Simba was diagnosed with DKA. Vet thinks we're out of options. Help :(

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Eric and Simba

Eric and Simba

Member Since 2018
TL;DR: Cat has DKA and our only option seems to be a bank-breaking ER visit. This seems extremely urgent and we're out of options.

Simba is the friendliest, most loving cat I've ever met. He's been my best friend for the past year and I'm getting desperate. If there's anything else we should be doing to help him, please let me know. This seems like something he should be able to get past, but the vet thinks we're at the end of the line here.

Posting as many details as I think might be relevant. Sorry if the post is too long, and sorry if this is the wrong forum.

We got Simba from the shelter last year. He was a 13 year old diabetic (but in remission). Since bringing him home, he had remained in remission for several months on a diet of Fancy Feast Classic Pate (4 cans per day). Early July, his glucose measured high (~3-400) on our home meter. Brought him to the vet & got him started on ProZinc insulin straight away (1 unit twice a day). Due to issues with that vet, we never actually got a real curve for him, or learned how to properly take a curve (big mistake, I know..) We spot checked occasionally and ended up raising his dose to 2 units.

Fast forward a couple months (October?), we got him to a different vet who prescribed Lantus. They taught us more about BG curves & we finally started taking the measurements we should have a long time ago. He was on 1 unit for a week or two. He measured very high throughout the day of the first curve (400+ - spreadsheet here), so they had us increase to 2 units. Next curve at 2 units was even slightly higher. They wanted us to wait another week or two before taking another curve and deciding if we should increase the dosage. I was planning on doing it this past Friday, but...

Thursday he threw up once or twice during the day and several times throughout the night. He tends to eat any garbage he can find, so this wasn't anything too worrisome. We got really concerned when he didn't eat his breakfast the next morning. He usually goes to town on it & finishes it immediately. So much that we've been giving him 1 of his cans frozen so he doesn't eat too quickly. He was also extremely lethargic (total limp noodle). Naturally, we brought him into the vet.

The vet gave us a pretty grim outlook. After going over the possible causes, she took him aside for a ketone test. Came back as what she said was "bad, right on the cusp of REALLY bad". Gave us 3 options:
1) Treatment at their facility, which involved fluid replacement/electrolyte therapy as well as further tests to try to figure out the cause of the DKA
2) ER visit, where they would have some "faster acting" insulin with a higher success rate... but she said this would likely run us thousands of dollars and potentially not even save him
3) Put him down...

We left him with them that night (Friday), not knowing if he'd make it through the weekend. They said the treatment had a chance of a sudden heart attack. We brought them his Lantus vial for them to administer while he was there. Luckily, he made it through for us to pick him up and bring him home on Sunday.
Results from the vet visit:
-He got antibiotics (some type that should stay in his system for 7-10 days) for a UTI as well as pancreatitis
-Gave him some anti-nausea medication (Cerenia)
-Fed him some food (some higher-carb Friskies) - they said he completely devoured it, which is how he usually is
-Gave him 1.5 units of Lantus one day, 2 units the next. Not sure about the rest of injections, as there should have been 4 total during his stay
-His BG readings were around 300, which is better than he'd been doing recently
-Fluid/Electrolyte therapy (they specifically said potassium)

Brought him home Sunday afternoon. He seemed much better than he did on Friday, but definitely nowhere near his usual self. He ended up finishing his food overnight (took him at least 5 hours, when it would normally be gone in 5 minutes).

Today, he still hadn't finished his breakfast by 6 PM. He normally gets feedings at 8AM & 8PM alongside his insulin injections. We gave him some canned salmon around 6PM, as I'd read online that something more pungent might be more appetizing. This worked a bit, but he still didn't finish it up. Also tried heating up his normal food to no avail. My SO was home, and she managed to get 2 readings earlier in the day (+3 and +6) and one PMPS. They were all 500+ (see spreadsheet). I picked up some ketone urinalysis test strips (CVS brand) and I was able to get one measurement while writing this. Looks like it's in the small to moderate range (attached pic).

The vet thinks he's still in DKA and says our only options are to retry the therapy or to give up. They gave us a fluid bag (potassium chloride & sodium chloride) for sub-q injection at home, but he really hates it and we haven't managed to get the full dosage in. I'm not even sure what this is supposed to help.

The whole situation looks dire. Took one more BG reading just now and it came in at 557. Is there anything short of a $3k ER visit that we can do? We don't want to lose him :(




edit for more info:
He's not eating or drinking much at all. I think we desperately need to get his glucose back down to normal levels ASAP but don't know how. The vet thinks he might be somogying and wants us to decrease his dosage to 0.5u for tomorrow. I don't think this is the case, as he has never actually measured at a low point since beginning insulin treatment. I think he needs a higher dose, but don't know how to be sure, don't want to make things worse, and don't want to go against the advice of the vet without good reason. However, it seems extremely urgent that we get him regulated ASAP. We are also planning on doing an extended curve tomorrow (measuring every hour) to get a better idea of what's going on.
 

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Please contact DCIN (Diabetic Cats In Need)….they may be able to help with the costs. (it will depend some on how low our coffers are....we're really down in donations this year)

If you have Facebook you can send a message HERE

Or you can contact us through our website
 
Chris & China said:
Please contact DCIN (Diabetic Cats In Need)….they may be able to help with the costs. (it will depend some on how low our coffers are....we're really down in donations this year)

If you have Facebook you can send a message HERE

Or you can contact us through our website
Click to expand...

Thank you for the links. I don't know if I would qualify but I'll contact. Also hadn't heard about the Care Credit option before.
 
It looks like Care Credit asks for a specific hospital. My current hospital has said they feel unable to give him the treatment he needs given their supplies.
Do you have any advice on choosing a good hospital that has experience with this kind of thing?
 
Any ER vet (that's open 24 hours) should be able to handle a DKA

Unfortunately, it's a common complication of diabetes.....if they don't get enough food, enough insulin and have any type of infection/inflammation, that's the recipe for DKA
 
My cat had something similar happen a couple of months back. Long story short, he went in for treatment of inappetance/vomiting with no ketones, had fluids and cerenia for a day, was sent home, still wouldn’t eat, developed ketones, went back in for 2 nights (IV, cerenia, syringe feeding, pain meds), came home with no ketones, STILL wouldn’t eat, went to different vet immediately with ultrasound. Diagnosed with pancreatitis, sent him home with meds. Once we had him on cerenia (half a pill a day), buprenorphine for pain (twice a day), mirtazapine for appetite (1/8 pill every other day) he rapidly improved and he’s fine now. He just needed extra support for pain and nausea at home after the ketones had been resolved. This is just anecdotal, it’s my only experience with this. Others probably know a lot more about this. I just hope that if you can get the ketones under control they’ll give you home meds to mitigate the pancreatitis. I think Bub was on all that for 5 days after his ultrasound and his numbers were a lot better with the pain under control. Big hugs to you.
 
I am sorry you are going through this.
Iwould not decrease the insulin either. With DKA it is important that the cat gets insulin, gets food and the infection/inflammation is treated. Also fluids are very important to flush out the ketones.
It is hard to treat DKA at home unless he is beginning to be on the mend. I would try and persist with the SubQ fluids if you are not going to take him back to the vet (which might be the best option)
Itis important to get him to eat.....anything at this point. Have you given more cerenia? Or do you have some ondansetron as well. They can be given together for nausea/vomiting. If you don't have any ask the vetfor a script for some.
Haveyou tried syringe feeding him?
 
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@Bubby & Ash I agree with all she has said and it is important to have pain meds for pancreatitis. It could take several days before Simba will eat properly as he is has a UTI, pancreatitis and DKA to deal with. Any of these will cause him to lose his appetite and feel pain poor love, Maybe the vet will give him another injection of cerenia.
I would try dryfood if he won't eat anything else. Sometimes cats will start to eat dry again before wet when they have been sick. When Sheba had a bad attack of pancreatitis she wouldn't eat but she did start to eat small amounts of dry and I was able to switch her back over to the wet after a few days. I just put down 6 pieces for her at a time to start with. I hate dry but whenyou are inthe situation you are any food is better than nothing
 
Thanks for the replies everyone. We were able to retest his ketones again and it seemed worse than before.

We rushed him to the ER and he is now spending the next few nights there. It's going to cost a pretty penny, but we should be able to manage it. If he's got a good chance, we can't put a price on his life.

As of now, they're going to do an ultrasound to check his pancreas for abnormalities (to ensure the original diagnosis was correct, and that there are no further issues) and use more aggressive insulin to get his BG down immediately. They also seem much more willing to work with us than any other prior doctor.
They mentioned pain meds for pancreatitis as well.

I really do appreciate the stories and advice. It's great to know that you guys were able to get through your struggles.

I'll keep this thread updated with info as it comes in.
 
So glad you have taken Simba to ER. You are right. You can’t put a price on his head. They are so precious. Sending prayers for a speedy recovery. :bighug:
You are great mama and papa beans!
Please keep us updated
 
Hang in there! An ER clinic should be able to treat DKA. Yes, it's very expensive but they can get through it. I've been there twice with my guy. They won't necessarily be able to pin down an exact cause. A pancreatitis flare, some inflammatory bowel disease, etc. can percolate in the background and set it off. It can also happen with dental infection,, UTI, etc.
 
Spoke with the ER vet a little while ago. They said he seems good, is eating and cleaning himself. Ultrasound showed no abnormalities on his pancreas, but he does have a fatty liver (I don't know much about what this means for him, but they said it can be normal for diabetics).
They still haven't been able to regulate his BG though. His latest reading was 496. I think they've been giving him Novolin. Don't know much about that kind of insulin, but I think there's a forum for it here, so I'll take a look in a bit.
They think he likely has some hormonal issue that is making him more resistant to insulin, but that he'll be good to take home. It sounds like they're going to try to get us Prozinc, as it's what originally worked for him at the shelter (2u BID->2u SID->0u (remission)). I'm not sure this will work, since he was on the 2u of Prozinc a few months back and didn't seem to respond to that either. He may just require a different dosage now, but I'm skeptical either way.

Aside from that, my main concern is that he'll go back to not eating once he comes home. I don't know what we'll do at that point.
 
Eric and Simba said:
Spoke with the ER vet a little while ago. They said he seems good, is eating and cleaning himself. Ultrasound showed no abnormalities on his pancreas, but he does have a fatty liver (I don't know much about what this means for him, but they said it can be normal for diabetics).
They still haven't been able to regulate his BG though. His latest reading was 496. I think they've been giving him Novolin. Don't know much about that kind of insulin, but I think there's a forum for it here, so I'll take a look in a bit.
They think he likely has some hormonal issue that is making him more resistant to insulin, but that he'll be good to take home. It sounds like they're going to try to get us Prozinc, as it's what originally worked for him at the shelter (2u BID->2u SID->0u (remission)). I'm not sure this will work, since he was on the 2u of Prozinc a few months back and didn't seem to respond to that either. He may just require a different dosage now, but I'm skeptical either way.

Aside from that, my main concern is that he'll go back to not eating once he comes home. I don't know what we'll do at that point.
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Make sure you ask your vet for antinausea meds and appetite stimulant meds to have on hand. At the first sign of not wanting to eat at home, dose with antinausea meds (Cerenia or ondansetron). If that doesn't jump start him, give an appetite stimulant (mirtazapine or cyproheptadine). Giving subQ fluids can help with dehydration that adds to their feeling generally crappy.
 
Eric and Simba said:
Aside from that, my main concern is that he'll go back to not eating once he comes home. I don't know what we'll do at that point.
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When you bring him home, get 2-4 cans of either Royal Canin 'Recovery RS' or Hill's A/D and a feeding syringe. If he won't eat, he's got to have food or he'll continue with fatty liver. You may need to syringe feed him for several days.

Fatty liver or Hepatic Lipidosis is caused by not eating or not being able to convert the food to energy. The body begins to burn it's fat stores for energy causing 'ketones'. Ketones in the blood can cause the blood to become ph 'acidic' which is then DKA (Diabetic Ketoacidosis). This throws off all the body's electrolytes making it all worse. Lot of other 'stuff' in that happens in there but that's sort of a quick explanation. You are giving subq fluids with electrolytes to help flush the ketones out of the body, rebalance the electrolytes and return to body to a neutral ph balance.
 
Eric and Simba said:
Aside from that, my main concern is that he'll go back to not eating once he comes home. I don't know what we'll do at that point.
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We had the same concerns when my cat had DKA.
Ended up fitting her up with Esophageal Tube for several weeks to insure she eats and takes meds and has her insulin dose daily. Best explained by Dr. Pierson here.
BTW, we picked our girl up after 24 h ER stay still with Trace (lowest) level of ketones and electrolytes being not good but stable.
I was home back then and with intensive 24 h care for a few weeks it turned out ok, it was in 2017.
My vet too was all sorrow and in very little option mood.
@Eric and Simba
How is Simba?
 
I agree you should get either the RS or A/D food from the vet. If you have to syringe feed mix the food with water. I use either a small food processor or even a coffee bean grinder to mix it to make it soupy.
 
I'll ask them about syringe feeding and pick up some stuff for it - thanks for the tip. Last I heard, he's been doing okay.
We should be able to pick him up later tonight. Fingers crossed that he's gonna seem a bit better & has a hefty appetite again.
 
Spoke with the vet just now. We'll be going to pick him up around 5 EST. They said he's been eating very well almost the whole time, so we'll hope that continues once he gets here. They agreed (after some bargaining) to send him home with some appetite stimulant in case of emergency. We still have some of the anti-nausea Cerenia from a couple days ago as well. They're also giving us some powdered potassium supplement to add to his food.

@Lisa and Witn (GA) @Squeaky and KT (GA) ~~ Question about the RS & A/D food - why are these preferable to his normal food? Are these easier to feed via syringe? RS doesn't seem to be available without prescription, so I'd likely need to talk the vet into it. And A/D is kinda high in carbs at 12%

His BG is still very high (near 600 last reading). They started him on 2u of Prozinc this morning, so we'll be looking to do a full curve on Saturday (after a full 3 cycles) and at least taking PS readings until then.
 
Eric and Simba said:
why are these preferable to his normal food?
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They are more calorie dense and easier absorbed with additional vitamins and minerals to help with healing. PLUS they're both easier to mix to syringe feed. The Recovery is a lot better at blending to a good consistency plus most cats like it. Lower carbs is a plus. You CAN order it from Chewys .com but have to order a case. It's not for every day after healing as it lacks some long term needed nutrients so is considered 'supplemental feeding'. It's usually priced about the same as the a/d, it's just harder to find. Hills gives the vets a much better 'sales' deal...
 
Squeaky and KT (GA) said:
They are more calorie dense and easier absorbed with additional vitamins and minerals to help with healing. PLUS they're both easier to mix to syringe feed. The Recovery is a lot better at blending to a good consistency plus most cats like it. Lower carbs is a plus. You CAN order it from Chewys .com but have to order a case. It's not for every day after healing as it lacks some long term needed nutrients so is considered 'supplemental feeding'. It's usually priced about the same as the a/d, it's just harder to find. Hills gives the vets a much better 'sales' deal...
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Chewy says they'll require a script as well. I'll be sure to ask the doc when we pick him up. Thanks!
 

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He's home and seems SO much better! Way more energy, exploring, purring super loud.. :')
Definitely seems we got through this.

It's still going to be an uphill battle trying to get him regulated, but I'm so glad we have him back. With everything going on and the doomsayer of a vet we were dealing with, I was so scared that we were going to lose him. Seeing him back to normal is the biggest relief.

Thanks so much for the advice and support, everybody. It really means a lot.
 

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So good to hear from you and that Simba is doing so much better!!

He's such a handsome orange boy!! I have a special place in my heart for orange tabby cats....my very first kitten was an orange tabby. He was a Christmas gift when I was 7.....He had the ever-classic name of "Kitty"...LOL
 
He was excited for dinner this time and gobbled it all up. Back to his normal self!

PMPS BG was 305. That's the lowest number we've seen in months. It's probably somewhat deflated - he did receive a bit more insulin at the doc's today (Novolin) because of a high reading earlier in the day. Regardless, it's fantastic to see his numbers coming down from the 4-5-600s.
 
Eric and Simba said:
Chewy says they'll require a script as well. I'll be sure to ask the doc when we pick him up. Thanks!
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You can also take the script to PetSmart if they have a vet's office in their store. Their vet will issue a prescription card so you can buy it any time at the store. This is very helpful when you cannot get to your vet's office before they close.
 
Bad news...

After seeming good since he came back from the ER, he threw up around 6am today. We were able to get a urine ketone check around the same time and it came up Moderate-Large (40-80 mg/dL). Gave him Cerenia and Cyproheptadine around 7. Still only ate a tiny bit of food at 8. BG was close to 500. Gave his usual dose of 2u Prozinc anyway. Gave subq fluids around 9, got around 150mL into him. He has been drinking some water.

My s/o is bringing him to the vet now. I don't know what they're going to say. We can't afford to keep putting him in the hospital.

I'm running very low on hope for our little buddy here :(

Tagged post as 911 in case anybody has more input, but I really don't expect much at this point...
 
I hope your vet can get him through this relapse. I think it's time to boost his insulin by a whole unit to 3 u. Hold that only 3 cycles or so and increase to 3.5 if he stays high. Keep that up until you see yellows and blues. This is much more aggressive dosing than we usually recommend but possible DKA is an emergency situation. What BG level was your vet getting him to last time in hospital? Was the vet using fast acting insulin to yank down BG? How was the 2 u dose determined? If you need to increase the carb level of his food to allow bigger insulin dose, do so. If that means giving dry food, do it. All the rules fall by the wayside right now.
 
Kris & Teasel said:
I hope your vet can get him through this relapse. I think it's time to boost his insulin by a whole unit to 3 u. Hold that only 3 cycles or so and increase to 3.5 if he stays high. Keep that up until you see yellows and blues. This is much more aggressive dosing than we usually recommend but possible DKA is an emergency situation. What BG level was your vet getting him to last time in hospital? Was the vet using fast acting insulin to yank down BG? How was the 2 u dose determined? If you need to increase the carb level of his food to allow bigger insulin dose, do so. If that means giving dry food, do it. All the rules fall by the wayside right now.
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Neither vet was able to get his BG down much. The first hospital said they didn't have the right insulin, so they used our Lantus. Second hospital used Novolin and said they still saw 5-600s. His first reading after he came home was 305. Lowest I think he'd been in a long time now.
Not sure why they decided to start with 2u.

Update from his vet visit just now - they flushed out some congestion, gave us more Cerenia, more fluids/needles for subq. Suggested increasing by 0.25u. I agree that this isn't the time to go slow, and we'll be bumping him up to 3. I understand that hypo is a serious issue, but we already have an equally serious issue at hand. We'll be able to monitor him closely while on the new dose.
 
Eric and Simba said:
Neither vet was able to get his BG down much. The first hospital said they didn't have the right insulin, so they used our Lantus. Second hospital used Novolin and said they still saw 5-600s. His first reading after he came home was 305. Lowest I think he'd been in a long time now.
Not sure why they decided to start with 2u.

Update from his vet visit just now - they flushed out some congestion, gave us more Cerenia, more fluids/needles for subq. Suggested increasing by 0.25u. I agree that this isn't the time to go slow, and we'll be bumping him up to 3. I understand that hypo is a serious issue, but we already have an equally serious issue at hand. We'll be able to monitor him closely while on the new dose.[/QUOTE
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Keep us in the loop. I'm glad you're increasing to 3 u. His numbers are high enough that the risk of ketones is much much larger than the risk of dropping too low. That's a lot easier to handle at home with carbs, etc. As I said above, don't keep that 3 u more than 3 cycles if it doesn't produce anything below pink. Then go to 3.5 u for 3 cycles, etc. Those numbers must come down.

You can post here or on the ProZinc forum or both. I'll be watching. Is Simba eating?
 
Here's info I gleaned from a lot of reading about post DKA here on FDMB:

Post-DKA "at home" management:
  • food and insulin are key! More calories per day are needed to prevent ketone formation (give high carb/high calorie if you can)
  • feed food high enough in carbs to allow a high enough insulin dose to be given
  • this is not the time to try to get BG down into ideal ranges - settle for "OK" (yellows and high blues, very low pink max.)
  • appetite can/will be variable so be prepared to address nausea first and add in the appy med second only if needed
  • hydrate, hydrate, hydrate!
NOTE: Cerenia can help with nausea but the human med ondansetron can work better. Some people use the two together for nausea because the drugs target different receptors. Ondansetron is the generic form of Zofran, a human drug for the nausea caused by chemotherapy. Zofran is very $$$. Ondansetron is not. You'd need a prescription from your vet to be filled at a human pharmacy. Nausea must be addressed before using appy meds.
 
Kris & Teasel said:
Keep us in the loop. I'm glad you're increasing to 3 u. His numbers are high enough that the risk of ketones is much much larger than the risk of dropping too low. That's a lot easier to handle at home with carbs, etc. As I said above, don't keep that 3 u more than 3 cycles if it doesn't produce anything below pink. Then go to 3.5 u for 3 cycles, etc. Those numbers must come down.

You can post here or on the ProZinc forum or both. I'll be watching. Is Simba eating?
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He isn't eating much, but has eaten some. He seems extra heavy and I think he's full of fluids right now. He's been drinking a lot since he came back an hour ago.
 
Eric and Simba said:
He isn't eating much, but has eaten some. He seems extra heavy and I think he's full of fluids right now. He's been drinking a lot since he came back an hour ago.
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Go easy on the fluids. It can be hard on the heart especially if there's any sign of cardiomyopathy. Once he's eating wet food, add water to each meal - 3 to 4 tablespoons.
 
Tanya and Ducia said:
@Eric and Simba



extra calories are crucial with ketones in the picture, just as proper insulin dose.
I found this syringes super convenient in case you'll need to assist feed.
Best wishes for Simba and speedy recovery!
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We did end up syringe feeding a bunch earlier. He's getting the rest of his food forced in right now. He did have a decent amount to eat today overall. Gave 3u Prozinc for his PM shot. Going to test around +4 before going to bed.
 
My gf didn't feel comfortable giving 3.5 so he got 3 again this morning. Even with both cerenia and ondansetron, his appetite has been nonexistent. He's at least drinking a ton of water. We were able to syringe feed him around 70% of his normal food amount for yesterday.

Ketone levels have been small to moderate every time I've checked. Gf said one measurement midday was high, but it had improved after that. BG readings have all been red/black. I'll make sure we up his dose by tomorrow morning if it doesn't improve.

He's also dealing with a respiratory infection that they gave us Clavamox for a couple days ago. Both the respiratory issues and medication may be contributing to his inappetence.

Between everything going on, he really has not looked good these last few days. Don't think he's gotten much sleep at all either.
 
You have to be comfortable with the dosing you're trying. I really do think he needs those regular 0.5 u increases though. I know it's hard to trust someone on an internet forum. We're still here to help though.
 
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