13 y/o Athena has DKA

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Timberowl, Jan 23, 2021.

  1. Timberowl

    Timberowl New Member

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    Jan 23, 2021
    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 herown, 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.

    Update: I just talked to my bf. He talked to the vet about an hour ago. They started her on insulin and got her blood sugar down below 200, which is great. She had a fever of 104° last night and they got that down to normal ranges too. But new issues have arose. Now her blood pressure is in the 70s, and her phosphorus levels are low (barely, but still low). The tube that was giving her phosphorus apparently fell out of her hind leg last night, and they’ve been unable to get it back in. They said if they can’t get it in and her levels keep dropping they’ll have to put a tube in her jugular.

    Update: Athena’s blood pressure is back to normal, but her glucose has spiked again and is over 300. They’re going to give her more insulin soon. They’ve still been unable to get the tube for phosphorus in her back leg, so will likely need to sedate again and insert the tube in her jugular soon. I’m so scared that we’re doing the wrong thing. It’s starting to look bleak, and I don’t want all these tubes and needles to be the last thing she ever experiences. We are paid through 4am Monday morning. I’m going to try my best to wait til then. This is supposed to be the best emergency vet in the area. If it was hopeless I’m sure they would have said so initially.
     
    Last edited: Jan 23, 2021
    Reason for edit: Update
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  2. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    I'm so sorry to hear about Athena Sending prayers for her ,she's a beautiful kitty.
    Please keep us updated . Poor baby :bighug::bighug::bighug:
     
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  3. Critter Mom

    Critter Mom Well-Known Member

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    Oh the poor love... (((Athena)))

    Praying for your girl, Timberowl. Athena is a very beautiful cat. Please keep us posted as and when you can with her progress.

    Just reposting the WSAVA DKA treatment guidelines here for you so that you can find them easily if you need them.

    :bighug:


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  4. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Sigh.... DKA is treatable, but it depends a lot on how early you catch it, how good the vet care, and, frankly, a whole lotta luck in how a kitty responds to the treatment. It helps that she was feeling energetic and zesty just a few days ago, it gives her a good base of health from which to work.

    Pulling for your beautiful girl!
     
  5. Timberowl

    Timberowl New Member

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    Jan 23, 2021
    Just this past Tuesday she jumped on the table and tried to eat my sandwich while I was changing my daughter’s diaper. That’s her normal self.
     
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  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Thanks for understanding about my goof.

    If you like the ER vet, I would ask if they can recommend a veterinary practice that's near you. I'd also have a talk with the first vet. The vet's behavior is going to cost you a good amount of money and the hospitalization could have likely been avoided.
     
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  7. Timberowl

    Timberowl New Member

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    Jan 23, 2021
    We plan to, trust me. We have already paid $6,200. The ER vet costs $2,000/day. They told me from the beginning to plan on spending about $10k, because she was so far gone by the time she arrived, and will need to stay 4-6 days.

    Good news though: her temperature, blood pressure and blood sugar are now all in normal ranges. The only issue at the moment is her phosphorus level. It’s not critically low, but it’s below the normal range.
     
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  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    That's great news! Electrolyte levels take a little while to stabilize. You're kitty has been through a lot!! Have they tried to get her to eat on her own?
     
  9. Timberowl

    Timberowl New Member

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    Jan 23, 2021
    They said they’re making food available to her about every 6 hours and encouraging her to eat, but not pressuring her too much. The tube feedings are still going very well. So far she’s shown no interest in eating or drinking on her own.

    My boyfriend FaceTimed with me a bit ago so I could see her (they let him visit twice a day) and she looks really depressed. Hopefully it’s just fatigue.
     
  10. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    You might want to ask if she’s in a stable enough place for an appetite stimulant. Or, your boyfriend could bring a food she likes from home to see if she’ll eat for him..
     
  11. Timberowl

    Timberowl New Member

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    Jan 23, 2021
    That funny. I just woke up and that’s exactly what they’re doing. They asked my boyfriend to bring a few different foods/treats she likes from home. And they’re going to let him try to get her to eat tonight.

    ALL of her levels are now in normal ranges! She’s walking around, and actually showing her personality again. Even acting annoyed when they check her tubes/bandages, LOL

    They said the only issue is that her blood sugar is still spiking up very high without regular insulin, and they think there’s a chance she’ll require insulin regularly after this. And that we’ll have to make sure she eats after getting her dosage.

    for the first time ever since she was admitted, they said they’re confident that she’ll be coming home.
     
  12. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    What a fantastic update!!!!!!

    It's not unusual to need insulin after steroid-triggered diabetes, but sometimes it's just for a short time. I definitely would not be reluctant to start insulin after a DKA like this one-- that and food are your two big weapons to keep the ketones from reoccurring.

    So happy to hear that she's doing better and showing her personality!!!!
     
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  13. Critter Mom

    Critter Mom Well-Known Member

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    Great progress update for Athena! :cat:

    I suggest double-checking with your vets about timing of the feeding. The normal routine is to feed before giving the insulin dose.

    ETA: It's OK to give additional food after the insulin dose (just not in the two hours prior to the preshot BG check, unless food is needed in those two hours to raise low BG numbers).


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  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    These little girls are fighters. I think they know that we haven't given up on them and they don't give up, either.

    In the many years that I've been on this board, all I can tell you is that there's no way to predict whether a cat will go into remission or need to be on insulin forever. We are not leading the dance -- our cats are directing progress. We're along for the ride. Remember, you're getting information from vets who were preparing you for the worst. (Which was a reasonable thing to do given the nature of DKA. Athena, thankfully, proved them wrong.) My point here is that no one has a crystal ball.

    A couple of things to consider. You'll want to get either Ketostix or some other brand of urine test strips that test for ketones. If Athena is shy about her litter box habits, there are blood ketone meters you can use. The latter is a bit easier if you're comfortable with home blood glucose testing. It's exactly the same except you use a different meter and strips that test for ketones. The downside is that the strips are expensive. You only have to test once or twice a day but if costs are an issue, it's something to think about. The Precision Xtra and NovoMax are the old reliables but there are lots of ketone meters now given the popularity of the Keto Diet. You can find ketone meters either at ADW or on Amazon. The urine test strips are available at any pharmacy.

    You'll want to test for ketones once Athena is home. For cats that have had DKA, until you are 100% sure that the kitty is stable, it can be easy for them to slip back into developing ketones. The testing is a preventative so you can intervene if you see a low level of ketones and avoid hospitalization.

    I'm not sure I remember what insulin you were using. The insulins that are recommended for cats are either Lantus (glargine) or Prozinc. It sounds like they have been using Humulin R (aka "regular" insulin). This is NOT what you want to be using at home. It's primarily used in the hospital since it's in and out very quickly. It may also be why your cat's numbers are spiking but that's for a different discussion. You want a longer acting insulin. Prozinc is formulated specifically for animals and available through either a vet or Chewy's. Lantus is a human insulin and can be purchased anywhere. It's very expensive in the US. Most people here purchase their Lantus from Canada at Mark's Marine Pharmacy in Vancouver. If you end up wanting to use Lantus, I'd suggest calling around and seeing if you can buy a single pen. Often Costco or Sam's Club will sell one pen. Some pharmacies will, as well. (It takes more than a day or two to get Lantus from Canada.)
     
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  15. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Any updates?
     
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  16. Critter Mom

    Critter Mom Well-Known Member

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    I hope Athena's doing OK.


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  17. Timberowl

    Timberowl New Member

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    Jan 23, 2021
    I’m sorry I forgot to update!

    Athena came home two days after my last update. She didn’t require insulin anymore by the time she came home. Her blood sugar, if anything, was a little low the first few days she was back. At first she ate voraciously. Then for a couple days she scared us and would barely eat. We bought some food paste on Amazon. And when she would barely eat, we’d feed it to her on our fingers. I think she made the association, so now she’s eating just fine. Her glucose monitor is off (she bit it off after days of trying) and her first check up is on Monday. She is 100% her old self now. You’d never know any of this had happened if it wasn’t for her fur still being shaved.
     
  18. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    My kitty was a DKA survivor. He got DKA when he was 12 and also was in critical condition when hospitalized. He lived to be 20.
    I am so happy to hear Athena is doing well :bighug:. Are you still checking her blood sugar? I think if it were me, I would have some ketone test strips and still be checking her for ketones now and again (since the DKA was so recent) and especially if she is acting off, like lethargic or not eating or throwing up. I wish you the Best Of Luck that she never has them again.
     
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  19. Timberowl

    Timberowl New Member

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    Jan 23, 2021
    Thanks! I just ordered some ketone test strips on Amazon. She basically has her own litter box (we have two other cats, but they’re almost always upstairs) so it shouldn’t be too hard to check once in awhile.
     
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  20. Critter Mom

    Critter Mom Well-Known Member

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    Hi Timberowl,

    We do worry when we don't hear anything for a while. :nailbiting: I am absolutely delighted to read the good news about Athena! Thank you so much for posting this update. :cat:

    It's great to hear that she's made a full recovery and is doing well. (((Athena)))

    Couple of general safety tips for a ketone-prone kitty:

    * As you've seen, sometimes there can be some lingering nausea during the convalescent period after an episode of DKA. Also, in the future you'll need to be that little bit extra-careful any time Athena's appetite gets a bit iffy (even if BG is OK). It might be an idea to ask your vet to prescribe some ondansetron tablets for you to keep in Athena's medicine cupboard for use ad hoc if needed. Obviously the vet would still need to be consulted to determine the underlying cause of any nausea/inappetence but, assuming an anti-nausea med is indicated, it is far, far easier to help a queasy cat to keep eating than trying to kick start the appetite of an anorectic cat. (The nausea-empty tummy combo tend to set up a negative feedback loop.) Having the meds to hand just means that treatment can be started quickly, no need to wait for a prescription to be filled - something that is especially helpful if the practice doesn't offer any out of hours/weekend cover. Sometimes just a few doses may be enough to help a kitty get enough food down to settle the tummy and restore normal appetite.

    * Even if Athena is now in remission, I'd recommend being diligent with keeping up BG spot checks (ditto for ketones); daily for the next few weeks then thereafter at minimum once a week)so that you'd be able to catch any upward drift quickly. If you did get an unusually high number on the weekly check, you could then start checking more frequently to determine whether the higher number was just a one-off or whether Athena might need a vet check-up. For example, UTIs and dental issues may tip a cat out of remission. With a history of ketone complications it's a good general safety measure to be that little bit extra cautious about such issues. :)

    * If you haven't already got one, I think a blood beta ketone meter is a good investment. The strips are pricey compared to those used for urine testing but you don't need to test very often and the blood meters detect the ketone bodies that have greatest involvement in DKA (beta-hydroxybutyrate) and blood ketones may be detected in real time and therefore can potentially give earlier warning of something brewing. If ever Athena seemed a bit 'off' you'd be able to do a quick test with the BBK meter to check her ketone status, and hopefully give you peace of mind that she's OK. You could also supplement blood ketone testing with urine ketone testing as circumstances require (detects acetoacetate, a surrogate indicator of beta-hydroxybutyrate levels).

    Helpful resources (worth bookmarking):

    Ketones, Diabetic Ketoacidosis and Ketone Meters

    Urine vs. Blood Ketone Testing

    Again, so pleased to hear your good news. Sending lots of cyberscritches to your beautiful Athena, and a :bighug: for you.


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  21. Critter Mom

    Critter Mom Well-Known Member

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    Another selling point for a BBK meter: no need to worry about whether you're testing the right cat's pee! ;)


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