Rebecca M
Member
Hi everyone - I'm new here and just desperate for thoughts, advice, answers. I love my cat more than anything but clearly have not taken his diabetes seriously because I've made a serious of rookie mistakes multiple times now, and I need guidance.
I'm so sorry for how long this is but I don't know which information is important and I don't want to leave anything out.
My cat, Yahiko (male, 15) has been diabetic twice before, and twice before he went into remission after being on only Fancy Feast. I had an AlphaTrak 3 glucometer that was giving really wild and inconsistent readings and I had to prick him multiple times to get blood out of him, which he hated and he is a BIG cat (healthy body weight for his size is 15.5 to 16 lbs - massive, and when he was first diagnosed with diabetes he was overweight at 18.5) so it was really difficult to hold him and get a reading. The vet said as long as he was doing okay, it was fine, and the freestyle Libre they gave either didn't take or I don't know what but the readings on it were WILDLY different - I would take it 4 times in a row, like within 1-2 minutes, and get numbers from the 60s to 200s even in the middle of the day or before eating. So we didn't replace it. Last time he went into remission, we had no idea and were giving him Lantus (1 unit every 12 hours) and he had a seizure one morning; this was about 7 or 8 months ago. He went off insulin. As with last time, he was able to maintain remission with just the Fancy Feast diet and the occasional treat here and there.
Here's where I messed up. He developed IBD and was losing weight due to malabsorption. They put him on a steroid, budesonide, specifically because it's good at not impacting blood sugar in cats. In October we realized he needed a tooth pulled (it wasn't infected yet but was at risk of it and was super inflamed) and we wanted to get some weight back on him before the surgery because he was at his lowest and was just not healthy, so we planned to put it off for a couple of months and we reintroduced a small amount of dry food. Diabetes was the furthest thing from my mind because of the remission, the upcoming surgery, etc. We very abruptly needed to move his surgery up to November 20 to remove a small mass on his abdomen (suspected mammary tumor, turned out to be a cyst), so for the week and a half until that point, we gave him more dry food. He gained weight at a reasonably healthy rate and it was still low at something like 13 pounds and he was still a little bony but it was better.
I missed a million warning signs over the course of about a week. He was hiding away behind our Christmas tree - I thought because he was healing from surgery. He was drinking a lot, but that can be normal for him even in remission (he has between stage 1 and stage 2 kidney disease, diagnosed earlier this summer around the same time as he went into remission). He stumbled a couple of times and I took note but thought maybe he was just off-kilter because he was still eating normally. Like I said, stupid mistakes. Sunday, December 10, I left for a one week work trip. Tuesday, December 12, my roommate/best friend messaged me after the cats ate dinner and told me she was worried because he'd barely eaten that morning or in the evening and was clearly hungry but doing "weird stuff with his mouth". I immediately assumed an infection from the tooth removal and told her to bring him to the vet. She did the very next morning - where they found his blood sugar was 619 and he was in DKA.
I flew home immediately while he was admitted to the ICU. My cat is extremely anxious and stubborn and was not doing well - the vet was giving me between 60-70% survival chance on the phone that morning but by the evening the night vet was much more guarded. He perked WAY up for me and ate a little bit as soon as I got there. (This is honestly normal for him - I have 6 cats but he is the only one who is like this around me, an absolute momma's boy.) So she was much more optimistic and told me that the ones who eat even at the beginning of treatment tend to fair better.
The morning vet called me at 8AM the next morning (yesterday) telling me she didn't think he was doing well. He was laying there, too weak to lift his head, and his potassium was low. I rushed over thinking we were about to euthanize. But once again, he shocked ALL the nurses and vets by immediately popping up and coming over to me when I sat down in front of him. He laid half in my lap and they wouldn't let him eat because he had an ultrasound but he clearly wanted to and drank. They gave him a potassium supplement and it got up to 3.3 (I think it was at like 1.8 before that - it was very low). They took him off the insulin drip and put him on 4 hours of the highest safe dose of potassium. I went to see him in the afternoon and he was MILES better, so much so that the same vet who was gently encouraging me to euthanize told me he was absolutely trending upward and began talking about long-acting insulin. His potassium went up to 3.3 (though his blood glucose, which had gone down to 280, was back up to 340), his ultrasound was completely clear, he was SO alert and perky and moving around and demanding more food/treats, it was great.
They wanted me to come back at 8:30PM to feed him and bring Lantus with me (they didn't have any, I had to go pick up a prescription). I did so but they had multiple emergencies and told me to come back later, so I came back around 10:45. They told me he had eaten a little around 9 (which was the idea; they wanted him on 9 to 9 to start the Lantus); for me he ate a ton, which was great, but because of that they decided not to do the Lantus until the morning at 9 because they want him on a regular schedule. But I could tell he was off. He was more lethargic and clearly wanted to come to me but couldn't get himself up on his hind legs. I asked if his potassium could have dropped and all 4 of them said no, they didn't think so, but I pressed a little harder and they processed his bloodwork and it turned out that yes, it had dropped to 2.5. They added more potassium to his IV. That vet (last night) was EXTREMELY optimistic. She was talking about diet when he comes home (to manage the kidney disease and diabetes and potentially the IBD if it's still there - they saw no evidence on ultrasound but unclear) and said his prognosis was "really, really good". I was so upset that his potassium had dropped but she was unphased and said it was normal because of the CPI(?) insulin drip which is why they were wanting to wean him off and switch him to Lantus.
I left around midnight and arrived this morning at 8:30AM to feed him per her instructions. It turned out they tried to feed him themselves and he actually ate an entire meal for them, which is amazing, and they gave him the Lantus right before they brought him to me. This time they put me in a new room with him, and he was walking around quite a bit (though very weak, stumbling a bit, etc) but I don't honestly know if that was because he had a lot of energy or if it was because he was scared and there wasn't a place for him to lay down comfortably on the hard floor. He drank a ton of water when we offered it and he wanted pets and kept going to the doors to try to escape LOL. I was feeling okay about it, not great, but the vet that came in this time was so much more guarded that it REALLY threw me off and I have no idea what to think. By now he's been in the ICU about 48 hours. She said that his blood glucose had gone up overnight to 380 but that that was to be expected because he kept eating and they were weaning him off the CPI. They got his potassium up to 3.1 and are continuing with IV and oral supplements. But she was being very, very guarded and just kept warning me that whether or not he'll be able to stabilize is a giant question mark and that he may never be able to self-regulate enough to come home.
I'm just so baffled (and obviously feel so guilty because this is 100% my fault and was completely preventable). We've seen 4 vets and it's been a complete yoyo of an experience. The first said good prognosis, the second was essentially telling me he wouldn't survive but then did a complete 180 by the end of the day, the 3rd was super optimistic, and the 4th (8 hours after the 3rd) sounds like she's telling me I shouldn't be expecting him to survive. I feel like if he's JUST started the Lantus and he's responded well to it in the past, and if it's just a matter of getting his potassium back up because everything else is great (and his vitals have been completely stable since he arrived), the prognosis should be good, like last night's vet said. But I can't get this vet's words out of my head and I'm absolutely distraught. She was there yesterday morning when he wasn't doing well and kept referenсing that and how he's still doing better now because yesterday morning he didn't want to be alive. But I also kept explaining to all of them - and everyone except her agreed with me by the end of the day yesterday - that this is NOT a normal cat. None of my other cats would act like this but he is extremely anxious and I am his lifeline. He went from "euthanize, he can't move" to walking around, meowing, eating in 60 seconds as soon as he saw me. So I don't know if she's just trying to play devil's advocate or if she's jaded after yesterday morning or if all of the other vets have been overly optimistic and he's actually still in really dire straights and there's a good chance he won't survive.
I know there are so many incredible experts and people who have been through this on this forum. Could anyone please give me your best interpretation, and also your best guidance? Should I be assuming he won't make it and hold off on any long-term plans? Does it seem like he's moving in the right direction and I should be looking at home glucose monitors? If so, which one do I start with? What do I need to look out for to tell if he's getting better or worse in the ICU?
I'm so confused and I'm so devastated. I'm grateful for any amount of time you can spare to give me your experience, opinions, guidance, etc. I'm scared to ask the ICU vet because I get a different answer each time and it's making it so hard for me to actually gauge where we're at.
I'm so sorry for how long this is but I don't know which information is important and I don't want to leave anything out.
My cat, Yahiko (male, 15) has been diabetic twice before, and twice before he went into remission after being on only Fancy Feast. I had an AlphaTrak 3 glucometer that was giving really wild and inconsistent readings and I had to prick him multiple times to get blood out of him, which he hated and he is a BIG cat (healthy body weight for his size is 15.5 to 16 lbs - massive, and when he was first diagnosed with diabetes he was overweight at 18.5) so it was really difficult to hold him and get a reading. The vet said as long as he was doing okay, it was fine, and the freestyle Libre they gave either didn't take or I don't know what but the readings on it were WILDLY different - I would take it 4 times in a row, like within 1-2 minutes, and get numbers from the 60s to 200s even in the middle of the day or before eating. So we didn't replace it. Last time he went into remission, we had no idea and were giving him Lantus (1 unit every 12 hours) and he had a seizure one morning; this was about 7 or 8 months ago. He went off insulin. As with last time, he was able to maintain remission with just the Fancy Feast diet and the occasional treat here and there.
Here's where I messed up. He developed IBD and was losing weight due to malabsorption. They put him on a steroid, budesonide, specifically because it's good at not impacting blood sugar in cats. In October we realized he needed a tooth pulled (it wasn't infected yet but was at risk of it and was super inflamed) and we wanted to get some weight back on him before the surgery because he was at his lowest and was just not healthy, so we planned to put it off for a couple of months and we reintroduced a small amount of dry food. Diabetes was the furthest thing from my mind because of the remission, the upcoming surgery, etc. We very abruptly needed to move his surgery up to November 20 to remove a small mass on his abdomen (suspected mammary tumor, turned out to be a cyst), so for the week and a half until that point, we gave him more dry food. He gained weight at a reasonably healthy rate and it was still low at something like 13 pounds and he was still a little bony but it was better.
I missed a million warning signs over the course of about a week. He was hiding away behind our Christmas tree - I thought because he was healing from surgery. He was drinking a lot, but that can be normal for him even in remission (he has between stage 1 and stage 2 kidney disease, diagnosed earlier this summer around the same time as he went into remission). He stumbled a couple of times and I took note but thought maybe he was just off-kilter because he was still eating normally. Like I said, stupid mistakes. Sunday, December 10, I left for a one week work trip. Tuesday, December 12, my roommate/best friend messaged me after the cats ate dinner and told me she was worried because he'd barely eaten that morning or in the evening and was clearly hungry but doing "weird stuff with his mouth". I immediately assumed an infection from the tooth removal and told her to bring him to the vet. She did the very next morning - where they found his blood sugar was 619 and he was in DKA.
I flew home immediately while he was admitted to the ICU. My cat is extremely anxious and stubborn and was not doing well - the vet was giving me between 60-70% survival chance on the phone that morning but by the evening the night vet was much more guarded. He perked WAY up for me and ate a little bit as soon as I got there. (This is honestly normal for him - I have 6 cats but he is the only one who is like this around me, an absolute momma's boy.) So she was much more optimistic and told me that the ones who eat even at the beginning of treatment tend to fair better.
The morning vet called me at 8AM the next morning (yesterday) telling me she didn't think he was doing well. He was laying there, too weak to lift his head, and his potassium was low. I rushed over thinking we were about to euthanize. But once again, he shocked ALL the nurses and vets by immediately popping up and coming over to me when I sat down in front of him. He laid half in my lap and they wouldn't let him eat because he had an ultrasound but he clearly wanted to and drank. They gave him a potassium supplement and it got up to 3.3 (I think it was at like 1.8 before that - it was very low). They took him off the insulin drip and put him on 4 hours of the highest safe dose of potassium. I went to see him in the afternoon and he was MILES better, so much so that the same vet who was gently encouraging me to euthanize told me he was absolutely trending upward and began talking about long-acting insulin. His potassium went up to 3.3 (though his blood glucose, which had gone down to 280, was back up to 340), his ultrasound was completely clear, he was SO alert and perky and moving around and demanding more food/treats, it was great.
They wanted me to come back at 8:30PM to feed him and bring Lantus with me (they didn't have any, I had to go pick up a prescription). I did so but they had multiple emergencies and told me to come back later, so I came back around 10:45. They told me he had eaten a little around 9 (which was the idea; they wanted him on 9 to 9 to start the Lantus); for me he ate a ton, which was great, but because of that they decided not to do the Lantus until the morning at 9 because they want him on a regular schedule. But I could tell he was off. He was more lethargic and clearly wanted to come to me but couldn't get himself up on his hind legs. I asked if his potassium could have dropped and all 4 of them said no, they didn't think so, but I pressed a little harder and they processed his bloodwork and it turned out that yes, it had dropped to 2.5. They added more potassium to his IV. That vet (last night) was EXTREMELY optimistic. She was talking about diet when he comes home (to manage the kidney disease and diabetes and potentially the IBD if it's still there - they saw no evidence on ultrasound but unclear) and said his prognosis was "really, really good". I was so upset that his potassium had dropped but she was unphased and said it was normal because of the CPI(?) insulin drip which is why they were wanting to wean him off and switch him to Lantus.
I left around midnight and arrived this morning at 8:30AM to feed him per her instructions. It turned out they tried to feed him themselves and he actually ate an entire meal for them, which is amazing, and they gave him the Lantus right before they brought him to me. This time they put me in a new room with him, and he was walking around quite a bit (though very weak, stumbling a bit, etc) but I don't honestly know if that was because he had a lot of energy or if it was because he was scared and there wasn't a place for him to lay down comfortably on the hard floor. He drank a ton of water when we offered it and he wanted pets and kept going to the doors to try to escape LOL. I was feeling okay about it, not great, but the vet that came in this time was so much more guarded that it REALLY threw me off and I have no idea what to think. By now he's been in the ICU about 48 hours. She said that his blood glucose had gone up overnight to 380 but that that was to be expected because he kept eating and they were weaning him off the CPI. They got his potassium up to 3.1 and are continuing with IV and oral supplements. But she was being very, very guarded and just kept warning me that whether or not he'll be able to stabilize is a giant question mark and that he may never be able to self-regulate enough to come home.
I'm just so baffled (and obviously feel so guilty because this is 100% my fault and was completely preventable). We've seen 4 vets and it's been a complete yoyo of an experience. The first said good prognosis, the second was essentially telling me he wouldn't survive but then did a complete 180 by the end of the day, the 3rd was super optimistic, and the 4th (8 hours after the 3rd) sounds like she's telling me I shouldn't be expecting him to survive. I feel like if he's JUST started the Lantus and he's responded well to it in the past, and if it's just a matter of getting his potassium back up because everything else is great (and his vitals have been completely stable since he arrived), the prognosis should be good, like last night's vet said. But I can't get this vet's words out of my head and I'm absolutely distraught. She was there yesterday morning when he wasn't doing well and kept referenсing that and how he's still doing better now because yesterday morning he didn't want to be alive. But I also kept explaining to all of them - and everyone except her agreed with me by the end of the day yesterday - that this is NOT a normal cat. None of my other cats would act like this but he is extremely anxious and I am his lifeline. He went from "euthanize, he can't move" to walking around, meowing, eating in 60 seconds as soon as he saw me. So I don't know if she's just trying to play devil's advocate or if she's jaded after yesterday morning or if all of the other vets have been overly optimistic and he's actually still in really dire straights and there's a good chance he won't survive.
I know there are so many incredible experts and people who have been through this on this forum. Could anyone please give me your best interpretation, and also your best guidance? Should I be assuming he won't make it and hold off on any long-term plans? Does it seem like he's moving in the right direction and I should be looking at home glucose monitors? If so, which one do I start with? What do I need to look out for to tell if he's getting better or worse in the ICU?
I'm so confused and I'm so devastated. I'm grateful for any amount of time you can spare to give me your experience, opinions, guidance, etc. I'm scared to ask the ICU vet because I get a different answer each time and it's making it so hard for me to actually gauge where we're at.