1. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    I am at the ER with Dewey now. I assume he is in DKA. He was normal this morning and ate all his food. His bs was in the 400s the way it has been and I planned to increase insulin tonight to 3.5u. By +3 hours he vomited all his food and was dry-heaving and having liquid diarrhea every few minutes. Checked BS and was in 300s. Tried to check ketones but meter kept giving errors. I scooped him up and took him to the ER and now I am waiting to see what the dr says. Needless to say I am sick with worry and feeling guilty because I couldn't go in with him due to COVID. Please say a prayer for us!
     
  2. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Oh Kristin, I'm so sorry Dewey isn't feeling well, I will be praying for Dewey .
    He is such a beautiful boy.
    None of us can go in with our kitties and I hate that we can't
    Please keep us updated. :bighug::bighug:
     
  3. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Prayers being sent!
     
  4. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    Kristin I’m so sorry to hear that! I just want to say I know the feeling having had to rush Minnie to the ER twice during covid19 and the first time with similar symptoms. It could be something to do with his GI tract so try to stay positive until you hear from the vet. And you did the right thing as he’s in the best place to heal now

    sending lots of love, positivity and healing thoughts to you and that ball of fluffy fur that is Dewey :bighug:
     
  5. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Oh no, how terrifying!

    It's a good sign that he wanted to eat this morning-- most cats with high ketones/DKA, food is the last thing on their minds.

    Any possibility he could have eaten something (string, etc.) that he shouldn't have? Those symptoms make me think of a blockage... really glad you took him in immediately.
     
  6. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Another thing to check for is pancreatitis, although it's usually a little more gradual coming on. Pretty common thing for diabetic cats, and the symptoms are consistent.
     
  7. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
  8. Tomlin

    Tomlin Well-Known Member

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    May 30, 2019
    Prayers being sent :bighug:. Dewey is adorable!
    Hang in there and I hope you get some answers and all will be well.
     
  9. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
    Thank you all for the prayers and comments. Dewey is staying at the hospital for now. The dr thinks it might be pancreatitis. She plans to do an abdominal ultrasound. She said he was relaxed and comfortable and very loving. She is an internal medicine specialist and said I could work with them to regulate him. She has seen many diabetic felines and is used to working with it. I miss him and worry but at least I will have some good guidance. I will update you when I know more.
     
  10. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    (((((Kristin))))) Dewey is where he needs to be. :bighug:
    This will give you time to rest and reset. Best wishes for your beautiful boy. We'll keep the lights on for ya.;)
    jeanne
     
  11. Tomlin

    Tomlin Well-Known Member

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    May 30, 2019
    Happy to hear Dewey is in great hands and being taken care of :bighug:. Hospitalization can really turn a cat with Pancreatitis around much more quickly than struggling at home, so although it is sad when they have to go in and stay, it is much better in the end. I hope you are able to go home and get some rest tonight. My thoughts and prayers and healing vibes are being sent your and Dewey’s way!
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I am so sorry Dewey is in the ER unwell, but it's the best place for him right now. Sending a load of get-better vines. Please keep us updated.
     
  13. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I'm glad Dewey is in good hands, hope you get some rest, praying for him, I'm happy to gear he is relaxed and loving.
    Please keep us updated :bighug:
     
  14. Lalkabee

    Lalkabee Member

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    May 1, 2020
    Seems like a good vet..I'm sure your babe is gonna be ok :) Still annoying because of covid to not being able to go inside :(
     
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  15. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Hoping all is well prayers!
     
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  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Please keep us updated on Dewey's progress.
     
  17. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Glad he’s getting help. The typical care for pancreatitis is daily sub q's for a few weeks, cerenia for nausea and bupe for pain.
     
  18. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
    Update: Dewey is home! No ketones, ultrasound showed moderately enlarged pancreas that she felt looked more like resolving or chronic pancreatitis. She saw 2 small nodules in the pancreas that could possibly be cancer :nailbiting: and if not ruled out with further data a biopsy could be done. He also had an ileus and enteritis. He ate like a champ last night and this morning and had a normal stool there. They placed a Freestyle Libre (I am so excited about this!) and it is working great so far. He doesn't seem bothered by it at all and completely ignores it. They gave him a bath and a little trim because he had poop all over him from the awful diarrhea. He looks so handsome but so skinny. One liver enzyme was high and she isn't sure what is causing it (liver looked normal), WBC and Lymphocytes are up slightly, BG in 300s, and all other labs look OK. She sent home Cerenia for nausea, Visbiome probiotic twice a day, and something to stimulate appetite as needed. He had some diarrhea this afternoon but it wasn't like yesterday. I have an appointment to bring him back on Friday.

    I want to thank you for the support. This is truly a great group! :bighug: I feel like I have found a vet I can trust and that is a huge weight off my shoulders. I am choosing not to dwell on the cancer possiblity at this point since I can't do anything about it. If she recommends a biopsy I will have it done. I was going to post pics but couldn't figure out how. Does anyone know how to do it?
     
  19. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    WHEW! So good to hear this THANK YOU . PLEASE give Extra sweet Dewey some scritches from all of us!:bighug::bighug::bighug:
     
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  20. Tomlin

    Tomlin Well-Known Member

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    May 30, 2019
    SO happy to hear this news :)....home...Yay!
    Happy you like the vet and the Libre! The CGMs are awesome! Will continue to keep you in my thoughts and will pray for continued good news for you guys :bighug:
     
  21. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I am so glad Dewey is home. Great no ketones. Your vet sounds good. Keep up the cerenia for the nausea. Frequent small meals.
    If you post the labs in the SS Marje will comment on them for you
     
  22. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
    I will do that. Thanks, Bron
     
  23. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    I'm so happy Dewey is doing better and you love the vet. I wouldn't concentrate about the nodules either, hopefully it's nothing.
    Continued prayers for your kitty :bighug:
     
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  24. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I am a big fan of S. boulardii for diarrhea. I've purchased ReNew brand from Amazon. I believe that Marje uses Jarrow's S. Boulardii + MOS. One of her kitties just went through a problem with diarrhea and the Jarrow's worked wonders. Denamarin is a good supplement for liver issues. I've never used ut but others here may have.
     
  25. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Points out of 10 to your vet!!! So many times I've seen reports here of vets who send DKA and pancreatitis patients home with no supportive meds for the convalescent period (been there myself, too). It can make the world of difference to recovery if one is armed with the necessaries to address 'hiccups' immediately they arise, instead of having to delay response while waiting for the vet to issue the required prescription(s).

    For general information, pancreatitis flares can lead to out-of-whack liver values. Hopefully this will resolve by the time of Dewey's next bloodwork.

    Following on from the recommendation above, if Dewey were not to find Denamarin an agreeable liver supplement, Hepatosyl Plus for cats is an alternative liver supplement you could try if one is needed.

    Wishing Dewey a speedy recovery from the diarrhoea!


    Mogs
    .
     
    Last edited: Jul 30, 2020
  26. Dusty & Roe

    Dusty & Roe Member

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    Apr 28, 2020
    Just a check in how is Dewey doing any better ?
     
  27. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    Great news!!! So happy for you and Dewey! :bighug::bighug::bighug::bighug:

    you can a pic by clicking on “upload file” next to “post reply” then you can select thumbnail or full image :cat:
     
  28. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
  29. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
    Unfortunately the CGM lasted only one day before falling off. We went back and got another one but it never worked. Got a third on put on today and it never worked, either, so I am done with those. It is too bad because I was so excited to get all that data. It would have been great to see trends. Oh well, sigh. The dr saw Dewey today and said his pancreas looked a little smaller but not normal. We are switching him to Lantus 1u tonight for better coverage. She wants me to do a glucose curve on Thursday and call her with the results Friday. Then a week later she will see him again and do another ultrasound. She said something about diabetic food and I told her the food he was on was Tiki Cat and it has 0 carbs....she seemed surprised. She is good but not THAT good :D. I will read up on the Lantus page tonight and give you an update soon. :cat::cat::cat:
     
  30. Liang & Nathan

    Liang & Nathan Member

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    May 15, 2020
    I read somewhere in this website that somebody said 0 carbs food may not be the best for diabetic cats. They suggested about 3-5% carbs, if I remember it correctly.

    update: here is the link
    https://www.felinediabetes.com/FDMB/threads/feeding-lowest-zero-carb-vs-lower-carb-foods.144220/

    They talked about 3% vs 7% carb.
     
    Last edited: Jul 31, 2020
  31. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
    Interesting. I thought Tiki Cat was one of the recommended brands. Any one else have any thoughts?
     
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  32. Liang & Nathan

    Liang & Nathan Member

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    May 15, 2020
  33. Dusty & Roe

    Dusty & Roe Member

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    Apr 28, 2020
    When my Cat had the Libre on it was put on with surgical glue did they use the same with Dewey ? I also fed Tiki cat and one she really liked was Weruva paw licken chicken it looks like shredded chicken lol
     
  34. Teresa & Buddy

    Teresa & Buddy Well-Known Member

    Joined:
    Jan 2, 2017
    I think the vets always want to sell you food, when you are feeding something they like & will eat they want you to give them something else. Hold on, I know it gets scary, but there are lots of us here that have kitty's that get pancreatitis and sometimes pretty bad, but most of the time with a lot of prayers and medicine we make it through. Hoping, your guy keeps improving and you can get some rest.
     
  35. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Awe cute pics of Dewey, one suggestion, in your signature you might want to say that you switched to Lantus on 7-31 . I see you put it on your SS in the remarks column but it might not be seen, you can also add it on your SS in that brown cell where you have Vetsulin Also if you can add your meter you are testing with to your signature.:cat:
     
  36. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    On carb % of food: I think it's not an "always", it's a "sometimes" that cats do better on food in the 3-5% range than 0%. So it's just something to keep an eye on-- if he likes the Tiki and does well on it, no worries! But if you are getting puzzling BG numbers, switching bumping up the carbs a tad is a (non-intuitive) option.

    Bummer about the Libre. That's one of the frustrations people have had-- some cats just can't seem to keep the monitor on them. My Amber never had to have one, but she did have to have a pain patch a couple times, and they always had a terrible time keeping it stuck to her-- something about how oily her skin was naturally, I think.
     
  37. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Curious, I thought I saw that it's not a good idea to switch to a depot insulin while recovering from illnesses such as DKA/pancreatitis due to the depot taking 3 days to fill. Anyone have info on that?
     
  38. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Try it. If your cat likes it that's a win. Tiki has great ingredients. After a year on Tiki my cat started getting tired of it. Plus I needed lower phosphorus. I give weruva now and she likes it a lot... Esp the play line.
     
  39. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    I didn't know about that. Maybe because he is doing so well it is ok? Or maybe it is since she thought it might have already been resolving when I brought him in? I still have the Vetsulin if he has trouble.
     
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  40. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
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  41. Kristin and Dewey

    Kristin and Dewey Member

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    Jun 26, 2020
    They did use surgical glue the 2nd and 3rd time but the devices didn't work. It also easily came off with the glue so I guess I give up lol,
     
  42. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Yes I saw it mentioned recently but don't remember who said it or if it would apply in Dewey's case. I believe it involved ketones being present though.

    @Bron and Sheba (GA) @Nan & Amber (GA) was it one of you?
     
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  43. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    maybe... I think of this as kind of a situational thing, really, rather than a hard-and-fast rule. Since Dewey is eating well and doesn't seem to have ketones presently, I think the benefits to Lantus in general far outweigh any disadvantage in this case. When cats come home in more precarious situations (for example, when they come home before being truly stabilized) and you need all the help you can get, having a non-depot insulin is probably better.
     
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  44. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    Gotcha, I wanted to double-check for Dewey's safety and since dose was lowered from 3 to 1u I wasn't sure. :)
     
  45. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    :banghead:
    I'm sorry, I missed that, yikes!

    We usually do a 1 to 1 (or close) switch in dosage when switching insulins. Was there a reason why the dose was lowered so much? Looking at Dewey's spreadsheet, he sure doesn't look like a cat that needs that much less insulin, he's still spending almost all his time in ugly numbers.

    Double-checking: did you switch syringes when you switched insulins? Lantus is a U-100 insulin, and the syringes should have an orange cap. They'll be different from the Vetsulin syringes (U-40, red cap).
     
  46. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    Yes I switched to U 100 syringes. I am not sure why it was lowered. I was just so happy about the insulin change that I didn't question it. I just figured it was the way it was done. I am calling her with a glucose curve 1 week post change and hopefully she will increase it then. I don't know, one more thing to worry about it. :nailbiting:
     
  47. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    I'll have to do some digging to refind it but I believe it said switching to a depot insulin you would maintain the dose or give .25u less? I think? Will have to check when I'm on my computer. But I don't think I'd wait, that depot takes a while to fill and you can end up months behind by dropping the dose back.

    Thoughts, Nan?
     
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  48. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    That's the usual. With Dewey's numbers where they are, I don't see much reason to put in that 0.25U safety margin.

    Not sure it's a worry so much as an inconvenience. I doubt Dewey is in any danger, it's just a pain to, as Elizabeth says, have to slowly adjust the dose back to where you were.

    Of course, your vet probably isn't thinking in terms of slowly adjusting dose by 0.25U at a time the way we do!

    How would you feel about going your own way on the insulin dosing from your vet? I do think Dewey would probably be better off with the 3U sooner rather than later, but you'd have to fess up to your vet when you did the curve.

    A lot of us here trust our cat's to a vet's care for everything but FD, and just do all our insulin dosing etc. on our own. Just seems easier for everyone that way :).
     
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  49. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I'm a bit rusty but I think the insulin choice when DKA is in play would depend on the status of the individual cat.

    IIRC, when a cat is hospitalised for DKA typically vets use fairly aggressive insulin therapy (ETA: with short acting, hard hitting insulins) to drive down BG levels and help to restart normal metabolic function. This aggressive therapy is possible at the vets because they can administer glucose intravenously to prevent the cat from hypoglycaemia.

    Speculating a bit here but if the cat is in hospital long enough, normal metabolism has been restored and it has been is restabilised on Lantus then presumably the cat would be able to continue on this basis upon return home. It might depend on the general state of the cat's BG regulation prior to the DKA episode. For general information, insulins like Caninsulin may not be that great duration-wise but they are good for yanking down high BG levels. Lantus on the other hand is not great at pulling down high numbers but it is good at keeping numbers down. Perhaps if the DKA kitty was very well regulated on a low dose of insulin prior to the DKA episode then perhaps their BG regulation might recover faster afterwards and Lantus (or similar) would do the trick? If a cat had not been so well regulated prior to the episode, or if there was an infectious process present to knock it out of good regulation then maybe an insulin other than Lantus could be a more appropriate post-DKA treatment choice, even temporarily?

    Hopefully other members with more knowledge and experience will be able to advise further.


    Mogs
    .
     
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  50. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    Isn't it a separate type of insulin they use in those cases, a very fast-acting insulin that they only use in the ER, not just a typical in-and-out insulin?


    So if kitty had already been on a depot insulin like Lantus it wouldnt be an issue because theoretically the cat would still have some of the depot (I guess depending on how long the cat was in the ER? I don't know how long it takes to fully deplete a depot). Because if a cat had ketones you would want to keep full-dosing as much as possible, but a depot would take a few days for them to actually get "full dose" as the depot fills.

    And right, would it be possible that an in-and-out insulin is a better insulin choice in general, even if the cat had originally been on Lantus - due to the depot being depleted? Hm!
     
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  51. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    It is generally recommended that Lantus/Lev not be used to treat DKA. In most cases with a hospitalized cat, the vets are using Humulin R/Novolin R. It is very short acting and can lower numbers rapidly. In the ER/ICU this gives the vet a great deal of flexibility due to constant monitoring along with the cat being on a dextrose drip. As the kitty is recovering, they transition to a longer acting insulin (often Novolin or Humulin N). Some vets will even ask you to bring your Lantus so they can use a basal/bolus approach. The basal insulin is Lantus and they use R as a "booster" or bolus to bring the numbers down. While it's possible to do this at home if your cat isn't critically ill, you would need an member with experience in using both Lantus and R to guide you through the process.

    Dropping the dose back to 1.0u makes no sense. The numbers weren't great at 3.0u. What was the dose at the vets regardless of what basal insulin was being used?
     
  52. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    If a kitty has come home from hospital after DKA it is not a good time to change over to a depot insulin from Vetsulin or Novolin (or whatever they were discharged on) until ketones are well and truely out of the picture.
    With pancreatitis without the complication of DKA or ketones I think it would be ok to swap over, but probably a good idea to test for ketones in the urine daily for a few days especially if the BGs are high. I agree with others that dropping to 1 unit makes no sense.
     
  53. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    I really appreciate all the advice! I do want to be clear that Dewey never had ketones. He was sick with probable pancreatitis (resolving when we went to the ER, or maybe a chronic case), gastroparesis and gastroenteritis. Some liver enzymes were high (Due to pancreatitis?). As for insulin history, Dewey was placed on Vetsulin at 3u to start, increased to 4u after a week and a vet glucose curve with high BGs, and then increased again to 5u after another glucose curve at the vet's after two more weeks. I started reading on here and then changed from high carb dry food to Tiki Cat wet food and decreased the dose to 3u because of the food change. I then read further about going slowly and increasing in small increments every 3 days. I read about missing the optimal dose so I started back at 1u and slowly increasing. I was later told that I should have increased to 3.5u instead of going back to 1u and starting over so I had misunderstood. I had increased back up to 3u and was about to increase to 3.5 the day Dewey got so sick, vomiting tons, then dry heaving and having liquid diarrhea all over himself. That is when I took him to the ER. He was only there a day. He had a normal stool and was eating great with no signs of DKA. The vet said it was not the typical case of pancreatitis but that something was going on there. I brought him back for an appointment 5 days later and that is when she changed the insulin to Lantus 1u. I assume you all are right about the dosing but the vet wants me to keep him where he is until I do a glucose curve and report to her in a week. While I know she may be wrong I don't want her to get mad enough to refuse treatment. She is so much better than my vet and I live in a small community with limited choices on specialists. With that said his numbers are as bad as ever. I was hoping after the depot was established they would drop some. I do feel quite worried about it because I don't know what I should do. I am stuck between a rock and a hard place because I want to give him a proper dose but don't want to burn bridges with a vet that seems pretty good overall.
     
  54. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Good synopsis of the story so far, Kristin. Thank you!


    Mogs
    .
     
  55. Tomlin

    Tomlin Well-Known Member

    Joined:
    May 30, 2019
    Hi Kristin,

    Pancreatitis &/or other inflammation causes blood glucose to increase and it can be substantial, so even if a depot is established you will see higher numbers. With that being said, the internal medicine specialists will typically adjust the dose during a flare to manage the increase in BG, but it has to be done carefully because as a flare starts to resolve and inflammation decreases, the BG will also decrease and then there is the risk of the dose of insulin being too high. This is more of an issue with a depot vs short acting insulin. Every cat is different so the extent of the increase in BG during a flare as well as how fast or slow it decreases will vary.

    Do not be afraid to express concerns with your current internal medicine specialist and establish a working relationship with them. If you hear, read or think something different from what is being recommended by your specialist, most do not mind explaining why they are approaching treatment a certain way. It is also ok to ask them to reach out to internal medicine specialists who are sub specialists in endocrinology/diabetes. One other option that is always available, is for you to to do a phone consult through Cornell University’s Feline Health Center’s Camuti Feline Health Line:https://www.vet.cornell.edu/departm...ealth-information/camuti-consultation-service). You are able to email records to them and ask for an internal medicine specialist to do the consult-let them know the situation. There is one specialist currently working the service who is a sub specialist in endo. There is also another vet who does calls with the service who is extremely knowledgeable & has extensive experience treating feline diabetes. Again, do not hesitate to have an open discussion with your current specialist &/or express concerns. If they are good, they will always welcome your questions as well as offer discussions about your concerns. They will welcome your desire to learn and involvement with treatment & care :). Even if they said to call in a week & you want to call tomorrow to go over the plan, go ahead and do so. Believe me, I have done this MANY times and no one became angry or upset :p.

    Hang in there! It is really, really great that Dewey is eating :bighug:! Eating can be a serious problem with pancreatitis & one of the early management issues/struggles so the fact that he has a healthy appetite is fantastic! Best to you and Dewey!
     
  56. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    Thank you, Tomlin! I believe I will call tomorrow and see what she thinks of the numbers so far. I may try the consulting option, too, if I feel uneasy after I speak to her. You are so nice to take the time to comment, as is everyone here trying to help. I am so grateful to all of you. If I am a little neurotic about it please forgive me! I just love my little guy so much.
     

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