911 Remember me? My Chloe is back in DKA! - Copied from Lantus

After approximately a year and a half of a pretty uneventful time with our Chloe managing her diabetes, Chloe slipped back into DKA officially on Tuesday. I was never able to ween her off of insulin (Lantis) less than 3/4 unit, twice a day, but I also didn't find this forum until she went into DKA after being dx with diabetes for 1.5+ years. I think had I found this, she could be OTJ. But, regardless, we were managing well at the low dose.

Due to life, work and so many other things, I quit testing her. Her appetite was the same, she was playful and ornery again and just full of life. But, a few weeks ago, I noticed that she wasn't quite getting enough food. She has been on LC food since May of 2015 and it's been great. I know exactly what to buy and how much to give throughout the day. But, one can of salmon pate a day wasn't enough. It turned into more and more until we were at 2 cans twice a day. On Friday, before I left for a trip, I took her to the vet after her vomiting 3x the day before. I was concerned that something was really starting to happen with her. The vet ran the tests and he had some suspicions but all of the tests were negative. It was when I was gone his big idea was smashed by a negative test. (Which I'm thankful for, but left us puzzled.) While I was gone DH was caring for her, but I knew she wouldn't have access to insulin without her kitty xanax and yes, so that DH could administer shots while I'm traveling, we got her on the as-needed xanax. It increases appetite, but it mellows her enough that he can usually get in one a day at least. Because she's been more feisty than normal, he wasn't able to get any insulin and so her lost dose was Friday night before my early flight on Saturday. By Monday she wasn't eating and acting very lethargic. He ran her to the vet after leaving work early and sure enough, the vet is certain she is in DKA.

I arrived home just about an hour ago and I'm getting ready to update her chart from the feedings and sub-con fluids, and insulin and glucose tests/doses. DH has had to take care of a sick dog and work from home in order to watch her and I'm considering calling off work the rest of the week (if I can).

She's not eating on her own, but seems to be drinking ok. They have her on Cipra and Cerenia to increase appetite, but like the last time, she won't really eat on her own. We've been having to force baby food or pureed pate down her throat. We've adjusted her insulin dose down per the vet's instructions as to not put her into a hyperglycemic state. I observe her as being fairly weak, her pupils are huge and her cry is broken. She's definitely not feeling well at all. She's skinny and I can tell that she's lost even more weight since Friday's vet visit. Even at that visit with her eating so much, she had lost 1/2 # since this time a year ago! I'm not sure how this works with weight, but it's definitely affecting her. On Thursday night though, because of her increased hunger, she found a roll that was sitting on the counter and ate it. Of course on Friday her #'s were in the high 500's. But, I knew she had spiked because of all of those carbs. I'm not sure if that put her into DKA? I'm trying to think back to 1.5 years ago and what all I learned then, to remember how that works.
I'm going to attempt to obtain a ketone strip test to see how her ketone level is, but she hasn't gone to the bathroom since I've been home. I administered 2 units (per the saline bag) of sub-con fluids and shot down about 2T of beef baby food. Her glucose at midnight EST (it's 12:36am EST now) was 122.

I will say though this time around, she's doing better than the last one, but I can tell she's out of it. She's just sitting here and staring off, and earlier DH said she was curled up in a ball and more restful. It had been about 5.5 hours since she had any food prior to my arriving home, so I'm wondering if that could be part of it?

Thoughts, ideas, suggestions? I hate that I'm back for this, but grateful that there is a place that us diabetic kitty mommies can turn to!

Heather

 

I have never had to deal with DKA so can't really help you, but I'm sending prayers and vines that Chloe gets well soon!

 

Replied on your Lantus 911 thread:

http://www.felinediabetes.com/FDMB/...-my-chloe-is-back-in-dka.165363/#post-1784195

Reposting text here to make sure you see it:

If Chloe s in DKA then it is really a condition that should be treated by a vet in a hospital setting. If she were mine I would be looking to get her treated as soon as possible by a vet with a proven track record in successful management of DKA. She needs insulin and food, food, food plus appropriate fluid treatment to rebalance her metabolism. You also need to treat for any infectious, inflammatory or other illness present.

She may be nauseated and that might be behind the reluctance to eat. If you don't get any present nausea managed the appetite stimulants won't be very effective. Cerenia is fairly quick acting and helps a bit with nausea (especially if vomiting is an issue) but ondansetron in combination with the Cerenia could probably help more. Ondansetron can take a day or so to reach a level where it is clinically effective. From what I read here ondansetron is given at a dose for a c. 10lb cat is 1-2mg every 12 hours (but may be given every 8-hours). I can't recommend onndansetron as a nausea treatment highly enough. Please consult your vet about it as soon as possible.

Nausea symptoms and treatments for nausea and appetite problems

As said above DKA really is one for hospitalisation but we live in the real world and if, for whatever reason, hospitalisation isn't an option then if you can get the time off work I strongly recommend you do so: intensive nursing by you (BG monitoring, assist feeding) could make a critical difference.

Please, please keep posting here and ask for input from members with experience of DKA. I am tagging @Meya14 to see if she will look in on you when next she is online (nu guarantee that this will be during the time you need help, Heather, but she is very knowledgeable).

I hope Chloe feels better soon: DKA is nasty and scary. Sending prayers and positive thoughts for Chloe to make a full and speedy recovery.


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