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

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Things aren't looking good. He hasn't eaten much of anything today and our only feeding syringe was destroyed by the dog. Our roommate is picking up another one now...

Simba is having trouble walking. He stumbles a lot now. Ketone test came up with a clear moderate. He has lost another half pound, down to 9.5 now. I don't know how much longer he can last. We are considering giving up... He is miserable and is not showing signs of getting better.

Do you think he still has a chance?
 
Eric and Simba said:
Things aren't looking good. He hasn't eaten much of anything today and our only feeding syringe was destroyed by the dog. Our roommate is picking up another one now...

Simba is having trouble walking. He stumbles a lot now. Ketone test came up with a clear moderate. He has lost another half pound, down to 9.5 now. I don't know how much longer he can last. We are considering giving up... He is miserable and is not showing signs of getting better.

Do you think he still has a chance?
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Unfortunately, the further along this path he goes the harder it will be to roll him back without a very expensive stay in a vet ICU. Only you can decide what course of action is open to you for any and all reasons from emotional to financial. Any decision made out of concern for a kitty's wellbeing is a good one. :bighug:
 
We were able to get some food into him (~1.5 cans of fancy feast). He's still very weak and having trouble standing. BG came up at 386, but he didn't eat much beforehand so it's probably not very accurate. Going to give 3.5u at 8est tonight and try to get a bunch more food into him by then. Going to do my best to monitor him throughout the night as well.

He is definitely miserable right now and I'm worried we might just be prolonging his suffering... I don't know when to say enough is enough. I feel like he still has a chance, and I can't give up on him while thinking I could still do more. This whole situation sucks :(
 
Eric and Simba said:
We were able to get some food into him (~1.5 cans of fancy feast). He's still very weak and having trouble standing. BG came up at 386, but he didn't eat much beforehand so it's probably not very accurate. Going to give 3.5u at 8est tonight and try to get a bunch more food into him by then. Going to do my best to monitor him throughout the night as well.

He is definitely miserable right now and I'm worried we might just be prolonging his suffering... I don't know when to say enough is enough. I feel like he still has a chance, and I can't give up on him while thinking I could still do more. This whole situation sucks :(
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Well, you can decide to go with those 0.5 u dose increases for a little while if you feel you can get enough food and fluid into him. Keep the ketone testing going. If you feel brave, bump him to 4 u - nothing to lose really and it just might help. If he had dropped into blue mid cycle today I wouldn't have suggested that but he's got a ton of room to drop even with a 386.
 
Kris & Teasel said:
Well, you can decide to go with those 0.5 u dose increases for a little while if you feel you can get enough food and fluid into him. Keep the ketone testing going. If you feel brave, bump him to 4 u - nothing to lose really and it just might help. If he had dropped into blue mid cycle today I wouldn't have suggested that but he's got a ton of room to drop even with a 386.
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I think we're going to try 4u, & stay up to monitor him throughout the night. I'm afraid that we'll be out of time if we can't get him to a good level this weekend.

I really appreciate everything you all have done for us. We would not have gotten this far without you. Thank you.
 
Eric and Simba said:
I think we're going to try 4u, & stay up to monitor him throughout the night. I'm afraid that we'll be out of time if we can't get him to a good level this weekend.

I really appreciate everything you all have done for us. We would not have gotten this far without you. Thank you.
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I'm glad to help. Increasing the dose might feel risky to you but the ketone risk trumps that. Keep getting food and water into him.

Here's the basic problem:
  • not enough calories = body breaking down fat stores for energy = ketones as a byproduct of this process
  • not enough insulin = inability to get glucose from bloodstream into cells = cells using fat for another source of energy = ketone development as above
  • dehydration = increase in ketone concentration in bloodstream = feeling yucky = inappetance, nausea, etc.
All of the above are connected. Having another infection or inflammation at the same time will make everything worse.
 
Eric and Simba said:
I think we're going to try 4u, & stay up to monitor him throughout the night. I'm afraid that we'll be out of time if we can't get him to a good level this weekend.

I really appreciate everything you all have done for us. We would not have gotten this far without you. Thank you.
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I think going to 4 is a wise decision.
 
I am really wishing you all the best and sending prayers for you and Simba.

I also think going up to 4 is worth the risk.
 
His PMPS just read 384. Pretty low for him. He didn't eat his normal amount of food today, so it's partially due to that. We're going to make sure he eats all of his food for the day (the lady is a better nurse than I).
I think I am still going to give him 4 units despite the low reading. Thoughts? Going to give the shot soon.
 
Just an observation...Clavamox absolutely destroys the appetite of several of our current crew of 6 cats. If possible, we usually go with a different antibiotic, although most can cause GI issues as well, but sometimes Clavamox is the best choice and we just need to deal with it until the course is over. Injectable Cerenia sometimes helps for appetite (and more so than the Cerenia pills in our experience). But Clavamox makes a couple of ours look and feel absolutely HORRIBLE - and that is just with an underlying infection and the Clavamox, not with diabetes and DKA piled on top!

While Simba overall clearly has some serious issues, the Clavamox could be making it seem worse than it is. I am sure others can share their experiences/thoughts on it too.

And similar to what @Kris & Teasel said...we don't know Simba, we can't see him...you know your buddy best and you are doing a phenomenal job, and any decision you make out of concern is the right one.

Our best to you, you'll remain in our thoughts,
Sandi.
 
I know it seems that way, but the data you have so far shows that you have a long way to drop before you are in dangerous territory.

Testing at +2 will be a good idea to let you see where he might be heading. I am in Eastern Time but I'll check in as long as I can.
 
Eric and Simba said:
His PMPS just read 384. Pretty low for him. He didn't eat his normal amount of food today, so it's partially due to that. We're going to make sure he eats all of his food for the day (the lady is a better nurse than I).
I think I am still going to give him 4 units despite the low reading. Thoughts? Going to give the shot soon.
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I think giving 4 u was the right thing to so. Get a +2 test this evening.
 
Ok, so you are still seeing a little bit of a rise in number as you have in the two nighttime cycles you've checked before now. That is pretty normal because the insulin isn't really kicking in yet, and this _probably_ means that you will have a safe and uneventful night with regard to BG.

I don't know if you'll be up with him all night anyway to feed and monitor even if his BG is safe -- if that is your plan, you could always take a nap now and get up at +4 to test again so that you aren't totally wiped out tomorrow. I expect Simba to be safe for the next two hours.

Edit to add: I'll set my alarm to check in on you then as well.
 
Sandi & Whisper said:
Ok, so you are still seeing a little bit of a rise in number as you have in the two nighttime cycles you've checked before now. That is pretty normal because the insulin isn't really kicking in yet, and this _probably_ means that you will have a safe and uneventful night with regard to BG.

I don't know if you'll be up with him all night anyway to feed and monitor even if his BG is safe -- if that is your plan, you could always take a nap now and get up at +4 to test again so that you aren't totally wiped out tomorrow. I expect Simba to be safe for the next two hours.
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We are planning on having one of us up to watch him pretty much throughout the night. I'll probably take a ~1hr nap before testing around 1:30 EST.
Would you continue testing every hour after that? 2hrs? How low can he go before we should start with hypo treatment?
 
Eric and Simba said:
Would you continue testing every hour after that? 2hrs? How low can he go before we should start with hypo treatment?
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No, I don't think it'll be necessary for you to test every hour. If the +2 had been lower than the Pre-shot, that can indicate it might be an active cycle, but his is a little higher.

Below 50 is your "time to act"....but I don't think you're going to have to worry about that tonight.

If you get a +4, I think that'll give you a pretty good idea if you need to continue to test tonight or not
 
So you don't yet really know what time he usually hits nadir (lowest point in the cycle), but it is normally between +5 and +7 for most cats most of the time. If your +4 is still, let's say...300 or more, you are likely safe not testing any more until AMPS if you need to rest.

That being said, all data is good data, and the more you have, you'll start to learn when onset and nadir are, which helps you make educated guesses on when to test next based on what BGs you see, so that you aren't testing nonstop. Therefore, if you are up tonight anyway, you could test every 2-3 hours after that until the morning shot just for data gathering purposes. Or once you see 2 rising numbers in a row, there isn't much else to learn because you are probably then past your nadir.

I'll see you around 1:30am.
 
Sorry, but I am really drifting off. I truly believe your BG is fine for the night based in +2 or I would force myself to stay awake. But folks in other time zones might be around.

I'll check on you in the morning.
 
Real sorry to say that we both slept right through the alarm...
+6 came in at 437 - still higher than the previous 2 readings. Good news is he seems to have regained some energy/stability with those few extra hours of sleep.
 
I'd give 4 u tonight and go to 5 u tomorrow AM. It's too soon to know if he's a high dose kitty. He might just have a lot of glucose toxicity from being so high so long. If so, you'll reach a "breakthrough" dose that will knock him down. All the other health issues make it harder but don't give up.

Is he eating?
 
Agreed, that's good news. Sometimes everyone just needs sleep. I almost warned you in advance of how easy it is to sleep through them when you've been doing intensive care for multiple days :p

It wasn't critical for you last night, but if it ever is critical for me to get up for a reading, I make sure to put my alarm across the room so that I have to actually get up to turn it off. That seems to help.
 
He is not really eating willingly. Only took a few tastes on his own last night, nothing earlier in the day. The syringe is a lifesaver.
 
Been testing every couple hours & his BG has at least been steadily decreasing since the AM shot. Numbers are still in the for now.
Seems significantly stronger than yesterday, but still quite weak. Not falling over as much, was able to jump into the bathtub & land gracefully from jumping off the bed (which he couldn't do yesterday).
Ketone levels are still around moderate. He's been drinking a lot (but only directly from the sink, not his bowl...) and we gave some fluids (~75mL) this morning.

He still has 3 days worth of Clavamox left from the vet. His respiratory issues seem to have gone away (no sniffles or clicking sound) - are there any other indicators to look out for?
We don't want to give it to him any longer than necessary, since it really does seem to be impacting him heavily. It looks like he's much more open to eating/drinking from his bowls when he hasn't had the pill in a while.
 
Don't stop the antibiotic until it's gone altho' I understand it's hitting him hard. The length of time is just as important as the dose amount. Stopping it too early can let those few remaining germs rebuild. It can also cause that antibiotic not to work as well next time either. I've been guilty of that before, NOT good.

I'm happy to hear he's getting better. One day he'll start eating again - he really will....
 
Need some dosing advice... His BG has been going down steadily the whole day.
I should be giving his shot in the next 20 minutes or so but he's at a pretty low level (for him at least, considering he hasn't rebounded this whole day - 358). Worried that 4u may be too much.
 
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He's still way too high.

I'd go ahead and give the 4U again tonight and test at +2....that should help tell us what he's going to do later in the cycle and how much you'll need to test tonight.
 
Unfortunately, yeah I agree you should finish the Clavamox. I hope you didn't think I was trying to get you to stop early -- I wanted you to be sure to not make a permanent decision based on what is hopefully a temporary situation.

I understand you are worried about the 4u, but your take action number of 50 is a long way away...and I mean that to be comforting, not discouraging!!! :woot:

Maybe I should just stop talking now... :p

358 for a pre-shot is certainly looking better, and once you get your next test, the info from last night should help you decide what additional tests to get tonight (if no one is on to help).
 
Sandi & Whisper said:
Unfortunately, yeah I agree you should finish the Clavamox. I hope you didn't think I was trying to get you to stop early -- I wanted you to be sure to not make a permanent decision based on what is hopefully a temporary situation.

I understand you are worried about the 4u, but your take action number of 50 is a long way away...and I mean that to be comforting, not discouraging!!! :woot:

Maybe I should just stop talking now... :p

358 for a pre-shot is certainly looking better, and once you get your next test, the info from last night should help you decide what additional tests to get tonight (if no one is on to help).
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I appreciate the input. I think things will be a whole lot easier once he's done with the Clavamox. The biggest problem right now is that he doesn't want to eat, so we have to force in the food & pills. It does seem like he's recovering slowly but surely.
 
Eric and Simba said:
Also, since the shot his BG has just been going up again as it did last night. Really strange.
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Not unusual when you're not in the good dose range yet. It's a pattern that tells you he's still drifting in the "too high" range and there will be minor ups and downs in that range. Once you're seeing yellows and blues a clearer pattern *should* begin to emerge.

I'd bump him to 5 u this AM if you feel brave, 4.5 u if you don't. Stay there for only three cycles then increase.
 
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I see you went to 5 u. Ignore those blacks. He could be rebounding from the pinks that were a 200+ point drop.

Any urine ketone test results?
 
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He's still being syringe fed most of his food. Peeing/pooping in box, no issues there. He's been sleeping an awful lot.

He has improved drastically over the course of the day yesterday. He looked barely alive on Thursday and is markedly better today:
  • He's got enough energy to resist syringe feeding a bit
  • Ketones have been decreasing
  • He is able to jump & land gracefully from several feet up (Thursday he would collapse if he tried)
  • He's still wobbly, but not as bad. He completely fell over several times on Thursday but has only lost his balance a few times since yesterday.
  • More responsive - wouldn't react to anything while sleeping, now he perks his head up some. Tail perks up some when petting him too
  • Sometimes goes for the DM dry food. He's had a couple bites over the past few hours without any prompting
 
Do you think you're getting more food into him lately? Increasing the calories is an important part of ketone treatment so if he's eating better now, that (along with increasing the insulin and hopefully getting whatever infection is going on under control) could be major factors in his improvement!

Let's hope it continues!! You're doing fantastic with him!!!
 
Eric and Simba said:
He's still being syringe fed most of his food. Peeing/pooping in box, no issues there. He's been sleeping an awful lot.

He has improved drastically over the course of the day yesterday. He looked barely alive on Thursday and is markedly better today:
  • He's got enough energy to resist syringe feeding a bit
  • Ketones have been decreasing
  • He is able to jump & land gracefully from several feet up (Thursday he would collapse if he tried)
  • He's still wobbly, but not as bad. He completely fell over several times on Thursday but has only lost his balance a few times since yesterday.
  • More responsive - wouldn't react to anything while sleeping, now he perks his head up some. Tail perks up some when petting him too
  • Sometimes goes for the DM dry food. He's had a couple bites over the past few hours without any prompting
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This is a very positive change! :) You're doing great.
 
Chris & China said:
Do you think you're getting more food into him lately? Increasing the calories is an important part of ketone treatment so if he's eating better now, that (along with increasing the insulin and hopefully getting whatever infection is going on under control) could be major factors in his improvement!

Let's hope it continues!! You're doing fantastic with him!!!
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He normally eats 4 cans of Fancy Feast per day. We've been getting him to eat around 3 of them per day since we started syringe feeding - not much has changed there. I think we managed all 4 yesterday. Despite him having a bit of an appetite now, he's not really eating an appreciable amount of food on his own.
 
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