test the blood sugars. That will help a lot with how much insulin Toby needs.

When you have time ( and I know you are busy with Toby at the moment) you might like to set up your signature which will help us when we help you. It will appear at the bottom of all your posts in little writing and tells us about Toby.
Here is the link.
http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

Also when you have time if. You can set up the spreadsher to put in the BG data.
If you have trouble setting it up ask for help
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

You can give some mirt after you have established that he is not nauseated or you have treated the nausea with cerenia.
Offer frequent small meals. Because it is really important he eats, offer him anything he will eat at this point.. we can worry about low carb when the ketones have gone, if necessary.

I'm so glad you have found us. We can help you with how to manage dealing with ketones.
Please ask lots of questions....we are happy to answer them.
Bron

 

Hi! Why don’t you ask your vet about doing some subcutaneous fluids at home? Very easy to do and it helps them stay hydrated and the kidneys flushed. I would do this along with the cerenia In case there is any mild pancreatitis going on. He is obviously feeling ill bc cats don’t eat less for no reason. Please talk to her tomorrow.

 

Did your vet test for ketones in your cat's urine or was it a blood test. If it was a blood test, those are very high levels. I would also start testing for ketones at home. You can purchase Ketostix at any pharmacy. This is a way to test for urinary ketones. Alternatively, there are blood ketone meters.

The "recipe" for ketones is an infection or inflammation + not enough insulin + not enough calories. It's important that you make sure Toby is getting about 1-1/2 times his usual amount of food in order to keep the ketones in check. Plenty of water in his food (or subcutaneously) can also be very helpful.

 

I would go ahead and have the urine culture done, because if he has an infection you want to get that treated as soon as possible.

 

Yes we are discussed that, I do fluids at home for my CKD cat. He is going back for a recheck on glucose and FPL. She did mention if FPL then we should stop insulin but I dont think we should until his glucose is under control. He is still unable to walk on his back legs although he tries

 

Okay thanks, They saved his urine from last night so they have plenty to test.
Thanks

 

fPL is the test to see if Toby has pancreatitis.
you definitely need to continue the insulin....even with pancreatitis...plenty of cats have elevated or positive fPL and continue with insulin. To stop it would invite ketones to form and elevate the blood sugars..
My Sheba had pancreatitis a few times and we always continued with the insulin.
I can't see the logic in stopping the insulin.....I'm not sure how much your vet understands about feline diabetes/ketones/pancreatitis.
How is Toby today?
Is he eating much?

If you are testing the blood glucose at home, there is no need to have it rechecked at the vet. Most cats have an elevated BG level at the vet because of stress. The true reading would be the ones you are getting at home.
Try and get your signature and SS up and running as it will help us help you
Please keep asking questions and keep us updated

 

Hi
Just got back from the vet to recheck his glucose and we also did just the snap FPL. The snap FPL came back negative and his blood glucose is now 140. We are both very perplexed is it 140 because the 2 insulin shots he has received has brought it down? She said not to give insulin tonight she is afraid it might send him into hypoglycemia. He isnt eating much, he ate a little tiny bit and drank some water with his insulin this morning, tiny bit this afternoon and a tiny bit just now. Nothing compared to what he should be. He is alert and acts fine but cant stand up on his back legs still.
Vet wants to a glucose curve, she spoke to internist at IDEXX and they mentioned one. IF I can find a very low cost meter I can do it at home otherwise they want 150 for it which I cant do until next week.

Im at a a lost I really dont know what to do.

 

Hi Liz
That is good the Snap fPL was negative.

I am concerned that the vet said not to give any insulin with ketones in the picture and Toby not eating much.
Are you continuing to give cerenia?

Do you have your glucose meter yet and the bottle of Ketostix.?
Have you tested the urine again for ketones?

I can’t stress enough how important it is to monitor the urine for ketones daily at least, and to ensure Toby is eating plenty of food.

As @Sienne and Gabby (GA) said above the recipe for ketones/DKA is not enough insulin, not enough food and an infection/ inflammation.

You can buy a human meter at Walmart very cheaply. A ReliOn Meter is suitable. There is no need to buy an expensive pet meter. The human meter is the one most of us use here.
I would go out now and buy a human meter and start testing. Also get the Ketostix if you haven’t already got them.
That is the only way you are going to know how Toby is going with the ketones and the BG levels. We will help you.

 

I would get a meter and strips and do a curve. A curve means testing every 2 hours for 12 hours. This may be a bit of a challenge since sometimes it's hard to get your kitties ears to bleed. We have lots of materials to help you learn how to test.

 

I am going to pick one up in the morning. I wasnt sure what to use the Alphatracj 2 is 47 from amazon and I just cant do that this week. He isnt peeing other than in the middle of the night on the pee pad he was sleeping on. Not sure how Im going to test urine with him not going in the litter box. He also hasnt pooped maybe he doesnt need to not eating much but not sure. She did not test the ketones tonight no urine. I dont think he has a uti his urinalysis looked good. Im still giving the cerenia. Should I give him a unit of insulin tonight if he eats? A bit afraid to now, maybe half a unit? I have a call into my specialist clinic with his labs and info. I will take him there for further diagnostics on the 26th but I cant do much more before than other than check his blood and give him insulin

 

I just ordered a relion meter from walmart and going to pick it up

 

I'm not sure what a pee pad is, but to get urine from cats that pees in a litter box the whole proceduren is a long one in order to get a urine sample.

Since our cats are used to their privacy when peeing and all of a sudden they have us stalking them when we see they are heading for the litter box, with our hopes to get a urine sample for the test strips.
Some simply can lift their butts up a bit while they are peeing and put the test strip right into their pee stream.
I lifted Simba's butt up a bit to get a plastic glas into his pee stream and then dipped the test strip into the urine in the plastic glass.
But first I had to oh! it looks like Simba is going to the litter box to pee and hurry up to follow him in there so I don't miss out on the chance to get some pee.
With Simba seriously thinking his mama had turned into a loonie stalking him to the litter box and not give him his privacy there but also lifted up his butt.
It took some trials and error and Simba continued to love me even if he taught I was a little bonkers and the procedure became both accepted and normal.

Perhaps you get the chance too with your pee pad.

 

He cant walk on his back legs. So he sleeps on a doggy absorbant pad. When I put him in the litter box he just lays down because he cant stand up on his back legs. I have him laying next to me on the couch on the pad so maybe that will work. Im going to see if I can get him into my specialist feline clinic. The vet there handles all my difficult cases. Meanwhile Im going to get a monitor and subq fluids tomorrow because he hardly drinks

Thank you

 

It sounds as if your kitty has diabetic neuropathy in his hind limbs often seen with unregulated diabetics. Sometimes they can regain use of their limbs but sometimes not. Could he get into a cookie sheet to pee? If you think he could, you could put a little bit of litter then cover it with Saran Wrap thoroughly and when he urinates on it, you then go and place your keto stick into the urine for the allotted time and then compare your strip to the colors on the side with the bottle. They do sell nonabsorbable sand called kit 4 cat which you could sprinkle on top of the Saran Wrap for your cat to move around before urinating. Or you could negate the Saran Wrap and normal litter and just place some of that on the cookie sheet. Amazon sells it. I’ll upload a picture of the bag I have. I agree with the moderators about continuing with some insulin. I would coax my kitty when she was off with some fortiflora dusted over her food or some dehydrated chicken bits which I also got from amazon. The sq fluids are a definite along with continued daily cerenia .

 

That is a good idea the saran wrap and cookie sheet. When I put him in the litter box he just lays down. I gave him some cerenia a bit ago and a sliver of mirtazapine just now and he is finally eating something.
Yes, my vet figured diabetic neuropathy. She got perplexed when his glucose was 140 tonight but I thought that is what the insulin was suppose to do.
Im getting a monitor in the morning but Im also hoping my other vet that treats my CKD kitty and my SCL kitty can see him.

 

I am glad you are getting a glucose meter. Please let us know if you have any problems with testing..
Here is a link to testing the blood glucose..
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

Update on Toby, He saw Dr Demos at exclusively cats today. So we ruled out diabetes as his glucose is normal now and staying normal. He has not had any insulin since Tuesday morning. So he definitly does not have diabetic neuropathy causing him not to walk on his rear legs. Looking at the previous x rays Dr. D thought she saw a possible melanoma on his spine in the sacrum area but new and not grainy x rays showed that spot isnt there. So thats not causing the no walking on hind legs. She kept him overnight and trying out a course of steroids and B 12 injections to see if he responds to that. She was also going to see if she could get him to eat as he only ate a little last night. He does have an appt. next week with animal neurology in commerce MI for consult. Outside of that and at the moment we dont know why he isnt walking on his back legs.

 

What do you mean by “normal” on the glucose because we’ve seen vets say 200 was normal. It’s not...it’s not even close.

It’s difficult to imagine that he had ketones and high glucose and he’s not diabetic. It also does sound like he has diabetic neuropathy and B-12 injections won’t help that. For a cat to have a BG of 376....that’s not white coat syndrome. The not eating also is very concerning. Did she run blood labs and check his blood ketones and electrolytes?

 

Yes all the bloods were re ran today electrolytes as well and all is normal. His glucose yesterday and today have both been 137 yesterday and 131 today. He has not had any insulin since Tuesday morning. I dont know that much about diabetes but I cant imagine with only 2 injections of insulin it would regulate him that fast? He has an appt next week with a neurologist to determine if something else is going on with his spine. Some type of injury, fall etc that I may not have seen happen.
I can post when I get the copies when I pick him up tomorrow.

 

No, it wouldn’t regulate him that fast, you are correct. Pls let us know what you find out.

 

Hello,
My vet ended up giving Toby dexamethasone injection on Thursday and he spent the night at the clinic.
She called me this morning to tell me that she took him out this morning and he walked a few steps. He is standing on his back legs as well.
I have him home and he is walking around the house. A little wobbly still. Will watch him over the weekend and Monday will call the neurologist and
see if they will want to see him. If they do thats fine but I wont be able to do an MRI rigjt away as they are 2000.00. So My vet said he could have hurt his
back and pinched something, it could be a subluxation, could be a spinal lesion. The steroid is bringing down the inflammation and
probably taking pressure off the spinal cord. She did redo urine and no ketones. So will see what happens.
I do thank everything for all the info and support. Im glad he isnt diabetic would just like to know what happened or whats going on with his spine

Liz