1/29 Sid - DKA again

I had a bad feeling this was going to happen - and the specialist also told me it likely would - but I still feel like a total failure and really awful. I feel so bad for Sid. He did not want to stay at the hospital and was rubbing on me to let me know that. If you all could only hear his sweet little meow - it would melt your heart. He did a lot of talking at me to let me know that he wanted to leave and come back home, but i had to leave him there only until Monday though.

I noticed this afternoon that he was doing the "staring off into space" while he just laid there on the couch and he was doing a bit of the heavy breathing but not as bad as before. He was also a bit weak and staggering a little so I knew that something was definitely wrong. I checked his urine and he had a lot of ketones. I called my regular vet and he told me I had a choice and should decide where to put my resources. That the way he saw it, Sid had *months* to live not years. He told me I could manage the DKA at home with fluids and the R insulin but i know better and told him that I cannot do that. I cannot stay up 24 hours/day to monitor Sid's levels and giving him fluids. Besides, I told him that the R insulin scares me and I'm not giving it to Sid.

I've already been spending almost all of my time watching Sid to make sure he is eating and checking his bg every hour. Saying that DKA can be managed at home is really not even practical. Well and as for resources, that's fine for him to say and I understand where he is coming from and yes, there is limited resources, but there is only one Sid and he can't be got back, so I'm not giving up on him.

Yesterday he was fine - eating on his own, walking around the house, and more alert than I've seen him in awhile. The DKA came on so fast (as I know it does), but I'm not sure what we are going to do because he can't keep going to the hospital every other week. I really wish there was a magic pill to fix this.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=62298

Oh (((Lydia))), I'm so sorry Sid and you are facing this again. I'm sending prayers your way. I know you feel awful, but I hope you do know it's not your fault. Sid is so lucky to have you taking such good care of him.

Oh Lydia I am so so sorry to hear this little Sid seemed to be doing so well. Please don't feel like you've failed him in any way you haven't, no one could do more for their kitty than you have been doing for your darling Sid. I am sending an avalanche of healing vines to wrap him in, I wish I could do more.

Lydia,

This is EXACTLY what happened to Tawny. EXACTLY. Today she is fine. There is only one Tawny, & there is only one Sid. I so understand completely and I am so incredibly sorry you and Sid are going thru this again.

The thing that was drilled into me by the experts here w/Tawny (Karrie, Sienne, Libby, etc.) is that we fight ketones with calories and insulin. I am not saying you should be using the R & Thank God you asked the board about it, it is awful that the vet didn't give you the details.

Tawny's bgs were all over the place when she was sick but we got it under control. Feeding high calorie Wellness (diluted to e-tube consistency of course) gave her the calories she needed. The 2nd time she went into the hospital with the DKA she stayed there a week, they watched her like a hawk and she beat it. Her ketones started to clear by the 2nd day, they were completely gone by the afternoon of the 3rd I think it was. The last time was different, they ignored the warning signs I called them about on Thursday and by Monday she was back in there. But that's another story & she beat it that last time too, almost 2 months ago now.

Ketones cannot be managed at home. Insulin and calories can. I think the formula Libby posted in one of Tawny's condos went s/thg like: Not enough insulin + not enough calories + infection = ketones. Sid's other health issues right now are most likely IMHO contributing to the recurrence of the ketones.

Lydia, THIS IS NOT YOUR FAULT. You are doing everything you possibly can for Sid & he loves you for it. He is ketone-prone right now & when Tawny had all that other stuff going on w/her health she was too. She beat this. Sid can too.

We are sending the strongest healing vines and prayers we can muster up for you and Sid right now & we will keep them coming for as long as you both need them.

Desi & Tawny & Everybody Else Too

Sending healing white light and snowflakes to Sid.

Poor baby, wanting to come home. We love you Sid.
Please give him a kiss from us, when you go visit him.
And bring him your pillow case or sweat shirt to lay with.
Sending feel better and no more ketones vines to Sid.

I am sorry to read this Lydia - out thoughts are with you. Be well Sid.

Sending Healing Vines & get well Prayers to sweet Sid--Please get better Boy! WE love you!

(((Lydia)))
I'm so sorry that you and Sid have to go through this. It does seem like there are some kitties, like Tawny and Garland, that go through a couple of bouts of DKA. I'm so glad you caught this and I hope Sid rallies quickly. Sending vines and snowflakes to your boy.

I'm so sorry Lydia. Do you think lantus was better for him that the newer insulin? I don't know much about insulin dosing - Maverick was a micro dose kitty for most of his diabetes and never once went below 50.

I do know with DKA its lots of food. 2.5x's the normal amount isn't it Desi? Or is it 1.5x's? I know you were giving Tawny around 300 or so calories a day.

Lydia - what food were you feeding. Do you know the carb and calorie content? Would Sid let you give fluids at home?

Would Lymphoma contribute to DKA or do you think there is also an infection going on? I'll PM Sandra and Black Kitty to pop in and keep an eye on your condos.

I would have done the same for Maverick. You know Sid will pull through. I felt the same with Maverick with his first tube surgery and him almost dying and the surgeon botched the pegtube placement and he needed major abdominal surgery to repair it. Then Maverick pulled it out before it healed (day 10) and needed a second major surgery. It was horrible. I was an absolute wreck. My husband was speaking to me by his second surgery LOL. But the finances and the emotional roller coaster was difficult. I couldn't have done it without the handholding from FAF members. I hadn't found FDMB by then as Maverick wasn't diabetic. The success stories on the FAF site under Links kept my heart filled up. You should read Kita's story. You know Sid better than any vet.

Sending you and Sid huge hugs. You are stronger than you know. So is Sid.

Prayers, vines and snowflakes being sent your way. So sorry you're having to go through this again! ((hugs)) You are a fantastic mamabean and Sid knows it. Hang in there!

Poor Sid...but he's so very lucky to have you as his bean. I'm sure it was heart breaking to leave him at the vet again, but he'll be home before you know it. We've got you in our thoughts and prayers!

I am so sorry that Sid is back in the hospital. I will be keeping both of you in my prayers.

I hope the vet can figure out of there is some infection present that would have brought the DKA back. It has been observed so often that DKA is linked to infection. You will likely be putting off the plans to start the steroid until all chances of infection are ruled out.

Re: 1/29 Sid - DKA again - question on food intake

thank you everyone. I appreciate all of the vines and good thoughts and Sid does too.

Sid has been on twice/day clavamox since late December(?). He's on the third bottle. Neither doctor (the regular vet and specialist) think he has an infection because his WBC has improved. In fact, all of his levels are drastically improved. Even his kidney values are normal now and previously they were very elevated.

They believe the inconsistent bg levels are happening from the IBD and the lymphoma so they are going to increase the chlorambucil (leukeron) to twice/week and start giving him prednisolone today and he will get that every day. The specialist said that with his chemistry/situation that he should get pred 2x day but we are only starting out with once.

If he should be getting 2x the amount of food, then I need to increase his food intake. I thought 1 can/day was pretty good but it sounds like he should get more? The specialist wanted me to feed him w/d. I do not like any Science Diet food but I did feed it to Sid because it was the only thing he would consistently eat. He ate this for a few days last week. Then he stopped wanting it and I offered Friskies supreme supper, which he loves and devoured. Last night I was at the pet store reading all of the ingredients on the cans and looking at Binky's food chart because I'm trying to find a new food for him. I don't get how some foods can be low carbs but have potatoes and/or rice in the ingredients.

What kind of Wellness do you recommend? or what other food would be best for him? The specialist is really driving home that he ONLY eat 2x day and that's it. Well, that is very hard to do when he starts dropping on any given day and I have to feed him to get the level back up. To me it is better for cats in Sid's condition to have a minimum of 3 meals/day but I want to do what is best for him. Sid weighs about 4.92 (yesterday) so how much food should he be taking in per day? I was told 1 can was enough - is that true in your experience?

I've talked to both vets about the insulin. The specialist believes that PZI is the best for right now and he doesn't want me to switch. I already asked about putting him back on lantus and he said NO (just like that). He said that Sid has to be on the insulin for several days at the same dose before we can determine efficiency and that he is not on a high enough dose to warrant switching right now. In other words, if it doesn't appear to be working, then I should increase the dose because he probably isn't getting enough insulin. He was only getting 1 unit. The problem is that he dips and spikes on every insulin he has been on so far (lantus, Humulin N, and PZI), which he will until the underlying disease is under better control. It is interesting that the specialist told me that if Sid's BG level was over 500, there is no way 1 unit of R insulin would drop him below 50 - of course as long as it is not given in conjunction with any other insulin.

I will update his SS. I have so much data to input! Now that Sid is at the hospital, I have some time to do something other than sit and watch him all evening long.

1/29 How are you and Sid today?

Lydia,

How is Sid this morning? How are you this morning? ~ Desi

Karrie and Maverick said:

...I do know with DKA its lots of food. 2.5x's the normal amount isn't it Desi? Or is it 1.5x's? I know you were giving Tawny around 300 or so calories a day...

Lydia - what food were you feeding. Do you know the carb and calorie content? Would Sid let you give fluids at home?...

Would Lymphoma contribute to DKA or do you think there is also an infection going on? ...

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Lydia,

Karrie is right, w/DKA it's lots of food. Here is a cut from one of Tawny's condos w/a lot of info in it and a link to that thread if you want to read thru it Tawny 12/18/11 DKA & Calories Needed Info etc.:

12/18/11 Desi wrote: "I have been trying to figure out exactly how many calories a recovering Tawny needs per day. The vet recommends 200 calories per day. It is my understanding that a recovering DKA kitty needs 1.5 times it's normal caloric intake, right? So if a cat needs 20-30 calories per pound per day, a 10 lb cat would needs 300 calories per day?

So when calculating what Tawny needs, do I use her current weight (~9.5 lbs) or her healthy weight (12-13 lbs)? So if I split the difference and use 25 calories per pound, at a weight of 9.5 lbs she would need 237.5 calories per day?

And then do I calculate the 1.5 times that amount for her recovery on her current weight or on her healthy weight? So for recovery 1.5 times that is 356.25 calories per 24 hrs?

I am not good at calculating so I may be way off in this which is why I am asking.

I am using the Tawny feeding SS Karrie developed for us. It calculates Tawny's daily intake for me but I need to know what her baseline requirements are still, I am not sure the 200 calories the vet recommended are enough, I think I read in Karrie and Maverick's story that Maverick was getting s/thg like 335?

So far today, "today" starting at AMPS, Tawny has consumed 174.72 calories..."

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The link to the feeding chart SS Karrie designed is here: Tawny Feeding Chart SS

Even tho the above presents the info as questions I asked on 12/18, I was on the right track and Tawny did need at least 300 calories per day, and usually she got closer to 350.

Some of Tawny's data on the Feeding SS is incomplete, but if you use 12/19 or 12/21 those two are accurate and you should be able to adapt it to fit your & Sid's needs. Karrie did all the research (# of grams per amt, etc.) and put in all the formulas so all you have to do is put in the green columns how much Sid eats (& this means via tube, assist, whatever) and it calculates the # of calories and gives you a running total. I created a new sheet for each day.

The vets told me Tawny only needed about 200 calories per day but they were wrong. 200 was closer to her normal requirements as a healthy 10 lb cat, not a multiple DKA recovering cat.

They taught me to do fluids at home but I never had to do them but it is a good thing to know how to do.

Tawny had at least one underlying infection and that was a stubborn UTI.

IMHO Sid's bg's may be screwy for a while like Tawny's were while he is fighting these other health issues. Also when Tawny simply refused to eat b4 she had her e-tube even tho she was diabetic they let her eat whatever she wanted (dry mostly). Which at the time I was totally on board with. "Let her eat what she wants, we'll control the diabetes with insulin..." was the plan. With DKA it's so important to get the calories into them. In fact they didn't believe I could get her back onto LC wet food exclusively but that's all she eats now & she is happy and healthy again.

We are here for you and Sid.

Desi, Tawny & the Gang

Desi, I just saw your reply. Thank you for all of the information about food intake. I will look that over and come up with a plan. Thank you very much!!

Oh and I did forget to mention that I am very comfortable giving fluids. I have a cat at home with CRF who gets fluids every day. I've also given Sid fluids. They did not feel he needs them at this time though.

Re: 1/29 Sid - DKA again - question on food intake

Lydia, you were posting while I was posting so I will add:

Lydia & Sid & Jake(GA) said:

Sid has been on twice/day clavamox since late December(?). He's on the third bottle. Neither doctor (the regular vet and specialist) think he has an infection because his WBC has improved. In fact, all of his levels are drastically improved. Even his kidney values are normal now and previously they were very elevated.

If he should be getting 2x the amount of food, then I need to increase his food intake. I thought 1 can/day was pretty good but it sounds like he should get more? The specialist wanted me to feed him w/d. I do not like any Science Diet food but I did feed it to Sid because it was the only thing he would consistently eat. He ate this for a few days last week. Then he stopped wanting it and I offered Friskies supreme supper, which he loves and devoured. Last night I was at the pet store reading all of the ingredients on the cans and looking at Binky's food chart because I'm trying to find a new food for him. I don't get how some foods can be low carbs but have potatoes and/or rice in the ingredients.

What kind of Wellness do you recommend? or what other food would be best for him? The specialist is really driving home that he ONLY eat 2x day and that's it. Well, that is very hard to do when he starts dropping on any given day and I have to feed him to get the level back up. To me it is better for cats in Sid's condition to have a minimum of 3 meals/day but I want to do what is best for him. Sid weighs about 4.92 (yesterday) so how much food should he be taking in per day? I was told 1 can was enough - is that true in your experience?

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IMHO they are wrong about the 2x/day feeding. Especially w/e-tube feedings, it depends on how much you can get into him at one time. If I could only get 15-20mls into Tawny at a time I would go back and do it again about 2 hrs later. If I got a little more into her, I sometimes waited a little longer. But I tracked her calories on the Feeding SS too so that helped me know. Of course you don't want to feed too much at once & make them vomit. An e-tube tube is 40mls according to Tawny's vet. But you have to get the calories into him and if that means 40 mls every 2 hours or 20 mls every hr or whatever that's how much he needs to eat, and twice a day is definitely not enough.

She got Wellness Chicken and Wellness Turkey mostly, I did not dilute it with CliniCare after the first couple times b/c the carbs are high in that. Mostly I just used water, which does water down the calories a little bit. She inhaled REcovery on her own, I think it is higher carb, around 24-28%, but this was at the "let her eat whatever she wants" stage.

Everything I learned about this I either learned here from people like Karrie, Sienne, others & the FAF group. Here are a few more important things I remember:

"Do not give a cat with a feeding tube any appetite stimulant (this can cause food aversion). (I don't know if Sid is getting one or not but just in case they suggest it ~ Desi)

It is best to feed s/thg thru the tube that the cat does not normally eat, also to avoid the possibility of creating a food aversion."

With Tawny I actually had the best luck finger feeding her than I did anything else. Sometimes it would take an hour just to feed her 40mls, but she would eat it all. I would pet her and talk to her and use it as good bonding time. Sometimes I would finger feed her the e-tube concoction, just measure it into a syringe so I'd know how many mls, squirt it onto a plate, then scoop it (hard to do with a liquified mess), then let her just lick it off my fingers.

I know Wellness is not cheap but at least while Sid is sick maybe you could try it for awhile. Tawny is back to eating her regular Friskies now, I think totally during her illness we probably went thru maybe 2 cases of Wellness. I made the e-tube concoction out of the Turkey and when she wasn't licking that off my fingers I finger fed her the Wellness Chicken right out of the can as I was trying to get her to eat on her own. That way she wasn't getting the same thing in her tube that I was trying to get her to eat.

Lydia & Sid & Jake(GA) said:

Oh and I did forget to mention that I am very comfortable giving fluids. I have a cat at home with CRF who gets fluids every day. I've also given Sid fluids. They did not feel he needs them at this time though.

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They are not giving him fluids at the hospital? He's DKA & they are not giving him fluids? I am not a vet but that's the first thing they did every time w/Tawny, IV and fluids. Why don't they think a DKA kitty does not need fluids? Like I said I am not a vet but don't the fluids help clear the ketones? Sienne or Karrie probably know, hopefully they will come by with some input.

That's not much help I know but now I am really curious.

Oh yes, he is getting IV fluids while he is there at the hospital.

I meant they said that he doesn't need daily subcutaneous fluids at home at this point. Sorry to be confusing. I did give him sub Q fluids daily for several days when his kidney values were so high, but now they are back to normal and so I hadn't been required to do that anymore. Maybe going forward he will need that, but they did say as long as he is eating and drinking well he doesn't need them at home.

OK, WHEW!!!! Sorry to panic like that! ~ Desi

Hi there

So sorry to see all you and Sid are going through - dealing with ketones and DKA is tough. Black Kitty survived 2 episodes.

Desi is correct about the recipe for ketones:
Not enough insulin + not enough calories + infection = ketones.

You should aim for 1.5 times the calories needed to maintain "ideal" weight and he needs to gain weight.
Let him eat whatever he will - don't be too concerned about carbs right now. You can use more insulin for that.

Any dental issues? BK had gingivitis which, when addressed, changed his whole picture for the better.
BKs WBC was never high when he had the infection in his gums.

Why does your vet have an aversion to Lantus?

Sid has most of his teeth removed due to recurrent gum disease - I think he only has 4 left. They have not found any infection in the gums.

Sid is seeing 2 vets right now - a regular vet and a specialist. The regular vet has an aversion to lantus and prefers Humulin N. We argued about this with Jake(ga) and now with Sid so I know his views and disagree with him. I believe he prefers N because it works really well for dogs. He tells me he has not had good luck with lantus or PZI and probably has never tried levemir and that he has had cats go into remission on N. I've already told him flat out No that we are not putting Sid on N.

The specialist believes any long acting insulin is good for cats and which one works depends on the cat. He said he has used lantus successfully with many cats but he does not feel based on Sid's history with lantus that it is a good choice right now and that's why we are trying the Prozinc. I understand that lantus is a really good insulin for cats and used it for Jake(ga) but the specialist is pretty adamant about Prozinc so that's what I'm using now.

AW, sending you and Sid all our love, Lydia!

vines, snowflakes, and healing energy coming his way in waves!

and Binks says the KTSS are experts at sneaking past vetty security to bring him
soup and spa treatments and snuggly company.

We love you, Sid...and you have the best possible bean taking care of you!

poor sid .. Sending more and more get well thoughts his way .. and extra hugs your way lydia!