repeating DKA - help with suggestions please?

Hello -

I'm Nancy and my cat Anabel (about 10 years old) was diagnosed with diabetes in the fall of 2008. After the usual "learning" period, we finally got her "regulated" on Lantus at 3 units 2x/day.

(please excuse me if I do not get all these medical terms right, I am still learning!).

So basically she was fine for a year until October 2009. She was on the Royal Canin dry diabetic food 2x/day and seemed fine. We did home testing to get the insulin levels set up, and once she seemed "stable" she was fine so we didn't do a lot of testing (which our vet said was ok). When we did test, however, her bg were really never that low - maybe 200-250.

Anyways, to make a long story short, she went through a hypoglycemic episode this October. Then she became very picky about her food. So we (on the vet's advice) were feeding her anything she wanted to get her to eat. At the same time he was ajusting her insulin dose. Her bg levels were usually between 150 and 400 (which we sent to our vet every few days).

She was also diagnosed with a thyroid problem before Christmas and put on the thyroid ear cream for that. She was down to 1.5 units 2x/day and seemed to be eating okay, then just stopped eating. She went into the emergency vet with DKA on 1/10 after she missed two meals and was "out of it." She spent four days at the emergency vet, where they got everything all straightened out with fluids, short-acting insulin, etc. They did not find any underlying cause of why this would happen and it seems they ran the gamut of tests, including ultrasounds. She did not receive her thyroid medicine while in the er.

So she came home the night of 1/13 and ate decently (a lot, actually) until the night of 1/19, when she had a little dinner. Had no interest in food the morning of 1/20 so took her to the internal med vet (located as part of the er) on the advice of my regular vet (who pretty much is stumped). He basically said she had ketones but her bg was okay (300ish), and that we should take her home and get her to eat (He did give her subcutaneous fluids, which perked her up a little bit). That didn't work (we have tried to force feed in past episodes and it didn't help) and she was worse by the time we got home from work.

So she's back at the er dept for another stint last night at getting her out of the DKA again. This time they found a little bit of respiratory infection (in her nose; hadn't reached her lungs yet) and one liver enzyme was slightly elevated. So she is also on antibiotics this time around. Other than that, they did not find anything again. She was still not eating this morning but it look her 1.5 days last week there to start eating. She'll be there until she starts eating decently (they said).

My main questions are: is this common? Do we have any hope here? Honestly, we can't just keep taking her to the er every week if/when she stops eating & looks thoroughly miserable. She's stressed, my husband and I are stressed, and our credit card is becoming stressed very quickly. Does anyone have any suggestions? Can we try to reverse this at home? I've asked about the effects of the thyroid and/or switching to a different insulin, and the vets just look at me like I am nuts.

Any advice would be greatly appreciated. Everyone is stressed!

Thanks,
Nancy

 

Hi Nancy

I'm sorry you guys are going through this!

A couple of things...

ketones usually need a combo of factors, including insufficient insulin, insufficient food and/or infection to occur. And some cats are way more ketone prone than others. So if we look first at insulin needs, it is important to know how well the lantus is or isn't working. Folks on the lantus ISG can help with that. Second, if she's inappetant, it is important to get on that right away. Is the inappetance due to high bgs, infection or other medical issue? Third, infection. If she has a mild infection (was it proven to be an infection and not a virus?) then longer than usual course of the appropriate antibiotic is important.

Now, to throw another factor in... a cat named French Fry used to develop ketones if she was fed a diet too LOW in carbs. Yes, you heard right. So her mom, Anne, had to raise the carb level just a bit. She is vacationing right now or I'd send her a heads up.

So here's my take...if you could provide some data on what her typical numbers are like, that would be great, then at least we can get looking at that, and move from there.

Jen

 

More lantus people will come on, but I think you need to start over at 1u twice a day and keep testing. You need to know her levels BEFORE shooting and then throughout her cycle.

Dump the dry food. If her levels when she was "stable" was between 200 - 250, sounds like in my opinion, not close to being regulated. She probably stayed on the high side because of the dry food. :cry:



Welcome to our FDMB family and be patient with yourself. You sound like you really love your cats, so you have come to the perfect place. Get some chocolate, sit back and get ready to read. Also, remember Every Cat Is Different. (ECID) Also, remember opinions may vary sometimes on this board, so you may get different views. Unfortunately, that is human nature.

Sorry this is very long, but there is a lot to say! Also, remember we were ALL newbies once and are feeling just like you are right now! OK……..breathe………. :RAHCAT

You do not need any type of prescription food or “special” diabetic food. Use Janet & Binky’s chart at http://binkyspage.tripod.com/canfood.html. . Low carb is best for diabetics. I try to stay around 10% or under. I feed Whiskas, 9-Lives and mostly Friskies. Diabetes is very treatable and does not cost as much as you would think. If you are giving a high dose of insulin and feeding dry, be careful with switching to canned food. You MUST reduce the insulin at the same time you switch to canned food.

Please create a profile if you have not already done so (viewtopic.php?f=6&t=531). It will help us to help you. We need to know what kind of insulin you are on, what needles you are using (U-40 or U-100), what are you feeding, how much insulin you are giving and when, BG test results, etc. There are many people on this board from all over the world, so it will be helpful to know what area and time zone you are in.

Remember that your cat is YOUR cat, and YOU are paying your VET to help you take care of him; diabetes was probably a day or two worth of notes when the vet was in college; it is probably NOT a day-to-day existence with his own cat trying to maintain a quality of life. Sorry to say, but I would have overdosed my guys on insulin if I followed my vet's advice. Vets, unfortunately are not as knowledgeable as they should be on diabetes.

Sometimes, as I did, you have to take a leap of faith and trust these people on this board who deal with diabetes day in and day out. Trust me. You will not be disappointed. OK………..breathe again……….get some chocolate…….. cat_pet_icon

Also, please realize that it takes insulin about a week to settle. START LOW AND GO SLOW!! The usual starting dose from our experiences is 1u twice a day for at least a week. Insulin in cats is NOT and I repeat NOT based on weight. This is a misconception that a lot of us have gotten from our vets here. pc_work

You have to be patient, as I also had to learn!! Do not adjust the dose upwards based on one test. Don’t freak out based on one test result. As long as the levels stay on the high side, keep the same dose twice a day for at least the initial week period and you should see improvements. When you have some time (hee hee), read my profile doc at http://docs.google.com/View?id=dfqss8sg_1cpgwhbd9 .

If you are not hometesting already, you really need to start!! Hometesting is VERY important. Most of us here us any human meter. Think of it as a human diabetic does. *If it were you or a child of yours, you'd be testing blood glucose levels at home prior to each shot; you'd be working with your doctor to determine a proper dose based on those shot results, correct?* Some vets do not agree with hometesting and I cannot for the life of me understand why. Most vets, sadly are not knowledgeable enough in feline diabetes. Insulin is a VERY powerful drug and you NEED to hometest before giving a shot. This is very important. Hometesting saved me a lot of money and it is VERY important for you personally to know the cat’s levels and how it is reacting to the insulin before you shoot so you do not pass up your ideal dosage.

Thanks to everyone's help here I learned to home test 2 cats and they both got off insulin within 3 weeks with diet change…but of course, they reacting both DIFFERENTLY with the process. If I can do it with 2 cats twice a day (and more on curve days), ANYONE can do it. It does NOT hurt them as much as you think it does. It just stings for a moment and then it is gone, you can try it on yourself. Also, put pressure on the ear after poking and it should minimize the nub. They won't mind it once they start feeling better. I use the True Track meter (CVS or Walgreens brand) which I love. And, the strips are also reasonable. Also, remember to give them a treat after the test. Here is a link to a member videos on hometesting:

http://www.youtube.com/watch?v=_zE12-4fVn8
http://www.youtube.com/watch?v=cZ6iXetR398

I would not feed DRY food if at all possible. Of course, it is better than nothing – you MUST get them to eat if you are giving insulin, but if there is any chance, get them off the dry. I took my guys off dry and within a month they were off insulin. Again, remember that switching from dry to wet can cause a drop in blood sugars, so you MUST reduce insulin at the same time to make sure you are not giving too much insulin. I truly believe also that I saved some of my many others from developing diabetes. I also saved so, so much money changing them all to regular canned cat food.
When Blackie and Jackie got diagnosed, I was afraid to start shots. The people on this board made me realize it was no big deal. (They went on PZI insulin around 3-25-06 and went off on 4-18-06! Please also realize that diet plays a BIG, BIG part in insulin needs. I switched my cats off dry food to all wet and I was never so happy. It was a challenge to try to regulate 2 cats at once.


Welcome to the Sugar Dance. flip_cat
Welcome to the Vampire Club.

If I can do it, ANYONE can!!!
It does get easier. Trust us.

You need to test BEFORE you shoot. It usually goes: Test, Feed, Shoot



There's a saying something like "better the sugar level is too high for a day than too low for a minute".

 

This does sound like a very stressful time and that you have tried really hard to get Annabel well.

Yes, I think there is hope. One of the best (and cheapest) things you can do is to take control of the things that are controllable from home. It is wonderful you are hometesting. I would increase the times you test. We say it is imperative to test before each shot, so you know it is safe to give insulin and how much is safe to give. And we want you to test at various times during the time, keeping track of the numbers and what food was fed when, etc. On the tech forum there is a great spreadsheet you can use that is color coded. It really helps you see patterns. viewtopic.php?f=6&t=16

As others have suggested, your insulin has unique properties and requires specific attention. At the lantus forum there are stickies at the top of the page that will give you lots of good information about how lantus works and how you can use it best for your cat. viewforum.php?f=9

Also agree with others that the dry food may be impacting Annabel, keeping bg levels high and insulin needs high. Here is a great website by a vet who explains why wet lo carb food is best for all cats, not just diabetics: http://www.catinfo.org

We were all just like you - scared, confused and overwhelmed. We read and printed off pages of info that we read and reread until we understood it. Then we came back on with questions and more questions. You will need to educate yourself and make decisions on what you think will work best for your kitty.

 

Hi Nancy,

I'm sorry your sweet Anabel is so ill.

I've been where you are so I do understand the frustration. Cats can get ketones and develop DKA with regulated numbers.

There was a period when my cat kept relapsing into DKA. I would have similar suggestions to the others, but here is my list:

Make sure you bring home all needed medications when she is released from the hospital, antibiotics, fluids, etc. This includes learning to give sub-q fluids if it is needed as she recovers.

Test glucose (ear prick) prior to every shot. Curve when you can - but realize that numbers are often out-of-whack when recovering from DKA.

Test for ketones daily. You can test with ketodiastix (available at any pharmacy) by dipping in the urine stream.
You can also test for ketones with the Precision Xtra meter http://www.childrenwithdiabetes.com/d_0i_191.htm
the strips are very expensive but you can find them on ebay, and use as-needed.

Don't limit food when she gets home - feed her whatever she will eat. I would also urge you to bring home an appetite stimulent to keep her eating as she gains strength.

As soon as she is eating well, transition her to an all-wet, lower carb food.

I guess that is my quick list. I would also urge you not to change from Lantus, unless you move to Levemir. You have a finicky diabetic and I don't think you can afford to mess around with lesser insulins.


When she comes home she will still be tired. It takes time to recover. Keep her eating, keep the numbers down, and follow-up with the vet to make sure the infection is gone and the bloodwork is normal.


I wouldn't waste money on a fructosamine since you will be taking the glucose readings yourself. you can get the average that way.

Please keep us posted on Anabel, and ask any questions you have. It can get better but you have to be on top of everything for a while to come.

Best,
Pam & Layla

 

Jen, cell99 (sorry I don't know your name!), Pam & Sue and all your beloved cats -

Thank you all so much for responding to me. I really appreciate it. I was so low and feeling so hopeless and now I feel there is hope and that we can figure out how to do this to keep Anabel happy and healthy and (hopefully) regulated!

I really appreciate all your suggestions and I am very very interested in trying them and implementing them when Annie comes home. I can definitely see that we are going to have to go a different direction with her food and a more rigorous testing program. We have never tested at home for ketones, but I can see the value of doing that. I think we'll have to do the non-urine stream one though; as she's not our only cat (we have six others) it is a bit difficult to keep an eye on exactly who is using the litterbox each time we "hear" something. (Anabel is by herself during the day when we are at work- has been for years - due to a long-term inability to actually "hit" the litterbox - she will pee near it, but not in it! She also loves using clothes, the couch, carpeting, the kitchen cupboards, the kitchen table, etc. as a litterbox... and yes, we literally tried everything for THAT problem!).

I did get to see Annie briefly on the way home when I stopped at the emergency vet's for a visit. She was very happy to see me. She even ate a little bit when I was sitting with her. The vet said that she is doing better, but she needs to be eating a lot more on her own before he will release her (hopefully tomorrow). And yes, I will also ask for an appetite supplement!

Also, I am attaching a Word file of Anabel's bg levels since she started "bouncing around" in November (for some reason I thought it was in October, sorry!). I know Jen wanted to see them; I don't know if they will provide any additional clues.

Thank you all so much for taking the time to suggest solutions and offer reassurance. I really appreciate it. If you have any other suggestions, please feel free to let me know! I'll keep you posted as to how she is doing!!!!!

Thanks,
Nancy

Anyways, I really wanted to thank you all.

 

Hi there!

Thanks for the numbers. What they show me...well, its more about what they don't show me, as in what happens in between shots. It is very important to know how the insulin is working inbetween shots to help guage what dose is needed.

definitely get her on a different food if she'll do it (after giving her a few days to recover) and test more frequently. I would NOT drop the dose to 1 unit or you could end up with her in the hospital again, but when you do change her food be very vigilant about testing 6-8 hours post shot for sure to make sure she's not going too low.

I'd also make sure to learn how to do fluids at home and get the supplies so that you can quickly get fluids into her at the least sign of trouble.

Other than that, I'm at my limit of knowledge but maybe Jess or Jojo will stop by!

Jen