DKA x 2 this year so far

[Stefani]

Hello

my name is Stefani & I have a newly diagnosed diabetic cat Fleck who is a domestic short hair, and seven years old. He was never sick before this.

Fleck was admitted with two bouts of dka - first admission was mid January for approx 6 days - he was managed with insulin and fluids, and we were started on 1 unit of lantus every 12 hours on discharge.

He then started acting “off” about two weeks after coming home from the vet. We brought him back & he was in DKA again - he was admitted for 8 days, he was discharged yesterday. Treatment while admitted again was iv fluids & insulin, and needed electrolyte replacement after they attempted to stop the iv fluids earlier in his care &became dehydrated. My vet also said he was harder to manage this admission. His fluids were stopped right before I took him home.

But I am still worried about how much water he is consuming and how often he is peeing. He is eating well, and no change in his level of consciousness

his blood glucose since being discharged:

@ 8pm Jan 31: 36 mmol/L (648mg/dl)
—- 2 units lantus given

@ 8am on Feb 1st: 29.8 mmol/L (536mg/dl)
—- 2 units lantus given

@ 8pm Feb 1st: 34.7 mmol/L (627mg/dl)
—- 2 units lantus given

took his blood sugar once more after the last dose & it was 27.6mmol/L (497.3mg/dl) 2 hours after lantus.


Long story short: should I be worried about another DKA bout? Or is this the tail end of the last one? We’ve spent $12,000cad this month on him and cannot afford another admission. Any help is very much appreciated. Thank you kindly

 

[Bron and Sheba (GA)]

Hi and welcome to the forum. I just wanted you to know I have seen your message and will get back to you very shortly
Bron

 

[Bron and Sheba (GA)]

Hi Stefani
I’m so sorry you and Fleck have had to go through this twice in such a short time.
I suspect the second time was because he didn’t fully recover from the first episode.
It sounds as if you are hometesting the BGs (blood glucose) is that correct?
Did the vet send you home with any antinausea medications ?
Did the vet mention doing sub Q fluids at home?
Which country are you living in?

The following is a plan you can follow to help Fleck recover over the next few weeks.

• you need to give one and a half times as many calories as Fleck normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating. Link to food chart below.
• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
• Test daily for ketones. Put the results of the tests into the remarks column of the spreadsheet so we can see. Please report any trace ketones at all. If you are not already testing for ketones you will need a bottle of Ketostix which you can buy from a pharmacy. Alternatively if you don’t think you can get a urine sample from Fleck you can test for blood ketones similarly to doing a blood glucose test. It is more expensive to do that and you would need to buy a blood ketone meter. Link to collecting urine sample below.
• Give antinausea medication if needed. Ondansetron is the best one but you can also use cerenia. It is a good idea to have some on hand in case Fleck gets nauseated when the vet is closed. Nausea is very common in post DKA cats.
• Give appetite stimulant if needed after the antinausea medication
• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
• Ask the vet about subQ fluids. This can help keep Fleck hydrated is he is prone to getting dehydrated at the moment. You need to get a clearance from the vet to give these fluids as the vet needs to check Flecks heart is ok first.
• Set up a spreadsheet and test the BG frequently. Link below. If you have any trouble setting it up ask and we will help.
• Post daily with updates and ask for help as often as needed. This is important.

FOOD CHART look for foods that are 10% or under carbs

HINTS ON COLLECTING A URINE SAMPLE

HELP US HELP YOU this has the link to the Ss and the signature and the hypo kit

[QUOTE="Stefani, post: 3242732, member: 42467"]his blood glucose since being discharged:
@ 8pm Jan 31: 36 mmol/L
—- 2 units lantus given
@ 8am on Feb 1st: 29.8 mmol/L
—- 2 units lantus given
@ 8pm Feb 1st: 34.7 mmol/L
—- 2 units lantus given
took his blood sugar once more after the last dose & it was 27.6mm/L 2 hours after lantus.[/QUOTE]

Are you able to get some tests in during the cycles? Lantus dosing is based on how low the dose takes the kitty, not the preshot.
It is possible Fleck could be bouncing at the moment. The only way to find out is to see some mid cycle tests as ell as the preshot BGs.
Here is an explanation on bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

[Stefani]

Hello Bron & Sheba
Thank you very much for your reply.

I am living in Toronto, Canada. I am home testing his bg every 12 hours pre insulin.
No anti nausea meds were sent, nor any subcutaneous fluids, and my vet is not open until tomorrow.
He is on zenoquin once daily, and tylosin twice a day.

Overnight tonight he seems to be less interested in food, and has been sleeping for most of the night. He has insulin due in about 5 hrs & I have not been able to get him to eat at all since his last dose. If hes not eating properly but his blood glucose was in the 20s, would it be be ok to give? I worry about hypoglycemia, but I also worry about the dka.

I am testing for ketones, but the litter I use is causing some staining on the strips… I can only see they are not turning the purple to indicate a high value of ketones. Also, is cat pedialyte a thing? Thank you so much for your reply.

Im going to attempt to get bg after his next dose to see if he is bouncing.

 

[Stefani]

Feb 1st @ 8pm: 34.7 mmol/L (627mg/dl)
—- 2 units lantus given

Feb 1st @ 10 pm: 27.6mmol/L (497.3mg/dl) 2 hours after lantus

^would that value signify he is not bouncing? Thanks again. So very much appreciated

 

[Bron and Sheba (GA)]

He is on zenoquin once daily, and tylosin twice a day.

What was he put on those for?

am testing for ketones, but the litter I use is causing some staining on the strips… I can only see they are not turning the purple to indicate a high value of ketones

I would try and get a speciman of urine from him. Try putting a spoon under him or just the strip u dr the stream of urine. Remember to read it at 15 seconds.

Also, is cat pedialyte a thing?

You would need to get the one that has no flavour or added sugar. However I would ask the vet about the sub Q fluids.

Overnight tonight he seems to be less interested in food, and has been sleeping for most of the night. He has insulin due in about 5 hrs & I have not been able to get him to eat at all since his last dose. If hes not eating properly but his blood glucose was in the 20s, would it be be ok to give? I worry about hypoglycemia, but I also worry about the dka.

Yes you can give the dose if the preshot BG is in the 20s (above 360 in the US numbers). And you test during the cycle.
I am concerned he has not eaten since the last dose. We need him to be eating every couple of hours to make sure he is getting 1 and a 1/2 times as many calories as normal. This is important. Try giving him anything he will eat. Don’t worry if it is not low carb.
Food is like a medicine for post DKA cats.

Im going to attempt to get bg after his next dose to see if he is bouncing.

To see if he is bouncing we need to see a couple of days worth of BGs. We would look for a low number followed by a high number, or a fast drop in numbers, or a drop to a BG number he is no longer used to, becasue he now thinks the high numbers are the normal numbers.

I worry about hypoglycemia, but I also worry about the dka.

To help stop these things happening, make sure you have a hypo kit set up with some high carb food and some honey in case it is needed.
And home testing will keep him safe if testing often enough.
As far as the DKA is concerned…you need to concentrate on

• Plenty of food
• Give the doses of insulin
• Test daily for ketones
• Give some extra fluids in the food if he will accept that.
• Ask about the sub Q fluids.

 

[Hendrick Cuddleclaw]

Hi and welcome to the group. My boy Hendrick almost died from DKA, he had to be hospitalized for a few days but thankfully recovered. However, if it weren't for the wonderful people here like Bron and others, he almost certainly would have had another DKA episode.

As mentioned, testing for ketones a couple times a day can be huge, so you can see if kitty is trending in the wrong direction. We used a blood ketone meter, the Nova Max+ , but the ketone test strips were like 2 bucks a piece. ouch. Pretty expensive but thankfully we only needed them for a few weeks to a month.

I wish you and Fleck the best of luck keeping the DKA away! And getting those high BG numbers down too! Lantus is a great insulin for cats, good news that you're already using it. Lantus is what helped my boy go into diabetic remission and become a diet-controlled diabetic feline.