Newly Diagnosed w/diabetes; has pancreatitis/ketoacidosis - Unsure of starting insulin tonight

Update: Tested BG again and it's at 248 but she isn't eating or drinking... I don't know what to do. Am I posting in the wrong spot as I'm not sure if this has been seen :/ Sorry if I'm not posting this correctly!

Well I'm back with a new kitty! I was so grateful for this forum 11 years ago as my cat at the time, Zoey, successfully went into remission after a couple months for the rest of his 18 years
Although I've been here before, I am feeling ridiculously overwhelmed with my current cat's diagnosis and seem to have forgotten quite a bit from the last time I did this...

Long story short, Baby is my 5 year old kitty that was just diagnosed yesterday with diabetes. She had a terrible weekend but luckily the emergency vet was able to get her back after she developed ketoacidosis, pancreatitis and a urinary infection (likely due to her sneaky undiagnosed diabetes) this past Saturday. They got her stabilized and I transferred her to my local vet for the day today and she has thankfully come home with me this evening.

I can provide more details but currently I'm just nervous to give her the prescribed dose of Levemir as she was being given humullin at the vet yesterday and today and hasn't gotten a long acting insulin as of yet. Her numbers today were 52, 100, 297, 151 (vet office, unsure of times) and 144 at 7:15 pm today (home test). she was given Mirtazapine and Buprenorphone today and an antibiotic injection yesterday. The vet bill shows she got an injection of humullin but not how much they gave; they did tell me she got it at 1:00 p.m. today.

I have purchased items for her hypo kit, insulin and testing supplies.

I am so overwhelmed and don't want to do the wrong thing so I am sending this with missing information likely! I'm just not sure about giving her the 1 unit of levemir as prescribe this evening as I am not sure what her BG numbers will do as this will be the first time she's getting the long acting insulin. Also, she did not eat after I tested as I think she's still not feeling well with all her issues.

Any advice/questions/comments are so very welcome!

I have added her records from the emergency clinic I can upload for more background info from Saturday 1 AM to today at 7AM if that is helpful, unfortunately my local vet did not provide me with as specific details from today.

Thank you!

 

Tagging Bron for you
@Bron and Sheba (GA)

 

Thank you Diane Tyler's Mom!

I just spoke with the emergency vet clinic and they suggested to not give her insulin unless she eats. They also suggested some options to entice her to eat, but it didn't work so far, and to contact my local vet for an appetite stimulate tomorrow. She was so very sick this weekend and I almost lost her, I'm just so nervous to do the wrong thing to put her back into the bad place she was at by either not doing enough or doing too much! Such a scary time :'(

 

Looking now.brb

 

Thank you!

 

A few questions....
How long ago was the last dose of insulin and was it humulin?
Did the vet give you anything for nausea? such as cerenia or ondansetron?
DO you know if she had anything for nausea at the vets?
Are you able to make the bottom half of the 1st ICU sheet any bigger so i can read it?
When is the next insulin dose due?
Is it too late to get antinausea tablets from the vet now?

 

I'm going to ask @Bandit's Mom to help you setup the spreadsheet and signature as you need to concentrate on Baby

 

Have you tested for ketones at home or did they tell you what the latest ketone test was?

 

• The last dose was Humulin at 1:00 p.m. today (approx. 10 hours ago)

• They did not send any meds home with me, just a prescription for Levemir

• She received anti-nausea meds at the ER vet last night but not at my local vet today

• I'll see if I can get it bigger

• The vet earlier today said any time after 7:00 p.m. (any time after approx. 4 hours ago)

• The ER vet is 45 minutes away but I can go if needed

 

I tried to zoom in on the bottom section and put it into a .pdf so hopefully you can zoom in on your computer? Is it any clearer?

 

I haven't tested at home, I completely forgot to grab test strips on my pharmacy run today :/ Didn't even realize till now that I forgot those. They didn't tell me what the number was (or if they did I don't recall as it was 3am :/) but it was high and they said it wasn't just stress induced.

 

Thank you!!!

 

I can see that they gave her (I presume an injection) of cerenia on 29th at about 3am...its a bit hard to see. That would only last 24 hours.
Is there anyone else who can go to the ER and get some things for you?
I think you need some antinausea meds to have at home. Most DKA cats feel sick and are not wanting to eat when then first come home. That is common.
But it is vitally important that they eat and eat a lot and they get insulin.
Also I would get some Hills A/D canned food to syringe feed.
Let me know if anyone else can go and I will tell you what to get

Have you tried to syringe feed her?
You can offer her any food at all that she will eat. Dont worry if it is not low carb at this point it doesn't matter. Eating anything trumps everything.

Yes i can see that much better thanks.
I can see they gave injections of Ampicillin ( an antibiotic) ...did they send her home on an oral antibiotic?

If the ketones were high still then it is even more important that she eats and gets the insulin.

 

I don't have anyone that will be able to go for me unfortunately but I may be able to have someone watch her while I go but they have limited knowledge/ability to do much for her...
I haven't tried syringe feeding yet; I may have some A/D canned food, I will check.
I have some dry food and Temptations I can try if low carb isn't an issue.
They did not send me home with any medication and very little information (local vet)...

 

OK

• lets see if she will eat any of the food you have there... try anything
• We can try syringe feeding if needed but we need to get food into her
• I think we need to give her the 1 unit of levemir now.
• As long as you can home test we can keep her safe by giving honey if needed.

If we get that done, then we can think about getting some things from the ER. How does that sound?.

 

She is eating Temptations, that's the only thing she is interested in at the moment but at least she's eating!
I will give her one unit; should I test her BGs before I do that?
I can home test as long as needed.
Sounds great, thank you!

 

Fantastic!

Yes test first please

 

She's at 336. Give 1 unit insulin?

 

yes please

 

Ok, done

 

How many temptations did she eat?

 

Maybe 6 before then seemed to not want them but now she's eating more...

 

she ate about 10-12 in total

 

So by my calculations it is just after midnight where you live.. I'm in Australia and its 4 pm Tuesday
So we have 2 options
1. We can try and get her to eat some more overnight and hope she will, and will be OK. And monitor the cycle. Then get what you need from your local vet in the morning. Do you have many temptations left? or any other tempting foods...cheese, parmesan cheese, roast chicken

2. We can make a list of what you need from the ER and you could take her with you in the car and get them to give her a cerenia injection while you are there. If you chose this option I would ring the ER first to ask them to have everything ready for you and if they would give her a cerenia injection while you are there.

This is the list I would ask for from either place

• Cerenia tablets
• Ondansetron tablets...they may not have them and may have to give you a script and you get it from a normal pharmacy
• appetite stimulant
• Ask about an antibiotic for the UTI...she should be having one
• Hills a/d cans to syringe feed..cats also find this food tempting so she may eat it herself
• ketone test strips to tide over til you get to the pharmacy.
• Ask about sub Q fluids

 

I will see what I have that may tempt her to eat. Do I wait until +1 to test her BGs again or do it sooner?

I'm not sure if I should just take her to the ER vet. She's a wobbly/clumsy when she tries to walk, but mostly is just sitting staring into space; her inner eye lids keep partially closing but she isn't closing her outer lids, are these normal symptoms for what her body is dealing with or a sign of anything dangerous?

 

yes wait until +1

What you are describing is not normal. It is a sick kitty.
Without knowing what the ketone level is, I can't really say. But I'm concerned the ketone level could be getting too high. She may need more IV fluids.
I would be much happier if I knew the ketone level and she was generally a bit better.
I would ring the ER vet and see what they think. If she was my kitty, I would take her back in.
She is only young and has a lot of living to do

 

BGs 17.1.
On hold with the vet clinic now

 

Hi @Emily and Baby ! Welcome to FDMB. Sorry you've had such a rough start to Baby's FD journey. Glad you found us. You are in great hands with Bron.
I've just sent you a PM with the details I need to set up your spreadsheet. Look for it in the Inbox at the top right corner of this page.

 

As I was speaking with the vet, Baby perked up and started eating more temptations. The vet said she is likely adjusting to all that has gone on and that she will be out of sorts especially as she is on a lot of medications. They said unless she starts mouth breathing or laboured breathing that she isn't in immediate danger... They said to speak with my local vet tomorrow about the appetite stimulant and anti-nausea...

 

Ok, thank you!

 

OK...I'm glad you spoke to them. and Im glad she is eating more.
Do you have plenty of temptations?

I think we need to get some fluids into her as she is not drinking on her own, is she?
Will she drink if you put water in front of her?

 

I'm glad I did too and so glad she's eating more as well!
I have a full pack of temptations.
No, she hasn't drank anything on her own. She was on fluids for about 36 hours until around 8 hours ago.

 

I just syringed about 7-10 ml into her mouth before she freaked out and ran lol.

 

Can you put some water in front of her and see if she will drink?
Otherwise I think you might have to syringe some water.
Just make sure it is into the side of her mouth, into her cheek and not down her throat
Here is a link to assist feeding. It also has some ideas to stimulate the appetite
Plus this link How to stimulate the appetite

 

I'm sure she is wondering what the heck is happening. I'm glad she had the energy to run away!
I'd get a +3 when you can to see how thing are going.

 

I'm glad she did too! She seems to be perking up bit by bit.
Ok, I'm going to have a lie down for an hour with her and I'll post when I test again or just update the spreadsheet unless it's gone below a certain level?

 

Just update the SS if you like. The onset of levemir is often around +3 or +4 and the nadir is later than Lantus. Try and get her to keep eating if you can as it is the food and the insulin which will get rid of the ketones. Plus some water every so often.
I'm going to give you a list of things you will need to be doing for Baby over the next few weeks to get her over DKA. Probably her lack of appetite and nausea is also due to pancreatitis.
Are you still giving her pain meds for that?

 

Ok, I will!
Thank you so much, that would be amazing. And thanks so much for all your help!
They gave her a pain medication shot at the vet today that they said would last for 3 days. She also got an antibiotic injection that lasts 2 weeks, i believe.

 

Here is the list of things you will need to be doing for Baby for the next few weeks until she fully recovers from the 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 Baby won’t eat the low carb food, feed her whatever he will eat as eating any food is better than not eating.

• 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. Ask for some cerenia and ondansetron to have at home. It is really important you have these to manage Baby at home. She has a double whammy with the DKA and pancreatitis as they both cause nausea and lack of appetite. Dont let the vet fob you off. Insist on getting the antinausea meds.

• Give appetite stimulant if needed after the antinausea medications

• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..

• Ask the vet about subQ fluids...you may be able to give them at home

• Maintain the spreadsheet and test the BG frequently
• Get a urine test done in 2 weeks to see that the UTI has completely gone

• Post daily with updates and ask for help as often as needed.

 

Very happy to help you anytime. I will be around for the next 5 hours so will keep an eye on the SS.
Then I will be heading to bed but will look in tomorrow morning, my time. Try to get to the vet and pharmacy early to get that list of things in post 24. If Baby is not eating or seems nauseated in the morning it might be worth while getting another cerenia shot.
I hope it all goes well tonight.

 

Awesome, thank you! I will keep this list handy, so helpful to know exactly what to do; this has been very overwhelming! Especially for my over-exhausted ADHD brain

 

She's slowly coming down, I just updated the spreadsheet. Thanks again for watching out for us! I will be contacting my vet in the morning (my time) and getting everything you suggested.
She's drinking water on her own at the moment, so that's great!
I have to work in 5 hours so I'm have to get some sleep after I offer her foods. Do you have suggestions for how often I should be testing right now as well as how to adjust her insulin time? 12 a.m. and 12 p.m. aren't going to work... was hoping more for 7:30 injections but not sure how to get her times changed now that I did it so late last night!

 

That is really good!

do you work from home or outside?

She is not dropping fast but the insulin is only on setting around now so I would get a +5 or 6 and then post That and we'll see if you need to test further.

You can only go back in 15 minutes twice a day OR 30 minutes once a day. So it will take you several days to get back on schedule.

 

So good!!!

I luckily work from home 4 days a week and in the office 1 day a week. I can see about the one day in the office for the short term, if necessary. Thankfully my office is only 7ish minutes away, so if I need to use my breaks and lunch to come home when I have to be in the office, I will be doing that.

She is at 14.2 at +6. When should I test again?

Oh crap... that's going to be tough to get back on schedule!

 

She ate about 15 temptation and may have eaten more; is there a max I should give her of those? She wasn't interested in anything else yet.

 

I think at this point we just want her to eat. Obviously they are not the best thing but that doesn’t matter at the moment. I’m just thankful she is eating. Let her eat all she wants. Then tomorrow after you have some anti nausea meds she might try something else…but I’d make sure you have plenty of the temptations in case she doesn’t eat anything else. Remember food helps stop ketones forming.
did she eat 15 more temptations or 15 in total.?
I see her BG has remained fairly flat. Probably the higher carbs in the temptations have helped with that.

How does she seem? Any better? Less lethargic?

 

Ok, I have lots on hand and will continue to offer them to her. She had 15 after I did her BGs a little while ago.

She seems much better, more like she was when she got home last evening. She's purring and cuddling and roaming a bit. I've locked me and her in a room with treats, water and litter so she can eat them as she likes without the rest of the kitties in the house stealing the treats and so I can monitor her better.

 

That is so good to hear. I’m relieved. I’ve been worried.
Do you have to leave her to work on the morning or will you work from home?

 

I was worried too.
I'll be able to stay home today now so that's a relief.

 

That is good. Try and get a few different cans of food tomorrow to tempt her to eat. Don’t worry too much about the carbs….eating is the most important thing. If she will eat low carb…good…but if not ..that’s ok too.
I’m heading to bed now and will look in when I wake up.
If you need any help @Bandit's Mom lives in India and she will be around for the next several hours and can help you. You can tag her.

 

Ok, thank you so much for everything! I will get a hold of the vet as soon as possible and keep enticing her to eat whatever she likes.
Hope you get a good rest!