Onre coming home late tonight situations still tenuous Need BG regulation help & suggested care plan

There's no more money to keep spending on emergency care so Onre is coming home. I am told she is a very sick kitty. I think she is but she also is exhausted from lack of sleep and the continuous feeding and venous poking. The feeding tube did not get put in because her sodium is high at 179 it's been steadily climbing. My personal seems less concerned about the sodium whereas the emergency vets are. Her potasium is low normal at 3.5 which is generally where it's been for about a month now. I am not sure what other electrolyte values is but I am told it's normal. She has never been tested for anemia but her gums are pink and they say a normal color for a sick cat. I was told she was producing ketones upon admission because I wanted to be sure she still is not producing ketones I just called and they checked with the vet. I was told she has never been tested for ketones during her entire stay. Unfortunately, this is not the only contradiction that I've found. Most I've found are because the right hand does not tell the left what was said. The left gets on shift and reads the exact notes and tells me what was done. It makes me really sad and frustrated it's unethical and make me feel that some of the vets (but not all) don't value my cat's life. She still cannot walk far although farther than a few days ago. After a certain point she literally just collapses though. For most of her stay she has stared off into space and does not seem to know I exist. Yesterday was different especially after she was brought to me in collapsed state on my visit. I roused, her massaged her and managed to get her in to coherence. I syringe fed her myself and she seemed recognized me and respond. The vet seemed to be advocating for euthanasia when she came in. My cat was about 6.5 lbs upon admission she feels lighter. One vet told me she is getting 2 cans of food per day another only one can. They are saying we should should syringe feed 25 mls every 4 hours of AD food The vet is supposed to figure out kilocalories/cans when she is released.Her BG have kept swinging high in the 400 range.

So the positive is we switched her to Lantus. There have been some closer to normal ranges but that is the support of short acting insulin. The last was at 136. . But my first question is how could we continue to support with short acting insulin? I started to post this and it didn't go up for some reason and I went back to the vet to compare insulin meters. They would to draw her blood in front of me even thought I told them I am not sqeeamish. Instead they brought blood into the room. The meters were apha track, relion and the vet had Bayer Breeze meter. The alpha was nearly the same, relion about 18 off. The BG was 425. The vet gave Lantus I am not sure how many units but I think they are giving her two units. After the shot she began to stiffen and shake. They said it was not a seizure. Her heart rate was much higher. It seems they only gave her 3 mls of food this afternoon and a very little water. Her mouth was dusty dry. She is dehydrated. They don't seem interested in her surviving. If this was not a public board I'd comment more. Basically, this is not a practice that tends to advocates for customers to become knowledgeable.It's the closest emergency vet they are pricey but the other one is worse. I wish she was beign discharged hydrated and standing ect but she is not. They are making it clear they don't feel she will or should survive and they don't like questions. I hope someone can tell me something that will help.

 

I started to post this and it didn't go up for some reason and I went back to the vet to compare insulin meters. They would to draw her blood in front of me even thought I told them I am not sqeeamish. Instead they brought blood into the room. The meters were apha track, relion and the vet had Bayer Breeze meter. The alpha was nearly the same, relion about 18 off. The BG was 425. The vet gave Lantus I am not sure how many units but I think they are giving her two units. After the shot she began to stiffen and shake. They said it was not a seizure. Her heart rate was much higher. It seems they only gave her 3 mls of food this afternoon and a very little water. Her mouth was dusty dry. She is dehydrated. They don't seem interested in her surviving. If this was not a public board I'd comment more. Basically, this is not a practice that tends to advocates for customers to become knowledgeable.It's the closest emergency vet they are pricey but the other one is worse. I wish she was beign discharged hydrated and standing ect but she is not. They are making it clear they don't feel she will or should survive and they don't like questions. I hope someone can tell me something that will help.

 

I'm so sorry Onre is so sick and the vets are not helpful! I can't add any words of wisdom, except keep up the feeding and hydrating, and stay on the alert for ketones. I will certainly keep Onre and you in my prayers.

 

If Onre needs continued veterinary care you can apply for help to DCIN (Diabetic Cats In Need). They are a great group who will help you if they possibly can. Our contact here is @Chris & China.

 

With the way they are acting I don't feel I can go back if she she has ketones. What can I do if she does? We can see our regular vet sometime tomorrow. Last question about ketones. I have these strips that detect several things in urine including glucose and ketones. I notice people are suggesting specific ketone strips. Do we need a specific type?

 

There are so many complex issues here that I don't know where to begin:

• she likely needs subQ fluids administered by you at home
• she needs syringe feeding at home
• meds for nausea and appetite might be useful
• the use of a short acting insulin on top of the Lantus is risky in your situation
• you have to try to test for urine ketones at home (human ketone test strips work - eg. Bayer KetoDiastix)
• she'll need constant nursing care at home for many days ahead

You should contact DCIN as was recommended by Squalliesmom. It seems that caring for her properly at home is going to be a very difficult challenge. Vet care is a much better alternative. If her ketone levels increase it becomes an emergency situation.

I'm sorry that you've been treated so poorly by the emergency vet clinic.

 

What I desparately need is anyone who will guide me to getting her regulated. I will talk by phone email on the board. We could still manage some regular vet appoinments just not the emergency vet. Overall it gets frustrating to go to the vet because often they have no answers. Then I get to trying to manage on my own when I get no answers. but I am not doing the best job of guessing what is going with her. I was hopeful because at least on of them was become open to the idea of testing.

 

This is your future goal. Your immediate very pressing issue is her current state of ill health. There are knowledgeable people here who can give some advice on what she might need in the way of nursing care right now. However, if her condition deteriorates further and ketones become part of the picture, she WILL need vet attention.

Yes, she needs insulin and enough of it to keep her BG low enough to reduce the risk of ketone development. That's not regulation though.

If you want to help advice givers here it would be best to set up the spreadsheet we use here. Enter all your BG data in it so we can see what's going on. @Tanya and Ducia had a similar experience to yours with a very sick kitty and no way to afford a vet clinic. Tanya spent hours/days/weeks getting Ducia healthy again. She might be able to give you some idea of where to start.

 

I am so very sorry for what you are going thru.
As suggested above by Squalliesmom and Kris please contact DCIN for financial assistance. Here is the link to their page - scroll down to the contact list.

We home cared for our kitty after DKA who has very similar diagnose. She is still being regulated but her BG numbers are incomparably better now. She is ketones free. Gained weight. We never had money for vets. What I am trying to say is that there is hope.

 

There are so many complex issues here that I don't know where to begin:

• she likely needs subQ fluids administered by you at home- I have several bags of fluids and know how to do them
  
• she needs syringe feeding at home- I am able to do this and I am experienced- I have had several cats with chronic illness I used to rescue
  
• meds for nausea and appetite might be useful- Have Cernia and Pepcid
  
• the use of a short acting insulin on top of the Lantus is risky in your situation- Ok will leave that alone
  
• you have to try to test for urine ketones at home (human ketone test strips work - eg. Bayer KetoDiastix)- I have mult value test strips for humans- Catching the urine is my challenge
  
• she'll need constant nursing care at home for many days ahead-

You should contact DCIN as was recommended by Squalliesmom. It seems that caring for her properly at home is going to be a very difficult challenge. Vet care is a much better alternative. If her ketone levels increase it becomes an emergency situation.

The challenge to caring for at home is that I am supposed to start a new job I can do day care at the vet but it seems like everyone is in too much of a hurry to feed her properly. Healthier more "viable" patients that require less attention seem to be a higher priority. Constant syringe feeding seems to be hassle to them but it's part of what was being paid for.
I'm sorry that you've been treated so poorly by the emergency vet clinic.
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Teasel's Spreadsheet

 

I have actually spent the past couple of months working on getting her healthier it was going well the vet had become willing to discuss testing and regulation and we were in a better place until this setback. It's been frustrating because there were actually insinuations by some staff that I have not done enough when she was total yellow and near death and I worked hard to get her back to where she was.

Overall though my frustration won't make her well. The trouble could be a 24 hour vet- They act like my cat is a bother and seem to be writing her off.If you attempt to advocate for your animal you seem to get even less service.

 

1. SubQ fluids - you need vet help with amount to give, etc. Also, any cardiac issues would be a complication.
2. Syringe feeding - check
3. Meds: Cerenia is good for nausea and vomiting. Appetite meds include mirtazapine (can have weird side effects) or a human drug, cyproheptadine (better tolerated)
4. Catching urine: try a shallow, long-handled spoon under her backside or a double layer of plastic food wrap over her favourite area in the litter box. You only need a tiny bit of urine.
5. Nursing care - she'll likely need day care at a vet clinic because she's too ill to be left alone at home right now.

Please do consider DCIN for financial assistance.

 

It might be helpful to potential advice givers on here if you give a concise timeline of what's been going on beginning from her date of diagnosis.

 

Can you get the copy of Onre's entire file from the ER clinic? You paid for it - it's your property. I got mine. Labs and attending veterinarian notes provided us with invaluable hints as to what was wrong with Ducia and how care for it at home.

 

There is one that gives a portion of the picture under the cat feeding tube post that is up now I will go back and find my other original post and put it up after I return from the vet I am off to go get her. She had DKA Hepatic lipodosis, and pancreatitis. She has developed a heart murmur in the past 3weeks that was not there before. I would like to know how it will affect her if her sodium is at 179.

 

Can you get SQ flids set from them? Also ask for meds that Kris listed above - Cerenia for nausea, appetite stimulant, Denamarin for liver. Something for pain management, too. You may not need it at once, but it's good idea to be prepared.

 

I will go home with buprenex, I have fluids, I will ask aboout denarmarin. Pray for us!

 

Advice givers will want to know when DKA/hepatic lipidosis/pancreatitis occurred relative to date of diabetes diagnosis. The more you can do to set up a simple, clear timeline, the better.

 

Appetite stimulant and Cerenia will be helpful.

 

No you don't need specific strips....as long as the ones you have will detect ketones, that's all that's important.....the strips that test for several things are a little more expensive than the ones that test for just urine ketones, but they work

If you are on Facebook you can send a message to Diabetic Cats In Need to inquire about help with emergency vet bills if you need to take her back (or to a different vet!!) if she start to throw ketones

 

Please post update on Onre after the clinic. I am going off for now but will be online again right after Midnight PST and will check in. Hang in there.

@Chris & China Chris, I pulled out Ducia's discharge papers from the clinic and reread - the similarities with Onre's situation are astonishing.. You followed us back then, don't you agree? I hope my experience will help here but you know I cannot advise on doses. The only thing I can say is that 2U seems too much for 6.5 lb not eating cat even with BG in 400s (vet's office stress, etc) and even with ketones. And I'd feed a little more than 25 ml slurry per feeding - if Onre agrees..We did 1 1/2 - 1 3/4 can of LC Friskie/ 24h + a lot of water + SQ f Ringer's solution. Please correct me if I am wrong.

 

I totally agree that it seems like 25ml every 4 hours isn't near enough food....I'm not as concerned about giving that much insulin with numbers that high, but she needs more calories!!

She can even feed high carb food and increase the insulin.....the key is to get a lot more calories into her and adjust the insulin as necessary.

@Meya14 is a wealth of information when it comes to ketones, but for now, she needs more food, more fluids and probably more insulin

 

She is severely dehydrated almost as if she stopped recieving IV fluids either yesterday or the day before her hydration was almost normal. Her legs keep stiffening up and shaking she cannot stand or walk. The vet said it's muscle wasting but she walked a circle around the exam room yesterday albiet a wobbly. I think it's muscle cramping from severe dehyrdration. I've given sub Q fluids and food and some clinicare. It has maltodextrin in it- is that OK? I have to get a little sleep. Her Lantus ended being free Iwill tell you about that later. Let me know what I can do. I was told her BG is 525 when she left and she is supposed to be producing ketones and that IV fluids won't help much.

 

Heading to bed shortly I have given SubQ fed some and gave water.

 

Ducia had - it will resolve will eating, gaining weight and exercise. Her legs are beautiful now.

 

I am not familiar with this medication but I recently read someone's opinion that it is not good for BG - can elevate, is it right? I think it was @Marje and Gracie who commented on maltodextrin.

 

High number might be explained by stress - you need to test at home in the familiar environ to get the idea of average number.
With eating+SQF+insulin my kitty recovered from DKA episode - so can Onre, I cannot agree with the vet on this. SQf do help.

 

The best thing, in my opinion you can do for Onre is to set up a speadsheet and post her recent LAB in there - in addition to the BG readings. You now have access to the wealth of FD knowledge on this Board but people who are willing and able to help need to know the whole story. Without data any advise =guesswork and people won't be able to share their experiences. Do believe me when I say that the collective knowledge here exceeds any of vet's you've known.

HERE is the how to set spreadsheet.

HERE is how to read it but you will get any help with setting it up or with interpreting.

I see you are not online. I hope you 'll have good rest and will post soon w/questions or for help for Onre.

 

I've gotten up to do a feeding her legs are still stiff and she claws and "cycles" her back legs.She feels hot especially her ears I am worried she may have a fever but I don't know where a thermometer is right now. She's on metro.
Since I've taken her home we are through just over a half a can of AD food I think I can get the rest in this morning. The food is cut with Clinicare. I also gave maybe 18 mls of water in between food syringes. I don't make the food waterey so she is mostly getting food. Her insulin shot is at 8 am I will test her then and post the number.

 

Also because she is so dehyrdrated I gave her just tiny bit more Sub Q about the size of half a golf ball. I know I should have that in ML's I've kept the room dimly lit so as not to stimulate her too much and for the next big amount I will. She seems to have absorbed nearly all of the 75 mls I gave around 1 am.

 

I am up because she needed to used the litter box she cannot do that on her own. Before she left the clinic they told me that she e experienced irritation from the IV cath bandage and they had put some triple antibiotic ointment on it and we should take the bandage off in the morning. I took it off and there is sore going all the length of where the bandage was it's all crusty and I suspect very infected. If they had even changed the bandaage once or checked the catheter they would have seen this. Clearly they did not. I am just sick!

 

I'm so sorry for the lack of care and compassion you and Onre received! I hope she starts feeling better soon.

 

Reading through this, I'm just heartsick at the lack of care. I'm not 100% clear about all the details, but is it possible your regular vet is more on top of things than the ER staff? If so, is there any way Onre could be seen/assessed by your regular vet today, just to get a baseline of care set up? If not, I do think it sounds like you have good tools in place and a reasonable approach set up for home care, I'm just thinking that I don't know that I'd trust the judgement of the ER vet about Onre's condition and needs, from what you've described, and it would be good to get some reliable professional advice. As others have stated, on this board we have a lot of experience dealing with diabetes care, but Onre has a lot more than that going on right now.

And seconding the from Sharon-- it is just so hard when our kitties are so sick. I hope thing start improving soon now that Onre is home-- sometimes, just getting away from the stress of the ER environment will help a lot.

 

She is severely dehydrated almost as if she stopped recieving IV fluids either yesterday or the day before her hydration was almost normal. Her legs keep stiffening up and shaking she cannot stand or walk. The vet said it's muscle wasting but she walked a circle around the exam room yesterday albiet a wobbly. I think it's muscle cramping from severe dehyrdration. I've given sub Q fluids and food and some clinicare. It has maltodextrin in it- is that OK? I have to get a little sleep. Her Lantus ended being free Iwill tell you about that later. Let me know what I can do.

 

Her BG is 309 however, I am pretty concerned she will simply have a normal blood sugar and never walk again.

 

I hope you can get some sleep and come back here in a clearer frame of mind. People here are trying to help as best they can with limited knowledge of the details of Onre's ongoing issues. Please try to settle yourself calmly so you can post a clear, concise step by step timeline of her medical issues going back to her date of FD diagnosis. The spreadsheet we use here would be an extremely valuable tool as well.

I certainly understand why you're feeling overwhelmed and very emotional right now. Unfortunately, it makes it hard for us to pull out the details of what has happened from your posts. Please take some time to give us the history in a set of bullet points or similar. It's hard to sort out the different things from lengthy posts.

I apologize if I'm upsetting you by saying these things but we need this to help you as well as we can.

 

I agree with Nan & Amber; can you possibly get Onre in to be seen today by her regular vet? He can help you set up a plan of treatment for her and provide the support that you certainly did not get from the emergency vets! It would also be good to have him take a look at the area that has become infected/irritated by the bandage. Keeping Onre and you in my prayers.

 

How is Onre doing now?

Is it a 5.5 oz can?

 

A cat recovering from DKA needs at least about 200 calories (about 1 - 5.5oz can of higher cal food) and 300 ml of oral fluids per day, but this includes the water in the food. So you should aim for about 100-150ml oral water by syringe. The more food you can get in and the more calories, the better -- so don't worry at all about carbs in the food. The goal for DKA is to be able to get as much insulin in her as safely as possible.

Did your vet do labs? Can you scan them and post them? I'm very concerned about the leg weakness, as in DKA potassium can go dangerously low and cause weakness in all the muscles of the body, including the heart. Also DKA can cause a certain type of anemia which can be serious and require transfusion, this can also manifest as weakness.

You should really consider calling around and finding a vet that has been successful in treating DKA, and get her there if possible.

There is no way to assess if there is permanent liver damage at this point. Most cats will have elevated enzymes/labs when they have ketones. As the eating improves and things are better regulated, often times the liver values improve or even go back to normal.

 

Maltodextrin can raise the BG. It might not raise hers...you'll just have to see.

Sending many vines and prayers.

 

How is Onre this AM?

 

Unfortunately, I lost my friend today. Her blood sugar was normal as was her blood pressure but she started having seizures the doctor felt the problem was neurological rather than her diabetes possibly a tumor. Other vets have speculated as much. To find out was way beyond my means after the amount that has been spent on two emergency hospitalizations. Thank you for reach

 

I am so very sorry for your loss. Fly pain free little Onre

 

So sorry to hear . May fond memories of you beloved, Onre, warm your heat always

 

-ing out. I have supplies I wish to share that I would like to share to help other owner be successful in managing their diabetess. I don't know absoulutely that it was a tumor but I know she was really suffering she could not stand even with help to use the litter box. I am having a terrible time with having to have made that decision. I picked her up after gettting hit by a car at 8 weeks old in 2004. I miss her. Hopefully, she is walking again in heaven with her other former kitty housemates

 

I'm so very sorry for your loss. Fly Free Sweet Onre, Land Softly

 

I'm so sorry that you've lost your kitty.

 

Sending many many ((HUGS)) for you at this sad time. You made the hardest decision a pet parent has to make and you made it with love. I made the same decision just over a month ago. I had spent a lot of money over the 2 1/2 years I fought the battle with my boy and had just spent close to $1000 just a month before I released him and was prepared to spend more for further testing. But he "told" me that he was too tired to fight and he had no QOL left. Releasing a kitty from their sick, broken body is the final and greatest act of love, even though it tears our hearts into pieces. You absolutely did the right thing for Onre.

Keep your special memories of Onre close in your heart to give you strength and comfort as you grieve the loss of your special girl.

 

Sorry for your loss. This was sent to me by my vet after losing one of mine.

 

I am sorry for your loss.

 

So terribly sorry for your loss. You did absolutely everything you could for Onre, and she is pain-free now.

 

I am so, so sorry to hear of your loss. My heart hurts for you. Onre will live on in your heart until the day you are reunited at the Rainbow Bridge.



Fly free, beloved Onre, and land softly

 

My deepest condolences.

 

I'm so sorry for your loss.