3/26 Smokey Not Really Eating, Vomited 3 Times

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Rusty & Smokey

Rusty & Smokey

Member Since 2015
So tonight Smokey seems to be having some tummy trouble... This morning he didn't finish all his food. His BG has actually been pretty good the last few days, as seen on his SS.

But tonight he vomited in the living room twice, and then just now, he vomited two more times. The first two times were watery with what looked like dog kibble remnants. The second pair of pukes were totally liquid, and were clear-brown-yellow color. He's now laying in the sunroom, where it's cool.

Should we be worried at all? He's been doing really well on the 0.75 IU dose of Lantus, though we haven't gotten a curve yet. He's drinking water normally.
 
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Have you been testing for ketones?
The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

If he's not better in the morning he may need to be seen by a vet.

Edited to add:
Signs of diabetic ketoacidosis
  • Drinking excessive amounts of water OR no water
  • Excessive urination
  • Diminished activity
  • Not eating for over 12 hours
  • Vomiting
  • Lethargy and depression
  • Weakness
  • Breathing very fast
  • Dehydration
  • Ketone odor on breath (smells like nail-polish remover or fruit)

 
We have not. We have a bottle of Ketodiastix from a few years ago from his original DKA episode. Can they still be used?
 
Jill & Alex (GA) said:
No, you'll need a new ones. They expire "x" amount of days after opening. It should say on the canister.
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Shoot. Okay.

I'm having really bad anxiety now, as we don't have the funds to pay for DKA emergency treatment a second time. And he's not acting like he did during his first episode. I'm just praying he maybe got into the dog food...
 
I’m pretty sure the expire 6 months after opening them.
May I ask why you haven’t been shooting when he is in the blue?
 
Minor update: Mom checked our doggy's bowl and his kibble was all gone! Her door was also open, and Smokey's brother also threw up earlier. We may have the culprit on our hands.
 
Hmm, that's interesting that they both vomited.
I wonder if the kibble has become moldy at all. It's more common than you'd think.

SLGS: You may want to re-read these three sections in the SLGS sticky:
  • How to handle a lower than normal preshot number
  • If the preshot number is far below usual preshot numbers
  • If the preshot number is near usual preshot numbers
There are guidelines within the protocol that could eventually have you shooting on preshot numbers greater than 90 mg/dL.
 
Jill & Alex (GA) said:
Hmm, that's interesting that they both vomited.
I wonder if the kibble has become moldy at all. It's more common than you'd think.

SLGS: You may want to re-read these three sections in the SLGS sticky:
  • How to handle a lower than normal preshot number
  • If the preshot number is far below usual preshot numbers
  • If the preshot number is near usual preshot numbers
There are guidelines within the protocol that could eventually have you shooting on preshot numbers greater than 90 mg/dL.
Click to expand...

We will go get new Ketostix in the morning and start testing, but I have a sneaking suspicion Smokey was grazing. He's been a life long free feeder, and had only been on a feeding schedule since he was diagnosed a few years back.

I will reread that section, thank you. :)
 
Update: He is very lethrgic this morning, and wouldn't even have a Temptations treat. And his third eyelid is showing. We called the vet and will be taking him in, though they said his specialist is no longer working there.

I feel like I'm going to faint. I'm having flashbacks to 2016 to his first DKA episode... I don't know what to do... I know the ER staff will recommend euthanasia.
 
Oh!!!! I'm so sorry.

Don't assume the worst. If this is another ketones episode, you're catching it relatively early, and sometimes in that case it doesn't need much intervention to get them back on their feet. And he may still just be reacting to getting some bad (moldy?) dog food. You don't know until you go in. And by bringing him in quickly, you are doing exactly the right thing for him.

:bighug: :bighug: :bighug:
 
Nan & Amber said:
Oh!!!! I'm so sorry.

Don't assume the worst. If this is another ketones episode, you're catching it relatively early, and sometimes in that case it doesn't need much intervention to get them back on their feet. And he may still just be reacting to getting some bad (moldy?) dog food. You don't know until you go in. And by bringing him in quickly, you are doing exactly the right thing for him.

:bighug: :bighug: :bighug:
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Thank you so much. We are so scared right now. His last DKA episode he became bony before the episode. This time around he's still pudgy, so here's hoping it's not full blown DKA...
 
Adding: it sure does sound like the trigger was the kibble, but another thing you might ask about given the symptoms might be pancreatitis, especially if he was showing any signs of abdominal pain. Treatment is similar to that for a ketones episode itself (fluids, appetite/anti-nausea meds), except with the addition of pain meds, which can be key to getting them feeling better.

Keeping fingers and paws crossed!
 
Nan & Amber said:
Adding: it sure does sound like the trigger was the kibble, but another thing you might ask about given the symptoms might be pancreatitis, especially if he was showing any signs of abdominal pain. Treatment is similar to that for a ketones episode itself (fluids, appetite/anti-nausea meds), except with the addition of pain meds, which can be key to getting them feeling better.

Keeping fingers and paws crossed!
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Might a sign of stomach pain be sitting in the loaf position alot? He was doing that alot last night.

Also, his hydration had been good. He hasn't been drinking tons of water like during his last episode, but he's been drinking a little bit. His normal amount.
 
Good luck today at the vet. You are doing the right thing to have him seen. By any chance does your dog food have corn in the ingredients? A while back my vet RX a higher fiber dry food for my boys. They both got sick and threw up and had diarrhea for a day. Corn was one of the ingredients. Now, I know better that a cat doesn't eat corn! Keep us posted.
 
Rusty & Smokey said:
Might a sign of stomach pain be sitting in the loaf position alot? He was doing that alot last night.

Also, his hydration had been good. He hasn't been drinking tons of water like during his last episode, but he's been drinking a little bit. His normal amount.
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Yes, the meat loaf position indicates they are in pain /and or do not feel well.
 
Rusty & Smokey said:
Might a sign of stomach pain be sitting in the loaf position alot? He was doing that alot last night.
Click to expand...

Yep, that's the classic sign. Could still just be stomach upset from that kibble, but I'd definitely at least get the SNAP test for pancreatitis (immediate yes/no answer), and if funds permit consider the Spec test (gives a more quantitative result indicating severity, but has to be sent away so it takes a while to get the answer).

Poor little guy, hope he's feeling better soon.
 
Please don't assume the worst. If it's ketones, early treatment by the vet is best. If it's full blown DKA early treatment is still best. I don't know why the ER vet would recommend euthanasia. It could also be an attack of pancreatitis from dog kibble overdose. That stuff is a lot higher in carbs and could set it off.

Meanwhile, syringe extra water into him if necessary and don't skip insulin. Syringe in baby food or other pureed food and ask for advice here on insulin dose. The fact that he's a good weight right now works in your favour wrt DKA.
 
Bobbie And Bubba said:
Good luck today at the vet. You are doing the right thing to have him seen. By any chance does your dog food have corn in the ingredients? A while back my vet RX a higher fiber dry food for my boys. They both got sick and threw up and had diarrhea for a day. Corn was one of the ingredients. Now, I know better that a cat doesn't eat corn! Keep us posted.
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Corn is the third ingredient in the food!

We're at the ER now. He doesn't look happy, though his third eyelids are also showing, making me anxious all over again.
 
Update: He is in DKA, his ketones are at a Large level. They need a deposit of 2250, but it could be up to 4000 when all is said and done.
 
The doctor said that according to their more accurate glucometer, Smokey's BG is actually over 400. That is quite different from 255... I'm a bit puzzled by it, to be honest.
 
Rusty & Smokey said:
The doctor said that according to their more accurate glucometer, Smokey's BG is actually over 400. That is quite different from 255... I'm a bit puzzled by it, to be honest.
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That is quite concerning.

Are they using an AlphaTRAK? Or is this from a blood test? I use the same meter you use and my cat has been to the vet a handful of times since becoming diabetic, I always try to test at the vet and with the same venous blood they take from her if I can to compare the lab number to my (human) meter and it's always been quite close in both low numbers and really high ones. I would investigate this further and make sure you have a fresh battery in your meter, non expired test strips that are stored in proper conditions (lid closed, within the temperature range on the strip bottle, low humidity etc.) Please also note, regardless of the expiry on the test strip bottle, they expire within 3 months of opening.

Have you tried testing yourself or another cat in the house (non diabetic) with the meter? Do you have control solution for it?

I hope Smokey is feeling better soon.
 
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I'm so sorry to hear Smokey is in DKA. I know hospitalizing is rough both emotionally and financially, but it's the best place for him to be right now.

Starting a YouCaring fundraiser for him may help. However, members must obtain approval from our board administrator, Robert and Echo, prior to posting links to fundraisers on the FDMB. Click on his name and then send him a private message/start a conversation with him asking for approval. In the meantime, I believe fundraising links are allowed in the FDMB Facebook group.

Rusty & Smokey said:
The doctor said that according to their more accurate glucometer, Smokey's BG is actually over 400. That is quite different from 255... I'm a bit puzzled by it, to be honest.
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Stacy & Asia said:
That is quite concerning.
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By all means, do check to see if your meter is working properly. Although, the difference could just be vet stress. Alex once went from 71 at home right before getting in the car to go to the vet. Her BG was measured (by the vet) at 300 when the vet saw her! I tested her with my meter and came up with a number close to the vet's results. I tested her as soon as we got home and she had already dropped 100 points. She hadn't had insulin that morning and yet she dropped to 147 @ +24.

Let us know how things are going.
Sending positive thoughts...



 
Rusty & Smokey said:
The doctor said that according to their more accurate glucometer, Smokey's BG is actually over 400. That is quite different from 255... I'm a bit puzzled by it, to be honest.
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Your vet is probably using the Alphatrak 2 meter which is specifically for dogs, cats, etc. You are using a meter specific to humans. There will always be a difference between a human meter and one specifically calibrated for animals. I have used both and in comparison, the AT2 is always higher, and in my testing comparisons, it is from 50 to 100 + points higher than a human meter. The human meter I have tested for comparison is the Relion Meter, equivalent to your Glucocard meter.

Wishing you the best for your sweet Smokey!
 
Update: Vet called. One of his kidney values is slightly elevated, which is expected. His bilirubin level is high thight, so she is concerned about obstruction or severe pancreatitis. I haven't told my mom yet. I'm a slight mess right now.

He's going to have an ultrasound to see what's going on.
 
Sending vines and prayers from Florida
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No update, just that my anxiety is through the roof. My mind keeps assuming the worst, that he's obstructed.. I'm seriously hoping it's pancreatitis.
 
Update: He had the ultrasound. No obstruction, though his gallbladder is a bit distended, the vet said it's due to the pancreatitis. It could potentially become an obstruction, but right now it is not. When she checked his blood work again a few hours ago, it improved slightly. Ultrasound also showed a little more changes in his kidneys, but that's not a surprise or a concern right now.
 
Rusty & Smokey said:
Update: He had the ultrasound. No obstruction, though his gallbladder is a bit distended, the vet said it's due to the pancreatitis. It could potentially become an obstruction, but right now it is not. When she checked his blood work again a few hours ago, it improved slightly. Ultrasound also showed a little more changes in his kidneys, but that's not a surprise or a concern right now.
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Glad to hear it isn't an obstruction, sorry about the pancreatitis. Healing vines to Smokey, I hope he's on the mend and back at home with you soon. :bighug:
 
Update: His bilirubin went back up from 3.something to 5.something. I have a feeling it's just part of the pancreatitis, though still fingers crossed it won't become an obstruction. This morning he walked around his cage and drank some water, but still won't eat. When I spoke to the vet at around 1 PM, she said she was going to place a triple lumen central line so that he's not being poked every few hours. His phosphorus level was low, so he's on a supplement now. Not surprised, since that happens with DKA treatment. We're still nervous wrecks, but I feel like at this point it's just a very nerve-wracking waiting game. The doctor also said his heart rate is back up at a normal rate, so that's very good.

On a side note, we're not pleased with the financial end of things. The ER doctor required a $2250 deposit yesterday, but had a lower deposit approved. We only had to put down $1500, and lucked out when my mom was approved for a $4800 credit from CareCredit. Last night, however, the doctor said we need to complete the rest of the deposit by paying another... $1500?!?! What the heck?! We feel like they're starting to nickle and dime us, and we didn't even tell the doctor we had CareCredit! The front desk girl told her! And the doctor threw it in my mom's face last night when she questioned the deposit being higher than originally. She was like, "Well, you were approved for $4800 of CareCredit!"

Seriously disgusted with the veterinary system right now with regards to money. It's absolutely horrendous. We now have put $3000 on the new CareCredit account, and it's only been 24 hours. I'm pretty sure DKA treatment is not THAT expensive. His first episode only cost us around $2000, and he was in much worse shape!
 
Rusty & Smokey said:
And the doctor threw it in my mom's face last night when she questioned the deposit being higher than originally. She was like, "Well, you were approved for $4800 of CareCredit!"
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Holy moly, that's an outrageous thing to say!!! CareCredit isn't a gift, it's debt you're going to have to pay back!!!!! With that kind of attitude, I'd be afraid that they are just going to keep charging you right up to that limit, because "you can afford it". Gah!

That said, you don't have much choice in matters right now-- the vet is where he needs to be until he's in better shape. I don't know enough to be able to critique some of the treatment decisions being made, maybe others will, but I have a couple of questions:

1) what is the current ketone status, is he still in DKA?
2) if there's pancreatitis in the mix, he should be getting some kind of pain meds (unless contraindicated by something else)-- is he?

It is great news that he's walking around his cage and drinking!
 
Nan & Amber said:
Holy moly, that's an outrageous thing to say!!! CareCredit isn't a gift, it's debt you're going to have to pay back!!!!! With that kind of attitude, I'd be afraid that they are just going to keep charging you right up to that limit, because "you can afford it". Gah!

That said, you don't have much choice in matters right now-- the vet is where he needs to be until he's in better shape. I don't know enough to be able to critique some of the treatment decisions being made, maybe others will, but I have a couple of questions:

1) what is the current ketone status, is he still in DKA?
2) if there's pancreatitis in the mix, he should be getting some kind of pain meds (unless contraindicated by something else)-- is he?

It is great news that he's walking around his cage and drinking!
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Yes indeed it's outrageous! :O

I know, the only other ER around here is the VCA, and they DEFINITELY won't be cheaper, lol!

He still has ketones and is still in DKA, but his hydration is MUCH better today. Still flushing the ketones out.
I believe he is getting pain meds. :)
 
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