? New Member UK - High BG levels & sweet breath after DKA

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Annie & Kozmo, Jun 29, 2020.

  1. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Hello, may I ask for some help please? We're not sure what to do.

    We took Kozmo to the vet five days ago (Thursday) with high levels of ketones in his urine. The vet set him up on fluids for two nights and increased his insulin (Caninsulin) from 1Ul to 2Ul and we collected him Saturday morning.

    Today (Monday) Kozmo's BG doesn't appear to be coming down as it has over the weekend. This morning's shot definitely hit the mark because I was holding Kozmo while my husband shot - I felt Kozmo flinch and Neil felt the needle penetrate.

    I've tested his urine for ketones and it was negative.

    What do we do?
     
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  2. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Ugh. Hate those numbers, and it is so worrying so soon after a DKA!

    Hang in there. High numbers alone don't cause ketones. I suspect he might be bouncing from the low blues (and maybe even lower) yesterday, and you'll just have to wait it out. How is he doing otherwise?

    The one thing you should not do is to give another shot now. We'll have to wait for the PM shot time.
     
  3. Annie & Kozmo

    Annie & Kozmo Member

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    Thank you so much for your quick reply, Nan. I was beginning to feel a little sick and you've certainly settled me back to normal.

    We'll keep monitoring his BG throughout today. He's totally flat but crawled out of his bed to the smell of beef that I was preparing for the BBQ but he wasn't interested in eating any of the scraps. That doesn't bother me however, because he's a 100% chicken devotee.
     
  4. Annie & Kozmo

    Annie & Kozmo Member

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    Apologies, Nan. I thought I clicked the reply tab under your response but it appears my head is elsewhere.
     
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  5. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Glad to hear he was interested in food (even if he didn't take a sample because it wasn't his fave :rolleyes:. How has his eating been in general?

    Explanation of "bouncing": when a cat has been diabetic for a while and has gotten used to high numbers, the first few (or first many, sigh) times he hits a lower number on insulin provokes a reaction. Even if that number is nowhere near hypoglycemic territory, it feels hypoglycemic to a cat, and the liver responds by dumping sugars into the blood to try to raise BG. That 5.6/101 yesterday (which may not even have been the lowest number hit) felt really low to Kozmo, who has been up in red/black numbers for a while. So he bounced back up to his familiar territory.

    The worst part? Bounces can last several cycles (although some kitties come out sooner-- let's hope Kozmo is one of them!). There is nothing to do about them but wait them out. You definitely don't want to increase insulin when in a bounce, because sometimes when bounces "break" they break fast, and the extra insulin can take them into dangerous territory. So, just wait.

    The one caveat here is that Kozmo is just out of DKA and thus in a kind of delicate situation. So you want to keep an eagle eye out for any other possible causes of high numbers-- discomfort or pain, infection, etc. That said, my bet is that this is a bounce.
     
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  6. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Annie, from looking at Kozmo's SS it does look like the blood glucose level is 'bouncing' (as Nan explains above). Bouncing is triggered when the blood glucose drops too low or too fast. 'Too low' doesn't necessarily mean 'hypo low', it can happen when the blood glucose drops significantly lower than the cat's body has become accustomed to. High numbers can become the cat's 'new normal', and even nice healthy numbers that aren't dangerous can feel threatening to the body and trigger a bounce.
    As well as releasing stored glucose into the system to raise the blood glucose level, the body can also release counter-regulatory hormones which cause temporary insulin resistance. It's a protection mechanism. And it can last anything from a single insulin cycle to a few days... When this happens all that can be done is to sit on your hands and ride it out... What you will typically see when this happens are numbers that are high and 'flat', that is to say, unresponsive to insulin. When the effect of the hormones wears off the body becomes responsive to insulin again...
    It may well be that the insulin dose is too high (I strongly suspect it is)... If your kitty hadn't just had an episode of DKA I would normally suggest reducing the dose at this point. But reducing insulin needs to be done with caution in a cat that is prone to ketones...

    I'm going to tag @Bron and Sheba (GA) to see what she thinks because she is very knowledgeable and is also familiar with your case.

    Meanwhile, what you can try to do is to use food to slow down the rate at which the blood glucose drops. With Caninsulin it's a good idea to feed, then wait maybe 20 minutes before giving the shot. But it can also be helpful to feed snacks over the next few hours to slow down the rate at which the blood glucose drops. If it's still dropping too fast you could try a food with a slightly higher carb level. ...Then, once past the peak of the cycle, when the blood glucose starts to rise, don't feed again until your kitty is due for the next shot (feeding during the second half of the cycle may raise the blood glucose further). So, this strategy is really to 'feed the drop' and 'starve the rise'.

    Eliz
     
    Last edited: Jun 29, 2020
  7. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Thank you for taking the time for your detailed explanation of "bounce". It made complete sense and we're inclined to think this is what's occurring too.

    He's on 25mg of Gabapentin twice for a slipped plate and arthritis pain, and he appeared agitated last night but not so much today (could very well be due to lethargy from high BG). We've learned that he's experiencing pain when he's agitated, fidgety and finding it difficult to settle. We have a nagging feeling that it was pain that pushed him into DKA last week because he's been given the all-clear from the vet on infection (full blood test).

    Perhaps we might need to discuss increasing his current dose of 25mg Gabapentin twice with the vet. It would be interesting to see if his numbers come down.
     
  8. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Thanks Eliz. Kozmo's never been a big eater but we discovered earlier on this forum to feed then wait 20 minutes when using Caninsulin. We're coming up to his +6 test and he hasn't had anything to eat since his AMPS. We'll keep food away from him until PMPS. Feeding the drop and starving the rise makes sense too and this is what we'll implement from now on. He's lost an incredible amount of weight (from 4500g October 2019 to 3860g now) and being a fussy eater doesn't help either. We've stocked up on various low carb wet foods and have an endless supply of chicken breast which is a fail-safe.
     
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  9. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Kozmo now.
     

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  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Hi Annie,
    I think Kozmo is most likely bouncing as well. Its really good that the ketones are negative. That is so important. Thanks for putting them in the SS for us to see.
    I am a bit concerned to see you didn’t feed him between the AMPS and the +6. With DKA it is really important that he eats as much as he can as food is one of the things that stops ketones forming. If the body doesn’t get the food for energy, it will start to use fat and protein from the body for energy and the byproduct of that process is ketones. So you need to be feeding frequently to stop this happening. So at this stage I would be offering snacks of food every 2 hours Except for the 2 hours Preshot.
    @Elizabeth and Bertie talked about feeding during the first half of the cycle to slow the drop which is very helpful and with the DKA recovery still in the picture you need to continue offering food up until + 10.. with DKA Kozmo needs to be eating as much as possible ... 1 1/2 times as many calories as he normally eats.
    Do you have cerenia if needed?
    The main things you need to concentrate on are
    • Feeding as much as Kozmo will eat
    • Making sure he is getting fluids
    • Giving the insulin and testing the BG
    • Testing twice a day for ketones
    • Keep posting and asking questions
     
    Last edited: Jun 29, 2020
  11. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Thanks Bron, sorry, I should have made it clear that it wasn’t a case of us not putting food down for Kozmo between AMPS and +6 - he was refusing to eat. He had some chicken breast snacks during the afternoon, more food pre PM shot and a decent amount before bed. He’s so thin and bony that getting food into him is important to us.

    Today his AMPS is 13.9 and he’s since had breakfast and his **** 20 minutes later. His ketones are negative but we’ll also test tonight.
     
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  12. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Thank you for your wisdom, Bron. :bighug:
     
  13. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Annie, do you know 'why' Kozmo isn't eating enough? Is he feeling nauseous? (Looking like he wants to eat but then not doing so? Starting to eat and then walking away? Lip licking? Any vomiting..?) Has the vet talked to you about anti-nausea meds, and/or appetite stimulants?

    Will Kozmo 'only' eat chicken at the moment?
    Will he eat any other foods at all?
    I've had quite a few oldies that I've needed to get calories into. Things that helped us include: Feeding snacks little and often; warming the food a little (couple of seconds in the microwave, or adding a little hot water); feeding higher calorie foods such as Gourmet Gold pates (these are smooth and can also be mixed with warm water to make them easy to lap up, or even used to syringe feed; 'sleepy eating' - gently waking the kitty and putting a tasty snack right under his/her nose - the cat will often eat immediately on waking without really thinking about it; sprinkling tasty toppings on food, such as crushed treats, a little grated cheese, Engevita yeast flakes, Fortiflora; giving extra treats to supplement the diet (the semi moist treats such as Nature's Menu for example seem very palatable); giving a liquid cat food called 'Liquivite' as a supplement to the diet. Liquivite can be a godsend if the kitty will drink it. Some cats absolutely love it, some are bit 'meh' about it it. It's a sort of chicken soup for kitties, and it increases fluid intake as well as adding calories and extra nutrients to the diet. With some of my kitties I've put a bowl of this alongside their water, and they will often drink this even if they're not interested in drinking the water.
     
    Last edited: Jun 30, 2020
  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Eliz has given you some great ideas to help try and get Kozmo to eat.
    If he is still refusing to eat, you need to go back to the vet and demand if necessary that you are given some cerenia and ondansetron antinausea tablets. If Kozmo is nauseated he won’t eat and at this stage eating is crucial in his recovery.
    If the vet wants to give you some appetite stimulants make sure you get the antinausea meds as well as he will need to be given the antinausea meds before he is given the appetite stimulant.
    Keep posting and telling us any issues and updates.
    Bron
     
  15. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Honestly, our eternal thanks to Bron and Eliz, and all of you for your ongoing support and invaluable knowledge. We want to do the best we can for Kozmo. I’m going to monitor his eating habits closer now and will keep you up to date xxx
     
  16. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Don’t be afraid to ask the vet for the antinausea meds. Most DKA kitties need some antinausea meds for a few days to combat the nausea. It is very common.
     
  17. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Annie how is Kozmo going?
    Is he eating plenty of food.?
    I see he is bouncing from the lower numbers.
    And that’s great the ketones are still negative.!!
    Is he feeling any better do you think?
     
  18. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Hi Bron, thanks for the follow-up

    Kozzie’s just recorded 32.7 AMPS - still bouncing? It feels like it’ll never end. Poor thing. This Caninsulin appears to be awful stuff. His numbers soar so high.

    I know to wait 20-30 minutes after feeding to shoot Cansulin - does it make much a difference when his numbers are already so high, or is to do with the effect of food in his stomach?

    He seems to be a happier cat at times but overall he’s still a zombie in comparison to his normal self. He eats small meals throughout the day and evening and his weight hasn’t dropped from pre DKA. He’s interested in food and doesn’t slap his lips. I read that he probably won’t start to gain weight until he’s stable? Our hope is to get him back to 4.5kg (from his current 3.87kg).

    I’m wondering when to approach the vet with Kozmo’s spreadsheet in another attempt to change to Lantus. She said she’ll consider it if we provide evidence that Caninsulin isn’t working.
     
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  19. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Those black numbers are a combination of bouncing and the fact that caninsulin doesn’t last 12 hours.
    Are you able to get any later tests in the pm cycles so we can see how low he drops? I wouldn’t like to increase the dose until we can see what happens in the pm cycles.

    You will need to stay with caninsulin for a bit longer because of the threat of ketones. Caninsulin is an ‘in and out’ insulin meaning the dose only affects that one cycle. With Lantus it is a depot insulin and one dose can affect another cycle because of the depot. The depot takes up to 5 days to fill in the beginning and there is a risk during this time that because the dose is not at its potential, that ketones could appear. Not sure I’m making sense, but we can’t risk that Happening until we have had a good stretch with no ketones and Kozmo eating well and looking better.

    I would still feed him 30 minutes before the shot even if the BG is high. The food will help stop the BG dropping too fast. You might like to give him a good snack at +1.5 to help that as well. That might slow the drop and help with the bouncing.

    How much is he eating a day?
    While his numbers are high he won’t put on weight but once he’s in more stable numbers he will.
    When Sheba was diagnosed she had lost a lot of weight but she regained all the weight (and more) and also all her muscle mass.
    So hang in there.
    Remember, lots of food, keep testing for ketones, testing the BG, give the insulin, and make sure he’s getting extra fluids.
    And make sure you treat yourself!
     
  20. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Thanks Bron, once again you’ve made yourself very clear. I can set an alarm for PM tests - how many and at what points? Also, how many AM tests should we be doing? We’ve done a lot recently but won’t be able to keep up with that number consistently due to work commitments etc (Kozmo is a high priority of course).

    Kozzie is eating almost one 85g can of either Lily’s Kitchen chicken pate (0 carbs) or Gourmet Gold Melting Heart chicken pate per day along with the equivalent in roast or boiled chicken breasts.

    We will be in contact with our vet later today to arrange for more Caninsulin and we’ll also be asking for anti-nausea and appetite stimulation medication (I’m on my phone and can’t scroll up to previous advice on the actual names).

    He’s not interested in his AM +1.5 snack so I’ll wake him up again soon to try again.
     
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  21. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I’m glad he is eating the can of food and the chicken breast. However he needs to be eating more than double that at the very least. this is not forever, just while he’s recovering from DKA.
    It’s very encouraging he has not had any ketones so far. That is really good.
    I hope you can get some cerenia and ondansetron from the vet... tell them he must have it to eat enough.

    You are doing enough testing during the day. If you could get a test in around the nadir, which can move around a bit but looks like +4 to +7 on the SS.
    So pick a time each night to do an extra test around those times. Kozmo is a lucky boy to have you caring for him.
     
  22. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Bron, I posted under this thread yesterday and I don’t know where it is now. I think i was diverted to the maintenance back up site.
     
  23. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    To follow on...

    At PM+9 Kozmo vomited and was licking his lips, I tried to feed him but he only ate 10g wet food. His BG was HI.

    AMPS his BG was HI and he refused food so we shot anyway. AM+1 his levels were down to 7.7. He ate 70g wet food and started to relax and settle soon after.

    AM+2 BG 9.9

    We're collecting a new vial of Caninsulin from the vet this morning and we've phoned to request anti nausea medication to be added. We've also left a message to push for a Lantus script, while being well aware that we need to stabilise on Caninsulin first.

    I accidentally posted on the temporary back up FDMB site and it didn't get added to this thread. I felt deserted when nobody answered and no wonder they didn't!

    We're concerned about Kozmo's black numbers at each end of the cycle. His bouncing appears to have settled over the last two days but we don't know what happened this morning with his vomiting and then huge crash from AMPS HI to 7.7 - could we have hit a blood vessel?
     
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  24. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I’ve just answered your other thread. I’m so sorry you had such an awful time. If that happens again, post again and tag us.

    He dropped so quickly because no food was there to counteract the insulin.
    Is he eating now. Are you giving cerenia
    If you get stuck like you did yesterday send me a PM and it will come through to my phone.
     
    Last edited: Jul 3, 2020 at 4:37 AM
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  25. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Hi Eliz @Elizabeth and Bertie
    I just answered the other thread too. I'll stay here. We're collecting more Caninsulin this morning and we've phoned and left a message requesting cerenia. We won't leave until we get what we want.

    Kozmo ate 70g wet food at AM+1... his nausea appeared out of nowhere, though come to think of it, I normally get up at 4:30am PM+8 and feed him but didn't last night. Could this be the reason he was sick?
     
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  26. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    He could have had some acid buildup from not eating for several hours...some cats do that. Then they can vomit.
    Or he just might need the cerenia, which I think is more likely.
    How often are you feeding him?
    Is he eating plenty of food?
     
  27. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Every time Kozmo walks into the kitchen I shove food in front of him and he’s actually eating more now that we’ve discovered Sheba Luxury pate, but he could do with more. I record his eating times and quantities on his SS.

    Neil’s currently at the vet to pick up a new vial of Caninsulin which is a waste of money because we don’t plan on using much of it. He won’t be driving away without cerenia either because we know we need it now and also for the transition to Lantus.

    Vet hasn’t agreed to Lantus but we’ve provided her with literature and Kozmo’s SS and now we’ll be banging on her door until she gives us a prescription for it. Keeping him on Cansulin is cruelty as far as I’m concerned. Poor Kozmo is like a zombie and that’s no quality of life for him.
     
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  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I’m glad you are feeding Kozmo whenever you can. I looked at the SS...it looks like he’s eating moe in the am cycle than the pm cycle. Hopefully once you get the cerenia he will eat more.
    It looks like he’s had 7 days at home since the hospitalisation...is that correct?
    He needs longer before we think about swapping him over to Lantus, but if you can get the script, that would be good.
    Let me know how Neil gets on at the vet.

    Where in Australia did you live? Are you just over there for a few years? Is Kozmo am Australian Burmese or UK Burmese?
     
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  29. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Correct at seven days home from hospital. Still no script for Lantus but we’re working on it.

    Neil came home with a pitiful amount of cerenia... they would only supply four tablets (half once a day) and for the privilege they charged us £28!!!!

    We’re extremely disillusioned with the veterinary situation at the moment - royally shafted. We’ve noticed a very big difference between vets in Australia and the U.K and it’s not good. We need to find a vet that specialises in cats.

    We’re from the Sunshine Coast, Queensland and brought our pets to the U.K. with us. Kozmo is a sun-worshipping Australian Burmese!
     
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  30. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    How strong are the tablets? What dose did the vet say..?
    I haven’t used cerenia for ages but I think the usual dose is around 8 mg per day. I going to tag @tiffmaxee as I think she used them a lot.
    Yes they are dosed once a day. They aren’t cheap out here either.
    I hope you can find a good vet.
    I’m sure the cats must miss the sunshine!
     
  31. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    How much does he weigh? Depending on that you would give 5-8 mg of cerenia. The dose is 1-2 mg per kg. every 24 hours. It used to be you only gave for 5 days and took two off but that changed years ago and it can be given every day for as long as needed.
     
  32. Annie & Kozmo

    Annie & Kozmo Member

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    Jun 13, 2020
    Kozmo currently weighs almost 3.9kg and the cerenia tablets are 16mg... so ½ tablet once daily as per the vet instructions appear correct.
     
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  33. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Sometimes you need to add a second nausea medication. I used the human drug ondansetron. It can be given every 8 hours and works in a different way so both can be given
     

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