Whitey has gone into severe ketoacidosis

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yes, if he'll eat the dry food, then it's ok to give. Just keep an eye on the BS and water intake. When max was sick I was adding a little water even to the dry food to make a mush so he stayed hydrated. You'll probably have to increase insulin with feeding dry. That's OK. Once he's free of ketones for 2 weeks and everything seems back to normal, you can slowly transition back to lowcarb and reduce insulin. Cats can and do backslide at times, so keep a watchful eye. Small ketones is a great sign, so is the interest in food!
 
Seeing your thread .. hugs & hopefulness for Whitney, thank you for being such great FURparents to your FURbaby!! :bighug:
 
So glad Whitey is better! I'm following your replies because my Tigger is being treated for the same thing, and hopefully can come home today. Hoping Whitey continues to improve!
 
My goodness, I hope Whitey gets through this! He's had a rough road.

The more I see of chronic conditions like Diabetes, the more I begin to respect the idea of nailing insurance for pets before they become ill. Some of the billing amounts you have related, are staggering. Folks with beloved pets are caught between a rock and a hard place.
 
Meya14 said:
Cats can and do backslide at times, so keep a watchful eye.
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@ryanms3030 - Well worth investing in a blood ketone meter going forward: it can alert you to problem levels of ketones earlier than urine test strips (I think by perhaps a couple of days but you'd need to confirm that with someone more knowledgeable).

Very good to read of Whitey's progress.

:bighug:


Mogs
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We upped his dose to 1.5. I just tested +2 hours and he's at 594! I've never seen him that high. We syringe fed about 6 syringes full of recovery food around the time of his shot but that's the most he's eaten in days. I know Lantus should just be starting to kick in but it doesn't give me much hope that he's going to get to even a safe level today
 
Jeanne Skadowski said:
The more I see of chronic conditions like Diabetes, the more I begin to respect the idea of nailing insurance for pets before they become ill.
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Saoirse's insured to the hilt with the exception of urinary tract issues (pre-existing condition) and I'm so thankful. There have been times when I was living on subsistence level income and I knew I'd never be able to afford treatment for her were she not to be insured so apart from the stuff essential to survival (I need to actually be here to look after her) her insurance was the first thing I budgeted for every month.

Is it tough getting pet insurance in the States?



Mogs
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ryanms3030 said:
We upped his dose to 1.5. I just tested +2 hours and he's at 594! I've never seen him that high. We syringe fed about 6 syringes full of recovery food around the time of his shot but that's the most he's eaten in days. I know Lantus should just be starting to kick in but it doesn't give me much hope that he's going to get to even a safe level today
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I think it might be a good idea for you to follow @Jill & Alex (GA)'s recommendation to post for assistance with dosing on the L&L ISG board.


Mogs
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He's eating more, and also, the dehydration that goes along with DKA can contribute significantly to the higher numbers. Try syringing 30ml or so of water and retest in about 40 minutes. If that helps a little, you probably need to increase the water intake. Be aware that on the L&L board, the increases for lantus happen every 3 days, and that is going to be too long of an interval to wait for an increase in DKA. You should be looking at 2-4 shots (1-2 days) at a dose and then re-evaluate if you need to increase. The increases need to happen a lot faster.

Cats in DKA can need quite a bit more insulin than they were previously on, but monitoring close for hypos is very important as well.
 
Thanks. I'll shoot 1.5 tonight and continue monitor and think about 2 unit tommorow. I posted on Lantus forum too with back story. I realize he's still critical and cant wait 3 days to increase
 
Also, if the numbers continue to be >300, you may want to call your vet and ask them to show you how to do subQ fluids at home, or at least take him in to get some fluids. They take about 10 minutes to do in office, and shouldn't be very expensive. The high #'s can be from dehydration and they can also cause dehydration. It's a vicious cycle, and sometimes a day or two of subQ help to break the cycle. Be aware, when he does get fluids, you should monitor carefully, BS can drop a lot with them.
 
To update Whitey's first day home. I gave him 1.5 unit Lantus this morning up from 1.0 he's been on. He has mostly stayed over 500 all day ( 594 +2, 525 +3, 547 +4, 510 +5, 426 +6, 566 +7). We did decide to give him some dry food (Instinct grain free) in hopes to get him eating. The good news is has little by little been eating on his own and seems more alert and energetic right now. He's looking when we call him and walking over to us as opposed to last night and this morning where he was mostly sitting around staring at the ground. We have put out dry food with water mixed in, wet food, high cal wet food and some meat baby food for him to graze as he wants. He's mostly eating dry which I am sure isn't helping the BG levels but at least he is eating more and more and eating on his own without appetite stimulants so at least that all seems like a good sign. He is also drinking water on his own.

I plan on giving him 1.5 unit tonight and letting him have access to dry food. Maybe try to cut out the dry food tomorrow and see if he'll eat wet food. And need to figure out if I should go up to 2.0 units tomorrow if he's still in the 400-500s after tonight's shot
 
Insurance for kitties can be expensive, but considering the costs once a cat becomes ill, makes it hurt a little less. Right now we don't have Dottie or Gizmo on insurance, because they were so doggone healthy. Now I wish I had..it would be like stuffing money in a savings account in order to be prepared for the worst.

The catch to putting money in a savings account is a double-edged sword. If your cat falls ill when you recently, (within a year or two) started the account, there's not enough money to make it really worthwhile and you have to start saving all over again.

But for an older cat? I should have seen this coming...but years ago, when I had many cats..it was also uncommon for vets in our area to even offer much more than basic care, and a few options for surgical procedures. Folks just felt it was out of their reach to do much. If a cat had an accident, and the surgery cost more than $1500 dollars, it meant for most people that the cat was routinely euthanized unless they had the money in the bank.

The whole mindset is changing in regards to pets, these days. More people not having kids, and they shower their attention on their pets. It's just taken a while for logic to catch up with their hearts. We have money for insurance for family..and cats have now become family in every sense of the word.

I'm curious about insurance in the U.K., Mogs. Here, the costs average anywhere from 28 dollars to 47 dollars a month. That's not bad, considering the cost of procedures offered for pets these days. Even a 'light' policy that doesn't cover everything can dig you out of a hole.

Here's some comparisons

Sorry I forgot to put in the link..it's ok now
 
@Meya14 Would like opinion on whether I should raise Whitey's Lantus dose again today. Yesterday went from 1.0 to 1.5. First cycle nadkr was 426 and mostly in 500's and I checked almost every hour. 2nd cycle he was 390 +4 and low 400s other tests.
He has been eating on his own since I've starting giving some dry food. It has been about 18 hours that he has had access to dry food and he has been regularly eating and drinking water on his own during that period.

Should I go up to 2.0 units considering he still needs to come down a lot or stick with 1.5 since the second cycle was lower then first? Thanks!
 
we talked to the vet and they recommended doing 2 unit this morning based on numbers and diet right now so that's what we did and watching
 
Your goal at this point is anything below 250ish and no ketones. If you are under 250, you can hold the dose for 3 days, then increase again based on the numbers if needed. You don't want too "tight" of control just yet so you have some buffer against hypos. Once you have no ketones and no symptoms for 2 weeks, you can tighten things up and adjust feeding as well.

Since you have no ketones today, I'd hold the same dose through tomorrow and see where you are at tomorrow.
 
Meya14 said:
Your goal at this point is anything below 250ish and no ketones. If you are under 250, you can hold the dose for 3 days, then increase again based on the numbers if needed. You don't want too "tight" of control just yet so you have some buffer against hypos. Once you have no ketones and no symptoms for 2 weeks, you can tighten things up and adjust feeding as well.

Since you have no ketones today, I'd hold the same dose through tomorrow and see where you are at tomorrow.
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Awesome, thanks for all the help! I will give 2 unit tonight. And you suggest even if he stays above 250 after tonight shot to keep him at 2 unit tommorow?

Also he's only interested in the dry food right now but at least he is interested and eating and drinking plenty of water. I was thinking maybe one more day of dry and then at least try to get him back on wet but are you saying wait 2 weeks before worrying about that?
 
I'd hold the 2 units through tonight and tomorrow. The drop from yesterday to today was looking pretty good, and lantus can pull down the numbers even more the next day or two, so if you hold numbers will probably in the good range tomorrow at 2u. Don't worry about the dry food until he's good and clear of ketones, sometimes, if you pull out the carbs too fast, the cat backslides because the appetite isn't 100% yet. Once you do adjust the food, you are probably going to need less insulin too. At this point it's better to focus on good appetite, no ketones, and no symptoms.

So, lets talk about what led up to your cat's DKA, because it's good to identify the triggers. In the past, I've seen 3 major triggers that seem to be the precipitating factors:

1. Acute infection - sometimes there is an infection or illness, and this is the only factor. Sometimes DKA happens for reasons other than infection.

2. Cat is chronically underfed or malnourished - We want our cats on the lowest carb diet we can find and to get the diabetes under control, however, sometimes, it's very easy to accidently underfeed a cat, which leads to fat breakdown, which leads to DKA. If your cat is on the thin side or losing weight, there is a possibility they are not getting enough food overall. Remember, lower carb food is often lower calorie food as well, so they need more of it. In addition to underfeeding, cats can be malnourished for a variety of other reasons - appetite issues, CKD, heart failure, irritable bowel, pancreatitis, etc. Check your cat's weight and body type regularly: http://www.petmd.com/sites/default/files/nestle_purina_cat_body_condition_chart_crop.jpg

3. Skipping insulin - Vets often advise to hold insulin if appetite is poor. If blood sugars are not low, AND the caregiver is knowledgeable enough to catch and treat low numbers, the advice to hold is not great advice. Often, it's better to shoot a reduced dose, and monitor. Withholding insulin for a diabetic is akin to withholding air for everyone else. A diabetic's body cannot function properly without insulin, as is has many other functions besides lowering blood sugar. Skipping insulin, even for a couple days can be the trigger for DKA.
 
Meya14 said:
I'd hold the 2 units through tonight and tomorrow. The drop from yesterday to today was looking pretty good, and lantus can pull down the numbers even more the next day or two, so if you hold numbers will probably in the good range tomorrow at 2u. Don't worry about the dry food until he's good and clear of ketones, sometimes, if you pull out the carbs too fast, the cat backslides because the appetite isn't 100% yet. Once you do adjust the food, you are probably going to need less insulin too. At this point it's better to focus on good appetite, no ketones, and no symptoms.

So, lets talk about what led up to your cat's DKA, because it's good to identify the triggers. In the past, I've seen 3 major triggers that seem to be the precipitating factors:

1. Acute infection - sometimes there is an infection or illness, and this is the only factor. Sometimes DKA happens for reasons other than infection.

2. Cat is chronically underfed or malnourished - We want our cats on the lowest carb diet we can find and to get the diabetes under control, however, sometimes, it's very easy to accidently underfeed a cat, which leads to fat breakdown, which leads to DKA. If your cat is on the thin side or losing weight, there is a possibility they are not getting enough food overall. Remember, lower carb food is often lower calorie food as well, so they need more of it. In addition to underfeeding, cats can be malnourished for a variety of other reasons - appetite issues, CKD, heart failure, irritable bowel, pancreatitis, etc. Check your cat's weight and body type regularly: http://www.petmd.com/sites/default/files/nestle_purina_cat_body_condition_chart_crop.jpg

3. Skipping insulin - Vets often advise to hold insulin if appetite is poor. If blood sugars are not low, AND the caregiver is knowledgeable enough to catch and treat low numbers, the advice to hold is not great advice. Often, it's better to shoot a reduced dose, and monitor. Withholding insulin for a diabetic is akin to withholding air for everyone else. A diabetic's body cannot function properly without insulin, as is has many other functions besides lowering blood sugar. Skipping insulin, even for a couple days can be the trigger for DKA.
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Thank you. The vet thinks he may have UTI that triggered it but I'm not sure if they tested or speculated. My wife dealt with the vet more so we need to clarify. He was 6.5 lbs when he was admitted to the hospital. He was 10 lbs in his prime before diabetes but since being on all wet low carb diet he has normally been around 7.5. I do agree he may be under fed. He has two cat siblings and they are fed together and let's say one of them is a pig and eats faster and more than the others so we need to find a way to deal with that even if it's locking her in the bathroom while Whitey and the other cat eat.

The only time I skip insulin is if he's under 80 pre shot because I find even when he's 80-100 he may drop to 40s after a shot and then I need to give him high carb emergency food to get up and that causes a yoyo effect for a few days...but skipping causes yoyo too. So I'll try reduced dose if we get back to that situation. I also feel like he may have other underlying issues. We think he's 15 but may be older as he was rescued off the street as an adult and we've had him for 10 years. He's been diabetic for 5 years and I know that even with perfect care it's doing damage to his organs over time. I think we need to address diet and getting him fed more.
 
Checking back in with a quick update today. I just gave him his evening shot. Second day on 2.0 units. Unfortunately I didn't get any tests in the +4 to +8 last night so data is not great. +6 would be 3:30am right now. Not a big deal to get up except we have our 8 month old baby sleeping in our room and I can't set any alarms that could wake her or I have another set of problems on my hands. +3 last night he was 223 and +9 326 so I'm thinking he probably got down to 100's and today he's been in 400's all day but seems to be going down as he was 322 before his shot. I'm going to make sure to wake up around 3am and test him tonight to make sure he's not dropping too low.

Good news is ketone urine strip showed no/trace ketones again today. He is eating on his own (dry food only) and drinking water and overall seems to be in much better spirits. He's getting up and coming over to us when we come into the room and even purring when we sit with him.

We are cautiously optimistic. Now starting to think about having to break him off dry food again which wasn't easy the first time. And even better all three cats are refusing the wet food now and only eating the dry. We bought Instinct Ultimate Protein which is at least grain free but I'm sure carbs are still pretty high. I really don't understand what it is with kibble that makes cats want to eat is so badly since it's not part of the natural diet. I guess grains, cereals and bread aren't part of our natural diet either but we've been conditioned over enough centuries to crave them. For now I'm just hoping he keeps going in the right direction.
 
My former kibble addicts go nuts over any of the wellness canned foods, especially the ones with the sliced meat chunks in it. And it's higher calorie, which is good for my old lady cat who has weight loss issues.
 
Today is Whitey's 4th full day at home after being in hospital for 3 days. This is 3rd day at 2 units of Lantus. He was 360 AMPS and dipped to 160 +5, 125 +6, 130 +7 and back up to 378 PMPS. Previous cycle was similar but he started a little lower around 320 PMPS last night. I tested ketones about an hour ago and showed negative on urine strip. Still exclusively on dry food but eating and drinking throughout the day on his own, we haven't been giving any appetite stimulants. His attitude seems to be back to normal. He is acting like his normal relaxed, lazy self. Lots of lounging around but laying in the sun and by the window instead of hiding in the kitty igloo. He's also coming up to us and curling up next to us on the couch and looking for and doling out affection on us, the baby and his kitty siblings.
 
Sounds like he's doing much better! As you know, we're in the same boat Question: is it hard to test for ketones? And what if there are any present? Does this mean another trip to the vet? $$$$$$!!!!! I'm worried sick that this will happen again. Scary thought!
 
Sounds great! It takes about 2 weeks of being back to normal before they are really out of the woods. In that time, try to identify the cause(s) and formulate a plan to prevent it from happening in the future. Testing ketones as soon as anything seems out of the ordinary should be #1 on the list. If caught right away, you can really avoid the expensive vet bills.
 
@Meya14 after BG readings getting a little lower over the past couple of days he was up to 581 AMPS today. I stayed with 2 units for this morning but should we think about going up again? Including today he's been on 2 units for the past 7 shots
 
I would try increasing the fluid intake if you can and watch the sugars if that helps them go down. If he doesn't go lower than 250ish during the day and hang out there for a while, I'd increase to 2.25U.
 
@Meya14 thanks again. Still no ketones as of this morning. Urine stick showed negative. Just tested +7 and hes 174 so came down quite a bit. I'll do 2 units again and hope he is getting a little more even. The other thing is we are trying to change his shot time. At the hospital they were doing 10am and 10pm and we need the get back to 8 and 8. Luckily we have 9 more days. I've been going back 15 minutes every 4th shot for now.
 
Looking at your numbers today and yesterday, you are probably safe bumping it up to 2.25U as long as the appetite is the same or better.
 
Meya14 said:
Looking at your numbers today and yesterday, you are probably safe bumping it up to 2.25U as long as the appetite is the same or better.
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Thanks. I already did his evening shot before reading this. He was 545. Still eating and drinking. I think appetite is better which might account for higher readings. I will plan on doing 2.25 tomorrow morning. He's gotten down below 200 a few times but then keeps getting back to the 500s
 
CarolandTigger said:
Question: is it hard to test for ketones? And what if there are any present? Does this mean another trip to the vet? $$$$$$!!!!! I'm worried sick that this will happen again. Scary thought!
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Hi Carol,

There are two types of test that you can do for ketones at home: urine, and blood. Urine is tested with reagent strips (e.g. Keto-stix) and blood is tested with a ketone meter in the same way as you'd test blood glucose. Of the two methods, blood ketone monitoring is superior in that it allows for earlier detection of ketone increases. From my reading here I understand that a blood ketone test can alert you to concerning levels of ketones days earlier than a urine test.

Another advantage of monitoring blood ketones is that it can be done 'on demand'; no need to wait to catch a urine sample. I bought a ketone meter for Saoirse and it is a godsend for us right now while she's convalescing - especially when she wouldn't eat for me (and also with me being so exhausted). Saoirse's not stressed by having to use non-absorbent litter (doesn't like it) and it makes this aspect of her nursing care much easier for her tired mama. Win-win!

The ketone meter test strips are pricey but more than worth it; doubly so for kitties with a history of throwing ketones.


Mogs
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@Meya14 decided to stick with 2 units this morning. He was at 222 which is first time first time he's been below 300 before shot since he's been home. Also seems to be dropping still from last night so figured increase is not needed or a good idea.
 
Probably a good idea, you can see where he's at starting in the 200s. As long as there are still no ketones, you're good.
 
Whitey has now been home from the hospital for over a week now. He is still on 2 units of Lantus and eating dry food exclusively. He still has no ketones in his urine which is good. But BG is still all over the place. He seems to be mostly in the 300's but was just 456 before evening shot and as high as 585 yesterday. But two nights ago I tested him at 80 +4. Unfortunately I missed the +6 but it's certainly possible he was in the 50's or lower and the 585 was the next morning before his shot so he could be bouncing really low and high. I didn't want to increase his dose yet since he may have gone low the other night. I would really like to get him off the dry food again but he has no interest in eating anything else so I will let it go one more week and then if all is well try to cut him back to wet food and probably lower the Lantus
 
What kind of wet food were you feeding prior to the DKA? It's very important that when you transition that he is taking in enough calories from the food, as that may have been a contributing factor. Most cats need from 200-300 calories a day depending on their size and activity. This is about 1.5-2 large cans per cat. Diabetics also need more than average too. I think if you want to start transitioning back to wet, that's fine. Watch carefully for hypos. Reduce by 0.25 if BS goes into the 50s. Reduce by 0.5 if below the 50s.

Don't skip shots. You may find that you can transition to wet, and then feed dry "snacks" to even out those swings. Having large swings like that is called "brittle diabetes". Really, these cats need -more- insulin to flatten out the higher numbers, but they can drop a little too much at the nadir. What we do in people when this happens is adjust meals - we feed low carbs at shot times, and about 1-2 hours before nadir, we will feed them and increased carb meal. Most "brittle diabetics" have some amount of malnutrition or liver disease, at least in people.
 
Meya14 said:
What kind of wet food were you feeding prior to the DKA? It's very important that when you transition that he is taking in enough calories from the food, as that may have been a contributing factor. Most cats need from 200-300 calories a day depending on their size and activity. This is about 1.5-2 large cans per cat. Diabetics also need more than average too. I think if you want to start transitioning back to wet, that's fine. Watch carefully for hypos. Reduce by 0.25 if BS goes into the 50s. Reduce by 0.5 if below the 50s.

Don't skip shots. You may find that you can transition to wet, and then feed dry "snacks" to even out those swings. Having large swings like that is called "brittle diabetes". Really, these cats need -more- insulin to flatten out the higher numbers, but they can drop a little too much at the nadir. What we do in people when this happens is adjust meals - we feed low carbs at shot times, and about 1-2 hours before nadir, we will feed them and increased carb meal. Most "brittle diabetics" have some amount of malnutrition or liver disease, at least in people.
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Thanks. He was originally on Fancy Feast but we switched to Friskies pate once we had 3 cats and it was getting too expensive. Generally we split 2 cans of Friskies between the 3 cats twice a day. If they eat it all and Whitey or the others act like they are looking for more we put out another can.

So last he was 109 +6 and 175 amps this morning. He did vomit some clear liquid in the middle of the night. That is nothing new but the first time since he's been home. The vet indicated that might be a symptom of pancreatis
 
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