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

Hi everyone,

My cat was diagnosed with diabetes mid November 2022. She has been hospitalized for DKA 3 times since then and is currently showing signs of DKA again (lethargy, weakness, inappetence, weight loss, ketones in urine showing up on dip stick as "small" or "moderate"-- tested today about 1 hour prior to writing this post).

She's using a freestyle libre 2 and has been averaging 307 mg/dl for the last week or so. We're using 1 unit of Lantus twice a day.

To help with her nutrition, during her third hospital stay, the doctors installed a feeding tube (e-tube). It's been about 5-6 days of using the e-tube. For her first 3-4 days at home, she was eating 50-75% of her meals orally and we finished the remaining 50-25% of the meal with tube feeding. Her energy levels were lower than normal, but the 5 P's were still present.

Since yesterday morning, she hasn't had an appetite and we've had to tube feed her entire meals. She's still peeing and I think I saw a poop yesterday, but she's no longer preening or playing. Maybe she might purr a little if she wasn't so annoyed with me fussing with her feeding tube...

We emailed this update to the doctor and I'm sure she will recommend that we bring her to the hospital. The hospital is 30-45 minutes away from our apartment (a $50 cab ride each way as we don't have a car), and the 3 hospital stays were $5000-9000 each. We can't afford any more hospital stays and don't know what to do. We can't seem to get the DKA under control and don't know how many future stays she might require. Is there anything I can do at home, especially since we have a feeding tube installed?

Other meds:
- Renakare (potassium supplement; other electrolytes looked OK at the hospital. This was the only one they're having us supplement)
- Cerenia (1/4 tablet every 24 hours)
- Mirtazapine transdermal ointment (daily)
- Zofran (haven't tried this yet but am planning to today)

Food:
Per vet's recommendation, we're feeding her Purina DM Wet Cat Food. Pre-diabetes, she was eating Smalls Chicken and occasionally TikiCat cans.

Apologies I haven't yet set up my spreadsheet or gotten the hang of all the lingo and posting protocol on this forum as I've just joined. Really appreciate any help here. Please let me know if there's any other info I can provide.

-TK

 

Anything above trace ketones really should be a visit to the vet.

From this information post: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters
The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

You need to get calories into her, more than you would normally feed her. I would definitely suggest you get that ondansetron in her, to help with appetite. With trace level of ketones, people usually give fluids to help flush out the ketones, so fluids are also important. Was she treated with infection or other inflammation (like pancreatitis) at the vet hospital?

That leaves the question of insulin dose in the formula above. When you say she's been averaging 307, what does that mean in terms of range? We determine how to change the insulin dose based on how low it takes the cat. There is a good change the insulin dose is too low. But we cannot help any more on that front without seeing blood sugar data. Details on how to let us see that data, and more, in this post:
New? How You Can Help Us Help You!

There are some organizations who can help financially. Diabetic Cats in Need is one such, tagging @Chris & China (GA) There are other options, including Care Credit, listed in this post: Financial Help Links

 

Hi and welcome to the forum. I’m sorry you have had such a hard time with your kitty and DKA.
I agree with Wendy that if the ketones are small or moderate and your kitty is showing signs of lethargy, not wanting to eat, weakness and weight loss, then she really does need to be seen by the vets as she will need to go on an IV drop and her electrolytes corrected as they will be beginning to get out of balance and once this happens you can’t correct this at home. It will be better and hopefully cheaper to take her in now than wait until she is worse.
I will post this but write more about what you can do once you get her home again.

 

Thank you both so much for the replies. I heard from her vet and she recommended we bump tonight's insulin dose from 1 unit to 1.5 units. I'll update with her historic range when I have a moment to dig into her Freestyle Libre data.
For now I'm desperately trying to get food into her via her feeding tube.

We have a potassium supplement at home that we've been giving her and will continue to do so.

Regarding fluids that are given at the hospital.. what does this mean exactly? We do have a feeding tube placed in her esophagus, so we've been able to put food, water, and medication through there if there are suggestions for that.

The doctors did diagnose her with pancreatitis last time - maybe this is a flare up causing DKA?

 

Wendy has explained what the recipe for DKA, so the treatment (once you get her home from the ER) is to make sure that you are addressing the recipe and taking steps to ensure the recipe ingredients is stopped. You may need to increase the dose of insulin
To do this, this is what I recommend:

• you need to give one and a half times as many calories as she 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 her whatever she will eat as eating any food is better than not eating.
• If you are tube feeding, offer frequent smaller meals and make sure you have supplies of foods you can tube feed easily such as Hills a/d which you can get from the vet.
• 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. I would definitely start the ondansetron. And she may need the antinausea medication s for some time after coming home again as many post DKA kitties have nausea.
• 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
• Ask the ER vets for a copy of any path results and post them so we can see please.
• Post daily with updates and ask for help as often as needed.

Will post this and then answer your most recent post.

 

Yes I think that is a good idea. Did you tell the vet how low the current dose is taking her?
As she ( please tell us her name) is on the libre, you will be able to monitor her BGs.
We need to get that SS setup as soon as possible. I will ask @Bandit's Mom to help you. She will be online in a few hours time and will contact you.
Do you have some higher carb foods at home in case you need them if the blood glucose drops low? Or some honey or Karo.
At this moment, if she will eat anything at all, let her have that. It doesn’t matter if the food is not low carb at this stage. Getting her to eat any food trumps everything. If she will eat dry food, let her have that. We can worry about the carb content of the food later when she is better. At the moment we need to get her over this crisis.

I would ask the vet if they would be happy for you to give some Sub Q fluids to her once a day. Lots of us do that here for kitties with kidney issues and also post DKA. We can help you with how to do it. You will just need to pick up the supplies from the vet and ask them how much they are happy for you to give her each day. It is usually around the 100 ml mark.

The fluids they give at the hospital are IV fluids that help balance the electrolytes. The next best thing which you can do at home is the sub Q fluids. Maybe after you get the OK from the vet you could get a taxi to collect the fluids from the vet and bring them to you….it would be cheaper than driving both ways,…just a thought. He will also have to give you needles for the fluids as well.

You can give her some extra fluids via the tube in the meantime, but you don’t want to make her sick. Do you run a little water through the tube before and after the food? Alternate the fluids and the food.
How often are you feeding her via the tube?

That is possible. The treatment for pancreatitis is pain medication, antinausea medication and SubQ fluids. It is a supportive treatment until the pancreatitis subsides.
OR the DKA has just not been completely knocked on the head. She needs lots of food, and enough insulin to ensure that ketones are kept away. That is why testing for ketones is so important.
I would test twice daily at the moment for ketones if you can. Whether ketones are there or not is telling us if we have the balance right of the food and the insulin. Fluids also play a part as well as they help flush the ketones away.

 

If she has pancreatitis, she may need a pain medication as pancreatitis can be very painful. Can you ask the vet about getting something for pain?

 

I can see you have the SS setup. That’s wonderful, thank you!
Can you add some of the data from the last few days please, before you put in today’s data. This will give us a bit of an idea of what has been happening with the BGs over the last few days and how low the dose has been taking her …thank you.
Also use the remarks column to add information about how she was/is each day..such as eating well or not, playing, lethargic, etc. this shows us at a glance how she has been and as time goes by all the information is in one place. If doesn’t have to be detailed.
Also put the results of the ketone tests into the remarks column please.

 

Unfortunately, we're not financially able to do emergency care at this time. With everything that's happened with the economy in the last several years, our donations are down and more people are needing our help with just the basics...insulin, syringes, meters and strips.

I'd check with Care Credit or Scratch Pay, and/or do a Go Fund Me fundraiser if you have friends on Facebook, Instagram or Twitter that may be willing to help (most friends know how much our cats mean to us and are willing to help if they can).

Sorry we can't be of more help.

 

How are things going?
How is Princess Tortilla?
If you feel all your questions have been answered for the time being, would you mind removing the 911 now, so that if you needing more urgent help you can put it up again and we know to answer quickly. Thanks.

 

She's still lethargic but I was able to give her food through the tube. We were able to schedule an appointment with her doctor tomorrow for some blood work so I'm grateful we'll be able to pay appointment pricing and not ER pricing. I'll be sure to ask about sub-Q fluids at home - thank you for that suggestion.

Her BG has come down to around 200 for the last few hours, so I'm going to stick with her usual 1 unit dose tonight vs the 1.5 that was recommended by her doc when she was consistently in the 300-400+ range (her Libre reads anything 400+ as just "HI"). Her last hypo event was on 12/31 and happened when her AMPS was 252.

Yes, I'm giving 54 ml of slurry through the tube at a time, and I flush the tube with about 5 ml of water every ~15ml in addition to about 5-10ml after the feeding is over. Does that sound like the right amount of water? I was mainly doing it to help with clogging. 54 mL 4x/day is her full day's worth of meals. I've had to do 100% tube feeding today and yesterday.

I was able to give the ondansetron tonight. In terms of appetite stimulant vs anti-nausea, how do I know which is which? I know ondansetron is anti-nausea, but for the maropitant/Cerenia and Mirtazipine, they both say they're for both nausea and inappetence.

I actually do have some pain medication (Buprenorphine) from her primary care vet who saw her before we had to take her to the ER. He prescribed it for pancreatitis. This was right before her diabetes diagnosis on 11/8/22. Her ICU/Internal Medicine doctors didn't say anything about using pain meds though... I will ask tomorrow. Should I use it tonight? I'm just worried something will happen overnight while I'm sleeping. Does this affect BG at all?

 

Thank you for the reply and suggestions!!

 

That is good and should be cheaper than the ER.
Hopefully they will check the electrolytes and see if they need to give her some IV fluids at the vet or adjust the potassium you are giving her.

Have you been able to recheck the ketones in the urine again today?.
Looking at the SS and the BGs you have added (thank you for doing that) it does look as if she could do with an increase in dose, especially with ketones in the urine.
With BGs in the range I can see in the SS I would suggest an increase to 1.25 units.
What was the BG when she had ‘her last hypo event’?

What is the food you are feeding her in the slurry?
Do you know how many calories she is getting each day? We need to make sure she is getting 1 and a 1/2 times as many calories as she normally gets. I would ask tomorrow at the vet for some Hills a/d which you will be able to easily put down the tube and clogging should not be a concern.
I think you need to be feeding her more that 4 times a day. I would increase it to 6 times ….3 times a cycle…and see if that helps with the ketones.
Do you have some high carb food in case of low numbers?or honey and Karo?

The cerenia is an antinausea medication and is given once a day. The ondansetron is an anti nausea and can be given three time a day at the the same time as the cerenia as it works on different pathways in the body. The mirtazipine is for the appetite so make sure you always give the antinausea medication first, then wait for it to works and then give the appetite stimulant.

I would ask the vet tomorrow about the Bupe for the pain.
And I would get up every few hours tonight to check how she is going, check the BG and give her some food and fluids.

 

@Princess Tortilla
I can see you have updated the SS to +11 on the am cycle. I would really encourage you to increase the dose to 1.25 units of Lantus at PMPS because of the ketones in the urine. You will need to monitor the pm cycle though. We really need to get those BG numbers down further.
If needed you could feed some higher carb food or add a couple of drops of honey to the slurry if needed.
What do you think? Are you able to stay up and monitor this cycle? I think it is Princess Tortilla’s best chance of getting the ketones down.

 

No, I haven't. She peed about an hour ago, but I put out too much litter in her box and it all got absorbed... ... She did poop just now which is good. I removed more litter so hopefully I get some liquid to test soon.

That sounds good, I agree. Her PMPS climbed back up to 334 so we're considering doing the 1.5... what do you think?

Her AMPS was either 234 or 252 (I have 2 scans around her shot time but don't have a record of the exact shot time to line it up with the Libre) and her +4 +5 numbers were between 57-69. I mixed some maple syrup with water and gave it to her orally with a syringe.

I'm using Purina Pro Plan Veterinary Diets DM Dietetic Management Wet Cat Food from the vet

The vet says based on this slurry recipe, it's 0.94 kcal/mL. So, 0.94 kcal * 54 mL serving * 4 servings = 203 calories per day. At the hospital last week, she weighed in at 5.04 kg (~11 pounds). I googled just now and it looks like she should be having between 250-290 calories per day, so this serving size seems to be too small.. I will ask about serving size and the 6x frequency at tomorrow's appointment. I'll ask about the Hill's as well - is there something you like specifically about this food?

 

It's currently 35 minutes past her shot time, and her PMPS is at 334. I'm giving one more serving of food to increase her calories and then will give insulin... I am leaning toward the 1.5 units - what do you think? I could stay up for probably an hour post-shot to monitor.

 

I would stay with the 1.25 units if you are not going to be able to monitor closely.
Can you set the alarm to get up a few times?she will need to be fed during the night
I’ll post this then write more

 

BGs of 57 to 69 is OK and is not a hypo. Under 50 on a human meter is considered too low unless she was symptomatic.

There are 163 calories per 5.5 oz can of food according to the website. How many cans are you using a day?
At 5 kg she should be getting almost 2 cans a day when well. So one and a 1/2 times as much calories as normal would be 3 cans.
It sounds as if you definitely need to increase the amount of food you are feeding daily. Food and insulin are the two things that can stop ketones.
I’m not sure the vet will know how much to feed per day…they don’t get much nutritional training at uni.
The Hills a/d is a recovery food and excellent for unwell cats. And it is a liquid so can be put down a feeding tube easily.

 

Here is some information about the Hills a/d canned food.
https://www.myhillsvet.com.au/products/cat-food/pd-ad-canine-feline-canned

 

Strangely, her BG went down from 334 to 273 after that extra serving of food... we gave 1.25 units and will be monitoring.

Oh, I see. Our guidance from the vet was to treat anything under 60 urgently, so once I saw it hit 57, I gave the maple syrup water immediately. She didn't show symptoms of vomiting or seizures, but may have been a little weak or lethargic, I don't recall exactly or have it noted.

The vet said 2 cans/day but the math doesn't add up with the calories in their slurry recipe (10 mL water blended with one 5.5 oz can of food). I'll ask about this in the appointment but regardless will definitely increase the amount I'm tube feeding.

The Hills food looks great. I'll see if the hospital has some I can take home tomorrow.

Thanks so much for all your help tonight (it's just past midnight here in NYC). I will post tomorrow with updates from the vet appointment!

 

I hope all goes well tonight and Princess Tortilla is improved in the morning. She is beautiful by the way..I love the avatar photo.
If you are able to, she will definitely benefit from some extra food and fluids during the night. And the monitoring of the BG.
The vet should have some Hill a/d. if not another vet should.
I live in Australia so will be awake for another 6 hours if you need to post. And I will look in on the SS.
I will ask someone else to look in on you in the morning when I am asleep. I hope all goes well with the vet appt tomorrow.
Please post an update after the appt as we worry about our kitties.

 

Just saying hi and good luck with the vet appointment. I had a similar experience with my Minnie, she was back and forth into the ER 3 or 4 times in the space of a month and had an e-tube....this was back in April 2021. It's a stressful time but once we got through that and the e-tube was removed (by her) and I learned more about managing the diabetes, things have been much easier. You are in excellent hands here. Sending you lots of support.

 

If that was a number using the Libre, you should know that we've noticed that the Libre isn't very accurate at lower numbers so it's important to re-check with a regular meter. We've had members who used the Libre and got numbers below 60 and when they re-checked with a meter, the number was in the 70's-90's.

Another option is the Royal Canin "Recovery" food. It's also made for tube feeding and is lower in carbs than the A/D.

Good luck with the vet!

 

It actually won’t hurt to have the carbs at 13% (a/d Hills) for a while as we want to get as much insulin into Princess Tortilla as possible at the moment with ketones in the urine.

 

Any news yet from the vet visit?

 

Just got back from the vet... quite a process today, poor kitty peed in her carrier while in the waiting room and we still need to get her properly cleaned up with her Libre and e-tube attached to her.

Dr. said her BG was 600 when they did the blood test, and right now (~4 hours later) her Libre is reading "HI". We gave 1.5 units of insulin this morning.
Ketones were trace.
Also, she is anemic. She had blood transfusions during her previous hospital stays, but they haven't done enough testing to determine the underlying cause of the anemia.

I also gave her some buprenorphine for pain management about 30 minutes ago, so hopefully that helps with her energy.

Just checked her ketones again (about 4 hours after they checked at the appt) and they're negative.

Re: food - the doctor said she prefers to keep Princess on Purina DM since it's better for diabetic cats and while we're feeding her through the tube, we can give her whatever food is best for her vs what she has the appetite for.

For at-home care, she recommended:

• Continue giving 1.5 units
• Check ketones twice a day
• Continue all anti nausea meds
• Give pain meds as needed
• Can give extra food as long as her stomach can tolerate it

I will update the SS now.

 

I’m glad the vet visit went well. I’m sorry the vet didn’t agree with the hills a/d. It is so much easier to tube feed with and would have been fine for her.
However I’m glad they are happy with everything else.
And fantastic no ketones in the urine. Yay! Keep up the good work.
What did he say about subQ fluids?

 

Thank you for checking in

I'm ok with making the slurry in the blender, so it's not a huge deal. I will say I've gotten so sick of the smell from handling it all day, haha

She said as long as we have the e-tube, we can continue giving her water through there and that should be good for now. We're going back for a check-up in 2 weeks, during which we can hopefully have the e-tube removed, and I can ask about taking subQ fluids home then.

I just updated my SS with some post-AM shot numbers. AM shot was around 11AM. Vet appt was at 12pm, so their blood test was around 12pm... You can see here it's off the charts (screenshot is from LibreView which doesn't graph anything above 350). I'm concerned about that big dip there. Vet reported her BG was 600 at the time of visit (~12pm). Then it dips below 70 as you can see here. I didn't do any scans between 11am and 4pm though. How would you interpret this?

 

@Bron and Sheba (GA)

 

The reason for the high BGs today could have been because she dropped low during the night . I can’t see any tests after about the +3 mark in the pm cycle, if I look at your graph. It helps a lot of you can transfer some of the BGs into the SS please.
A low during the night could have shot up the BG at AMPS.
The huge drop from +1 to +2 in the am cycle is enough to trigger another bounce and high BGs.
And then there is the stress a cat feels at the vet. That can and does send a cats BG up high during a vet visit. so there are three reasons why she could be showing those high BGs.

The graph is showing she dropped to 70 at around ?+3 today but that is not in the SS.if you could fill in the SS to show those extra Bg recorded on the libre,that would be great and give us more of an idea what is happening.
If she is dropping to 70, you don’t want to increase the dose.

ki think to help stop these early and huge drops in the early part of the cycle…I would recommend giving another smaller feed at +2 to try and slow down these big drops which appear to have happened during the past 2 cycles. So instead of giving 4 feeds a day of the same size, I would suggest giving the two main meals before the shots and then some extra feeds during all the cycles but making them a bit smaller. So for example giving a snack of say half of the main meal size at +2 +4 and +6 and +8 to see if we can even out the BGs a bit. That will also give some extra calories overall. Is that doable? You would also need to give some extra feeds during the night. It shouldn’t go on for too long but we need to get her back to normal.

 

Got it.. I will try my best with the additional feedings and will insert a note in the SS on the corresponding cell to track the BG with the feedings.

Also, I'm happy to report that the buprenorphine has helped a lot - Princess is still relatively low energy, but she's now up and walking around, sitting in different spots, and even purring. I even got her to play with some string for a minute. The prescription on that says to give every 12 hours for 5 days - is that the general length of a pancreatitis flare up or should I double check with the vet about that? I googled and found "2 to 5 days in mild cases to 1 to 2 weeks or more in severe cases"

 

Thank you so much for the support! I'm glad to hear things have been going well with Minnie The e-tube is a lot of work but I'm grateful for it.. how long did Minnie use it for?

 

Fantastic. Pain can stop them wanting to eat and they feel terrible.

you are very lucky to have the etube as it makes it so much easier if they won’t eat. Don’t let them remove it until she is eating very well on her own

 

So she got through 40 ml of her 5th feeding and vomited up the slurry 90 mins later she vomited again but it was clear... the first time I figured it was because I was feeding her too quickly or too much food, but the second time I can't tell if it's still because of the extra food or because of something else. Could it be the pain meds wearing off? It has been 8 hours since I gave her the buprenorphine (0.15 ml).

Should I give Cerenia/Maropitant? I've been mixing this with water and putting this through the tube since it's hard to give her pills, but am afraid she'll throw up anything I put through the tube.

 

@Bron and Sheba (GA)

 

How long since she has had any cerenia?

 

@Princess Tortilla I would definitely add DKA 3 times to your signature, it's important members know that. Tap in your name up top then tap on signature add it then tap save

 

I last gave it about 48 hours ago. I thought I gave it yesterday but used the ondansetron instead. My main concern is putting it through the tube and her throwing up again

 

I would give the cerenia to her now via the tube then wait an hour before trying to feed again. Offer a smaller amount of food when you start feeding again to see if she is ok.
I would give her the cerenia each 24 hours routinely at the moment. And you can give ondansetron at the same time as cerenia as they work on different pathways. Ondansetron can be given every 8 hours if needed.

 

Gave Cerenia an hour ago and just heard her throwing up... didn't see any vomit on the floor, just a little spit up on herself. Her BG readings on the Libre are coming up "HI" and I gave 1.5 units ~3 hours ago. Right now she's drinking water out of her bowl

 

I would say she is bouncing from the 60 at +3 in the am cycle.
It says in the SSremarks column you gave Zofran at 3.30 pm. How long ago was that? If it is 8 hours ago, I would repeat the dose.
We need her to eat if we can.
how long since she has eaten and kept the food down?

 

What does this mean? How/why does it happen?

It was about 10 hours ago. I can give more Zofran now, but it would be through the tube and I worry about her throwing up again.

It's been about 4-4.5 hours since she ate and kept it down. I tried giving her another serving an hour after but that's when she started throwing up.

 

I would give her some zofran now with a little water and then wait 30 minutes before trying to feed a smaller amount…..More on that a bit later

 

Once the 1/2 hour is up after the zofran, I would start off with just giving her 10 mls of food at a time and see if she can keep that down. If she can keep that down for an hour, I would try that again. It’s not much food but better for her to keep something down then nothing, then hopefully we can increase the amount of food.

When a newly diagnosed diabetic cat drops the BG fast, or too low or lower than it’s body is used to, the kitty bounces. Bouncing is common in newly diagnosed kitties and is nothing to worry about. Here is an explanation about 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).

 

I gave the Zofran, waited 30 mins, then started giving a little bit of food through the tube 1-2 mls at a time for a total of about 10 mls over the course of 45 minutes. I then flushed with about 5 mls of water. She seems to be doing ok with that. Her BG is still "HI"... very late here in NYC so I will pick this up in the morning.

Thanks so much for your continued help here. Thanks for the info on bouncing!

 

You are doing a fantastic job caring for Princess Tortilla
Are you able to do the 10mls again in 2 hours?

 

How are things going now? I hope she has managed to keep the food down.
I am just about to head to bed in Australia.
I’m going to ask @Bandit's Mom and @tiffmaxee to keep an eye on you. ill look forward to an update tomorrow (my time)

 

Thank you!

She was able to keep that 10mls down but I didn't give any more after that.

I've worked out a feeding schedule so she's given food every 2 hours: 2 meal-sized portions before shot times and 3 snack portions in the middle of the day for a total of 300 calories per day. I think she will tolerate this amount of food.

I gave the buprenorphine again this morning but unfortunately it doesn't seem to have the same positive effect on her as it did yesterday.. she's sitting very still with her eyes closed and head low

 

Mid-afternoon update here:

Princess is still looking terrible and either sitting in the corner and not moving or hovering over her water bowl and getting her chest soaked. In the past, we would have checked her into the ER by now as we know these are her DKA signs.

I've seen her wobble over to the litter box to pee a little bit, but I haven't been able to get enough liquid to test for ketones today. I've now removed 95% of the litter and hope to have some liquid to test soon.

Her Libre readings keep coming up "HI" which means the BG is above 400, but it's impossible to see the exact number. Yesterday at the vet, it came back in her blood test as 600.

I've been able to keep up with the feedings every 2 hours (she's had 2 meals plus 1 snack so far - about 140 calories). I've been flushing her etube with water during and in-between feedings, but I want to make sure I'm giving the right amount of water. Is there any guidance on that? I want to give her enough fluids but not make her throw up.

 

Does Zofran need to be given on an empty stomach? The bottle says it does, but the doctor said it doesn't. I gave Princess Zofran about 10 minutes after giving her the 2nd snack (25 mls) and she threw up

 

Tagging
@Bron and Sheba (GA)

@Suzanne & Darcy

@Wendy&Neko

@Princess Tortilla
If you don't get a response I googled your question and found this
Ondansetron ( Zofran ) is generally given to cats by mouth in a liquid or tablet form, with or without food. When given on an empty stomach, if vomiting or nausea is noticed, you should give the future doses with snacks or meals.

 

It is better to give it before you feed her and let it take effect for 30 minutes before feeding.
If the vomit was within 10 minutes of giving the zofran that she threw up and you think she threw up the zofran, then you can repeat it.

 

Can you take her to your normal vet and get her bloods checked to see if she needs something extra and maybe get some subQ fluids into her?. It does sound as if she needs vet care and her electrolytes looked at. I know you can’t afford ER but maybe the local vet can help you during the day.
We do have another kitty in the same position as you and she is taking her kitty to the vet during the day and bringing her home at night. It’s not ideal but better than nothing.
If we can see a ketone result, it will help a lot.

 

Did the vet check her bloods yesterday and do you know if they checked the potassium?
Also as she is anaemic that won’t be helping.
I saw in the SS that you got negative ketones in the urine at 7pm…was that today?

 

Yes that was today and sorry I meant it was +7 after the AM shot. I was able to test it again about 2 hours later and it was negative again.

Yesterday the vet said electrolytes looked OK but they're having us continue the potassium supplement that was originally prescribed (2x/day).

I'm wondering if there's anything I can do for the anemia at home. I googled and found some answers about iron supplements but also another answer saying anemia in cats is rarely due to an iron deficiency... I don't recall exactly but I think the vet said there isn't much we can do at home, just that we'd have to do more extensive testing to find the root cause of it.

Sounds good. I do think she threw up the zofran, so I gave it again and will try giving food again soon.

 

I’m not very experienced with anaemia but I have an idea that B vitamins can help but probably only if it is mild. I’ll tag @Wendy&Neko as she may know.
If the electrolytes were ok and negative ketones today, then I am wondering what is going on. Maybe she is just recovering from the DKA….so I would continue with the extra food, giving her fluids and testing for ketones.
Did the vet do a test for pancreatitis? It would have been a separate test called an fPL test?
Did you give the bupe today?

 

Do you have the blood test results? Is there a HCT or PCV? Those are used to measure anaemia. Which can be caused by multiple things. Did the vet have a suggestion why she was anaemic? Lots more on it here: http://www.felinecrf.org/anaemia.htm

 

How are things going?
Have you managed to give more food and has she kept any down?

 

I heard back from our vet and she advised us to lower tonight's dose back to our usual 1 unit (from 1.5) due to the bouncing. And she actually recommended we lower the feedings since she's been vomiting so much. I gave bupe twice today - morning and night - but it didn't seem to make a difference like it did the first day I gave it :/ ... not sure why. Princess is still lethargic and is staying leaning over/into her water bowl which is really concerning me.

I'm not sure what kind of testing they did for pancreatitis but the vet confirmed it.

 

Thank you for the link. I don't have the blood test results but can request them. She said they would need to do more extensive testing to identify the root cause

 

@Princess Tortilla
PLEASE DO NOT LOWER THE DOSE DUE TO THE BOUNCING. She needs that insulin to combat the ketones! I can't believe the vet said that!
The bouncing is not caused by the dose of insulin, it is from the drop to 60 yesterday. Lowering the dose will not effect the bouncing but it will certainly effect whether ketones can form again.

I would also disagree with your vet here as well. I thought you had already reduced the amount you were giving. To reduce it further would be very unwise in my opinion.
I would make sure that she has enough cerenia and ondansetron so that she doesn't vomit.
Don't wait unit she vomits to give it. Give it routinely for the next several days.
I would push for some A/D hills wet food as well. it is well tolerated and cats like the taste. And it is absolutely fine for diabetic cats. Yes it is a bit higher in carbs at 13% but getting food into her and getting her to eat is far more important than carb content at this point.

 

I'm confused.. maybe I can add some detail to this: she dropped to 60 after we increased the dose from 1 to 1.5 units. So the vet's saying due to the Somogyi effect, her body overcorrected and became hyper. However, we did give 1.5 units two times after that initial drop to 60, and her readings have been HI and she hasn't come back down.

Her 2 ketostix were negative for ketones today so I'll make sure I keep testing as frequently as I can.

We're still tube feeding all of her meals. Unfortunately she has no interest in eating orally. I will definitely be keeping up with her regular doses of cerenia and zofran.

 

I'm sorry to keep contradicting your vet but there is no such thing as somogyi effect in cats. I can go into that more later but haven't got time atm

The reason she has not come back down yet is because she is bouncing, which was explained earlier. Bounces can last from 1 to 6 cycles. There is nothing you can do about bouncing except wait them out. Reducing the dose does nothing for the bouncing except give the cat less insulin.

I am sure you are torn between wanting to believe your vet and wanting to believe me. So I know you are in a difficult position.
However I can only tell you we get a lot of post DKA kitties here and are very successful in helping them get better.
Most arrive here with no post DKA care instructions from their vets.

This is very very common in post DKA cats so don't get disheartened about that. Just keep up the antinausea meds and the tube feeding and every so often try her with something she normally likes.
If she also has pancreatitis she has a double whammy as not wanting to eat is one of the main symptoms with pancreatitis.
Please consider at least going back up to 1.25 U in the morning dose.
And remember it is enough food, enough insulin and treating the infection or inflammation that treats DKA.

 

Please listen to what Bron is telling you and not your vet, I agree with every thing Bron is telling you.
I have copied this for you to read

There is actually no such thing as Somogyi effect in cats. Don’t know why vets often quote it.
Here is information @Sienne and Gabby (GA) wrote about Somogyi :
Simply put, no.
This is a soapbox issue for me. I'll try to be succinct. The term first appeared in 1938 and was named after Michael Somogyi. It was based on a very small sample of humans and urine glucose was being measured. The "research" (if you can call it that) appeared in a local St. Louis medical publication - not a major medical journal. The results have never been replicated and have been contested in recent years. Consequently, the entire idea of Somogyi in humans is controversial. There's an article in Wiki that is a decent summary as it relates to humans.

With cats, there hasn't been any research let alone research with new insulin such as Lantus and Lev that are pharmacologically very different from what was available in 1938. I haven't a clue why vets continue to contend that a cat is in "chronic Somogyi rebound" when a cat may be bouncing off of a low number or fast drop. With humans, the recommendation is typically to decrease the dose in order to alleviate the problem What we've seen repeatedly is that when a caregiver does this, the cat stays in high numbers (because you're not giving enough insulin) and you end up wasting a good deal of time as a result of working the dose back up.

As long as you are systematically increasing the dose according to the protocol, you won't be giving too much insulin.
Here is an explanation of 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).

 

I agree with Bron to push for the Hills A D Wet Food. If your vet has it just tell him or her you want to try a can. It's your cat

 

@Bron and Sheba (GA) @Diane Tyler's Mom

ahh wow ok, I will read through this again later and consider. For now, two other urgent issues have come up:

1. Her Libre sensor just stopped working out of nowhere and is saying I need to replace it. I have requested a new one with the vet but who knows how long that will take and I don't really trust it anymore. I haven't done BG testing any other way and I see there are a bunch of options. Is there one you can recommend I go out and get in the morning? (it's middle of the night here)
2. Princess is slumping into her water bowl and I don't want to take the water away but I'm really worried she's going to face plant into it and pass out and drown. Her chin, chest, and front paws are all soaked from doing this but I can't get her to move away from it. What should I do? I'm reading other threads here of this behavior reported but not sure what people have done about it. I also just gave her cerenia mixed with 8 mls of water through her etube and she threw it up...

 

I would get a ReliOn Premier meter from Walmart in the morning along with some test strips and a box of 100 lancets size 26 0r 28 and some cotton balls.

Oh dear! I'm sorry she is still vomiting. Can you retry the cerenia with less water?
When did she last have any ondansetron? If it is 7 hours, she could have another dose of that as well as the cerenia.
I would take her to the vet first thing in the morning and ask for a cerenia injection. She may need those daily for a little while if the vomiting doesn't settle down.
Regarding the sitting beside the water...this is common. Maybe make sure the depth of the water is low
I would also ask the vet to give her some sub Q fluids in the morning and ask them to let you give them at home daily. Lots of care givers do this.

 

Ill be around for the next 3 hours thenIi can ask someone else to help you if you need it so you need not feel you are alone.

 

@Bron and Sheba (GA) thank you so much for the help. I’ll try to get her in to our neighborhood vet in the morning.

going to try to get some sleep for now

 

Are you going to try and get some antinausea meds into her first

 

We spoke to our vet this morning and she told us to give 1.5 units so we did that and she also said since her ketone tests have been negative (they were also negative at the checkup on 1/5) there is possibly something else going on with her likely related to the anemia. We’re currently en route to the hospital to get full bloodwork and a repeat ultrasound to look into the anemia. She was anemic the first and third hospital stays but not the second.

This morning I was able to successfully give her the zofran, cerenia, buprenorphine, insulin, 30ml of slurry, and the potassium supplement.

I’m really worried about her and hope we don’t have to keep her there overnight again.

I’m going to ask for sub q fluids to take home and for some hills. If she’s getting food through the tube I’m wondering why it’s being suggested we ask for Hills? Is it to entice her orally?

wish us luck…

 

The Hills is easier to tube feed as it is a liquid. Also cats like it. Main reason is because it is a recovery food and a liquid

 

Please give us an update when you can.
What’s happening about testing the blood glucose? Are you getting another libre fitted or are you going to test yourself. Very important something is worked out as we need to see those BG numbers

 

On the way home from the hospital now… she has elevated kidney values and is very very dehydrated. They said she isn’t in DKA and she doesn’t have pancreatitis right now. BG at 500.

We decided to hospitalize her so they can get her hydrated and run more tests on her kidneys. It’s possible those results indicate a bad prognosis it’s also possible those tests don’t give us answers… But it sounds like kidney disease on top of difficult diabetes. I’m so worried about her not being able to recover and have a good life after this

 

I'm sorry to hear the news. If she's dehydrated, that could make the kidney values worse. Giving her fluids should help. Keep us posted.

 

I am sorry to hear this. I did wonder if something else was going on. But that is really good she is not in DKA and doesn’t have pancreatitis.
If she is very dehydrated, the kidney values can look really bad, but once she is better hydrated and the kidneys given a few days to recover, they can look much better, so wait and see what they are like after being on a drip for a day or two. I have seen this happen with other kitties. So give it time.
And cats with both diabetes and kidney disease can live for years with the appropriate care.
Im glad you decided to leave her there and get her well hydrated. Please keep us updated with her progress. Vets can sound very pessimistic but don’t give up on her and don’t let them talk you into putting her to sleep without exhaustion every avenue. Sometimes vets take this road as the easy option.

 

Progress is looking poor.. things got worse overnight… they diagnosed her as HHS which based on my research sounds like there’s a low recovery rate. On top of that, kidneys are still not looking great. Electrolytes are off, i think high sodium and low potassium. They’re doing a blood transfusion today and I think more tests on her kidneys. There was a lot communicated over the phone it got so overwhelming but overall it would be a lot more money for a low chance of recovery and a difficult life for Princess.

We definitely don’t feel pressured by the team of doctors to make a decision in any direction. But at this point we’re coming to terms with the reality that she likely won’t recover from this. She would need ideally a week more in the ICU which we can’t afford, and if/when we do bring her home it’s likely she’ll be back in the hospital again soon.
I’m absolutely heartbroken and dreading the next call from the hospital. I feel that we’ve done everything we possibly could do and have pushed our financial boundaries way past our limits.

 

Your situation sounds similar so here's my story. A few years ago I took a diabetic posted on this board. Four days later Chance crashed very badly - dehydrated, wouldn't eat, lethargic. I gave something for nausea, syringe fed and he vomited. Gave sub-q fluids but it wasn't enough to correct dehydration. He needed to be on an IV so was admitted to the hospital. Based on blood panels and urinalysis, it appeared he might have been brewing a kidney and/or UT infection and the stress of moving to a new home tipped him over the edge into DKA. His WBC was high, potassium and sodium were really low and electrolytes, kidney and liver values were all out of whack. He was flat, too weak to move and unable to raise his head. The vet cautioned that he may not survive the night and only gave him a 50-50 chance of recovering if he did.

When I visited the following day he was mostly unresponsive, didn't open his eyes or react to being touched. After 3 days in the hospital Chance was somewhat better and blood panels improved. His survival odds were increased to 70-30 but he was still weak and not eating on his own. I'd been through this before so brought him home and syringe fed a/d and baby food, and kept dry Instinct available. He also needed sub-q fluids, antibiotics and supplements.

Committed home care is critical to recovery and maintaining hydration is at the top of the list. One of the first things they do for sick cats at the vet is give fluids. Dehydration can make a cat go downhill really fast and since you've been through this before, tell your vet you want fluids to have at home. Tube feeding can be a life-saver but putting too much liquid orally into an already sick cat's stomach makes them feel even more nauseous and likely to vomit. Sub-q fluids are absorbed slowly and leave room for food. I've found that to be true for cats that have kidney disease, pancreatitis or recovering from DKA. I 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

Liqui-Tinic is a vitamin/iron supplement that may help with anemia and is safe for diabetics. Amazon has it: https://www.amazon.com/Liqui-Tinic-Flavored-Vitamin-Supplement-Puppies/dp/B00152C8MK

 

Oh I am so sorry to read this. I do hope they can do something. Deborah has written a very good post above.
Are they giving her IV fluids and correcting the electrolytes imbalance. I’m sure you are feeling overwhelmed and upset.
I do hope they can help her. Please let us know how she goes.

 

I'm sorry to read this, all I can do is say many prayers for her and hope things turn around . You definitely did and still doing everything you can. My heart goes out to you ♥ Whenever you can please update up

 

Thanks everyone for the continued support and advice. I really appreciate it.

We picked Princess up from the hospital tonight, and she seems to be a lot brighter. We're obviously happy to see her in better spirits, but are cautiously optimistic. This has happened before where she leaves the hospital feeling better but a few days later needs to go back. The main thing is the hospital's ability to keep her on an IV drip the whole time she's there. We still don't know what mysterious underlying disease/factor is triggering her to go back into these intense diabetic crises... the doctors have deemed her a particularly difficult case of diabetes.

Luckily the IV drip helped the dehydration/kidney injury caused by dehydration. Her kidney values went down, but they still diagnosed her with chronic kidney disease.

She just ate half her dinner orally (!!) which was so great to see. I'm going to see if she's interested in eating more before tube feeding a little, but I don't want to overwhelm her stomach tonight. I know the Hills urgent care food has been recommended here, but I've asked multiple doctors about this and they all think it's too fatty for her and might cause diarrhea. They said she's fine with the Purina Pro DM food, and recommended using baby food to entice her.

I asked again about subq fluids to bring home, and the doctor who discharged us said she'd have to get approval from another doctor who wasn't present at the time to give them to us. We'll follow up with them about this tomorrow.

I also asked for a recommendation on a glucometer, and the doctor recommended the Alphatrak, saying it's widely used in hospitals and was one she personally had used on her diabetic cat. Any thoughts on that one vs the Relion that was previously mentioned in this thread? I plan to order one of these on Amazon ASAP.

It's been such an emotional rollercoaster these last few days. I'm so happy she's home. I reeeally hope this was the last hospitalization she needed to get her diabetes on track.

 

Great news that she's home again and feeling like eating. I really hope they get on letting you give fluids at home.

The test strips for the Alphatrak are too expensive. The meter is pricey too. Plus you can only get the test strips at the vet (when they are open) or on line. Hard to get backup in an emergency. Stick with the Relion. Back when I started here, it was the days before the AT was heavily marketed to vets, and everyone, including vets, used human meters. People here are much more used to human meters and our dosing methods are based on them.

 

So relieved to see your post! And that's wonderful that she's eating on her own - getting hydrated makes a huge difference. Sweetie, you really need the sub-Q fluids. I cannot stress this enough. Princess was severely dehydrated and could easily back slide. Given her history, your vet should already know this. Chance got fluids daily for at least a week after coming home from the hospital. I'm actually pretty liberal with fluids anyway and get them by the the case. If your nitwit vet refuses to let you have them, I'd be happy to send you some along with some needles and IV admin line.

You don't need the expensive glucometer/strips that the vet recommended. Get thyself to Walmart for a Relion. I've been caring for diabetic cats for almost 20 years and have always used a human meter.

 

@Wendy&Neko @Deborah & Muffy(GA) & Wendall

Thank you for the thoughts on the glucometer! I'm not near a Walmart, but can order the Relion on Amazon. Does this kit look like it has everything I need?

Re: fluids - yeah, I don't know why they've been so hesitant to let me take the sub-q fluids home. I think I remember them saying something about it affecting her heart (?)
We just got home from the hospital 2 hours ago, and she's already taken many trips to her water bowl and has been hanging out there for longer than she should be. They had her on an IV drip the whole time there. I'm not sure why it's so hard to keep her hydrated at home...

 

thank you so much for the offer! You are too kind. I'll follow up with them about this in the morning and let you know what they say

 

I’m so glad to hear an update on Princess Tortilla. I second the ReliOn meter. Make sure to get lancets size 26 or 28 gauge. You will also need some cotton balls to put behind the ear when testing but can get those from a pharmacy.
Also second sub Q fluids. Also good for kidney issues. It’s true you need to be aware of any heart issues but if they were giving her them there should be no issue. Just check the amount per day.
Crazy not wanting to use the Hills a/d. Oh well! It’s called recovery food for a reason.
Keep us posted

 

Yes everything you need those 50 test strips will go fast
You can pick up from Walmart The Relion Premier Classic meter and test strips

https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103. 9 dollars

https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197. 17.88 for 100



Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

A video one of our members posted, she is using a pet meter ,strips too expensive plus you have to code it
A human meter is just fine, most of us use human meters ,that's what our numbers are based on
When you get your meter can you add the name of it to your signature and spreadsheet


VIDEO: How to test your cat's blood sugar

Here is another link to read
This is a link to one of our posts on home testing.

 

Can't throw a rock around here without hitting a Walmart. The beauty of a Relion is the strips are less expensive and Walmarts are everywhere, except apparently where you are. I've mostly used a Contour and get test strips on ebay.

Her heart, huh? Well, she was getting fluids in the hospital so ... As long as Princess doesn't have a heart condition and you don't over-hydrate there shouldn't be a problem. One of my cats started getting fluids when she was 16 (kidney kitty that had to be hospitalized for dehydration) and had them every day for the next 5 years while she ate her second breakfast. That Princess is already hanging out at the water bowl tells me she's not recovered yet and is going to need sub-q fluids for awhile. Please don't wait on that. Make sure the vet knows she's already seeking water and you'd rather not have to hospitalize her again. You are competent and capable and there's help here if you need it.

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

I looked up HHS because it's so uncommon I'd never heard of it and I've been on this board for 19 years. Sounds similar to DKA and treatment is pretty much the same with fluid therapy being critical.

 

That's an important detail. Have they heard a heart murmur? My girl was getting fluids for her kidneys but went into heart failure because of it due to a heart problem. She had had a clean echocardiogram 6 months earlier. She did recover from that heart failure. I understand being cautious if there is any concern about heart problems.

 

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

No heart condition reported, I think they mentioned a risk to the heart if we over-do it. But sounds like I should be able to get guidance on the right amount to give. I just gave her crushed Zofran mixed with 8 ml of water through the e-tube and she threw up 15 mins later I was able to put the pill in her mouth after, but I don't want to rely on just the e-tube + water for hydration. As I write this, she's sitting by her water bowl with her head hanging over it...

So I can just call up my local vet and ask for subq fluids? They're not updated on her situation but I can kick that off.

Ha, yeah I'm in NYC and there are actually no Walmarts here! But I've ordered that kit I linked on Amazon, which should be coming tomorrow. I'll order some extra strips too and the lancets.
She's been reading HI on the Libre for the last 12 hours, so I'm eager to try the ear prick method.

 

Hi Tiffany, yes your local vet should have the sub q fluids , I used to give them to Tyler's brother for kidney disease. Not hard at all to give. Sending prayers for your precious girl.

 

Thank you <3

 

OK so our local vet will see us tomorrow first thing for a checkup and demo for the subq fluids!
Until then I hope she can stay hydrated with the water that's mixed with her tube food and the water she's been drinking on her own.

I've just been giving her tap water (the same water I drink).. we live in NYC so the tap water is perfectly fine to drink.. but now based on some googling, I'm wondering if I can improve this for her by filtering it or giving her bottled spring water. Do you think this would make a difference?

 

I wouldn't do that, I would wait until your vet gives them to you
I also know they have 2 size needles you can use one is bigger and make the fluids go in quicker and one is smaller which make the fluids take a little but longer .
Perry was calm so I would use the bigger ones to get it done faster ,he wouldn't fight me
I would put him on the kitchen table, it was against my wall , put him in a towel. Then I would get one of those hooks I think they were the 3M plastic hook and put it on the wall and then hang the bag on it. It has to be up high so the fluid could come out
I'm sure your vet will show you everything

 

Ok great! Thank you

 

@Princess Tortilla
The ones like these they sell them in any supermarkets all different sizes

 

gotcha - I have some at home I can use. Thanks for the tip! Will let you know how it goes tomorrow

 

This is what in the sub fluids
Injectable fluids come in various forms, but only a few should be used for subcutaneous administration. Lactated ringers, 0.9 percent saline, Ringer's, Normosol-R, and Plasmalyte are most commonly used

Also my vet gave me a tip, the fluids will be sort of cold, so she told be to lay the bag in some sort of container with warm water so it doesn't feel that cold to the cat.
I layer the bag in a dish pan, the ones you wash dishes in until it felt a little bit warm.
Yes let me know how it goes and ask the vet for the 2 different size needles
After I gave the fluids I would just throw away the needle and put a new one in so it's ready to go for the next time
@Princess Tortilla

In case you want to watch a video here

 

Perfect, I was just going to suggest that!

As far as the right amount, some vets will say 200 mls or whatever a couple times a week. That's too much at one time and can leave the cat thirsty the rest of the time. It's better to give less but more often. The goal is to maintain hydration so the cat doesn't have to drink much which will improve her appetite and help her heal.

Diane gave you some good tips and I'm going to add mine. I do infusions on the kitchen counter and use a big S hook that came from a garden center to hang the fluids from the top of the cabinet, but a wire clothes hanger works as well. Cats prefer fluids at body temperature so I warm them in a big bowl of hot water for a few minutes. Give her a towel to lay on and put some food in front of her as a distraction. Sassy, the old cat I referenced before, learned to come for her fluids because of the food.

 

very helpful, thanks so much!

I'm still worried about her drinking so much water today.. she threw up just now about 90 minutes after her last tube feeding of 30 mls that was given to her over the course of an hour. In the past it seemed like I was tube feeding her too quickly which was making her vomit, but observing her now, she is drinking SO much water herself that I feel like there's just too much water in her little stomach for her to handle... should I try taking away the water bowl for periods of time?

edit: maybe worth adding that at the end of her tube feeding I gave her 0.9 ml of clavamox (an antibiotic we just started at home today - pretty sure they gave this to her at the hospital too) that says to give with food