DKA recovery

Hettie

Hettie

Member Since 2018
I had to take my boy to the ER on Monday afternoon and they said he was in DKA. He was there about a day a half while they gave him fluids and got his BG under control but then developed a fever that wouldn't respond to antibiotics. After 4 days, we just couldn't afford to keep him there and the vet was out of ideas as to why his fever wasn't going down on the antibiotics. blood tests showed elevated ALT and bilirubin. So I brought him home last night and the vet suggested to try a different antibiotic, which we started him on last night- I took his temp this morning and it was normal 100.4. His temp has been stable all day, but his BG has gone back up to the 600's- they told me to start him out on 1 unit (his 'normal' dose was 3). He still isn't eating on his own, and has an NG tube that I feed him through and give meds and liquids. He's still lethargic. I'm worried he's going into DKA again. I don't have a ketone tester. He is due again for his next shot in about 20 minutes - the vet said to give him 2 units ,but I feel like it's not enough.
 
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I should also note that we switched him from the Prozinc to Lantus about 2.5 months ago.
 
I am sorry this is happening, too. I don’t know enough about some of the details you mentioned, either. My Alice survived a DKA hospitalization back in April. All I can say is that her recovery was slow for awhile and then suddenly she was doing much better. I see you just updated a comment with numbers so going to take a look.....
 
Do you know what they gave during hospitalization? Was he on a drip or did they give lantus as well?

If no one answers, I’d be inclined to just continue giving 1 unit for this cycle until someone with more experience chimes in.

It’s good you’re able to feed via NG tube. Keep that up as calories is part of the solution to ketones.
 
Crista & Ming said:
Do you know what they gave during hospitalization? Was he on a drip or did they give lantus as well?

If no one answers, I’d be inclined to just continue giving 1 unit for this cycle until someone with more experience chimes in.

It’s good you’re able to feed via NG tube. Keep that up as calories is part of the solution to ketones.
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The gave him the "short acting" insulin - I don't remember the name but they gave it every 4 hours.
 
I’m wondering..... with Lantus being a depot insulin, if there’s a way you could gain some regulation with an insulin that acts differently....? Just a thought.... When I used NPH one of the only beneficial things was that I had much more specific control in the moment. I don’t think 1u makes any sense at all with those numbers and what your dose used to be.

Agreeing with Crista it is good you have the tube. How much are you able to get in him? If you are capable of getting food in him then I don’t see why there would be a reason for a higher dose to be a dangerous thing—calories and insulin are critical in DKA recovery, and I personally would rather have to give higher carb I think while in the depths of DKA, than not give enough insulin.
Others with more experience than me need to chime in, though.
 
AliceMeowliss&Cassandra said:
I’m wondering..... with Lantus being a depot insulin, if there’s a way you could gain some regulation with an insulin that acts differently....?
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In certain situations, owners have given their kitties lantus + a short acting insulin like humulin R. I don’t have experience with that and someone that does will have to guide you if that becomes an option.

Although I suspect since Max was on 3.25 units before he probably does need to go back up. But again, I’d wait for the experts.
 
AliceMeowliss&Cassandra said:
I’m wondering..... with Lantus being a depot insulin, if there’s a way you could gain some regulation with an insulin that acts differently....? Just a thought.... When I used NPH one of the only beneficial things was that I had much more specific control in the moment. I don’t think 1u makes any sense at all with those numbers and what your dose used to be.

Agreeing with Crista it is good you have the tube. How much are you able to get in him? If you are capable of getting food in him then I don’t see why there would be a reason for a higher dose to be a dangerous thing—calories and insulin are critical in DKA recovery, and I personally would rather have to give higher carb I think while in the depths of DKA, than not give enough insulin.
Others with more experience than me need to chime in, though.
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I'm giving him 75 cc every 6 hours - It's the Royal Canin renal support liquid stuff. He hasn't been throwing up and seems to tolerate pretty well. The vet said that I would expect to see his numbers elevated from the liquid since it has more carbs.
 
Okay, I've never dealt personally with DKA.

Link to Financial Aid. http://www.felinediabetes.com/FDMB/threads/financial-help-links.131190/ (some of the links may be outdated).

You can measure ketones with urine ketone strips. Most pharmacies carry them. Here is how to use them: https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

A blood ketone monitor is good to have if your cat is shy in the litter box. It measures ketones in the blood.

Also read this link on DKA: http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

DKA = not enough insulin + not enough food + an underlying infection or condition.

It is important that you get enough food on board. The Royal Canin Renal Support D, E, and F run between 16% and 23% That is considered high carb and probably one of the reasons why you are seeing high numbers.

It is also important to get enough water on board. Did the vet give you subq fluids to give at home? Are you adding water to the food? Ketones need to be peed out.

Did you give 2 units tonight?

I apologize for the quiet night on the board. It's usually not this quiet.

Tagging @Tanya and Ducia who has experience with DKA.
 
Hi, I'm so sorry to hear this, I know what you are going through as have been living the DKA rollercoaster for a few months now.
As the others have said, fluids, calories and insulin are the key to ridding the body of ketones, and time. My vet also told me to go to 1unit, we were back in DKA within a week, I'm no expert by any means but just wanted to say I understand and send you my very best x
 
If you can test frequently, have lots of high carb food around, can get food in him, I would give his original dose. Buy urine ketone test strips and test at least twice a day while he is high. Make sure he is hydrated to flush out ketones. Do you give subq fluids?

Looks like you shot 2 units tonight, can you test 2 or 3 hours later?
 
@Hettie
Hi,

hang in there - you were dealt a very rotten card but you are neither a 1st one to get it nor will you be the last one.
It is tough but manageable.

When discharged from the ER hospital - did Max receive any written plan of treatment?

Such as a schedule of medication, sub Q. fluids, length of antibiotic course & dose?..etc?
Can you share it? It is a good point to start, in most cases anyway.

Basically , as other suggested above - food, water (arch important) and proper insulin dose is what wards off the ketone's recurrence.

Post DKA my cat Ducia was fit with Esophageal Tube - we could feed up to 20 ml per session every 3 - 4 hours - day and night do the total caloric intake was about 250 Kcal (1.5 can of Friskies Pate 5.5 oz).

I do not have the full picture of Max's illness in my head but your vet's advice on lowering the dose of the insulin just past DKA is rather odd.

You r today's PMPS is high. It is the 2nd dose of Lantus at home.
Can you take the +2 test and post it here?
Can you also note in the SS as to what you have fed and when?
It is important to take in the food influences when assessing a dose.
 
Hi everyone -thank you for the replies. I'll try to respond to all of it in one message here:

The discharge instructions were as follows:
-prednisolone: 1ml once daily
-doxycycline: 5ml every 12 hours. (he was on clavamox for the two days prior)
-metoclopramide: 2.75 every 8 hours
-75cc Royal Canin Renal support liquid diet every 6 hours
-flush tube with 5ml of water after medication or food (I was not instructed on sub-Q fluids)

They said to feed him through the tube until he starts to eat on his own. The other medications above will be given until Monday, then we will reassess his progress.

PM dose of Lantus was at home (2 units given) and I am monitoring every 2 hours- feeding was at the same time as his PM shot
his +2 was 584
 
https://www.royalcanin.com/uk/cats/products/vet-products/renal-liquid
"Formulated to support renal function in case of renal insufficiency: high quality proteins and restricted levels of phosphorus. Contains EPA + DHA and antioxidants.
Very high energy density which provides daily energy requirements in a reduced feeding volume.
Complete and balance liquid diet to support nutritional restoration and convalescence of dogs and cats requiring assisted enteral nutrition.
The synergistic antioxidant complex helps neutralise free radicals.

Milk and milk derivatives, cereals, oils and fats, vegetable protein extracts, minerals, derivatives of vegetable origin. Source of protein: low-lactose milk, caseinate, soya protein concentrate.
Vitamin A: 3330 IU, Vitamin D3: 320IU, E1 (Iron): 30mg, E2 (Iodine): 0.3mg, E4 (Copper): 1.8mg, E5 (Manganese): 2.4mg, E6 (Zinc): 28mg, E8 (Selenium): 0.15mg.
Guaranteed analysis: Crude ash: 0.9%. Crude oil fats: 5.5%. Moisture: 85%. Protein: 7%.
 
Tanya and Ducia said:
Why?
It is a steroid medication, the well known high glucose causer, why was it prescribed? @Hettie
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They said it would be short-term to help him feel better overall and hopefully get him interested in eating, but the vet did say it would cause BG to go up, but that we'd compensate with insulin.
 
Hettie said:
She said it would help him feel better overall and maybe get him interested in eating on his own.
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this "diagnosis" sounds like fine kettle of fish.
The steroids are the nukes of the Pharmacy world - it is given as a last resort. Never as what if it start the appetite.
What was wrong with Max that he had to go to the most dreaded med?

The things that we were done at home for our post DKA girl was mostly food 250 KCal/ 24 at least (super important - the calories X 1.5 times the reg amount)), water - up to 100 ml subcutaneously in addition to the watered wet food, and all of the meds on time - that is vet determined (amount/ volume + frequency= food intake).

I strongly suggest that you find out why you r cat was given the most dreaded med, the Pred.
Other than that do keep giving enough insulin and food to help the situation. The Black numbers in your SS are scary. I hope you 'll find a way to help it.
 
Hi and welcome. I am so sorry you are going through this. :bighug:
You have been getting good advice.
I agree with Wendy.......I would increase the dose back up to 3 units ( his normal dose). You can always give higher carb food to bring up the BG if needed.
Do you have higher carb food at home if needed?

Also he needs more fluids then he is presently getting I think. Can you ask the vet about subQ fluids.?
In the meantime I would give some extra fluids orally via the feeding tube. Just 10 mls hourly would help.

And I think he should eat more often than every 6 hours.
I'm surprised the vet didn't suggest Hills A/D food. Can you ask about that?

And I think it is really important you are testing for ketones so you know how Max is at any given time.
Can you go out and buy a bottle of Ketostix from Walmart or a pharmacy?
You just need to collect a urine sample from Max and dip the test strip in, wait 15 seconds exactly then read it against the colours on the side of the bottle.

Keep asking questions. We are all happy to help and support you. Cats with DKA take time to recover and need lots of nursing and support from their carers.
You are doing a really good job with Max and it is great you have reached out to us for help and support.
 
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update: I took Max to our primary vet this morning as he started having diarrhea last night and this morning. They gave him some sub-Q fluids and showed me how to give it at home as well. I have increased the amount the of water I'm giving him through his tube. He still doesn't seem interested in eating on his own, but I do have some high carb wet food if he will eat it.

I'm in the process of getting him set up so I can test his urine or blood for ketones.

Thanks everyone for the advice and support.
 
Bron and Sheba (GA) said:
Hi and welcome. I am so sorry you are going through this. :bighug:
You have been getting good advice.

And I think he should eat more often than every 6 hours.
I'm surprised the vet didn't suggest Hills A/D food. Can you ask about that?
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Is the Hills A/D food a liquid? He isn't eating on his own yet, I'm just feeding him through his NG tube which is very tiny and only allows liquids.
 
Hettie said:
Is the Hills A/D food a liquid? He isn't eating on his own yet, I'm just feeding him through his NG tube which is very tiny and only allows liquids.
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Hi Hettie, it's not a liquid it's a very smooth paste/pate which goes well in a syringe, but can be watered down even further. It's a complete rRestorative food with all the essential nutrients. If you need a liquid, I have also used liquivite who are super fast at delivery, again a complete food and totally liquid. X
 
Hettie, you are getting lots of response and help now, would you please remove the 911 from your thread title? That red 911 beacon increases our heartbeats a bit and gets the adrenaline flowing whenever it shows up. :)

Thanks me dear, and take good care of yourself as you take good care of Max.
 
DKA can take a while to recover from. Sebastian had his feeding tube for about two weeks until he started eating on his own again.

Definitely get ketone testing strips, they'll help get you ahead of any issues.

Dose seems very low for that high of BG, but since it's Lantus it will take time to build so you don't want to increase too much too fast. I would strongly suggest introducing some R as it can help get things down in the meantime. Most people here will act like it's one of the scariest things on the planet but as long as you are careful with it, it works great. You can get it over the counter, Walmart is the cheapest I've heard. Start with a very small dose, like a drop, and then test every hour to see the effects. Don't give more than one dose a cycle and try to not overlap the lantus cycle, i.e. try to give it between +4 and +8, since it's on about an 8 hour cycle and that way you won't be doubling up on nadirs. Do a dose size for two cycles or so so you can confirm the effects and then increase as necessary until you start to see movement. Again, take it slow because there's a pretty find line between when it works and when it doesn't and if you give too much it'll really move. You can look over Sebastian's spreadsheet to see the effects. I've been using it for the past week or two at various dosages and you can see pretty clearly at what point it starts to work and by how much. If you do decide to go the R route, let me know and I can offer you a little more direct guidance.
 
Justin & Sebastian said:
DKA can take a while to recover from. Sebastian had his feeding tube for about two weeks until he started eating on his own again.

Definitely get ketone testing strips, they'll help get you ahead of any issues.

Dose seems very low for that high of BG, but since it's Lantus it will take time to build so you don't want to increase too much too fast. I would strongly suggest introducing some R as it can help get things down in the meantime. Most people here will act like it's one of the scariest things on the planet but as long as you are careful with it, it works great. You can get it over the counter, Walmart is the cheapest I've heard. Start with a very small dose, like a drop, and then test every hour to see the effects. Don't give more than one dose a cycle and try to not overlap the lantus cycle, i.e. try to give it between +4 and +8, since it's on about an 8 hour cycle and that way you won't be doubling up on nadirs. Do a dose size for two cycles or so so you can confirm the effects and then increase as necessary until you start to see movement. Again, take it slow because there's a pretty find line between when it works and when it doesn't and if you give too much it'll really move. You can look over Sebastian's spreadsheet to see the effects. I've been using it for the past week or two at various dosages and you can see pretty clearly at what point it starts to work and by how much. If you do decide to go the R route, let me know and I can offer you a little more direct guidance.
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Justin what is “R”?
 
Hi Hettie
While R might be an option for you to try, I would definitely not use it without the guidance and help from someone like @Marje and Gracie.
You would be using two different insulins with different nadirs and in the beginning you need someone to stay with you to guide you through it until you understand the effects the combination of the two insulin have together.
Please don’t just look at someone’s else’s SS who has used it and think that is enough help. While it will give you an idea of how it works, ECID and will react a bit differently.
In the meantime I would look at increasing the dose of Lantus if the BG are still in the black and red

ETA I’m so glad you got some subQ fluids done and can do them at home. And great too on getting the ketone testing sorted. That really important.
I hope the diarrhoea settles
 
Bron and Sheba (GA) said:
Hi Hettie
While R might be an option for you to try, I would definitely not use it without the guidance and help from someone like @Marje and Gracie.
You would be using two different insulins with different nadirs and in the beginning you need someone to stay with you to guide you through it until you understand the effects the combination of the two insulin have together.
Please don’t just look at someone’s else’s SS who has used it and think that is enough help. While it will give you an idea of how it works, ECID and will react a bit differently.
In the meantime I would look at increasing the dose of Lantus if the BG are still in the black and red
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That's a long wait for a train that doesn't come. I had to figure it out on my own because there's no one around here regularly who uses it.
 
Justin & Sebastian said:
That's a long wait for a train that doesn't come. I had to figure it out on my own because there's no one around here regularly who uses it
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Justin, You may have successfully used "R" on your own up till now because there was an issue finding someone to help you learn how to use "R" with Lantus but that doesn't mean it's appropriate or safe to suggest others use it without some experienced help. As a Registered Nurse who understands the physiology of diabetes and pharmacological action of insulin very well I would never have tried using "R" with my IAA kitty without someone experienced using it for cats to teach me the ropes. You are lucky to have managed Sebastian safely up till now but what worked for you isn't going to work for everyone else. I had no intention of using my girl as a guinea pig and I don't think it's appropriate to be suggesting others do so without specific instruction for their cat. When using "R" it's important to know when to use it and even more important to know when not to use it.
 
Well every cat is different and I don't think it's fair to Hettie and Max to not lay out all the available options and let her make her own decision. Personally I'd feel more than a little guilty if I knew about something that could potentially save her cats life and didn't say anything. But whatever.

Best of luck Hettie, hope you're able to get the help you need.
 
Justin & Sebastian said:
Well every cat is different and I don't think it's fair to Hettie and Max to not lay out all the available options and let her make her own decision. Personally I'd feel more than a little guilty if I knew about something that could potentially save her cats life and didn't say anything. But whatever.

Best of luck Hettie, hope you're able to get the help you need.
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Justin, I know you have good intentions and want to help Hettie and Max but using R is a specialist area and needs a very experienced person to say that is the way to go and for them to guide you with dosing.
At this point it has not been established that R would be the best option for Max. He may just need an increase in Lantus or we might find that R is needed. It is not something which should be jumped into without discussion..
Getting some tests in for ketones will help with decisions.
I agree wholeheartedly with @MrWorfMen's Mom comments. I am also an RN and understand diabetes well.
I would always defer to the experienced R people for any decisions and for them to guide the carer through the process.
 
Justin & Sebastian said:
Well every cat is different and I don't think it's fair to Hettie and Max to not lay out all the available options and let her make her own decision. Personally I'd feel more than a little guilty if I knew about something that could potentially save her cats life and didn't say anything.
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I AGREE.

I FULLY UNDERSTAND and AGREE with ALL that's been said in this thread regarding the use of R.

However, we currently have a problem on this board, specifically in this forum. We do not have experienced users who can be around enough to guide others in the use of R as a bolus.

So do we not mention R -OR- do we mention R and encourage the caregiver to
  • find help?
  • speak to their vet?
  • search the board for R instructions given to others?
  • ask 5 million questions?

R use has become rare in recent years. I bet you'd all be surprised if i told you that when I started here in 2006 most Lev users also used R because the onset of Lev wasn't until generally +4 or+5? There wasn't any exclusive little club of R users.

I do not want to minimize the dangers of R use, or as was pointed out, when not to use R can be just as important or even more important than when to use R, BUT there are times when it may need to be brought up for the sake of the cat.

That said, I honestly do not think using is crucial to Scout's treatment/recovery at this time. However, I do agree with exploring the subject with the caregiver. It's something she may want to discuss/pursue with her vet.
 
Thanks Jill, that was the point I was trying to make. I don't disagree that it should be supervised by an experienced person, the problem is they don't exist. And I definitely wasn't trying to suggest someone just look at my spreadsheet and wing it from there. I mentioned that if she did decide to use it, ask me for help. I hardly consider myself an expert on it but at the same time, if you need an experienced user and it's a question of life or death, I'm pretty much the only option right now.

I also agree that it shouldn't be this exclusive little club. I've had tremendous success using it with Sebastian and it seems a little silly that such a tool is being overlooked so much. Obviously we don't want to be carefree with it but we need to find a middle ground.

I'll defer to you all on whether it should be used in this case since you do have more experience with a wider variety of cats. It just seemed to me, having a DKA cat myself and it being mentioned previously how important it is to keep the BG low, and knowing that Lantus is slow acting, dose increases are relatively slow to occur, and Max is possibly on too small a dose, it seemed like the right option. I'd be interested to know why you don't consider it a good fit right now.
 
Hettie said:
Is the Hills A/D food a liquid? He isn't eating on his own yet, I'm just feeding him through his NG tube which is very tiny and only allows liquids.
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Get yourself a little blender. When we had to feed Sebastian the A/D through the tube I got a Magic Bullet and I would just blend the pate food up in it and then put that in the syringe. Worked really well, never had a clog. Also pro tip: a caulk gun makes it WAY easier on your hands. Trying to squeeze a whole 80ml syringe at once was killing my hands until I had the idea to try it out.
 
@Wendy&Neko @Marje and Gracie @Sandy and Black Kitty

@Justin & Sebastian - I beg to differ. There are people experienced with R here on the Board. Everyone here has a life outside of FDMB. Several of those who are experienced with using R have been away or dealing with events in their lives. If you read Jill's post, she noted that the experienced members are here but aren't around 24/7. The people exist but I doubt you took the time to figure out who they are or tagged them.
 
Sienne and Gabby (GA) said:
The people exist but I doubt you took the time to figure out who they are or tagged them.
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Are you being serious right now? I've made dedicated posts asking for R guidance, as recently as about a month ago. We even had a whole big thread about it with Jill involved. Maybe look at my post history before you go running your mouth about something you know nothing about and calling me a liar.
 
Hattie, I have a ketone meter I can send you. Send me your info via PM and I will get it in the mail to you tomorrow.

My Gizmo was hospitalized 3x's with pancreatitis and was put on steroids as a last resort that put him in FD. Don't give up. They can recover but it is a long, slow road. My heart breaks for you and Max. He reminds my if Gizmo in your avatar. He never had a feeding tube but I did have to assist feed with a feeding syringe.

Fortunately Gizmo never had DKA, but he had numerous health issues we managed with FD. Did your vet test for pancreatitis? Did they give any nausea meds? Pain meds? Is this vet you have used for a long time and have a repor with Or some one new?

Is he showing any interest in eating on his own? I always gave Gizmo the opportunity to eat on his own before I forced fed. Are you giving any water via feeding tube?

What did he eat before Diabities?

Besides the Hills and Royal you might try Weruva BFF Play patés (Petco carries them). They are very loose and could be watered down and fed through the feeding tube (I think). They are ~5% carbs.

https://weruva.com/brand-summary/b-f-f-play/
https://weruva.com/nutrition-landing/bff-play-ni/
Chicken Checkmate
Chicken & Turkey Topsy Turvy
Chicken, Duck & Turkey Take a Chance
Chicken & Beef Best Buds

:bighug::bighug:
 
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