Update 11/1 4:00 PM ET: Luna bouncing back from DKA

[For_Luna]

Luna was admitted this afternoon for DKA. She stopped eating late on Thursday 10/24. The morning was completely normal. By that night she was really lethargic. Took her to the ER and her blood work was normal except for slightly elevated bilirubin. Given anti-nausea injection and told to watch her.

Yesterday morning she still wasn't eating so we took her to our regular vet. Did x-ray of abdomen and said she was constipated and given miralax and appetite stimulant.

Late last night my wife (I was at a wedding for my family, she stayed back to watch Luna)took her to the ER again. She was really weak and still not eating. They gave her antibiotic more anti-nausea and did another x-ray.

When I got home early this afternoon she looked really bad. Immediately took her to the ER where they did blood and urine test again. DKA. BG was 304 before we left. All of this happened in about 36 hours.

I asked about DKA our first visit and they said the blood work and her BG in the 200s didn't indicate it. They said it could have been pancreatitis but again the tests didn't indicate that. They had us stop insulin because she wasn't eating..which probably made things worse.

When she gets home, we will be getting a meter that can test for ketones (urine not an option).

I'm mad that two vets didn't think to check for DKA in a diabetic cat that was in such a poor condition. I know her blood test was normal, but I feel like they should have checked out of caution. It's also our fault for not checking for ketones at home. I hope she'll be ok.

 

[Sue and Luci]

I'm so sorry to read this about Luna! I certainly hope she'll be ok! Sending strong healing vines for her speedy recovery!

 

[Tomlin]

Dan, I am so sorry to hear this happened but I am relieved to hear Luna is home .

Do you know if they did the SNAP fPL? Just making sure they did the appropriate test for pancreatitis. Once it’s done then it should be sent out for an actual value (that test is fPLI)
https://www.idexx.com/en/veterinary/snap-tests/snap-fpl-test/

FYI-One keto meter is the Abbott Precision Xtra. Doesn’t require a lot of blood.

Sending healing thoughts your way!!

 

[Idjit's mom]

Hoping for the best outcome for sweet Luna. So sorry to hear that she's so ill. There are many members here who have experience with DKA and you can review the info here on the board about DKA. Good idea about the ketone meter, so you can get immediate readings when she comes home.

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

 

[For_Luna]

Dan, I am so sorry to hear this happened but I am relieved to hear Luna is home .

Do you know if they did the SNAP fPL? Just making sure they did the appropriate test for pancreatitis. Once it’s done then it should be sent out for an actual value (that test is fPLI)
https://www.idexx.com/en/veterinary/snap-tests/snap-fpl-test/

FYI-One keto meter is the Abbott Precision Xtra. Doesn’t require a lot of blood.

Sending healing thoughts your way!!

She was just admitted a few hours ago. Sorry, I was rambling in my post.

I don't know about the pancreatitis specific test. I think they were basing everything on imaging and the regular blood work. I'll ask when we check in

 

[Tomlin]

She was just admitted a few hours ago. Sorry, I was rambling in my post.

I don't know about the pancreatitis specific test. I think they were basing everything on imaging and the regular blood work. I'll ask when we check in

Totally understandable Dan . It’s an upsetting situation!

Definitely ask for them to do the SNAP fPL which is a quick in office test to determine if Pancreatitis is probable-it’s a screening test. They then send it to IDEXX to run the actual Spec fPLI (if the SNAP is not normal) to determine the actual feline panreas specific lipase. While they are at it, they also have the option to ask for a full GI panel from the bloodwork. It’s being sent to IDEXX at TAMU, so may be worth just having them do a full panel while they are at it.

Again, sending thoughts & prayers your way

 

[Olive & Paula]

Sorry to hear Luna is so ill. It does come in rapidly. I have nova max ketone/glucose meter. Takes small drop can be temperamental. Ketone strips are pricey and you only get 10 in a box. Getting urine from Ollie is impossible. Meter is more accurate. Good luck, keep us posted.

 

[For_Luna]

Sorry to hear Luna is so ill. It does come in rapidly. I have nova max ketone/glucose meter. Takes small drop can be temperamental. Ketone strips are pricey and you only get 10 in a box. Getting urine from Ollie is impossible. Meter is more accurate. Good luck, keep us posted.

I don't mind the cost... especially considering what we paid for 3 ER visits and now hospitalization.

I'm looking at the keto mojo meter. Strips are about $50 for 50. The Abbott Precision Xtra isn't terrible either.

When we start testing, what can we do about ketones if we catch them? Just get her to the vet sooner?

 

[Olive & Paula]

I don't mind the cost... especially considering what we paid for 3 ER visits and now hospitalization.

I'm looking at the keto mojo meter. Strips are about $50 for 50. The Abbott Precision Xtra isn't terrible either.

When we start testing, what can we do about ketones if we catch them? Just get her to the vet sooner?

I believe if reading on meter is over 2.45 then seeing vet is in order. Some have treated at home but it's tricky and serious. The electrolyte balance is off and needs to be monitored 24/7. To try to prevent it is to make sure they keep eating, give insulin, and find if it's from an infection somewhere and or pancreatitis. Having appt stimulant at home, meds for first sign of nausea, possibly even subq fluids to start right away if ketone meter starts showing elevated levels before it reaches the 2.45

Maybe think about the TR dosing to get glucose lower faster. try to never miss insulin shot. Put DKA in your signature so everyone is aware it is an issue.

DKA is from not enough insulin, not eating, and infection/inflammation somewhere. Those are the 3 things you need to address and stay on top of.

 

[AmandaE]

Oh Dan, so sorry to hear about Luna's DKA, I am no help at all but I just wanted to let you know I am thinking of you and Luna and I am sending tons of healing vines for your dear girl.

I would find your vets really frustrating for not thinking of DKA as well.

Feel better soon Luna

 

[For_Luna]

Oh Dan, so sorry to hear about Luna's DKA, I am no help at all but I just wanted to let you know I am thinking of you and Luna and I am sending tons of healing vines for your dear girl.

I would find your vets really frustrating for not thinking of DKA as well.

Feel better soon Luna

Thank you. I even mentioned DKA because I read about it here. But because her numbers were in the 200s and her blood work was pretty normal, they thought it was unlikely.

We're getting a meter now and won't let this sneak up on us again

 

[For_Luna]

I believe if reading on meter is over 2.45 then seeing vet is in order. Some have treated at home but it's tricky and serious. The electrolyte balance is off and needs to be monitored 24/7. To try to prevent it is to make sure they keep eating, give insulin, and find if it's from an infection somewhere and or pancreatitis. Having appt stimulant at home, meds for first sign of nausea, possibly even subq fluids to start right away if ketone meter starts showing elevated levels before it reaches the 2.45

Maybe think about the TR dosing to get glucose lower faster. try to never miss insulin shot. Put DKA in your signature so everyone is aware it is an issue.

DKA is from not enough insulin, not eating, and infection/inflammation somewhere. Those are the 3 things you need to address and stay on top of.

Thanks for the info. We were following TR for the most part, though we were guilty of holding a dose for an extra day occasionally.

We showed our vet the spreadsheet and she was concerned with the up and down of Luna's numbers and is constantly changing the dose. She wants us to hold .75 for 2 weeks before adjusting. To be honest, what we're doing isn't working, so I'll try just about anything.

 

[Tomlin]

Thanks for the info. We were following TR for the most part, though we were guilty of holding a dose for an extra day occasionally.

We showed our vet the spreadsheet and she was concerned with the up and down of Luna's numbers and is constantly changing the dose. She wants us to hold .75 for 2 weeks before adjusting. To be honest, what we're doing isn't working, so I'll try just about anything.

Dan, I have watched you really work your you know what off trying to get Luna regulated. Right now you have your hands full, but maybe give some serious thought to making the trip to Ryan Hospital’s Diabetes Center at UPenn &/or dropping a call to the Cornell Feline Consult line to discuss your situation. You are fortunate that you are not too far from a leading specialized center. Just a thought given how hard it has been to regulate Luna & now the DKA

Again, my thoughts are with you & Luna

 

[For_Luna]

Dan, I have watched you really work your you know what off trying to get Luna regulated. Right now you have your hands full, but maybe give some serious thought to making the trip to Ryan Hospital’s Diabetes Center at UPenn &/or dropping a call to the Cornell Feline Consult line to discuss your situation. You are fortunate that you are not too far from a leading specialized center. Just a thought given how hard it has been to regulate Luna & now the DKA

Again, my thoughts are with you & Luna

We were just talking about that today. We'll probably give them a call once Luna is home and things settle down

 

[For_Luna]

Just spoke to the overnight tech. It's only been 4 or 5 hours, so not much happening yet. They're still trying to feed her and she hasn't gone to the bathroom yet. Her numbers are slowly coming down; 270s now, 300s when we left her. Hopefully we'll see some progress by tomorrow afternoon when we visit

 

[Bron and Sheba (GA)]

Dan I am so sorry this has happened.
I am very surprised that the vets said to stop the insulin when Luna was not eating and then when they gave an antibiotic yesterday,
That surely should have rung a bell for checking ketones. Ketones and DKA develop when there is not enough insulin, not enough food and an infection or inflammation present. So Luna had the perfect recipe .......and they didn't see it!
This is not your fault......you pay the vets for treatment.

Hopefully now Luna is on the mend. Please keep us updated and when she comes home we can help you with the care she will need until she has fully recovered.

 

[Tomlin]

That is great news Dan...:any progress is welcome!

Here is some contact info at Penn:

Rebecka S. Hess, DVM, MSCE, Dipl. ACVIM
Professor of Internal Medicine
Chief, Section of Medicine
Department of Clinical Sciences & Advanced Medicine
School of Veterinary Medicine, University of Pennsylvania
Voice mail: (215) 898-9427Pharmacy: (215) 898-7881
Appointment Desk: (215)-746-VETS Emergency Room215)-746-V911
Fax215) 573-6050. E-mail:rhess@upenn.edu

Dr Shea is collaborating with Dr Hess. I wouldn’t be afraid to drop an email to Dr Shea explaining your situation & inquiring about who will be available on clinics with respect to Diabetes specialization in the upcoming weeks/months. I believe they work their appts like some other universities where you are able to ask for specific vets clinical rotation time & then schedule the appt with the person you would like to see when they will be there. That is nice because there are some clinics where you don’t have the ability to do that—like at TAMU.

I hope you are able to get some sleep tonight & tomorrow is a much better day for Luna!

 

[Ti-Mousse (GA) Pepe (GA)]

So sorry for little Luna . Vets did not do a great job.... a good thing you're there Dan!
Keep posting ! We want good news of our Rocket Queen !

 

[For_Luna]

Do we need to tell them to syringe feed Luna or just let them follow their plan? It sounds like they're just putting food down and hoping she'll eat once she gets down to normal BG numbers. If not eating is part of what caused this, shouldn't they be getting food in her? I asked if they'll make her eat if she won't on her own, and they said that's for the doctor to decide.

Our regular vet had us start syringe feeding. This is a separate hospital.

Edit: my wife fed her 9ml at 1 PM today, so she had something. I'll bring it up when we go tomorrow.

 

[Sienne and Gabby (GA)]

I'm so sorry. DKA is nerve wracking. I went through it when Gabby was diagnosed. I suspect they caught it early if the initial bloodwork wasn't showing much of anything. Hopefully, the first set of labs they ran included electrolytes. Unfortunately, ketones can develop quickly. Please let us know if there's anything we can do.

You may need to ask if they have her on a dextrose drip. Again, I'm assuming they do. Usually, they have dextrose running and use a short acting insulin to hammer the BG numbers down. The dextrose tempers the action of the insulin (typically either Humulin N or R). The sugar solution is a form of nutrition but as you suspect, food is better. They are likely going to get Luna on something for nausea and an appetite stimulant.

 

[carfurby (GA)]

I'm so sorry. I hope Luna gets better quickly and will eat on her own soon. Sending prayers.

 

[For_Luna]

I'm so sorry. DKA is nerve wracking. I went through it when Gabby was diagnosed. I suspect they caught it early if the initial bloodwork wasn't showing much of anything. Hopefully, the first set of labs they ran included electrolytes. Unfortunately, ketones can develop quickly. Please let us know if there's anything we can do.

You may need to ask if they have her on a dextrose drip. Again, I'm assuming they do. Usually, they have dextrose running and use a short acting insulin to hammer the BG numbers down. The dextrose tempers the action of the insulin (typically either Humulin N or R). The sugar solution is a form of nutrition but as you suspect, food is better. They are likely going to get Luna on something for nausea and an appetite stimulant.

Ah, ok. They said she was on a fast acting insulin drip and I thought the vet mentioned glucose, but she could have said dextrose. Either way, I feel better that's at least some nutrition.

They mentioned electrolytes and potassium were normal the first test. And I think we got it early, but it could have been sooner if they tested again at the ER when we were there at 2 AM.

 

[Sienne and Gabby (GA)]

I absolutely agree that they should have been getting labs. (Personally, I'd having a stern talk with whoever is in charge of the clinic and asking them to adjust the bill.) It frosts me that many professionals assume that we don't know what we're talking about even when we're right..

They may use glucose or dextrose -- they are both simple sugars.

 

[For_Luna]

I absolutely agree that they should have been getting labs. (Personally, I'd having a stern talk with whoever is in charge of the clinic and asking them to adjust the bill.) It frosts me that many professionals assume that we don't know what we're talking about even when we're right..

They may use glucose or dextrose -- they are both simple sugars.

They got labs our first visit, but we were back less than 24 hours later. I think they assumed not much could have changed. There probably needs to be different thinking for diabetics

 

[Sienne and Gabby (GA)]

Not to belabor the point, none of us here are vets. WE know how quickly ketones develop. And trust me, if it was a human who had back to back ER visits, as soon as they get you in. a room, they draw blood for labs. It should be no different for our kitties.

 

[Crista & Ming]

I am so sorry this is happening, Dan. I am so disappointed and saddened to hear how things transpired for you, Luna, and the family in the last few days. You did everything in your power to help Luna. I agree with Sienne: the vets/practice you saw over the last few days need a stern talking to.

There was one time where a diabetic cat came in for inappetence and vomiting and we were attempting to get a urine sample but the kitty voided her bladder onto her towel and her bladder was empty. We desperately squeezed those droplets of pee out of that towel to try to get a ketone test and when that didn't work, we kept the kitty with us until she peed again. Her BG wasn't insanely high then but I'd be extremely disappointed in any vet if they didn't think to test for ketones with a diabetic patient that is not doing well.

In regards to the snapFPL vs specFPL. To save on cost, since Luna is already hospitalized, I'd go for the specFPL. She's most likely already getting treatment for pancreatitis and the spec test is much more accurate.

 

[Bellasmom]

Sending prayers for you all and Luna

 

[Figaro's Liz]

I am so sorry this is happening. I can't offer any help except moral support and shared outrage that it seems this could have been prevented had your vet been more tuned in. Thinking of you and Luna.

 

[Jerry dutchboy]

Oh poor little Luna and you as well. Thinking of you and healing vines being sent your way.

 

[Tina Marie (GA) and Jan]

Prayers for Luna and Dan and wife. Rooting hard for you Luna - we believe you'll get much better You have great people and support, even if you, Dan have to lead the way. Be strong and know you aren't alone . . .

 

[Tina and Salem]

Luna was admitted this afternoon for DKA. She stopped eating late on Thursday 10/24. The morning was completely normal. By that night she was really lethargic. Took her to the ER and her blood work was normal except for slightly elevated bilirubin. Given anti-nausea injection and told to watch her.

Yesterday morning she still wasn't eating so we took her to our regular vet. Did x-ray of abdomen and said she was constipated and given miralax and appetite stimulant.

Late last night my wife (I was at a wedding for my family, she stayed back to watch Luna)took her to the ER again. She was really weak and still not eating. They gave her antibiotic more anti-nausea and did another x-ray.

When I got home early this afternoon she looked really bad. Immediately took her to the ER where they did blood and urine test again. DKA. BG was 304 before we left. All of this happened in about 36 hours.

I asked about DKA our first visit and they said the blood work and her BG in the 200s didn't indicate it. They said it could have been pancreatitis but again the tests didn't indicate that. They had us stop insulin because she wasn't eating..which probably made things worse.

When she gets home, we will be getting a meter that can test for ketones (urine not an option).

I'm mad that two vets didn't think to check for DKA in a diabetic cat that was in such a poor condition. I know her blood test was normal, but I feel like they should have checked out of caution. It's also our fault for not checking for ketones at home. I hope she'll be ok.

 

[Tina and Salem]

I hope your baby will be ok i had to admit salem to for dka hes gradually getting better i havent been aware too to check the ketones i will be checking his ketones too for now on . There is so much involved with these diabetic cats . Im so grateful for DCIN is helping salem . Hope your baby gets better . Salem did the same as your baby very weak and largethic . Also be aware they get very dehydrated too salem was severly dehydrated .

 

[Pamela & Amethyst]

Prayers and love,light and healing

 

[Sandy and Black Kitty]

Sending healing vibes to your sweet Luna.

But because her numbers were in the 200s and her blood work was pretty normal, they thought it was unlikely.

We're getting a meter now and won't let this sneak up on us again

Testing is the first line of defense. Glad to hear you are getting a meter that checks for the presence of ketones. They were just coming onto the scene back in our day.
Lunas experience highlights the fact that BG doesn’t not need to be crazy high for ketones to develop.

 

[Suzanne Burton]

Your family is in my thoughts and prayers.

 

[LizzieInTexas]

Prayers for Luna.

 

[For_Luna]

Luna isn't doing well. Her BG is in the 180s, but the electrolyte and potassium supplementation isn't working. Both numbers came back low. They're afraid she won't make it through the night if the numbers don't improve. The next test is coming this hour, so we're waiting to hear.

We just visited and spent an hour with her. She was holding her head up some and looking around, but she could barely stand and walk. We brought her favorite blanket...not sure that helps but she got on it when we were there.

If she improves today, they're going to take a closer look at her abdomen when the specialist is there tomorrow.

 

[Tomlin]

Dan, many, many prayers for healing for Luna. Know that SO many are praying for her recovery. I’m sure it was helpful for her to see you & to get her favorite blanket to bring her comfort. Their blankets with familiar scents are very helpful especially in the hospital.

 

[carfurby (GA)]

Sending more prayers.

 

[AmandaE]

Max healing vines for sweet Luna, hang in there girl, you’ve got all of us sending healing vines and prayers your way

 

[For_Luna]

Just heard from the vet. Electrolytes and potassium are still dropping, but it's slowed down. Hopefully that means the supplements are close to the proper dose. They're increasing and also increasing insulin since she's back up to 240. She was 220 at 11AM, and that 180 was from earlier.

Next test is in 4 hours. We're probably going back to see her later before they switch to the overnight staff.

 

[Red & Rover (GA)]

So glad Luna has a familiar blanket. We are all fighting hard for her with our thoughts, vines, and prayers.

 

[MrWorfMen's Mom]

Keeping Luna in my thoughts and prayers and sending healing vines.

 

[For_Luna]

Picture from just last week.

It's sunny and the birds are outside her favorite window chirping. She likes days like today.

 

[Tina Marie (GA) and Jan]

electrolyte and potassium supplementation isn't working. Both numbers came back low. The next test is coming this hour, so we're waiting to hear.
We brought her favorite blanket...not sure that helps but she got on it when we were there.

We will be waiting (hopefully for any improvement) on next electrolyte and potassium test, and hoping for even better blood glucose with decreasing ketones. Fluids should be helping - sending more healing vines for little Luna - we love her through you.
Visiting her, and bringing her favorite blanket, are most definitely little extra ways to help Luna. Continued prayers and don't think the worst. Think of all the things that do help, that she is getting.

 

[Ti-Mousse (GA) Pepe (GA)]

Sending prayers for little Luna ! Waiting for the next hopefully good update!
Nice that she has her blanket.

 

[Dyana]

I'm glad she has her favorite blanket.
The visits to her, help.
Keep thinking positive thoughts.
Prayers for your Luna to make it through.

 

[J.J. and Phoebe Squeak]

Oh my gosh, Dan! My heart dropped on the floor as I was reading through this just now. I am SO sorry this is happening! I was just thinking of Luna today and wondering how she was before I read all this. I am sending tons of prayers, vines, support and comfort for you, your wife and your dear sweet, Luna. Please keep us posted and know that Team Luna is there for you.

 

[Amanda and a Loudogg]

Adding more healing vines to the pile Dan. You can never have enough. Many hugs for you and your wife.

 

[For_Luna]

Just heard from the vet. BG went up to 240s. Going to increase insulin if it gets over 250

Potassium and Chloride (?) values stopped falling and increased by .1 each. Potassium was 2.2 and I'm not sure what the other was. I didn't have pen/paper nearby.

She's no where close to being out of danger, but at least we're not falling anymore. Next electrolytes test is in 6hrs. The vet said we're already at a high but safe level of potassium, so she doesn't want to increase again yet.

If she's ok through the night, they want to do a more in depth scan to see if they can find what triggered this. I'll ask about the pancreatitis test tonight, but they seem to think something else is going on. After that we're going to discuss a feeding tube. She said they need to sedate, so she wants her electrolytes better before we consider.

We're going back soon to visit. They keep saying "if she makes it through the night"...I know I can't, but I want to stay with her in case things take a turn. A scary cage surrounded by strangers is not what I want for her in the end