Please help. My cat is recovering from ketoacidosis

Hi, my name is Barbi and my cat Zoozey was diagnosed with diabetes in January after he suddenly lost a bunch of weight. I was able to keep him healthy with diet until he got a UTI last week. He developed ketoacidosis and he stopped eating. He spent two days at the vet getting fluids, insulin, and antibiotics. They were able to lower his glucose level some but Zoozey is a nervous cat and was super stressed at the vet so they couldn't get his levels down below 300. He was at 400 when I picked him up this morning. They sent him home hoping he'd calm down enough to get his glucose under control. He's home now with a vial of Lantus (he is supposed to have 1.5 units twice a day) and some more antibiotics and he's weak and lethargic. He wouldn't eat this evening so I gave him half of his insulin dose like my vet told me. I'm concerned he won't eat tomorrow morning and he'll have to go back to the vet. But if I take him to the vet I'm worried about stressing him out even more and making his glucose level even higher. Plus since it will be Sunday I'll have to take him to the crazy expensive emergency vet, which will be even more unfamiliar and stressful for him. I really don't know what to do here.
I'm guessing he didn't eat because he's still nauseous. Will his half dose of Lantus help him feel better enough to eat tomorrow morning? Is there anything I can do at home to help him feel better so that he will eat? Also, does anyone have a good recommendation for syringes? The ones I got from my vet only mark one unit, so it's difficult to discern half and three quarters.
If anyone has been through this and has some advice for me, I would be incredibly appreciative.

 

Barbi

I'm so sorry to hear about Zoozey but you found the right place.

As you know, DKA is caused by infection, not enough insulin, and not enough food and water. A few questions...does Zoozey normally eat only low carb canned food or a raw diet? Do you hometest? Did the vet send you home with subq fluids? Are you testing his ketones at home with either a blood ketone meter or ketostix?

We normally do not recommend that you shoot a reduced dose of insulin with a DKA cat. Are you able to syringe him a high calorie food? When it comes to DKA cats, we want you to get as many calories in them as possible so we don't care if you have to feed them high carb foods...we just want alot of calories and alot of fluid in them. Do you add water to his food?

We're they giving him 1.5u of lantus bid at the vet? For lantus, you need U100, 3/10cc needles. You can either get 30 or 31g, long (1/2") or short (5/8") syringes. I'm not sure where you are but if it is in the US, the easiest place to get syringes with 1/2 unit markings is WalMart. You might have to be insistent because some of the clerks might not realize they carry syringes with 1/2u markings. The syringes are Relion and you usually have to get them from the pharmacy folks...they are behind the counter.

 

Thank you so much for you reply! It hadn't occurred to me to give him food via syringe.
Zoozey has been eating Purina's prescription DM food for diabetics, dry and canned, which he really really loves when he feels okay. My plan is to feed him canned food only from now on. I just now found a tiny syringe that came with his antibiotics and I gave him 3ml of water which he tolerated, and when I finish writing this I'm going to give him some more water. I hesitate to give him food this late in the day, and the vet said he did eat this morning. Can I give him food now via syringe without giving him a shot? He's just so skinny and weak and I want to get some nutrition into him, but I don't want to make a bad situation worse.

I never needed a blood glucose or blood ketone meter until now because he did so well on the food, but that's all changed now. I do intend to get one ASAP. The vet sold me UltiMed U100, 3/10cc syringes, but already I don't like them because it was so hard to give him an amount of insulin that wasn't an even unit.

I'm new to the world of insulin and shots (I just gave my very first injection this evening) and even though I've been reading some stuff online about DKA, insulin, and checking blood glucose I feel clueless. The vet did not send me home with subq fluids, but he was on iv fluids from Thursday morning to Saturday afternoon. And he was eating and drinking water at the vet! But now that he's at home he won't eat or drink! I'll try feeding him with a syringe in the morning if he still won't eat.

Thank you thank you thank you for your help!

 

You don't have to only feed at shot times. Do feed him whenever he will eat - he needs it to recover.

 

You need to figure out how many calories he needs. A good formula is 20 calories per pound of normal weight with normal weight being not heavy and not thin. So if he should weight 10 lbs, then he would normally need 200 calories a day. For a DKA cat, we say 1.5x the normal calories. You will never get that much him in with a small syringe. Nyou need the large 12 cc/ml syringes.

Try to syringe feed him something like MaxCare or a/d. The MaxCare is the better choice if you can get it....they re both prescription. Here is a great video on Assist Feeding Your Cat .

 

I think the food Marje is referring to is called MaxCal and is made by Iams. It is calorie dense and low in carbs.
http://www.iams.com/cat-food/iams-veterinary-formula-maximum-calorie-canine and-feline
One can has 333 calories, so if you cat's ideal weight is 10 or 11 pounds, then 1 can a day of this food should equal the formula Marje is talking about.

We would recommend that you go buy a human glucometer and some test strips and lancets (a lot of people use the ReliOn from WalMart as the test strips are the least expensive), and learn to home test your cat's blood glucose.
You don't want to skip on insulin when a cat has or has recently had ketones. If you can test his BGs from home, you will know when a higher carb food is needed to bring his numbers up.

I wish you luck.

My cat had DKA and it is very scary.

 

I hope Zoozey is eating on his own this morning, if not, I would start the assist feeding as soon as possible.
You can also send a PM to Karrie and Maverick to help you with the eating issue.

I would test for ketones this morning, and if they are over a trace, I would call the vet. Please let us know.

 

Thanks Dyana...yes it is MaxCal. I was bleary eyed last night and evidently bleary brained.

Hope your kitty is better today. Please let us know.

 

Hi Barbie:

When one of my cats was sick and wouldn't eat my wonderful vet suggested chicken baby food in a syringe. It is hard to find just chicken but it is out there. He loved it and with the help of antibiotics and baby food it helped him get back to normal.

 

It's Beechnut Homestyle Stage 1 baby food. It's chicken (or turkey or beef) in broth. I wouldn't try the ham in broth one - your cat doesn't need the extra salt from the ham. http://www.beechnut.com/Our Baby Fo...tValue=2&SearchType=By Product Type&ProdType=

There's a "liver shake" you can temporarily feed to a sick cat: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=30432

Have you tried FortiFlora?

 

I've heard of Fortiflora, but I've never tried it. It might be helpful. I went to visit him at the vet this afternoon and he was eating on his own! They offered him both dry and canned cat food, and oddly he was more interested in the dry food. But food is going to be important in the coming weeks. These are great suggestions and I'm going to go pick up some baby food before he's released so that I'll have something else to offer him if he won't eat. Zoozey is down to 9lbs and that is way too small for his frame. He's terribly emaciated and some of his muscles have atrophied. His poor little body has been through a lot this last week. He's lost a pound since Wed (and he was too skinny to begin with), he was nauseous and wasn't even able to keep water down. He was so deydrated that he developed cerebal edema and he's been really confused. He had trouble sitting up and walking. But the good news is that he's doing much better. The e-vet has gotten his glucose down to 103. They were feeding him when I got there because they were concerned about his glucose levels going lower. He's been on short and intermediate acting insulins, and they're going to try giving him his Lantus this evening. He's sitting up and standing, eating, using his box, and he looks so much more alert and comfortable than he did yesterday morning.

I'm going to bookmark the liver shake recipe, and buy some baby food to keep on hand just in case. He LOVES chicken and he will eat chicken and chicken flavored things even when he feels terrible, so the chicken baby food will probably work well in the future.