Cat not improving...

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Woodsywife said:
I wonder if maybe finding a grain free dry would help. My civvie (non diabetic) Tripper would vomit every couple of days. I always mentioned it to my vet. One visit we had to see an associate and he told me the dry would be like a sponge and swell in the stomach and when it built up cat would vomit. He told me to change to grain free. We did and the vomiting has for the most part stopped. If what the vet said is true or not I don't know but it worked. Just wish I could get her off the dry all together.
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Yeah, we bought some grain free wet food that we have never tried before so if he doesn't eat his normal stuff we will try that.
 
My two go-to options for a cat that isn't eating is either meat and broth only baby food (Gerber Stage 2 have 4 different flavors) or 9-Lives Tuna & Egg or Tuna & Cheese (both available from Walmart if you have one locally...not too expensive either). I don't finger feed because some of ours don't like taking food from anyone's hand, but I do put a little food on a teaspoon and give it to them that way...that sometimes seems to be 'special' enough to encourage them to eat just a little.
 
Mackenzie Obermeyer said:
We left out 4 different foods today for him which he didn't want. We also tried putting it on our finger, didn't work either.

Some of the symptoms did look familiar. He has a loss of appetite, he was drooling a little 3 days ago, playing with water (but he has done that everyday of his life haha), sniffing food and walking away, and licking the gravy off of food only.

Here is one of my favorite pictures of Mayton, he has these huge eyes that look so cute in this picture!
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If that isn't just the cutest darn cat!!!! I love those eyes!
 
Mackenzie Obermeyer said:
He has a loss of appetite, he was drooling a little 3 days ago, playing with water (but he has done that everyday of his life haha), sniffing food and walking away, and licking the gravy off of food only.
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That really does sound like nausea....since he's already on the cerenia, I'd talk to your vet about adding the ondansetron along with it and see if it helps.

I'd also try the cyproheptadine instead of the mirtazapine after you've gotten the nausea under control....it's really not good to give an appetite stimulant if they're nauseous too....you know how you feel when you're sick to your stomach? The last thing you really want to do is eat so giving an appetite stimulant on top of feeling icky isn't a good idea
 
How has Mayton been doing poop-wise since he came home from the vet hospital?

I agree with Chris about Mayton showing classic symptoms of nausea and about asking your vet for ondansetron. I found it helped Saoirse much better for nausea treatment than Cerenia. If he isn't pooping properly also ask your vet about whether he might have nausea related to motility problems/constipation. (See my earlier posts for info on treatment for this.)


Mogs
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Chris & China said:
That really does sound like nausea....since he's already on the cerenia, I'd talk to your vet about adding the ondansetron along with it and see if it helps.

I'd also try the cyproheptadine instead of the mirtazapine after you've gotten the nausea under control....it's really not good to give an appetite stimulant if they're nauseous too....you know how you feel when you're sick to your stomach? The last thing you really want to do is eat so giving an appetite stimulant on top of feeling icky isn't a good idea
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Update: he was eating a new food and then all of a sudden he threw it all up. :( when this happens do we give him insulin still or lower the dosage or just not give him anything? Also we tried to get a blood sample but after about 10 pokes we decided to just try again tomorrow because Mayton wasn't having it at all.
 
Critter Mom said:
How has Mayton been doing poop-wise since he came home from the vet hospital?

I agree with Chris about Mayton showing classic symptoms of nausea and about asking your vet for ondansetron. I found it helped Saoirse much better for nausea treatment than Cerenia. If he isn't pooping properly also ask your vet about whether he might have nausea related to motility problems/constipation. (See my earlier posts for info on treatment for this.)


Mogs
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He had runny poop for just one day but since then it has been normal.
 
With the history of DKA, it's important that he get his insulin

Did he eat the food quickly and then throw it up soon afterwards? If that's what happened, it could be a "scarf and barf"....where they eat too fast and it comes right back up. If that's what happened, try spreading his food out on a flat plate instead of putting it in a bowl so it will slow him down when he eats

Can you syringe feed him if you have to? Might try giving a small amount (like a teaspoon or two) at a time and see if it stays down.
 
Chris & China said:
With the history of DKA, it's important that he get his insulin

Did he eat the food quickly and then throw it up soon afterwards? If that's what happened, it could be a "scarf and barf"....where they eat too fast and it comes right back up. If that's what happened, try spreading his food out on a flat plate instead of putting it in a bowl so it will slow him down when he eats

Can you syringe feed him if you have to? Might try giving a small amount (like a teaspoon or two) at a time and see if it stays down.
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No he ate it slowly. We are calling out 24 our emergency vet to see what they suggest right now.
 
Mackenzie Obermeyer said:
No he ate it slowly. We are calling out 24 our emergency vet to see what they suggest right now.
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Wise decision, Mackenzie; I hope they can do something to help Mayton quickly. I've been through bad kitty nausea and I really feel for you both.

Sending prayers for things to improve very soon.

:bighug::bighug::bighug:


Mogs
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Critter Mom said:
Wise decision, Mackenzie; I hope they can do something to help Mayton quickly. I've been through bad kitty nausea and I really feel for you both.

Sending prayers for things to improve very soon.

:bighug::bighug::bighug:


Mogs
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They said to take his glucose levels but we can't get any blood... me must have tried 20 times. We tried heating it, rubbing the ear, using a anti biotic cream to slick the hair down. We tried all over the ears and paws. Luckily he ate a spoonful of baby food and about 1/3 package of tuna so we are going to give him some insulin.
 
His ears will "learn" to bleed more easily over time. What also helps is to have 28 gauge lancets instead of the thinner 30 or 31 G type. The 28G are often labelled "for alternate site testing" or similar. If you use the rice sock method for heating his ear, it has to be quite warm and you might need to carefully cover/rub his ear with it for longer than you might think.
 
Kris & Teasel said:
His ears will "learn" to bleed more easily over time. What also helps is to have 28 gauge lancets instead of the thinner 30 or 31 G type. The 28G are often labelled "for alternate site testing" or similar. If you use the rice sock method for heating his ear, it has to be quite warm and you might need to carefully cover/rub his ear with it for longer than you might think.
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Yeah, we read that the 28 gauge is better after we bought the 30 gauge. When we went back to the store they didn't have any of the 28. We tried heating it with a damp wash cloth that was heated up and holding that over his ear. But we have tortured that cat way to much tonight so we will try again tomorrow morning.
 
Mackenzie Obermeyer said:
Yeah, we read that the 28 gauge is better after we bought the 30 gauge. When we went back to the store they didn't have any of the 28. We tried heating it with a damp wash cloth that was heated up and holding that over his ear. But we have tortured that cat way to much tonight so we will try again tomorrow morning.
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Definitely make yourself a rice sock: old clean sock that has lost its mate, fill toe part with maybe 1/2 cup uncooked rice, tie above toe part or make a knot in the ankle part of the sock, nuke in microwave until it's very warm (but you can tolerate it on your skin), put over kitty's ear and rub in circular motions for as long as it takes to get the ear well warmed. I don't think they like the wetness of a warm washcloth and it won't hold its heat as long as a rice sock.
 
Mackenzie Obermeyer said:
We tried heating it with a damp wash cloth that was heated up and holding that over his ear.
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That explains a lot. My vets taught me to do similar with a big wodge of cotton wool and I had awful problems at first. I got on better with a plastic pipette containing warm water; more comfortable because it was dry, it wasn't bulky and it held the heat better. A small rice sock would also hold the heat better, too.

Here are some of my tips for home testing:

1. Smear a thin film of Vaseline over the test area then warm the ear thoroughly (can take much longer than you think in the early days).

2. Wrap a 1" strip of folded kitchen paper around your index finger then wrap the ear around the finger in a similar fashion.

3. Hold the ear and paper support in place with light-firm pressure from your thumb and middle finger so that the skin of the ear is taut. (Helps reduce head movements, too.)

4. Make sure the bevelled edge of the lancet is facing you then poke at a slight angle to draw blood sample.


Mogs
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Call your vet and ask if they tested potassium levels at the last hospitalization. A low potassium can lead to what is called paralytic ileus (slow bowel) and can cause nausea -with- vomiting. Most of the DKA cats I've seen here typically don't have vomiting, just signs of nausea. Low potassium can then be supplemented, and other medications for constipation/nausea can be added to increase motility. Bowel issues can be overlooked at times, but this is probably a frequent trigger for DKA for some cats.
 
Are you using the lancet device? or are you free-handing? The lancet device should be set on 3 or 4. You might have better luck free-handing.
 
Morning Update: mayton ate super well! He ate almost all of his dry food. We got some blood from his paw as well. However I accidentally feed him before we took the blood so that might have changed the results. He ate about 15 minutes before the sample was taken. It was 404. Do you think they are that high because we feed him before? He is just about to get his full 2 units of insulin.
 
Good to see that Mayton is eating well today!! Testing 15 minutes after eating should not affect the reading, since it does take some time for the food to affect numbers. It is always best to test, then feed then shoot just to makes sure though ;)
 
Tuxedo Mom said:
Good to see that Mayton is eating well today!! Testing 15 minutes after eating should not affect the reading, since it does take some time for the food to affect numbers. It is always best to test, then feed then shoot just to makes sure though ;)
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So it is probably high because he only got .5 unit last night?
 
What a very welcome update, Mackenzie! I'm so pleased for you all. Well done getting the BG test. :bighug: Any joy with ketone testing yet?

Mackenzie Obermeyer said:
So it is probably high because he only got .5 unit last night?
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Might be due to the lower insulin dose and the dry food might be carbier.


Mogs
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Update: Mayton had been eating super well so he has been getting his full 2 units of insulin. I checked again for ketones last night and I was negative. This morning when we took his blood it was 536... which is pretty high. Is there something we are supposed to do to lower it?
 
Mackenzie Obermeyer said:
Update: Mayton had been eating super well so he has been getting his full 2 units of insulin. I checked again for ketones last night and I was negative. This morning when we took his blood it was 536... which is pretty high. Is there something we are supposed to do to lower it?
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It sometimes takes a while for those preshots to come down. So glad he's eating! Try to get some mid cycle numbers. Is he on all wet low carb food? Maybe you could add what he's eating into your signature.
 
JanetNJ said:
Try to get some mid cycle numbers. Is he on all wet low carb food? Maybe you could add what he's eating into your signature.
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He eats a 1/4 cup of dry DM. You need 2 people to get a blood sample from Mayton, he is very squirmy. So the only times we could take a blood sample is in the morning and around 9-10 at night.
 
Hi. I just scanned your thread this morning, and have to log off now to get to work. I also checked your spreadsheet.
I am so glad his ketones were negative. Keep testing for them a couple times a day if you can, while he's high and not acting normal (like the throwing up). He could be high right now, because he went lower the night of the 4th, as he was throwing up his food, even though you gave him a partial dose, and he could have gone low (for him) last night as well. He could be bouncing. Sending eat your food vines to Mayton.
 
Mackenzie Obermeyer said:
He eats a 1/4 cup of dry DM. You need 2 people to get a blood sample from Mayton, he is very squirmy. So the only times we could take a blood sample is in the morning and around 9-10 at night.
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He won't eat wet at all? I ask because the dm food is about 12% carbs. My cat loves dry so we got her young again zero carb food. You could ask them for a free sample.
 
So, considering that you've gone through DKA twice in a row, I wanted to talk about possible causes or risk factors. Basically, the ketones form due to fat breakdown in the body which can happen for multiple reasons. It's helpful to remember that while insulin lowers BS, it also allows cells to use glucose for energy. Without insulin, cells starve. Starving cells tell the body to burn fat so they can use ketones for energy (dangerous if this occurs for more than a little bit).

Infection: Infection causes the body to need more insulin to heal, if more insulin isn't available, the body will try to burn fat. Common infections are UTI, bowel parasites or infections, viral infections such as feline herpes, etc.

Too low calorie intake: You should look at a cat body chart and see where your cat falls as far as weight. Basically, if you can see the outline of the shoulder blades, your cat may be too thin. Any cat that is on the thin side and having issues with BS control or DKA should -NEVER- be restricted in the amount of food they eat. Low body weight makes "brittle diabetes" more of an issue, makes BS harder to control, and predisposes to illness. Also, not all calories are processed the same way, proteins and fats have a complex metabolism that relies on several enzymes that may not be present in certain illnesses. Carbs are a much simpler pathway, and may allow faster weight gain and glucose stabilization in skinny cats. Ultra-low carb diets in skinny cats may lead to DKA if prone.

Chronic Illness: Illnesses that make food hard to absorb should be considered as causes - pancreatitis, liver disease, IBS, bowel lymphoma, diarrhea or constipation, cancer, other GI issues. Also some illnesses cause higher metabolism or calories to burn - hyperthyroid, cancer, heart failure, kidney disease, parasites, etc. These should all be ruled out.

Too low insulin: Insulin is like air - a body always needs it to survive. Without insulin, cells starve, and metabolism goes haywire. The body makes some amount, but it may not be enough to allow the metabolism to remain normal. We -INDIRECTLY- monitor insulins effect on the body through BS tests, but that's not the only function of insulin. When BS is normal to low in response to insulin, there is actually 2 options to keep sugar at good levels - you can either reduce insulin, or increase food. The right choice really depends on the situation. Same goes for high blood sugars - you can either reduce food or increase insulin. It's good to think about the results of the choices in relation to the kitty's needs (ie encouragement or prevention of weight gain).

Dehydration: If chronic kidney disease, diarrhea, or heart failure are issues, dehydration can be the initial trigger. Balancing hydration in complex kitties really requires vet monitoring/lab monitoring.
 
Meya14 said:
So, considering that you've gone through DKA twice in a row, I wanted to talk about possible causes or risk factors. Basically, the ketones form due to fat breakdown in the body which can happen for multiple reasons. It's helpful to remember that while insulin lowers BS, it also allows cells to use glucose for energy. Without insulin, cells starve. Starving cells tell the body to burn fat so they can use ketones for energy (dangerous if this occurs for more than a little bit).

Infection: Infection causes the body to need more insulin to heal, if more insulin isn't available, the body will try to burn fat. Common infections are UTI, bowel parasites or infections, viral infections such as feline herpes, etc.

Too low calorie intake: You should look at a cat body chart and see where your cat falls as far as weight. Basically, if you can see the outline of the shoulder blades, your cat may be too thin. Any cat that is on the thin side and having issues with BS control or DKA should -NEVER- be restricted in the amount of food they eat. Low body weight makes "brittle diabetes" more of an issue, makes BS harder to control, and predisposes to illness. Also, not all calories are processed the same way, proteins and fats have a complex metabolism that relies on several enzymes that may not be present in certain illnesses. Carbs are a much simpler pathway, and may allow faster weight gain and glucose stabilization in skinny cats. Ultra-low carb diets in skinny cats may lead to DKA if prone.

Chronic Illness: Illnesses that make food hard to absorb should be considered as causes - pancreatitis, liver disease, IBS, bowel lymphoma, diarrhea or constipation, cancer, other GI issues. Also some illnesses cause higher metabolism or calories to burn - hyperthyroid, cancer, heart failure, kidney disease, parasites, etc. These should all be ruled out.

Too low insulin: Insulin is like air - a body always needs it to survive. Without insulin, cells starve, and metabolism goes haywire. The body makes some amount, but it may not be enough to allow the metabolism to remain normal. We -INDIRECTLY- monitor insulins effect on the body through BS tests, but that's not the only function of insulin. When BS is normal to low in response to insulin, there is actually 2 options to keep sugar at good levels - you can either reduce insulin, or increase food. The right choice really depends on the situation. Same goes for high blood sugars - you can either reduce food or increase insulin. It's good to think about the results of the choices in relation to the kitty's needs (ie encouragement or prevention of weight gain).

Dehydration: If chronic kidney disease, diarrhea, or heart failure are issues, dehydration can be the initial trigger. Balancing hydration in complex kitties really requires vet monitoring/lab monitoring.
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Thanks for the information. I always try to leave food out for him at all times, he had been eating more than he has been for the past month which is really good. He has definitely lost weight. He weighs 11 pounds now and he looks skinny. We found him on the streets so we don't know what breed he is... but I think he is at least part Maine coon, he has a large structure. I think he used to weigh around 17 pounds. I'm going to try to test his blood by myself before he eats dinner. Hopefully I can get some. :)
 
JanetNJ said:
He won't eat wet at all? I ask because the dm food is about 12% carbs. My cat loves dry so we got her young again zero carb food. You could ask them for a free sample.
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So far the DM is the only one we can get him to eat consistently and enough of. Thanks for the suggestion I will look into it
 
Great job getting the spreadsheet up and running, Mackenzie; you're playing a blinder. :)

Great to hear about ketones being negative again and that Mayton is getting more inclined to eat sometimes without the assist. You're correct that you need to make sure he has some food on board prior to giving each insulin dose but, as you've observed, when the insulin starts kicking in it can give a kitty a bit of an appetite boost so they will eat more at that time. I think it's a good plan to leave food out for Mayton to graze.

At the moment if the DM is working well for Mayton then I'd suggest sticking with that; he's getting his calories and while he continues to eat regularly that will help the nausea symptoms to reduce (and hopefully disappear!).

With regard to testing is there any way that, in addition to the morning and evening preshot tests, you could get a test in at +3 hours after the evening dose every day? For the sake of one extra test a day during workdays it would give you a much better picture of how Mayton is responding to his insulin.


Mogs
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So sorry to hear about your kitty and his DKA. My own maine coon kitty, Ozzy, is also recovering from his first DKA episode (he was hospitalized a week ago) and it has been very stressful and heartbreaking. We didn't know he had FD prior. As you probably know, Maine Coon kitties are one of the larger breeds (and one of the sweetest IMO). My kitty used to weigh between 18-19 lbs and now is 15.3 lbs. When I saw your kitty went from 17 lbs to 11 lbs, it really stuck a chord with me and broke my heart. I know how much my cat's appearance changed (and so quickly) when losing weight and I can only imagine how shocking it was for you as well. I am praying that your kitty gets better and very quickly.

Ozzy has been home for about 6 days now and he is also not eating well. I learned a lot on this board already from the amazing members and now know that post-DKA nutrition is super important. We are unfortunately syringe feeding our kitty still to make sure he gets adequate nutrition. He will eat some on his own, but not enough.

I am also new to BG testing and have poked my poor Ozzy's ears more in the past few days than I'd like to honestly admit. I drove home from work today thinking there is NO way I am doing that to my kitty again tonight. But when I got home and saw he still didn't feel well and didn't want to eat, I just needed to know his numbers to I could make some sense on why he would not be eating still. I think someone on here mentioned that cats with high BG don't feel good and so they don't want to eat. I am just hopeful his insulin will start to bring his numbers down over the next few days and things will change. I am hoping the same for your kitty.

I really hope your kitty gets better soon. I'm going through the same thing so just wanted to let you know I understand your hardship, worry, stress, frustration...etc. I have hope for both our kitties, though. What another member told me is that they just really need our help to eat.
 
Ozzy Pawzbourne said:
So sorry to hear about your kitty and his DKA. My own maine coon kitty, Ozzy, is also recovering from his first DKA episode (he was hospitalized a week ago) and it has been very stressful and heartbreaking. We didn't know he had FD prior. As you probably know, Maine Coon kitties are one of the larger breeds (and one of the sweetest IMO). My kitty used to weigh between 18-19 lbs and now is 15.3 lbs. When I saw your kitty went from 17 lbs to 11 lbs, it really stuck a chord with me and broke my heart. I know how much my cat's appearance changed (and so quickly) when losing weight and I can only imagine how shocking it was for you as well. I am praying that your kitty gets better and very quickly.

Ozzy has been home for about 6 days now and he is also not eating well. I learned a lot on this board already from the amazing members and now know that post-DKA nutrition is super important. We are unfortunately syringe feeding our kitty still to make sure he gets adequate nutrition. He will eat some on his own, but not enough.

I am also new to BG testing and have poked my poor Ozzy's ears more in the past few days than I'd like to honestly admit. I drove home from work today thinking there is NO way I am doing that to my kitty again tonight. But when I got home and saw he still didn't feel well and didn't want to eat, I just needed to know his numbers to I could make some sense on why he would not be eating still. I think someone on here mentioned that cats with high BG don't feel good and so they don't want to eat. I am just hopeful his insulin will start to bring his numbers down over the next few days and things will change. I am hoping the same for your kitty.

I really hope your kitty gets better soon. I'm going through the same thing so just wanted to let you know I understand your hardship, worry, stress, frustration...etc. I have hope for both our kitties, though. What another member told me is that they just really need our help to eat.
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For Mayton we have never been able to get him to bleed in his ears... we use his paw pads and it works every time for us. It's not the best situation and he doesn't like it that much, but it's to help him. If you haven't tried it already I might. Hope Ozzy gets better soon!
 
Critter Mom said:
Great job getting the spreadsheet up and running, Mackenzie; you're playing a blinder. :)

Great to hear about ketones being negative again and that Mayton is getting more inclined to eat sometimes without the assist. You're correct that you need to make sure he has some food on board prior to giving each insulin dose but, as you've observed, when the insulin starts kicking in it can give a kitty a bit of an appetite boost so they will eat more at that time. I think it's a good plan to leave food out for Mayton to graze.

At the moment if the DM is working well for Mayton then I'd suggest sticking with that; he's getting his calories and while he continues to eat regularly that will help the nausea symptoms to reduce (and hopefully disappear!).

With regard to testing is there any way that, in addition to the morning and evening preshot tests, you could get a test in at +3 hours after the evening dose every day? For the sake of one extra test a day during workdays it would give you a much better picture of how Mayton is responding to his insulin.


Mogs
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Yeah I could probably get one in around 10pm.
This morning his blood test said "Hi" which means 600+ :( and we did it twice so we know it's accurate. The emergency vet said to keep his insulin at 2 units still which I thought was weird since his blood has few been high for the past 2 days. We gave him 2 units this morning and they said test it in 1 hour and if it his still high we need to go and get a curve at the vet.
 
With Lantus it usually does not start showing much effects until +2 or +3 with the peak effect showing around +5-+7, so it not surprising that the +1 test was still high. You can do a curve at home when you are available for the day. You would want to test at preshot and then every 2 hours for a 12 hour cycle. This will help show how well the dose is working and when the nadir (lowest number) is, which is good data to have. A curve done at the vets may not be as useful, since many kitties are very stressed with a vet visit and stay, which will cause the readings to be higher than they would be in a relaxed atmosphere. It may be that Mayton needs more insulin but until you have more data is is very difficult to make that call.


ETA Well done getting your spreadsheet up. It is such a valuable tool to have.
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Tuxedo Mom said:
With Lantus it usually does not start showing much effects until +2 or +3 with the peak effect showing around +5-+7, so it not surprising that the +1 test was still high. You can do a curve at home when you are available for the day. You would want to test at preshot and then every 2 hours for a 12 hour cycle. This will help show how well the dose is working and when the nadir (lowest number) is, which is good data to have. A curve done at the vets may not be as useful, since many kitties are very stressed with a vet visit and stay, which will cause the readings to be higher than they would be in a relaxed atmosphere. It may be that Mayton needs more insulin but until you have more data is is very difficult to make that call.


ETA Well done getting your spreadsheet up. It is such a valuable tool to have.
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My dad took him to the vet for them to do a curve today since we wouldn't be able to until Saturday. We wanted to make sure we are giving him the right amount of insulin. He should be back tonight. Yeah
 
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