Still in the hospital... but trying to learn fast

Hello everyone. My name is Jen and I live in northwest Washington State. My ten year old cat Tink was just diagnosed this past weekend with diabetes. Unfortunately, he was in diabetic crisis by the time I took him in. He's never had any health issues... has always been a tad overweight (14lb or so but he's a pretty stocky lil guy). He was feeling a little blah the last few days... but they do that from time to time so I didnt think much of it. He's always been a "browser" with his food, nibbling a little throughout the day and I didn't see any increase in appetite. I did notice he was drinking a bit more frequently. He waits on my bathroom counter and gives one quick "meow" when he sees me, which I've come to learn means "human... turn faucet on...now" That's his favorite way to drink - straight from the source. In any case... Friday and Saturday he spent more time sleeping than usual (24hrs rather than his usual 23.5). Sunday he got up on the counter but when I turned the water on he just put his face by it but didn't drink - just stared at it, or past it really. I picked him up and he was weak. Inner eyelids were visible and he seemed unable to focus. I knew something was wrong and luckily we have a vet that's open 7days a week and doesn't charge a special fee.

Anyway... he's been there since Sunday and the bill is racking up. Almost $1000 and they think he'll need a couple more days. I have ZERO experience with this vet, but I haven't had great experiences with any of the vets I've tried nearby. The one vet I'm really comfortable with is only a walk-in clinic and is not nearby - though I've seen him for major things in the past as he's VERY affordable. Once Tink is home, I'll pay him a visit and see if he has advice. But in the meantime, I'm at the mercy of this vet who seems hellbent on keeping my cat as long as possible.

It's extra frustrating because I have more experience than the average newbie. I do my own vaccines, I've done subQ fluids, I've syringe fed... I did 8 years of fostering cats, most of which required some sort of special care. But this vet doesn't know my history (and doesn't seem that interested when I try to tell him). They insist he needs IV fluids - but after 3 full days, I'd think subQ would do the trick at this point. They've currently got him on "CRI", which today's vet explained as a constant insulin feed to maintain levels. Which tells me they aren't even dialing in on an insulin dose yet... which was what the other vet said was the plan for YESTERDAY. :/

After reading a TON of useful info here, I made the mistake of asking about diet after he comes home. To which the reply was that they have an rx dry food at the office (Science Diet I'm guessing, given the huge display in the office). Given what I'm reading, this makes me wonder if this place knows what they're doing. I'm going to visit him this afternoon - they've never offered, but I finally asked if I can come see him so he knows I'm still here. Poor guy has been in my house since he was 4weeks old (bottle baby rescue) and is one of those cats that most people dont know I have because he hides when people come over. At least todays vet seemed to listen when I told her I didn't think he'd improve fully there, due to the environment. He stresses VERY easily and is only comfortable at home and with us. Even when people move into my home, being allowed to pet him before six months have passed is a true blessing. It just feels like they dont get it.

I'm concerned with trying to find the right food and work with this vet. I've always been super picky with food. No corn, no byproducts. I used to feed Wellness or Felidae, but it got too expensive. I found that Costco's "Kirkland" foods are corn and byproduct free and the label is quite similar to Felidae... so that's what they've been getting. But after reading stuff on here, I'm wondering if any of them should be on dry food. My other 10yr old had a pretty bad UTI, but has been ok since. But I know canned is better for that too. I just worry about their teeth, eating nothing but canned. Plus the cost of feeding 4 cats canned food. Do ya'll use dry for your non-diabetic cats?

Anyway... I guess at this point I'm just introducing myself and reading up as much as I can. I'm sure I'll be asking a ton of questions once he's home. In the meantime, I guess I just wait. At least once I see him tonight I'll know if I need to fight to get him home or if he really needs to be there still.

Thanks for listening... and for being here in general. I can already tell this place is gonna be a life-saver (maybe literally!).

 

If he has diabetic ketoacidosis, the hospital is where he belongs. They monitor glucose, insulin, electrolytes, etc., which can't be done at home.

Can he be transferred to your regular vet?

Once he is not spilling ketones, his electrolytes are normal, and he is eating on his own, he can come home ... with insulin. Get Lantus, Levemir, or ProZinc; everything else lasts too short of a time, leaving uncontrolled glucose for 2 or more hours each day unless you give it every 8 hours (Humulin/Novolin last 6-8 hours; Caninsulin/Vetsulin lasts about 10 hours).

Home testing will be critical. Pick up an inexpensive meter such as the Arkray Glucocard 01 or 01 mini from our shopping partner ADW (link at top of page), or the branded version, the ReliOn Confirm or Confirm Micro from Wal-Mart (also a shopping partner), 2 boxes of test strips (always have a spare box!), and 26-27 gauge lancets to prick the ear just between the peripheral ear vein and the outer edge of the ear. Practice on yourself and on an apple to get a feel for it.

As far as food, don't buy it; tell them you'll follow up with your vet. Then feed canned Friskies pates or Fancy Feast Classic pates which are low carb. For more low carb, go to Cat Info and click the list in the black column on the right.

 

Thank you. I've already learned I'll get nowhere with this vet re: food. Their solution is Hills w/d dry food. I stated I wont feed Hills as my pets have all been corn and byproduct free for their entire lives. She said "well, we can special order Purina". UGH. I'm thinking I might get a small bag of Hills to bring home just long enough to learn what the heck I'm doing... but then transition to the low carb stuff. I saw lots of great brands on that list, many of which I can pick up a few blocks from home. My challenge will be that he's never been a canned food fan (unless it's regular human tuna... he can smell that from a block away!).

I also mentioned home testing, which the vet (at least the one I spoke to yesterday, not the one who's done most of Tink's care so far) kind of balked at. She said they prefer to do glucose curves at the office. She didn't TOTALLY argue the idea... but she wasn't thrilled about it. Which is sort of "strike two" in my eyes. Unfortunately I dont yet have a "regular" vet that is a full service vet. My go-to vet is at a neuter/vaccine clinic. He is highly capable and saved me thousands when my dog needed knee surgery... but I dont know if he's set up to have overnighters. And he's 45min away, so visiting wouldn't be an option. Still... I'll try to call today and see if I can at least talk to him about it. At least I know he's on board with food issues.

As for him being at the hospital, yes, they said he had ketoacidosis. After visiting with him yesterday, I'm much more confident that he indeed still needs to be there. He looks better... but not great. His eyes are fully open and he is starting to "lean into" his pets... but he's still feeling pretty blah. His blood sugar is down in the 200's now (it was over 400 when I took him in), but is on a constant rate drip of insulin until they get his electrolytes and everything corrected. Poor guy. He seems to be doing ok there though, not nearly as stressed as I thought he'd be.

I'll look into the monitors today. If these animals keep it up, I'm going to be getting up at 3am just to make it to work on time. Aside from feeding chores, I've got goats to milk and now blood sugar to test and insulin to give. Oye! Oh well... it'll become routine, I know. Gonna be real fun till we both get the hang of it though. :?

 

Sounds like you are getting up to speed fast. After DKA, you definitely want to be home testing so you can keep him in safe numbers. (crazy idea to do tests in vet's office. Stress raises bg levels so numbers aren't likely to be accurate anyway. If you don't test before each shot, how can you be sure the dose you are thinking about is safe?). We also suggest ketone testing so you can stay on top of those. Just like humans use - inexpensive.

While you are waiting for him to come, home, do a lot of reading and research. This disease is really managed at home, just like human diabetics. We feed wet low carb, test and monitor levels. We'd love to help you and your sweet Tink.

You might take an unwashed tshirt to the vet so Tink can smell your scent.

If you want suggestions for a FD friendly vet, we do have people in Seattle and I think Spokane - maybe other towns also.

 

Welcome to FDMB, Jen & Tink ! Everyone here is awesome and totally willing to help you.

Hope Tink will be back home soon. cat_pet_icon

Keep us posted, especially with the type of insulin you will be using so we can point you in the right direction....there are insulin-specific forums here....but posting where you are will be fine for now.

Sue and BJ have already given you great info....there will be a lot more to follow when you need it. :smile:

 

Thanks all. I'm in Skagit County Washington. Sedro Woolley, Mt Vernon, Burlington are the towns I'd be looking at for vet care. If anyone knows one vet that's better than other for FD, let me know. Unfortunately the one person I knew who had a diabetic cat passed away a couple years ago... so can't ask her. The rest of the people I know think I'm a little bit crazy for paying all this money to bring home a ten year old cat that will now require a whole new level of care. Glad to find support and knowledge here!

 

Hows he doing today? I hope he feels better.. heres a few of my thoughts

1. Food - many of us here feed fancy feast classic pates, friskies pates or wellness grain free. Low carb canned is best for remission and good regulation, and helps prevent future kidney issues
2. home testing - you don't need your vets permission for that. I would do it anyway. Below is a shopping list. You could tell the vet you just can't afford frequent vet curves - especially after this incident!
3. Insulin - talk to your vet about what insulin they will recommend. You want a good one with a good chance for remission - Lantus, Levemir or Prozinc. You don't want Vetsulin or Caninsulin as they don't work well in cats and are very harsh.

Wendy

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

 

Thank you... that's a very helpful list. And timely... thought I'd go pick things up today. I was afraid to get supplies too early and jinx myself.

So... the ketone strips... do they work in the same meter as the bg strips? Wasn't sure on that one. I was surprised that all these things are quite affordable at Walmart. WHEW! My initial vet bill was almost $1000 day before yesterday... I'm afraid to know what the total will be. @-)

Tink was SO much better last night, though they still haven't released him. He wont eat yet, but looks SO much stronger and alert. I took some of his regular food over there as well as a used pillowcase, to make him feel more comfortable. Finding a food he'll eat is going to be a challenge. I'm waiting for a call from the vet right now to see how he is today, as I'm not going to be able to get over there today due to a longer than normal workday. I think as soon as he starts eating on his own, they'll release him - which due to my hectic schedule today, it might be today. LOL Since I'd have to do some serious re-arranging to go get him. :roll:

I'm kind of hoping they send him home mid day tomorrow. That way I can be home the first few days with him to keep an extra close watch. I'm concerned about leaving him alone for my workday right away. But, there's only so much I can do. So far the vet has not discussed home care at all, so I'm not sure what to expect yet. I know it'll be twice daily insulin... but that's all I know. I'm going to home test - humans test before they take their insulin... I dont know why a cat wouldn't need to. Seems incredibly dangerous not to. Might use my other cats as guinea pigs between now and then - if they let me. At least one will, I think. If he stops headbutting me long enough. As overweight as he's always been... probably good to test him once in awhile anyway!

 

I think the ketone sticks that Wendy was talking about are not "meter strips". Rather, they are strips that are used by placing them in the urine stream when your kitty is peeing in the litter box.

They do make meters that can test for both blood glucose and blood ketones. I used one called a NovaMax Plus on my cat, Bob, because he wasn't going to let me interrupt him while using the litter box. The strips for testing blood ketones are pretty expensive though. At least $2 or $3 per strip depending on which meter you might use.

The keto-stix are much more affordable, provided you are able to "catch" a fresh urine sample. People here have all sorts of tricks that will help you do that.

On the food issue....
Your vet needs to understand that there isn't a prescription dry food made that is low enough in carbs for a diabetic cat. Hill's and Purine DM are too high. The Purina DM canned food is not too high in carbs. But it's way overpriced, and in terms of quality, no better than many easily available grocery store brands.

I think someone has already given you a link to Dr. Pierson's food charts? If not, here it is.
http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

If you could just convince your vet to click on "www.catinfo.org", maybe he'd understand why dry food is not only not good for diabetic cats, but for cats in general. "Prescription" doesn't mean "good for you". ;-) Although somehow the sales reps from Hill's have convinced a lot of vets otherwise.

 

You're correct about home testing - it is as dangerous for animals as it is for humans not to check the glucose levels before giving insulin. Many folks won't do that for their cats and will put them down if the vet suggests it, so the vets won't. Some vets are concerned about the client making changes without involving the vet ... yet human diabetics learn to do that for themselves. And some vets want the income of doing the glucose curves themselves.

 

Ok... that makes sense on the ketone strips. I was thinking about that last night... that it's probably a urine test.

Still just waiting on my stubborn boy to EAT on his own. Ugh. I hope he eats better at home than he does there... been there 7 days now and still wont eat or drink. They're syringe feeding (and I'm sure that's got a dollar number associated with it). As for drinking... this cat would need to be dying of thirst to drink from a bowl. He drinks from the faucet. Even the fountain isn't "good enough" unless he's really thirsty. Just one of "those" cats. Plus he doesn't like an audience.

Anyway... got most of my supplies last night. They didn't have any ketone strips so I'll have to get those later. How often do you test for those? Just if the bg is high?

Never did get around to learning how to get blood from a cat. My intended guinea pig will be WAY easier than Tink I think... but we'll see. Maybe he'll figure an ear prick is a lot better than walking around with that IV in his arm. Sounds like he's starting to get pretty feisty for the vet... which is good. I mean, sort of. Means he's feeling better... but is probably increasing his stress level too. REALLY hoping I can bring him home today.

 

What are they offering him? What did he eat previously to this hospital stay? Some cats get their appetite back when offered babyfood - Beechnut is a good brand, without any spices. I know this sounds ridiculous, but sometimes offering the food on your fingers gets them started again. (it's like they forget that food tastes good.....),

 

They've offered several things, though it seems Hills is mostly what they have in the office - and most of the cats I've had (including 300+ fosters over the years) wont touch that stuff. He was eating Kirlkand (Costco brand) kibble, which I took over there for him at their request on Wednesday. He'll need to come off it, but they felt it's best that he eats ANYTHING on his own at this point. I'm going to take a can of tuna over today. He can smell that the second that can is pierced from three rooms away! They keep acting like he's not stressed there... but I know my cat. He's stressed. He's never been outside the house since he was 4 weeks old. He hides if anyone new is in the house. Tolerating the vet staff and not being stressed are NOT the same thing.

I so dont know what to do about the vet situation though! This vet does NOT seem interested in anything but rx dry food. After seeing everything on here and doing my own research... it seems this is recommended by basically NOBODY. EVERYTHING says low carb, high protein canned food. Most things say even healthy cats really shouldn't be eating the amount of carbs in dry food. I did print out the AAHA paper on Diabetes Management that's pinned here (complete with highlights... GOD they're gonna LOVE me! :lol: )... it addresses both food and home testing so maybe it'll educate them. If not, I'm lost. Guess I'll be calling all the vets next week and seeing who will talk to me about their views for treatment. I've never needed a "regular" vet. They've always just been for spay/neuter or a one-time issue, so the clinics have always been fine. SO many of the vets around here just see $$$ and I dont know how to find one that isn't in it just for that. I LOVE my clinic vet that I normally go to, but his hours are very limited, it's walk-in only (meaning it takes half a day) and he's 45min away. His prices can't be beat and he is 100% honest and in it for the animals. I still need to call him though and at least talk about it.

 

Don't be afraid to be firm with that vet about home testing, "correct" low-carb foods, and other things you have learned from FDMB.

I am sure he will eat better at home...he is probably very stressed (and misses you very much).

You go girl !!!!

I printed out Rumpelteazer's spreadsheet and showed it to my NEW (Yeah..prior vet did not impress me with FD....learned more on FDMB)vet. She absolutely loved it. Was so impressed about the detail and info it contained regarding RumpelT's sugardance.

Is Tink coming home today?

 

The old dry isn't great, but if he will eat that, it is better than not eating. But if he isn't eating that, I'd try some stinky wet or babyfood.

My vet and I agreed to disagree on food. She liked the wet PurinaDM but I didn't like the ingredients or the cost. Once you get him home, the vet won't be able to see what you feed....

 

There are Vet Interview Topics in my signature link.

 

How did things go today? Is Tink coming home soon or is he already at home?

 

He's come out of the ketoacidosis, but his jaundice has gotten worse so now vet thinks fatty liver. He still won't eat and syringe feeding just isn't cutting it. I took a can of tuna...his fave in the whole world...and he just sniffed it. :'( So now they're doing a feeding tube. I'm so worried for him now. Crying even as I type this. This is costing Sooooooo much and I don't even know if it's going to matter.

 

Sending Hugs to You and Healing Vines to Tink from me and RumpelT.

:YMHUG: :YMHUG: :YMHUG:

 

A feeding tube is great because it will get food into him way better than a syringe. Hepatic lipidosis happens from not eating enough food and their liver basically turns to fat. I had a previous cat that got that and I had to tube feed him for a while. Looking back on it, it was easier to tube feed him than it is to give Mikey shots sometimes. :lol: Try not to stress too much.

The DKA has cleared up so that's fantastic. They put a feeding tube in for the fatty liver, so that's also a positive sign because the best treatment for fatty liver is EATING and now he'll be able to "eat." The tube is not as horrible as it sounds so get that thought out of your mind. It'll also make it easier for you to care for him when he comes home because you won't have to syringe-feed into his mouth. My previous cat used to purr when I would feed him and that's what helped him get better.

 

The vet may have given a lay name for hepatic lipidosis. Basically, fat breakdown for calories overwhelms the liver, preventing it from working properly to help digest food. Bile backs up into the bloodstream instead of going into the digestive tract. It is serious, but can be treated successfully if done promptly.

Have you heard of Diabetic Cats in Need? You might apply to them to see if they can help, maybe set up a Fund Razr for donations.

 

And one of the side-effects of hepatic lipidosis is a lack of appetite, so that's another reason why the feeding tube is great. It took my previous cat about two months before he started eating on his own again even though he was "all better" from the fatty liver after about 3 weeks. He was the most severe case my vet has ever seen so YMMV. Some cats recover their appetite relatively quickly, but don't base his health on his appetite since that's going to be messed up right now anyway.

 

If you want to come down here to Redmond sometime and practice glucose-testing my diabetic cat, PM me. Teddy's pretty chill. We can show you the ropes.

 

Thanks everyone... especially KPassa. The tube idea really had me freaked out. At least you all make me feel like it really is what he needs. And yes, I think he did say hepatic lipidosis. He was going to insert the tube last night... how long does it take to see improvement in the jaundice? My poor baby looks like a fuzzy black oompa loompa. I just want him home!!! I don't think he'll ever eat there. The better he feels the more scared and angry he is just being there.

 

Have you taken in a shirt which smells like you? It can be reassuring to your kitty.

And if they'll let you, see if you can get him to eat off your finger or from a plate you offer.

 

Hello,
so sorry! I might get yelled at, but I'd try just a few grains of dry kitten food (3 or 5, perhaps) to see if your kitty would eat. That's what I did with my Pudge earlier this year when I thought I'd lose him because he refused to eat & syringe feeding didn't provide sufficient nutrients. Worked for him. I used Kitten food for the soul. Knocked him out of his remission but all I cared about is that he start eating. Best wishes, Sophie

 

I took a pillow case from my bed (where he spends his days usually) a few days ago. Tried feeding of my finger too, canned tuna even. He sniffed the tuna juice And licked off the juice I put on his nose, but that's it. Last night the vet said he's tolerating the feeding tube well...no vomiting. However the long acting insulin wasn't working at one unit, so he's trying two. The shorter lasting stuff was working great, but we need the twelve hour stuff at home. He said if two units doesn't work he'll either try three, or try a different one. Soon as they get that figured out he comes home. I just
hope I can keep up with his care. I work full time...but we'll figure it out.

 

Lantus & Levemir are depot insulins - remind the vet the dose cannot be evaluated until 5 DAYS ON THE SAME DOSE starting out.

 

Prozinc is having zero effect on his blood sugar. Unfortunately hats that's all the vet keeps on hand, so now I'm off to buy lantus and pray that it works. Can't remember the name of the one that's working...he usually just calls it regular insulin.... but it has to be given every six hours, which I can't do unless he becomes the office cat.

 

What dose, and what is the cat eating and when.

Regular insulin is Humulin or Novolin. It lasts only 6-8 hours.

 

Hey there

It might not be the prozinc thats not working - could be the food he is getting from the tube - if its high carb

To answer your prior ketone question - you want to test twice a week, or whenever he is over 340. Its good news he isn't in DKA any more!

Wendy

 

UGH!!!!! Major setback yesterday. With the ProZinc not working, his blood sugar spiked overnight. It was over 400 when they tested him in the morning, so was likely high for up to 12 hours. Poor guy was in really bad shape when I saw him yesterday... though did seem to perk up a bit while I was there. Purred the loudest he has since being there and layed on his side for tummy rubs. But he was SO weak - pretty much as bad as day one. I am SO irritated with the vet that WHILE hospitalized he could have had to endure this! We dont have large practices here... nothing that's manned 24hrs/day. But knowing he needed 24hr care, the vets have been taking him home with them. I understand they need to sleep... but if he LOOKED poorly in the morning... he should have been tested earlier!

I bought the Lantus (holy crap! $200+) and took it over yesterday, so HOPEFULLY that works. They're tube feeding Science Diet a/d I think it was? Not sure on the letters. It said "critical care". I just CANNOT get these vets to buy into the low carb thing - Science Diet has them wrapped around their finger. He did mention that this NEW Science Diet diabetic formula (a dry food) is low carb... but HOW low I dont know. It's the "latest and greatest", according to him. Probably has corn as the second or third ingredient. :-x

Anyway... if the Lantus doesn't work... I'm not sure how much more Tink OR my checkbook can handle. His quality of life is NOT good right now. I'm REALLY hoping he's MUCH better when I see him today (which is conceivable if the insulin works - he looked great a few days ago). But if not... I'm not willing to make him fight much longer...

 

Oh Jen, I am so sorry to hear that Tink is struggling so hard. Are they not using the R (regular insulin) anymore? It is commonly used to supplement other insulin when numbers are very high. What is their diagnosis - is he still in DKA?

 

The Lantus will last up to six months if you keep it in the fridge and don't shake or roll it.

A/d is 12% carbs, a bit high for diabetic cats - you want under 10% - so that won't be helping the blood sugar.

How often are they testing? He could drop low at night and bounce up in the morning.

Wendy

 

Yes, they are still supplementing with regular insulin as needed... which is why I'm so irritated they let it stay so high for so long. With his liver being in such poor condition, his body can't handle the ups and downs like this. I think they're only testing him every 12hours - which doesn't seem sufficient in this case.

I just looked on their website and it looks like the a/d is actually 15% carbs! Yikes.

Oh... and with the prozinc... he had him up to 2units, but it still wasn't moving his bg at ALL. So we switched to Lantus last night. Haven't gotten an update yet. Still... I was a bit worried with his plan. He was going to use the regular insulin at 6 and then do the Lantus at 9, before bed. I asked "couldnt that make him go hypo if it works?" He said there's a risk, but he felt comfortable with it and would start with a low dose. I just dont know why he wouldnt just use the Lantus at 6 so he could test at 9 and see if it was working or not... and if not, then use the stuff that we know works. He DID say that he may stop using the prozinc all together as this is the second time it's been completely ineffective. I dont know how many cats he's tried it on... two??

 

2 units isn't that high on prozinc especially if he is getting high carb food.... he could just need a higher dose...

Wendy

 

Do you have any other options for vets? Are there any 24 hour emergency vets around? I am thinking it sounds like you are losing confidence in this guy. I agree with you that he needs to be checked more often than every 12 hours, and that changes in insulin are best made when you can monitor. Any chance he'd let you take Tink home overnight? It would mean learning the feeding tube, but others have said it isn't terribly hard. And you would want to get up to speed right away with testing but we can help with that. Then you can monitor him and work on getting him to eat.

Go with your gut, Jen. It is usually the best guide. If you think he is safer at the vet, then he stays there. If you aren't sure they are doing all they can, I'd say change something.

 

Dear Jen,
Yes, trust your gut. I agree with Sue. Your vet sounds undereducated. I almost killed my Pudge by following my vet's advice: 4 units of ProZinc without testing! I believe that this board saved my Pudge & my sanity. While hospitalized they injected 4 units into a 71 BG! Pudge had no other health issues. He went into remission on ProZinc - that did not happen until I changed his food to wet low carb FF & Before Grain. He's very carb sensitive. His 2nd remission happened after a brief (mere days) interlude of Levemir (there was a shortage of ProZinc at the time). I have another kitty who's also in remission off ProZinc & Levemir. Pudge seemed to adore traipsing through all the scary colors while on insulin &, then, suddenly he'd be OTJ.

Get your kitty home as soon as you can! All my best to both of you, Sophie

 

Vets are brainwashed by the large pet food companies; you just can't talk to some of them on the topic. The only options are to 1)find a vet who is a little more open, or 2)nod and smile and then go home and feed your cat whatever you want.

However, if the cat's not eating AT ALL and we're worried about fatty liver, it's important to try to get the cat to eat ANYTHING up to and including red velvet cupcakes. Once that immediate danger is past, you can turn your mind to transitioning to a more optimal food.

 

ohmygod_smile Jen...I am so sorry Tink is going through this. IMHO...This vet is 'torturing' your poor guy. I would get Tink out of there ASAP !!!! Vet does not seem to know anything about FD and with Tink's other issues going on I can't believe how awful this is.

Only testing every 12 hours??? ohmygod_smile
Giving major high-carb food?
Not enough insulin?

Please Jen....try to either take Tink somewhere else and/or learn the feeding tube and bring him home. Huge possibility he will do better/faster with you treating/testing/feeding/etc. at home....he will not be so stressed out because he is not with YOU at home in an atmosphere he is comfortable with. PLUS...BIG TIME PLUS...all of us at FDMB can help you through this.

Apologies if I sound panicky....but...if Tink was my furbaby....I would have already told that vet to go pound sand and taken Tink home or somewhere else for treatment.

I send the longest healing vines, biggest hugs, and many many prayers to you and Tink so everything goes well. cat_pet_icon

 

If he's no longer in DKA and already has a feeding tube, you should be able to take him home, barring any other complications from the hepatic lipidosis (like needing fluids, which you can also give at home if you're so inclined). First, you'll be able to monitor his BGs whenever you feel like it instead of relying on them to monitor his BGs every 12 hours. It sounds like they're using the humulin/Novolin as a bolus, which still requires much more frequent monitoring than it sounds like they're doing.

Second, I wanted to point this out again:

It's better (and cheaper) if he were at home with you to monitor during those 5 days. Again, barring no other complications.

Finally, if they're already tube-feeding him, it's highly doubtful they're feeding dry:

You can do this at home yourself with a lower carb wet food and you might be able to see lower numbers much faster as a result. Tube feeding does require many small "meals" throughout the day and it seems like he's taking to it fairly well (no vomiting). If you have the time or flexibility, I'd see about getting him home sooner rather than later. Since he's not feeling well, he'll be much more complacent when it comes to home-testing, which we can help you with. Same with insulin dosing by using the humulin/Novolin timed properly with the Lantus (there are several members here who use this method with their kitties).

Find out from the vet why they think he needs to remain hospitalized. If it's just for administering insulin, BG testing, and tube-feeding, you can do all of that yourself from home and probably much better than they're doing it because he'll have 100% of your attention vs. limited attention at the vet's.

 

While I agree that this vet is undereducated... I'm afraid we're out of options. I am already at $2500. Tink is in NO better condition than the day I took him in. He is back on IV fluids as that's the only thing that seems to improve him at all. I've asked multiple times about subQ fluids which I can do at home, but am repeatedly told this will not work in this case. While I could conceivable drive home at lunch to administer insulin every 6 hours... I cannot do anything more frequently than that. At this point, I dont think he's in good enough shape to come home.

Yesterday I did see that they had him set up to check bg every 2 or 3 hours, which was reassuring. And as to my mention of dry food above, I did not mean that they are tube feeding it. They are tube feeding a/d canned, which the website says is 15% carbs. The dry food I was referring to is what we'd be taking home, if I listened to the vet, and feeding once he's off the tube.

Unfortunately, after ten days with no improvement and no response to any of the long-lasting insulins... I'm afraid I can't make my little guy keep going through this. The vet and the internist he's been consulting are both very interested in getting an ultrasound and possible biopsy of the liver... but that will require a two hour drive and another $500+. It could tell us if his liver even has the potential to recover... but I just can't handle the expense.

If I get there today and he looks much better, I would reconsider... but at this point I'm afraid it's time to end the suffering. wings_cat

 

Jen, I am so sorry to hear that Tink is not improving. I so understand how difficult this situation is. Please know that whatever you decide to do is the right thing for you and for Tink, because it is a decision made from and with love. If you decide to let him go, you might consider being there. With both my kitties that I had to let go, I held them while they got the shot and told them how much I loved them and what good kitties they were. I think it was easier for me and I hope for them.

((Hugs)) Sometimes letting them go is the best thing we can do for them. You have given him a wonderful life full of love.

 

There has been improvement as he's no longer DKA. He was just started on the Lantus a couple of days ago, which isn't enough time (~5 days) to see a response to the depot-style insulin.

This schedule should be fine. Lantus is administered every 12 hours with mid-point (nadir) testing around 5-7 hours to see how the dose is working. I'm not familiar enough with using R insulin together with Lantus, but since it lasts only around 6 hours, I'm sure there's a schedule that could be worked out with the help of others on this board who use it in that manner.

Patrick (my cat that recovered from hepatic lipidosis) had exploratory surgery to figure out what was going on with him because they thought it might be a problem with his kidneys. He wasn't jaundiced and his only symptoms were lack of appetite and this horrible, awful head-tilt. The second they opened him up, they saw his liver was completely white. This was about 15 years ago and he was given only a 5% chance of survival because there had never been a case as severe. Your vet caught the fatty liver fast, got the tube in fast, and began treatment fast. This gives Tink a much better chance all around.

Personally, I wouldn't waste money on a biopsy, either. He's already been diagnosed with hepatic lipidosis, which means he does have the potential to recover...through eating. The only thing that this ultrasound and biopsy would show is confirmation of it being fatty liver and maybe if he had a co-morbid renal issue, which at this point is like checking to see if a person with pneumonia has a cold. Either way, it won't make any difference in the treatment plan of getting him to eat (which is what the tube is for) so it's rather pointless.

I pray for both of you that he's getting better, but whatever decision you make, you absolutely know what's best for Tink. {{HUGS!}}

 

So staying true to feline form, Tink is making this decision difficult. He looked better today. Less jaundiced and more alert, still not strong, but close to where he was last week when I thought he'd be home in a day or two. However, then I noticed that he was back on CRI with the insulin. Ugh... Regular vet wasn't there...it was the young girl again. Had zero answers as to why and didn't even know when they'd last given his regular insulin, prior to going back to cri. I kinda went off on her.

So she had the regular vet call me. I basically called him out on the whole setback this weekend, saying I'm paying for all this care, how can they let his bg go so high for so long... I can monitor it better than that at home, and am willing to do so.

Finally he agreed that the plan will be to get his potassium up, then take him of the iv. He'll come home to be tube fed and injected with regular insulin every six hours, plus sub q fluid as needed. Once his liver Isn't acting up, we'll work on longer lasting insulin.

Of course once he's home I'm getting him on some low carb food, so hopefully that will be a huge help. I think I finally convinced the vet that I can handle all that and have done most of it. I just don't see him getting better there. He needs to be home, where he's comfortable. Plus even with the minimal amount of time I've had to learn, I feel like he's got abetter chance at home, especially with all you guys to help.

 

I've been following your story and just wanted to wish you the best of luck. Tink sounds like a little fighter! cat_pet_icon

 

Been watching for an update. This is good news. Yes, we will be thrilled to support you and Tink the best we can.

 

Jen & Tink,
you're both awesome warriors. Anything & anytime! Hurrah! Good thing you called the vet on the carpet. Take good care of yourself so you can help Tink!
With best wishes & admiration, Sophie

 

That sounds like a good plan! I have a few thoughts

1. Make sure they show you how to give sub Q fluids - and get a bag and drip line etc

2. take in your meter and strips and ask they show you how to home test his ear. I have provided tips but it might help if they show you too. Heres some ear testing tips https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

3. Buy those urine ketone test strips - you will need them . How to collect pee https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

Let us know when he is home and we can help you from there.
Wendy

 

Jen and Tink,

What an ordeal for both of you to be going through. But you are not going to go through it alone. These fine people are invested in you and you now have a family of new friends who know exactly what you are going through, and can help. My heart goes out to you and your sweet Tink. Once he's home with his mama, he's going to feel so much better. Stay strong Jen. You two are fighters (but even fighters need hugs) :YMHUG:

 

This sounds really promising if it's just the potassium levels that is keeping him hospitalized! (Hypokalemia is another potential side-effect from either the DKA and/or the Hepatic Lipidosis, so it's another thing to not overly worry about.) Good job on sticking to your guns. Please let us know how Tink is doing today and if the vet gives you an ETA for when he might be able to come home.

 

just read all this. Hope Tink will be ok, looking forward to an update.

 

Ok... FINALLY. So, although the vet still "officially recommends" continued hospitilization, he is willing to send him home. I could have gotten him this afternoon, but we decided to wait until tomorrow afternoon so we had time to get him back on his insulin injections, rather than the CRI. The CRI was basically done so the "fill in" vet didnt have to get up in the middle of the night to give insulin (we dont have a 24hr vet, but they've been taking him home with them).

His potassium level is low-normal now (he's been on IV drip again since his bg spike over the weekend), but I really want it normal or better before taking him home. So we're going to continue the IV fluids until I pick him up, but take him off the CRI first thing in the morning and go back to regular insulin injections, which I can then take care of the "middle of the night" dosing.

At home, he'll still have the feeding tube and will get subQ fluids (which I've done on both cats and dogs) once or twice a day. He wants me to check his bg half way between doses of insulin to see how low it goes. I think I might check before dosing too... but we'll see. I dont know that doing it every time is an option, with the regular insulin. 4 injections, plus 4 pricks sounds like one pissed off cat. So we'll see. Open to suggestions there.

He's also on amoxi for a uti and the vet wants to keep him on that for "a week or two" because it could help his liver too (depending on what the issue is, but he says it COULD be an infection also). I guess it can't hurt. He's never really been on antibiotics before (except maybe once as a kitten) so I'm not too worried about it.

He's being sent home with a/d for tube feeding... but I'd really like to get to a low carb food sooner than later. I dont see potassium listed on any of the food lists... though it might be listed on the can... I can't recall. Wouldn't mind getting a food high in potassium since he's struggling to keep that up. But I think getting him back to normal via IV, then tube feeding should be ok. He didnt have the tube yet when they took him off IV the first time.

He's going to put him on 1.5u of regular insulin every 6hrs. So I'll be doing that at 6, 12, 6, 12... how would you all suggest I do the bg monitoring??

I got a ReliOn Prime meter. Is that ok? I wanted to get the Confirm or Micro as some had suggested, but the strips were WAY more expensive (like $40 vs $9 for 50). Will it work? At first the vet was adamant that a human meter isn't calibrated for cats and dogs and I needed a pet meter... but then yesterday he said someone gave him a bunch of human diabetic supplies that he'd give me - so I think maybe the internist he's been talking to set him straight??

With doing the sub Q fluids, he says I should give the insulin injection somewhere else, rather than in the scruff. He wants it in the muscle (which is odd, if the scruff is an option)... but he doesn't HAVE much muscle right now. Where's the best place to give it? I know he'll tell me where... but I want to hear your thoughts as well as I think this room has a lot more experience with FD than he does.

 

Do you know when he wants you to switch over from the R insulin to the Lantus? Or are you going to do it based on Tink's recovery progress?

You want to test before injecting the insulin just in case Tink is already low, so 4 injections = 4 pricks before shots + 4 pricks mid-cycle. Here's a page of ear-testing tips to help you get started. Cats have less nerve endings in their ears than we do in our fingertips so it doesn't really hurt them. I test Michelangelo 10 to 20 times or more a day and at this point, half the time he's the one seeking me out for a test. What annoys them more than anything is being restrained. I wrote this up to help with creating a conducive environment for ear testing that will not only help you with testing, but also with the tube-feeding (a lot of the techniques I used to get my part-feral Michelangelo to let me ear-test him I actually borrowed from when I had to figure out how to tube-feed my part-feral Patrick).

As for feeding only twice a day, this is not a good idea. You'll want to feed several small meals throughout the day, most especially at each shot time and possibly half-way between shot times if his numbers are low. You want to make sure you feed only a little bit at a time (don't overload the tube) and flush the tube with water after every syringe of food. You also want to stroke under Tink's chin in a downward motion to help trigger his salivary glands and stomach digestion since he's not eating through his mouth. This will probably be the easiest step out of everything else you're having to deal with. Food generally makes cats happy, even cats who aren't eating, and Tink will most likely be very accommodating. This also might give you a good chance to do ear-testing on him if you have an extra set of hands because Tink will be sitting relatively still while he's "eating."

Yep, the Prime is fine to use. It does require more blood than the Confirm/Micro so you might want to look for larger gauge lancets labeled for "alternate site testing." Warming the ear with a rice sock is highly key when first starting out because it helps get the blood flowing. (Rice Sock: fill sock with rice, beans or lentils, microwave 10-25 seconds, test heat against forearm like a baby's bottle.) You also want to make sure you apply pressure directly after getting blood to stop the bleeding and reduce bruising because the first couple of weeks, their ears will look terrible! Once their ears "learn to bleed," the bruising clears up and you won't even be able to tell that you test him.

Here's a great diagram of places to give injections on cats that might help. Most people shoot in the flank or scruff. You don't want to shoot the insulin into the muscle so I don't know why he's telling you to do that?? I give "flat" shots to Mikey because when he was first diagnosed, he was a 4.8 pound 6-month old kitten who had nothing to "tent" properly. What you do is lightly pull up on the fur/skin so you can see the "shot spot" clearly. Then, you want to slide the needle in at about a 20* angle, not so shallow that it pokes through the other side but shallow enough that you don't hit muscle. You can practice this angle on a cut apple or potato that will allow you to "see" the needle through the skin/meat as if it were a cross-section.

 

So glad he is coming home. Tink will be in better hands with you taking care of him with the help from everyone here at FDMB.

Even though I am not very experienced with some of the things you will have to do, Rumpelteazer and I are following your ordeal and keep giving healing vines and paw-hugs every day.

Glad to hear you set the vet straight. :thumbup

You are a SUPER FUR-MOM and Tink will surely be happy to be home with you taking care of him.

Prayers sent for Tink's recovery. cat_pet_icon

 

Wow, glad to hear he's coming home! I'm just new here. My cat has his appt tomorrow to see if he is diabetic. He's got all the classic symptoms. Lots of awesome information and great people from what I've been reading!

 

@KPassa
The subQ will be once or twice a day... not the feeding. That will be at least 4x/day, corresponding with his insulin injections.
The plan for longer lasting insulin is to try the Lantus again once Tink is in better shape. Once the feeding tube is out and he's been regulated on the regular insulin for awhile. Probably a couple weeks. I think once he's feeling well and not being stuffed with carbs, it might be easier to get the longer lasting stuff to be effective.

So... a question for ya'll.

With feeding... should I just keep doing the Science Diet a/d for a bit as the vet is going to suggest, while we're tube feeding? Even on the can it says "for intermittent feeding only" which tells me it's probably not as nutritious as it could be. It's also labed for "feline/canine" which I found extremely odd since they have completely different needs. I'm guessing any pate could be fed with the tube. Should I switch ASAP to Wellness or Evo or something... or should I just stick with a/d for now? I just dont trust Science Diet AT ALL. I'd rather get him back on a good quality food asap, but managing the bg and getting his body back in order is my primary concern. He needs to gain some weight and build some muscle. My mind is telling me I should seek out a high protein, maybe high fat, low carb, and preferably high potassium food. But I dont want to get things out of whack with his system. The first ingredient in the a/d is water. Corn gluten isn't far down the list. I'd rather he be eating food that's packed with what he needs, not with water and fillers. I mean, he needs water... but we're already adding water to the food for tube feeding... plus he's getting fluids. I'd rather his food be, well, FOOD. Thoughts?

 

The A/D can is a complete diet and can be used indefinitely. It is formulated to be complete for both felines and canines. I would do as your vet suggests "keep doing the Science Diet a/d for a bit". Just not for long.
Any finely ground food can be tube fed. However, just make sure that there are no lumps and other stuff like that in the food since that could clog the tube. Many tube feeders pass the food through a strainer before tube feeding to remove large pieces.
I would transition by mixing A/D with the other food and increasing the amount of the other food in the mixture.

 

Jen,
No experience tube feeding kitties, but lots with people (my mom). I remember that many people, with time, refuse to take anything by mouth. Do you or does anyone know if one should be offering a few pieces of tempting cat food every few hours? Just not to miss out on the moment when kitty's appetite returns? Anyone? Your vet? I realize that now the important point is tube feeding yet...future is around the corner!
Many (((hugs))), Sophie

 

Yes, they said it's good to offer it, as at some point his appetite should return. Once he eats on his own, the tube can come out. I'm just not sure WHAT to offer. His favorite food in the world is canned tuna, so that might be good. Not to let him eat a lot of... but to get him eating. He's a dry food addict, so we're going to have to find a canned food he'll eat. That might be challenging. I think I'm going to switch my other cats over to at least a grain-free dry. Maybe mixed with canned, to try to reduce their overall carb intake as well, and prevent anyone else from having these issues. I thougth I was feeding good food... based on the research I did years ago when I took them off of mainstream brands. But there was no talk of carbs not being good for them back then (at least not that I found)... it was just concerns over corn and byproducts mostly. But the carb thing makes sense. You dont see cats eating grains and things in the wild.

I'm going to have to keep him separated from the rest of the "herd" when I can't supervise, to make sure my rowdy kitten doesn't pick on him or stress him out. So I will probably just put some extra food in a dish. If it's been touched, I'll know it was him. He has never liked to eat with an audience. I just worry about him getting food without insulin... but I guess with the current dosing every 6hours, that's probably not too much of a concern.

I just hope I dont have too much trouble with bg testing at first! I know it'll get easier... it it HAS to be done... NOW. I can't exactly wait till I figure it out. It LOOKS easy enough. But I've thought that about other things and they turned out to be quite difficult! Plus I've always been a bit squeamish about blood... but guess I'll have to get over that real quick!

 

If you must use dry:
Evo Cat and Kitten dry
Stella & Chewy's Freeze dried
Young Again 0 Carb (5% calories form carbs the way we calculate it, and internet orders only)

 

He' home!! Curled up on my lap snoring. Probably the best sleep he's had in a week. Spent a little time exploring.

First attempt at bg testing was a dismal failure. Got blood but not enough for my strips. Should have just spent the extra on the micro. Didn't think there was that much difference between .3 and.5 microliters... but yeah. Plus his ears are black and fuzzy.

 

So glad he's home!

What size lancets? Humans use 30-31 gauge. Cats usually need 25-27 until their ears"learn to bleed". Did you warm his ear with a rice sack or warm water in a little bottle? That can be vital in the beginning. You can also double poke - a quick second poke in the same spot. And if you get blood and he starts to move, get the drop on your fingernail and test from there.

Oliver had black ears. It was easiest for us to poke from the inside so we could see the spot easier and milk the ear if we needed to. Be sure you have something to poke against. We used a small makeup sponge; some people like a folded kleenix.

And really poke. The biggest mistake lots of beans make is being too gentle and not just giving it a good push.

There was someone who said they might help. I think it was further up your thread.

Keep trying. Three tries and then treats for bean and cat. You will figure out what technique will work for the two of you. It just takes some time.

 

A dab of Neosporin ointment (not cream) on the ear a few minutes before testing, then wiped off, will reduce some of the annoyance, plus help the blood bead up.

 

Yay.....He Is Home !!! We Are Sooooo

Maybe start a new thread "Tink Is Home" so we can follow his "happier-home-treatment" by you. cat_pet_icon cat_pet_icon cat_pet_icon

Keep us posted on his progress and keep asking all the questions you have in mind. Everyone here is anxious to help you and Tink in any way possible.

Best of luck from me and RumpelT.