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Please help - kitty with ketones

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by CCG, Jun 13, 2019.

  1. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    I will preface this by saying: I understand the best course of action would be to take our kitty to the vet. But we do not have the financial means to do that right now after paying a lot for his medical bills over the last month.

    Full story here:
    http://www.felinediabetes.com/FDMB/...one-to-ketones-running-out-of-options.215587/

    Came home from the vet on Tuesday and I just did a urine test and he already has trace levels of ketones again. His glucose levels have been high... mainly above 400 the last two days. This is our last chance to try to tackle this issue before we have to put him down because we cannot afford it. I am devastated.

    Any advice you can give on what to do right now is helpful. He is still eating and drinking and I am mixing water in with his food. I just gave another half dose of Lantus to try to bring his blood sugar down. Not sure what else to do.

    Spreadsheet here:
    https://docs.google.com/spreadsheet...hO9GnB5MpdyS8syA7AdO5S12k/edit#gid=1182885903
     
  2. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I have to rush out but keep feeding as much as he’ll eat. Put water with food if he’ll tolerate it.
    Is the spreadsheet up to date?
    Put the 911 prefix to get attention. I will look back in when I return
     
  3. CCG

    CCG Member

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    Jun 12, 2019
    Thank you <3. Will keep feeding and monitoring. He is not interested in water but will eat food with water in it.
    Spreadsheet is up-to-date with current numbers from his last two days home. I can add from the past but not sure how helpful it is.
     
  4. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Why have you reduced down to .5?

    You mean on top of the .5 you gave at PMPS?
     
  5. CCG

    CCG Member

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    Jun 12, 2019
    Yes. .5 at 7am, .5 at 7pm, .5 at 11pm when we discovered the ketones.

    Vets recommended the reduction from 1U 2x/day to 1U 1x/day after his last DKA episode. They thought there was a somogyi effect occurring where his glucose levels dipped super low and then jumped back up because of the insulin.
     
  6. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    I disagree with your vet but there are lots of days missing on your spreadsheet too

    How low was he dropping? And unfortunately, "bouncing" is normal, especially at first.

    It's not a good idea to give extra lantus ….because then you can end up with more than 1 nadir, but with him running that high, I doubt it'll hurt much tonight.

    You can use a different insulin with Lantus called "R" (Rapid) though, but you need to have someone with experience using it helping you if you do

    Keep pushing food and as much water as you can get into him.

    You might also want to try contacting Diabetic Cats In Need ….if you're low income, they may be able to help
     
  7. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Added missing days to the spreadsheet. We just joined the site yesterday after Ty's most recent DKA episode so all of my numbers were in a different spreadsheet.

    Haven't given him an off dose shot of insulin before this. A last ditch effort because his numbers are so high.

    Will keep with the food and water.

    I have looked into those programs and we do not qualify :(
     
  8. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    OK...I still don't see any numbers so low that I would have suggested decreasing the dose. The lowest I see is the 167 and that's still higher than we want.

    And again, it's very common for cats to bounce, especially at first.....cats are so good at hiding that they're sick so usually they've been diabetic for quite some time before we start to see signs and take them in and get the diagnosis. Their bodies have gotten used to living in those high numbers and it'll take some time to re-train them to accept them.

    We want them to spend as much time in normal numbers as possible so the pancreas can hopefully heal and start working again.

    If you're using the AlphaTrak meter, normal would be 68-150

    Especially with the DKA, I'd take him back up to 1U tomorrow.
     
  9. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I am glad you have been able to post as well @Chris & China (GA). I'm back from the school run now.
    I'm amazed the vet said to only give the insulin daily especially after DKA....what are they taught at university..
    @CCG ...looking at the SS it says you gave 1 unit this morning, is that correct? And then 0.5 unit PMPS, and then 0.5 at +3 is that correct?
    I see you have just posted again Chris......I was going to say the same thing. I also agree that she should go up to 1 unit twice a day.
     
  10. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    I think we're probably going to need to fast track her if the 1U doesn't do any better than it has been but we'll see what happens

    @CCG ....with the DKA in the picture, you shouldn't worry so much about the carb content of what he's eating. The important thing is to increase the calories for now.....and we may want to increase his insulin quicker than normal too. The "rules" for treating a DKA cat are different from one that hasn't been in DKA
     
  11. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Keep getting as much food into him as he will eat, with the water added....that's good. And get a urine test whenever you can for the ketones.
    With the increase in dose tomorrow morning to 1 unit twice a day, that should hopefully keep the ketones at bay but you will need to keep the food and fluids up and testing the BSL.
    Keep asking questions.
    You can take down the 911 now that Chris and I are here.
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Absolutely I agree with everything you have said!
     
  13. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Unfortunately, Chris has to get off soon because tomorrow is her mom's "hair" day (these 90 year old woman take their hair appointments very seriously)

    @Bron and Sheba ....Thanks for being here!
     
  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    You are a great daughter!
    ThankYOU for being here...... :bighug:
     
    Last edited: Jun 14, 2019
  15. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    How is it all going @CCG ?
     
  16. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Hi there and Welcome to L, B, & L land. What a scare DKA is! It's a good thing that Ty is eating for you and good job adding as much water as you can to her food as water helps to flush out ketones. Stay as vigilant as you are with the ketone testing as you don't want it to get out of hand . Here's the basic recipe for developing DKA: a systemic stress or infection, not enough calories, and not enough insulin. So, push the food and water.

    She needs to be dosed twice a day with insulin, 12 hours apart each dose. Your vet is really wrong to tell you to only give it once a day especially to a DKA kitty. I agree with Chris that giving extra in the middle of the 12 hour cycle can be problematic to have two sets of nadirs ( the lowest point in the cycle ) to deal with.

    If she were my kitty, I would increase to 1.25 when you can monitor her . Keep posting and let us know how we can help you.
     
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  17. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    @CCG glad you made it here. How’s Ty this AM?
     
    CCG likes this.
  18. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Aug 9, 2015
    What about subQ fluids (Ringers Lactate) to flush out the ketones?
     
  19. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    I'm not going to comment on the DKA as I haven't got time to be on the board this weekend.
    But just wanted to say that given the costs you have incurred, you may want to think about swapping to a human meter to save some money. They work just fine, in fact if you start to follow one of the dosing methods that we use on this site it is preferable to use a human meter as both dosing methods were developed by CG's using human meters and conversion is problematic.

    I have never used a pet meter, managed to get George into remission and keep him safe using a human meter, having strips that are economical meant I could test as mucha as I wanted without having to worry too much about the budget.

    Just a thought.

    If kitty is eating and drinking normally and you can add extra water to food may not be necessary, also important that kitty has no heart issues before subqs are given. :)
     
  20. CCG

    CCG Member

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    Jun 12, 2019
    Hi all. Thank you so much for responses. I don't know what was going on but I could not access the forum this morning.
    I had to go to work for a presentation while my husband stayed home with Ty this morning.

    The good news is that he is still alert and acting generally okay (slightly sluggish, but not like the last time he went into DKA), and he will drink water for me. He ate around 1:30am and I checked his blood glucose every 2 hours throughout the night. It was finally getting lower after the rogue 11pm shot of insulin I gave him to try to bring him down.

    This morning my husband gave him insulin later than usual because he was not eating and glucose levels were already low(er). Spreadsheet is updated. He is hovering in the high 100s right now.

    The bad news is that he still has not urinated so we have not done another ketone check. And he also is no longer eating for me. I am not sure what to do.
     
  21. CCG

    CCG Member

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    Jun 12, 2019
    Thanks for the tip. Will definitely check this out if we can get through this episode. The AlphaTrak2 test strips alone are ridiculously priced. $1 each, essentially.

    Ty doesn't have heart failure but they did find a murmur and aren't sure how long he has had it.
     
  22. CCG

    CCG Member

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    Jun 12, 2019
    He actually had three doses of .5 U each yesterday.
    At the end of the day the vet called and said we should do 1 U in the morning and .5 in the evening. But then I found ketones yesterday night.
    I regret giving him the rogue dose of insulin at 11pm because it makes regulation harder. But I was desperate with his glucose levels being as high as they were and seeing ketones.
     
  23. CCG

    CCG Member

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    Jun 12, 2019
    @Bron and Sheba @Chris & China (GA) thank you so much. I am so sorry I am just seeing these. I kept getting a 'database forum' error and panicked because I could not get on the site. I stayed up monitoring Ty's glucose levels last night and put them into the spreadsheet.
     
  24. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    How much water does he drink?
    Post DKA kitties are recommended to have extra water - up to 300 ml a day.
     
  25. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    UPDATE
    Ty just urinated and I tested for ketones. My husband and I are having a pretty tough time interpreting the strip. You'd think it would be straightforward. Assistance appreciated. We tested three times and are still having difficulty. Photos were taken exactly 40 seconds after dipping with urine, which is what the test strip protocol recommends.

    Ty's test strip compared to a 'negative' ketone color: https://drive.google.com/file/d/1S4-pVxsCUoSVH0ilpD1h3Zi5188Wouc9/view?usp=sharing
    Ty's test strip compared to a 'trace' ketone color: https://drive.google.com/file/d/1JXj9POu0H-J60jLP_Se_cVXCcZajh5kB/view?usp=sharing
    Ty's test strip compared to a 'small' ketone color: https://drive.google.com/file/d/1OVOuEvOH3-VM7MoZnduAIeQNQSiwLPNW/view?usp=sharing

    Thoughts???
    Husband and I are both in agreement that the color from right now is LIGHTER than the color last night. We interpreted last night's strip to be "moderate" ketone level. So we are trending in the right direction no matter what.

    Biggest concerns now:
    How to get Ty to eat. He still hasn't eaten since ~1:30am (it is now 12:15pm here)
    He is having diarrhea. He hasn't eaten anything abnormal since he returned home from his hospital stay on Tuesday. But I think this could be a ketone flare-up because of something GI related. Or maybe it's the other way around.

    Thank you all so much for being here.
     
  26. CCG

    CCG Member

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    Jun 12, 2019
    I should be monitoring more closely but he is drinking close to that each day. I give him a full bowl (~ 8 oz) and he drinks about all of it each day.
     
  27. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    It is hard to say certain on the picture. I always check in the daylight v. electric. makes it easier to read.
    Just keep testing every time he goes to LB, increase his water intake to make him go more frequent.

    Do you have feeding syringes at home?
    You can get some at either your vet or a pet store.
    He needs calories asap. and water - not only to flash the ketones out but to keep hydrated BC dehydration can cause inapetance.
    Do you think he is nauseated - like sniffing the food and walking away, lip licking? These are nausea symptoms in cats.
    @CCG
     
  28. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    it is common practice to Rx antibiotics post DKA/ hospitalization , and some AB are harsh on cat's tummies.
     
  29. CCG

    CCG Member

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    Jun 12, 2019
    Yes the picture is even tougher than in person.

    We don't have feeding syringes but will go pick some up. I have been spoon feeding him water and he is drinking it without much of a fuss. But is not willingly going to the water bowl.

    He will sniff food but then move locations when I try to put it near him. He could be nauseated.
     
  30. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    Here is what I have for my post DKA girl:
    -Cerenia - vet pills for nausea. If possible get Ondasterton (Spellling?)too which is human pill for nausea.
    Each work on different aspects of been nauseated and helps a lot, often used in combination.
    The dose should be vet defined.
    -Appetite stimulant such as Mirtazapin pills.
    -Pain killer (in case there is pain)
    -If no heart problems then ask the vet if adding Lactated Ringers Solution subcutaneously (SQF therapy) would be good. We had 100 ml - 75 ml a day in addition to 100 ml water taken orally (with food).
    -If AB is still needed to be taken then ask the vet if it can cause diarrhea and which other AB can be used instead.

    Post DKA food and water and good dose of insulin is the number one medicine.
    Please try to figure out what causes not eating and try to remedy it. I do hope anti nausea meds help.

    It is worrying that he is without food for that long.
     
  31. CCG

    CCG Member

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    Jun 12, 2019
    Thank you. He has been in the hospital for DKA twice and they didn't give us any medications or recommendations :(

    His glucose levels are remaining steady below 200 which is much better than they have been.
    I just spoon fed him water and just under half of a can of watered down Fancy Feast. I didn't want to give him too much at once and make him sick. He was not happy about it but participated in the feeding and so far is keeping all of it down. Will continue this at routine intervals if he continues to do OK.
    He is agitated with me which is just like his normal self :). He's our grumpy old man. He still has some fight in him
     
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  32. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    :(:mad:
    you really need to have the meds I posted about earlier - they are your tools.

    it is good but could be due to under eating.
    This is great!
    HERE is the link to the video on assisted feeding - just scroll down the screen until you see the video.
    I only post it in case you need it in the future.

    My Ducia was very underweight post DKA and needed to gain weight asap.
    We fed her via etube about 1.5 cans of Friskies classic pate 5.5 oz/ can in 24 hours.
    Small feeding portions like 20cc syringe - one or two at once if possible and tolerated well.
    She needed no less than 250 - 300 Kcal a day for awhile.

    I hope you are successful with feeding.
    Post for help as many here had done it.

    I agree with others who posted above - I would have started on 1 Unit dose 12 hours apart, and feeding every 3 hours day and night. Not enough calories+not enough insulin=ketones development.
    @CCG
     
  33. Amy47

    Amy47 Member

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    May 30, 2019
    Healing wishes & thoughts your way :bighug:. Its good to hear he is keeping the FF down. Its also good to hear that he's fighting & being his "grumpy" self...thats a nice sign & hopefully you are heading in a better direction.
     
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  34. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    :(:mad:
    do you think if you call them and ask they'll oblige?
    These are very good tools to keep handy, especially after DKA.
    it is very good but could be explain by the lack of food.
    You are right on about no getting sick!
    Ducia being underweight needed 250Kcal - 300KCal a day , it is 1.5 can of 5.5 oz Friskies Pate. Each can about 180 Kcal.
    FF is slightly less calories, if I am not mistaken, and it means you may want to feed more.
    Small portions by syringe - like 20 cc diluted pate a sitting every 3 to 4 hours.
     
  35. CCG

    CCG Member

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    Jun 12, 2019
    They might. I am a little nervous about introducing anything else new to his system right now. Will see how the next day goes and if we need it.
    Prior to today, Ty was willingly eating 1.5-2 cans of FF per meal on his own. But still losing weight. :(

    We did about 20ccs 45 min ago and will try again in an hour or so if all goes well.

    I am about to check his glucose again. Hoping that the lower numbers aren't just due to the lack of food. I'm hopeful because he ate in the early hours this morning and even ~2 hours after that (w/no additional insulin) his #s were dropping into the 200s from the 400s.
    But we will see if this theory is true in a bit...
     
  36. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    I would wholeheartedly agree ...if it was not for the DKA.
    The threat of ketone development is real and we had seen cats in the upper 100s throwing ketones.
    You do not have to start on any additional meds but to to keep your hands on them.
    Crisis often come when vets are closed. And Ty needs to eat, more so with the DKA in picture.
    If it was my cat not eating I'd start with anti nausea - a small dose and see if helps the eating.
    I hope appy improves today.

    I am worried that the next day or so might be a little too long and enable ketones to start reappearing if he does not eat well and his dose remains.
    Food is a must for now, truly.
    It's better to up the dose ETA: DOSE OF INSULIN a little to counter all of the extra food then to give smaller dose due to lack of appy - not post DKA cats anyway - I also think 1 unit dose 12 hours apart , with multiple feeding throughout the day is way to start.

    Would you please post your next test number?

    And how many hours post injection is it for you?
    I have a little trouble reading your SS at a moment.
     
    Last edited: Jun 14, 2019
    Reason for edit: ADD ETA TO CLARIFY
  37. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    @CCG
    I forgot the link - HERE it is - some tips on how to stimulate appy.
     
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  38. CCG

    CCG Member

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    Jun 12, 2019
    Thanks so much.

    Spreadsheet is a little tough to understand right now because yesterday I gave:
    .5 U Lantus @ 7:00am
    .5 U Lantus @ 7:00pm
    @ 11:00pm, found ketones in urine. We panicked and gave another dose of .5 U Lantus @ 11:00pm to try to at least get his blood sugar down (it had been in the 400s+ since had returned home from the hospital.
    He ate multiple times between 11:00pm-1:30am last night.
    I checked his glucose levels after that which are in the 6/13/2019 row, +4-+8 columns after PMPs. These were values between 1:30am and 6:00am

    Today, he did not eat his breakfast as usual at 7:00am.
    Between that and the fact that I gave him another dose of Lantus @ 11:00pm, and that his blood glucose was lower (high 100s), we decided not to give him more insulin until 10:00am.

    So we are now +4 after his most recent dose of Lantus (1 U) @ 10:00am.

    Fed him 1/2 can FF (syringe feeding) @ 1:00pm - 1 hour ago now.
    His blood glucose was 155 prior to feeding.

    He's now at 175 1-hour post feeding, +4 after morning insulin injection. (+7 after AMPS column on spreadsheet).
    Also spoonfed more water after glucose testing.

    Will do another glucose test and try to feed some more in 1 hour.
     
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  39. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    You can take the BG test later on - like 2 hours later but do not skip planned feeding.
    The numbers in Blue are so welcome!
    His nadir is likely is still ahead but with different dosing/ timing it is hard to be sure nor can we see the dose true potency in the 1st cycle, it often happens on the 3rd cycle because the Lantus "depot" has to settle in first.
    I hope the 1U works for Ty!
    nice food bump - the number of point up after eating. :)
     
  40. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    @CCG
    I wanted to tag Cassandra @AliceMeowliss&Cassandra whose girl Alice too is a DKA survivor.
    And she had some no appy times. Cassandra might have some feeding tips for you , guys.
    I have to log off to get some groceries or humans here will starve tonight (the cat's pantry is full thou).
    Please keep updating your SS as you go so people can have a look at the day progress.
     
  41. CCG

    CCG Member

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    Jun 12, 2019
    Just fed him ~8cc more FF in syringe w/water. Lots of angry growls by the end. Also gave him more water.
     
  42. CCG

    CCG Member

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    Jun 12, 2019
    Thank you so much @Tanya and Ducia
     
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  43. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    aw, poor baby!
    I hope he'll improve for you soon!
    Have you checked the tips on appy stimulants?
    Ducia too was not happy about feeding... but I am sure that in the hind sight she appreciates my efforts... and does Ty, they know we are helping even if the process sucks.
     
  44. CCG

    CCG Member

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    Jun 12, 2019
    Your notes reminded me that they *DID* give us mirtazapine last time he was in the hospital for DKA (April). I am going to give him the suggested dose.
     
  45. CCG

    CCG Member

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    Jun 12, 2019
    and by suggested dose, I mean the dose suggested by vet.
     
  46. CCG

    CCG Member

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    Jun 12, 2019
    Blood glucose now at 171.
    Gave mirtazapine
     
  47. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    Okay caught up on all comments.... responding in progress.

    I would not give the mirtazapine without a nausea med. this is a reason to request Cerenia from your vet. Ondansetron (brand: Zofran) would also be great but I know that is an expensive human med. (I once personally for a human dose paid out of pocket more than $3 a pill but that was a few years ago.....)
    The reason; who wants to be starving hungry and nauseous at the same time?
    I have taken mirtazapine as a human, for sleep, actually. It has a cumulative effect and really does increase appetite ridiculously much. But please try to address the nausea first. The interest in water but avoidance of food would suggest nausea to me as well.

    What helped Alice:
    first, @Chris & China (GA) was a great support when I was in a panic, so between her and everyone else I have to say I agree with the advice you have received.
    Alice became regulated and gained weight again through: lots of fluids in food (may cause some soft stool, not as important as calories and water!!!), feeding as much as she wanted pretty much (when she did have an appetite, which was actually most of the time), antibiotics post-DKA, and lots and lots of insulin. Your vet may tell you one thing differently from here because they are used to treating certain cases but maybe they just don’t have enough experience or time to really educate themselves on your case.

    Another choice for short-term control would be, and anyone correct me if this is a bad idea please, but right after hospitalization and before I got Alice onto Lantus, she was on NPH three times a day. I had to test a lot. But it did give me short-term direct control. Please do not go this route without appropriate support and advice. You could feed high carb if you had to.

    Alice bounced a lot at first on Lantus and I felt SO lost, but after about 5 weeks without much sleep I started to really feel some padding on her bones again, and she started to show more patterns of low numbers.

    IF you have problems with the spreadsheet, or need someone to update it for you, we have a forum for technical help. There is a way to give someone else permission to access it and maybe they can fix it and update older numbers for you. The more data we all have, the more we can help.

    I have a human meter and strips to sell at super low cost so I can trade them for the strips I need (definitely not looking for a profit!!!), but I need to look at everything and count stuff up. I saw someone mentioned switching to a human meter so this is why I mention it. :)

    Darn I took too long to respond and see you gave the mirtazapine. Let us know if appy improves at least! I have found that Cerenia seems to restore appetite sometimes just because it can take care of the nausea which is the underlying cause to avoidance of food.....
     
  48. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    Are you on Facebook? I saw you had trouble accessing the website here one night. It might help to have another way to contact a couple members, via phone text email Facebook whatever, just so you’re never in a bind with no support. That’s always really hard when it happens, for me!!! Especially earlier on or with chaos of extra problems.
     
  49. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    So short version to what I have to say, Ty may benefit from fast track dosing. I am not the expert there. Feed, feed, and feed. All the water ever. If he is getting what is a normal amount for him, try to increase it.
    I stock 20% w gravy, 14% w gravy, Sheba snacks because she loves them (about 3%), freeze dried meat 0%, 4% and 2% regular pate foods, corn syrup.
    I stock Cerenia and mirtazapine and do not have ondansetron right now. Ketone strips.
    I always have a ton of strips if I can help it.
    Cotton balls. Dishes. Neosporin. Clean containers or spoons for pee collection. Lancets with more than one gauge if I have the option. Some days if she is hard to bleed due to cold ears or other circumstances a larger gauge is helpful in making the testing process quick, but a 30-32ga works fine for me mostly, that she has built up more capillaries.
    Always try to keep extra syringes too, and I keep a paper little notebook to track her blood sugar before I put it into any electronic thing. I also make notes on poops and feeding and meds given and other relevant stuff.

    Oh also wanted to say your Raegent strips are the complicated ones I tried to start out with too. Maybe try simpler strips made just for ketones.

    I will check back in later, and please keep asking questions!!!


    I know you must be very tired, stressed, and even scared right now. Know that you are doing your best. Feline diabetes is quite a marathon sometimes, but the interrupted sleep and panic and stress will subside over time and all get easier. Keep going. No one thought Alice would get better and a number of people in my life recommended I euthanize her but I knew she had more life in her left. Hugs and chin scritches to you both. Your pick who gets which. Lol. :bighug:
     
  50. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Thank you very much. You are all so helpful and supportive. I wish I had found this site earlier!

    Wish I would've seen the comment about nausea before I gave him the mirtazapine. Going to call the vet now to see if we can get an anti-nausea Rx.

    Yes... I feel like we are getting conflicting advice from the veterinarians we've seen. They are both very nice and professional and seem to be doing their jobs well. I guess every kitty is different and needs different things, and what they've been recommending hasn't been working for Ty. So we are trying to slowly figure out what works better for him. I am hopeful that he is ketone-free later when I test. Will look into easier-to-read test strips. Though I do remember these not being cheap, so I will probably wait until we run out :-/.

    He is resting now... and was quite agitated with me earlier. Going to let him sit for a bit longer, then test* sugars again and feed more.

    I am not on FB :-/, and admit I was lost this morning. If anyone is willing to share their email with me, I really would appreciate it. You could message it to me if you don't want to post it in the forum.
     
  51. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
  52. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Blood glucose @ 181.
    Fed ~7cc more food and more water, too.

    It must've been the site backup.. I must have tried to log in at the exact wrong time.

    Need to decide when to give insulin tonight and how much to give.
     
  53. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Where are you up to with the 181? That is +?
    I am finding your SS difficult to read. When did you last give the insulin?
    Was it at what you called +3 this morning? (12 hours after the previous extra dose??) If so you need to give the next dose at 12 hours after that last dose of insulin which will be the new PMPS time. It should always be given 12 hours apart. Give 1 unit again and stay with that dose unless you are advised otherwise. Keeping up the insulin is very important.
     
  54. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Just looked at the SS again. It looks like the 181 is +9 right? Which is really +6 because you gave the insulin 3 hours later last time. So insulin is not due for another 6 hours. Is that correct?
    The red and blue further along that line on the SS is confusing. Are you able to get rid of those two colours in the +3 and 4 of the current pm cycle?
    Also with the explanation you wrote with why you gave the insulin late, can you put that in the remarks column, and put what you now have as +1 +2 and +3 into the previous pm cycle as they were +13 +14 and +15 and put them on top of each other in the +11 column. Then start the AMPS today with the current +3 BSL as that is when you gave the am dose of insulin. Does that all make sense?
    Can anyone else think of a better way to do it.?
    Ketostix strips are only about $10 or &12 I think at Walmart.
    You are doing a great job looking after Ty!!
     
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  55. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Sorry. People are getting confused by the SS so instead of confusing myself too much, I duplicated today's row (6/14/2019) and put it at the top of the spreadsheet. What I had before is still there, but I put a strike through it and made a comment to ignore. does that help?
     
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  56. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Blood glucose (+7 after making the adjustments in the SS) is now 195. Have been feeding in small doses every 45-60 min. Over the last 3 hours he has had about 1 can of FF (mixed with water) via the syringe and I've also spoon fed him at least a few tsps of water during every feeding. He is not happy about it but tolerating everything with growls.

    Should also say that he would usually have eaten ~1.5-2 cans of FF by this time of day. So we are behind on the amount.

    Not vomiting, but still lethargic. Also hasn't urinated again for me to check ketones. Hoping he will soon.

    @Bron and Sheba - vet newly recommended yesterday afternoon (before we learned of the ketones) to do 1U in the AM, .5U in the pm. What do you think based on his numbers.
    I will stick with **12** hours apart.
     
  57. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    How frequently is he urinating, today?

    I was also going to say, the ketostix are fairly cheap. Cheap is relative though and I understand financial constraints. Going to simpler ketone test strips did help me a lot though.

    Could you please remind me, was there infection? Antibiotic? When? What?
     
  58. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    First, with respect to your spreadsheet, the convention here is that the older numbers are at the top. The most current numbers are at the bottom. It will make those of us who have been looking at spreadsheets for years very confused since for this site, your spreadsheet is upside down. When you have a chance, can you rearrange the page?

    If you decide to ditch the pet meter, you may want to consider buying a blood ketone meter. The strips are pricey but you don't have to wait hours for your cat to urinate in order to test for ketones. NovaMax makes a good ketone meter, as dose Precision Xtra and they are available on the ADW website.

    Did your vet run labs when treating Ty's DKA. If so, get a copy. The recipe for DKA is an infection/inflammation + not enough calories + not enough insulin. If Ty wasn't given an antibiotic, I'd be very surprised unless the white count was normal and there was no indication of a UTI. Do you know if your kitty has any dental issues like gingivitis? It can also contribute to the infection/inflammation issue. When Gabby was diagnosed with DKA, she was discharged from the ICU with an antibiotic, an anti-nausea med, an appetite stimulant and something else. (It was a long time ago an I didn't put the meds on her spreadsheet at the time.) Please keep in mind that water is good but food is necessary. Ketones develop when a cat is burning stored fat rather than metabolizing newly ingested food.

    The other anti-nausea med is ondansetron (Zofran). It's a human med. The tablets are expensive. The injectable form is much less costly but it stings when injected. Some cats need both Cerenia and ondansetron to get past nausea.

    You might want to try giving Ty baby food. Many cats love the stuff and it's a great way to get a cat eating. You would want to find a Stage 2 food that is only a protein and broth. The downside is that it's fairly low in calories.



     
  59. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Relatively infrequently.
    He went last night (large amount) around 11pm, when we tested.
    Did not go again today until noon (large amount, again) when we tested.
    Hasn't gone since noon. He just pooped (diarrhea - very runny), no pee.

    We have lots of urine strips for now to test for ketones, but will look into Ketostix when we run out.
    The problem is the AlphaTrak2 test strips for the glucose meter.. 50 strips on Amazon = $50. Definitely how they make their money, because the entire AlphaTrak2 meter was only $25.

    No antibiotics, no infection.
     
  60. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I disagree with your vet. Ty needs enough insulin to keep the ketones from forming. Give 1 unit both cycles. If necessary give some higher carb food to keep the BSLs from dropping low. Enough Insulin and enough food is what he needs.
    Can you tell us your name please. Can’t keep calling youCCG;)
     
  61. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Courtney :)
     
  62. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Blood glucose now at 165. Fed more. He has had about 1.25 cans of FF total today through the feedings
     
  63. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Someone answered this already and I am having difficulty finding it on the thread - losing track of messages.
    How long before his next dose of insulin (2.5 hours from now) should I stop feeding Ty? Should I stop feeding him now? 2 hours before?
     
  64. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    2 hours before. There would be exceptions if blood sugar was dangerously low, etc. you’re fine at 165 generally. :)

    [eta: “generally” I say because ECID]
     
  65. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    As for difficulty finding info: at the top right of the page there is a search feature where you can search the boards.

    It’s a great help when you’re feeling frantic and no one has popped into your thread yet! :p
     
  66. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    This concerns me.... I feel like there should be a little more output. Especially since now he has diarrhea, I would be concerned about dehydration. What options do you have available to help increase fluid intake? Do you know how to pull the back of the neck to check for hydration?

    A tsp of pure pumpkin may sometimes help with constipation or diarrhea, either one. Make sure it is the plain pumpkin kind, no spices etc added.

    Also here is a fecal score chart link, helps me sometimes describe allllll the weird weird poops Alice has had since the FD. https://images.app.goo.gl/U5ZLEzysSz1a2aCDA
     
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  67. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    I do know how to pull the back of neck to check, but unfortunately I just don't have a great eye for it. His skin seems to fall back into place and at the speed that it usually does. It looks the same as my other cat who is healthy.

    I have been continuing to spoon feed him water. I'm not sure what else to do because he does have a heart murmur so I don't know if anything else is a good idea without professional supervision. Ideas welcome.
     
  68. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    His blood glucose is also back up to 243. Could be related to the food I gave him at +8 Amps
     
  69. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    243 seems pretty good for the hour you are at, all things considered. It’s not “healthy cat” good but that takes time to achieve as part of the process of getting kitty regulated..... to me with a lot of wild numbers, anything in the yellow for the beginning and end phases of a cycle makes me pretty happy overall. Alice always acts like she is feeling better even in yellow. ECID.

    What are current clinical signs? Moving around on his own? Purring? Accepting petting? Drinking water on his own at all, showing interest in food or not, etc.......?
     
  70. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Courtney!
    Yes plain pumpkin does help with diarrhoea. Just a teaspoon three times a day will help.
     
  71. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Here was an update I received while he was in the hospital.

    Physical Exam:
    Wt: 4.44 kilograms
    Temp: 102.5 F Pulse: 188 bpm Resp: 40 rpm
    Mentation: QAR
    MM/CRT: Pale pink/<2 sec
    Pulse Quality: Moderate
    Body Condition Score: 4/9
    CSU Pain Score: 0/4
    Hydration: persistent 3-5% dehydrated
    EENT: Clear AU. No ocular or nasal discharge. Normal menace and palpebral responses OU. Pupils equal and reactive. Fundic
    examination not performed. Oral examination not performed due to demeanor. No palpable thyroid slip
    LYMPH NODES: No peripheral lymphadenopathy
    CARDIOVASCULAR: Grade II/VI parasternal heart murmur NOT auscultated today. Femoral pulses strong, synchronous, symmetrical
    RESPIRATORY: Resolved increase respiratory rate, with normal respiratory effort. No crackles/wheezes. Normal bronchovesicular
    sounds
    INTEGUMENT: No significant findings
    ABDOMEN: No pain or masses noted
    MUSCULOSKELETAL: Ambulatory x 4 but generalized weakness, full orthopedic examination not performed
    NEUROLOGIC: Quiet,Alert and mentally appropriate. Generalized weakness. Full Neurological exam not performed
    UROGENITAL: External normal
    RECTAL: Not performed.

    Working Diagnosis/Problems:
    Lethargy
    Hyporexia
    Diabetes, ketoacidosis
    Chronic nephropathy
    Hyperechoic hepatomegaly
    Heart murmur (Not auscultated 6/9/19)
    Stress leukogram
    Thrombocytopenia: resolved
    Mild hypokalemia
    Mild hypocalcemia

    Diagnostics:
    ER 6/8/2019:
    Serum Ketones: 80 mg/dL
    Glucose: 500 mg/dL
    CBC:RBC 8.17, Hct 41.48, Hgb 14.8, WBC 18.92, Neut 16.66, Lymph 1.11, Mono 0.70, Plt 274 (L)
    Chemistry: Glu 345 (H), BUN 27, Crea 0.9, Phos 3.8, Ca 7.6 (L), Na 149, K 3.6 (L), TP 7.5, Alb 4.5, Glob 3.0, ALT 75, ALP 47, tbil 0.2,
    amyl 313
    CG8: pH 7.178 (L), pCO2 17.6 (L), PO2 126, BE -22, HCO3 6.8, TCO2 7, SO2 98, Na 149, K 3.7, iCa 1.27, Glu 361 (H), PCV 38, TP 11.2, L
    fPL: Negative
    NIBP: 142 mmHg
    UA:SG >1.050, Pro 30 mg/dL, pH 6.0, Ket 80 mg/dL, Gluc 1000 mg/dL, Neg bld, bil, rbc 0-3 hpf, 0-2 wbc hpf, no casts, crystals,
    bacteria obs; epithelial 0-2 hpf
    UCS: Idexx
    TXR:
    Findings
    Thorax (Right lateral, Left lateral, VD images; 3 total images):
    The cardiac silhouette and pulmonary vessels are normal in size and appearance. The pulmonary parenchyma is normal and there is
    no evidence of soft tissue pulmonary nodules or pulmonary infiltrates. No abnormalities noted within the pleural space or
    cranial mediastinum. Included portion of the abdomen is normal. The osseous and extra-thoracic soft tissue structures are
    normal.

    Conclusions
    Unremarkable thoracic study however chronic lower airway inflammation (i.e. asthma) cannot be ruled out.

    Treatments:
    NormR 12 ml/hr (45 ml/kg/d + 1 ml/kg/hr losses) + 10 mEq KCL + 10 mEq KPhos
    Maropitant 1 mg/kg IV once
    Ondansetron 0.5 mg/kg IV BID
    Insulin CRI after 4-6 hr on IVF ***Total IV rate IVF plus Insulin CRI to equal 15ml/Hr***
    Serial BGs
    Recheck Lytes, serum ketones
    Monitor for fluid overload (Increase RR/RE, weight gain, serous ocular or nasal discharge, chemosis, etc)

    Daily update to owner:
    9:50a: Called owners with an update. Ty is doing fairly well. Still a bit weak but is eating. Still a bit dehydrated. I do not hear a
    murmur on auscultation today. No abdominal pain or discomfort. Plan is to restart unasyn pending urine culture submitted by
    2 of 3ER, continue to monitor BG q 2 hours and adjust insulin CRI, then re-evaluate general labs and serum ketones in am. Owners are happy with todays plan.
     
  72. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Current clinical signs are not great.
    He is alert when I walk by and will accept pets but does not seek them out.
    He can move around on his own (he tries to get away from me while I am feeding him and giving him water), but is pretty content to lay in his spot so he has barely been moving.
    Not purring, but has never been much of a purr-er.
    Not drinking water on his own. Not interested in food.
     
  73. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Did they restart the antibiotic that they were giving? They say in that report they are waiting for a urine culture. Really important to follow that up because if he still has an underlying infection (UTI) it needs treating.
    @Marje and Gracie are you able to look at this report and comment please?
     
  74. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    Grooming at all?

    One thing I use to check how Alice is feeling and also to get her some exercise when she is well (and not recovering from surgery or DKA) is a laser pointer. When she is weak but feeling kind of okay, she will move her head to watch the red dot, but if she is exceptionally well (for her), she will chase it for a brief stint.
    —with DKA so recent, I do not suggest Ty get exercise. That could just burn more body tissue like fat and build up too many ketones. But something like that can help indicate alertness, and also mood/ability to be interested in something beyond -pee poop eat drink sleep.- It is an extra thing....

    I also put some weight on ability to fight back and act cranky. If kitty expresses unhappiness, they are choosing to exert precious energy. This can (but does not always) help indicate improvement. Alice wouldn’t fight me over anything when she was a sickly bag of bones.

    I feel like if you are seeing persistent dysregulation and other issues that there just is something underlying going on. I wish I could be of more help.
     
  75. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    I am pretty confident he does not have a UTI. He was checked at our normal vet appt just shortly before he went into DKA again. But it is weird that they never followed up with me about the culture. Given the amount of money we spent, they should have been more thorough in reporting and communicating with us. I just called the hospital but the internal medicine dept is not there. They are going to call me back tomorrow.
     
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  76. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Yes. He is grooming after I feed him.
    And agreed on the crankiness. Last week when he slipped into DKA, his mood shifted immediately. He was lethargic, not alert at all. I could pick him up and move him and he was limp, and would sometimes get up to slink away somewhere else, but generally rotated between two spots. He would lay completely flat on his side.

    Today is different. He is lethargic but "alert" - he opens his eyes when I walk by and watches me. He sits up when I pet him and even when he's just hanging out, instead of fully on his side.

    I feel the same way about something underlying but so far they haven't been able to pinpoint anything.
    I think it also makes it tough that we have never really landed on an insulin dose/regimen that has seemed to REALLY work for him. Other than today, his glucose levels have ALWAYS been above 200... with a few rare occasions... since I started testing.
     
  77. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    Alice wasn’t regulated ish until she was either on NPH 3x/day, or Lantus after about a month at a high ish dose (especially for her size) with a lot of food. ....... Over time you can gather more info on the underlying issue. For now, I really think someone who can better advise on fast track dosing might be helpful for you. I cannot do that. Maybe you just need to give Ty some time and keep nursing him. I know it gets exhausting and feels so desperate at times.

    It’s a good fight though. You’re doing well, really. A lot of people would not have come this far. :)
     
  78. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Dosing consistently twice a day is key and with a DKA kitty it is important to increase the dose more rapidly than a normal
    FD kitty. You are on the right tract now you are giving 1 unit twice a day. If that is not enough we can increase the dose.
    Do you have plenty of higher carb food there? Because if needed Ty can be given higher carb food and the dose of insulin can be increased. But let's wait and see how he goes with this and how the ketones are going. Others may weigh in with suggestions.
     
  79. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    @CCG , Courtney,

    Thank you so much for typing in the entire page - the vet's log, extremely valuable. I had mine too.
    I hope Marje will be online soon to help

    but I have a question:
    what was the plan post hospitalization?
    A follow up with your regular vet? When?

    I might be good to check the electrolytes levels again.
    I do think Ty would benefit from daily LRS SQF, small dose like 50 - 70 ml but only if the vet thinks it is ok with his heart. I noticed that the ER doc didn't hear the murmur. It gives hopes that SQF therapy at home short term might be allowed.
    It could help not only with the electrolytes but the appy, too.
    He was up to 5% dehydrated on the day of the records - fluids should help.

    You spent a lot but the treatment listed above is just what was needed, IMHO.
    All very common in treating DKA patients.


    If it is any consolation: some of Ducia's reads were worse then Ty's. And her weight was less than 3 kg.
    And she pulled thru.
     
  80. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Thank you. I just took his blood glucose (287), fed him ~25cc of FF which is a little less than half of a can, and gave him more water. Going to give 1 U in about 10 minutes from now.
     
  81. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    We don't currently have higher carb food - our other cat and Ty both eat the FF pate. But we do have corn syrup and honey ICE. We also live in a big city, there are lots of 24 hour places within a few blocks where we can go and grab something at any time if needed.
     
  82. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    This.
    Over $2,000 spent on Alice’s DKA and that was 3 days, plus I had my own insulin for part of it, my own food, any little thing that could save a few dollars. Never mind all the other bits here and there, and surgery this week to address some underlying issues. She needed all this stuff to survive. It sure does stink though that survival has such great costs. It’s frustrating. :(
    One thing we do is learn how to reduce those hospitalizations when possible by doing a few more things at home. For example, you don’t need a fructosamine if you are home testing regularly! And subq fluids can turn things around before they get critical, sometimes. :)


    I don’t know about labs but Alice’s weight was as low as 1.8kg!!!! Now she is about 3kg.
     
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  83. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    There was not much of a plan, to be honest.
    They chalked up his first episode of DKA (in April) to persistent high blood glucose. That was when he was on 1.5-2U of Humulin 2x/day. After that they recommended we switch to Lantus.
    They chalked up his second episode of DKA (last week) to something environmental. Stress, or a GI flare-up, or acute pancreatitis that they couldn't detect in his bloodwork. So they wanted to stay the course with 1U of Lantus 1x/day. They also basically said we are doing everything we can :(, which is hard to hear... because I am sure there are things we could be doing better. I already learned from all of you that we should be feeding him more often than just 2x/day. I think they are very cautious and want to avoid hypo.

    Our regular vet is great and really cares. Called us on Tuesday and yesterday to talk through everything. He too was wary of staying the course because of the issues we have. That is when he suggested 1U in the morning, .5U in the evening. (Before we knew of the ketones). I tried to call him today but he was not in the office, and will be tomorrow morning.


    I am going to call our regular vet first thing tomorrow morning again, especially if Ty has not improved significantly.

    I also agree on the treatments... didn't mean to imply that anyone was doing a poor job or that they were doing too much. My main issue is with the communication that we've had this second round. Like I said, they kind of told us that we were doing all we could and didn't have any major suggestions or plans to shift treatment. It feels a little bit like they gave up. But that is my interpretation, not at all what they said to me at the hospital.



    That is so helpful to hear. I am hoping for the best. Preparing for the worst.
    Clearly he isn't loving life right now and he does not like me sticking a syringe in his mouth full of food and water. So we can only do that for so many more days before we need to take different steps.
    Selfishly I want him to live forever. But for his sake I only want to keep him going if I think that his quality of life will still be good.
     
  84. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    It is frustrating, I agree. On the other hand, I get it. These places need to stay in business and they can't do everything for free. The technology they use to do all of the things they do is expensive. As is their education so that they can know what to do. I don't blame them for keeping their doors open. But it does stink when you're the one having to pay. I feel so fortunate that we have been able to pay for Ty's care thus far. At the very least it has given us more time and more happy days with him.

    Wow. 1.8kg. I can't imagine. I already think that Ty looks like skin & bones.
     
  85. Sybil and Zoe

    Sybil and Zoe Member

    Joined:
    Oct 16, 2018
    :bighug::bighug::bighug:Blessings to you both. I know how hard it is. I had one with leukemia years ago. He was my first kitty and my beloved. It was a hard decision but it was time for his suffering to end. We support you whichever way it goes. I pray for a rally but if it doesnt come then I pray for yours and his sweet peace.
     
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  86. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    That cycle today is the best he has had on the SS. You are doing a great job !
     
  87. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Thank you for your sweet note.
    I am also hoping for a rally.

    Ty is my first kitty. My first pet that I decided to get and care for on my own.
    I've had him since I was 18 and we have been through so much together. I had to go to probably ten shelters to find one that would let a college kid adopt a cat. I understand their logic, but I do think Ty got pretty lucky by getting adopted by a college kid :). It is hard to see him suffering.
     
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  88. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    It is definitely the best we have seen since he was diagnosed.
    Thank you all for all of your help.
    I really think feeding in between shots is helping a lot.
     
  89. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    I see.
    It was recommended to us upon ER discharge to go and see our regular vet in 3 days which we could not do and instead we proceeded at home with insulin, feeding via E-tube and SQF. Finished all the meds and run another blood test. Some reads improved a great deal, some - not so much. Got equipped with Cerenia pills for nausea, appy stim, a paikiller, a bag of LRS and took it from there. Run another blood work in a month or so - great improvements yet.
    I keep Ducia's results in the LAB Tab at the bottom of the SS - it shows the progression.

    I think you should go and see your reg vet and discuss what's next.
    He (supposedly) will receive a copy of all ER papers but I would take what you have posted above with you to the appointment - just in case there is a delay on the ER part. The part on the chest exam suggest (to a lay people like you and I, not medics)it is ok to try SQF. If it is so and the vet agrees - ask him to teach you how to give it at home. (it is much easier than you can imagine at the moment).

    Not eating is very worrying. It can open a Pandora box of ailments in cats and thus having all tools to remedy not eating is a must. Ask you vet about Cerenia - Ty got it at the ER.
    I might be wrong but this fPl test rules out pancreatitis.

    Again, I hope some others will chime especially with regards to the blood works and Xrays. In case not - try to get your vet tomorrow. Something needs to be done about eating asap and lytes levels checked in case they are dropping again.
     
  90. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    I am huge advocate of the Esophageal Tube - it saved Ducia's life, and many more cats.
    Care at home requirements are easy - provided you have to "home care" kit that is usually dispensed to ea patient upon discharge.
    The procedure is it out patient,a few hours only and ,amazingly, not as expensive as one would think - $160 in 2017.
    Then nursing hours are added along with materials and you got a hefty bill. Nursing at home cuts at least half the cost, and I do believe very strongly tubes saves lives. Dr. Pierson wrote about it in her blog. Please consider the idea or talk to you vet about it.
     
  91. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    He is now at 363 blood glucose 1 hour after receiving insulin and eating ~3/4 can of FF (thru syringe)
     
  92. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    He also got 0.5 mg/kg ondansetron bd (twice a day) at ER so you could ask for that as well for nausea. I think you definitely need to get cerenia and ondansetron from the vet. And ask about subQ fluids.
     
  93. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    I think he might have decided that he stayed in low blue numbers long enough for one day and it is time to go up for a bit. There is no need to test hourly unless BG drops dramatically which I doubt but cats had proven me wrong in the past.
    If it is possible take a test at +3 but I believe he is going to be high. If you are up anyway to feed grab a quick test.
    If it is possible to set an alarm and check between + 6 and +9 it would be even more informative than +3 for the dose assessment in the near future.

    I hope you both will have quiet and restful night.
    Looking forward to read a good update on Ty tomorrow.
     
  94. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Also, I am sorry for the loss of your sweet boy. I hope he is happy wherever he is now.
     
  95. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    I think you are right. That is the plan for tomorrow.
     
  96. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Thanks so much. I tested at +2 before I read this and he still high (347).

    I will be setting alarms tonight to feed him & to check BG. Will do +3-4 to make sure he isn’t dropping and between 6-9 as you suggest.

    We got another ketone reading. He urinated and has diarrhea again. Ketone reading looked the same as this morning. Negative or trace, so hard to tell even with lots of different light.

    As others have suggested, I feel like this is either a tummy/nausea issue, or he has some underlying GI issue that could be more serious and is now starting to display signs, since he doesn’t have ketones (at least they aren’t high) but still refuses to eat or drink without my coercion. Will be hoping for the best and checking with vet tomorrow.
     
  97. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    And thank you all so, so much for your help.
     
  98. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    One of Alice’s litter mate sisters went to a college kid. They were all bottle babies. Had her (and her brother who passed at 7) since I was 20 years old! Same sort of story. She’s been by my side for so much.

    No matter what, I hope you do know that you have done your best and you have done much, much more than many others would ever do, and most importantly you have loved him and been his best support for his whole life. You’re going to love him no matter what, but I hope you have more days together. :bighug:
     
  99. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Just to be clear....ondansetron is a human drug....your vet probably won't have it there but he/she can write you a script
     
  100. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Yes that’s right, thanks @Chris & China (GA) i forgot to mention that.
     

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