Whitey has gone into severe ketoacidosis

Discussion in 'Feline Health - (Welcome & Main Forum)' started by ryanms3030, Feb 5, 2016.

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  1. ryanms3030

    ryanms3030 Member

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    It has been a while since I have posted. Life has been busy, we have a new baby at home, many good things but unfortunately our diabetic Whitey is not doing well right now. He is about 15 years old and we have been treating his diabetes for nearly 5 years with thanks to all of the incredible knowledge here. And seriously, the people here have been so much more valuable than any vet when it comes to expertise in this realm. He has been on Lantus since he was diagnosed and it's been a battle. He will be on 1 unit doses and ok and start to get higher readings and go up to 1.5 and then all of the sudden he would start dropping into the 40s +4,+5+6. Then we'd go back down and he'd start getting back to 400 and 500s at some points during the day. But I have done my best with diet and monitoring daily and trying to adjust doses here and there. As recently a 12 days ago he was dropping into the 100s and lower. But for the past 10 days he's been in the 300-500's pre shot and with the baby, work and everything else I haven't been able to get as many spot checks as I should.

    Last night he tried to jump up on the couch about 2 feet off the ground and didn't make it and bounced off onto the ground. This morning he vomited and wasn't eating. Tonight when we got home he was hiding in a cat house that he never goes in and when we got him out he could barely use his back legs or stand up. My wife is at the vet with him now and they said he is in severe ketoacidosis. Two days ago he seemed fine and active and suddenly we are here. The vet said he is critical but hopefully not too late. I just wanted to share mainly to get it off my chest to some people who understand
     
  2. Critter Mom

    Critter Mom Well-Known Member

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    Sending prayers and healing vibes so that Riley will pull through. :bighug:


    Mogs
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  3. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thank you. It will be $3000-5000 to try to save him. We certainly don't have that money to burn with the baby now but we aren't going to let him go. Thanks for the thoughts
     
  4. Critter Mom

    Critter Mom Well-Known Member

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    I feel for you. My own little is in a bit of a crisis right now (Saoirse). I'm glad that Whitey has such loving beans. One of the greatest lessons I've learned from my little ones is how unique and precious each living being is. I know exactly what you mean about the money. I've starved in order to get my girl help in the past. Wouldn't occur to me to do anything else if the situation called for it.

    Congratulations on your new baby, BTW. I wish your baby a long, happy, healthy and fortunate life.

    We're all here rooting for you. Be sure to post updates of how you're all getting on.
    :bighug:


    Mogs
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    Last edited: Feb 6, 2016
  5. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Sending lots of vines for your sweet Riley and prayers for a quick recovery!!

    Does your vet take Care Credit? It would let you pay it off over 6 months or more (depending on the deal they give you ...if you pay it off in time, it's 0% interest....higher if you don't)
     
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  6. Liz & IttyBit

    Liz & IttyBit Member

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    Praying your furboy pulls through and recovers quickly.
     
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  7. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    The hospital wanted to keep him for 3-4 days which would be $6000. We really can't afford so we are opting for plan B right now which is overnight stay with fluids, short acting insulin, monitoring for about $1800 and then pick him up and take him to his regular vet in the morning because it will be less expensive. They are saying his kidney is shrunk and he has a heart murmur and they are pushing for euthanasia if we can't pay for the full hospital visit. And of course they can't guarantee he will make it even if we pay $6000 for the full treatment. He's in grave condition We have been through so much with him. This is a difficult and painful night

    The vets at the hospital don't seem to be able to fully explain treatment options and possible outcomes which makes it so hard.
     
    Last edited: Feb 6, 2016
  8. Critter Mom

    Critter Mom Well-Known Member

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    @Meya14 - If you're online is there any advice you can give re treatment options?

    @ryanms3030 - Sending more prayers. :bighug::bighug::bighug:

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  9. Meya14

    Meya14 Well-Known Member

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    I think intensive care is the best solution but if that is absolutely not an option, they may be able to keep him for a day, use short acting, and subQ fluids to get him a little more stable. If you have the time to invest it's possible to do the intensive care at home. Have them check labs before he leaves for electrolytes. Have them teach you how to do subQ fluids and send you home with some. Get the high-cal recovery food like Iams max cal, or similar recovery food.

    Home care consists of:
    SubQ fluids per vet recommendation
    Syringe feeding every 1-2 hours, at least 1-5.5oz can/day
    Oral fluids once able to tolerate (can use plain pedialyte)
    Supplementation of potassium and other electrolytes based on labs.
    Nausea control - anti-nausea medication
    4-5+ times a day glucose checks.
    adjusting insulin to BS levels (goal is 150-200 - higher than normal for a "buffer")
    1-2X per day ketone checks.

    It sounds like you have what is called a brittle diabetic. That is a diabetic that actually needs more insulin for the metabolism, but when you give the increased dose, the BS tanks. This usually happens when there is an element of malnutrition. When feeding a very low carb diet, it's possible that due to their metabolism that they are malnourished. Other diseases can contribute as well (IBS, etc). One approach is to increase the carbs so you can balance out the swings. While your cat is in DKA let her eat ANYTHING even if it is high carb. You need to be able to give the insulin. Even if you gotta mix honey in the food in order to raise her BS so you can give insulin, you do it.

    I wouldn't worry about the kidneys/heart just yet. DKA can cause acute kidney injury from the dehydration, which can resolve once dehydration is improved. Both things she mentioned are symptoms of this.
     
  10. Critter Mom

    Critter Mom Well-Known Member

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    @Meya14 - Thank you so much. :bighug:


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  11. Critter Mom

    Critter Mom Well-Known Member

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    Prayers continuing for Whitey, and some :bighug::bighug: for the beans.


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    Last edited: Feb 6, 2016
  12. Dyana

    Dyana Well-Known Member

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    Praying for Whitey to make it through.

    My J.D. was a DKA survivor. It was expensive, but I thought not nearly as expensive as compared to a human having to be hospitalized which made me feel better. He lived 9 more years after his episode, and passed away at 20.
     
  13. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    @Meya14 Thanks so much for all the advice! We are picking him up in about an hour. We paid about $1800 for overnight stay last night to do fluids etc. We plan on taking him to his regular vet. Even the emergency vet said it would be cheaper if the regular vet can do the treatment. But knowing there is home treatment possibility is great. As luck may have it I just started a planned 2 week vacaction/staycation so I will be home for the next two weeks so we have time to do this kind of care at home

    Thanks everyone else for thoughts, prayers, kind works and hope
     
  14. Mogmom and Goofus

    Mogmom and Goofus Well-Known Member

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    I can't add anything to the care aspect of this situation, just wanted to let you know that I'm hoping Whitey will be ok. I can relate as I'm dealing with the possible loss (trying to give her more time to see what the new meds do but can't stand to watch her suffer) of one of my civies, Mouse, to chronic respiratory infection, laryngeal polyps and possible squamous cell cancer. :nailbiting: The cost is staggering and I just retired a month ago due to health problems. I guess we'll both due what we can and what we think is right for our babies. Best wishes for you and Whitey. :bighug:
     
  15. Critter Mom

    Critter Mom Well-Known Member

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    Checking in to see how Whitey and all of you are doing, and to send more prayers and healing thoughts. What serendipity that you'll be able to home nurse if you need to. :bighug:

    Be sure to let us know later how your little fella is doing.

    Mogs
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  16. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thanks everyone. Whitey is now at vet and staying all day. As of this morning he seemed to be much more alert and bs was 150 when he left hospital. He still isn't eating. We found another hospital that is much more affordable so he may go there tonight for another night of IC
     
  17. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Oct 18, 2015
    So happy you found more affordable care! Hugs & prayers :bighug:
     
  18. Dyana

    Dyana Well-Known Member

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    I'm glad you found a hospital that is less expensive. :bighug:
    This was back in 2006, but J.D. was hospitalized for 8 1/2 days at the University of Pennsylvania School of Veterinary Medicine and he was admitted in critical condition. He very slowly improved every day. His electrolytes were all off, and he had some anemia and had to have a couple transfusions. The total bill was about $4800, and that was with round the clock monitoring and the best of care.

    More vines being sent for Whitey. It's good he's more alert today.
     
  19. Critter Mom

    Critter Mom Well-Known Member

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    Very glad to hear that Whitey's improving. Also that you've found another option for IC.

    What are they doing for that? (If you search Meya's post history you might find some useful info there.)

    Sending more prayers and :bighug::bighug:.


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  20. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    The vet was trying to syringe feed him but said he still won't eat. We're on our way to pick him up from the vet and discuss next steps.
     
  21. Critter Mom

    Critter Mom Well-Known Member

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    I don't know enough about DKA to say whether or not it's possible to give appetite stimulant and anti-nausea meds. Ask the vet about whether it's possible to give any of these commonly-used meds:

    Cerenia for nausea (injectable - may get into system faster than ondansetron
    Generic ondansetron for nausea (NB: Zofran, the branded version, is insanely expensive - more than 10x the price of a generic in the UK. Ondansetron is a human med and an Rx can be filled at a regular pharmacy)
    Cyproheptadine for appetite stimulation

    Anti-nausea meds need to be given a little bit before the appy stimulant.

    If you're planning to home nurse, it might be worth enquiring whether a feeding tube is an option for a kitty with DKA, and if yes then get very comprehensive information on the risks involved (e.g. anaesthesia, infection). (NB: I have no idea if this is possible or even sensible. I'm just brainstorming on this one.)

    Also see:

    Persuading Your Cat to Eat

    Nausea Symptoms and Treatments



    Mogs
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  22. ryanms3030

    ryanms3030 Member

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    We just dropped him off at hospital number 2 for tonight. The vet there is suggesting that we might want to switch off Lantus and go to the faster acting insulin. Because his levels are hard to control on Lantus. Does anybody have an opinion on that? Obviously he's been on the fast acting for past two days in hospital and they have him constantly around 150 right now
     
  23. Critter Mom

    Critter Mom Well-Known Member

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    Might be worth also asking the question on the L&L board. A lot of Lantus users don't post on Feline Health and you might get additional input.

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  24. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

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    Just fyi -walgreens has lactated ringers 80$ a case (good price) if you need them ... many prayer to you and Whitey:bighug::bighug::bighug:
     
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  25. Squalliesmom

    Squalliesmom Well-Known Member

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    Jun 26, 2015
    Sending prayers and healing vines for Whitey! So glad you found a less expensive alternative for treating him. Please keep us posted on his progress! :bighug: :bighug: :bighug:
     
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  26. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    Because Lantus has a hard time pulling down higher numbers many of us with cats prone to developing ketones have experience using Humulin R or Novolin R (same insulin, but different brands of "Regular" insulin, fast-acting) as a bolus insulin (in addition to Lantus).

    Novolin R can be purchased at any Walmart without a prescription for around $25 a vial. Last time I checked, Humulin R was $95 a vial at my local pharmacy. If you go this route, PLEASE post in the Lantus & Levemir Insulin Support Group for help and guidance. Don't try it on your own! Using a bolus insulin such as R is a great tool to have in cases like this, but can be downright dangerous if not used properly. A tiny amount packs a big punch!





    Some links you might find helpful:


    Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

    Syringe/Assisted Feeding (Video and Tips)

    How to Give Subcutaneous Fluids (Video) --- Be sure to check out the info on BBraun DEHP free bags at the bottom of the post. An FDMB member explains how to cut the price of a case of bags to $31.80 ($2.65 a bag)!




    If you need help, don't hesitate to ask.
    Good luck!
    :bighug::bighug::bighug:


     
  27. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thank you and thanks for links. The vet actually recommend NPH which I guess is Humulin but maybe not same as Humulin R? I think we will stay with Lantus for now and try to monitor more. The hospital is going to switch him back to Lantus tonight. I have always been doing pre shot check and injection before feedings per info I had gotten here. But the vet at the current hospital is telling us even with Lantus to feed him first, wait a while and make sure he doesn't vomit then check his blood and then give Lantus. He also said not to shoot if he's below 150. That seems to be in line with some info here although I usually was using 100 and have gotten to the point where I would shoot if he's around 80 if I had enough data for the day to believe he was on the way up. If I shoot below 100 I always check every hour for 3 hours at least. But I hate to have to skip a shot because that always seems to guarantee a major yo yo effect for a couple of days.

    Thanks everyone. He is in good hands and we plan on taking him home tomorrow night
     
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  28. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    Humulin is Eli Lilly's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two.
    Novolin is Novo Nordisk's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two.
    Novo Nordisk's Novolin insulin is typically less expensive that Eli Lilly's Humilin
    Walmart also the same insulin under there house brand of Relion and it less expensive than Humulin and Novolin

    I have used R for special situations but more frequently use N/NPH. Since your vet recommended NPH I would go with that and get the N/NPH fro Walmart.
     
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  29. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    So sorry to hear about Whitey's DKA.
    Sending prayers that he will very soon be well again.

    Huge (((HUGS))) to you and your family, and gentle head scritches to Whitey. :bighug::bighug::bighug:

    Eliz
     
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  30. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    Because your cat is not eating, its artificially lowering his BS. In DKA, even if the blood sugar is lower, the body still needs the insulin (and food) to convert the metabolism away from producing ketones. So the best approach is to use higher carb foods to "steer" the blood sugar above 200s in order to be able to give the doses. You may need higher doeses as she starts to eat on her own when you are using higher carb food. That is ok. -**Do whatever it takes so you don't have to skip insulin**-, even if this means feeding her straight honey every hour or mixing it in her food to syringe. Target BS at this point is >150 but less than renal thresh hold (about 200-250?) so you have some wiggle room.
     
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  31. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    See how it goes. You can incorporate the use of Novolin R at any time if Lantus alone isn't doing the job.


    Your vet's recommendation to go with NPH is also a good one given the circumstances. N/NPH can be doses more frequently than Lantus. Again, you'll have to see how things go.

    Meya14 offers some excellent advice!

    Update when you can. Let us know how we can help.
    Good luck!

     
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  32. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thanks for all the thoughts and info everyone. We just talked to the vet at the hospital. They started him back on Lantus today and his blood sugar was 450. He has eaten a little bit of baby food but they said he hasn't had enough food to raise his blood sugar that much. Blood work also shows he has pancreitis.
     
  33. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Poor Whitey. :(

    I don't know how concurrent DKA and pancreatitis should be managed. Perhaps other members can chime in on that.

    Solely with regard to pancreatitis, when Saoirse was at her most inappetent she got a Cerenia injection and a B12 injection (cyanocobalamin) plus an appetite stimulant. It helped her to start eating a bit within a few hours (but obviously she didn't have the DKA imbalances in the mix). The B12 really seemed to help her.

    For information, here are the IDEXX pancreatitis treatment guidelines. Again, not sure whether any of these treatments can be used when DKA is present. Sorry I can't be of more help.

    Are they assist feeding or leaving Riley to eat from a dish? If it's a dish, ask them to raise it a few inches when presenting it to him (can help a lot when a kitty is nauseated). Feeding very small, very frequent micro meals can help a lot for the pancreatitis side of things.

    Sending more prayers for Riley. :bighug:


    Mogs
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  34. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013

    Thanks. They have been feeding baby food with a syringe. They are trying to leave food for him to eat on his own. They said he's smelling and showing interest but not eating on his own yet
     
  35. Critter Mom

    Critter Mom Well-Known Member

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    That's really encouraging - he's getting some appetite back. If they could leave the food dish propped up on a couple of books or something similar in the cubicle with him it could help him a little if he tries to eat under his own steam. Pancreatitis can make a kitty really nauseated. I hope that they may be able to give him something to help with the nausea. If they manage to keep at least a little food in his tum it will be a help against tummy acid build-up.

    Sending more prayers. :bighug:

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  36. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    When Max had DKA, I used dry kibble and placed it in some warm water so it turned into a mushy soup. He was able to lap it up, and it provided some extra calories/carbs/fluids.

    Are you doing subQ fluids at home? The dehydration can weaken them and fluids can help them have more energy to eat.

    Do you have an anti nausea?

    Did your vet check labs including a potassium level?

    For fluids, consider getting plain pedialyte instead of syringing water. This will help replace some of the electrolyes that are lost in DKA. You may have to get potassium tabs from the vet as well if he is low. Low potassium is deadly, and very common in DKA, please ask about it.
     
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  37. CarolandTigger

    CarolandTigger Member

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    Apr 14, 2015
    I'm so sorry to read about your kitty. Wanted to let you know that we are dealing with the exact same thing right now, as of today! Tigger was fine the other day, then wouldn't eat yesterday and threw up. Tried to hide too. Just not him! Took him to the emergency vet this a.m. Where he will stay the night. $1800...so far Could be looking at more, depending. She said he has promise...he wasn't terribly bad, and we may have caught it in time. I'm hoping!! Now I'm dreading the phone ringing.minthought we were doing ok with him..he's been diabetic since last April. His numbers appeared to be coming down, and I wasn't getting that "ketones?" Message on the monitor, so I was stunned when she said it was DKA.
    Hope Whitey continues to improve!!
     
  38. Meya14

    Meya14 Well-Known Member

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    Sorry to hear that your kitty is sick too.

    The "ketones" indicator on home meters is just a warning for human diabetics to check their ketones, the home meters are not actually testing for ketones. This is a very confusing message that most home meters have. In cats (and humans), ketones and DKA can happen at any blood sugar levels depending on the cause, so it's very important to test urine or buy a meter that does actually test for ketones. This is especially true for cats who've already had an episode.

    After DKA resolves, most kitties are no worse for the wear. There are many DKA survivors on this board, including my kitty Max. Getting through that critical period is the hardest part.
     
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  39. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Sorry to hear about Tigger too. I'm sending him good vibes too. These things are so difficult
     
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  40. Critter Mom

    Critter Mom Well-Known Member

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    @CarolandTigger -

    I'm very sorry to hear Tigger is in hospital, Carol. Sending prayers and wishes for a speedy recovery. :bighug:


    Mogs
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  41. Critter Mom

    Critter Mom Well-Known Member

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    I was wondering about whether or not anti-nausea and appy stimulant meds might be contraindicated in cats with DKA, Meya. Is it OK to give anti-nausea and appetite stimulants to cats with DKA? If yes, which ones are suitable? (Trying to learn so I might be able to help a bit more in future.)


    Mogs
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  42. Meya14

    Meya14 Well-Known Member

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    Anti-nausea are very helpful in DKA to help the cat start eating again, and that's usually the first sign of recovery once they start eating. The appetite stimulants usually take 1-3 weeks to work (they work on the serotonin/norepinephrine and histamine systems) and therefore they aren't as useful in DKA unless there was an underlying appetite issue that led to the DKA.
     
    Last edited: Feb 7, 2016
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  43. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Whitey is back home relaxing. They gave us appetite stimulant. They said his potassium levels looked good. They put him on 1 unit of Lantus now. They told us to give the appetite stimulant wait 30 min and test BG and then feed him then give him his shot 15 minutes after he eats. And they told us not to give you shot if he's below 150. His shot timing is about 2 hours later than normal but luckily I'm on vacation for 2 weeks so we can slowly bring it down maybe 15 minutes per day to get back on schedule but we will stay on this schedule for a few days
     

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  44. Liz & IttyBit

    Liz & IttyBit Member

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    Dec 16, 2015
    Happy to hear Whitey is home. Poor little guy, that face says it all.
    I'm sure he's feeling better now that he's back home.
    Wishing him a quick recovery.
     
  45. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Welcome home, Whitey! :bighug:

    I'm so glad you posted his picture. :)

    @Meya14 - Thank you for telling us about the suitability and usefulness of anti-nausea and appy stimulant meds in cases of DKA. That's a great help, and much appreciated.

    @ryanms3030 - If Whitey doesn't start eating straight away at home go back to the vets immediately and insist on an anti-nausea med. Certainly in cases where pancreatitis is in the mix it's the nausea that's the main problem. The appetite stimulation may be necessary for a while but nausea management is the key to successful treatment.

    Fingers and paws crossed that Whitey will eat well.


    Mogs
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  46. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    I'e been trying to check Whitey's BG every couple of hours since he's been home. I've got 6 tests and he's been 291-410 and most in the upper 300's That is on 1 unit of Lantus and not much food. We had to force feed him a little last night but this morning he's looking for food. But vet said no feeding in between meals and next meal/shot is 3 hours away. He is alert and walking around, cleaning himself, going over to food bowls etc this morning and he was able to jump onto the couch on his own so these are all good signs to me.

    My question is for Lantus should I stick with 1 unit (vet recommended) or maybe bump to 1.5 for his next shot. I will be around all day with him and know how to handle if he drops low. But seems like he is staying around 400 all day with 1 unit and very little food
     
  47. Meya14

    Meya14 Well-Known Member

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    Bump up to 1.5, and PLEASE feed every 1-2 hours a small amount if you are syringing. Allow him to eat as much as he wants if he's eating on his own. If you are able to test and intervene if your cat goes lower, there is NO reason to only feed twice in the day. Feeding only 2x per day prevents the cat from getting enough calories and will definitely make the DKA worse. Also, if you are feeding baby food, it doesn't really have enough calories. Consider asking your vet about a high-calorie food (IAMS max cal, royal canin recovery) or feed an over-the counter food with 200+ cals per can (most wellness brand foods are high cal).
     
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  48. Meya14

    Meya14 Well-Known Member

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    Lots of food and enough insulin are the cure for DKA.
     
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  49. Meya14

    Meya14 Well-Known Member

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    Also, is it possible for you to check the ketones at home. Most pharmacies sell the ketone urine strips in the diabetes section. Place a little bowl or something under him when he's using the box and test. This will give you a baseline and tell you if he's improving or getting worse. Its hard to tell from the BS alone if the ketones are getting better or worse.
     
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  50. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    @Meya14 Thanks so much for all of your ongoing advice! The vet gave us a few cans of recovery food. I just gave him some and he ate a few mouthfuls on his own but not much. He is drinking water. I have ketone strips and just tested him and it showed Small/15 range so I'm guessing that is pretty good sign.
    I am going to up his next shot to 1.5 units. Do you think some dry food for a couple of days is worth it at this point because I am pretty sure he'll eat all that I give him of that? Or just keep with the canned recovery food and force feed that if needed? One of us will be here with him at all times for the next few days so we will constantly monitor BG and ketones
     
  51. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    yes, if he'll eat the dry food, then it's ok to give. Just keep an eye on the BS and water intake. When max was sick I was adding a little water even to the dry food to make a mush so he stayed hydrated. You'll probably have to increase insulin with feeding dry. That's OK. Once he's free of ketones for 2 weeks and everything seems back to normal, you can slowly transition back to lowcarb and reduce insulin. Cats can and do backslide at times, so keep a watchful eye. Small ketones is a great sign, so is the interest in food!
     
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  52. Nicole & Baby

    Nicole & Baby Well-Known Member

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    Dec 28, 2009
    Seeing your thread .. hugs & hopefulness for Whitney, thank you for being such great FURparents to your FURbaby!! :bighug:
     
  53. CarolandTigger

    CarolandTigger Member

    Joined:
    Apr 14, 2015
    So glad Whitey is better! I'm following your replies because my Tigger is being treated for the same thing, and hopefully can come home today. Hoping Whitey continues to improve!
     
  54. Jeanne & Dottie

    Jeanne & Dottie Member

    Joined:
    Jan 9, 2016
    My goodness, I hope Whitey gets through this! He's had a rough road.

    The more I see of chronic conditions like Diabetes, the more I begin to respect the idea of nailing insurance for pets before they become ill. Some of the billing amounts you have related, are staggering. Folks with beloved pets are caught between a rock and a hard place.
     
  55. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @ryanms3030 - Well worth investing in a blood ketone meter going forward: it can alert you to problem levels of ketones earlier than urine test strips (I think by perhaps a couple of days but you'd need to confirm that with someone more knowledgeable).

    Very good to read of Whitey's progress.

    :bighug:


    Mogs
    .
     
  56. Liz & IttyBit

    Liz & IttyBit Member

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    Dec 16, 2015
    Great news that Whitey is wanting food and eating on his own. Keep it up little guy!
     
  57. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    We upped his dose to 1.5. I just tested +2 hours and he's at 594! I've never seen him that high. We syringe fed about 6 syringes full of recovery food around the time of his shot but that's the most he's eaten in days. I know Lantus should just be starting to kick in but it doesn't give me much hope that he's going to get to even a safe level today
     
  58. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Saoirse's insured to the hilt with the exception of urinary tract issues (pre-existing condition) and I'm so thankful. There have been times when I was living on subsistence level income and I knew I'd never be able to afford treatment for her were she not to be insured so apart from the stuff essential to survival (I need to actually be here to look after her) her insurance was the first thing I budgeted for every month.

    Is it tough getting pet insurance in the States?



    Mogs
    .
     
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  59. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I think it might be a good idea for you to follow @Jill & Alex (GA)'s recommendation to post for assistance with dosing on the L&L ISG board.


    Mogs
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  60. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    He's eating more, and also, the dehydration that goes along with DKA can contribute significantly to the higher numbers. Try syringing 30ml or so of water and retest in about 40 minutes. If that helps a little, you probably need to increase the water intake. Be aware that on the L&L board, the increases for lantus happen every 3 days, and that is going to be too long of an interval to wait for an increase in DKA. You should be looking at 2-4 shots (1-2 days) at a dose and then re-evaluate if you need to increase. The increases need to happen a lot faster.

    Cats in DKA can need quite a bit more insulin than they were previously on, but monitoring close for hypos is very important as well.
     
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  61. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thanks. I'll shoot 1.5 tonight and continue monitor and think about 2 unit tommorow. I posted on Lantus forum too with back story. I realize he's still critical and cant wait 3 days to increase
     
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  62. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    Also, if the numbers continue to be >300, you may want to call your vet and ask them to show you how to do subQ fluids at home, or at least take him in to get some fluids. They take about 10 minutes to do in office, and shouldn't be very expensive. The high #'s can be from dehydration and they can also cause dehydration. It's a vicious cycle, and sometimes a day or two of subQ help to break the cycle. Be aware, when he does get fluids, you should monitor carefully, BS can drop a lot with them.
     
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  63. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Yin and Yang!

    What a beautiful picture. :)

    .
     
  64. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thanks. That was a magical moment to catch those two in the perfect yin yang
     
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  65. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    To update Whitey's first day home. I gave him 1.5 unit Lantus this morning up from 1.0 he's been on. He has mostly stayed over 500 all day ( 594 +2, 525 +3, 547 +4, 510 +5, 426 +6, 566 +7). We did decide to give him some dry food (Instinct grain free) in hopes to get him eating. The good news is has little by little been eating on his own and seems more alert and energetic right now. He's looking when we call him and walking over to us as opposed to last night and this morning where he was mostly sitting around staring at the ground. We have put out dry food with water mixed in, wet food, high cal wet food and some meat baby food for him to graze as he wants. He's mostly eating dry which I am sure isn't helping the BG levels but at least he is eating more and more and eating on his own without appetite stimulants so at least that all seems like a good sign. He is also drinking water on his own.

    I plan on giving him 1.5 unit tonight and letting him have access to dry food. Maybe try to cut out the dry food tomorrow and see if he'll eat wet food. And need to figure out if I should go up to 2.0 units tomorrow if he's still in the 400-500s after tonight's shot
     
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  66. Jeanne & Dottie

    Jeanne & Dottie Member

    Joined:
    Jan 9, 2016
    Insurance for kitties can be expensive, but considering the costs once a cat becomes ill, makes it hurt a little less. Right now we don't have Dottie or Gizmo on insurance, because they were so doggone healthy. Now I wish I had..it would be like stuffing money in a savings account in order to be prepared for the worst.

    The catch to putting money in a savings account is a double-edged sword. If your cat falls ill when you recently, (within a year or two) started the account, there's not enough money to make it really worthwhile and you have to start saving all over again.

    But for an older cat? I should have seen this coming...but years ago, when I had many cats..it was also uncommon for vets in our area to even offer much more than basic care, and a few options for surgical procedures. Folks just felt it was out of their reach to do much. If a cat had an accident, and the surgery cost more than $1500 dollars, it meant for most people that the cat was routinely euthanized unless they had the money in the bank.

    The whole mindset is changing in regards to pets, these days. More people not having kids, and they shower their attention on their pets. It's just taken a while for logic to catch up with their hearts. We have money for insurance for family..and cats have now become family in every sense of the word.

    I'm curious about insurance in the U.K., Mogs. Here, the costs average anywhere from 28 dollars to 47 dollars a month. That's not bad, considering the cost of procedures offered for pets these days. Even a 'light' policy that doesn't cover everything can dig you out of a hole.

    Here's some comparisons

    Sorry I forgot to put in the link..it's ok now
     
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  67. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Sending more prayers for Whitey.

    :bighug::bighug::bighug::bighug:
     
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  68. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    @Meya14 Would like opinion on whether I should raise Whitey's Lantus dose again today. Yesterday went from 1.0 to 1.5. First cycle nadkr was 426 and mostly in 500's and I checked almost every hour. 2nd cycle he was 390 +4 and low 400s other tests.
    He has been eating on his own since I've starting giving some dry food. It has been about 18 hours that he has had access to dry food and he has been regularly eating and drinking water on his own during that period.

    Should I go up to 2.0 units considering he still needs to come down a lot or stick with 1.5 since the second cycle was lower then first? Thanks!
     
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  69. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    Because of DKA I would increase. I would go to 1 3/4 unit
     
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  70. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thanks.
     
  71. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Just tested ketone with urine strip and looks like it's negative now! I know urine is not as accurate as blood so won't get too excited. But he's eating on his own without the appetite stimulant and energy and behavior seem to be back closer to normal. BG still very high though
     
  72. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    we talked to the vet and they recommended doing 2 unit this morning based on numbers and diet right now so that's what we did and watching
     
  73. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Vets are not used to dose adjustments in 1/4 units like we use here.

    Yay for negative ketones!!! Keep them away, Whitey :cat:
     
  74. ryanms3030

    ryanms3030 Member

    Joined:
    Jan 22, 2013
    just to updated. Gave 2 units this morning and +6 he's 299. Not great but much better than yesterday. Hopefully he'll come down more on the next cycle.
     
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  75. Jeanne & Dottie

    Jeanne & Dottie Member

    Joined:
    Jan 9, 2016
    At least he's going in the right direction.:bighug: Give him lots of love and scritches.
     
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  76. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

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    Oct 11, 2015
    prayers...:bighug::bighug::bighug:
     
  77. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    Your goal at this point is anything below 250ish and no ketones. If you are under 250, you can hold the dose for 3 days, then increase again based on the numbers if needed. You don't want too "tight" of control just yet so you have some buffer against hypos. Once you have no ketones and no symptoms for 2 weeks, you can tighten things up and adjust feeding as well.

    Since you have no ketones today, I'd hold the same dose through tomorrow and see where you are at tomorrow.
     
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  78. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Awesome, thanks for all the help! I will give 2 unit tonight. And you suggest even if he stays above 250 after tonight shot to keep him at 2 unit tommorow?

    Also he's only interested in the dry food right now but at least he is interested and eating and drinking plenty of water. I was thinking maybe one more day of dry and then at least try to get him back on wet but are you saying wait 2 weeks before worrying about that?
     
  79. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    I'd hold the 2 units through tonight and tomorrow. The drop from yesterday to today was looking pretty good, and lantus can pull down the numbers even more the next day or two, so if you hold numbers will probably in the good range tomorrow at 2u. Don't worry about the dry food until he's good and clear of ketones, sometimes, if you pull out the carbs too fast, the cat backslides because the appetite isn't 100% yet. Once you do adjust the food, you are probably going to need less insulin too. At this point it's better to focus on good appetite, no ketones, and no symptoms.

    So, lets talk about what led up to your cat's DKA, because it's good to identify the triggers. In the past, I've seen 3 major triggers that seem to be the precipitating factors:

    1. Acute infection - sometimes there is an infection or illness, and this is the only factor. Sometimes DKA happens for reasons other than infection.

    2. Cat is chronically underfed or malnourished - We want our cats on the lowest carb diet we can find and to get the diabetes under control, however, sometimes, it's very easy to accidently underfeed a cat, which leads to fat breakdown, which leads to DKA. If your cat is on the thin side or losing weight, there is a possibility they are not getting enough food overall. Remember, lower carb food is often lower calorie food as well, so they need more of it. In addition to underfeeding, cats can be malnourished for a variety of other reasons - appetite issues, CKD, heart failure, irritable bowel, pancreatitis, etc. Check your cat's weight and body type regularly: http://www.petmd.com/sites/default/files/nestle_purina_cat_body_condition_chart_crop.jpg

    3. Skipping insulin - Vets often advise to hold insulin if appetite is poor. If blood sugars are not low, AND the caregiver is knowledgeable enough to catch and treat low numbers, the advice to hold is not great advice. Often, it's better to shoot a reduced dose, and monitor. Withholding insulin for a diabetic is akin to withholding air for everyone else. A diabetic's body cannot function properly without insulin, as is has many other functions besides lowering blood sugar. Skipping insulin, even for a couple days can be the trigger for DKA.
     
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  80. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thank you. The vet thinks he may have UTI that triggered it but I'm not sure if they tested or speculated. My wife dealt with the vet more so we need to clarify. He was 6.5 lbs when he was admitted to the hospital. He was 10 lbs in his prime before diabetes but since being on all wet low carb diet he has normally been around 7.5. I do agree he may be under fed. He has two cat siblings and they are fed together and let's say one of them is a pig and eats faster and more than the others so we need to find a way to deal with that even if it's locking her in the bathroom while Whitey and the other cat eat.

    The only time I skip insulin is if he's under 80 pre shot because I find even when he's 80-100 he may drop to 40s after a shot and then I need to give him high carb emergency food to get up and that causes a yoyo effect for a few days...but skipping causes yoyo too. So I'll try reduced dose if we get back to that situation. I also feel like he may have other underlying issues. We think he's 15 but may be older as he was rescued off the street as an adult and we've had him for 10 years. He's been diabetic for 5 years and I know that even with perfect care it's doing damage to his organs over time. I think we need to address diet and getting him fed more.
     
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  81. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Checking back in with a quick update today. I just gave him his evening shot. Second day on 2.0 units. Unfortunately I didn't get any tests in the +4 to +8 last night so data is not great. +6 would be 3:30am right now. Not a big deal to get up except we have our 8 month old baby sleeping in our room and I can't set any alarms that could wake her or I have another set of problems on my hands. +3 last night he was 223 and +9 326 so I'm thinking he probably got down to 100's and today he's been in 400's all day but seems to be going down as he was 322 before his shot. I'm going to make sure to wake up around 3am and test him tonight to make sure he's not dropping too low.

    Good news is ketone urine strip showed no/trace ketones again today. He is eating on his own (dry food only) and drinking water and overall seems to be in much better spirits. He's getting up and coming over to us when we come into the room and even purring when we sit with him.

    We are cautiously optimistic. Now starting to think about having to break him off dry food again which wasn't easy the first time. And even better all three cats are refusing the wet food now and only eating the dry. We bought Instinct Ultimate Protein which is at least grain free but I'm sure carbs are still pretty high. I really don't understand what it is with kibble that makes cats want to eat is so badly since it's not part of the natural diet. I guess grains, cereals and bread aren't part of our natural diet either but we've been conditioned over enough centuries to crave them. For now I'm just hoping he keeps going in the right direction.
     
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  82. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    My former kibble addicts go nuts over any of the wellness canned foods, especially the ones with the sliced meat chunks in it. And it's higher calorie, which is good for my old lady cat who has weight loss issues.
     
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  83. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Today is Whitey's 4th full day at home after being in hospital for 3 days. This is 3rd day at 2 units of Lantus. He was 360 AMPS and dipped to 160 +5, 125 +6, 130 +7 and back up to 378 PMPS. Previous cycle was similar but he started a little lower around 320 PMPS last night. I tested ketones about an hour ago and showed negative on urine strip. Still exclusively on dry food but eating and drinking throughout the day on his own, we haven't been giving any appetite stimulants. His attitude seems to be back to normal. He is acting like his normal relaxed, lazy self. Lots of lounging around but laying in the sun and by the window instead of hiding in the kitty igloo. He's also coming up to us and curling up next to us on the couch and looking for and doling out affection on us, the baby and his kitty siblings.
     
  84. CarolandTigger

    CarolandTigger Member

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    Apr 14, 2015
    Sounds like he's doing much better! As you know, we're in the same boat Question: is it hard to test for ketones? And what if there are any present? Does this mean another trip to the vet? $$$$$$!!!!! I'm worried sick that this will happen again. Scary thought!
     
  85. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    Sounds great! It takes about 2 weeks of being back to normal before they are really out of the woods. In that time, try to identify the cause(s) and formulate a plan to prevent it from happening in the future. Testing ketones as soon as anything seems out of the ordinary should be #1 on the list. If caught right away, you can really avoid the expensive vet bills.
     
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  86. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    @Meya14 after BG readings getting a little lower over the past couple of days he was up to 581 AMPS today. I stayed with 2 units for this morning but should we think about going up again? Including today he's been on 2 units for the past 7 shots
     
  87. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    I would try increasing the fluid intake if you can and watch the sugars if that helps them go down. If he doesn't go lower than 250ish during the day and hang out there for a while, I'd increase to 2.25U.
     
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  88. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    Still no ketones?
     
  89. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    @Meya14 thanks again. Still no ketones as of this morning. Urine stick showed negative. Just tested +7 and hes 174 so came down quite a bit. I'll do 2 units again and hope he is getting a little more even. The other thing is we are trying to change his shot time. At the hospital they were doing 10am and 10pm and we need the get back to 8 and 8. Luckily we have 9 more days. I've been going back 15 minutes every 4th shot for now.
     
  90. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    Looking at your numbers today and yesterday, you are probably safe bumping it up to 2.25U as long as the appetite is the same or better.
     
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  91. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thanks. I already did his evening shot before reading this. He was 545. Still eating and drinking. I think appetite is better which might account for higher readings. I will plan on doing 2.25 tomorrow morning. He's gotten down below 200 a few times but then keeps getting back to the 500s
     
  92. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Carol,

    There are two types of test that you can do for ketones at home: urine, and blood. Urine is tested with reagent strips (e.g. Keto-stix) and blood is tested with a ketone meter in the same way as you'd test blood glucose. Of the two methods, blood ketone monitoring is superior in that it allows for earlier detection of ketone increases. From my reading here I understand that a blood ketone test can alert you to concerning levels of ketones days earlier than a urine test.

    Another advantage of monitoring blood ketones is that it can be done 'on demand'; no need to wait to catch a urine sample. I bought a ketone meter for Saoirse and it is a godsend for us right now while she's convalescing - especially when she wouldn't eat for me (and also with me being so exhausted). Saoirse's not stressed by having to use non-absorbent litter (doesn't like it) and it makes this aspect of her nursing care much easier for her tired mama. Win-win!

    The ketone meter test strips are pricey but more than worth it; doubly so for kitties with a history of throwing ketones.


    Mogs
    .
     
  93. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @ryanms3030 -

    Really glad to read such encouraging updates about Whitey! :)


    Mogs
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  94. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    @Meya14 decided to stick with 2 units this morning. He was at 222 which is first time first time he's been below 300 before shot since he's been home. Also seems to be dropping still from last night so figured increase is not needed or a good idea.
     
  95. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    Probably a good idea, you can see where he's at starting in the 200s. As long as there are still no ketones, you're good.
     
  96. ryanms3030

    ryanms3030 Member

    Joined:
    Jan 22, 2013
    Whitey has now been home from the hospital for over a week now. He is still on 2 units of Lantus and eating dry food exclusively. He still has no ketones in his urine which is good. But BG is still all over the place. He seems to be mostly in the 300's but was just 456 before evening shot and as high as 585 yesterday. But two nights ago I tested him at 80 +4. Unfortunately I missed the +6 but it's certainly possible he was in the 50's or lower and the 585 was the next morning before his shot so he could be bouncing really low and high. I didn't want to increase his dose yet since he may have gone low the other night. I would really like to get him off the dry food again but he has no interest in eating anything else so I will let it go one more week and then if all is well try to cut him back to wet food and probably lower the Lantus
     
  97. Meya14

    Meya14 Well-Known Member

    Joined:
    Jan 2, 2015
    What kind of wet food were you feeding prior to the DKA? It's very important that when you transition that he is taking in enough calories from the food, as that may have been a contributing factor. Most cats need from 200-300 calories a day depending on their size and activity. This is about 1.5-2 large cans per cat. Diabetics also need more than average too. I think if you want to start transitioning back to wet, that's fine. Watch carefully for hypos. Reduce by 0.25 if BS goes into the 50s. Reduce by 0.5 if below the 50s.

    Don't skip shots. You may find that you can transition to wet, and then feed dry "snacks" to even out those swings. Having large swings like that is called "brittle diabetes". Really, these cats need -more- insulin to flatten out the higher numbers, but they can drop a little too much at the nadir. What we do in people when this happens is adjust meals - we feed low carbs at shot times, and about 1-2 hours before nadir, we will feed them and increased carb meal. Most "brittle diabetics" have some amount of malnutrition or liver disease, at least in people.
     
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  98. Kitty mom

    Kitty mom Member

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    Nov 2, 2014
    Sending love and prayers to Whitney
     
  99. ryanms3030

    ryanms3030 Member

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    Jan 22, 2013
    Thanks. He was originally on Fancy Feast but we switched to Friskies pate once we had 3 cats and it was getting too expensive. Generally we split 2 cans of Friskies between the 3 cats twice a day. If they eat it all and Whitey or the others act like they are looking for more we put out another can.

    So last he was 109 +6 and 175 amps this morning. He did vomit some clear liquid in the middle of the night. That is nothing new but the first time since he's been home. The vet indicated that might be a symptom of pancreatis
     
  100. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I did not know that. Meya, why do diabetics need more?


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