Possible DKA??

http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=98890

6.5 year old male feline diagnosed diabetic on 5/21/13

His first visit his urine tested positive for ketones and blood sugar (BS) was 372

His vet started him at 1 unit glargine twice daily & ½ can wet m/d low carb food at 7:15 am & 7:15pm (Every 12 hours).. We went back to the vet a few days later because had he had been consistently negative for ketones but seemed very lethargic. At that time the vet changed his insulin to .5 unit twice a day. Two days later his urine tested positive for ketones again and when we called the vet the practice told us that his vet was no longer working there and advised that he return to 1 unit twice daily again. He was negative for ketones all week but by the next appointment (about a week later) his urine was positive again.The new vet moved him to 1.5 units twice daily and said that it is ok for him to also have ¼ cup of dry m/d low carb food between feedings. Since then he has been mostly ketone-free and no lethargy.

Then our other cat (F-6yr) started scratching badly enough that we were concerned because she had bumps on her neck & face that seemed to have started when we began the hard food in between feedings. We figured she may be allergic to the dry food so we started subbing the dry food with friskies pate (low carb) which they have eaten before without problems and her skin issues went away so we have been keeping that up. Until last night he has been clearing his plate at all feedings and would also eat what she left over.

Yesterday we noticed that he was not eating as much as usual and didnt appear to be feeling well so we tested blood sugar about 12 hours after insulin and it was at 297. He ate a little this morning but didnt finish & vomited sometime after (mostly liquid). Even though he is drinking water he appears to be dehydrated (camped at his water bowl). Turgor test is maybe a little slow to return but not severe and capillary refill is normal (1-2 seconds). His urine tested Positive for ketones again (high) and he was very lethargic. He is only taking a few steps at a time before laying back down and hasnt eaten much since vomiting so we tested his blood sugar again & it is at 303 (about 8 hours after insulin).

Im afraid he is experiencing diabetic ketoacidosis but have thought that before because of the ketones and he just needed a dosage change. Im not sure what other information might be helpful but Im at a lost for what to do. I already owe hundreds to the vet and am sure they will hospitalize him if I go in there saying I think hes in DKA. Is there anything else I can look for to confirm or does that require lab work? My boyfriend and I are militant about his feeding & insulin schedule and check his urine regularly for ketones and he has been negative. I dont understand how he can suddenly be so sick. Ive decided while typing this that I am taking him to the vet as soon as my boyfriend returns from work with our vehicle but any advice would be appreciated.

Thank you.

 

I just re-read your last paragraph, I'm glad you are taking him to the vet as well. I hope your kitty feels better.

 

Ending purrs and prayers for recovery, Glad you are going to the vet.

 

Trace ketones should be a call to the vet.

High ketones in the urine sample should be visit to the vet ASAP, emergency vet if required.

In combination with the dehydration, DKA is more likely with the high ketone levels.

 

Sorry to hear this, let us know how he gets on and then we can put together a plan for getting him back on track.

Wendy

 

First, glad that you decided to bring him to the vet. All I can add is that DKA usually happens very quickly. My cat Bob was diagnosed with diabetes, and no ketones were present in his urine. Three days later, he was in the ER with DKA. From zero to sky high in no time flat. The symptoms you described above sounded very familiar to me. Especially the lethargy and not wanting to eat. Bob would take a couple of steps, howl, and lay down. He did it for over 24 hours before I could get him to the vet. She told me then that if I'd waited another 24 hours, he most likely wouldn't have survived them.

Sending healing thoughts and prayers to your little guy.

 

Back from the vet with Bubba. The vet was concerned at the fact that ketones were present but also stated that his clinical signs seemed to indicate that he was hypoglycemic. We asked multiple times about DKA and the vet explained that the way that they test for DKA is to obtain an arterial blood sample and that it isn't recommended. He also mentioned that his BG being at 300 wasn't really that high, and with ketones only showing up in the last few days, he wasn't too concerned about DKA. He said DKA takes a while to really set in, and usually with higher glucose levels. We don't think he believed it was hypoglycemia or DKA, but he basically said "We don't know".

They gave him some fluids and sent us home, and the vet mentioned "he's not critical", which made us feel better. We got home and checked him BG; it was at 299, so it appears his high is around 300. We opened a can of food and set it down for him. That was about 30 minutes ago and he refuses to eat any. The vet specifically told us, if he doesn't eat tonight, give him his insulin anyways, if he also doesn't eat again tomorrow morning, don't give it to him and bring him in.

We want to get a bit of food in him, but it looks like he isn't going to be eating much right now. Once we give him his insulin we will be checking his BG every 3 hours to make sure he isn't getting too low. Hopefully, he will eat a little in the next few hours so we can feel better about it.

 

I'm certainly not a vet, and not an expert when it comes to DKA, but from my experience with Bob, and with others I've witnessed here, I don't agree that DKA takes a while to set in. Nor do I believe that high BGs are required.

DKA usually has 3 "ingredients".

Insufficient insulin.
Insufficient food.
Some sort of infection present.

Dehydration also seems like a common thing.

I understand them wanting to make sure you give insulin. And if you can keep testing, you'll see any drop in BG if it happens. You can try a few things to get him to eat. Sometimes parmasean cheese on top of the food will work. Mixing a little warm water into the food can work too. Sometimes they'll lick food off of your finger if you pester them enough. Water from a can of tuna on top of the food. Heating it for a few seconds in the microwave. Anything that makes it stinkier seems to help. If you have to force the issue, if you have some sort of feeding syringe you can mix the food with water and force him to eat. Just do so in small amounts so he doesn't choke on it.

Let us know how it goes.

 

Mishka never ran high numbers....heck, she came to me in DKA and we have battled it too many times plus times it was only ketones, not DKA. DKA is based on the blood pH and Mishka usually was in the mid 100's and also no sign of infection, no UTI, ultrasounds done...apparently Mishka never needed a reason because every test run never gave us a reason. Vet is wrong......trace can go to max in a heartbeat, not several days. Ketones are nothing to mess around with or wait on.

 

Thank you for your reply. We have tried several of your suggestions and unfortunately, none of them have worked. He seems almost disgusted with food at the moment.

We have been giving him his insulin regularly, but last night, I think I missed with the injection (I don't think I pierced the skin). Other than that, he has been eating fine, and we have been giving him his insulin regularly. Is it really possible that 1 missed injection could cause DKA? I think that is why his Dr mentioned it probably isn't DKA, because he has had plenty of food, and had his insulin on schedule, and he hasn't had any ketones in his urine because we checked 2 days ago.

I think we are just confused mostly. From what we have read, the lack of food is what can cause DKA (as you have suggested), not the other way around. He got sick and stopped eating, it's not that he wasn't eating, and that made him sick (at least we think). We don't really have much experience with this though, so I guess we will just have to wait and see in the morning. I am going to stay up all night with him, watching for him to eat and checking his BG. If nothing has changed or he has gotten worse by 7:30 when the vet opens we are going to take him in.

I just want to say thanks to everyone on behalf of my girlfriend and I; we really appreciate the support. I read about your cat Bob, Carl&Bob and I am happy to hear you were able to get him help in time.

 

It is highly unlikely that just one missed shot would cause DKA. Most people "miss" with shots on occassion. We call them "fur shots" because you can usually feel the wetness from the insulin on the fur. It's just something that happens once in a while.

The other thing that can happen if a cat won't eat for an extended period of time is heptic lipadosis (I probably botched the spelling on that!). Also called "fatty liver". But that usually won't happen in just one day. Other things that can cause lack of appetite are pancreatitis, an infection or inflamation of the pancreas. That's usually very painful and cats suffering from that usually won't eat, and just lay around in what we call the "meatloaf" position feeling and looking miserable.

I'm glad you're planning on taking him in first thing in the morning if you don't see any improvement. Ask the vet if there could be any infection present. It could be something as simple as a UTI.

Hoping he feels better soon.

 

His ketones are at the max, the stick turns dark purple almost instantly. This has happened once before though and then it went away almost instantly. One time before I missed his injection (missed the skin). I obviously didn't want to try and give him more in case I was wrong about missing, so I just waited. About 9 hours later I tested his urine and Ketones were in the "Large" category; it surprised me how fast it happened. I gave him his next injection on schedule and 6 hours later I tested his ketones again to find there were none.

But what does that mean? I was under the impression that, yes ketones are very bad, but that it wouldn't be serious unless we let the problem persist. If we went several days I could see it becoming a problem, but him not getting insulin with 1 meal is enough to cause all this?

I guess what we really want to know is, what do we do? Is there anything we should be telling the vet we want done? We just aren't sure how we should be handling this.


EDIT: Thank you Carl & Bob, that is what we were looking for. We plan on getting a full blood panel done tomorrow morning and the vet even said if we come in early we could have the results back by the end of the day.

 

Great on the blood panel. What the vet will most likely be looking at besides the ketones and glucose levels are his electrolytes. I think they get all out of whack when it's DKA, and those numbers will help your vet in determining exactly what's going on.

 

Ok sounds good. Just as an update, we just checked his BG, 2 hours after his 1.5U of Lantus he is at 245. For comparison he was at 299 right before the insulin which was 12 hours since his last injection.

I'm happy he isn't too low, but at the same time now we are starting to question whether or not he was regulated correctly, considering he is still at 245 without eating a single thing. We will be doing more BG tests throughout the night, checking every two hours. I'm interested in seeing how low he gets without any food.

Thanks again!

 

No matter what sort of numbers you see, don't let one cycle of insulin make you draw any conclusions as to how well or not the Lantus is working. Take a look, when you have time, at any cat's spreadsheet. You'll see two, four, six, you name it, cycles on the same exact dose, and not often will you see any duplication of numbers.

The most important thing to keep in mind is that a BG test is nothing more than a snapshot in time. What you will see, over time, is "patterns" in the numbers, where the exact values aren't important, but rather the trends you see are what matters. Besides food and insulin, there's a lot of "other things" going on daily inside a cat's body that can affect the BG numbers. Try not to let the numbers drive you bonkers.

 

That's a good point, thanks.

Update: Bubba just vomited. It was entirely water, not even discolored except for at the end it had bile in it. He has been literally laying down with his head in the water bowl lapping up water. I am stunned by how much water came out of him. He seems ok, and started cleaning himself immediately. Now he is just laying back down in his favorite spot and hasn't tried to drink any more water. We are going to check his glucose again in about 1 hour.

 

Update: Bubba was really trying to give eating a go, but he didn't really eat anything. He took maybe one little nibble. It's like he want's to eat, but just can't stomach it. At this point, I can't wait for morning to take him back in.

Just checked his BG and it was at 233; 2 hours ago he was at 245, and he started at 299. He is sniffing around the food again, and I think I am going to put down a fresh can of tuna hoping he might eat even a little. He just seems interested in licking the juices off though. I think he is just so nauseous he doesn't want to eat anything. :YMSIGH:

I will check his BG again in 2 hours.

 

Hope he does better. Just learning the stress have not even gotten ours on insulin yet and already a scare.

 

Don't stress out too much, it get's easier. I still have no idea what is happening with him and I think that is what scares me most.

But once you get them regulated and monitor them well it will get easier.

 

I'm glad you're taking Bubba to the vet, and I hope you go first thing in the morning as soon as they open.

My cat had the same symtoms and he did have DKA, and he is a DKA survivor.
I have been on this board and the ones before this one, for a long time. I have heard of cats that can go into DKA without high BG numbers, and it can come on suddenly.

I hope you keep thinking possitive. I'm glad you're getting the blood work done, and I wish the best of luck to you and Bubba at the vet today.

 

Thank you. I am really hoping we can get him over this and regulated properly.

I just checked his BG, exactly 6 hours after his 1.5U of Lantus and he was at 280. That is without anything to eat. Here is what his BG looks like for the night:

8:35 right before insulin: 299
10:35 two hours after insulin: 245
12:35 four hours after insulin: 233
2:35 six hours after insulin: 280

Come to think of it, I have never seen his BG below 250 except for tonight with no food. I really just think we never had him regulated properly. I think we will mention that to the vet and take our spreadsheet.

Thanks again.

 

If he doesn't eat this morning, ask the vet for some feeding syringes (they usually give them to you for free). He needs to eat. You may need to blend some food until it is the consistancy of a milkshake (with no chunks that can get stuck in the syringe) and help him to get some calories into him. Here is a recommended video on assist feeding: http://www.youtube.com/watch?v=U6o17wH6ujk He may need this help with getting calories into him, until he feels better and eats on his own.

You may also want to try insulin syringes with the 1/2 inch needle on them, if you're not already using them. That may help you with the piercing of the skin issues.

 

I'm almost certain the vet is going to hospitalize him. I'm sure they will either force feed him themselves or give him a feeding tube of some kind. We are worried about how much that will cost, but at this point we are willing to do anything to get him feeling better.

Thanks for the tips though. If the vet does let him come home, I will definitely do that.

 

I'm glad you know that. He really needs some hospitalization to get through this.
I had two choices of hospitals, and each were over an hour away. I chose the University of Pennsylvania School Of Veternary Medicine in Philadelphia. I went to visit him everyday, and that really helped him to know that he wasn't alone or abandoned, and he very slowly got better.

Take a Tshirt or your pajamas or your pillowcase, something with your scent on it, with you to put in his cage, and bring another one everyday when you go to visit.

I found the costs to be less than 1% of what a human would have to pay for the same treatment my cat got. J.D. was hospitalized for a lot longer than normal (8 and 1/2 days) and the cost was about $4300. Most cats are only hospitalized for about 3 to 5 days.

Keep possitive. Your Bubba can get through this. Once he's feeling better, if you keep posting, we can help you with getting his diabetes more in control. Best Of Luck to Bubba.

 

Thank you. I'm happy to hear your cat got better. I'm concerned about leaving him there over night. I know no one will be there to take care of him for probably 10 hours a day, and I want to see about being able to drop him off in the morning so they can do their thing, but bring him back home at night. Do you know what they do when they hospitalize them? Are they just trying to get them stable with food and insulin?

Thanks for the reply.

 

Update: We took Bubba to the vet this morning and we have been there for a few hours. By time we left, he seemed to be doing worse. We got him there and they took him back almost immediately because he was breathing fast and heavily.

The doctor came in and we went over the usual with him. The doctor was very concerned with his breathing and said he wanted to do an X-ray to rule out and lung issues. We agreed, and also agreed to let them hospitalize him. We waited around for the X-ray results, and we got some news we weren't expecting. His liver is enlarged quite a bit; about 2x the doctor said. There didn't seem to be any masses or anything, and the doctor said he couldn't feel anything.

So right now, it's not looking good. The doctor basically said there is a very small possibility that there may be a mass we can't see, but it's most likely caused by something else. From what he told us, he seems to think it's either complications from the diabetes or maybe something like pancreatitis.

Right now, we are just telling ourselves that if it was from the last few days of food changes and a missed insulin shot that put him in such a horrible state, he probably wasn't going to make it very long anyways.

Like I said in a previous comment, it could be that he never actually has been regulated, and maybe he's been sick for a while, although he did have a full panel done about a month ago that we figure should have shown problems with the liver.

Currently, they are trying to regulate him, they are giving him I/V fluids, and also trying to syringe feed him. No one is on premises overnight, so we will most likely be taking him home tonight.

I think we have both come to the realization there is a good possibility he won't make it through this. It was just so sudden. He was fine a few days ago. I guess now we wait. I will be calling them in a few hours for an update. Thanks again everyone for your support.

 

Bubba and you are in our positive thoughts and prayers. Hoping for the best.

Bringing Bubba home sounds like what I would do if there wasn't 24 hour monitoring at the vet.

Please keep us updated when you can. We will be worrying and hopeing right along side you.

 

Thank you so much Deb. Right now, we are just hoping for the best but expecting the worst.

 

I am Hoping The Best for Bubba, too. Did they get the blood work done and the results back?
Were they able to feed him during the day?
J.D. was in critical condition when he went in to the hospital and was barely able to lift his head the first day or two, but he slowly got better in the care of the hospital. He came home with a feeding tube. They kept saying they would not release him until he ate on his own at the hospital but he just flat out refused, so they put a feeding tube in, and after 8 and 1/2 loooong days he finally came home, and he soon was eating on his own after a couple of days of being home. That was over 7 years ago.
I hope your boy pulls through too.

 

Thank you Dyana, I'm very happy for you and J.D. We did not get any blood work done because apparently his BG was much higher than we were reading, so the doctor diagnosed it as DKA.

We just got him home and he is doing a lot worse. He can barely hold his head up, and he almost looks drugged. We are pretty sure he won't make it through the night. At the same time, every once and awhile he gets a little burst of energy and he rolls onto his back or gets up to get some water, so that is good. They checked his BG right before we left and he was at 338, which is down a lot from 490, but like I said, it's pretty hard right now to think he is going to make it through the night. It feels like he is barely hanging on. When he does walk he stumbles and is very wobbly. I guess we will just have to wait and see, but right now I think we have both come to the realization that he most likely won't make it to morning.

 

If you pull up his scruff, does it return to place quickly? If not, dehydration is probably part of the problem.

Is he showing any interest at all in eating?
Take a look at his gums and see if they appear pink.
I wish I had some idea of how to help you besides prayers...

 

Yes, he is very hydrated. They gave him a ton of fluids today and the doctor even mentioned he is definitely better in the hydration department.

No interest in eating at all. I opened a can, and he would usually come running, but instead, he just laid on the ground and didn't even flinch.

His gums appear pink, although I don't know how pink we are looking for. It looks like pink taffy.

Thank you for your prayers Carl, you and everyone else here have been great in supporting us.

Unfortunately, I just think he is too far into DKA. We were under the impression it takes weeks for that to happen, and weeks of ketones but apparently that is not the case. If he does make it through the night, I am hoping we can get him in and on an I/V again with insulin to get him to normal levels. Right now it is not looking good though.

Thank you again everyone.

 

Pink taffy is good. You can also press on the gums, which should make the color go away and then return. White or gray is not good.

If the vet assumes DKA then they should be trying to balance or return his electrolytes to where they are supposed to do. I think they do that by adding supplements to his fluids. His BGs are not awful, it's the ketones that have to be gotten rid of. Don't give up hope. If he can make it back to the vet, they can make things better.

 

Thanks Carl. Yea, they give him all types of supplements today I believe. The thing with his ketones is, when we tested him yesterday, it went instantly to the dark purple marker (the darkest one). We tested him when he got home today, and it went to the dark purple marker, but did it much more slowly. It took almost the full 15 seconds to get that dark. I don't know if that means anything, but it was nice to see.

While we haven't given up hope, we are just trying to be realistic I guess. We don't want to get our hopes up. :YMSIGH:

Thanks again Carl.

 

Sending prayers to your Bubba. I hope you can get him to the vet first thing in the morning.

 

Sending more prayers and positive thoughts for Bubba. Hope he can rally.

 

Sending many prayers that Bubba rallies back.....healing vines also!! o o o o Sincerely.......Cindy & Sabrina cat_pet_icon

 

Thank you so much everyone. Bubba made it through the night, and I think he wasn't as bad as we had thought initially. Throughout the night he seemed very sick, but it also seemed like maybe he was just exhausted.

We took him in today, and he didn't seem any different than when we took him home. They gave him a BG test right when they got there, and to our surprise she came back saying he was at 90. This has us worried because if he is 90 now, 12 hours after getting insulin, what was he at 6 hours ago? His behavior last night was closer to that of a cat experiencing hypoglycemia, so we are a bit worried. We gave him insulin this morning about an hour before his BG test, so that isn't good either. They said they would monitor him very closely and probably give him some sugars to raise him a bit.

The doctor seemed very concerned, because she was basically saying at 90 he shouldn't be acting this way, but also said he has been through a lot physically and mentally. This whole thing doesn't make any sense. At 7:30 P.M. last night he was at 338 still, so they gave him his 1.5U of insulin and sent him home with us, and now 12 hours later he is at 90. I just don't understand it.

Last night around 8:30 P.M. we called the doctor because we had a few questions, and we ended up talking to a different doctor because ours had gone home for the night. We mentioned he was lethargic and seemed drugged and she told us to put Karo syrup on his gums. We ignored this and assumed she just didn't know his situation, but now we are thinking he might have been very low.

Does this make any sense to any of you?


EDIT: We are sitting here talking and we think we know what happened.

Like I said, our doctor went home yesterday early around 5:30 so another doctor took over monitoring him. At 7:30 P.M. the replacement doctor checked his BG and he was at 338. She had instructions to give him 1.5U of his insulin and she gave it to him. About 1 hour later at 8:30 P.M. we talked to her (the replacement doctor) and told her he was acting drugged and really out of it. She said we should put Karo syrup on his gums to bring his BG up a bit, and we thought she just didn't understand his situation.

Now here is what we think happened. At 7:30 the replacement doctor checked his BG, he was at 338. She saw in the notes that she was to give him 1.5U of insulin, and she gave him fast acting insulin, not realizing he was suppose to be given lantus. That would explain his hypoglycemic behavior around an hour after getting the insulin, and his low numbers even now. Right now we are a little pissed off that this happened. It explains why she thought it was normal for him to maybe have gone from 338 to too low in a matter of an hour.

We are just so tired of all this crap.

Thanks as always everyone, you have been a huge help.


EDIT 2: Now we are sitting here thinking about what kind of damage this caused him. If he is at 90 right now, he was hypo all night and he clearly was showing signs of it. We were thinking he was just on his way out, but in reality he was just hypoglycemic. The doctor this morning even mentioned that he shouldn't be in such terrible shape at 90, but it makes sense now knowing he has probably been hypo all night. It's all starting to make sense now. He appeared very "high" last night. He is at 90 now, but what damage could this have caused if he was hypo for the last 12 hours?

 

Thank you for the update. Keep us posted please.

Sending calming vines and 'go away stress' vines and get some sleep vines to you. You are real troopers caring for Bubba the way you have been and you must be exhausted.

Hope you can get some rest soon.

Please, take care of yourself and come cry on our shoulders or rant against the vet mistakes or anything else you need to do. We have been there and understand what you are going through.


deep breath, hold, breathe out. deep breath in, hold, breathe out. deep breath in, hold , breathe out. Slow and steady.

 

I remember one time I went to go visit J.D. in the hospital when he had DKA and there was a paper list attached to his cage, and he was pretty sick, so I was non-chalantly looking at it and read a 28 and realised that was a BG number they had recorded for him. My eyes got kind of big and I had to ask a resisdent if I was correct and she said "yes". I never saw that list attached to his cage anymore for some reason (like they didn't want me snooping). Anyway, R insulin is often used to get the BGs down in a hurry when the cat is in the hospital with DKA and a dextrose drip is used simultaineousy to bring the BGs up if they go too low, while the cat is tested and monitored continuously.

 

Thanks guys. You all are very good at making us feel a lot better. We just feel so stupid not realizing he was hypo last night. I guess the good thing is he wasn't seizing or unconscious. I am hoping they can keep him steady and get some food in him. Maybe if we can keep that up for a few days, he will start to get better. To be realistic though, his liver is still enlarged, which we aren't sure if that is something that will get better. I guess we will just have to wait and see. Thanks again everyone.

 

233 and 245 are basically the same number due to 20% meter variance....299 could also be near the same, again, due to variance of the meters....So basically, he could be running "flat"...

 

No disrespect intended: I would fire that vet immediately, if it was me. I am infuriated reading everything that you and kitty have been through with his vet "care". Just my opinion, though. And no disrespect to you; you have been on quite a rollercoaster. Now, if you would like to find a GOOD vet who is familiar with diabetic cats, insulin and promotes home testing, let us know your approximate area and we can surely recommend someone for you. I sure hope kitty is better; hang in there You're in my prayers

 

I am sorry you are having so much trouble and hope Bubba feels better soon. One of my cats has had a hypo and been in a coma. He has a residual tremor and his vision isnt great but otherwise he is fine.

Once he is a bit better let us know and we can work out a plan to stop this happening again. The main thing - home testing - will be key here to keep him safe and preventing another incident.

Wendy

 

Thanks for all your comments guys. We are pretty mad right now, we just aren't sure what to do. Right now we are just hoping it didn't cause any damage, and that he can pull out of this. I am waiting on a call back from the doctor right now.

As for finding a new vet, we are definitely going to. The only reason we are even with this place at the moment is because of our original doctor who was there. We found a doctor that we were absolutely in love with and she was just perfect. We saw her a few times over the next couple weeks. We brought him in on a Friday afternoon to check his numbers and things and everything was great. I called her the next day with just a general question and I was told "She isn't with us anymore". They won't tell us what happened, but we are assuming she was let go. Friday afternoon there was no indication from her that she wouldn't be with the practice anymore, and then the next morning she was gone. After that happened, we simply stayed with this practice because we had an outstanding balance with them.

Thanks again everyone!


UPDATE: The doctor just called. He said his BG numbers were still stable at 125, and he is still holding down 5ml of wet food every 2 hours. His words however were "He still looks terrible". They checked his electrolytes and found he was low, so they have been giving him potassium and other supplements in his fluids to try and get him feeling better. He said he looks a little better and more alert, but he is still really sick.

The doctor said "I know you want to bring him home tonight, and usually I would say that's a good idea, but because his electrolytes are so low, I think maybe we should leave him here hooked up to the I/V all night. If you take him home tonight, it will be like starting over tomorrow morning." I completely agree with him, but at the same time we are now a bit hesitant to leave him there all night after last night. I do trust this doctor the most, but we are still pretty scared.

 

I'm disappointed with your vet too, because I think they should have run the blood work to see if his electrolytes were messed up, as often happens with DKA. How do they know without testing, if he needs and what he needs added to his IVs?

Good luck finding your beloved vet again, but if you can't find her right away, I would try another vet.

I hope Bubba is eating at the vet either on his own or by assistance from the vet techs. He needs food, especially if his liver is sick.

 

Thanks Dyana. They have been giving him 5ml every 2 hours, so that is good. Hopefully he can just stay strong long enough to get through this.

 

I'm glad he's eating. If he comes home with a feeding tube or if you have to assist feed with a syringe for a while, once he's home be prepared. If you can get IAMS Maximum Calorie that would be great for assist feeding as it is low carbs (about 6%) and has 330 calories per can.

 

I think the vet tonight on an IV is a good idea.
Ask if you can have a copy of his chart, or ask for an itemized bill that shows everything they've done. If he was given 1.5u of anything other than lantus, it should be listed somewhere. Then you'll know for sure.

 

UPDATE: We just got back from seeing Bubba. His BG was at 130, which is really good considering he hasn't gotten insulin in 12 hours. The doctor said he won't be giving him insulin tonight because he wasn't low which made us feel better. Bubba isn't necessarily looking any better unfortunately. I mean he is a tiny bit perkier and the vet mentioned him acting a bit better, but it was negligible in my opinion.

The vet is worried because he is saying once they get their BG at a reasonable level, he should start improving. His potassium levels were low. 2.2 this morning and 2.9 now, and the doctor said he wants him in the 3s. They are continuing to give him 4x the normal amount of potassium in his I/V tonight, so he thinks he should be at normal levels tomorrow. He said if he doesn't show signs of improvement within 24 hours we should really start to worry and "consider other options".

So I have to ask. For those of you that have battled DKA before, what was the turning point? Once their BG levels got under control did they start improving quickly? I figure that because he has been through so much in the last few days, it may take a few days of him at normal levels to start improving, right? The doctor seems surprised to not see him getting better, although at the same time he is saying his low potassium levels could definitely be causing him to still be as sick as he is. I just feel like it would make sense that he may need a few days at good BG and potassium levels to start improving; he has been through a lot.

As always, thank you everyone for being here for us. It really means a lot.

 

I have first hand experience with low potassium and DKA. Bob had both at the same time too.

Once Bob was ketone free, hydrated, and started on PZI insulin, the improvement was obvious. It took weeks for me to slowly get his potassium up to the normal range. That was done by giving fluids daily, then every other day, then 3 times and 2 times per week. It took weeks, but the supplement was not large. It sounds like your vet is being more agressive with the potassium. Bob also had to go to the vet every couple of weeks to have his potassium level checked so that it didn't go too high, because too high is just as bad as too low.

The big symptom of low potassium with Bob was overall muscle weakness. So he was lethargic. Once I got him home, he didn't look "sickly" but he was definitely lethargic and lazy for the first few days. He came home with a normal appetite, which was good so I knew he was eating enough. And the fluids insured that he was hydrated enough. I just had to be patient with his muscle weakness but he improved gradually. Within two or three days I could see he looked overall better off. It was a comination of the insulin, the food and the fluids that got him there.

Bubba's BG numbers tonight sure do look a lot more encouraging! And if he can spend another day or two staying hydrated, managing to eat even if it's forced on him, and his potassium numbers come up, I think you'll notice he looks and feels better that quickly.

They may send you home with a bag of fluids, with or without added potassium. They might give you potassium supplements to mix into his food to help his levels stay "normal". If they do that, ask for the pill or powdered form rather than the tube of paste kind. Usually the paste style had some sort of added sweetener in order to make it "palletable", but sweets and diabeties don't mix. I used the powdered kind for a while too, and I just used to mix it in Bob's food and he didn't seem to notice it was there. Actually, he's what we call a "hoover". He sucks up his food so fast I doubt he tastes much of it. :smile:

Overall, in your shoes, I'd be encouraged even if you aren't seeing rapid or vast improvement with Bubba yet.

 

See, that is how I feel. I think it's good to see his number normalizing but I think he might need a couple days to start feeling better. I guess we will just have to wait and see. We are so exhausted. I've slept maybe 5 hours in the last 60 hours and we have hardly eaten. I am trying to distract myself with TV and movies, but I just feel guilty once I actually start to enjoy anything, because I know Bubba is so miserable.

Thank you again.

 

I know how you feel. J.D. was hospitalized on December 22nd and stayed there through Christmas, and I just couldn't think about anything but him. I slept little and must have looked ragged those long days. My joy everyday day was going to visit him and comfort him. It was a long time ago, and I didn't know that much about asking questions, but I know J.D.'s electrolytes were off but I don't remember which ones. The first couple of days, he could barely lift his head. Maybe by the 3rd day he was laying down but holding his head up. On the 4th day when I went to visit him he was moved out of ICU and into the Intensive Care Unit and he was sitting up but kind of leaning his weight on the back of the cage. I saw him try to groom himself a little that day, and felt he was getting better. Of course I never gave up hope. After a day or so in Intensive Care, he was moved again to Internal Medicine. He slowly got stronger, but it took a long time. Twice he had to have a blood transfusion. Like I said he was released after 8 days (right before New Years), and he was weak when he got home, but much better. He came home with a feeding tube, but was soon eating on his own. Right now 7 and 1/2 years later, he is behind me climbing up on his cat tree and anxiously waiting for me to get off the computer so I can take him outside. I still test him for ketones when he goes high, but he hasn't had any since.
I hope along with you, that your Bubba is healing and gets to come home and finish healing soon, like the rest of our cats that are DKA survivors on this board, and there are a lot of them. Blessings to you and Bubba cat_pet_icon

 

Have they given you any liver enzyme results, like ALT or AST?

Enlarged liver could be many things. A couple are
- hepatitis - liver inflamation, possibly from an infection
- hepatic lipidosis - fat breakdown overwhelms the liver, blocking bile drainage. May include jaundice, a yellowing of the skin. Totally disrupts digestion and thus deranges metabolism, sometimes severely.
- malignancy

More info here: Merck Manual Hepatic Disease in Small Animals

 

Thanks for your stories about J.D., Dyana. Crystina went and saw Bubba this morning and said he is looking a little bit better. The vet however seems to be convinced there is something wrong. She wants to do an ultrasound today, and she really seems to think they will find something. Crystina said the doctor just thinks he should be better by now, but when I read stories like yours Dyana, I think he is doing ok. His first day in, he couldn't even hold his head up hardly. Yesterday he seemed a bit more alert and was holding his head up, but still laying down. Crystina said today he was sitting up, and was reacting to sounds, which to me sounds like he is improving.

Here is a picture of him taken this morning.

http://i.imgur.com/xGP6rOj.jpg

We keep thinking the doctor expects to see more improvement, but then we ask her "Are you expecting to see more improvement by now?" and her answer is "No not really". It's possible that she is just trying to rule everything out maybe? I guess we will know in a few hours with the ultrasound results. His BG levels were high again, around 400, so maybe that is concerning her? He hasn't had insulin in 24 hours (at that point; they have given him a bit now), so that seemed kind of normal to me.

I don't know.. Part of me thinks I'm starting to be too optimistic, and part of me thinks the doctor is just being pessimistic in case something does go wrong. If the ultrasound shows nothing abnormal, we are going to get a full panel done to rule anything else out hopefully. Then we just plan on keeping him hospitalized as long as he needs.

Thanks everyone, you are all awesome.

 

A full blood panel should be done to check all his electrolytes, his blood pH, his kidney values, etc. A blood test called a fPLI should also be done to rule out pancreatitis which can be painful. The liver is amazing and can completely turn around but if he starts becoming jaundice, a feeding tube will be needed. Are they giving him anything for being nauseous? Catinfo.org has everything on feeding tubes. Sometimes we never find out why they stopped eating but the tube pulled them through till they decided on their own to eat again. The E tube, through the neck is a quick surgery and much less invasive than a stomach peg tube.

Sending prayers for Bubba, such a cute kitty that looks so sad right now, and for both of you that he is soon home and feeling well again. Is there any chance of a 24 hr. ER facility to take him to with Sunday coming up? He should not be left alone.

http://catinfo.org/?link=feedingtubes

 

I think Bubba going from laying down to sitting up sounds like he is improving.
I am keeping Bubba in my daily prayers along with you.

 

Thanks guys. Hope, does he look that bad? He definitely looks a lot better compared to yesterday. The place he is hospitalized at in open 7 days a week, but no one is there at night. Do you think we shouldn't do what we did last night and leave him there with an I/V?

We are still waiting on the ultrasound results, so I don't want to get my hopes up on anything yet. Thanks guys.

 

I just called the vets office and asked if Bubbas results were in. The tech put me on hold and came back a few minutes later and said "We did get them back but no doctor is available to go over them with you at the moment. Can we call you back?" and I said yea, that is fine. He then said "Ok, we will give you a call back, but it probably wont be until after 6:00". 6:00 is conveniently about the time the doctor we are seeing goes home for the day. Right now it looks like they may have found something and are having another doctor give us a call at the end of the day. We are preparing for the worst.

 

No, he doesn't look that bad...just sad and feeling yucky. He is sitting up and that is a good sign. If he needs the IV then you need to leave him. If he can do without the IV at night and the potassium level is up, ask if he can go home till a.m. and see if he'll eat at home. If he has pancreatitis, he may also be in pain. Does he even attempt to eat or does he gag at the smell of food? That picture just makes one want to reach out and hug him cat_pet_icon Glad to know they are open 7 days. Keeping Bubba in my prayers.

 

I thought he looked disgusted being in the room with all the dog pictures on the walls. Like he was saying "I want my own cat dedicated exam room. No droolers need ever cross my path. Come on now, make it snappy with the redecorating."

 

Thanks Hope. He won't eat on his own, but they are feeding him 5ml of food every two hours and he has held it all down. They have said he still is drinking water on his own, but doesn't have any interest in food. Right now, I am just worried about his ultrasound results, because they are waiting until the end of the day to tell us and are having a different doctor tell us. Like I said, we are trying to be prepared for the worst.

 

Haha, yes he does. I don't know if that would make a difference. He doesn't care for the vet much at all.

 

Ok, the doctor called and she said she didn't see any tumors or anything, but that his liver is enlarged, and his pancreas is swollen. She said we should do a full panel to help rule out anything that may be wrong with his pancreas. I get the impression from talking to her, that his liver and pancreas are the problem, and he is sick because of that, not the other way around. We have asked her if those things could happen due to DKA and she basically said "Well yea they might".

Like I said, she seems to think he is sick because his liver and pancreas are having problems, not that he is sick and it is affecting his liver and pancreas. Unfortunately they close at 6:00 so we wont be able to go down and see him again tonight. :sad:

From what we have read, an enlarged liver is a clinical sign of diabetes. We are thinking that because he has been receiving insulin, the doctor thinks he was well regulated. We are pretty sure he was never actually regulated, because we thought if he doesn't have ketones he is good to go. His BG has never been below 250, so I think he is basically in the same boat as a lot of cats that have never been treated for their diabetes. I don't know, at the same time he did get a lot better before this. He was gaining weight, eating a good amount, running around the house and playing. I understand why they are concerned it may be something else, because if these were just complications from the diabetes, he shouldn't have gotten better once we started treating his diabetes.

As always, thanks for the support guys. We are going to go see him tomorrow morning, and hopefully he is looking at least a little bit better.

 

The fPLI test will show if it is pancreatitis and if they even suspect it, he may be in pain from it and could use some pain meds. There are also good meds for the liver.......Denamarin is one...I use Marin and Denosyl individually whereas Denamarin combines the two together. Ursodiol is another good med if gall bladder might be affected. So glad they didn't find anything bad like the C word and he can pull through this. By now they should have done a full blood panel....not waited....and looked at everything. A B 12 shot wouldn't hurt either. I give a shot once a week to my three diabetics. Sure hope you can see him tomorrow......that is so important to the kitties.

 

Thanks Hope. I am relieved, because I feel like he at least now has a chance. I am just hoping the blood tests don't reveal anything too serious. If that is the case, I am confident he can stay strong and make it through this. To be fair, we opted out of the blood test on Wednesday because we still weren't too sure how serious it was. Hopefully the results should be back by tomorrow evening. Crystina (my girlfriend) went and visited him this morning and let me sleep because I had only slept a few hours over the past few days. We planned on going again tonight towards the end of the day, but the doctor didn't call until 6:00, and when I mentioned coming by she said they were closing up for the night (they usually close at 7:30).

Thanks again. We are trying to stay optimistic while realistic at the moment. He has improved, but the doctors seem to be expecting more of an improvement.

 

It does sound like he has turned a corner for the better. Sending more purrs and prayers for Bubba. You are in our positive thoughts.

Sending {{{{{{Hugs}}}}}} to you {{{{{{Herdo}}}}}} and to your girlfriend {{{{{{Crystina}}}}}}.

Please, keep us posted. We want to know what is going on with one of our FDMB family members.

p.s. I don't think you have ever told us your name.

 

I would ask your vet about Denamarin. It might be good for Bubba's liver.

 

We just got a call from the doctor with terrible news. It seems as though Bubba has taken a turn for the worst. His temperature was dangerously low this morning when the doctor arrived,I think they said 94 degrees, and his BG was very low as well. They have him in an incubator right now trying to raise his temperature. The blood tests came back showing signs of pancreatitis.

Apparently, the pancreatitis is causing his BG to fluctuate wildly with even just a small dose of insulin, so he is going from 400 to dangerously low with even a small amount of insulin.

I have found a few stories of cats with both pancreatitis and diabetes online, and it seems like it's a constant uphill battle that requires hospitalization often. My fear right now is that we are going to get him better just to have to put him through this again. For the first time in my life, I understand what it feels like to want to end my babies suffering. I really hate to say that, but I can't imagine putting him through this again, and it seems as though within cats pancreatitis is most commonly chronic.

They said he is too sick to come see right now, and they would call when we can come in. We think right now they are just trying to get him to a point where we can come in and see him one last time.

Has anyone else dealt with this before? I'm thinking it might be time to say goodbye, as much as that hurts me to say. I know I feel this way because I am more afraid of what it means if he makes it through this. I know pancreatitis can be very painful, and I just don't want to drag this out.

So does anyone agree that maybe it would be better to say goodbye?

 

Prayers and lots of knees here...come on sweet baby, this can be overcome!

Yes there are several members who's cats have had pancreatitis and got over it...I'm sure they'll post,,,

BIG HUGE HUG,,,

 

There is chronic pancreatitis and unlike dogs, where you give them a low fat diet and dogs always seem to eat, cats are harder. Main thing is support and pain control. It is painful and that alone can affect them so pain meds are needed. That fPLI test should have been run sooner so pain meds could've been used. Then there is acute pancreatitis which is basically a one time deal......they either pull through or they pass away. Mishka suffered an acute attack, was extremely sick but she did survive and has never had an attack of pancreatitis again.

I have to say that low temp is not good news...almost like his body is shutting down. Not what you want to hear but I would immediately go see him. Forget what the vet says, go see your boy, give him lots of love and kisses, let him know you are there and ignore how he may look. He needs to know he hasn't been abandoned.

Many, many prayers coming for Bubba.

 

Bubba passed away today at about 2:15. We made the difficult decision to end his suffering after the rest of his blood results came back and his liver appeared normal. The doctor said she was fairly convinced his liver was cancerous, because if it was anything else, it should have shown up in the blood panel.

We are so crushed right now. I've lost my best friend.

Here is the post I made about his passing: viewtopic.php?f=28&t=98890

I just wanted to say thank you to everyone here for keeping us strong through this. We couldn't have done this without you.