Update on Vegetable & Question

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Vegetable (GA)

Vegetable (GA)

Member Since 2015
I just got off the phone with the vet, vegetables test results came back and her liver enzymes are up slightly as well she has keytones & protein in her urine. They want to do more tests but I just cant afford it right now. The doctor did say that the keytones have gone down so that is very good news and no sign of infections, also very good news. They want to keep her until tonight or until she eats & drinks on her own again then she can come home.

My question now is what does it mean to have slightly elevated liver enzymes? I have to delay getting the protein & pancreatitus test done for a month or so until my finances can recover a little bit, is this going to do major harm to vegetable? What are the signs of pancreatitus? I know in humans if you have pancreatitus it is VERY painful and vegetable didn't seem to be in any obvious pain so is this just another cash grab or scare tactic from the vet?

I'm going to go see her later this afternoon after work and see for myself how she is doing. I have also contacted my regular vet clinic to get a copy of her medical records then I can compare the two and see how she has been doing.

I asked about the B12 injection, the doctor said it is something they do in diabetic kitties every 2 or 3 months and costs about $20 or $30. Again this is something that I will have to wait until probably the end of the month to do as finances are really tight.
 
The liver and kidney tests can be elevated due to the ketones and not eating. The urine protein may be due to dehydration. I think having them tested right now won't really tell you anything. These tend to improve after the DKA is gone. If they are still elevated a month or two after she's better, then that might be an indicator you may want to investigate.

Do ask your vet to give you subQ fluids to take home, as well as cerinia.
 
Danged financials! Know the feeling only too well, Jennifer.

Great to see that Vegetable's stable and the ketones are coming down.

Purely speculating here, but if the pancreas is inflamed then it could be irritating the liver - they're right beside each other.

The discomfort a cat may experience from pancreatitis can vary from moderate to severe. Here is a link to the IDEXX guidelines for treatment of pancreatitis. It is a very good introduction to symptoms, diagnosis, treatment and ongoing management if the condition is chronic. An initial course of weekly B12 injections is recommended, and then monthly maintenance injections after that. I'm not sure how well oral supplementation might work in comparison, but it is a possible alternative treatment method. (Absorption can be a problem when pancreatitis is present, hence the recommendation for injections.) Two brands of methylcobalamin I've seen recommended here are Vitacost and Zobaline - both available online. Perhaps other members may be able to chime in on whether this might be a viable method of B12 supplementation for Vegetable for the time being.

Pancreatitis flares are rough - for cat and caregiver. I've found it much more challenging to manage than the diabetes in Saoirse. Finding a food that agrees with one's kitty is key to managing it. The 'meatloaf' crouching behaviour is a sign that the cat is feeling discomfort / pain. I'd recommend familiarising yourself with the clinical signs of nausea and inappetence listed on Tanya's site. They have good advice on supportive meds there, too. (CKD cats have problems with nausea, vomiting and inappetence but similar treatments are used for treating and managing pancreatitis. If your vet is recommending running a Spec fPL, I think it's a good idea (if only to rule out pancreatitis). Knowledge is definitely power when it comes to treating and managing the condition and if it were to be positive you'd be able to save Vegetable a lot of discomfort if you get a suitable treatment regimen in place. Based on my experience with Saoirse it really does make a difference to respond to symptoms straight away because it can help to stop a minor flare fairly quickly.

Be sure to give your precious girl some scritches from me when you go visit later. I'm so glad she's getting better! :)


Mogs
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Meya14 said:
The liver and kidney tests can be elevated due to the ketones and not eating. The urine protein may be due to dehydration. I think having them tested right now won't really tell you anything. These tend to improve after the DKA is gone. If they are still elevated a month or two after she's better, then that might be an indicator you may want to investigate.

Do ask your vet to give you subQ fluids to take home, as well as cerinia.
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Yes, I asked about the Sub Q Fluids, they said they would send the supplies home with me. I'm not sure waht the cost will be but I will find out soon. As for the cerinia if that is the same as the metoclopromide my husband has 5mg tablets that he takes for migraines, he is willing to share with Vegetable if she needs it but I will definatly talk to the vet first and make sure it's ok for her to take.
 
Critter Mom said:
Danged financials! Know the feeling only too well, Jennifer.

Great to see that Vegetable's stable and the ketones are coming down.

Purely speculating here, but if the pancreas is inflamed then it could be irritating the liver - they're right beside each other.

The discomfort a cat may experience from pancreatitis can vary from moderate to severe. Here is a link to the IDEXX guidelines for treatment of pancreatitis. It is a very good introduction to symptoms, diagnosis, treatment and ongoing management if the condition is chronic. An initial course of weekly B12 injections is recommended, and then monthly maintenance injections after that. I'm not sure how well oral supplementation might work in comparison, but it is a possible alternative treatment method. (Absorption can be a problem when pancreatitis is present, hence the recommendation for injections.) Two brands of methylcobalamin I've seen recommended here are Vitacost and Zobaline - both available online. Perhaps other members may be able to chime in on whether this might be a viable method of B12 supplementation for Vegetable for the time being.

Pancreatitis flares are rough - for cat and caregiver. I've found it much more challenging to manage than the diabetes in Saoirse. Finding a food that agrees with one's kitty is key to managing it. The 'meatloaf' crouching behaviour is a sign that the cat is feeling discomfort / pain. I'd recommend familiarising yourself with the clinical signs of nausea and inappetence listed on Tanya's site. They have good advice on supportive meds there, too. (CKD cats have problems with nausea, vomiting and inappetence but similar treatments are used for treating and managing pancreatitis. If your vet is recommending running a Spec fPL, I think it's a good idea (if only to rule out pancreatitis). Knowledge is definitely power when it comes to treating and managing the condition and if it were to be positive you'd be able to save Vegetable a lot of discomfort if you get a suitable treatment regimen in place. Based on my experience with Saoirse it really does make a difference to respond to symptoms straight away because it can help to stop a minor flare fairly quickly.

Be sure to give your precious girl some scritches from me when you go visit later. I'm so glad she's getting better! :)


Mogs
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You are such a wealth of information & support! I will be doing allot of reading tonight if I can keep my eyes open that is, , the lack of sleep and lots of stress over the last few days is catching up to me but soon my fur baby will be home and we will both feel much better.

I will defiantly give Veg some scritches for you, I'll make sure to tell her they are from you as well :)

Thank you to everyone for all the support and information, I don't think I would have a vegetable around still if I had not found this forum!
 
If your vet doesn't want you to give metoclopromide, you can also give her 1/4 tablet of Pepcid for nausea. It's cheaper than Cerenia. :) Also, be aware that Cerenia can cause lethargy and can be sedating. Just wanted to let you know so if you give it to her and she gets lethargic, you'll know it's the drug and not a new symptom to worry about. :)

Get some rest and let us know how she does!
 
Tonight is a rough night for me. Vegetable looks like she's doing better, she's eating a little on her own which is awesome but her blood sugar is on the low side & the vet said we are skipping her dose of insulin tonight & he wants to start her on insulin once a day from now on.

I'm missing vegetable tonight & still worried about her but wanting her to get better so I decided to let the vet keep her for one more night. She's still on the IV fluids which is good so hopefully all the ketones will be flushed out & she will be better tomorrow.

I forgot to ask about the cerenia, I'll put that on the list for tomorrow.
 
Lantus doesn't usually last a full 24 hours in cats, and therefore, she'd be without insulin for a number of hours during the day. This can cause ketones to increase, and is not typical advice for treating ketones. It's better to feed karo or honey to keep the sugars up, monitor closely, and shoot twice a day. If your vet recommends a dose, I'd shoot half in the AM and half in the PM rather than once a day. A major cause of ketones is not enough insulin, even when the sugars are low.

Hang in there. Hope she starts eating well soon, it's a good sign that she's eating something.
 
That's what I was thinking as well & im also thinking a full unit at a time might be to much for her & she will get to low. I think I'm just going to bring her home tomorrow no matter what & put her on a routine that works for both of us & that includes insulin twice s day.
I'm sure she's going to have a bounce tonight cause she's not getting her shot.
 
Yeah when you bring her home, and see where her sugars are at, you'll have a better idea where her dose needs to be. 1U in a single dose is quite a jump when you had been giving 0.5U and she had some lower numbers. Once she's eating on her own, she'll need quite a bit of extra calories to clear out the rest of the ketones.

I'm wondering what brought them on, does she have a poor appetite usually. Is she thin or losing weight? How much does she weigh? How much were you feeding her prior to getting sick? The possible pancreatitis might be the trigger too.
 
She usually eats really well, she's on wellness wet food but I was having problems getting her off the dry food. I feed vegetable at least half of a big can of food a day. In the morning I get up & check her blood sugar at 7 then food then shot at 7:30. I make sure she has food when I leave for work at 8:30 & then when I get home around 3 I check blood sugar again & more food. Then around 5ish I give more food. Check blood sugar again at 7pm then food then shot at 7:30. More food around 9 & I try to test her blood sugar before bed around 10 or 11. I end up checking her blood sugar more then I do mine! I think she's getting enough food, if she lets me know she's hungry I give her more food right away.

Vegetable is a little girl, she's up to 5.7lbs that's half a pound more then she was in May. Vegetable has always been a thin kitty but just before she was diagnosed with diabetes she lost some weight that's why I took her to the vet in the first place.

When she comes home she will be on a very strict wet food diet with a tiny amount of dry food at night so I can get some sleep! Vegetable has this way of waking me up at night cause her bowl of food isn't full enough of the food bowls for the other kitties is not full enough.

In may when she was diagnosed she had ketones in her urine but the vet said she should be fine once she got going on the insulin. I'm going to shop around for a new vet, I'm not really happy with either vet clinic I've dealt with so far. It feels like every time she goes to the vet they want a bunch of tests that cost a fortune & some are not necessary right now but would be better in a month from now when she's more stable. And every Dr that I talk to has a different opinion on the dosing of her insulin.

The vet clinic just gave me heart failure!!! They called about veg & the reason they were calling was to see if I left specific food for her or not!! Why would a clinic do that to a person at almost 11 o'clock at night?! They have been feeding her science diet high calorie prescription duet for diabetic kitties since she went in yesterday. They did just check her blood sugar & she's not at 9 up from 4.4 earlier. I think my instincts will be right & she will do better on .5 units twice a day when she comes home.
 
Pancreatitis combined with insufficient insulin and eating will do it for ketones. Glad to see you're still planning to shoot twice a day. Vitally important that she keeps getting enough insulin and once a day shooting isn't going to cut it. Your lantus dosing has been a bit all over the place. I highly recommend that you start posting daily in the lantus/levemir insulin support group forum at least for the time being so that the lantus experts can get little vegetable sorted out. Can you please add the ketones and that you're still feeding some dry into your signature as these are important factors to be considered in dosing for her.
 
For the food, if she is underweight right now feed her at least 200-250 calories a day until she puts on a little weight. For wellness foods that's a little less than a can and a half of the 5.5oz cans. If she wants more than that, it's ok to feed as much as she wants for a while. When cats are underweight or calorie deficient, it makes it difficult to regulate the blood sugars. When you give even a small amount of insulin, they go too low, so it limits the amount of insulin you are able to give, even if they actually need more. What you end up with is blood sugars both very high and very low, and nothing really in between.

I'd agree, if you are unhappy with your vet, it's time to find someone new. Vets really vary in their knowledge of diabetes and complications. It's best to find someone who treats a lot of diabetics, you can ask them how many patients they have with it. Some vets are much more willing to work with you on the financial part too, expecially considering that you will be a frequent flier with a diabetic cat.

Our goal when vegetable comes home is to make sure she eating and drinking, and to -slowly- try to get the highest dose of insulin in her as possible. This might take some careful testing, and even mixing honey or karo in her food or giving it to her straight.
 
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