Newly diagnosed and problems with dehydration

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Karen P, Dec 2, 2018.

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  1. Karen P

    Karen P New Member

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    Nov 27, 2018
    1. I've been lurking a lot here and am so grateful you exist since I feel we are rather on our own in figuring out how to best deal with all this (we have gotten some pretty dodgy advice from the vet who up to this point I felt was excellent). Our 15-year-old cat Nippers went from "boring" numbers at his last appointment -- great news since he is managing several conditions -- to a month later losing his appetite and ultimately getting the diabetes diagnosis. We've had a very dramatic few weeks due in some part to terrible advice (like telling us to take him home after his blood sugar got too low with the instructions to give no insulin for 5 days). He ended up in the hospital for 3 days (in sad shape, and with DKA) and I feel lucky he survived. I now feel really stupid for following instructions that ridiculous but we're such newbies I hadn't yet realized to what extent vet advice on diabetes can be seriously off the mark. They also told us taking our own readings was optional but I realize from reading here that was also bad advice. We've just started taking readings using an Alphatrak 2 and so far just have two (both taken 1 hour after a meal, approximately 12 hours after insulin). First was 130 and second was 134. It's been too crazy to do a chart but we will get to that. He is on 1/2 unit of lantus, one shot a day (in the morning).

      The big problem now is that he'll eat well (or at least well given the new diagnosis) for a couple days and then get dehydrated and lose his appetite and stop pooping. He has always had a constipation issue and was on miralax and cisapride but we've never had the dehydration issue. (The vet replaced the miralax with lactulose for the time being.) Once he gets fluid therapy he feels much better, starts eating and pooping again, but then two days later he's dehydrated again. My theories are that he's just not eating nearly as much as he used to (he was a big eater, and a healthy, not overweight, almost-12 pounds...now he's down to 8.4 pounds and eats about 1/3 as much as he used to). Is he simply getting too little water because of this dramatic decrease in food intake? Or should we be giving a smaller dose of lantus every 12 hours? Is there a problem with only getting it once a day?

      Other than those theories I'm at a loss as to why he so quickly gets dehydrated. He drinks water willingly and we only give him wet food (mostly Fancy Feast beef, beef/chicken classic pate, Tiny Tiger beef/turkey pate, with other various wet foods and salmon/chicken fillet treats when we're desperate for him to eat...we have three cats and a wide variety of foods). We syringe feed if necessary to keep up the insulin. We're taking him in for fluid therapy later today because after having a good appetite post fluids yesterday he's back to no appetite.

      Nippers' other health issues besides constipation include intestinal lymphoma (two years in remission, on prednisolone...probably cause of diabetes...and Leukeran) but the vet has taken him off the Leukeran for now. He also has a heart condition which was controlled with a tiny amount of a diuretic and anti-clot med. The vet took him off the diuretic temporarily due to dehydration and has been carefully monitoring fluid in the lungs (there is none).

      Sorry for such a long post but wanted to include all info that might help and Nippers is "complicated." Thank you!!
     
    Last edited: Dec 4, 2018
  2. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Welcome! Lantus does work best when given twice a day. Now that you’ve started home testing, you can set up our spreadsheet and it will help you track Nippers progress. I’m not sure why Nippers is getting dehydrated, but you can add water to his wet food and also have the vet show you how to give SubQ fluids at home. It’s easy and would be less stressful for Nippers. Many of us add miralax to our kitty’s daily feedings, but since it works by drawing water into the colon, extra water should be added to the food. Some also swear by adding canned pumpkin to the food. Just be sure it’s pure pumpkin and not pie filling.
    Here are the spreadsheet instructions. If you need help, let us know and someone will do it for you
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    Here’s some info on giving subQ’s
    http://www.felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/
    Just be sure to discuss this with the vet so you don’t worsen the heart condition with too much fluid. It can be a fine line.
     
    Kathleen Einwich likes this.
  3. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi and welcome to you and Nippers to the forum:)
    It is a steep learning curve in the beginning but you have come to the best possible place for help and support.
    My Sheba used to get dehydrated a lot in the beginning and I was back and forth to the vet for subQ fluids. But if he has a heart condition you would have to be careful to not overload his system.
    I used to give extra warm water in the food each time I fed Sheba to try and combat the dehydration.
    Sheba also lost weight after diagnoses but did eventually regain the weight.
    As Sharon says, Lantus works best if given twice a day. To do that you would HARVE the current dose and give it every 12 hours....that would be 0.25 (1/4 unit) twice a day of Lantus.
    But if he is getting a reading of 130 an hour after a meal and 12 hours after the shot, he certainly does not need an increase in dose....he may need a decrease.. If I were you I would start taking the blood sugar before EVERY shot to ensure it is safe to give the shot. Anything under 150 I would stall, don't feed and I would post and ask for advice. Put HELP WITH DOSE in your subject line.
    Then I would take another test at +4 and +6 after the shot to see how low the insulin is taking him.
    Because he has had ketones recently it is important that he does get his insulin and he does get food.
    Do you have a bottle of KETOSTIX at home to test for ketones each day.. can be bought from Walmart of a pharmacy and test the urine each day to ensure no ketones develop again.
    Keep asking lots of questions, we are happy to help and it is the best way to learn...plus read the yellow stickies at the top of the pages..
    Here is a link to FAQ
    http://www.felinediabetes.com/FDMB/forums/health-links-faqs-about-feline-diabetes.14/
     
    Last edited: Dec 2, 2018
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  4. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Just a couple more things. Can you put in his signature that he was hospitalised with ketones (did he have DKA?) please and are you giving any antinausea medications. Nausea will stop a cat wanting to eat. Cerenia and ondansetron are both very good for nauseated/ vomiting cats.

    Also re your meter. Did you mean an Alphatrak 2 meter or a accutrack 2 meter? I have not heard of an accutrack 2 meter, but I could be wrong. One is an animal meter and the other would be a human meter and it makes a difference with the numbers.
    I am going to tag @Wendy&Neko as her Neko had several of the issues that Nippers has and she may be able to help you.
     
    Last edited: Dec 2, 2018
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  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Neko got most, if not all, of her issues from her acromegaly, a condition caused by a benign tumour on the pituitary that caused it to send out excess growth hormone. I am saying this because she started with acromegaly, then diabetes, then the other conditions, while Nippers started with SCL first, the prednisolone leading to diabetes. Which is the opposite. Neko’s heart issues meant she could not take pred, so she took budesonide instead to help her gut inflammation. It didn’t impact her blood sugars like pred does. Not sure why your vet has stopped Leukeran. In treating small cell lymphoma, cats will sometimes eventually be tapered off of pred, but stay on Leukeran. Are you seeing an internal medicine vet? They can be good at balancing multiple issues.
     
    Bron and Sheba (GA) likes this.
  6. Karen P

    Karen P New Member

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    Nov 27, 2018
    Seems like everyone agrees on the Lantus 2x day. I will start adding water to his food -- thanks for that tip. The vet did show us how to give SubQ fluids today and the video will help! I didn't think that would be possible b/c of the heart condition but it sounds like, as you say, you just need to be careful. The concerning news we also got today is that our vet thinks Nippers should go on a feeding tube because he is losing too much weight too quickly and his liver values are starting to decline. This is our regular vet practice we went to instead of the specialist who had been seeing him (and the more I learn, it seems has given a steady stream of not very good advice). I even asked her (the specialist) if Nippers should go on a feeding tube last week and she said that wasn't something to worry about right now. I'm actually relieved because I thought the rapid weight loss and significantly lower amount of food being consumed was a recipe for trouble and that's why I had asked about the tube. So I think the dehydration and what goes with it (weakness, lethargy, constipation) are symptoms of the bigger problem which is too much weight loss too quickly (because the diabetes got out of control quickly). So that's tomorrow's crisis, and I'm just hoping he does OK with the anesthesia for the tube insertion since he's so weak. After that passes I'll get to the insulin dosing questions etc. It really is a major stressor on a daily basis ever since this diagnosis. How does everyone here keep their anxiety in check???
     
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  7. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    I think the feeding tube is a good idea. Not sure if all anxiety ever goes completely away, but over time you’ll get it in check. The feeding tube will help and getting a good plan for insulin dosing will too. Keep us posted.
     
  8. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Good luck with the feeding tube Karen, and I sure hope that helps Nippers to feeling better very soon. We all wish you well and I hope in time, with you educating yourself about feline diabetes treatment, that you can feel less anxiety and get more comfortable with treating him. Please do keep us updated on what's happening with Nippers. :bighug:
     
  9. Karen P

    Karen P New Member

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    Nov 27, 2018
    We have lost Nippers. We are so indescribably sad. It's all been a blur, and all happened so suddenly. He was a thriving cat with medical conditions in check less than three weeks ago. Our next follow-ups were scheduled for 6 months and a year. And now he's gone. It feels like everything changed overnight. We are grief-stricken and in shock. Thanks to all on the board who tried to help. I wish I had known all of this valuable information before everything happened, as I think the outcome would have been very different, but there is no going back. If a cat of mine ever gets diabetes again at least I'll know all the things I wish I'd known a month ago, and can also educate friends. If only the vet had 5% of the knowledge exhibited here. Nippers had a good 15 years, but he deserved a longer life and certainly a better end. I will try to focus on the abundant love he provided and that we returned, and all the good times that made our lives together a blessing. Heartbroken.
    :rb_icon:
     
  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    (((((((Karen and Justin))))))
    I am so so sorry you have lost Nippers. You fought very hard to get him better. I am sure he knew you are trying to help him. They are so precious to us and it is heartbreaking when we lose them.
    Sending my deepest condolences
    Fly free Nippers and land softly at the rainbow bridge:rb_icon:cat_wings>o
    Bron
     
  11. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    So sorry to hear Nippers has left you :bighug::bighug::bighug::bighug::bighug:

    Fly free sweet Nippers and land softly. There are lots of friends at the bridge to welcome you and show you the best fields to chase butterflies and the sunshiniest places to nap. Send your brokenhearted mama a sign that you're happy, healthy and waiting until the day you're together again forever cat_wings>o
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Karen and Justin, you might like to change your subject line to let people know Nippers has passed away. There is an option to write GA which means gone ahead when you click on the subject line.
    People like to send their condolences and support you at this very sad time.
     
  13. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Oh no! I'm so sorry to hear this sad news. My condolences
     
  14. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    I’m so very sorry:bighug:
    Fly Free Sweet Nippers:rb_icon:
     
  15. Coco’s Momma

    Coco’s Momma Member

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    Jul 14, 2018
    So sorry to hear the heartbreaking news. Fly free Nippers :rb_icon:
     
  16. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    Karen and Justin, I am so very sorry to read that Nippers has left you. You tried so hard and cared so much. We hardly got to know you and Nippers, but the loss is deeply felt. Peace and comfort to you both, I hope you feel our arms around you and know that we share your grief and tears.
    Yes, please let FDMB be a resource for you or anyone you encounter that needs help with feline diabetes and other health problems. I wish you well as you heal, and can remember more joyful memories as the sadness fades a little. :bighug::bighug:cat_wings>o
     
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