911 Remember me? My Chloe is back in DKA!

Discussion in 'Lantus / Levemir / Biosimilars' started by Chloe'sMom (GA), Sep 21, 2016.

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  1. Chloe'sMom (GA)

    Chloe'sMom (GA) Member

    Joined:
    May 14, 2015
    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
     
  2. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
    Bumping you up..so sorry...:(:bighug:
     
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  3. billysmom (GA)

    billysmom (GA) Member

    Joined:
    Feb 26, 2015
    You could also post this in health. It might get some eyes of people with DKA experience that don't frequent the lantus forum.
     
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  4. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    The recipe for DKA is not enough insulin+ not enough food + infection/inflammation, so I'd make sure to get as much food into her as possible, even if it's high carb and you have to increase the insulin

    Now is not the time to worry about "putting her into a hyperglycemic state by feeding too much" OR reducing her insulin

    And I'd probably have bloodwork repeated if it hasn't been done in the last few days to make sure there's no infection going on and have them look at her teeth good too

    Sending prayers and vines for your sweet Chloe
     
  5. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    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 of 1-2mg every 12 hours (but may be given every 8-hours - vet can check formulary). I can't recommend ondansetron 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.


    Mogs
    .
     
    Last edited: Sep 22, 2016
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Hi, Heather.

    What did the vet mean by he's "certain" she's in DKA? The vet needs to run lab tests to diagnose DKA since there's a metabolic imbalance with DKA. Because electrolyte values are off, DKA is typically a critical condition and does require hospitalization to monitor these levels closely. Have you been able to get ketone tests at home?

    It's crucial to get as much insulin as you can into Chloe. This is also a reason that cats are typically hospitalized if they are ketotic. The vet relies on a fast acting insulin to bring numbers down while keeping a cat on a dextrose (sugar) IV drip.

    Perhaps the situation isn't exactly DKA but if it's not, then you need to know exactly what's going on. Did the vet run either a Spec fPLI or a Snap fPLI to rule out pancreatitis?

    As Chris noted, insulin and food are very important in helping Chloe recover. You need to get as many calories into Chloe as you can.

     
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  7. Chloe'sMom (GA)

    Chloe'sMom (GA) Member

    Joined:
    May 14, 2015

    Ok, they have her on an antibiotic just in case and her blood work was done Friday and no signs of infection that we see. I think I need to force more food into her. Thank you for reminding me what spins them into DKA.
     
  8. Chloe'sMom (GA)

    Chloe'sMom (GA) Member

    Joined:
    May 14, 2015
    Yes, they did rule out pancreatitis. And thyroid disease too. They are certain due to how she looks from the same situation last year. She was starting to turn around yesterday, but has slowed off again. I"m trying to force feed her as much as possible, but I think I need to even more after reading these posts. She was hospitalized last year and that emergency vet wanted to put her down. This board and my local vet pulled her out of DKA last year - the pricey MedVet wanted to euthanize her.... I've updated her chart with her morning numbers. The local vet was hesitant to give too much insulin - so we're only giving .5 unit. Her numbers are pretty good right now, but she's not eating much. Give more food - even carby food and give more insulin you think? Thanks.
     
  9. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    For DKA, a typical cat needs a minimum of one can of 5.5oz food per day, more if possible. A higher calorie food is better (IAMS max cal, wellness foods, kitten foods) You want to aim for 300ml of water per day, this includes the water in the wet food - so usually about 100ml extra water is needed on top of the food. If she will eat dry food, feed her that and adjust the insulin up.

    The DKA comes from not enough insulin and the body breaks down fat. So to stop the DKA you need lots of food and lots of insulin. It's better to add higher carb than reduce insulin if the blood sugars are lower. Don't worry about sending the sugar high, you can always raise the dose. More insulin is what she needs. If blood sugars are below 200, you can mix water with kibble and wet food and syringe that, or you can add some honey or karo to the wet food every time you feed. In the hospital, we usually have people on a dextrose (sugar) IV to help the insulin work in reducing the ketones.

    In the future, if you go out of town, you may want to consider boarding your cat a a vet so that insulin could be administered. My vet has a "kitty hotel" of closet-sized rooms that you can board in if cats need medications when owners are away. In a ketone-prone kitty, even a few days of no insulin is enough to cause the DKA. I don't think you need to really worry about infection or other causes as you know that insulin wasn't administered and that your cat has a history of the same situation in the past.

    Also, the vet is the right place for your cat, but I understand the financials involved and that some vets will only offer to euthanize for DKA. I would however, ask your vet to take a blood test for electrolytes every 2-3 days. Potassium can become dangerously low, and you need to catch it early to supplement (it shouldn't cost too much).

    What insulin are you using/dose? What food? Also please track BS and ketone tests so we can see.
     
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  10. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    Hi Heather,

    You may want to take a look at the "Where Can I Find?" thread - there are posts on assist feeding, stimulating a kitty's appetite, and multiple saved posts on ketones and DKA. Look in the section under "my cat may be ill, have a special condition."

    I agree with Meya's advice - enough insulin + enough food are 2 things you can do at home to help. Lots of water added to her food, plus the sub-q fluids will also help.

    Does that 2u means that you gave that amount of fluids? Or that you added 2u of something to the fluids? You didn't add insulin to the fluid bag, right? That's not a good idea to combine them. People typically spread out the administration of fluids and insulin - separate them on the body where you're poking and by time. We gave insulin at the typical preshot time and usually gave subq fluids at +3 in a slightly different location.

    I'm not sure what the Cipra is that you've mentioned. Could it be Cypro, an appetite stimulant?

    It would be good to test for ketones regularly right now. There are blood glucose and ketone test meters now - the NovaMax is one that also checks for ketones which can be really helpful. Your other choice is to check urine. Staying on top of it will help you help her as much as possible.

    Sending my best your way. I hope Chloe improves!
     
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