HELP! Cat has DKA and I need advice - NEW THREAD

Status
Not open for further replies.
Laudie

Laudie

Member Since 2018
Hi all,

Just continuing on my last thread so I can continue getting advice for these next few weeks. I appreciate all that everyone has already done.

A short background for those who don't want to read through the old thread.

Took our cat in on Sunday to the vet and admit him for 48 hours to treat for DKA. Vet sent him home after he started eating. Bandit has not eaten on his own since being home Tuesday night but we have been syringe feeding him as much as we can and trying to ensure he gets insulin. We've also got Cerneia and some anti-stimulant we are giving him in the mornings as well as sub-q fluids.

I'm keeping his spreadsheet up-to-date as best I can.

Old thread if you want it
http://www.felinediabetes.com/FDMB/threads/help-cat-has-dka-and-i-need-advice.198202/#post-2218302
 
Okay, so picking up where we were on the dosing....:)

If you and your husband are around and comfortable getting frequent BG tests, and if Bandit is tolerating the BG testing well, you can consider trying 8 hour injections. This can get tricky though, so consider carefully. You need to be very consistent about the 8 hours. If you get off schedule, it can really mess up your day/sleeping schedule. You'll want to give one injection right as you go to bed, one first thing in the morning, and one in the afternoon - halfway between the other two. You'll need to be able to maintain that schedule for at least a week, two is better. In between each injection, you'll need to get at least two mid-cycle tests. The reason for two is that you need to know the number is either flat or rising before the next injection. If the number is still falling, then giving the injections this close together can get dangerous.

The benefit of TID (three times/day) injections is that you can hopefully get the numbers down and hold them down better. The downside is that it's exhausting and requires a lot of monitoring. While you're doing it, it will take over your life. Given that you're dealing with DKA, it could be a helpful approach, but again, it will put a strain on you and DH, and care-giver burnout is a real thing. You need to do what you can both commit to and sustain. TID doesn't need to be forever - you can switch back to 12-hour shots, but it's best if you start it that you sustain it for a bit and not go back and forth between the two approaches.

If that seems like too much, then you can stick with two shots/day and we can increase the dose as quickly as we can while still keeping him safe. You'll still need to be doing at least two mid-cycle tests, but on this version, there aren't as many cycles (a cycle is the time between two injections). The downside of this is that prozinc doesn't always last 12 hours, so there is a little more up and down in BG values. The upside is that it's much more sustainable and doesn't take over your whole life to the same extent.

So talk it over with DH and let us know which scenario seems most realistic for the two of you, then we can talk about how to adjust the dose.

If you see this in time (I know it's almost your shot time), I would suggest going to 2.5u this morning. As long as you are able to syringe feed successfully, you can keep getting calories in him and keep him safe.
 
My vote would be to increase the dose to 2.5 u right away but stay with BID dosing. There are several reasons I suggest this: if you're giving meds you have to track those times, if syringing food/water you need to keep a schedule for those as well, and added to all that are dosing times and testing times. That's already a lot to track and schedule. There might be more BG ups and downs with BID but it's more manageable in the critical couple of weeks ahead. You could go with the recommended method for fast-tracking ProZinc dosing by increasing as often as after every three cycles to get the BG range down as quickly and safely as possible. Feeding higher carb food (10-12% or so) for now is what I'd do because it gives you a cushion against lows.

I agree with Djamila's advice of getting at least two mid cycle tests to follow his progress. One at +2 or+3 can give you a heads up if he's about to dive and another in the +6 to +8 range will give you an idea of the effectiveness of the dose. How low it takes him if the key to assessing that.
 
Last edited:
We talked it over and are going to stick with dosing at 12 hours. We'll see how he does over the next week and re-evaluate. If we need to try TID we will. Also I did see this before we dosed so we are going to give 2.5 :-).
 
I think that's a good choice. TID is great, but I know it's more than I could handle! So in that case, you'll want to follow what Kris was explaining about fast tracking the increases. You'll want to increase every third cycle. So stay at 2.5 tonight and tomorrow morning, then move to 3u tomorrow night, assuming that the numbers you're seeing allow it. If the mid-cycle numbers are above 200, go for the increase. If they dip below 200, we'll need to re-evaluate. Kris' suggestion of getting a test at +2 or +3, and then again at +6 or +7 is exactly right. If your schedules don't allow that, go with what you can do. The middle of the cycle is the most important because that's when most cats are the lowest, and that's the number we need to see. That earlier test helps you catch a low before it happens which is important for safety at this point since you're just beginning to collect data and we don't know Bandit's patterns yet.

By the way, great job getting your signature and spreadsheet set up so quickly! That's really helpful!
 
Also, I'm hoping someone can chime in who knows more about this than I do: I know there is an order and timing that works best with the anti-nausea and appetite stimulant meds. I believe the cerenia should be given first, but not sure how far apart, and how long before food is given? Can someone clarify that?
 
The vet I spoke to said just give him both in the morning but I don't know what order. Today I gave him the cerenia about 20 minutes before the entyce.
 
I'd start with Cerenia. It can take a little while to kick in so maybe give it an hour or two? At that point give your appetite stimulant. I'm not familiar with the one you have (Entyce). I doubt if giving them closer together as you did is a problem. What you don't want to do is give only an appetite stimulant. Once Bandit is eating better, continue the Cerenia. Many cats will keep eating without an appetite med if the nausea is well controlled. Did your vet say how long you could give Cerenia? Vets used to say a certain number of days on it then take a break for a couple of days. I think that advice has changed and many people give it daily as long as its needed. Maybe other members can be more specific about this.
 
Well my normal vet admitted she isn't a specialist but she was like "keep giving him the cerenia and fluids every day he isn't eating on his own".
 
I think the positive takeaways from the last few days are that he has not rejected the food we try to give him and he has not vomited any of it up (and he was vomiting everything up before we took him in). He's also walking around a tiny bit but I can tell he still has the will do go about the house like he used to, he just doesn't have as much energy.
 
Laudie said:
I think the positive takeaways from the last few days are that he has not rejected the food we try to give him and he has not vomited any of it up (and he was vomiting everything up before we took him in).
Click to expand...
That's great!
Laudie said:
He's also walking around a tiny bit but I can tell he still has the will do go about the house like he used to, he just doesn't have as much energy.
Click to expand...
Did your vet mention anything about his potassium levels? If his potassium is low it could account for trouble with walking and lack of energy. Low potassium is common in diabetic ketoacidosis...
 
Jill & Alex (GA) said:
That's great!

Did your vet mention anything about his potassium levels? If his potassium is low it could account for trouble with walking and lack of energy. Low potassium is common in diabetic ketoacidosis...
Click to expand...

I do remember them mentioning it while he was at the emergency vet. We did buy the unflavored pedialyte. Should we try and force him to drink some of that?
 
Cerenia can be given every day. There is no need to take a break. Depending on the dose you are giving now, it's may be possible to increase it.

Cerenia is best when given 1 hour before eating. In relation to appy stimulant I do not know.
 
When DKA is being treated in hospital potassium chloride is often added to the fluids that are given IV. I don't know how this can be addressed at home. Maybe you could call your vet for advice? This isn't something you''d want to give on your own because it could cause a dangerous electrolyte imbalance. This is where treating DKA by the simplest means of home support is tricky.
 
Re BG numbers: getting them down from black and red is the goal but you don't need to shoot for low blue and dark green right now. Maybe try for mid 100s? I'd also feed slightly higher carb food for now to support an effective insulin dose that gets you to mid blues.
 
Ketones were back in the small range. He did make his way outside but is so far under the steps we can’t get him to test his blood right now
 
The potassium levels for him were at 2.9 before he left (slightly below average she said). They did say if he wasn't eating we should try another stimulant but we spent good money on the stimulant we are giving him so I don't know...
 
Ketones do cause a loss of appetite, and low potassium can be contributing to the problems. I would ask your vet about potassium supplementation, and then a plan to monitor that so it doesn't go too low or too high. Pedialyte can help with hydration and from getting worse, but isn't enough to help him recover if his potassium is low. If your vet isn't sure on this, it might be worth a call to the emergency clinic. They are sometimes better versed in treating DKA than a regular vet's office.
 
I'm glad Kris gave you that link. It contains a lot of helpful info.

How have things been going today? How is Bandit acting... how much has he eaten... is he moving around normally? Is he eating on his own at all?

I'm having Internet connection problems. If I can't get back, the answers to those questions will help others help you.
 
Well I was taking his blood and realized the meter was calibrated to a 36 and it should be a 37 and my husband said he might have accidentally hit it yesterday or today so now I hope the readings aren't terribly off but we took it at the correct calibration now and it's still very high so I'm going to continue doing the 2.5 units.

Bandit is more active today but still very lethargic. He got up and walked to different places in the house and outside but not very far at once. I think this is good for his spirit though. Still not eating on his own but a few times it seemed like he opened his mouth on purpose for the syringe. And he got probably another 30mL of the can of friskies pate mixed with water. Should we try and get more food in him? That's probably about 50 mL of food total for the day counting breakfast and dinner.
 
Laudie said:
Well I was taking his blood and realized the meter was calibrated to a 36 and it should be a 37 and my husband said he might have accidentally hit it yesterday or today so now I hope the readings aren't terribly off but we took it at the correct calibration now and it's still very high so I'm going to continue doing the 2.5 units.
Click to expand...
Sounds good.
I had my meter calibrated incorrectly for about a week and a half once. It didn't seem like it made much difference so I wouldn't worry about it now. You might want to note it on your spreadsheet. The important thing is it's correct now.
Laudie said:
Bandit is more active today but still very lethargic. He got up and walked to different places in the house and outside but not very far at once. I think this is good for his spirit though.
Click to expand...
I agree. I'd worry more about him if he weren't moving at all. However, if he's still not moving around much tomorrow you might want to think about bringing him in to check his potassium levels. It's usually a good idea to have that done 3 - 4 days after the first check anyway.
Laudie said:
Still not eating on his own but a few times it seemed like he opened his mouth on purpose for the syringe. And he got probably another 30mL of the can of friskies pate mixed with water. Should we try and get more food in him? That's probably about 50 mL of food total for the day counting breakfast and dinner.
Click to expand...
It's a good idea to feed approximately the equivalent of one 5.5 oz can or two 3oz cans in a 24 hour period. When Alex wasn't eating I attempted to give her 10 - 12 ten mL syringes of blended (almost whipped) food without water mixed in over 24 hours. I don't like to "force" feed. I prefer to make up syringes ahead of time and then feed frequently over the course of the day and night (while I was up). You may have to work up to that amount.

How are you and your husband doing with all this? Caring for our kitties can be exhausting. I hope you can manage some rest in-between caring for Bandit.
 
Jill & Alex (GA) said:
It's a good idea to feed approximately the equivalent of one 5.5 oz can or two 3oz cans in a 24 hour period. When Alex wasn't eating I attempted to give her 10 - 12 ten mL syringes of blended (almost whipped) food without water mixed in over 24 hours. I don't like to "force" feed. I prefer to make up syringes ahead of time and then feed frequently over the course of the day and night (while I was up). You may have to work up to that amount.

How are you and your husband doing with all this? Caring for our kitties can be exhausting. I hope you can manage some rest in-between caring for Bandit.
Click to expand...

I guess I'm wondering what the equivalent of syringe mL is to the oz in the can.

My husband and I are doing pretty good actually. It's a tag team effort when I'm here and Bandit is so chill he makes it fairly easy. I try and wake up and give him the Cerenia and fluids before DH wakes up and then when he gets up he gives the stimulant and food and injection. And it's the weekend so we'll both be here the next 2 days!

As for potassium levels, as much as I would love to do it again it's $121 for the test which is a lot more than I'd prefer to spend if I can avoid it.
 
I'm sorry. My Internet continues to drop my connection. It's frustrating! Not sure if or when this will post.
Laudie said:
I guess I'm wondering what the equivalent of syringe mL is to the oz in the can.
Click to expand...
I wish I knew. I didn't use water when blending food for syringe feeding. Water made it too messy. I'd get 10 - 12 ten mL syringes per 5.5 oz, so roughly 5 mL = 1 oz... if I guestimate using a 5.5oz can divided up into 11 10mL syringes. Again, that's without water added to the blended mixture.
Laudie said:
My husband and I are doing pretty good actually. It's a tag team effort when I'm here and Bandit is so chill he makes it fairly easy. I try and wake up and give him the Cerenia and fluids before DH wakes up and then when he gets up he gives the stimulant and food and injection. And it's the weekend so we'll both be here the next 2 days!
Click to expand...
Oh good. It's definitely easier with two!
Laudie said:
As for potassium levels, as much as I would love to do it again it's $121 for the test which is a lot more than I'd prefer to spend if I can avoid it.
Click to expand...
Ouch! That's a lot! Hopefully he'll be even better tomorrow so it'll become a moot point.

I'm sorry. I've been trying to post for the past 15 minutes or so. I'll have to catch up to you tomorrow...
 
Jill & Alex (GA) said:
I wish I knew. I didn't use water when blending food for syringe feeding. Water made it too messy. I'd get 10 - 12 ten mL syringes per 5.5 oz, so roughly 5 mL = 1 oz... if I guestimate using a 5.5oz can divided up into 11 10mL syringes. Again, that's without water added to the blended mixture.
Click to expand...
That doesn't sound right. I'm terrible at math!
Maybe someone who's good at it will figure this out correctly.

Without water, I'd get 10 - 12 ten mL syringes per 5.5oz canned food.

Roughly, how many mL to an ounce?
 
Chris & China said:
1 ounce is 30cc's (or 30ml's)
Click to expand...
Yes, one fluid ounce = 30 cc's or 30 mL's.

However, that means when I blend a 5.5 ounce can of food (sans water), twelve ten mL syringes would yield only 4 ounces of food at best. That doesn't compute considering I started with a 5.5 ounce can of food.

I think the problem in using that math has something to do with an ounce of weight (as in canned food) isn't the same as an ounce of fluid and there isn't any standard conversion between weight and volume unless you know the density of what you're measuring (according to Google).

Yes, I'm confused and may be waaaaay off, but here's what I do "know":
Blending a 5.5 ounce can of food (sans water) yields 10- 12 ten mL syringes. Less blending = 10 ten mL syringes. More blending = 12 ten mL syringes (mousse consistency). My goal was to feed the equivalent of one 5.5 ounce can or more a day.

:confused::D:confused:
 
Last edited:
Jill & Alex (GA) said:
Yes, one fluid ounce = 30 cc's or 30 mL's.

However, that means when I blend a 5.5 ounce can of food (sans water), twelve ten mL syringes would yield only 4 ounces of food at best. That doesn't compute considering I started with a 5.5 ounce can of food.

I think the problem in using that math has something to do with an ounce of weight (as in canned food) isn't the same as an ounce of fluid and there isn't any standard conversion between weight and volume unless you know the density of what you're measuring (according to Google).


:confused::D:confused:
Click to expand...

That's why I was confused but that makes sense based on what you "know" from experience. I'll factor in the water and try to get him about 110-120 mL of food. So probably more like 140 mL per day.
 
If you have an immersion blender it works really well to convert a can of food to a thick mousse. If needed you can add two or three tablespoons of warm water to make blending easier. That doesn't dilute the food much. If you put the whole can of blended food in a separate container and draw from that you can track your progress as you get through the can's contents. It's hard to convert the ounces in the can to volume of blended food. As Jill pointed out, there's a difference in fluid volume ounces and weight ounces. Some foods are more dense than others so there's more weight in a smaller volume and vice versa.

As you do this with one can you can see how many 10 mL syringes are in that can for that type of food with the 2-3 Tbsp of water you added to blend it - or not.
 
Not eating again today and his blood is so high still ugh. But we got probably 45mL of food/water into him this morning. He's fighting it a little more so I'm taking that as a good sign. We'll leave a variety of food out for him today to see if he eats it. He has some hiding spot in the backyard because we spent 30 minutes looking for him last night and my husband stayed awake and kept checking. Eventually he turned up though ha
 
Laudie said:
Not eating again today and his blood is so high still ugh. But we got probably 45mL of food/water into him this morning. He's fighting it a little more so I'm taking that as a good sign. We'll leave a variety of food out for him today to see if he eats it. He has some hiding spot in the backyard because we spent 30 minutes looking for him last night and my husband stayed awake and kept checking. Eventually he turned up though ha
Click to expand...
he's still so high. Do you all think it's time to go to 3 units? @Kris & Teasel
 
Yes, increase to 3 u this evening. He's had 3 doses of 2.5 u and you can increase according to established ProZinc guidelines after 3 cycles. If three cycles at 3 u don't get him to yellow at least , increase to 3.5 u after that.
 
I second this. You want to increase every 3 cycles while he's this high. It's imperative to get that BG down soon. Have you checked for ketone levels today?
 
Are you feeding higher carb food right now? You need a higher insulin dose to get his BGs down and the extra carbs add some leeway there.

Try to get a urine ketone test as often as you can - more than once a day if you can.
 
Jill & Alex (GA) said:
Did your vet mention anything about his potassium levels? If his potassium is low it could account for trouble with walking and lack of energy. Low potassium is common in diabetic ketoacidosis...
Click to expand...

Laudie said:
I do remember them mentioning it while he was at the emergency vet. We did buy the unflavored pedialyte. Should we try and force him to drink some of that?
Click to expand...

LRS (Lactated Ringer's Injection, USP is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment in single dose containers for intravenous administration. It contains no antimicrobial agents.)

is a better way to fight the electrolyte imbalance and to hydrate a patient.
Administered SQF a home.
Dose/ frequency is cat dependent.
We did 100 ml/ 24 h and then 75 ml for an underweight <7 lb cat.

LRS is available in human pharmacies w/ Rx. Less then $20 w/ lines.
@Laudie


ETA: I mean that Pedialyte won't do it for you.
 
Last edited:
Thanks everyone. We haven’t been able to get ketones today. He hasn’t gone in his box at all. His spirit is so much better when he is outside so I’m letting him hang out in the back.

We did go up to the food with slightly more carbs but are going to try and give him the low carb for dinner. I’ll up the dose to 3 units since his low is only at 380.
 
Ketones were at trace tonight! We still had to feed him and I really don't want him to become averse to the food but he isn't eating on his own. Sugar is still very high but we were able to give him the low carb FF and I'd say we got him about 3/4 of the can and gave him 3 units. We'll see where his levels are a bit later and tomorrow morning.
 
Laudie said:
really don't want him to become averse to the food
Click to expand...

One way to keep that from happening is to only force feed with the other foods, and keep the food that you want as his regular food away from him right now. That way he doesn't start to associate it with being sick.

So good to hear ketones are at trace tonight!

Fingers crossed we can get him out of those black numbers soon!
 
Laudie said:
Ketones were at trace tonight! We still had to feed him and I really don't want him to become averse to the food but he isn't eating on his own. Sugar is still very high but we were able to give him the low carb FF and I'd say we got him about 3/4 of the can and gave him 3 units. We'll see where his levels are a bit later and tomorrow morning.
Click to expand...
You are doing an awesome job!!!
 
Trace ketones - much better! Try to get as much water into him as you can, if not with his syringed food then by syringing water alone often.

We're all rooting for you and Bandit! :bighug:
 
Status
Not open for further replies.
Back
Top