My kitty was diagnosed on November 11th after noticeable weight loss. Ketones at that time were 7. She spent the night at the ER vet as my vet doesn't provide after hours care. Over the next 3 days she spent the day at my vets office for fluids and monitoring. We started Novolin N on November 14th. After some research and finding this group I asked to switch to Lantus and I transitioned to a low carb diet. She had picked up weight and we were seemingly doing ok. She was found to have bladder & kidney stones and we switched to purina DM a few days ago. So far she has hated the DM food regardless of what I mix in it. On 12/4 she vomited bile after refusing most of her breakfast her glucose was 493 which is higher than it had been for a few weeks, urine ketones were negative. I tried everything I could think of to get her to eat and finally boiled chicken was a winner and no vomiting. This morning her glucose was over 500 and 3 hours after her 1U of lantus she was closer to 600. So I contacted my vet and took her in. I just picked her up and her ketones were 3 at drop off and when I picked her up they were over 5 despite IVF and her glucose is over 600. I dropped food off and the cans are unopened. I have a feeling they did not feed her at all today. They want me to bring her back in in the morning for more fluids ketone recheck, and a glucose curve. I feel like doing a curve while in ketosis isn't accurate. As soon as I got home she's eaten half a can of medium carb food and is drinking like there is no tomorrow. Her eyes are bright shes walking around. Is there anything else I should be doing for ketones overnight!? I also feel as if I need to look for a new vet because my current one is "unfamiliar" with feline diabetes and I'm getting frustrated. I've attached her spreadsheet for reference. https://docs.google.com/spreadsheet...3VdncB1lKu59r4ILNpTGpR3CQjg/edit?usp=drivesdk
Hi there! I am not experienced enough to answer your questions, but you’ve come to the right forum. Hopefully a senior member here will respond soon!
Goodness, what an ordeal. It sounds like she’s feeling better, which is good. The basic recipe for DKA is is an insufficient supply of insulin + inappetance + infection or other systemic stresses. Keep adding as much water into the food as you can, and at this point, get as many calories in as she’s willing to eat. Keep testing for ketones at home, you really want to watch for any signs that ketones are building up, so test as often as possible. Keep an eye on her behaviour, if she becomes lethargic and stops eating again, along with ketones more than a trace with the Ketostix, it’s time to take her to a vet. You don’t need to run a curve there, you can and do test BG at home. If she is continuing to eat, and you are testing for ketones, the best they can offer is fluids. Take the DM food back, they’ll give you a refund, just tell them your cat won’t eat it. How is she doing tonight?
They prescribed the DM food for the bladder & kidney stones, but if she won't eat it then I feel like we are not helping anything. She's eaten 2.5 3oz cans of FF since 630 pm EST they are all 14 carbs a can, but she's eating so I'll take it. Shes drinking tons of water. I have a blood ketone meter arriving Saturday. Glucose was 503 and 522 an hour after 1U of Lantus on the Alphatrak 3. The relion meter just says Hi. So far urine ketones are still trace. I am looking for a vet that is more familiar with feline diabetes.
I’ve not had experience with kidney or bladder stones in cats but I find that odd that the vet would prescribe diabetic cat food to treat those conditions.
I had to do a little research...he originally prescribed Hill's but it was almost 30% carbs. The purina DM is a safe carb % and has the st/ox environment to prevent crystals that form stones.
Hi Ash and Esme and welcome to the forum. I am sorry you have both been through this. Here is a list of what you need to be doing if your kitty has had DKA 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 she will only eat higher carb food or even dry food at the moment, let her. It may not be ideal, but eating anything trumps everything. 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. Are you using urine strips or a blood ketone meter at home? Either is ok. Give antinausea medication if needed. I would ask the vet for some ondansetron. You will need him to write a script and then you take it to the human pharmacy to be filled. DKA kitties are often nauseated. 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. I see at the moment you are going back for fluids at the vet. Are the fluids the vet is giving IV or sub Q fluids? test the BG frequently. Why are you using 2 types of glucose meters? It is better to stick to one if you can. The human meters are fine. Post daily with updates and ask for help as often as needed.
We do 2 meals and I have an automatic feeder with ice packs for wet food snacks throughout the day and overnight. I have ketone strips at the moment, I have a blood meter coming tomorrow. I mix water with her food and snacks to make sure she stays hydrated. The vet did IV fluids, but is sending me home with supplies for subq if I need them over the weekend. I used Alphatrak in the beginning before I found the forum and the strips are EXPENSIVE. I switched to the relion mostly except for yesterday when the relion just read Hi and I could get a reading on the Alphatrak. I came back to the vet this morning for ketone recheck and she has gone from 5.2 yesterday to 5.5 today, but our glucose is under 500 unlike yesterday. She is eating without issue. My vet wants to switch to hills prescription food to keep her bladder stone from worsening, but we are going to hold off on the switch until her ketones are down and her glucose stabilizes. Where is the best place to post if i need semi-emergent advice?
@Bron and Sheba (GA) @AshC I tagged Bron for you , it's 1 AM where she lives Australia , but I'm sure she will respond later on tonight
@AshC Can you set up your signature Your signature should be in gray letters, do you see mine at the end of my post This is where you can set up what we call your signature, it's at the end of everyone's post in gray letters. Just tap on your name up top then tap on signature and add this information. You will link it to your spreadsheet Add info we need to help you: Caregiver & kitty's name DX: Date Name of Insulin (do not include dose or frequency) Name of your meter Diet: "LC wet" or "dry food" or "combo" Dosing: TR or SLGS or Custom (if applicable) DKA or other recent health issue (if applicable) Bexacat or Senvelgo (if applicable) and dates Acro, IAA, or Cushings (if applicable) Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find. Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile. Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information. When you get your ketone meter you can add what the ketones are in the remarks section of your spreadsheet
That’s good news that she is continuing to eat and that the vet has given you subq fluids to administer at home. How much did the vet suggest to give? You want to be careful not to over hydrate and/or be cautious if the kitty has an underlying heart condition. Hopefully your vet has checked that out. Haven’t given subq fluids before, here is a helpful video https://www.felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/ You can keep posting here on Main with updates and questions
Thank you! He didn't mention a specific amount actually. I've never given subq fluids either, but I put IVs in people so hopefully that helps me somehow. She had an ultrasound a couple of weeks ago and they did a brief look at her heart and it was normal so was everything else except the bladder & kidney stones and mild CKD was mentioned.
You’re welcome . I’d maybe give them a call and ask, since you want to start off gradually with the lowest amount that will maintain hydration. By small amount it’s usually around 60-100 ml a day for cats around 8-10 lbs, but best to ask your vet for guidance. Since your kitty seems to be fairly stable at the moment, with no vomiting or diarrhea it would seem to me a good place to start.
Yes post here for help. If it is urgent I would change your subject line to reflect that and put help in the line. If it is an emergency you can use the 911 sign which is there at the beginning of the subject line. With subQ fluids I would not give more then 100mls and you need to make sure the fluids you have given before have been absorbed. They create a bulge of fluid so it’s not hard to see. And don’t give the fluids in the same place in her body you give the insulin. Check with the vet but I would suggest giving her the fluids each day because they will help flush out ketones. I am concerned the ketones are above 5 at the vet. Keep testing at home and put any results into the remarks column of the SS please so we can see easily. With the food, is she getting 1and 1/2 times as many calories as she normally gets? If not I would increase the amount of food she is getting. And I would let her eat whatever she will eat at the moment. I wouldn’t try any switching of food. Keep posting any time you have a question and feel free to tag me anytime.
@AshC today’s BG numbers are looking much better, how are you doing with the ketones? Post if you need any help
Ketones were 0.9 yesterday! So we are doing pretty good. I've checked her right before I leave for work which is a couple of hours before her PM shot. Of course shes not as hungry and thirsty as she was with the glucose of 500 and ketones, but still eating and drinking. With the decreased water intake she does have a small amount of blood in her urine again. Im currently looking at a couple of feline vets in my area that are more familiar with diabetes
I can't thank you enough!! I'm trying all of the tricks to keep her eating (parmesean cheese, oregano, toppers etc....). She has an appetite she just isn't thrilled with most of the wet foods I've offered including the ones she has loved previously. She was strictly kibble fed before. She won't touch Dr. Elseys. I have samples of other flavors and Epigen, but with the stones I'm not sure those are beneficial long term
You are doing a great job helping Esme. It can be hard at times but you will get there Esme is lucky to have you!
We saw a new vet yesterday who is more familiar with diabetic cats. She was wonderful! She looked over Esme's spreadsheet and is happy with the progress we've made. Her labs are perfect, even her fructosamine is within range. We started Cerenia yesterday to help with the cystitis we've been battling through all of this and we're going to give the purina DM food another go why we are on the Cerenia in case it upsets her stomach. We'll continue the Gabapentin for discomfort and recheck urine in a week or two. Her ketones are all over the place over the past couple of days, but after the Cerenia yesterday she was running around like her old self so fingers crossed we continue having pretty good days and she starts gaining a little weight back.
Those ketones are dropping down into more normal levels. Keep up the food and fluids and insulin. Are you getting a Preshot test in the pm cycles? I can’t see any for the last several days. Also a test during the pm cycle if possible.? Lantus dosing is based on how low the dose is taking the BG and at the moment we are missing half the data. It looks like you may need a dose increase but I would need to see data from the pm cycle before suggesting that.
On the nights I work I check her glucose right before I leave which is about 2.5 hrs before her insulin as my husband can't check it. I'm off for the next few days so I'll be able to get PM cycles and I'm going to do a curve tomorrow. We are going to give the DM food another try and see if I can convince her to eat it. My vet mentioned potentially adding the hydracare packets as well to make sure she is drinking enough water with the stones.
It isn’t necessary to feed the DM food. There is nothing special about it. Ordinary low carb canned food is just as good and most cats like it better. At the moment we want Esme to be eating lots of food. If she doesn’t like the DM food don’t worry. Can you teach your husband to test the BGs? I thought my husband would never agree to learn but when I had to go into hospital unexpectedly he learnt to do it and was great at it. And it was so good to have a second person who could test
We've talked about it and may attempt it soon. Esme let's him give her insulin because she's distracted by dinner, but she doesn't tolerate much else from anyone but me and I dont want her to hide from him and not get her insulin. Luckily I leave for work pretty late in her cycle. We had hoped the SX/OX properties in the purina DM food would help with the bladder/kidney stones and prevent surgery if at all possible, but with everything I have read if I can find wet food within the safe carb range and low in phosphorus it has the same effect
We've had a few AMPS less than 200 and have adjusted her dose, then she'll rebound. Last night we attempted her full dose (1UF) and it looks like her liver panicked any advice?? https://docs.google.com/spreadsheet...3VdncB1lKu59r4ILNpTGpR3CQjg/edit?usp=drivesdk
@Bron and Sheba (GA) Any advice if she should increase the dose , I see in her signature she's following TR @Bron and Sheba (GA)
@AshC I don't know if this will help you with the food Tyler was blocked once, had to take him to the ER , He had struvite crystals ,I needed to change his food. The food that was suggested by the ER was too high in carbs so I found this and have been feeding this , never raised his BG and knock on wood hadn't been blocked since Purina Pro Plan Urinary Tract Health Beef & Chicken Entree flavor Pate Purina Pro Plan Urinary Tract Health Chicken Entree They are both low carb and low in phosphorus The Purina Pro Plan Urinary Tract Health islow carb and low phosphorus Beef and Chicken Entree pate Carbs are around 4.80 Phosphorus is 1.44 dry matter They also have Chicken Entree in Gravy which isn't pate it like tiny pieces of chicken like the size of a chicklet piece of gum lol remember them, they are like tiny tiny chunks Carbs are 4.5 Phosphorus 0.78 dry matter Can you add TR to your spreadsheet somewhere up top, I see you do have it in your signature
I will take a look at the purina! She actually likes chunkier foods so hopefully these will work. I've looked at a raw diet, but I'm still researching. I'll add TR to my sheet. I was hoping to have a little better/tighter control at this point, but the cystitis caused a few bumps in the road and these lower AMPS and her bouncing after have caused some difficulty. Any idea on the carbs & phos for the purina pro turkey & giblets??
This is from the Chewy site where they ask questions Turkey and Giblets should be fine What is the as fed basis for phosphorus and sodium? Answer by • Sep 14, 2023 This recipe has a Sodium content of 0.23% as fed (1.02% on a dry matter basis) and a Phosphorus content of 0.31% as fed (1.36% on a dry matter basis). 0LikesReport Answer This Question What is the percentage of carbohydrates on a dry matter basis and an as fed basis? Thank you. Answer by • Jul 19, 2023 This variety contains approximately 1.2% Carbohydrate content on an as fed basis (5.3% on a dry matter basis).
Well all those look like great options!! She ate purina urinary dry before so I think it'll be a hit.
@AshC I hope she likes at least one of them or all of them I bought them at PetSmart and Petco first to see if Tyler liked any of them
Hi Ashley, You are holding the dose too long. Can you post more often for advice? If the F in the number of units stands for fat, we don’t use those until the cat is on a tiny dose and only needs a tiny adjustment. At the moment Esme is not in that position. I would increase the dose to 1.25 units. Do you have the 100 unit syringes with the 1/2 unit markings?
@AshC Please see Bron's post above about increasing the dose of you got the syringes with the half unit markings since we adjust the doses by 0.25 units at a time, I only tagged you to be sure you saw it Maybe re- read about the TR dosing method again Full and half-unit syringe scales: If you are using the Lantus pen you would You can order the U-100 syringes with half unit markings from Amazon without a doctors script https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO What state do you live in ? Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there We use the syringes because with using the pens you can only adjust the dose by whole units with a pen so we use the syringes since we either increase or decrease by 0.25 units at a time
I do have the U100 with 1/2 unit markings. I can increase to 1.25 tonight. I had a caliper sheet created already.
I am in Kentucky. I've always used syringes with my lantus pen and the Relion U100 syringes at Walmart are pretty cheap
Make sure you get a couple of tests in during the cycle following an increase in dose. And try and get a test during every cycle moving forward if you can including the pm cycles.
Would we increase to 1.25 still where she has had low AMPS recently and a bounce last night?? I go back on PM shift on the 28th for 5 days so I will not be able to do PM cycle testing until I am off again on the 2nd
We've tried multiple times over the past week and she absolutely isn't having any part of it even with her Gabapentin. She's a finicky lady with mostly everything in existence. I spoke to our vet about the Libre and it isn't completely off the table, but she's afraid with her grooming habits it'll get displaced even with a shirt/onsie
I arrive home an an hour before AMPS. 2+ 293 I caught her on my dresser ripping a bag of Friskies treats open so I'm sure she helped herself to a few shes never even been on my dresser but apparently she figured it out
I think all you can do when you work during pm cycle is get a test close to when you leave to see the BG is not too low to shoot the PMPS and if concerned, post and ask for help. It’s not ideal but you have to work with what you have got. Does your husband give snacks during the PM cycle? Do you have an automatic timed feeder he can use during the night. They always find the treats!
I leave the canned food for her dinner on the counter when I leave for work and my husband mixes it with water and gives it to her with her shot (I draw it up before I leave and leave it in the fridge). I have an automatic feeder for wet food that has 6 slots so it goes every 2 hours until the 2 hour fasting window. If I've learned anything during all this it's to do the best we can with what we have thats for sure!
The BGs might have dropped after +4 this morning and that could be causing a bounce. Good the ketones are normal.
+1 581, I'll keep her spreadsheet updated until I go to bed in a few hours. She had loose stool about an hour before PMPS, but she is currently refusing the same food more than twice in a row regardless of any toppers I try which is driving me absolutely bananas. With the bounce we just wait it out and let her body adjust to the lower numbers correct??
Shes vomited once so I gave her 1 mg of Zofran. Shes feeling pretty crummy. If she doesn’t seem to feel any better by morning then I'll make a call to my vet
The Zofran we normally do 1 mg if needed. She still refused to eat or drink after an hour (she hasn't eaten or drank since 11 pm EST) so I gave her 100 ml of Subcutaneous fluids. Her heart appeared normal on her ultrasound. My vet had given them to me just in case with her 2 episodes of high ketones.
I think you may not be giving her enough zofran. In a recent post @Wendy&Neko said she gives her cat who is 8 lb a dose of 2 mg which is what her vet suggested. If you don’t give enough zofran, it won’t work and this dose can be given 3 or 4 times a day.
Well our lab work looks worse since 12/11..... 12/11: Fructosamine 330, now 407 Creatinine 1.2, Now 2.8 BUN 40, now 76 we're running urine right now....it's a rough morning
Ondansetron dosing is 0.5-1.0 mg/kg of cat given 3-4 times a day. It doesn't last a long time in the cat. For a 9 pound cat (which my non diabetic now weighs ) that is 4 kg, so you can give 2 mg or even 4 mg if the 2 doesn't work. My previous cat Neko got too small a dose of ondanestron, but that was before the 2016 guidelines were published. If vomiting you can also give Cerenia, or it's generic maropitant which is now available in the US, you can give 2mg/kg of cat once a day. Glad you are researching the food. I had a kitty diagnosed with idiopathic cystitis, which also meant crystals, one week after Neko's FD diagnosis, so I had to find a food that both could eat - Neko would bully him for his high carb "urinary" food. His vet suggested raw, but the key turned out to be low carb/low phosphorus with lots of water added. Cerenia helped too, with it's side effect of helping inflammation. And also supplements to help his bladder wall, Cosequin is what I started with.
Well our lab work looks worse since 12/11..... We just finished a coarse of Cerenia last week. Are there any low carb/low phos foods you'd recommend?? We did Cosequin for a short time and she had another bout if ketones so we peeled it off
This list of Diabetic CKD foods might help: https://www.bizave.com/foodlists/Combined_Food_Lists_Feeding_Guide.pdf I never found Cosequin to raise the blood sugars.
I had just ordered the Essence food yesterday! No pet store near me has that, the fussie cat, or inception options listed
Just a suggestion. Weruva.com You might want to try Weruva Pates low carb/ low phosphorus if you tap on this link and look at post #32 I listed some Weruva pates for another member that's low carb/ low phosphorus with kitties with CKD https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3124085 You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts. This is where I was told where to look by a member. On the Weruva on the left are 3 lines click that and then click on cat foods , when you pick one to look at click on it then click on click on click to view Detailed Nutrition Information You can even check out the soulistic pates https://www.soulisticpet.com/pate When you click on one of the flavors then click on COMPLETE NUTRITIONAL INFORMATION (link to page) and look at the same two places like on the weruva
If it's not too much trouble, could you please start a new thread? We try to cap threads at 50 posts so there's not too much to read through.
@AshC I think you can start posting on the Lantus Board starting tomorrow. We like you to post everyday. You can introduce yourself and Esme and say it's your first post on the Lantus Board, that you were posting on the Health Board before We have a certain way to post there , put in your title Date Esme AMPS # and any additional tests after that. Continue with the PMPS # and any additional tests after that To add the tests tap on the words Tool thread to the right then tap on Edit Title, add those tests then tap save We always link your previous days post to your new ones . To link your previous posts Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be Just ignore where it says insert and cancel Just copy your previous days post and then paste it when you do your new post new thread Like I said your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it. I hope so You will post everyday and link your previous days post to your new one. So if you post on the Lantus Board tomorrow you will link this post to it https://felinediabetes.com/FDMB/threads/newly-diabetic-dka-x2.296331/#post-3232048 Link to the Lantus Board to the right post new thread https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
