He smelt it and seemed like he wanted to eat but wouldn't do more than a few licks.
That can be a symptom of nausea, Darnell, and nausea can be a symptom of ketone build-up, though there's no way of knowing until you test for them.
I take it from your most recent reply that the vet did not test for ketones. If both the vets you have consulted failed to test for ketones in an inappetent cat -
especially a cat with a history of DKA - they both made a serious error by not doing so.
If the second vet is now treating for a possible dental infection then he has doubly failed Sprocket by not testing for ketones:
Not enough insulin + not enough food + infection/other systemic stressor => very high risk of D.K.A.
The first vet who told you that because Sprocket's BG is high there is no worry about DKA is WRONG!
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From the Merck Professional Online Manual:
Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes
characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. DKA occurs mostly in type 1 diabetes mellitus (DM).
It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia.
DKA is most common among patients with type 1 DM and
develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients.
Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin ) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress).
Common physiologic stresses that can trigger DKA include
- Acute infection (particularly pneumonia and UTI)
- MI
- Stroke
- Pancreatitis
- Trauma
[Emphasis mine]
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I can't stress strongly enough how important it is for you to test for ketones yourself now, Darnell, as a matter of great urgency. Again from your last post I take it that you don't yet have ketone strips at home. Please, please get some today and test Sprocket's urine. You're not getting adequate veterinary support so you've got to do this for Sprocket.
If Sprocket is throwing ketones he will need immediate treatment at the vets to flush them out of his system and also they will need to ensure that he eats and gets enough insulin. If there is a ketone build-up it can very quickly tip over into DKA and yourself and Sprocket have had the misfortune to have already travelled that awful road together: as you already know it's life-threatening and requires intensive care in a hospital setting.
What are Sprocket's blood glucose levels like, Darnell?
Are you managing to still give Sprocket any insulin? You've got to manage the situation with your vets to get him food and insulin on board.
Again, I urge you to call the vets again to make a very assertive request for anti-nausea treatment for Sprocket. The appetite stimulant won't be much help if he's nauseated. You are his sole advocate. It shouldn't really be the case but sometimes we as caregivers have to push to get the right support from a vet. Since I joined FDMB time and again I've seen vets fail to provide anti-nausea support for inappetent cats in a timely fashion (and some of those stories didn't end well). Regardless of the initial reason for a cat going off its food, when the cat goes too long without food it can then develop problems with excess stomach acid which is another possible cause of nausea. It's a vicious circle. (As Carol asked above, are you giving Sprocket famotidine?) The vets may argue that they're not sure whether it's nausea and say they're reluctant to prescribe an anti-nausea med. If that is what you're dealing with ask them to spell out in mile high letters exactly why they consider it not to be an appropriate treatment for Sprocket. Also ask them whether giving anti-nausea treatment will do any harm. If they say it won't do harm then put the argument to them that it might do some good - and something has to be done to help Sprocket eat as a matter of urgency. This is not a 'lets wait and see if the antibiotics will help' situation. If you don't get Sprocket to eat on his own imminently then you'll need to either start assist feeding from a syringe or else asking your vets to put in a feeding tube.
In the meantime, keep offering Sprocket the blended food. Dip your fingers into it and try to get Sprocket to lick the food off your fingers. Do it little and very often. Whether or not the problem is his teeth
do anything you can think of to get food into Sprocket and post for help here about what to do about with his insulin if you're not sure about that (and Sprocket needs his insulin, too). Any food you can get Sprocket to take while you're trying to get the right veterinary help for him is better than getting nothing into him at all.
I lost a cat to hepatic lipidosis because the self-styled practice "cat expert" hadn't a bull's notion how to treat an inappetent cat and completely failed to treat her as the emergency case she was. She was hospitalised with them for
nearly a week and still they lost her. She had no underlying illness and up to that point she had been a very healthy and happy cat. She was only seven years of age.
Initially I didn't get great support for Saoirse's appetite issues when she had her really bad pancreatitis flare.
It is through the members here sharing their experience that I heard about ondansetron for nausea and, after losing Danú to lack of food, there was no way I was going to let that happen to Saoirse. I had to
repeatedly request the prescription for ondansetron from our vets and eventually they prescribed it for her. That was after she had gone through the unnecessary discomfort of having chronic diarrhoea for three weeks. Ondansetron completely turned things around for Saoirse: it not only saved her life, it gave her back her quality of life. It saved Saoirse's life again in the last couple of weeks when she was struggling to eat after her operation. Saoirse would never have been prescribed ondansetron if I had not fought to get it for her. It would have been a mistake to just rely on what the vets were offering. I think that you are in a similar situation in that you need to fight to get Sprocket the veterinary help he needs.
If I was in your shoes and getting nowhere with the vets consulted thus far I would be looking to find another vet to see Sprocket
today. If I hadn't managed to test for ketones myself I would flag up to the vets in mile high letters that Sprocket has a history of DKA and I would insist on their testing for ketones. They may test negative, and that would be great news but it is far too great a risk to Sprocket's well-being not to test for them at all. I would also do my darndest to get a Cerenia injection at the consult (it may kick in faster than an oral anti-nausea med) and a prescription for ondansetron for home use. A vitamin B injection may also help boost appetite a little so I'd ask the vet about that, too. (NB: The branded version of the drug, Zofran, is crazy expensive over here but the generics are very affordable (less than 10% of the branded drug price). There may be similar pricing where you are. Saoirse is on a generic ondansetron and it works really well for her.)
I am praying very hard for you to be successful today in getting Sprocket the help he needs.
(Sorry if the above is a bit repetitive/rambling: I'm very, very tired.)
Mogs
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