? Elmo had DKA emergency, under control but little awareness. Considering bringing him home

My 7.5 year old orange Tabby Elmo is currently at the emergency vet.

Timeline of events:

Sat 10/2: Throwing up 3-4 times at night, first time all food, then just water. Stopped eating, but is drinking.
Sun 10/3: Throwing up 5-6 times at night, not eating, very slow and lethargic. Drinking water. Slowly walks upstairs.
Mon 10/4: We take him to his primary vet at 8am. Vet says BG is 640 and needs to be taken to a 24hr emergency immediately and has DKA and UTI. We take him to the emergency vet at 12pm. Over the course of the next 24 hours, they bring his BG down and stabilizes him and infection clears up. They sedate him to insert tubes and hook him up to IV.
Tues 10/05: Elmo's awareness is very low. He is not eating, or standing up. They give him a feeding tube through the nose and calcium supplement, appetite stimulant. At this point, his BG is under control and infection cleared up, but he is not standing up and has little awareness. When we went to visit him, he was able to sit up for a moment but came down and had no interest in food. I had a bad feeling about the vets. They seemed like they had given up on him, even though we agreed on a feeding tube as the next step.

Wednesday 10/06 - Apparently Elmo's condition improved since last night. He was able to stand up and walk outside of his crate and had regained some awareness (according to the neurologist). After speaking with our primary vet, she recommends that we bring him home and try to nurse him back to health and let him recover slowly in his home. ER Vets are unsure what is causing this, but I have a feeling he needs to just recover slowly from the DKA. It's only been 48 hrs and I've read online that it can take up to a week for cats to fully recover.

We plan to bring him home and feed him through the feeding tube (nasal) and hope that he slowly starts to eat on his own. I don't feel comfortable leaving him at this ER vet. Has anyone gone through DKA and have any insight or tips on the situation, tips on recovery, anything? Please let me know if there's any information that may help.

Thank you and apologies for the long post. The past 3 days have been a rollercoaster of emotions and events for our family and we sincerely hope that none of you have to go through this.

 

I'm so sorry about Elmo
I can tag a few members for you but first looking at your spreadsheet you haven't been testing everyday looks like you've been testing monthly. There are no test for the rest of Sept and no test after giving insulin after his night time shot
@Sienne and Gabby (GA)

@Wendy&Neko

@tiffmaxee


Some previous posts


https://www.felinediabetes.com/FDMB...s-returns-after-progress.241490/#post-2726368

https://www.felinediabetes.com/FDMB...betes-after-leg-weakness.240249/#post-2706106

 

Sorry about the DKA. Like Diane said we need more recent testing. Has he been on 1.0 all this time? I’m not a Vetsulin user as it’s really not a good insulin for cats. Can you switch to prozinc, Lantus, or Levimir soon to get him into better numbers?

 

I am sorry you and Elmo are going through DKA. It can be very scary.
Once you get Elmo home you will be busy for a week or two helping him recover.
There are things you can do before he comes home to be prepared:

• buy Ketostix for testing ketones. Can be bought from Walmart in the US or a pharmacy.

• Ask the vet for antinausea medication such as cerenia or ondansetron. Most post DKA kitties are nauseated for a time.

• May also need an appetite stimulant. Always give the antinausea medication first before the appetite stimulant.

• Ask the vet about giving sub Q fluids at home

• Get a range of canned food for when Elmo gets home including some higher carb foods.

• Make sure spreadsheet and the signature are up to date

• Get a copy of the path results from the ER

Once you get home

• you need to give one and a half times as many calories as Elmo 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,
• 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 SS so we can see. Please report any trace ketones at all.
• Give antinausea medication if needed
• 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
• Maintain the spreadsheet and test the BG frequently
• Post daily with updates and ask for help as often as needed.

You are going to have to test a lot more than you have been doing, to ensure that Elmo remains safe.
At this point I would stick with the vetsulin (or Prozinc) as you need an ‘in and out “ insulin until Elmo is well last getting any ketones. This could be several weeks. Once you get past this point, then look at swapping to Lantus or Lev.
Insulins like Lantus amd levemir, while they are excellent insulins for cats, take several days for the depot to fill in the beginning, and there is a risk during that time that ketones could reform.

I think you could take down the 911 now as your questions have been answered

 

Please remove the 911.

 

I've taken down the 911. Bron has given you a very detailed plan and checklist. My only comment is that ondansetron is a better choice of anti-nausea than Cerenia, but Cerenia is better if they are vomiting. You can also give both.

 

My cat Buddy was hospitalized for 5 days for DKA two months ago, along with severe pancreatitis and also had a UTI. They told us that her prognosis was guarded to poor- it really looked like we were going to lose her. Vet care is so expensive here, and it cost us 10k and insane stress and worry. But she made it home, and as of yesterday, she’s been home for 2 months and thriving!

Bringing her home was scary, stressful and hard work at first- but with the help of this group, and especially the amazing advice of @Bron and Sheba (GA), who we can never thank enough, she improved!

My best advice is to follow all of the wonderful advice she outlined above. It’s super important to get lots of calories and water into them.

A few things we learned from our experience:

- My cat needed an appetite stimulant for two weeks or so. She’d never had them before, and I was reluctant to give them- but they helped, and eventually she didn’t need them any more.

-When she first came home, it was less important *what* she ate, and more important *that* she ate. At first, that meant we were giving lots of high carb food, and sometimes a bit of dry food/treats. Eventually, she went back to her regular low carb fancy feast, but it did take a few weeks before she would reliably eat only FF again.

- Greenies pill pocket saved our lives. Giving our cat pills would have been an impossible nightmare without them- and we were giving like 10 pills a day! With these treats, you shove the pill on them, and the cat (truly) has no idea.

- Test for ketones consistently- at least once a day. The only way we could catch her pee was to wait till she started going, and shove a plastic container lid under her, and then she would pee on that. Eventually we switched to a blood ketone reader, which is way more expensive (the strips are $2.50 where we are in Canada, and we test for ketones twice a day) but worth it for the convenience and accuracy- it gave us peace of mind. We track the ketones in our spreadsheet, so take a look if interested

- Anti nausea meds have been a life saver. She is still on them after two months, though way less frequently and at a lower dose. The hospital did not want to give them to us, for some reason. In fact, they refused at first. I kept calling and asking, until they relented. It was worth it and played a huge part in her recovery. We started on cerenia, and then got an ondansetron prescription from our regular vet. Both work well for our cat- sometimes if she’s extra nauseous she needs both, other times just one does the trick.

- If possible, keep some subcutaneous fluids on hand. This was another thing the emergency vet refused to supply us with- so I went to my normal vet and begged. Whenever Buddy would start to show ketones, we would give her 100ml of subq fluids, and it seemed to make a big difference. We plan to always keep a bag on hand just in case. (It’s not too hard to learn how to give the fluids, though it is easier to do with two people!)

- If you need a med, or fluids, and the emergency vet won’t give it to you, ask your regular vet, and vice versa. Don’t be afraid to advocate for your cat!

Thinking of you, and wishing you and Elmo well. Dont be afraid to ask questions here as there is a lot of help to be found here!

Buddy’s mama

 

@DArcey and Buddy, it is so good to hear from you and see Buddy’s progress!
Thank you for posting all that wonderful information about how you managed Buddy’s recovery for Elmo.

 

@Elmo's Mama My boy Cooper is very new diabetic and actually suffered from DKA and pancreatitis within a few weeks of being diagnosed.

Cooper ended up being in an ER vet for 5 days. We didn’t want to take him home until he was off of tube feeding and under control to where we could just start our routine with him and hope that we could manage him right.

This all was a complete shock. Cooper was a normal, crazy, playful cat and then he just randomly lost most of his appetite to every type of food. Thinking it was his teeth we scheduled a teeth cleaning and our vet informed us of potential diabetes. After further tests it was confirmed and our life immediately became wrapped around how to handle Cooper and make sure he was ok.

Literally in the matter of 10 days he went from having what we thought were teeth problems to being ER bound and us being told there is a chance Cooper (only just about to turn 4) could not make it. The emotional and mental pain me and my fiancé went through was literally the worst we have ever felt. We felt like even if we made it out of this are we good enough and smart enough to make sure Cooper gets the care that he needs.

The biggest thing I can say for you to do is make sure you get the keto sticks and get comfortable with testing Elmo’s BG. I try to test Cooper’s urine for ketones once a day as that will be your sign that you need to get Elmo care. Also, get in as many BG tests as you can so you can better understand how Elmo’s numbers work and if the insulin you’re using is working. I am still questioning at points whether we are doing the right things for Cooper but we think back on it now and we now have our fun loving, insane little boy back who has to get into everything and cause as much mischief as he can. He lost that for what seemed like forever and testing him and keeping him on the schedule we came up with has been what I believe is keeping him ok at this point. He had adapted extremely well and I was absolutely horrified about testing him. He even enjoys the testing now because he gets freeze dried treats which he absolutely goes nuts over.

Most important is to stay calm and confident in yourself to manage this. Like I said, I still question if I’m doing right for Cooper but then other times I feel proud that I was able to bring him back from such a low point to now even him knowing that he needs to come out from hiding whenever it’s testing or insulin time.

I am not a veteran in this by any means but please let me know if you have any questions and I’ll try my best to help. The most important thing is you’re getting through the hardest part of this. Now let’s make sure Elmo bounces back stronger than ever

 

Hi can you please add DKA and UTI in your signature so members know and the date. It is important we know this Thank you

 

My kitty was in the hospital for a week with DKA. From not eating he developed hepatic lipidosis. Having an esophageal feeding tube placed saved his life because he was able to get the nutrients that he needed. He did need to be at the ER vet for all those days though because they really had to work to stabilize his electrolytes through the IV. If they are out of whack it is dangerous. Is your kitty home now?