GA [Continued] DKA happening now, on feeding tube; can't afford 4th hospital stay in 2 months

@Bron and Sheba (GA) @Diane Tyler's Mom @Deborah & Muffy(GA) & Wendall @Wendy&Neko

The original thread was getting long, so I'm starting a new one here with Princess Tortilla's updates

We took her to her primary care vet this morning to get subcutaneous fluids. They gave us Lactated Ringers and instructed us to give 50 ml once a day. They did a demo on her there, so I will attempt tomorrow.

She's been reading HI on the Libre since we brought her home 2 days ago. At the vet this morning (1.5 hours pre-shot) she was 481 on the Alphatrak. This vet and our internal medicine specialists advised us to go up to 2 units today, so that's what I did.. but then the Libre sensor stopped working... because of course... ugh! We were supposed to have 11 more days on it. It's been about 1 hour since I gave her the 2 units.

My Relion meter from Amazon is supposed to arrive tomorrow, but since she's never had 2 units before, I really need to see how low it's going to take her this afternoon.

I'm not near a Walmart to get a Relion - how important is it to get that one? I can easily get to a CVS or Walgreens. If anyone has a recommendation for any of the meters the drugstores have in stock, please let me know! Otherwise I'll just get one I see in the store.
- CVS Health True Metrix ?
- Walgreens brand True Metrix ?
are these two the same?

Oh and she has tolerated 2 tube feedings of 30 ml each so far today with no vomiting, even with the clavamox - yay!

 

Glad you got the fluids to give at home and great news about her keeping the food down
Anyone of those meters are fine, at least you will have another backup with the Relion

 

You can use any human meter. Most of the meters will come with some extra strips. The only benefit with the Relion meter is that the strips are inexpensive. Pick up a meter that you can use until the Relion is delivered. It never hurts to have a backup.

 

If you get another meter, just try for one that needs a smaller blood drop and cheaper test strips.

 

Alright, I picked up the True Metrix from Walgreens as it was the only option ($22 for the meter, $5 for 30 test strips). She's reading 483 mg/dl at +4. AMPS Was 481 mg/dl with the Alphatrak at the vet. This was her first dose on 2 units of Lantus (we were previously giving 1.5 units and 1 unit before that)... I did give her 30 ml of food through her e-tube between +1 and +2 since the doctors instructed us to give her small meals throughout the day, not sure if that is keeping her BG elevated.

 

What food are you feeding through the feeding tube? The feeds should not be keeping the BGs elevated unless they are high carb.
Have you tested recently for ketones ?
How do you feel Princess Tortilla is today?

 

I'm feeding a slurry made by blending 10 ml water per can of Purina Pro Plan DM canned food. I'm using the Minced (Pate) which says it's less than 8% carbs. Good to know the feeds shouldn't be keeping BGs elevated. I asked her internal medicine doctor if we should increase from 2 units tonight but haven't heard back yet.

I haven't tested for ketones since she got back from the hospital 2 days ago. She tested "trace" on 1/5 and negative from 1/6 to 1/9.

I feel like she is really suffering she sits next to her water bowl with her head slumped in.. she wobbles around with her tail low.. she keeps her eyes closed when she's sitting (she has a corneal ulcer in her right eye we're treating with ointment and drops, but I'm told they're pretty painful), and she'll let out a sad meow every now and then.

 

I would not increase the dose any higher at the moment, especially if the ketones are negative. Can you test for ketones today?
Lantus takes 3 days for the depot to fill and the full effect of the dose to be felt.
Is she showing any interest in eating on her own at all?

 

Ah, I see. I'll keep doing 2 units. She hasn't shown any interest in eating on her own.. I offered her favorite treat earlier (salmon tiki stix) and she didn't react...

Yeah I can try to test for ketones.

We're also going to stop the clavamox since her urine culture returned negative (so, no kidney infection?). Maybe if she was feeling any side effects from that they'll subside?

From googling: "What are some of the possible side effects of Clavamox? The most often reported side effects in dogs and cats include inappetence, lethargy, vomiting, and diarrhea."​

 

This just breaks my heart reading this. Poor baby. You are doing a great job taking care of her. Always praying for her to get better

 

Happy to hear things went okay at the vet and you got the good fluids.

I don't like that she's still hanging over the water though and after all she's been through, I'm concerned that 50 ml is not going to be enough to keep her hydrated. How much does Princess weigh? When they give fluids there's a little pouch that forms, usually on the side above/ behind a front leg. If that's not there, it means she's already absorbed all the fluids.

It's going to take time to see any real improvement so please don't get discouraged. You really are doing great.

Does anyone else find it ironic that many vets who are opposed to using human meters are perfectly happy to glue those Libre things, also for humans, onto a cat?

 

Thank you so much for the support and encouragement @Diane Tyler's Mom @Deborah & Muffy(GA) & Wendall
It's been a lot to handle mentally and emotionally. I haven't really been able to work since she's been on the tube and those feedings take up the whole day and evening.

I agree hanging over the water bowl is concerning us too... I haven't been able to catch her peeing tonight to test for ketones (I did see 2 normal poops today, so I'm happy about that)

Today at the vet she weighed in at 8.7 pounds, and he said aloud he was using this figure to calculate the right amount of fluid to give her. The profile picture here is a healthy 11-12 pounds.

I just used the TrueMetrix to test her PMPS just now: 333 mg/dl! She is down a lot from 483 at at +4 earlier today and 481 AMPS (AMPS was read by an Alphatrak at the vet).
We gave 2 units again. This is fine & what we were hoping for with the increase to 2 units, right? Now I'm paranoid she'll go too low overnight lol

I remember someone saying on the old thread the alphatrak was heavily marketed to vets so I guess most of them have only used that one? My vet today used it and the vet at the ER said she's only seen alphatrak used in hospitals. I definitely have some beef with the Libres though. Each one was about $100 at the hospital and the last 3 we had stopped working before the full 14 days were up.

 

I would get a +2 to see what is happening this coming cycle. It is possible she is coming off the bounce and could drop further.

 

Ok I can do that!

 

Hi Tiffany just a suggestion when you test with the truemetrix I would put that in the cell , members might not see it in your remarks section or read it in your posts

 

340 at +2.5
Idk if it’s just the learning curve of using a meter but I had to use 6 test strips to get this reading many E-0 readings.. hopefully it just gets easier with time!

 

50 ml is what I gave my 5.5 lb. senior kitty. If Princess were my cat, I'd go for at least 75 and preferably 100 ml tomorrow. Fluids will make her pee more, diluting some of the sugar and should help bring down her blood glucose levels. All that excess sugar in her system is part of what's making her so thirsty and feel so lousy. It's good that you'll be testing and great job on getting that test, by the way!

Personally, I couldn't put one of those Libre things on a cat. They're so fussy about grooming and having to use clothes or an E-collar to prevent removal would make them very unhappy.

When the AlphaTrak first came out in 2006 one of the members here, Hope, did a comparison with several meters, including the AT. Her conclusion was that the AT was no better than a human meter and not worth the price. You can read about it here: http://www.felinediabetes.com/glucometer.htm

I've been at this since 2004 when there were no special pet glucometers. All of us here - and most vets - used the human ones. When a glucometer manufacturer became aware of this, they capitalized on it by 'creating' one specifically for animals, which actually was an Alphatrak label stuck on a Freestyle meter. Seriously, the original label was underneath. Then they convinced vets that measuring glucose in blood was somehow different for animals, a clever marketing strategy. Blood is blood, sugar is sugar. It's not that complicated.

I had the opportunity to compare my human meter (Contour) with my vet's AT a couple of years ago and there was a negligible 15 pt. difference. And years before that we compared my meter to a jugular draw and got a 7 pt. difference. And got my result faster that the fancy vet machine

 

Can you add that into the SS please ? Maybe you are not adding enough blood into the strip. What does E -0 reading mean on that meter?

 

Are you back to using the libre? If not

Hi Tiffany just a suggestion when you test with the truemetrix I would put that in the cell , members might not see it in your remarks section or read it in your posts
Or note it next to the BG

 

"E-0. The system will trigger an E-0 error message when it detects an HCT range that is < 20% or > 70%"
I guess because she is anemic her range is low and that's triggering this error?

Also I noticed that I need to touch the tip basically perpendicular to the blood drop and try not to get any on the back of the strip. When I've gotten blood on the back it also gives an error...

 

I was adding a note on each cell with the meter name but just realized you can't see them on the web published version! I added the meter name into the cells next to the BG number, that way the conditional formatting still works for color coding each number.

549 AMPS this morning... looks like she's been really high in the mornings

 

Hello and hugs to Princess Tortilla I was just passing through and saw you picked up a True Metrix glucometer as well. It was also the only one at our pharmacy and the strips do not cost as much as the more popular brands. Anyway, I was going to say to dip the strip at a 90 degree angle to the blood drop but I see you’ve already figured it out!

I think the True Metrix really doesn’t need a big drop but it does want enough to run up the little sensor thingie. I went through many strips before getting the technique down.

Not sure if helpful for your or anybody but Henry doesn’t like his ears to be touched, but if I roll up a small gauze to hold his ear tip, and poke from the back (the furry side) he doesn’t mind it at all.

Again hugs to the Princess!

 

Thank you! Yes, I can see why people were saying you run through the strips so quickly - not just from testing multiple times a day but sometimes having to do multiple attempts!

 

This morning Princess was 106 before her AM shot time, so I didn't give insulin. It's the morning of the third day of giving 2 units, so maybe she's now feeling the effects of the 2 units?

Also, we've been doing subq fluids for 2 days now, and she hasn't vomited in those 2 days! She still isn't interested in eating, but the subq fluids have been helping her keep food down.

Speaking of food - her poops have been soft and SOOO stinky!! Yesterday and the day before, her poops were a light brown and soft. She pooped 3 times yesterday and twice the day before. Before, her poops were smaller, darker, firmer, and more normal looking. I looked through some older threads on here like this one where it was suggested possible issues with the pancreas causing digestion problems. She's been on the same food for the last month and this only just started happening, so I don't know if it's the food itself or if she's developed digestion issues.

There was also a suggestion that smellier poops could be correlated with high BG, but for Princess, she was just as high if not higher last week when her poops were normal (firm, dark, nuggety). Any thoughts? I sent this info to her doctor as well.

 

Sounds like Princess might be starting to turn the corner. Well done!

Her poops are softer because she's better hydrated and stinky because it's Purina DM. It's a common complaint and just one of the reasons people switch. You probably didn't notice the odor before because they were so dry. Have you offered her any other foods to temp her to eat on her own? There's really nothing magical or special about DM except the price.

 

Tiffany, what meter are you using on the SS now?
Can you clarify please. If possible
E it is better to stick with one meter as using 2meters when one is a pet meter and the other a human meter is very confusing to work out what the BGs actually are…thanks

Its not a good idea to skip Amy doses of insulin with DKA in the picture.
I would reduce the dose to 1.75 units and stay at that dose, to see if you can shoot both cycles. can you get some tests in during the pm cycles. She dropped during the pm cycle last night.

I would really commend you get some Hills A/d and offer it to her to see if she will eat it herself. Cats like it.
She is probably off all her usual food as she probably associates it with feeling sick and won’t want to eat it.

 

Oh I see, that makes sense. I've offered her favorite treat, Tiki Stix, and her favorite flavor of her usual food, Smalls Chicken, as well as chicken baby food, which she was interested in at the hospital.

I've been giving her mirtazipine for her appetite too. No luck getting her to eat. I suspect the pain from her corneal ulcer may also be keeping her from eating
I did get some Hills m/d from another diabetic cat parent. I could try offering that orally tonight.

I'm using the TrueMetrix on the SS now. The Alphatrak was just used one time at the vet's office because that's what they had there. But our internal medicine vet wants to get her back on the Libre to have continuous monitoring since her levels are fluctuating so much.

Ok so we should just keep feeding and testing until her number is high enough and then shoot? Yes, we can try to move her insulin time earlier so we can get some tests in during the PM cycles. Her shot times are currently 11am/11pm, so it's been hard to get those PM cycle tests. But since we missed this morning's shot, we can move the time up, right?

 

If you get a lower than normal preshot again. Stall, don’t feed and test again in 20 minutes. And post and ask for help
Yes, because you have skipped the am dose you can bring the PMPS back to where you want it. It’s a really good chance to get back to normal.

 

Ok got it. Right now it's 6:30pm, I just tested and got 103. This morning (7.5 hours ago) she was at 106. I didn't do any other tests today but am a little confused by these numbers.
I still plan on feeding her about 100 more calories today.

 

Keep getting some tests in during this cycle so we can see what’s happening.
When did you want to do the PMPS?

 

I see you are using the Relion Meter on your SS , will you be using that from now on ?
@Princess Tortilla

 

How are things today Tiffany?

 

We had to say goodbye to Princess Tortilla over the weekend.

Her condition declined rapidly over the course of an afternoon and evening; she'd gotten very pale and was peeing/pooping all over the place. It was when she started letting out these long, low cries that I knew she was telling us it was her time to go. Luckily her primary care doctor was able to take care of us privately after hours in his office.

We are so heartbroken but we know we did our absolute best for her - many many thanks to you all here in the FDMB. We would not have made it this far without this community and are so grateful for the help and support.

Here is Miss Princess during happy days about a year ago:


and in her favorite spot on the bed:

 

I am so very sorry for your loss. Fly free little one and land softly.

 

Tiffany, I am so sorry to hear about your loss. She knows how much you love her and did everything you could for her.

Fly free sweet Princess Tortilla and watch over everyone who loves you.
.

 

Tiffany, I am so so sorry to hear that you had to help Princess Tortilla cross the rainbow bridge.
You tried everything possible to help her get better but it was not to be.
She knew how much you loved her and tried to help her..
I know how much you will be hurting but you must take comfort in knowing you did every possible thing and when she told you it was time, you did the kindness thing you could do and helped her cross.
Fly free Princess Tortilla and land softly at the rainbow bridge

 

I am sorry for the loss of your beautiful Princess Tortilla you did everything you could for herlots of hugs, take care of yourself

 

You gave her the gift of love and then the gift of releasing her from that pain.
Some people are never able to hear that last request, you did because you loved her and she is thankful for that. Fly softly Princess Tortilla

 

Tiffany Im so sorry to hear about Princess Tortilla , as all of us have said you did everything you could to help her and she knew it. Fly high sweet girl, I'm sure all the kitties were there to greet you and you are chasing butterflies with them.
Come and visit your mama so she knows you're ok.
Take care of yourself Tiffany

 

Thank you so much, everyone <3 These messages mean so much

 

Hi Bron!
Just wanted to chime in about AD --it was a miracle for my boys especially when they were not feeling well ...it is easy to eat .

 

I am so sorry .....you gave her the last gift you could, peace and free from pain