New here: Need advice on DKA, possible euthanasia

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Kelly P said:
The easiest thing for me to get her to eat is the freeze dried chicken. Is it going to cause problems if she is eating mostly that right now?
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Just to confirm, when you say freeze dried chicken you mean chicken breast treats, not the Instinct food freeze dried chicken?
 
Kelly P said:
I'm okay. I really don't know how this is going to end up, but I'm committed to listening to her and fighting as hard as I can if she's still down to fight. I'm suppressing the other emotions and just focusing on what needs to be done and when. I'm SO SO grateful for the support of this community, though, it actually moves me to tears.

I decided to wait before administrating gabapentin again. The vet said it was helping her stay comfortable with all of these interventions and her pancreatitis, but she seemed happier when it wore off (she even laid on the bed in the sun and showed her belly).
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Fwiw gabapentin increases appetite in some cats
 
Kelly P said:
Thank you for responding and helping us. The last thing I want to consider is euthanasia but the finances are becoming unbearable. Getting her through this next round of DKA will put us up to nearly $30k and into debt. But we are waiting until at least tomorrow to see if she is showing signs of improvement. She did bounce back after her first episode of DKA in 2022, so we know it's possible, but I'm not sure why she relapsed after just one day this time.

She did not eat during her DKA in 2022 which is why she needed the feeding tube. She did eat during last week's DKA. She is currently only eating a little bit so a feeding tube is likely going to be necessary.

If we can get her through this, I would do whatever program needed, including frequent home tests. I already bought all the stuff including Relion monitors and ketone strips. But again, I'm concerned that she relapsed so quickly, is showing less interest in food this time, and about the incredibly burdensome finances of it all.

Her lab work from 10:43 am this morning:
Test Results Unit Lowest Value Highest Value Qualifier
IP 4.6 mg/dl 2.6 6.0
Mg 1.7 mg/dl 1.8 2.7

Ketones 40 (no unit of measurement given)

Here are some from earlier this morning:

01-27-2025 7:49:06am,
PCV: 25%
T.P: 7.4 g/dL
BC: 1%
Plasma: Clear
Clinic Notes / Specifics
Blood gas-346521001-2025-01-27T07:46:46
Blood gas, electrolytes, metabolic
BloodGas
Result Date: 2025-01-27T07:46:46
Test Results Unit Lowest Value Highest Value Qualifier
pO2 80.8 mmHg 27.0 50.0
O2SAT 92.3 % 50.0 80.0
pCO2 32.3 mmHg 31.0 51.0
HCO3-act 11.6 mmol/L 15.0 27.0
mTCO2 11.2 mmol/L 16.0 25.0
pH 7.163 7.250 7.430
BE(ecf) -17.0 mmol/L -5.0 2.0
Na+ 145 mmol/L 148 163
K+ 3.7 mmol/L 3.6 5.6
Cl- 118 mmol/L 111 128
Ca++ 1.22 mmol/L 1.21 1.51
AGapK 21 mmol/L 9 26
Lact 1.79 mmol/L 0.50 3.20
BUN 24 mg/dL 15 32
Crea 0.63 mg/dL 0.50 1.90
Glu 256 mg/dL 63 133
Hct 22 % 28 50

Results from last night at 10:45 pm:

Test Results Unit Lowest Value Highest Value Qualifier
Ketones 15

Test Results Unit Lowest Value Highest Value Qualifier
BUN 41.6 mg/dl 15.0 32.0
CRE 0.8 mg/dl 0.8 1.8
BUNCreaRatio 52.0
IP 4.7 mg/dl 2.6 6.0
Ca 10.1 mg/dl 8.8 11.9
TP 7.6 g/dl 6.0 8.0
ALB 3.5 g/dl 2.3 3.5
GLOB 4.1 g/dl 2.8 4.8
AlbGlobRatio 0.9
GLU 362 mg/dl 70 130
TCHO 229 mg/dl 70 200
ALT 67 U/l 0 100
ALP 32 U/l 0 90
GGT < 10 U/l 0 10
TBIL 0.1 mg/dl 0.0 0.5

Test Results Unit Lowest Value Highest Value Qualifier
WBC 11.69 10^3/uL 5.50 19.50
NEU# 10.47 10^3/uL 3.12 12.58
LYM# 0.50 10^3/uL 0.73 7.86
MON# 0.28 10^3/uL 0.07 1.36
EOS# 0.43 10^3/uL 0.06 1.93
BAS# 0.01 10^3/uL 0.00 0.12
NEU% 89.6 % 38.0 80.0
LYM% 4.2 % 12.0 45.0
MON% 2.4 % 1.0 8.0
EOS% 3.7 % 1.0 11.0
BAS% 0.1 % 0.0 1.2
RBC 4.64 10^6/uL 4.60 10.20

Test Results Unit Lowest Value Highest Value Qualifier
HGB 7.3 g/dL 8.5 15.3
HCT 23.0 % 26.0 47.0
MCV 49.7 fL 38.0 54.0
MCH 15.8 pg 11.8 18.0
MCHC 31.8 g/dL 29.0 36.0
RDW-CV 19.5 % 16.0 23.0
PLT 272 10^3/uL 100 518
MPV 13.4 fL 9.9 16.3
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one thing for you to keep in mind (and remind advisors as they help you with her dosing): anemia can alter blood glucose values on meters (and Libres). It can mske the BG appear higher than it actually is.

This is important to keep in mind as most advisors are used to human meters reading lower than the true number and so rely on that difference to a degree. The dose advise/reduction guidance/etc take this into account which is why there’s a different spread sheet for human and pet meters.

while Vesper is so high this won’t be as important but when her numbers get lower it may. In other words, if she remains anemic then rather than reading lower than she really is her meter is more likely to be reading the true number or even higher. Just something to keep in mind.

so glad she’s doing better. Good luck
 
Ugh, we are having a frustrating morning. Our libre sensor stopped working, and despite poking her several times, we weren't able to get a Relion reading. Vesper is 10/10 spicy and can be VERY difficult to handle. She has also wisened up about her meds in pill pockets, so we've had to go back to pilling. We gave her the insulin because her readings have been so high, and we'll try to get some readings throughout the day but I'm feeling a little worried about not being able to do that.
 
Hi Kelly, the libres can be super frustrating! We tried so many. Are you using a lancet pen? If so, start on setting 5 or 6 and aim for the very outside of the ear. Does she have a favorite food that you can smear on a dish so she is preoccupied when you prick her ear? When I do this, I feed on a table so Petey is at a good height. Or I suggest a sneak attack while she's sleeping, just very matter of fact and no restraining. I use cotton rounds on one side, and lancet the other. At first they take many tries to bleed and then you'll be doing it in one or two pricks!

I have made a beef liver pate to hide pills in, works every time.. just roll the pill in as small of a ball as needed and offer as a treat. They never, ever refused it and it's impossible to get the pill out. I made a big batch, divided into small jars, kept one in the fridge and froze the others. Just only use as much as necessary as it is rich and full of nutrients too.

You'll find what works for you and Vesper soon enough! :bighug:
 
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Laurie&Petey said:
Hi Kelly, the libres can be super frustrating! We tried so many. Are you using a lancet pen? If so, start on setting 5 or 6 and aim for the very outside of the ear. Does she have a favorite food that you can smear on a dish so she is preoccupied when you prick her ear? When I do this, I feed on a table so Petey is at a good height. Or I suggest a sneak attack while she's sleeping, just very matter of fact and no restraining. I use cotton rounds on one side, and lancet the other. At first they take many tries to bleed and then you'll be doing it in one or two pricks!

I have made a beef liver pate to hide pills in, works every time.. just roll the pill in as small of a ball as needed and offer as a treat. They never, ever refused it and it's impossible to get the pill out. I made a big batch, divided into small jars, kept one in the fridge and froze the others. Just only use as much as necessary as it is rich and full of nutrients too.

You'll find what works for you and Vesper soon enough! :bighug:
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Thanks for the tips, we will try them. I'm wondering if the miratz is affecting the ability to get a good drop of blood? She has that all over her inner ears right now, and I'm struggling on the outer ear since they are black and very hard to see the blood. It doesn't help that she's a super aggressive cat with stuff like this.
 
Kelly P said:
Thanks for the tips, we will try them. I'm wondering if the miratz is affecting the ability to get a good drop of blood? She has that all over her inner ears right now, and I'm struggling on the outer ear since they are black and very hard to see the blood. It doesn't help that she's a super aggressive cat with stuff like this.
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I'm not certain about the Miratz, but I imagine the black ears make it super hard to see a tiny drop of blood! Petey is aggressive too, so luckily those two tricks make it doable for us. Two months ago I didn't know how any of this was going to be doable! Now I do it all on my own, I found having my husband trying to help just freaked Petey out more. He trusts his Mama, for like 8 seconds :D.
 
Small flashlights were vital to see the bead of blood on my dark-eared cats. As does a small dab of Vaseline to prevent the blood from dissipating into the fur. I always used the fur side to poke.

I used the opposite ear to the one I used for Mirataz.
 
As you can see in J.D.'s picture his ears were white on the insides, so I always poked and got his tests from the inside of his ears.
Wishing you luck in testing. Once they get used to it and you give them a treat each time, they get with the routine.
 
Kelly would you mind starting a new thread please as this one has got too long?. When you do can you link it to this thread for continuity please? Thanks. Keep DKA in the subject line somewhere too.
How are things today?
 
Bron and Sheba (GA) said:
Kelly would you mind starting a new thread please as this one has got too long?. When you do can you link it to this thread for continuity please? Thanks. Keep DKA in the subject line somewhere too.
How are things today?
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Yes, I will create a new thread later today! She is doing well. She is eating and drinking regularly, and seems to have a good energy level. Our only struggle right now is pills and glucose testing. She's very spicy, so I have been focusing on the pills right now. I'm hoping once she's less angry about the pills, we can settle into a routine with the ear testing. She has gained a few ounces and is back up to 9 lbs. I'll keep you updated!
 
Diane Tyler's Mom GA said:
@Kelly P
Did you get AMPS for 1-31 thru 2-3. I don't see any for the PMPS and any tests after you gave insulin
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We've been struggling with the home testing given her aggressiveness, so we decided to hold off a bit until we were done with all the medications, so we weren't subjecting her to repeated pilling AND ear pricks. I have had some success with home testing today, and I think we're getting another libre put on her tomorrow, so hopefully we will find a groove soon. I've been monitoring her urine on occasion for ketones and those have been negative. It's on my to-do list to start a new thread and update her ss, but it has been a busy couple days at work. Thank you so so much for checking in.
 
@Kelly P
When you start a new thread I would start posting on the Lantus Board
Here is the link
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
It will say post new thread to the right
You can say it's your first post on the Lantus Board and you can introduce yourself and Vesper
As Bron said Please
Keep DKA in the subject line somewhere too. 3 DKA Episodes

On the Lantus Board we have a certain way to post in the title
Date Vesper AMPS and any additional tests after that and you can continue with the PMPS in the title.
To do this tap on the word Thread Tools to the right then tap on Edit title and add those tests s then tap save
Try to post everyday.
We like to link our previous days post to the new one continuity . Here is how to do it


To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post new thread





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it, only way I can explain it :cat:









austin-logo-240.jpg
 
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