TIFIL DKA advice please

Tıfıl was feeling bad yesterday, she was lethargic, she vomitted two days ago, also she had constipation, her stool was very very dry for two days.and she didn't eat at night so I fed her in the morning with cheese (which she loves) then she went on front of her water bowl and stood still like she did when she was first dka. I called my vet and we went to him in the morning. Her electrolyte levels are upside down and also she has keton in her urine

She is at the vet now, she is taking serum, the vet told me to come at 6 pm to take her. I want to ask, what should I want from the vet? I mean is there anything that I am missing.

He said that she became ketoacidosis because of too much insuline????? what does that mean, can there be a chance that too much insuline couses dka? He thinks that too much insulin made her resistance to it?
After she recovers, the vet wants me to stop giving insulin :sad:

What am I going to do??????

 

Re: TIFIL DKA

That sounds confusing to me.
Hopefully, she has some ketones, and is not in full fledged diabetic ketoacidosis. Did the vet say DKA? I am used to the vets hospitalizing cats who have DKA, meaning they have to stay there for a few days to get fluids, electrolytes, insulin drip, glucose drip, and all kinds of 24 hour monitoring.
If she has to stay, I would say make sure the vets get enough food into her.
((((Isil)))))

 

Re: TIFIL DKA

Her electrolytes levels are upside down, also her blood ph has dropped..He didn't say it's dka unfortunately BUT he said that she was about to and he said that with these blood levels it's strange that she doesn't feel as bad as she should.

I know that she has to stay in the vet tonight if it's dka but I guess he thinks that she is ok to take her home and if necessery to bring her again tomorrow morning.

I am confused, I did my best, I just can't understand why this insulin dose is not working. I mean, the vet says it's too much, but I've read that ketons accure due to insulin scarcity, am I write?

 

Re: TIFIL DKA

My understanding is that DKA comes from not enough insulin + not enough food + infection. Have they checked her for an infection? I'm sure there's more to it than that, as they never found an infection in my cat when he was DKA.

I'm sorry, I have to get ready for work in about a half hour, but others will be here for you, soon. Hang in there.

 

Re: TIFIL DKA

Yes they checked for infection, there is no infection says the vet...hard to understand...
Have a nice day at work, thank you for helping dear Dyana..
By the way, when you come back, I would like to here your cat's story about no infection..
Kisses

 

Re: TIFIL DKA

Hi Isil,

Normally here we advise that DKA is a result of the combination of too little insulin, not eating well, and infection (or at least two of those three). When I have observed the veterinary treatment of DKA, it has involved IV fluids supplemented with electrolytes, glucose and R insulin; antibiotics; and assisted feeding (sometimes a feeding tube).

I would ask from the vet a complete blood panel and urinalysis, to see what Tilfi's health problem might be. The blood panel can suggest a number of things, including a bacterial or parasitic condition, that are causing Tilfi to feel like crap. Once she feels like crap, her diabetic condition will worsen. If the BW suggests other problems, more advanced blood tests may be needed.

I would ask for a broad-spectrum antibiotic to address whatever infection she might have. My choice would be Doxycycline. I would ask for a urine culture and sensitivity to see whether she has a urinary tract infection (UTI) that needs to be treated. I also would ask the vet about diagnostic tests for an upper respiratory infection (URI) as well as likely parasitic diseases in your area that that could cause an infective state. In the US, I might ask for a test for hemobartonella, which is an parasite that causes anemia and which is spread by ticks and fleas.

I would ask the vet to continue IV fluid therapy, supplemented by the "stuff" Tifil needs to improve electrolyte levels. If Tifil's BG numbers are high. I would ask the vet to put Tifil on a constant rate infusion of regular "R" insulin, which should help to bring her BG numbers down.

I have not heard that too much insulin causes DKA. But there is a possibility that too much insulin causes a chronic redound situation.

I have set my options on this thread so that I am emailed whenever there is a response. I am available at xxxxxxx@xxxx.xxxx. All I can give you is Diabetic Cats in Need's (DCIN's) experience with cats in DKA, but perhaps that will help.

Edited to say:

Sienne's response below said

That is absolutely true and I agree with that policy. I am not often on the Board these days and I was trying to give you an alternative way to contact me if the information you are posting went somewhere other than this thread. But there are lots of people here who have experience with DKA who can help you if I don't happen across your 911 call for help.

 

Re: TIFIL DKA

Isil,

I am sorry I have no advice, but I am praying that Tifil is OK. Hugs.

 

Re: TIFIL DKA

Thank you Venita,
I am so frustrated
After she comes back from the vet, I have no hope and I don't now how to deal with Tıfıl's diabetes. I mean, what am I going to do with her dosing? I am about to go crazy

Should I change Lantus?

By the way, R doesn't work good on tıfıl, it drops her too fast, you can see it on my spreadsheet...

I feel terrible

 

Re: TIFIL DKA

No advice, but (hugs) to you and chin scratches to Tifil!

 

Re: TIFIL DKA

(((((isil)))))

a complete blood panel and urine tests obtained via cystocentisis (needle into the bladder) are the first places to start looking for a problem. obtaining a clean urine sample will allow them to do a culture and sensitivity test which will help determine the best choice of antibiotic (if one is needed). i would definitely have those 2 things done. like venita said, depending on the results, more testing may be required. something is going on and the source should be found.

i wouldn't worry about tifil being given R insulin. it's usually given intravenously with a glucose drip to keep her from dropping too low along with electrolytes in the IV... and sometimes an antibiotic. this is standard treatment when a kitty is in DKA. it will depend on the amount of ketones she has in her blood.

you'll find a good explanation here of how ketoacidosis happens as well as treatment for it: http://petdiabetes.wikia.com/wiki/Diabetic_ketoacidosis.

"Veterinary care for DKA involves intravenous (IV) fluids to flush the animal's system of the ketones and when necessary, to replace depleted electrolytes[19][20][21], such as bicarbonate; intravenous or intramuscular fast-acting insulin to bring the blood glucose levels down[22][23]; measured amounts of glucose or force feeding, sometimes by feeding tube, to force the metabolism back from fat-burning to glucose-burning."

i'm confused by your vet saying ketones are the result of too much insulin. as mentioned in the article above, DKA is caused by not enough insulin combined with certain systemic stresses. IV fluids, insulin, food, and antibiotics when necessary are the keys to successful treatment.


since we are a peer reviewed message board, please continue posting your questions and concerns on the board. we'll help you in any way we can.

 

Re: TIFIL DKA

It might help you to understand DKA if you read this link. One of the basic causes of DKA is no enough insulin. If Tifil is dehydrated, IV fluids will help not only to get rid of the ketones but it will also help the insulin to be better absorbed. It doesn't make sense for a vet to say that ketones are being caused by too much insulin. Stopping insulin in a cat that is producing ketones sounds like a very dangerous suggestion.

When your vet says Tifil's electrolytes are "upside down," what does that mean and which electrolytes is he referring to? Venita's suggestion regarding getting blood tests will tell you this. Electrolyte levels can be effected by a number of factors, including dehydration or vomiting. If the vet tested and found ketones present, at what level?

You might also ask the vet to get a spec fPLI (specific feline pancreatic-lipase immunoreactivity) test. This is a very specific test for pancreatitis. Pancreatitis is a painful inflammation of the pancreas and can make your cat feel lousy. Many of the cats here were initially diagnosed with pancreatitis since the pancreas is the organ that produces insulin and it is the pancreatitis that caused the diabetes.

As far a chronic rebound (also called Somogyi rebound), the original research was done on humans in 1938. Since then, no study has been able to replicate the findings in humans, let alone in cats. The concept is considered to be controversial, at best. Further, there has never been any research to substantiate the existence of chronic Somogyi rebound when using a long-acting insulin, such as Lantus. (I've done 2 extensive literature reviews in both human and veterinary databases.)

And just a reminder, while it's very kind of Venita to provide you with a way to directly contact her, it's the Webmaster's policy that all information regarding the management of your cat's diabetes is in the public forum. That way, you have the advantage of many people's input. This is for everyone's protection since none of us are veterinary professionals.

 

Re: TIFIL DKA

Just want to say we've got you guys in our thoughts and prayers. Please do keep posting your questions...the folks here really understand this stuff and will help get you and Tifil through this!

 

Re: TIFIL DKA

Hello everyone, Yhank you for helping...
I will take the blood test reslts from the vet when I will go to take tıfıl.
Dear Sienne, tıfıl had the FPLI test last month, thanks good she is not pancreatitis.
Today the vet looked at her teeth and said there is nor problem with them, but i insisted on taking a dental film, he will take it today (I hope)
He said there isn't any infection in tıfıl's body...but I don't depend on him, I hope he took every single test to confirm this...
After Tıfıl comes from the vet, what should I do with the dosing tonight?
Do I have to continue my regular dose, or do I have to give an increased dose. My vet told me to stop using insulin, how can I make him to give R, it's impossible, he thinks everything is because of the high dose of insulin
Unfortunately I have to do the insulin dosing on my own

I phoned him, he said that tıfıl is great, she is not dka she will be fine tomorrow, but I am suspicious of the treatment tıfıl's been on...
I will ask him to do every single test to understand the underlying reason...
He said to me that, according to my spreadsheet, Tıfıl is not responding to insulin, the bg levels are stable during the day...so he thinks that she doesn't need insulin, what a thinking!!!

I feel terrible...
shold I buy levemir?
what am I going to do

 

Re: TIFIL DKA

By the way, vet said that she is not dehydrated....
Is there any supplement that regulates the electrolyte levels? Is the only meditation ıv fluids with electrolyte?

 

Re: TIFIL DKA

Get the vet to give you a copy of Tifil's lab results, including the electrolyte levels. If you can translate the results, including the reference ranges, we can help you make sense of what the vet is saying. If the vet questions why you want this, say it's for your records especially if Tifil should ever need emergency care when his offices are closed. Many of us routinely get copies of our cat's lab tests for that reason. (Look at Gabby's SS -- I have her labs on a tab on her SS.)

I'm seeing if I can round up some of the Lev users to give you feedback. I've not used Lev. The pharmacology of Lantus and Lev are different but they are both long-acting types of insulin. The primary difference you will see is that the nadir with Lev is later in the cycle than with Lantus.

 

Re: TIFIL DKA

as usual, good advice from sienne.

personally, i don't think "now" is a good time to switch to levemir. since tifil has been receiving lantus, you have a lantus shed/insulin depot in place. at this time, it would make more sense to increase the lantus dose depending on the information you bring back from the vet.

if you were to switch to levemir now... it would almost be like starting over. it would take several days for the full effects of the levemir to be seen. i really think you're better off sticking with lantus at least until this crisis has passed.

just my thoughts...

 

Re: TIFIL DKA

Hi guys ... No advice from me, it seems like you are getting good advice from more experienced members on this board .. all I can give you are my positive thoughts and prayers your way ..

 

Re: TIFIL DKA

Ditto on what the others have said. Tawny has just gone thru s/thg similar being in hospital 3 times in 7 wks from the first of Nov. til about the 2nd wk of Dec. Her electrolytes (potassium) levels were low, her BGs were high, she had DKA, pancreatitis and FHL according to some of her discharge papers. She got an IV w/a constant infusion of R insulin constantly monitored, along w/a broad spectrum antibiotic, fluids and s/thg to bring her electrolytes up. She was on potassium supplement, ABs, appetite stimulant and various other meds over the course of her illnesses. She finally got an e-tube the last time she came out of the hospital so that I could feed her at home when she would not eat, she is eating on her own now well and consistently and I am thinking it is time to have it removed, calling vet today in fact.

I have never heard that ketones are caused by too much insulin and in fact in my recent experience with this the experts here have drilled into me, and convinced me, that we fight ketones w/insulin and calories. It also helps to add as much water to Tifil's food as she will tolerate to help with dehydration. If it was my cat I would not quit the insulin and in fact would probably consider increasing it (remember to increase by .25u at a time only when following the protocol). I am not qualified to give dosing advice but I can tell you what happened w/Tawny, how we battled it, and what I personally would do. Consider what some of the others here might have to say about an increase if you want to think about doing that.

The last time Tawny got out of the hospital the vets wanted me to decrease her dose from 3u to 2.5u. First, by following the protocol, the reduction would only be .25u, not 5u. Most vets I have had experience w/simply cannot get their heads around the idea of being able to measure .25u doses. As you know around here we do it all the time. Secondly, the vets I have dealt w/are not comfortable w/BG #s lower than the mid-200s. Their idea seems to be "leave the BGs there and we'll control the diabetes w/insulin." The goal here for most of us of course is to maintain lower #s and eventually go OTJ whenever possible. We are comfortable w/lower #s b/c we have learned from this board how to handle them. The vets are not. Your vet may be looking at Tifil's yellow #s on her SS from the last few days and thinking along the same lines as the vets I have encountered. My vets based their recommendation to reduce Tawny's dose on just one day of mid to high yellow #s.

I refused to lower Tawny's dose when I got her home, have been vet-lectured over this several times, but I stuck to my [FDMB] guns. I am so glad I did! Just look at Tawny's SS now! She is doing great, surfed blues all day yesterday, started out w/a lovely low yellow # this morning. She is getting healthy, she is happy, she is putting on weight and she is eating a lot, on her own. The ketones have not returned and I attribute this to her finally getting enough insulin, and getting the calories she needs. I add water to her food, Tinkerbell's too.

Again, ditto on what the others have said. If it was my cat, I would not under any circumstances reduce her insulin or take it away completely.

Sending healing vines and snowflakes to Tifil, strength and wisdom vines to you. Please keep posting, I am not a qualified expert but I have experienu ce w/this and will keep eyes on you.

Desi

 

Re: TIFIL DKA

((((isil)))) i'm so sorry tifil is ill. others have far more experience on this than i have, and the only thing i can think to mention is that you've said several times that the advice you've gotten from your vets hasn't been good. so i hope you can trust that the people here know how to help you through this.

i like the idea of posting the results from the labwork so others can help you unravel what is going on.

many hugs!!!! julie

 

Re: TIFIL DKA

(((((((Isil & Tifil)))))) I don't have any advice, but wanted to stop by and tell you Leo and I will send Tifil a ton of healing vines for her to get better!

 

Re: TIFIL DKA

Good luck! If it were my cat, I would not reduce the dose either. My first diabetic cat, Jake, was diagnosed in 2002 and I knew nothing about diabetes. The vet had him on glipizide for about 4 months. I had fructosamine tests done periodically and his levels were 300-400 usually. He became dehydrated, couldn't poop, weak, and lost weight. I finally took him to a different vet who immediately put him on insulin. He was almost to the point of DKA but not quite. With the insulin twice/day and me finally learning how to bg test at home, he lived for 8 years as a diabetic.

My current diabetic cat Sid, is in the hospital right now. This is his 5th day. He had a DKA crisis and was very ill. It happened very fast because he was eating 2-3 cans of FF every day along with some baby food, drinking a lot of water, urinating, acting fine, etc His bg levels were higher than I wanted but I didn't think high enough to cause DKA because he was just diagnosed about 6 weeks ago. Obviously I was wrong about that. The day I took him to the emergency vet, he vomited profusely several times, hid under the bed, and when he wasn't hiding, he stood with his head over the water dish. The vet said he probably had a kidney infection but they have also determined that he is probably in renal failure now too.

It sounds very similar to Tifil. Is there any way you can switch vets? or get another opinion?

Good luck. :YMHUG:

 

Re: TIFIL DKA

Isil, I'm just fishing for information for anything that might be related. Might not be at all important, but i'll ask anyway.

yesterday you mentioned that you are giving Tifil spirulina. When did you start giving her that? Not seeing it mentioned on her ss.

Is there anything else other than cat food that you've given her or that she might have gotten into?

 

Re: TIFIL DKA

Hello, I am posting the lab results;
I don't know what they mean but meanwhile I will search from the internet

bun 11mg/dl 16-36
crea 1.0mg/dl 0.8-2.4
ca 9.5 mg/dl 7.8-11.3
chol 432 mg/dl 65-225
amyl 456 U/L 500-1500
LİPA 2758 U/L 100-1400

pH(ven) 7.26 7.24-7.40
HCO3(VEN) 13.6 mmol/L 34.0-36.0
AnGap ----mmol/L
BE -10.8 mmol/L
tCO2 (ven) 14.6 mmol/L 27.0-31.0
PO2 (ven) 53.0mmHg 34.0-45.0
tHb (ven) 16.4 g/dl 8.0-15.0
SO2 80.0% 93.0-100.0
Na 152.0 mmol/L 150.0-165.0
K --mmol/L 3.5-5.8
CL 108.0 mmol/L 112.0-129.0

HCT 38.7% 24.0-45.0
HGB 12.8 g/dl 8.0-15.0
MCHC 33.1 g/dl 30.0-36.9
WBC 10.70 K/ul 5.00-18.90
GRANS 6.50 K/ul 2.50-12.50
%grans 60.7%
L/M 4.2x10^9/L 1.5-7.8
%L/M 39%
PLT 374 K/ul 175-500


Urine;
ph 6.0
pro 30 mg/dl
glu 1000mg/dl
keton 150 mg/dl
UBG 1mg/dl
BİL neg
BLD 25 ERY/uL

 

Re: TIFIL DKA

Sending healing energy, prayers and love to you and Tifil.

celi & binks

 

Re: TIFIL DKA

Dear Julie,
I do^n't think it's because of spirulina, tıfıl was anemic and spirulina saved her from anemia..

I only gave ff and lysine except from spirulina...



My vet insist on not giving insulin tonight and tomorrow morning, I don't want to do such a thing, so I am going to lie. Tomorrow morning he is waiting for us..He said he will continue on giving IV fluids...
He is angry at me that I am searching a lot. He thinks I sould stop searching and start obeying what he says...
He wanted me to give tıfıl diabetic food today, royal canin diabetic dry food He thinks that fancy feast is cousing the high bg numbers
I don't have another vet to go to, I must go to him, but I am not going to do what he says..

What should I dose, should I go on with the same dose tonight?

My vet doesn't think that the ketons are important, I am waiting for my ketostix to come...I hope the ıv fluids that he is giving are cleaning the ketons...

After Tıfıl came home she cleaned herself, wanted food, I gave her ff but she didn't eat much
She made her poo poo...

By the way,

My vet says there is no infection in tıfıls body. But I just can't trust him
Yes the symptoms are the same with your cat...
How can I understand the kidney infection and the renal failure?
Which tests should I want from the vet...
He is so angry with me when I want something from him ....


I wanted her dental film, but the vet said she doesn't need it...he says there is a tooth decay but it is nothing to do with her diabetes...

I said I want that tooth pulled, he is insisting that there is no need

I am about to go crazy

 

Re: TIFIL DKA

Dear ((((Isil and Tifil)))),
We are sending lots of healing vines and prayers, too. I am certain that someone knowledgeable will be along soon to help you to understand what the test results mean. You've gotten lots of good advice from people who know what you are going through and I'm sure that Tifil will be feeling better soon.
Lots of hugs,

Ella & Rusty

 

Re: TIFIL DKA

isil, i have contacted several people who are good at interpreting lab results (i'm not) and have asked them to look at tifil's lab results.
i have an appointment i have to keep, but i will check back in with you as soon as i get back.

 

Re: TIFIL DKA

Thank you Jill

 

Re: TIFIL DKA

the wise ones have got you, Isil...hang in there, my friend

:YMHUG:

 

Re: TIFIL DKA

Işil'cik, burada da :YMHUG:

I have sent a message to my cousin in Ankara asking about vets.

 

Re: TIFIL DKA

I'm sorry you are having such a hard time with your vet. :sad: Your best bet right now is to try to get food into her any way you can. Get a couple of BG tests tonight too. Sometimes when a cat has had fluids, the numbers will drop later in the day. Not always, but test just in case.

I'm glad you are not thinking about reducing or stopping the insulin. All you need to do is look back to when you reduced the dose a few weeks ago and you can see that a smaller dose was not enough. Since you increased to 2.75, her numbers are now looking better than they have in a while. I'm really sorry you have to lie to the vet, though. That must be hard, but I do think you need to keep giving insulin.

((((Hugs))))

 

Re: TIFIL DKA

Isil,

The vets were not able to find an infection in Sid's kidneys through any tests. His urine tests were clear. They are guessing about the kidney infection due to Sid's very high BUN and CRE levels that spiked up so quickly in one day. In my opinion, and I am by no means an expert, Tifil could have gone into DKA without an infection present.

I feel so bad for you and know how frustrated and scared you must feel when you have to rely on a vet whom you don't fully trust.

Sending lots of healing vines and snowflakes for Tifil. I hope for the best. Tifil is lucky to have you. :YMHUG:

 

Re: TIFIL DKA

Thank you very much everyone,
I shot tıfıl her regular dose; 2.75 iu
Her Pmps was 231, +1 249....

She doesn't feel good but I gave her raw meet and she finished it

The vet wanted me to feed her at 12.00 am and not feed her anymore untill he gets a test when tıfıl is hungry...I AM NOT GOİNG TO DO WHAT HE SAYS...I guess he doesn't know much about dka and he doesn't know that tıfıl has to eat not to burn from the fat or whatever...

I feel so so so bad for not having any vet who knows much about dka and feline diabetes, I feel terrible to do everything secretly, but I feel wonderful to have you and the LL

Thank you everyone

 

Re: TIFIL DKA

Isil, here's what i think about you:





You have my greatest admiration. you have educated yourself. you are advocating for tifil in spite of resistance. i don't mean to be snarky, but sometimes men in positions of power like to hold the power and try to squash women who don't silently accept their authority. stand firm. is there any way you can go to the vet that Hande takes Shanga to?

i want you by my side when i have a crisis. you go girl! :YMHUG:

 

Re: TIFIL DKA

Is there a value for potassium (K) on the labs. You noted that it was low but there's not an actual number there. Also, do you know what BE is? It's not a lab that I'm familiar with. Is there a value for the anion gap? I can calculate it but I need the K value to do so.

 

Re: TIFIL DKA

So sorry that you're both going through this and will be sending you the best healing vibes today. One thing to maybe consider is that I don't think the test for pancreatitis is 100% accurate (someone may correct me?) my understanding is that the only way to confirm is by biopsying the pancreas. Although sometimes it can be dx with an ultrasound, this was how Vyktor's triaditis was dx recently.

You are doing a great job Isil, hope Tifil's feeling better very soon.

Serryn

 

Re: TIFIL DKA

I asked the same thing to the vet, what is the potassium value? He said it is too low that's why the machine didn't give a number, but If you ask my opinion, that is a big lie, I guess he ran out of potassium test...

He said he will make a test again on wednesday for K...Maybe he ordered it, who knows...

I googled BE, but I couldn't find it, it's some sort of a blood gas but I don't know, I can ask him tomorrow

There isn't a value for the anion gap

 

Re: TIFIL DKA

Julie you are so so sweet...
I will always remember the proximity I saw here and I will be with you if you ever ever have to live a crisis like this, but I am praying to good that nobody will ever ever and ever live the same despair like I do

 

Re: TIFIL DKA

We do it for love...and your love for Tifil is beautiful.

celi

 

Re: TIFIL DKA

Thank you celi,
I hope our love for our cats will heal them forever...

 

Re: TIFIL DKA

i'm so glad you gave tifil insulin tonight! like libby mentioned, we saw what happened with a reduced dose a couple of weeks ago.
people are currently looking at tifil's lab results...

 

Re: TIFIL DKA

Thank you everyone, for helping me and Tıfıl...

 

Re: TIFIL DKA

Isil:

Tifil's renal values are good....there is no indication of renal failure but it is interesting that her potassium is so high they couldn't read it. Abnormally high potassium values are known as hyperkalemia. You said her urination is normal? One cause of hyperkalemia in non-renal kitties can be decreased urination. If she does have really high potassium values, I wonder what kind of fluids he's giving her because alot of the fluids have potassium in them and I wouldn't want her to have more potassium if she is high. Is her heart rate ok with no arrhythmia?

She does not appear to be anemic....so either the vets were wrong before or the spirulina worked. Her HCT/HGB are good.

It is true that you cannot often diagnose a kidney infection from urine...even a sterile urine draw done by cystocentesis. Often, an ultrasound of the kidneys are needed; however, one would expect to see a temporary increase in the renal values if the kitty has a kidney infection...that isn't the case with Tifil. And her white blood count is normal.

It would also be interesting to see her phosphorus level which is usually run with the other renal values.

 

Re: TIFIL DKA

I am really sorry, I went back and edited my post...I wrote it wrong Her potassium levels are low...
Very sorry for that mistake...

 

Re: TIFIL DKA

I didn't see where you made the edit. What was the K value?

 

Re: TIFIL DKA

I made it on this post of mine....I don't have the value, he said it was too low, but as I said, I think he ran out of the kit for potassium, that is only my opinion...
By the way, when tıfıl was first dkaed last year at May, she had hypocalemia

 

Re: TIFIL DKA

We know she has some of these but how many of the below symptoms does she exhibit? These are all associated with hypokalemia:

twitching, trembling or shaking
weakness and muscle wasting
stilted gait in the front legs
stiff neck or inability to hold up head
hoarseness
increased night time urination
lethargy
trouble breathing
appetite loss
constipation

Occasionally, if the blood is hemolyzed, the potassium can be low. I'm sure it would be difficult to get that info out of the vet but in the US, it usually states on the lab work if the blood was hemolyzed. Cnversely as I said above when we thought the potassium was high, if she is getting lactated ringers IV, then that is supplemented with potassium.

 

Re: TIFIL DKA

Isil, I'm just sending you (((hugs))).

 

Re: TIFIL DKA

sending healing vines and strength

 

Re: TIFIL DKA

Tawny's vets said the same thing about her having a UTI and treated her for it as well even tho only one time did her urine show what they described as "rare bacteria" which did not mean a rare form of bacteria but mean "only a few". They treated her for UTI anyway with various types of ABs. They did more cultures over the course of her hospitalizations and found "no growth".

One thing Tawny got when her potassium was low was 2.5ml of potassium gluconate twice a day. I think it was 2.5ml. I'll have to run upstairs and look at her pprs to be sure. If it's different I'll post the new amount. Did your vet give you anything like that?

If you look at Tawny's SS you can see that she too went into DKA when I reduced her dose and tried to start over. My schedule was awful and I kept having to skip shots so I finally decided to just start over as if she had been recently dx'd. This was obviously a huge mistake and I often feel as if I may have pushed her into illness with my stupidity. The guilt will consume you if you let it, don't. (I have left my business as of 1/1/12 so my schedule will not be an issue anymore. I plan to get me a 9-5 M-F job where I can have a life! But I digress...).

Good for you for sticking to your guns and giving Tifil her insulin. You go Girl! You have certainly earned that trophy! We are here for you. Keep posting.

 

Re: TIFIL DKA

Isil --

We didn't forget about you and Tifil!! We're trying to get in touch with a few people who are experienced with interpreting lab values. We want to make sure we give you reasonable suggestions that make sense.

We'll be back!!

 

Re: TIFIL DKA

Hello,
It's morning now,
After 2 hours I will shoot and take tıfıl back to the vet...Tıfıl is nor looking good, she is hidding.
Today at the vet I must be sure that he is giving the right ıv fluids...
I feel terrible, it's so bad not to have a vet to depend on

Today I will want the potassium value from him...


After I leave tıfıl to the vet, I will go to work, I have only 3 lessons today to give, after I'll come back to the vet and ı'll stay next to tıfıl all day...

The vet wanted me to bring her as hungry but I remember that feading was important on DKA, should I feed?

 

Re: TIFIL DKA

bumping you up to see if we can get an answer for you.

 

Re: TIFIL DKA

i want to make sure people see your answer there in the quote - I missed it at first.

so you need to know within 2 hours if you can feed her, is that right? just want to make sure we have the information here for when someone gets online. the east coast people have all headed for bed, i think.

 

Re: TIFIL DKA

isil, did the vet say why he didn't want you to feed after midnight tonight? that's usually an instruction that you get if the vet is planning to use an anesthesia, say for a surgery or some kind of invasive medical procedure that would need the cat to be unconscious.

was there any talk of something like that?

or did the vet give any reason for not wanting tifil to eat?

 

Re: TIFIL DKA

Hi Isil

A few people asked me to look at your thread. I think the test results are strange; I'm sure the potassium isn't too low to read because that would cause death. Even cats have such low potassium that they can't raise their own heads, still have a readable potassium. It's weird that the amylase below normal ... I don't know, it's strange. For the blood gas results (HCO2 etc), they are not as valid with blood sample from a vein so these are often all over the place when you use blood from veins.

I do agree that something is going on with your cat. I assume you don't have the option of another vet? If you are in Istanbul, can you take her to the veterinary college for treatment? Wherever you go, I would get some x-rays of her abdomen, or an abdominal ultrasound (sonogram) to make sure there isn't something in her intestines that is causing her to feel poorly and not eat.

It's possible that she's on her way to DKA and she is just a cat who can't tolerate any ketones without feeling poorly. I think that would be a diagnosis you can only make once you have tried to rule out everything else though. If you can get her to the veterinary college or another vet whom you trust, that is best as she may need to be hospitalized to clear her ketones and make sure she's eating.

Please keep us posted.

 

Re: TIFIL DKA

Sending good vet vines, today. You and Tifil will be close in my thoughts all day.

 

Re: TIFIL DKA

Isil:

Jess is a veterinary technician. She is very smart and one of the people we were trying to contact because we were confused by the lab results from your vet. I think Jess' suggestion of seeing if you can get an appointment at the vet school is a good one.

 

Re: TIFIL DKA

Sending healing vines to tifil. i hope you can find some answers soon. ((((((((((Isil))))))))))

 

Re: TIFIL DKA

We're continuing to hold you in our thoughts and prayers today....

 

Re: TIFIL DKA

My thoughts are with you. Hope you get some answers.
Sending healing vines your way.

 

Re: TIFIL DKA

Thinking of you and Tifil and sending healing energy.
Liz

 

Re: TIFIL DKA

sending lots of healing vines and snowflakes your way today

 

Re: TIFIL DKA

Isil, I hope that you can get Tifil to the other vet today. We are thinking of you, sending healing vines to Tifil, and sending you and Tifil lots of strength.

Many hugs,

Ella & Rusty

 

Re: TIFIL DKA

sending many healing vines to Tifil

 

Re: TIFIL DKA

You have the A Team here! I'll just add healing thoughts and positive energy for Tifil's recovery. Hang in there, Isil.

 

Re: TIFIL DKA

Still sending many healing thoughts and snowflakes that Tifil will be ok and you can get her to the veterinary hospital. Keeping you all in our prayers.

 

Re: TIFIL DKA

Hello,
Today was a strange day, I took tıfıl to the vet and I lied about not giving the insulin. Tıfıl started to take ıv fluids with electrolytes in it (it's strange that in the ingredients there isn't potassium). I asked the vet to add potassium in it but he said it isn't necessary
Then I went out of the clinic and my father called, he told me that he arranged an apointment with a proffesor at the vet faculty...
we took tıfıl and went to vet faculty...the prof that we met asked me what our story was, I told him that tıfıl was first diagnosed on May with ketoacidosis. He asked "with what", I said ketoacidosis, he asked again with what???? I said diabetic ketoacidosis, he said, I am a surgeon, I can't help you, you must go to bla bla bla He called bla bla bla and we went to see him..
He asked me the story, I answered, he said are you a doctor, where do you know all this stuff, I said I love to read, he said, too much reading is not good and added "I don't believe tıfıl is diabetic."..I said, she is, and has been for a long time...
He brought a glucometre and he tested, aaaannnnnndddddd the result was 44
I was on a shock!!!
How can that be,,,
He started to make fun of me on front of his students..."you see, your cat is hypoglysemic NOT hyperglycemic!!!

He said he won't count on the lab results that I had 2 days ago and he will be waiting for me to get a new test tomorrow, annddd he said he doesn't see anything abnormal with the electrolytes levels!

I came home immediately and I tested tıfıl, she was 209...sooo I guess our genius vet took a small amount of blood and got some wrrroonnnggg result OR I guess his glucometre's calibration has gone crazy....

He also said that tıfıl's teeth are not good, but he thinks that this won't effect the BG... :shock:

BLA BLA BLA...another stupid day has passed...I spent my time trying to explain the vet prof. that my cat is really really diabetic and I am not daydreaming!!





I came home, tıfıl was feeling better, I guess the ıv fluids have worked...She ate...she went to sleep....

Mean while, I called my vet Mr.Bla Bla 2, he said " Haven't I told you not to shoot insulin anymore" guess why he said this???? stupid me, by mistake I told him that I shot this morning....He said, he won't continue on giving ıv fluids if I don't obey to what he says...so, I hope my nose won't extend while lying....

I must say, Mr.Bla Bla 1 the vet at the faculty said that tıfıl doesn't need ıv fliuds so this means we ara continuing with Mr.Bla Bla 2.....

Dear Jess, Thank you for coming and helping us...I went to the faculty today as I mentioned but the result was not good
Tomorrow I will go again and I will ask the things that you said and propose for x-ray (which I am sure he is going to get angry) ...

Thanks god tıfıl is eating and today my ketostix came and I will test her urine...
Do you suggest taking somekind of supplement for electrolyds?

 

Re: TIFIL DKA

Please do not give supplements of any kind -- at least not until you know what you are dealing with. Giving things like supplemental potassium could kill your cat. This is why electrolytes, such as potassium, are not in IV solutions. They are added ONLY as needed and are added very slowly. (Potassium, for example, is in balance with sodium. If you give too much of one, the other is effected. They will effect the nervous system and muscle contraction -- like in the heart muscle -- so you have to be very careful.) Many supplements are manufactured or packaged with little regard to product safety. In some cases, you have no idea what's in them. Recently, for example, freeze dried chicken treats from China that were being distributed for animals in the US were found to be contaminated. It's the same for many of the nutritional supplements -- not all of them are made by companies with good product safety regulations. Right now, don't give Tifil anything that could change her lab values.

Also, it's possible that the fluids your usual vet gave lowered Tifil's BG levels. In addition, some cat's BG numbers will go lower when they are stressed. I would print out a copy of your spreadsheet to bring with you if you are going back to the vet at the University. That way he can see what Tifil's numbers have looked like. You might also want to bring your meter so you can compare it with his results. Is he planning on running any lab tests? I would tell the vet that you have very close friends/family in the USA who work with feline diabetics a lot. Just don't tell him your friends are all on the internet!!

 

Re: TIFIL DKA

Dear Sienne, taht's a wonderful idea. I can tell him this

He is planning to take only two tests which I didn't understand what they are...
Bt the worst part is, he is not planning to give iv fluids, so I must go to my other vet to take it...


I am waiting for tıfıl to go to her litterbox to test for ketons...

Thank you for being there...

 

Re: TIFIL DKA

I hesitate to clutter up your condo with something that is not advice--I know you are trying to work through so much right now. But I just wanted to say that I am so angry at the vets you are dealing with--especially the one who was going to withhold fluids if you gave insulin. How could someone threaten to withhold lifesaving care just out of spite? Makes me so upset.

I guess what I am saying is, I really admire your perseverance and love for your kitty. I don't think I could do all that you have done. Bless you! And I hope Tifil is better soon.

 

Re: TIFIL DKA

If your vet is giving lactated ringers solution (LRS), it does have sodium and potassium in it; I double checked our bags. These, of course, would be in balance in the solutions. If he's giving Normosol, it also has potassium. Both fluids have potassium in the form of potassium chloride. Here is the info on what is in LRS:

Sienne is correct that you do not want to give any oral supplementation of potassium until we get a reliable reading for potassium and note that it is low (below "4" in US labs) and determine why it is low and if supplementation would be appropriate. As she said, you have to really be careful with the sodium/potassium balance.

 

Re: TIFIL DKA

If your vet is giving lactated ringers solution (LRS), it does have sodium and potassium in it; I double checked our bags. These, of course, would be in balance in the solutions. If he's giving Normosol, it also has potassium. Both fluids have potassium in the form of potassium chloride. Here is the info on what is in LRS:

Sienne is correct that you do not want to give any oral supplementation of potassium until we get a reliable reading for potassium and note that it is low (below "4" in US labs) and determine why it is low and if supplementation would be appropriate. As she said, you have to really be careful with the sodium/potassium balance.

 

Re: TIFIL DKA

Tomorrow I will look what kind of iv fluids they are giving...today they said that they are adding something inside with minerals and vitamins...

 

Re: TIFIL DKA

Watching and waiting. Dayan Işil'cik. :YMHUG:

 

Re: TIFIL DKA

♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥

 

Re: TIFIL DKA

She is sitting on front of the water again

Our 6th cycle has finished...
How much should I increase? 0.25 or 0.50?
She looks like she needs more insulin, should I go for 0.5?

 

Re: TIFIL DKA

I think if you change the 911 to a question mark icon, or put "Dose Question" after DKA in the subject line, more people will see your question-

 

Re: TIFIL DKA

How much time do you have before you have to give Tifil her dose? It appears none of the advisors are online.

 

Re: TIFIL DKA

if tifil was given fluids today you might want to hold off on an increase because as you've seen... fluids can sometimes lower BG numbers.

edited to add:
i'm basing my recommendation on the presumption that drop to 44 today *could* have been accurate.

 

Re: TIFIL DKA

It's 11.47 pm here, I will shoot at 10.00 am in the morning...

By the way tıfıl is 324 at +1...she is feeling terrible...
I feel terrible also, tomorrow I must find a way to test tıfıl's potassium...

 

Re: TIFIL DKA

The only way I know to have potassium tested is through blood work.

Also, did you get a ketone reading?

Please be aware that you can give too much fluid. This is called "hypervolemia." It can put a strain on the heart. Fluids are given for medically necessary reasons -- dehydration, ketosis, some kidney issues, etc. It's not something that is routinely done.

 

Re: TIFIL DKA

I waited for tıfıl to go to her litterbox, she didn't so I took her...and sorry to say +++keton
what am I going to do
I called my vet, he is still saying that it isn't important, he is saying wait till the morning...should I find a place to give ıv fluids now?

Should I give ıv fluids by myself???
what sgould I do?
she is not eating and she is feeling terrible

 

Re: TIFIL DKA

bump

 

Re: TIFIL DKA

Hold on; I've asked for help.

 

Re: TIFIL DKA

What were the ketone results, Isil?

 

Re: TIFIL DKA

I can find the iv fluid from pharmacy on duty...Tıfıl needs to flush these ketons and I don't have a emergency vet to go to...There are not much in Ankara...
Tıfıl started to lie on the floor (stone). Just like she did when she was first dka...
I feel terrible...

Does anybody know how much iv fluids that she has to get for one day?
If she takes the fluids in the vet, do I have to give more fluids during the night at home?

 

Re: TIFIL DKA

Re: TIFIL DKA
by ISIL&TIFIL » Wed Jan 04, 2012 2:44 am

I can find the iv fluid from pharmacy on duty...Tıfıl needs to flush these ketons and I don't have a emergency vet to go to...There are not much in Ankara...
Tıfıl started to lie on the floor (stone). Just like she did when she was first dka...
I feel terrible...

Does anybody know how much iv fluids that she has to get for one day?
If she takes the fluids in the vet, do I have to give more fluids during the night at home?

 

Re: TIFIL DKA

hang on - i'm looking for help for you.

 

Re: TIFIL DKA

I posted your emergency on the main board to see if someone will come over and help

 

Re: TIFIL DKA

+++ keton

 

Re: TIFIL DKA

It stands for 500mg/dl

 

Re: TIFIL DKA

Isil, is this test 15 seconds after putting the stick in the urine? My bottle of Keto-Diastix only goes to 160.

 

Re: TIFIL DKA

I have seen subcutaneous fluid doses from 50 ml each day for a 3.5 lb (about 1.5 kg) cat to 100 mL per day for an 8 lb (roughly 3.5-4 kg) cat.

It also may help to add some water to her food, maybe warm it up a bit so it smells good to eat.

 

Re: TIFIL DKA

Yes after 15 minutes....it's Bayer keto-diastix....

What am I going to do, should I give water from her mouth with a syringe?

 

Re: TIFIL DKA

Please do two things: First, check the expiration date on the bottle of Ketostix. Second, test yourself. It's the best way to know if the ketostix are registering properly.

If Tifil is registering large ketones, you cannot treat this at home. Is there an emergency clinic?

 

Re: TIFIL DKA

Those are the same ketones sticks I have. But, the stick is compared to the bottle chart after 15 seconds exactly.
Did you wait 15 minutes?

 

Re: TIFIL DKA

15 seconds, isil

 

Re: TIFIL DKA

Sorry ı wrote it wrong, yes I waited 15 seconds

The expiration date is 06/2013...they are new

 

Re: TIFIL DKA

Test yourself. Please.