New here: Need advice on DKA, possible euthanasia

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Trigger warning: asking about euthanasia

I am new to the group and have a 13 year old cat, Vesper, who is my absolute soulmate in life. Unfortunately, I could use some advice on a very emotional subject.

Vesper’s first episode of DKA happened in 2022. It was very bad and resulted in fatty liver disease and she was on an esophageal feeding tube at home for 4 weeks. It was very difficult, but we got her through it, and she was diagnosed with diabetes and put on Novolin.

We thought we achieved stability but didn’t know about this group or home testing. The vet thought she was going into remission and we lowered her dose from 3 units to 1 unit last fall. In the past 2 months, she has lost a significant amount of weight.

She vomited and stopped eating last Wednesday so we rushed her to the hospital, and they admitted her and she was diagnosed with her second DKA episode. She was hospitalized for 3 days and rebounded faster than they thought. She was out of her acidotic state and discharged on Saturday and placed on Lantus. They noted that she had some evidence of chronic pancreatitis and think that may have caused the DKA.

Within 24 hours of being home, she urinated outside of her box 4x, which was highly unusual. She acted very hungry but didn’t eat a ton and still seemed a bit off (was hiding, not snuggling). We brought her back to the ER last night and they found ketones in her blood (level 15) and admitted her.

This morning, we were told she is acidotic again. Her ketones are 40, and she is not showing much interest in food. They are estimating another week in the hospital.

I always said I would never let finances get in the way of treating Vesper, and enrolled in pet insurance when she was 8 weeks old to prevent exactly that. But pet insurance has maxed out for these conditions at $3k, and we are currently up to $17k, not including any upcoming hospitalization, which is estimated to be another $15k.

I’m at a total loss at this point about what to do. Another 7 days in the hospital will be at least $15k more. They said she’s not currently in pain and could potentially recover but also that she could have DKA again and don’t know if she will be able to get her diabetes under control. They do not think home treatment is possible due to her current electrolyte disturbances.

They are holding off on further diagnostic tests at this point to focus on keeping costs down and treat her DKA.
I never thought I’d be in this situation, and was so encouraged to join this group and learn about home testing and Lantus. So now I’m hoping for this group’s wisdom about what we should do moving forward. Are there viable paths that we aren’t thinking about? Are there other questions we should be asking? We have reached the point where we are thinking about euthanasia but the thought makes me sick knowing that she could recover from this. But we also don't have $30k and hate to put her through more treatment if this is going to be futile.

I don’t know what I’m looking for—just a sounding board and to make sure we’re not missing anything? Thank you for reading. My heart is shattered.
 
Trigger warning: asking about euthanasia

I am new to the group and have a 13 year old cat, Vesper, who is my absolute soulmate in life. Unfortunately, I could use some advice on a very emotional subject.

Vesper’s first episode of DKA happened in 2022. It was very bad and resulted in fatty liver disease and she was on an esophageal feeding tube at home for 4 weeks. It was very difficult, but we got her through it, and she was diagnosed with diabetes and put on Novolin.

We thought we achieved stability but didn’t know about this group or home testing. The vet thought she was going into remission and we lowered her dose from 3 units to 1 unit last fall. In the past 2 months, she has lost a significant amount of weight.

She vomited and stopped eating last Wednesday so we rushed her to the hospital, and they admitted her and she was diagnosed with her second DKA episode. She was hospitalized for 3 days and rebounded faster than they thought. She was out of her acidotic state and discharged on Saturday and placed on Lantus. They noted that she had some evidence of chronic pancreatitis and think that may have caused the DKA.

Within 24 hours of being home, she urinated outside of her box 4x, which was highly unusual. She acted very hungry but didn’t eat a ton and still seemed a bit off (was hiding, not snuggling). We brought her back to the ER last night and they found ketones in her blood (level 15) and admitted her.

This morning, we were told she is acidotic again. Her ketones are 40, and she is not showing much interest in food. They are estimating another week in the hospital.

I always said I would never let finances get in the way of treating Vesper, and enrolled in pet insurance when she was 8 weeks old to prevent exactly that. But pet insurance has maxed out for these conditions at $3k, and we are currently up to $17k, not including any upcoming hospitalization, which is estimated to be another $15k.

I’m at a total loss at this point about what to do. Another 7 days in the hospital will be at least $15k more. They said she’s not currently in pain and could potentially recover but also that she could have DKA again and don’t know if she will be able to get her diabetes under control. They do not think home treatment is possible due to her current electrolyte disturbances.

They are holding off on further diagnostic tests at this point to focus on keeping costs down and treat her DKA.
I never thought I’d be in this situation, and was so encouraged to join this group and learn about home testing and Lantus. So now I’m hoping for this group’s wisdom about what we should do moving forward. Are there viable paths that we aren’t thinking about? Are there other questions we should be asking? We have reached the point where we are thinking about euthanasia but the thought makes me sick knowing that she could recover from this. But we also don't have $30k and hate to put her through more treatment if this is going to be futile.

I don’t know what I’m looking for—just a sounding board and to make sure we’re not missing anything? Thank you for reading. My heart is shattered.

I'm so sorry this is happening to you and Vesper . I tagged Bron for you who is very knowledgeable about DKA
@Bron and Sheba (GA)
 
I am so sorry you and Vesper are in this situation. DKA is certainly treatable if caught early and treatment started which sounds as if that is the case with Vesper.:bighug:
I don’t know if she would need to stay in hospital another 7 days if they are getting things under control. Most cats stay in for 3 or 4 days and are then discharged. But it depends how the blood work is going and if they are stable in that area.
Just going forward to kitties who are discharged, we have a plan on how to help you through the first few weeks and then things you can do to make sure she does not get into that situation again.
We can certainly help you once she gets home with a plan and we can support you through the following few weeks and beyond. Vesper is only 13 years old so I personally would not consider euthanasia but she is your kitty and you must decide.
Yes if you could post the lab work that would be great.
I am assuming she is on a IV drip and having treatment to get electrolytes back in balance.
Is she eating anything at the moment?
 
Kelly, DKA is caused when there is not enough insulin, not enough food and an infection or inflammation present. That is the recipe for DKA. Cats always get ketones before DKA and it is important to monitor for them if the cat is prone to them and is unwell, not eating or just seems generally off colour. That way you can treat the ketones before they progress into DKA.
She does need to stay in hospital until the electrolytes have been corrected.
We would encourage you to hometest the blood glucose so that you can see how the insulin is affecting the BG (blood glucose).
We see quite a few kitties with DKA and the vast majority go on to live happy lives. Food and insulin is very important in their recovery and lives moving forward. And if you are hometesting and following one of our dosing methods you have a good chance of regulation.
We cannot predict the future but if you think you can manage financially, and you are willing to follow our post DKA plan, hometest the BGs moving forward, and post here for assistance, you will be giving Vesper the best possible chance of a good future.
 
Thank you for responding and helping us. The last thing I want to consider is euthanasia but the finances are becoming unbearable. Getting her through this next round of DKA will put us up to nearly $30k and into debt. But we are waiting until at least tomorrow to see if she is showing signs of improvement. She did bounce back after her first episode of DKA in 2022, so we know it's possible, but I'm not sure why she relapsed after just one day this time.

She did not eat during her DKA in 2022 which is why she needed the feeding tube. She did eat during last week's DKA. She is currently only eating a little bit so a feeding tube is likely going to be necessary.

If we can get her through this, I would do whatever program needed, including frequent home tests. I already bought all the stuff including Relion monitors and ketone strips. But again, I'm concerned that she relapsed so quickly, is showing less interest in food this time, and about the incredibly burdensome finances of it all.

Her lab work from 10:43 am this morning:
Test Results Unit Lowest Value Highest Value Qualifier
IP 4.6 mg/dl 2.6 6.0
Mg 1.7 mg/dl 1.8 2.7

Ketones 40 (no unit of measurement given)

Here are some from earlier this morning:

01-27-2025 7:49:06am,
PCV: 25%
T.P: 7.4 g/dL
BC: 1%
Plasma: Clear
Clinic Notes / Specifics
Blood gas-346521001-2025-01-27T07:46:46
Blood gas, electrolytes, metabolic
BloodGas
Result Date: 2025-01-27T07:46:46
Test Results Unit Lowest Value Highest Value Qualifier
pO2 80.8 mmHg 27.0 50.0
O2SAT 92.3 % 50.0 80.0
pCO2 32.3 mmHg 31.0 51.0
HCO3-act 11.6 mmol/L 15.0 27.0
mTCO2 11.2 mmol/L 16.0 25.0
pH 7.163 7.250 7.430
BE(ecf) -17.0 mmol/L -5.0 2.0
Na+ 145 mmol/L 148 163
K+ 3.7 mmol/L 3.6 5.6
Cl- 118 mmol/L 111 128
Ca++ 1.22 mmol/L 1.21 1.51
AGapK 21 mmol/L 9 26
Lact 1.79 mmol/L 0.50 3.20
BUN 24 mg/dL 15 32
Crea 0.63 mg/dL 0.50 1.90
Glu 256 mg/dL 63 133
Hct 22 % 28 50

Results from last night at 10:45 pm:

Test Results Unit Lowest Value Highest Value Qualifier
Ketones 15

Test Results Unit Lowest Value Highest Value Qualifier
BUN 41.6 mg/dl 15.0 32.0
CRE 0.8 mg/dl 0.8 1.8
BUNCreaRatio 52.0
IP 4.7 mg/dl 2.6 6.0
Ca 10.1 mg/dl 8.8 11.9
TP 7.6 g/dl 6.0 8.0
ALB 3.5 g/dl 2.3 3.5
GLOB 4.1 g/dl 2.8 4.8
AlbGlobRatio 0.9
GLU 362 mg/dl 70 130
TCHO 229 mg/dl 70 200
ALT 67 U/l 0 100
ALP 32 U/l 0 90
GGT < 10 U/l 0 10
TBIL 0.1 mg/dl 0.0 0.5

Test Results Unit Lowest Value Highest Value Qualifier
WBC 11.69 10^3/uL 5.50 19.50
NEU# 10.47 10^3/uL 3.12 12.58
LYM# 0.50 10^3/uL 0.73 7.86
MON# 0.28 10^3/uL 0.07 1.36
EOS# 0.43 10^3/uL 0.06 1.93
BAS# 0.01 10^3/uL 0.00 0.12
NEU% 89.6 % 38.0 80.0
LYM% 4.2 % 12.0 45.0
MON% 2.4 % 1.0 8.0
EOS% 3.7 % 1.0 11.0
BAS% 0.1 % 0.0 1.2
RBC 4.64 10^6/uL 4.60 10.20

Test Results Unit Lowest Value Highest Value Qualifier
HGB 7.3 g/dL 8.5 15.3
HCT 23.0 % 26.0 47.0
MCV 49.7 fL 38.0 54.0
MCH 15.8 pg 11.8 18.0
MCHC 31.8 g/dL 29.0 36.0
RDW-CV 19.5 % 16.0 23.0
PLT 272 10^3/uL 100 518
MPV 13.4 fL 9.9 16.3
 
If they sent her home on lantus and were giving her a different insulin in the hospital, that could have been part of the problem. In the hospital they would have used an ‘in and out’ insulin which means the full dose would have been used by her body.
With Lantus, because it is a ‘depot’ insulin (and a great insulin for cats normally) the full effect of the dose would not be felt for up to 5 days.
This can mean that Vesper might not have been getting enough insulin. And insulin is vitally important post DKA.
Until a DKA cat is well past the initial DKA and has no longer got any ketones, it is better for the cat to be given an ‘in and out’ insulin. That way we know the cat is getting the full dose. Then when the cats has improved and there are no ketones in the picture, we can swap to Lantus insulin. Does that all make sense?

And was she eating enough food once she got home? She needs to be eating 1and 1/2 times as much food as normal during the recovery phase. Food and insulin are like medicines for a post DKA kitty.

A feeding tube could well be a good idea. It will take the stress out of making sure she eats enough and will be easier for her as well.
We do see a few cats relapse early on but it is usually because they were not given the right instructions when sent home.
I can give you a list of all you need but will wait and see how things go overnight.

I’m going to ask @Suzanne & Darcy ti come t on the labs if she is around.
 
That's very good to know about Lantus. We also have novilin at home. Would that be something that works better after DKA? I will ask the vet about using a different insulin until she is more stable and we can work up to Lantus. We will get another update tonight and then again tomorrow morning. If she hasn't improved tomorrow, we are going to start the harder conversations. I will post updates here. Thank you so so much for guiding us.
 
And i should say no, she was not eating 1.5x at home, nor is she in the hospital. Should I push for a nasal feeding tube in the hospital and ask for more aggressive feeding? I'm not sure we can do the esophegeal feeding tube again. That was VERY hard on her in 2022, as she was never able to tolerate higher quantities no matter how slow we administered them. She vomited, so we had to do very small doses and feed her about 14x a day just to keep her weigh stable. She ultimately self-removed the feeding tube, so it was quite traumatic.
 
That's very good to know about Lantus. We also have novilin at home. Would that be something that works better after DKA? I will ask the vet about using a different insulin until she is more stable and we can work up to Lantus. We will get another update tonight and then again tomorrow morning. If she hasn't improved tomorrow, we are going to start the harder conversations. I will post updates here. Thank you so so much for guiding us.
The vetsulin might be better than the Novolin N as the in and out insulin or you could ask for Prozinc. That is a cat insulin and a recommended one and also an in and out one. All three could be used as they are all in and out insulins.

And i should say no, she was not eating 1.5x at home, nor is she in the hospital. Should I push for a nasal feeding tube in the hospital and ask for more aggressive feeding? I'm not sure we can do the esophegeal feeding tube again. That was VERY hard on her in 2022, as she was never able to tolerate higher quantities no matter how slow we administered them. She vomited, so we had to do very small doses and feed her about 14x a day just to keep her weigh stable. She ultimately self-removed the feeding tube, so it was quite traumatic.
Most DKA and post DKA kitties are nauseated and need an anti nausea medication, sometimes for a few weeks. A lucky few ones come home and eat well, but most need the antinausea med and sometimes an appetite stimulant as well to get them over the hump.
I would ask them are they giving her an antinausea medication. Options are cerenia or ondansetron. We find ondansetron often works better for nausea. It is a human medication and has to be got from the pharmacy with a script from the vet.
As far as the feeding tube goes, I will have to leave that up to you. If you think it will be too distressing for her, she might be better without it.
What type of food were you putting through the tube?. Was it a recovery food that is almost a liquid?
And feeding many times a day is what most care givers have to do for a couple of weeks. We don’t expect the cats to eat a lot in a couple of meals. They have many snacks or small meals throughout the day and evening.
 
Ok good to know about the insulin, I will ask about that for sure. Yes, she was on cerenia when she came home but not an appetite stimulant. I will ask about adding an appetite stimulant and switching to odansetron. When she had the e-tube, I blended a prescription recovery wet food with water and followed the instructions to a tee. She is the most affectionate/loving cat to me but also the most aggressive cat when it comes to treatments. My husband and I are the only ones who can do her shots, etc. (and even that can be tricky) so she definitely puts up a huge fight over any sort of intervention. Trying to balance all of her needs. It's hard. But I feel more motivated to give this a little time. I have drafted a complaint to the insurance company and will wait to see what the doctor says tonight and tomorrow.
 
I am new to the group and have a 13 year old cat, Vesper, who is my absolute soulmate in life. Unfortunately, I could use some advice on a very emotional subject.

I'm so sorry you're having to consider all of these overwhelming options. :bighug: I'm glad you found the forum, Vesper sounds like such a fighter. I hope she pulls through this again, this group can no doubt help you both.
 
Cerenia is primarily an anti-emetic (anti vomiting) drug but can sometimes help with nausea too. Ondansetron is more of an anti-nausea. They can be given together, but for some reason vets don’t tend to offer that. I’d push the issue for both. As for appetite stimulant, you don’t want to give that until nausea is under control as it can definitely make them food averse. A common appetite stimulant is mirtazapine, but the pills can have more side effects in some cats than the transdermal (“Mirataz”). If you’re going with a appt stimulant, I’d request Mirataz. You put a small amount on the ear.

I assume you were crushing the meds and putting them through the feeding tube last time rather than pulling by mouth (if not, keep it in mind for this time). Cerenia also comes in an injectable, which I preferred because that way I knew my cat got a full dose even if vomiting.

I know the finances can be daunting. Care Credit is one option people use, if it’s available in your area. I don’t know if you’re able to swing it financially or not, but from a purely medical standpoint, DKA is often survivable given the right treatment and underlying causes. That means balancing the electrolytes, plenty of food, proper insulin dosing, keeping the cat hydrated, and addressing any underlying infections and/or inflammation.

Did they take a sterile urine sample to test for a urinary tract infection? It would be a urine draw directly from the bladder and then a culture and sensitivity (C&S), which you’d want done before starting antibiotics (antibiotics can mask infection and alter the results). If pancreatitis is suspected, I’d also want an fPLI test be run to rule that in or out (preferably a send-out blood test for specific results rather than an in-house snap test).

Another culprit can be dental issues/infection.

Often, however, it seems that quite a few folks who end up here with a cat in DKA haven’t been given the tools or knowledge to prevent it — probably aren't home testing, no clear dosing methodology other than the vet just saying use this or that dose without a lot of data to support it, then an infection and lack of food throws the cat off a cliff, so to speak. Bron told you the recipe for DKA and even though it can happen in any diabetic cat, the tools offered here can definitely stack the deck in your favor.

I wish you good luck and peace of mind as you go forward in making some difficult decisions. I’ve seen it go both ways so I don’t want to give you false hope. But many cats can win this battle and go in to never suffer DKA again with the right care. Knowledge is power. Data is key. Please let us know what happens. :bighug:
 
Hi all, I have a good update. Vesper is a fighter and she is out of her acidotic state. They had to adjust her insulin over the night and also continue potassium supplementation. She still has ketones in her blood (all they told me is "low") and is still a little low in potassium but she is eating on her own. They are reluctant to switch her off of the Lantus and say a shorter acting insulin will not help, so I have asked them to put on a libre device before discharge. They say she is doing well on gabapentin and suggest continuing that instead of an antinausea, but I do have some cerenia at home from her prior bout of DKA. I also have some transdermal miratz left over from a different cat's illness. I'm hopeful, but nervous, about the next 24h. I am so glad to have found this board and hope that you can advise us during this next critical stage.
 
Hi all, I have a good update. Vesper is a fighter and she is out of her acidotic state. They had to adjust her insulin over the night and also continue potassium supplementation. She still has ketones in her blood (all they told me is "low") and is still a little low in potassium but she is eating on her own. They are reluctant to switch her off of the Lantus and say a shorter acting insulin will not help, so I have asked them to put on a libre device before discharge. They say she is doing well on gabapentin and suggest continuing that instead of an antinausea, but I do have some cerenia at home from her prior bout of DKA. I also have some transdermal miratz left over from a different cat's illness. I'm hopeful, but nervous, about the next 24h. I am so glad to have found this board and hope that you can advise us during this next critical stage.


I was so scared to click and see your update. Literally reliving my own cat's DKA right now, so glad to hear that she is fighting! Eating on her own is so huge. Making me all emotional over here.

















...dammit, where's that tissue box :bighug:
 
Can someone help me come up with a plan post-discharge? She will have the libre, and I also bought the Relion and ketone strips. I have so many questions and feel like I don't have enough time to get caught up to speed. Do the ketone strips require clean urine or can I test by sticking it in the litter box? Can I rely on the libre or should I also use the Relion? If she is only eating small amounts at a time, what food should I focus on giving her? What treats are best? She likes freeze dried chicken, is that okay? In addition to keeping her on gaba, what other meds should I be doing?
 
Can someone help me come up with a plan post-discharge? She will have the libre, and I also bought the Relion and ketone strips. I have so many questions and feel like I don't have enough time to get caught up to speed. Do the ketone strips require clean urine or can I test by sticking it in the litter box? Can I rely on the libre or should I also use the Relion? If she is only eating small amounts at a time, what food should I focus on giving her? What treats are best? She likes freeze dried chicken, is that okay? In addition to keeping her on gaba, what other meds should I be doing?

  • People have tested for ketones by just poking a strip into urine in the litter box, yes
  • I would not recommend relying solely on the Libre. The Libres are known for not always being super accurate, especially at the lower numbers. They can fail, the batteries sometimes go out, or other issues. Doing hometesting with a meter is a good idea regardless of a Libre or not.
  • Low carb wet food (under 10% calories from carbs)
  • Freeze dried treats are great that's what we give our diabetic kitty, specifically a kind called Whole Life Just One Ingredient


The post-DKA discharge plan involves giving kitty about 150% of their normal caloric intake, making sure plenty of fresh water is available, and regular insulin doses. My cat's DKA was in January of 2022 so it's been a while. I'll let one of the super-expert people chime in here as I think I may be forgetting something.
 
Ideally you want the cat to pee on the stick which you hold. You can also try holding a small cup or deep ladle under the cat to collect the urine and then pour the urine onto the test strip. You can also get a clean brand new litter box (litter dust and residue will affect the strip result) and put some non-absorbent material in it (clean fish tank pebbles, Kit4Cat litter) and just wait for your cat to pee. Collect the urine and put on test strip. There's a link with more tips but I can't find it at the moment.

Have a Human meter on hand just in case the Libre falls off or fails.

I also have some transdermal miratz left over from a different cat's illness. .

How long has the Mirataz been opened? If I'm not mistaken, it's only good for 30 days once you open it.

Feed your cat whatever low carb canned food she likes and will eat. A sprinkle of FortiFlora on any food will entice any cat to eat. It's important that your cat gets enough calories daily to avoid fatty liver disease. The Liver Shake recipe is helpful: https://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

Freeze dried treats are great :cat:
 
Hi all, I have a good update. Vesper is a fighter and she is out of her acidotic state. They had to adjust her insulin over the night and also continue potassium supplementation. She still has ketones in her blood (all they told me is "low") and is still a little low in potassium but she is eating on her own. They are reluctant to switch her off of the Lantus and say a shorter acting insulin will not help, so I have asked them to put on a libre device before discharge. They say she is doing well on gabapentin and suggest continuing that instead of an antinausea, but I do have some cerenia at home from her prior bout of DKA. I also have some transdermal miratz left over from a different cat's illness. I'm hopeful, but nervous, about the next 24h. I am so glad to have found this board and hope that you can advise us during this next critical stage.

Also Can someone help me come up with a plan post-discharge? She will have the libre, and I also bought the Relion and ketone strips. I have so many questions and feel like I don't have enough time to get caught up to speed. Do the ketone strips require clean urine or can I test by sticking it in the litter box? Can I rely on the libre or should I also use the Relion? If she is only eating small amounts at a time, what food should I focus on giving her? What treats are best? She likes freeze dried chicken, is that okay? In addition to keeping her on gaba, what other meds should I be doing?
@Bron and Sheba (GA)
 
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With DKA, it's common for electrolytes, kidney and liver values to be all out of whack but they can get back to normal. Committed home care is critical to recovery and maintaining hydration is at the top of the list. Dehydration can make a cat go downhill really fast and since you've been through this before, tell your vet you want fluids, preferably Lactated Ringers, to give at home. Sub-q fluids are absorbed slowly and leave room for food. Putting too much liquid orally into an already sick cat's stomach makes them feel even more nauseous and likely to vomit. I've found that to be true for cats with kidney disease, pancreatitis or recovering from DKA and would urge everyone with a diabetic cat to have sub-q supplies on hand and know how/when to use them. Thriving Pets has everything needed:

Administration sets: https://thrivingpets.com/products/iv-admin-set-bbraun-v1402

Terumo needles (smaller, sharper, preferred by cats):
https://thrivingpets.com/products/terumo-needles-thin-wall-21-gauge-1-inch-box-of-100

Lactated Ringers fluids - need a script for this or your vet may sell you a bag:
https://thrivingpets.com/products/lactated-ringers-inj-usp-1-liter-bags

If you've never given fluids before, here's a good tutorial:
http://www.weirdstuffwemake.com/weird/stuff/pets/cats/sophia/catjuice.html

Cats prefer fluids at body temperature so I warm them in a big bowl of hot water for a few minutes. Provide a towel to lay on and offer some food as a distraction. Most cats are not going to be cooperative at first and no cat likes to be restrained, but they do like boxes to feel like they're hiding. Change out the needle after infusing so there's a sterile one ready for next time and to prevent contaminating the line.

It's important to address nausea before using an appetite stimulant as it often doesn't work for cats that have stopped eating and can cause food aversion. CBD oil and B-12 shots can help with appetite and are safer. Getting enough calories into her is critical so feed whatever she'll eat while she's recovering. Baby food or a/d may be more appealing than canned food and you may need to syringe or spoon-feed. I've found that the odor of some wet foods can be off-putting to a sick, nauseous cat and that sometimes dry food is better tolerated. My go-to is Nature's Variety Instinct Original Chicken formula dry food. It's low carb and most cats find it irresistible.

Best of luck to you and Vesper.
 
Kelly I am so glad it read your updates and hear Vesper is doing well.
Here is a plan for you for the next couple of weeks. I would recommend you post on here daily with updates so we can see and tweak anything that needs tweaking.
Regarding the Lantus v an in and out insulin…if they have kept Vesper on the Lantus while in the hospital, that will have given it time for the depot to fill. They will have been monitoring it more closely than you could at home while this adjustment has been taking place and could adjust things if necessary. So as long as that is the case, she should be ok on the Lantus now.

Here is what you can do before Vesper comes home to get prepared. You may have already done some of these things.
  • 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. I would press for some ondansetron as it is vitally important that nausea is brought under control and Vesper eats well. Don’t let them fob you off. You don’t want to get home and find you don’t have a suitable antinausea med to give Vesper. Gabapentin is for pain and is not an antinausea.
  • 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 Vesper gets home including some higher carb foods. She may be picky so have several things to tempt her
  • Set up a spreadsheet and the signature before Vesper comes home
  • I would definitely buy a human glucose meter as well as the libre.
  • Continue to get lab results from the vet.
Here is the plan for when Vesper comes home
  • you need to give one and a half times as many calories as Vesper 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 Vesper won’t eat the low carb food, feed her whatever she will eat as eating any food is better than not eating. We can worry about low carb food later is necessary.
  • 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 (spreadsheet) so we can see. Please report any trace ketones at all.
  • Give antinausea medication if needed. If she is at all nauseated I would give it routinely for a while. Cerenia and ondansetron can be given together as they work on different pathways. Cerenia is given once a day and ondansetron can be given up to 4 times a day.
  • 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
  • Set up a spreadsheet and test the BG frequently
  • Post daily with updates and ask for help as often as needed.

Here is a link to collecting a urine sample

COLLECTING A URINE SAMPLE

LOW CARB FOOD CHART
low carb is under 10% carbs, medium carb is 11 to 15% and high carb is 17% and over. Get a few of the higher carb foods and mark the top of the can what % they are.

Keep asking questions
 
Kelly I'm sure all this info is very overwhelming, but you got this. :bighug: My last kitty had to have sub Q fluids, and it was not something I was comfy doing myself. I was fortunate to find a vet tech that lived close by that came before and after work to give Emma her fluids. Maybe that could help you. It was WAY cheaper then the vet!
 
You are all AMAZING and I am working on doing everything on that list. We just got home. Vesper immediately ate some food, urinated in her box, and did a little grooming. She ate some warmed up fancy feast wet food and also was very keen to eat freeze dried chicken. I will continue to try to get her to eat as I review the other instructions from this group.

A few concerning things/initial questions:
(1) They would not give me sub q fluids. Is there another way to ensure hydration?
(2) They gave me cerenia but would not give odansetron. Perhaps I can call her regular vet tomorrow and get a prescription?
(3) She was not on Lantus while hospitalized. She was on a CRI, and while she was receiving the CRI, she had wild insulin swings (from 60 to the 300s) so they had to continuously adjust.

She is next due for cerenia tomorrow morning. Should I add an appetite stim at this point if she is eating? And how many cans should I try to make sure she is eating?

Can I still give her Lantus in 4 hours even if she wasn't on it in the hospital?
 
You are all AMAZING and I am working on doing everything on that list. We just got home. Vesper immediately ate some food, urinated in her box, and did a little grooming. She ate some warmed up fancy feast wet food and also was very keen to eat freeze dried chicken. I will continue to try to get her to eat as I review the other instructions from this group.

A few concerning things/initial questions:
(1) They would not give me sub q fluids. Is there another way to ensure hydration?
(2) They gave me cerenia but would not give odansetron. Perhaps I can call her regular vet tomorrow and get a prescription?
(3) She was not on Lantus while hospitalized. She was on a CRI, and while she was receiving the CRI, she had wild insulin swings (from 60 to the 300s) so they had to continuously adjust.

She is next due for cerenia tomorrow morning. Should I add an appetite stim at this point if she is eating? And how many cans should I try to make sure she is eating?

Can I still give her Lantus in 4 hours even if she wasn't on it in the hospital?
@Bron and Sheba (GA)
 
@Kelly P
I'm so happy Vesper is home and has eaten , used her little box and groomed a little
Here is the information we need for your signature
Just click on your name up top and then tap signature and add this information.
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Bexacat or Senvelgo (if applicable) and dates
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Here is the link to set up your spreadsheet, it will also explain how to use it
https://felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/

If you don't have a meter most of us use a human meter

Here is the link for the meter and test strips so you don't have to search for them. If you have a Walmart by you
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
At least if you need more test strips you can run into Walmart and pick them up or if you're running low you can just order them from Walmart
 
1) They would not give me sub q fluids. Is there another way to ensure hydration?
Try putting a teaspoon of warm water into every snack.
If necessary you might ask your regular vet for some sub Q fluids. You always need a clearance from a vet to give those fluids because the cats heart needs to be checked first as some heart issues rule out sub Q fluids. She may not need them.
They gave me cerenia but would not give odansetron. Perhaps I can call her regular vet tomorrow and get a prescription?
Yes please ask your regular vet for a script for some ondansetron and then you pick it up at the pharmacy.
She was not on Lantus while hospitalized. She was on a CRI, and while she was receiving the CRI, she had wild insulin swings (from 60 to the 300s) so they had to continuously adjust.
What dose of Lantus do they have her on now?
And yes you need to give her the next dose when it is due. We don’t want you skipping any doses of insulin with DKA in the picture
One of the most important things you need to do is test the urine daily for ketones as this will tell us if she is getting enough food and enough insulin.
If you can get the spreadsheet set up asap and test before every dose and again during the cycles that will help us be able to help you.
We can only do that is we can see data. If you think you may need help with the SS or you don’t have time at the moment to set it up I will ask @Bandit's Mom as she can set it up in 2 minutes…she is a whizz at it!
Should I add an appetite stimulant at this point if she is eating
If she is eating well at the moment I would wait and see with the appetite stimulant.

And how many cans should I try to make sure she is eating?
She needs to be eating 1 and a 1/2 times as many calories as normal so if you can work that out, that would be good. I usually tell people to feed a good meal before every dose and then offer a snack of normal low carb food every couple of hours day and evening and at night if you are up.food is very important in this recovery.
A snack is a teaspoon or two of low carb food or what ever she will eat.

Are you going to be using the libre as the glucose monitor. If so you need to be aware that when the BG drops under 100 on the libre, the BG can be unreliable and we recommend you retest with a hand held meter. Always post and let us know if there are any issues. Someone is always around. I live in Australia so it is 1 pm here atm. So I’ll be around for the next 10 hours and then there will be others from the US around.
If you test the preshot BG and it is lower than 200, stall, don’t feed and test again in 20 minutes to see if the BG is rising. And post here and ask for help. If you do that , change the subject line to something like ‘preshot BG. xxx, stalling HELP’. And make sure DKA is still in the subject line.
 
Ok I think I got the signature and spreadsheet working? Her current dose is 1 unit of Lantus, and she is due in 1h 15 min. Her libre said she was at 400 about an hour ago, and I will try checking her soon using the Relion and update.
 
Ok I think I got the signature and spreadsheet working? Her current dose is 1 unit of Lantus, and she is due in 1h 15 min. Her libre said she was at 400 about an hour ago, and I will try checking her soon using the Relion and update.
Well done! The SS looks great and the signature also. When you put the data in can you indicate if libre or ReliOn. If mostly using libre just indicate ReliOn.
 
Update!

I accidentally bought the wrong test strips, so couldn't use the Relion. We got a temporary device from the pharmacy until we get compatable Relion strips. The device is called True Manager Air. We successfully tested and the result was 341. We are due to give her lantus now (1 unit).
 
Just gave her the lantus. According to the spreadsheet, I test in 1 hour? Do I need to test every hour?
No you don’t need to test every hour. And you don’t necessarily have to test at +1.
If you were shooting a lower than normal preshot, we would suggest getting a +1 or a +2 so you can see what is happening.
I would suggest a +3 and then maybe a +6 depending on where the BG is up to. We would suggest testing more often if the BG is dropping fast or quite low. Hang on…you have a libre don’t you, so you can see what is happening all the time at the moment anyway. So you can add any data in you like but don’t add every hour in as it’s not necessary and just clutters the SS with a sea of colour.

Did she eat well at the preshot meal?
And I would give her a snack at +2
 
Our libre said 400 when the other one said 341, so I'm not sure how accurate the libre is. She has been grazing since she got home and has eaten probably 3/4 of a fancy feast can and 1/4 cup of freeze dried chicken. She did not eat a ton at the preshot meal but I think it's because she has been eating. Should I take her food away to make sure she eats more right before the shot?

We will test at +3. We also have to give her potassium soon. The pill is quite large and she doesn't take pills easily, so that is our next hurdle.
 
Should I take her food away to make sure she eats more right before the shot?
I should have mentioned to take the food away for the 2 hours before the preshot BGs, so the preshot is not food influenced.
Our libre said 400 when the other one said 341, so I'm not sure how accurate the libre is.
You will always find variations in the BG with different meters. And there can be a 20% variance with any meter. That is why it is good to try and stick with the one meter for most of the time.
But in saying all of that 341 and 400 are both high BGs so it was safe to shoot

We also have to give her potassium soon. The pill is quite large and she doesn't take pills easily, so that is our next hurdle.
I have to pill one of my cats every morning. I hold her on her back and by the scruff of her neck with one hand and open her mouth with the other and pop the pill in.
I had to give her a very large pill for 6 weeks a couple of years ago and she is not the best cat to pill but when I used that method she was very good. Good luck

Whats happening about testing for ketones?
 
I found this that was posted by one of our members about pilling
I wanted to share some tips for pilling I’ve found work well every time.

I wrap the pill in a super tin layer of pill pocket. Not a whole pill pocket, not even half, I grab a tiny bit and wrap it around the pill. It helps it slide down their throat because it’s oily and it also prevents the pill from dissolving in their mouth so they don’t taste the bitterness, which is what causes the foaming at the mouth. You can also do the same thing with frozen butter. Wrap the pill in a tiny ball of butter and put it in the freezer. The trick here is that the butter will start to melt pretty fast once you hold it in your fingers so you have to be fast about it. If they’re food motivated, you can wrap it in a small ball of Easy Cheese and see if they’ll eat it what way. Minnie used to but not Bobo. I use the pill pocket trick with him. Sometimes he’ll spit it out but it’s still wrapped in the pill pocket so I can just pill him again.

You can also get a piller from chewy like this one that has a compartment in the back for water so when you push the plunger, the water makes sure the pill goes down:
https://www.chewy.com/dp/136745?utm_source=app-share&utm_campaign=136745
 
This is how I used to pull my cat Tyler
I didn't wrap him in a towel though . I would just put him on the couch and have his butt against the side of me so he couldn't back up and then give him the pill. I would also blow lightly on his nose. This should stimulate swallowing and rub his throat up and down I hope bill isn't that large
Usually they will lick their lips , then you would know they swallowed it Make sure to tilt his head back. I hope the pill isn't that large

I was reading about potassium for cats

How do you give a cat potassium supplement?



Potassium is given by mouth in the form of a tablet, powder, gel, or liquid solution. It should be given with food to help prevent stomach upset.

I wonder if you can get it in liquid form from a compounding pharmacy if the pill is really big and you have trouble giving it to Vesper , ask your vet.
I would be so nervous giving it if it was really big, but that's just me
 
Last edited:
I should have mentioned to take the food away for the 2 hours before the preshot BGs, so the preshot is not food influenced.

You will always find variations in the BG with different meters. And there can be a 20% variance with any meter. That is why it is good to try and stick with the one meter for most of the time.
But in saying all of that 341 and 400 are both high BGs so it was safe to shoot


I have to pill one of my cats every morning. I hold her on her back and by the scruff of her neck with one hand and open her mouth with the other and pop the pill in.
I had to give her a very large pill for 6 weeks a couple of years ago and she is not the best cat to pill but when I used that method she was very good. Good luck

Whats happening about testing for ketones?

Our +3 test didn't go well. We got error messages two times on the True Manager device, and the box says that could be from dehydration or anemia (or other factors). She did have some anemia at the hospital. Because we couldn't get a reading on the True Manager, we used the libre device, which showed 361, so I entered that on her chart (sorry it is a different device). She ate a snack at +2 but does not seem hungry at +3. She drank a little water, but seemed out of it and hovered over the bowl for a bit. She is now hiding under the bed.
 
This is how I used to pull my cat Tyler
I didn't wrap him in a towel though . I would just put him on the couch and have his butt against the side of me so he couldn't back up and then give him the pill. I would also blow lightly on his nose. This should stimulate swallowing and rub his throat up and down I hope bill isn't that large
Usually they will lick their lips , then you would know they swallowed it Make sure to tilt his head back. I hope the pill isn't that large

I was reading about potassium for cats

How do you give a cat potassium supplement?



Potassium is given by mouth in the form of a tablet, powder, gel, or liquid solution. It should be given with food to help prevent stomach upset.

I wonder if you can get it in liquid form from a compounding pharmacy if the pill is really big and you have trouble giving it to Vesper , ask your vet.
I would be so nervous giving it if it was really big, but that's just me

Yes, it's quite large, and she is an aggressive cat, which makes it difficult to do anything (tests, pills, injections). I wonder if it caused nausea, she does seem a bit more out of it now. Ugh, and we have to do it every 12h.
 
Our +3 test didn't go well. We got error messages two times on the True Manager device, and the box says that could be from dehydration or anemia (or other factors). She did have some anemia at the hospital. Because we couldn't get a reading on the True Manager, we used the libre device, which showed 361, so I entered that on her chart (sorry it is a different device). She ate a snack at +2 but does not seem hungry at +3. She drank a little water, but seemed out of it and hovered over the bowl for a bit. She is now hiding under the bed.
@Bron and Sheba (GA)
 
I should have mentioned to take the food away for the 2 hours before the preshot BGs, so the preshot is not food influenced.

You will always find variations in the BG with different meters. And there can be a 20% variance with any meter. That is why it is good to try and stick with the one meter for most of the time.
But in saying all of that 341 and 400 are both high BGs so it was safe to shoot


I have to pill one of my cats every morning. I hold her on her back and by the scruff of her neck with one hand and open her mouth with the other and pop the pill in.
I had to give her a very large pill for 6 weeks a couple of years ago and she is not the best cat to pill but when I used that method she was very good. Good luck

Whats happening about testing for ketones?

Oh and I have ketone strips, but I haven't been able to catch urine, so I have the plastic beads being delivered tomorrow.
 
Our +3 test didn't go well. We got error messages two times on the True Manager device, and the box says that could be from dehydration or anemia (or other factors). She did have some anemia at the hospital. Because we couldn't get a reading on the True Manager, we used the libre device, which showed 361, so I entered that on her chart (sorry it is a different device). She ate a snack at +2 but does not seem hungry at +3. She drank a little water, but seemed out of it and hovered over the bowl for a bit. She is now hiding under the bed.
Those error messages sometimes happen. I would not worry.
Which country do you live in? Do you live in the UK or Europe? The reason I am asking is you are using the am cycle of the SS.
Can you cut the pill in half and do it twice?
Or maybe ask the vet if it comes in a liquid
 
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