HELP HIGH KETONES

My cat Boombox was bouncing off insulin into high numbers ( 400+) so I decided to get him off the insulin to start dosing over & his sugar was much lower & more stable 275-330. He's been off the levemir for 5 days, then I started drop dosing him to start and he's had 3 cycles of 1 drop. I just checked his urine and its the highest ketone reading. I gave him .5 insulin and 175ml fluids. What should I do? I can tell he has not been feeling well all day ( anorexia mostly) and its getting worse but he's still alert.

 

Charisse Boombox
Joined:
Today
My cat Boombox was bouncing off insulin into high numbers ( 400+) so I decided to get him off the insulin to start dosing over & his sugar was much lower & more stable 275-330. He's been off the levemir for 5 days, then I started drop dosing him to start and he's had 3 cycles of 1 drop. I just checked his urine and its the highest ketone reading. I gave him .5 insulin and 175ml fluids. What should I do? I can tell he has not been feeling well all day ( anorexia mostly) and its getting worse but he's still alert.

 

You need to call your vet. Ketones is very serious.

 

I would take him to the vet NOW. he could be developing DKA. Stopping insulin is not a good idea for diabetic cats.
Please take your kitty to the ER now. It is quite urgent

 

I agree you need to take your kitty to the vet NOW. He could be developing DKA which needs urgent care. Please don’t delay and think it will improve because it won’t.

 

My cat Athena (about 13 y/o—she was an adult when I adopted her 10 years ago) is in the ICU with diabetic ketoacidosis. We are a complete mess and terrified. She has been there since very early Friday morning. Her blood sugar was in the high 200’s. She was severely dehydrated, unable to stand or hold up her head.

She seemed fine up until this week, save chronic ear infections. My boyfriend took her in to the vet (a brand new vet, since we just moved a few months ago) on Monday for her ear, and they diagnosed it with an infection and gave her a steroid shot (depo) and sent her home. She started acting weird by Tuesday evening (lethargic, little interest in food, which is NOT normal for her). Wednesday she spent all day sleeping on the back porch. Wednesday night she threw up water several times (my boyfriend was up with her), and he took her to the same vet again on Thursday. I left town Thursday morning for vacation, but really didn’t expect any big news—I thought she was just having side effects from the steroid that would wear off soon.

The vet ran some tests and diagnosed her with diabetes. He gave her some fluids under her skin between her shoulder blades, and a shot of insulin, and said to come back the next day.

She continued to refuse food and water, and got to the point where she couldn’t stand up. He said he put her in front of the food dish, and she just fell over and gave up. He kept thinking maybe if we just waited it out, once that steroid shot was out of her system she’d start eating again.

A few hours later, She was struggling to breathe, wheezing, so he took her to the ER in the next town. They diagnosed her with diabetic ketoacidosis, and said it was not looking good. She’s severely dehydrated. They have been giving her fluids and a feeding tube. 20 calories every 6 hours, they said. I asked if they were giving her insulin, and they said no, because they didn’t want to “rock the boat” and they were sticking to fluids for now to see if fluids alone could lower her blood sugar.

Are we doing the right thing? Up until Monday, she seemed to have most of the “zest for life” that she’s always shown-trying to sneak food off our plates, laying in our laps purring, playing with her laser pointer, watching squirrels from the screened in porch, etc.

The last update I got was late last night (about 20 hours after she was admitted) and they said her blood sugar was still about the same as it was when they got there, but that she did seem stronger (holding her head up, using the litter box on her own, albeit very weak, etc.). They said if things took a turn for the worse into the night they’d give me a call. I’m sure they have to say those things, but that didn’t make me feel any better.

 

I’m am so sorry that you are going through all of this. How incredibly scary. I’m glad your boyfriend got her to the ER as soon as he did. I’m not experienced in DKA although Howie has been prone to ketones even in the 200s. I just didn’t want your post to go unanswered as I know how much you can be glued to the forum hoping and praying for any response. I’m sure the more experienced folks will respond soon. For now, Im Sending you big hugs and healing thoughts for Athena.

 

I'm sorry you're having to deal with your kitty being in the ICU. It's incredibly stressful.

Chances are that the steroid shot is what triggered the diabetes (FD). Steroid induced diabetes is not uncommon. In addition, the stress of the ear infection may have also contributed. I hope the vet who gave the steroid also ran a fructosamine test. This is similar to a HgbA1c (hemoglobin A1c) that humans are tested for and lets you know if blood glucose (BG) levels have been elevated over several weeks. Your first vet's handling of this is worrisome. Giving one shot of insulin and having your boyfriend return the next day makes no sense. Insulin needs to be dosed every 12-hours in cats. In fairness, the vet may have been planning on teaching you and/or your boyfriend how to give shots. (And thank goodness that your boyfriend was attentive to how your cat was behaving! He likely saved her life.)

The most common way that DKA is treated is with fluids (they help to "dilute" both ketones and BG), a fast acting insulin like Novolin/Humulin N (they are the same insulin), and a dextrose drip. The dextrose and insulin offset one another. Obviously, the insulin helps to lower BG and the dextrose prevents it from dropping too low and also has the benefit of providing calories. In addition, they should be running labs on a frequent basis in order to determine if electrolyte levels are returning to normal or if any supplements are needed. Please be aware that DKA is serious. It is typically the result of an infection/inflammation + not consuming enough calories + not enough insulin.

When my cat was diagnosed with FD, she was also in DKA and also had hepatic lipidosis and pancreatitis. Both my vet and the ICU vet (different places) told me that not all cats survive. She survived and was back home with with me in 3 days. (She had a lot of attitude!) So while DKA is not something to be cavalier about, cats can bounce back.

You might ask if it's OK for you to visit your cat. If they will allow you to visit, you can bring something that smells like you from home. It may help to alleviate some of the stress on your cat of being in a strange place with strange smells and sounds.

 

I am in complete agreement with Bron. High ketones cannot be managed at home and there is a risk for DKA developing. Please get your cat to a vet or ER.

It is not recommended that you stop your dose of insulin and start over if numbers are bouncing. In addition, without seeing a spreadsheet with your numbers, we would not be able to offer any dosing help.

 

I'm going to merge the two threads.

 

I'm so sorry to hear that Athena is in hospital. Your boyfriend did great to get her to the ER.

Here are the WSAVA guidelines for treatment of DKA. It's a bit techie in parts but there's enough of it in plain English to help you see what treatments Athena should be receiving and it might help you in your discussions with the vets treating her.

As Sienne says above, DKA is serious and cats get really sick with it, but it is definitely possible for cats to survive it and go on to make a complete recovery.

Sending prayers for you and your little one.

(((Athena)))




Mogs
.

 

I am so sorry you are dealing with this. You've gotten some good information already (the link Mogs gave to the treatment guide for DKA is definitely worth some attention), but I just wanted to ask about this:

That adds up to 80 calories per day, which doesn't seem like enough. How much does she weigh?

 

Speculating here but I wonder whether they might be starting off slowly with the food to avoid risk of refeeding syndrome?


Mogs
.

 

@Sienne and Gabby (GA), I'm getting confused with the merged thread-- aren't these two different cats with DKA?

 

I'm clearly losing my mind! I don't know if I can separate them.

 

I made a new thread since mine was accidentally merged with this one. But yes, we are NOT HAPPY with the first vet. The ER vet said she should have been on an IV DAYS ago. So for the first vet to just give her a shot of insulin and send us on our way, when the shot he gave her is what set the whole thing off, is NOT okay with us.

 

Is your cat ok

 

Update on this thread:

https://www.felinediabetes.com/FDMB/threads/13-y-o-athena-has-dka.241947/


Mogs
.

 

I was hoping to know how Boombox @Charisse Boombox were doing.