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

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He showed more interest in food today! I thought he was going to eat but ended up backing away. But PROGRESS yay! He also started fighting us so much more when we were syringe feeding which shows more energy but also since he's not eating is making it more difficult ha.

And his morning number was MUCH lower than yesterday. We did give him about another 3/4 of a 3oz can for breakfast but it was a mid-level carb can so I went ahead and gave 3 units. I'll keep testing his blood throughout the day.
 
Laudie said:
He showed more interest in food today! I thought he was going to eat but ended up backing away. But PROGRESS yay! He also started fighting us so much more when we were syringe feeding which shows more energy but also since he's not eating is making it more difficult ha.

And his morning number was MUCH lower than yesterday. We did give him about another 3/4 of a 3oz can for breakfast but it was a mid-level carb can so I went ahead and gave 3 units. I'll keep testing his blood throughout the day.
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Have you tried putting FortiFlora on his food
 
Oh wow! I love seeing that AMPS! It's still way too high obviously, but so much better than it's been! Fingers crossed he has a good cycle today.

I second Janet's suggestion of fortiflora. It comes in little packets - you can buy a box off Amazon or from a vet - you sprinkle a little on top of the food and it often entices them to eat. Other possibilities: nutritional yeast (sold in most grocery stores - often in the bulk section), Parmesan cheese, tuna water (not oil), bonito flakes (also off Amazon, Asian section of the grocery store, or some pet food stores sell them as treats), or crushed up kibble. Heck, at this point, you can just try giving him kibble to see if it will entice him to eat on his own. Getting him back on food is the most important thing, and you're doing sub-q fluids, so dehydration wouldn't be as much of a concern.

Hopefully his hint at being interested in food will just keep growing.
 
@Kris & Teasel yea at this point I'm just so perplexed. He was looking so good this morning and now he isn't decreasing! I even just checked again, hoping it would have decreased, and it didn't.

FYI I did buy the FortiFlora and it will arrive on Tuesday.
 
Laudie said:
@Kris & Teasel yea at this point I'm just so perplexed. He was looking so good this morning and now he isn't decreasing! I even just checked again, hoping it would have decreased, and it didn't.

FYI I did buy the FortiFlora and it will arrive on Tuesday.
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Yes, I understand how discouraging those numbers are. Just continue the methodical increases after 3 cycles at a dose. It's not unusual for the BGs to be up and down when you're not yet at the good dose range. The DKA also makes them more volatile in their response to insulin because it messes with their physiology. It's very early days in his recovery. Hang in there!
 
If you can, try to get a test before bed tonight to see if he budges at all during the evening cycle. It's unfortunately not uncommon to have a cycle like you saw today at this point. Try not to get too discouraged by it. DKA is a slow recovery, and this being his second round of diabetes, it often takes longer for them to respond to the insulin than it does during the first diagnosis.
 
We actually just gave him his shot and I'm about to hit the sack but I'll try and get up a bit earlier than normal and get a test right when I wake up...that would probably be about +8
 
He's doing about the same. He didn't show interest in food again so we had to syringe feed him again. He is fighting it so much though it's becoming difficult. I'll take this as a good sign. He finally pooped just a little which makes me happy too and he was apparently moving around a lot more last night. He even purred when my husband came to bed (which he did before he was sick and hasn't done it since). I upped his dose to 3.5 today as well
 
You're doing what you can. Get as much water in as you can too. Try for a urine ketone test today. Bright side: a red pre shot BG is better than a black. Is he still getting Cerenia and Entyce? It's possible he might do better with mirtazapine or cyproheptadine as a appetite stimulant.
 
We are still giving cerenia and entyce and sub-q fluids. I'll give my vet a call today. Oh and we tested ketones last night and it looked negative to us!

I'll see if DH can syringe him some water or pedialyte today at different points in the day.
 
Take a look at post #44 where @Tanya and Ducia posted about Ringers. Is that what you're using for the sub-q? That may be better than just adding water as he needs to get his electrolytes back into balance. Hopefully Tanya (or someone else with experience in that) can clarify if that's accurate.
 
Laudie said:
Oh I have the ringer's one! She told me 100 but I've been doing 150
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I'd ask your vet about exceeding the recommended amount of subQ fluids. In cats that have a cardiac issue (diagnosed or not) the extra fluids can put a strain on the heart (congestive heart failure). If you want to increase the added fluids above the 100 mL subQ you can syringe in extra by mouth. It doesn't affect the heart the same way.
 
The vet just gave me an earful though because she said I need to stop forcing him to eat and she was saying he cannot be on 3.5 units because spot testing the glucose doesn't show you the whole picture and blah blah blah. And she said he really needs to go get rechecked to see if it's inflammation of the intestines or pancreatitis causing this appetite loss but I just can't afford any more tests so sorry it's just not going to happen.

Now that his ketones are gone from the urine I feel more comfortable not feeding him for 24 hours so we'll try and leave food out and only give him half the normal dose of insulin we had given him (so I'm thinking I'll give 1.5 units tonight).
 
I am concerned about your vet's advice. A lack of calories and a lack of insulin are leading contributors to DKA. If you withhold food and reduce insulin, there is potential for Bandit to fall back into that again. You've seen his ketone level decline and his BG start to lower using your current approach. I don't understand why your vet would want you to change directions at this point.

I am not an expert in DKA. I've never dealt with it myself. So I really hope that some of our more experienced folks will chime in and share their thinking in case I'm wrong. This just doesn't sound like a good idea to me. Maybe revisit that link that Kris shared in post #19, and some of the info that was shared on your original thread (the one that was closed).

@Jill & Alex (GA) @Tanya and Ducia @Kris & Teasel @Bobbie And Bubba I'm not sure who else to tag with this?

Now back into an area in which I do know a few things: It's so great to see that yellow show up today! I just wanted to give you an idea of what to expect next. Because this is the lowest number Bandit has seen to date, he will most likely be back up in the blacks tonight, and maybe tomorrow. When the BG drops lower than the cat is used to, the liver will dump glucose into the blood. It takes a couple of cycles to clean that out. So this process isn't exactly linear. You'll have a good cycle, and it will often (though not always) be followed by a couple of higher, flatter cycles. So if that happens, try not to worry. It's just part of the process. Sometimes a cat gets lucky and will have a few good cycles in a row, but that's less common this early in the game. It happens more as they get closer to being regulated.

Assuming that's what happens, and if you want to keep going with this approach, you'll keep the 3.5u dose for three cycles, and then do the next increase. If Bandit gets another good cycle before it's time to increase, we might reconsider that.

As far as eating, it's really okay to try anything at this point. Does Bandit have a kibble he likes? Treats? tuna? really anything - you just want him to remember that he can eat on his own again.
 
Djamila said:
I am concerned about your vet's advice. A lack of calories and a lack of insulin are leading contributors to DKA. If you withhold food and reduce insulin, there is potential for Bandit to fall back into that again. You've seen his ketone level decline and his BG start to lower using your current approach. I don't understand why your vet would want you to change directions at this point.

I am not an expert in DKA. I've never dealt with it myself. So I really hope that some of our more experienced folks will chime in and share their thinking in case I'm wrong. This just doesn't sound like a good idea to me. Maybe revisit that link that Kris shared in post #19, and some of the info that was shared on your original thread (the one that was closed).

@Jill & Alex (GA) @Tanya and Ducia @Kris & Teasel @Bobbie And Bubba I'm not sure who else to tag with this?

Now back into an area in which I do know a few things: It's so great to see that yellow show up today! I just wanted to give you an idea of what to expect next. Because this is the lowest number Bandit has seen to date, he will most likely be back up in the blacks tonight, and maybe tomorrow. When the BG drops lower than the cat is used to, the liver will dump glucose into the blood. It takes a couple of cycles to clean that out. So this process isn't exactly linear. You'll have a good cycle, and it will often (though not always) be followed by a couple of higher, flatter cycles. So if that happens, try not to worry. It's just part of the process. Sometimes a cat gets lucky and will have a few good cycles in a row, but that's less common this early in the game. It happens more as they get closer to being regulated.

Assuming that's what happens, and if you want to keep going with this approach, you'll keep the 3.5u dose for three cycles, and then do the next increase. If Bandit gets another good cycle before it's time to increase, we might reconsider that.

As far as eating, it's really okay to try anything at this point. Does Bandit have a kibble he likes? Treats? tuna? really anything - you just want him to remember that he can eat on his own again.
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I agree with Djamila.

Many vets discourage "assisted feeding" because they feel it creates food aversions because of the stress/pressure involved. They prefer that the kitty is given meds for nausea and appetite or, in a more extreme situation, has a feeding tube installed. Whether a food aversion develops from assisted feeding depends a lot on the cat. It's done often by a lot of people with good success.

Re inflammation: vets want to know the cause of the DKA. It can be from infection or inflammation (eg. pancreatitis, inflammatory bowel disease, etc.). There's an expensive blood test for pancreatitis that can give an indication of whether it's the problem but it's not foolproof. As far as IBD goes, the gold standard test for diagnosis is biopsy of various locations in the digestive tract. An abdominal ultrasound can show thickening of intestinal walls and that's an indicator. All these tests are expensive and some very invasive so many owners opt to treat the symptoms (meds, fluids, etc.).

Re insulin dose: it needs to go up in the methodical way we've recommended. Vets like to have doses held a longer time and sometimes have the idea that around 2 u is the highest dose a cat will need. Doing the pre shot tests and a couple of mid cycle tests daily will tell you how well a dose is working better than a weekly curve either done at home or at the clinic.
 
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Kris & Teasel said:
I agree with Djamila.
Re inflammation: vets want to know the causes of the DKA. It can be from infection or inflammation (eg. pancreatitis, inflammatory bowel disease, etc.). There's an expensive blood test for pancreatitis that can give an indication of whether it's the problem but it's not foolproof. As far as IBD goes, the gold standard test for diagnosis is biopsy of various locations in the digestive tract. An abdominal ultrasound can show thickening of intestinal walls and that's an indicator. All these tests are expensive and some very invasive so many owners opt to treat the symptoms (meds, fluids, etc.).
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I've already done the blood test at the beginning of June when he first got sick (before DKA) and he had signs of pancreatitis. I got the ultrasound done 3 weeks later after he was feeling better and it showed nothing out of the normal with the exception of slight thickening of the intestinal walls). I don't really see what the point is in taking him in, spending another $1,000, and having them tell me exactly what i know already.

Re Insulin Dose: I'm really thinking of following what the vet says for 24 hours. Especially since he doesn't have ketones in his urine. If this doesn't seem to help him then I'll continue treating how we've been discussing on here. I'm so conflicted....:(
 
I agree with Djamila. I would not fast him for 24 hours or decrease his insulin. The recipe for DKA is not enough food plus not enough insulin plus an infection or other stress. I had to syringe my kitty J.D. I bought a case of Iams Maximum Calorie (333 calories in a 6 oz can) before they stopped making it. I can send you some cans if you like.
You don't really want to syringe the food he normally eats as that may cause him to think of that food as the stressful syringe feeding.
And your vet saying that spot testing won't give you the whole picture is bizzare. That's how we tell how the insulin is affecting him.
 
Dyana said:
I agree with Djamila. I would not fast him for 24 hours or decrease his insulin. The recipe for DKA is not enough food plus not enough insulin plus an infection or other stress. I had to syringe my kitty J.D. I bought a case of Iams Maximum Calorie (333 calories in a 6 oz can) before they stopped making it. I can send you some cans if you like.
You don't really want to syringe the food he normally eats as that may cause him to think of that food as the stressful syringe feeding.
And your vet saying that spot testing won't give you the whole picture is bizzare. That's how we tell how the insulin is affecting him.
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Thanks for the offer but we have lots of cans of food we can feed him. She said he needs to be tested every 2 hours to get a clear picture because he could be going much lower than I am showing with my tests...even though they are 3 hours apart.
 
I'm so sorry you're feeling conflicted. It is really hard to decide if you are going to follow your vet's advice (with their degree on the wall), or a bunch of crazy cat ladies on the internet. When I first got here, I was really unsure about what to do, and who to listen to, and what would be best for my cat. Please know that we are here for you no matter what. We will always give you our best advice, but at the end of the day, Bandit is your cat, and we will respect and support you no matter what. You're dealing with some complex, difficult, and stressful things right now. Know that you are not alone and that we understand how hard this is. :bighug:
 
Oh boy! With all due respect, your vet's advice is absurd. Like the others, I have huge concerns about following this latest from your vet. Yes, determining an underlying cause is the way to go, BUT you aren't the first and won't be the last who cannot afford all the diagnostics to figure out exactly what is going on. Many of us treat symptoms for any number of reasons. Bandit needs to eat. He needs whatever amount of insulin he needs to pull his numbers down to get him over this hump. Chances are, it won't be forever.

I agree 110% with everything already said and strongly urge you to reconsider. No ketones. BG numbers are coming down slowly, but surely. Looks to me like Bandit is currently headed in the right direction.

If you have doubts, please get another opinion.
Djamila said:
I'm so sorry you're feeling conflicted. It is really hard to decide if you are going to follow your vet's advice (with their degree on the wall), or a bunch of crazy cat ladies on the internet. When I first got here, I was really unsure about what to do, and who to listen to, and what would be best for my cat. Please know that we are here for you no matter what. We will always give you our best advice, but at the end of the day, Bandit is your cat, and we will respect and support you no matter what. You're dealing with some complex, difficult, and stressful things right now. Know that you are not alone and that we understand how hard this is. :bighug:
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YES to this! Every one of us understands what you're going through because we've all been there in one way or another.
 
Laudie said:
She said he needs to be tested every 2 hours to get a clear picture because he could be going much lower than I am showing with my tests...even though they are 3 hours apart.
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PS what your vet is describing with the every-two-hour tests is called a curve. They are helpful, especially for people who work all week and can only get mid-cycle tests on the weekend. They are also used by vets because the vet can't test the cat day to day and must get as much info as they can on a day when the owner has brought the cat into the clinic. You and DH are testing enough to have the information you need at this point. We do often recommend that people do curves around here, but I see no need for one for Bandit right now. You're doing just fine on your data collection.
 
So assuming the cat didn't have DKA but had pancreatitis, how would you treat?

And also how would you treat thickened intestinal walls if that was all he had?
 
Laudie said:
So assuming the cat didn't have DKA but had pancreatitis, how would you treat?

And also how would you treat thickened intestinal walls if that was all he had?
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Pancreatitis treatment is aimed at relieving the symptoms so meds like Cerenia for nausea/vomiting, an appetite stimulant if needed, fluids if dehydrated from vomiting and/or diarrhea and pain meds.

The thickened intestinal wall is from inflammation. If minor it isn’t treated but if it’s worse then steroids can be used to decrease inflammation.
 
Laudie said:
So assuming the cat didn't have DKA but had pancreatitis, how would you treat?
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One does not exclude the other. The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses. Pancreatitis would be considered a systemic stressor/illness. DKA likely developed as a result of the p-titis if Bandit has p-titis. These are symptoms of P-titis Marje has listed in her "Primer on Pancreatitis" (copied and pasted):

"Symptoms
Cats with pancreatitis, even when severe, often present with non-specific clinical signs. In one study of 40 cats with severe pancreatitis the following clinical signs were reported:
• lethargy (100%)
• anorexia (97%)
• dehydration (92%)
• hypothermia (68%)
• vomiting (35%)
• abdominal pain (25%)
• a palpable abdominal mass (23%)
• shortness of breath (dyspnea) (20%)
• loss of muscle coordination (ataxia) (15%)
• diarrhea (15%)

In diabetic cats, BG levels often increase possibly in response to pain but also inflammation."

Treatment consists of much the same as treating DKA: fluids, pain management, addressing nauseousness, making sure the cat eats (including via syringe or feeding tube if necessary), appetite stimulants, antibiotics (if bacterial infection is present), antacids, supplementing with Zobaline and/or SAM-e, and sometimes giving steroids. This is all explained in detail and better than I ever could in Marje's p-titis document linked above.

The insulin dose is increased accordingly. Marje also mentions close monitoring is crucial because as kitty gets better, it's likely BG numbers will drop and insulin needs will decrease. This can happen quickly.

Please read through the document. Reference materials are included at the bottom.
Laudie said:
And also how would you treat thickened intestinal walls if that was all he had?
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I'm not well-versed on this subject so I will step back and hope others will respond.
 
Thickening of intestinal walls is often indicative of IBD. General home treatment for IBD, if it's not severe, is good quality food (often raw diets are recommended, but not required) and probiotics. As mentioned, steroids are sometimes used when it's more severe. They do complicate diabetes treatment though, so we tend to avoid them when possible around here. It's not always possible to avoid them though and when needed, we dose around it.

My kitty has diabetes, pancreatitis, and IBD. So it's possible that there is more than one thing that contributed to the DKA for Bandit. But please know that all of these things are treatable and manageable, especially since there is a lot of overlap in the treatments - what works for one, works for the others to some extent. It's just a matter of learning about them. Right now it probably feels like you're being blasted with a fire hose of information. Just take it little by little.
 
I hope you try the 3.5 u dose again today - if you're comfortable doing that. It's always your call. It resulted in a much nicer BG at +7 yesterday afternoon and the lowest PMPS yet. That 308 is very close to being yellow. This morning's PS will likely be high because of the lower dose last night so don't be alarmed.

Is he eating anything on his own?
 
Just checking in. I’m curious to see Bandits BG this morning. I know it seems like we’re all throwing info at you but it’s because we really care about the kitties in here. They and their beans become part of our family.
 
Please continue to check for ketones. It's more important than ever given the reduced dose.
Hope Bandit is feeling better and eating on his own...
 
Hi all,

I 100% appreciate all of the information! I'm super happy to read through everything. He did not eat last night or this morning but showed some interest in a temptations treat today so we'll see what happens tonight at dinner time. We are leaving food out for him. We left some of a new can of cat food he hasn't had before as well as some canned tuna and the temptations and some kibble. I also will be getting the FortiFlora today so I'll add that into some food.

We checked his ketones around 10 and still negative! I think if he is still at negative later then I feel ok skipping one more meal. Especially since he BG hasn't skyrocketed yet and the 1.5 dose seems to be bringing him down a little.
 
Yay for negative ketones!

I would not skip any more meals, but that's up to you. Cats can not go long without food even if they aren't recovering from a recent dx of DKA. They can get fatty liver disease from too much reduced calories or too much fasting. This latter is also serious. I am only coming from my experience of making sure my cat J.D. had the calories he needed when assist (syringe) feeding. The specialist vet I went to said to try for 220 to 280 calories a day, and that's what we did.
I am guessing you are trying to fast him to see if he will eat on his own if he is hungry enough?
 
Dyana said:
Yay for negative ketones!

I would not skip any more meals, but that's up to you. Cats can not go long without food even if they aren't recovering from a recent dx of DKA. They can get fatty liver disease from too much reduced calories or too much fasting. This latter is also serious. I am only coming from my experience of making sure my cat J.D. had the calories he needed when assist (syringe) feeding. The specialist vet I went to said to try for 220 to 280 calories a day, and that's what we did.
I am guessing you are trying to fast him to see if he will eat on his own if he is hungry enough?
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The vet was very adamant I stop force feeding now because there are lots of studies that say cats will become food averse and stop eating even if they are hungry. So I'm just trying to give it a little of time considering she is the expert but I won't do more than tonight.

And yes we are trying to get him hungry enough to want to eat and not be averse to his food.
 
I would say that if he doesn't start eating some food on his own soon you might have to revisit the syringe feeding issue in spite of what your vet says. The danger of developing hepatic lipidosis is real. The alternative to syringe feeding is to have a feeding tube installed. It sounds much worse than it is and can be a life saver. Anorexia in cats is a strange condition. It can start for one reason (DKA, etc.) but then takes on a life of its own and continues unless there are significant interventions. At the very least I'd call your vet to ask about the threat of hepatic lipidosis (fatty liver).
 
Ketones have been checked 3 times today and negative each time!

Levels are a bit high still but look way better. Here's to hoping he eats tonight
 
Hi there and I am so sorry you are having these issues with your baby. I agree with everything that everyone here has said. Eating is paramount with a kitty who is throwing ketones. My ex- vet ( ex the optimum word here ) told me to not force food either because of food aversion blah blah blah but as Jill gave you the recipe for DKA event to happen: Not enough insulin, a systemic stress or illness, and in appetence. So, please keep trying with the food.

Whenever Bubba goes off his feed ( he is normally a pig so when he does, he is sick or in pain !) I can usually get him to eat baby food. All meat , either chicken or turkey or ham . If Bandit is eating you can get the required insulin in him to bring down the numbers. Also ,I have sprinkled oregano on his food which has gotten him to eat ( sounds weird but it works)

And as others have said, add water to each meal he does eat as it helps to flush ketones if they form.

Good luck with Bandit. I know how very upsetting it is when our kitties don't feel well and they won't eat. Sending you lots of good appy vines! ( vibes, we call them vines on Lantus and Levemir forum)
 
Let us know if the FortiFlora tempts him. Did he actually eat one of the temptations on his own?
 
Laudie said:
We checked his ketones around 10 and still negative!
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Laudie said:
Ketones have been checked 3 times today and negative each time!
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That's fantastic!!! Undoubtedly the sub-q fluids are helping. Please remain vigilant about testing. Things can go south quickly... especially with a reduced dose and without food.
Laudie said:
I think if he is still at negative later then I feel ok skipping one more meal. Especially since he BG hasn't skyrocketed yet and the 1.5 dose seems to be bringing him down a little.
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Laudie said:
Levels are a bit high still but look way better.
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That's most likely because he hasn't eaten.
Kris & Teasel said:
I would say that if he doesn't start eating some food on his own soon you might have to revisit the syringe feeding issue in spite of what your vet says. The danger of developing hepatic lipidosis is real. The alternative to syringe feeding is to have a feeding tube installed. It sounds much worse than it is and can be a life saver. Anorexia in cats is a strange condition. It can start for one reason (DKA, etc.) but then takes on a life of its own and continues unless there are significant interventions. At the very least I'd call your vet to ask about the threat of hepatic lipidosis (fatty liver).
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Kris is on point with her comments. Please reconsider. Feed Bandit if he's not eating well on his own...
 
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