HELP! Cat has DKA and I need advice

Status
Not open for further replies.
Laudie

Laudie

Member Since 2018
Hi all,

I've been reading a lot about a post from Chloe's mom from a few years ago and I thought I might as well add my situation to see if anyone can help us out. Our cat was diagnosed with DKA on Sunday night and we admitted him to the emergency vet. He spent 48 hours there and was discharged because he started eating yesterday morning and afternoon after having been given a appetite stimulant.

He came home and didn't eat but I figured he wasn't hungry because he had eaten at 4pm at the vet. We tried this morning around 7am and he still wasn't eating. I took his blood using my AlphaTrak meter and it was at 27.3 mmol/L (491 mg/dL). I gave him about 100mL of sub-q fluids too. We called the vet and asked to come pick up an appetite stimulant and they agreed. We gave that to him about 11am and he still wasn't eating so we force fed him some baby food around noon. This triggered him to eat some off a plate (he probably ate 15ml). No shot was given in the morning. Tried to test his urine and we think it was in between trace and small.

I got home from work around 6:45pm and we gave him another 5ml of baby food and I gave him 2 units of ProZinc Insulin after his BG was at 38.9 mmol (700mg). At around 9:15 we gave him another 5ml of food and his BG is at 35.6 mmol (640 mg). Tested urine again and it seemed to be between trace and small again.

Should I give him another shot? Should I just wait until the morning? I'm so worried that his sugar is so high but don't want to throw off the whole twice a day shot thing.

Also, if we want to try and force feed him his normal food (which is the basic fancy feast), should we just blend it with a little water? Is that what most people do?

Thank you all for your help! We have spent so much money already and really can't afford to spend more so I want to do all I can at home. I might not have as much time as other posts I've read but I'm willing to try as much as I can. He does still have some energy and goes outside sometimes to lay down but obviously this is a few week adventure for us.
 
Ah! I think we're in the same time zone. You do need to wait for the next shot. It takes about 4-7 hours to know how far the dose will bring him down, so if it's only been three hours it's much too soon to shoot again. At the earliest, Prozinc can be given at eight hours, and only if your schedule allows you to keep an eye on things so he doesn't go too low. With the numbers you're getting right now, you probably don't need to worry about that too much just yet. Do your best to not skip a shot again. With ketones, it is essential that they get insulin.

And yes, you can add water to the regular food, blend it, and syringe it that way.

As far as costs, if you use a human meter instead of an alphatrak, you'll save a bunch on the test strips. AT2 are about a dollar each, human meter test strips are about 25 cents. Most of us around here use human meters for regular testing, and then use the AT2 to report numbers to the vet.
 
I have not had to deal with DKA, so I'm hoping someone with more experience in that area will hop on soon and be able to help you out.

A few more questions about the Prozinc: How long ago was your cat diagnosed with diabetes? How long has he been on Prozinc? Was the vet getting a good response on the 2u in clinic? Or is that your starting dose? How long has he been on 2u? If it's possible tonight, if you could get a test at around +5 or +6 hours after the shot, that would be helpful data so we can see how he's responding to this dose. If that doesn't work because you need to sleep, I understand. You need to take care of yourself in all of this too.
 
Thanks Djamila! That’s what I was worried about. We didn’t want to give him insulin because he didn’t eat but I’ll just test before and give him less if he doesn’t eat. I actually can get free test strips at work which is where I grabbed my meter to use. But good to know if I ever leave my company.

I’m in California. Where are you located?

Is there anything else we should be doing to help him get over this DKA?
 
I'm in Seattle. There are a few Californians around here though. If you post over in the Prozinc forum, I'll connect you. For now though, this is probably the best place to be posting so you can get help with the DKA. Once you're over this hurdle, we can help you work out dosing in Prozinc-land.
 
He was diagnosed 2 years ago and was on 2 units 2x per day for a long time until he went into remission. In April sometime we noticed him drinking more water again and they said do 1 unit 2x per day. Beginning of June he got sick so we took him to emergency vet and they said pancreatitis and our normal vet said up to 1.5 units. 700mg is the highest I’ve ever seen him so I just went up to 2 units because we used to do that
 
And I’m about to go to bed for a 7am meeting so I can’t do a test in 2 hours but I’ll have my husband do a midday test tomorrow to see where his levels are after 5-6 hours
 
Tomorrow after work, it would be great to get a spreadsheet set up and then we can help figure out some dosing to hopefully get these numbers down into better ranges. I'm about to fall asleep myself, so we can get you directions for the spreadsheet tomorrow. It's all set up already, you just have to link it. Sleep well and here's hoping that your fur baby keeps eating and healing. :bighug:
 
Here is some information about DKA
http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

Not enough food +not enough insulin + infection = recipe for DKA

It is really important that your kitty eats so you can give insulin when she is recovering from DKA.
As @Djamila said it is important that insulin is given consistently after DKA. Don't miss a dose...if you are unsure or if Chloe is not eating well post and ask for help before giving the shot.
Plenty of fluids as well....I see you are giving subQ fluids which is good.
Maybe Chloe is nauseated and needs some cerenia or ondansetron medication. Please ask your vet about getting one or both of these meds to see if that helps with eating.
An appetite stimulant is no good if she is nauseated.
Was there an infection as well...is she on antibiotics?
I am going to tag @Meya14 as she is experienced with DKA.
 
Briefly, an antinausea med should be given before any appetite stimulant. Cerenia is a good one for nausea and vomiting and is often the vet's first choice but ondansetron (brand name Zofran), a human drug for the nausea caused by chemotherapy, works well too. Some kitties do better with Cerenia, some with ondansetron and in some a combination of the two is best. Generic ondansetron is cheaper than the extremely expensive brand name Zofran.
 
I forgot to mention that we did give him cerenia in the morning before we tried the stimulant. He has not vomited any times we gave him food yet so that makes me think he isn't feeling sick. But should I give him another cerenia this morning before feeding?
 
I would recommend keeping up with the cerenia once/day until he's eating on his own. Cats are hard to read sometimes. They can feel nauseated and it can be hard for us to detect. They'll just do subtle things like turning their heads away from food, or licking their lips. In general around here and in pancreatitis groups, conventional wisdom is to never give a stimulant without an anti-nausea med as the two together are more effective in getting an anorexic cat back on food.
 
Thanks I just texted my husband to give him half a pill so he's going to give him one. I took his blood around 6:45am today and it was at 543 mg so that's better than yesterday. I asked my husband to try and get his blood about 5-6 hours after he injects Bandit this morning so he's going to try. We gave him the stimulant right before I left for work along with 150 ml of sub-q fluids. We were going to wait to see if the stimulant kicked in and he's giving him the half a pill now (7:45).

He'll try and syringe feed him in a bit if he doesn't start eating and then give him another 2u.

Laudie is just a nickname I had growing up. My cat's name is Bandit.
 
We only have 3 days worth of Cerenia left after today. Should I call my vet and get some more or is there somewhere to buy ondansetron?
 
I don't know much about prozinc to offer advice on that. But it's very important you not miss giving insulin. But it's a catch 22 because bandit needs to eat. At this point anything he eats is what is important. You might have to assist feed to get food into him. You might a have to increase dose of insulin to accommodate and that's okay. He's got to eat to turn it around. The vet should have a Rx food called a/d recovery or critical care food. A lot of cats like it when they are sick. It mixes easy with water to syringe it in. And the baby food you are already giving.

Did the pancreatitis bring him out of remission? With DKA 48 hrs in hospital usually isn't enough time. But so be it. You are giving subq fluids at home. Getting the anti nausea and vomiting meds, as well as pain meds to give at home for at least a week if not longer is ideal (should always have it available once a kitty has been through either DKA or p'titis).

If you can a ketone meter is so much more accurate than dip sticks. The strips are super expensive though and you only get 10 in a bottle. So you can spot check with the urine sticks and if the indicator is getting past the trace or small you double check with the blood ketone meter.

Not enough insulin, food or infection (has infection been ruled out) causes DKA which in turn creates a very expensive overnight hospital stay of many days.

With strict diligence and routine you might turn it around. If husband is willing to help set up a schedule so you both can take turns doing what has to be done and so both of you also get sleep.

Keep a well written log of what's given and when so nothing is missed nor anything given twice and make sure you both read it before giving anything so it's not given twice.

Depending on how bad the episode is, it can be very stressful and gruelling. But you can do this.
 
@Olive & Paula I'm not sure if the pancreatitis brought him out of remission. It's very possible it was subtle for a few months and then flared up. Definitely no infection based on all the blood work, xrays, and ultrasounds we did.

I'll see if I can get my hands on a ketone meter and some strips. Does any human ketone meter work? I'm pretty sure I can get some ketone strips at work too.

Hubs just texted and said he blended up some of his food with water and was able to give him 1/2 to 3/4 of the can with the syringe. And he gave him 2u of insulin. Great start to the morning.

I can tell he could be in a much worse state. He just has no energy to do anything. He gets up and will walk a little and then plop on the floor but he purrs when we try and feed him or give him fresh water. He is even purring when I am pricking him a million times trying to get his blood.
 
That is the other brand. Didn't know Wal-Mart had them now. However, the Nova strips are much cheaper, something to consider.
 
Thanks I can get these ones for free at work thankfully. I'll grab some when we have them in stock.
 
I had to hand feed my cat for at least 2 and a half weeks after a dka episode.

Getting her hydrated really helped. Also i found she would not touch canned food or soupy watered food at first, but would eat if I took tiny bite size pieces of wet food and wet them a bit and rolled them into tiny bite size balls and placed them right in front of her. It took a long time to feed her that way, but it was better than the force feeding I had been doing for a couple days.
 
beggargirl said:
I had to hand feed my cat for at least 2 and a half weeks after a dka episode.

Getting her hydrated really helped. Also i found she would not touch canned food or soupy watered food at first, but would eat if I took tiny bite size pieces of wet food and wet them a bit and rolled them into tiny bite size balls and placed them right in front of her. It took a long time to feed her that way, but it was better than the force feeding I had been doing for a couple days.
Click to expand...
I'm so glad to know you did it for that long so I can know what to expect. I will not be too discouraged if we do this for awhile now.
 
Hi can I ask which appetite stimulant your cat is being given?

The reason I ask is because the Royal Veterinary College in London told me to avoid megestrol acetate with a diabetic cat.
 

Attachments

  • 5A4CCF72-2D5D-412A-AD8F-C0A010633343.png
    5A4CCF72-2D5D-412A-AD8F-C0A010633343.png
    213.3 KB · Views: 149
Laudie said:
He is using Entyce.
Click to expand...
Ok good to hear!
My cat did have dka however she got over it in the vets and didn’t have high ketones again, so I can’t give any advice as I don’t know much but I hope your cat will be ok!
 
Laudie said:
My husband just took his ketones (1:00pm) and it's at moderate. What can we do?
Click to expand...
Anything more than "trace" ketones usually involves a vet visit/hospitalization. If I were in your shoes I would call your vet to let them know you're bringing him in because of moderate ketones. He needs therapy with IV treatment and regular insulin. Home treatment is definitely not recommended under these circumstances.
 
Just took his blood and it's at 318 which is much better. I'll call the vet. I cannot afford any more money though. We've already put $5,000 into him over 2 days.
 
Laudie said:
Just took his blood and it's at 318 which is much better. I'll call the vet. I cannot afford any more money though. We've already put $5,000 into him over 2 days.
Click to expand...
Hospitalization is best. If there's no way that can be done you could try treating at home, but be prepared for it to be labor intensive. You'll want to have an appy stimulant, something to address nauseousness, an antibiotic to address infection (if necessary), fluids to be administered subcutaneously, oral syringes for feeding on hand, and any other meds your vet thinks he needs. If you don't know how to administer sub-q fluids ask for a demonstration.


The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

If one has to treat kitty at home, the idea is to treat any illness/infection, administer a sufficient amount of insulin (current amount is inadequate), make sure kitty is eating well, and plenty of liquids are consumed/administered to keep kitty hydrated as well as wash the ketones out of the body. Be aware that treating at home is not ideal because you aren't addressing any electrolyte imbalances/concerns by giving subcutaneous fluids. You're also not able to give large amounts of insulin intravenously.

  • Foods: The goal is to syringe feed (if necessary) his usual amount of food plus another half of that over the course of 24 hours. Addressing nauseousness and giving an appetite stimulant help. Give kitty whatever he'll eat even if it high carb. Eating trumps feeding a low carb diet.
  • Fluids: Your vet will advise you on the amount and frequency.
  • Insulin: Ask your vet about shooting a somewhat reduced dose every 8 hours instead of every 12 hours in an effort to get more insulin into kitty. See what he/she thinks. Close monitoring of BG levels is essential. Make sure you have an ample supply of testing supplies.
  • Meds: Have all meds necessary available.
  • Test for ketones at least once, preferably twice a day.
I'm sorry I cannot stick around. Some friends just stopped by unexpectedly. Others should be available to add onto what I've posted. Will try to check back in later tonight.


Management of Feline Diabetic Ketoacidosis
 
Last edited:
Thanks @Jill & Alex (GA) . I've got almost all of those things. I'm waiting for my normal vet to call me back and will ask about doing insulin every 8 hours. I'm also planning to ask about recovery food that was mentioned above.
 
Ok I spoke with my normal vet as well as the internist at the ER vet I went to. Main vet said she'd give me more cerenia and to give it to him every day until he is eating normally. And internist said don't worry too much about the ketones and let's go off how he is acting and not to stress so much. She also said get a range of foods for him and not to worry about the low-carb for now because we just want him eating.
 
Kris & Teasel said:
@Tanya and Ducia successfully nursed her kitty at home when she had DKA. I'm not sure if she'll see this tag or not.
Click to expand...
Hi Laudie and Bandit,
I have recovered my girl from DKA at home..Can I help?
I am happy to post /answer any of your questions.
BTW:
Olive & Paula said:
With DKA 48 hrs in hospital usually isn't enough time.
Click to expand...
it is plenty, dear Paula, - for the impoverished US population. No one can afford any more. So it is plenty - just like it was for me and my cat, she got 24 hours in the ER and then back home in to our care or willing effort, call it whatever.
And, BTW, any Vet with a Clue can deal with DKA in 24h. Not to cure, but to prime to the right direction and to let a pet owner to deal with the rest at home with no more fancy charges.
Are you aware that a hospital stay 24h in , for instance CA, is over $1200?
Are you aware that 65% of US population does not have funds for an emergency with humans, let alone cats? No?
Well...
I mean it is pointless to tell someone without means to go ahead and to book a cat into a hospital where one won't be able to afford.

The only way out of this system is to do it at home.
Educate yourself. Read. Talk w/ people on this Board. Many dealt w/ DKA.
You do not have to pay for your vet's Porsche, Laudie. You can do it at home.
@Olive & Paula

@Laudie
When my cat was in DKA I had her fit with the Esophageal Tube for feeding and meds administration - only 5 - 6 weeks in. It worked miracle for her. Have your vet mentioned it at all?

It won't be as expensive as a week long stay at a clinic - and will provide you with an opportunity to take charge. You cat will be better off if you are the prime caregiver, - not some remote located vet who is in debt for the vet school up to his/hers eyeballs and to whome, most likely, every patient is a conveyor type deal.
 
@Tanya and Ducia thank you so much. I know I've already spent more than most people could afford and feel very fortunate we were able to do what we could.

My vet has not mentioned the tube yet but maybe if in a week he's still not eating I could call them and mention it. The vet actually told me to not force him too much so that he doesn't become annoyed with food and just not want to eat. So I'm just going to buy a bunch of random cans of food (she said low carb doesn't matter at this point), and see if he will eat anything and she said if he doesn't eat a lot that's ok and just give him a smaller dose.

I started updating my spreadsheet so you can see he's not at risk of going too low at this point so I know it's very important to get him the insulin.
 
Laudie said:
The vet actually told me to not force him too much so that he doesn't become annoyed with food and just not want to eat.
Click to expand...
That makes a bit of sense because this way you are giving you cat an opportunity to start eating on its own v. force feeding. Esp if appy stimulant and an anti nausea meds are administered.

However, if you are not lucky with the assisted feeding via syringe (like I was) it is dangerous for the cat.
Either they have no food on board when the insulin kicks in and they can go Hypo - and die.
Or, they remain underfed and develop Fatty Liver syndrome, another DKA gateway.
The DKA recipe is not enough insulin plus not enough food plus some sort of infection/ inflammation that cats easily develop if go underfed for 24 - 48 h. It is tough.

May I suggest that you keep do what you do - like the assisted feeding and giving insulin and if no eating in 36 hours at the most - go to ER? Please keep testing the blood glucose levels and if possible the urine for ketones , etc

Try to feed at least one and a quarter/ half of 5.5 oz can of low carbs, like Frieskies pate. That what I fed my Ducia via Etube - water diluted Friskies Pate, one or one and a quarter can a day.

Do not wait for whole week of none eating to think about the E-Tube. You vet won't get hurt if he/she explains you what E-Tube means and how it works. Certainly, I am, just like any one else w/ experience on the Forum will help.
@Laudie
 
Oh no way I would not wait a whole week of not eating. We would keep feeding. Just meant one week of not eating on his own!

I wouldn't feel comfortable not feeding at all TBH but I'll probably give him a little more time on his own. We did fancy feast chicken with water this morning but I'll try the friskies pate so that it's not the food we normally give him. I'm going by the pet store to pick some up after work anyways :-)
 
It's sometimes recommended that you feed higher carb food so a higher insulin dose can safely be given. You might try something in the 10+% carbs range and might have to give a higher insulin dose to get the BG down more effectively.
 
Laudie said:
We did fancy feast chicken with water this morning but I'll try the friskies pate so that it's not the food we normally give him. I'm going by the pet store to pick some up after work anyways
Click to expand...
Oh, I see.
By any chance is there a PetCo store near you, so it it is convenient to stop by?
If yes, I can give you the SHORT list of foods to try for a diabetic - on top of the Friskies Pates, of course?
(BTW, try to avoid fish flavored cans altogether - but especially with Friskies or Fancy Feast (FF) Pates, try poultry instead. )
 
Generally it's recommended to feed fish style foods no more than once a week because of mercury contamination, etc. They might also be higher in phosphorus - not positive about that.

When DKA is in the picture and a kitty doesn't have a good appetite your goal is to get food in, any food (within reason). All the rules about carb level and whether it's kitty-appropriate go out the window. Many people get kitty through a bad patch by feeding plain meat in broth human baby food (no seasonings, onion, garlic, etc. added).
 
If I don't feel like mixing the high and low carb one to make medium, what are some good options for me to buy?
 
Status
Not open for further replies.
Back
Top