Tommy, Steve and Charlene-New In Town

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Charlene Byrne

Charlene Byrne

Member Since 2019

I am reposting this from introductions :)

Our boy Tommy (7) was diagnosed with DKA Monday 10/28/2019. He was very lethargic and his appetite declined the Saturday afternoon before. He has been losing weight over the last 3-4 months and didn't seem quite like his energetic self overall. We took him to urgent care 2 days in a row and they referred him to the hospital last Sunday. We were overwhelmed by the cost the vet gave us but had already spent a lot for 2 days in urgent care. His blood glucose was only 220 so the vet didn't think it was DKA at first and his blood was lipemic (?) and it wouldn't separate in their equipment because of the fat in it. They had to send it to a lab and the results weren't ready until Monday morning.

Sunday night we took him to Veterinary Referral Center of Colorado in the Denver area and he was there until this evening. I am at work and have a job where I work 24 hour shifts and sleep overnight (a group home) so I won't go home until Monday morning. My husband brought him home and so far he is talkative and doing okay. His prescription is for Lantus 2 x a day. Steve learned to do the injections and went to the pharmacy after taking Tommy home. My older brother lives with us and is retired--he is home most of the time so Tommy will have supervision and company along with my brother's dog and our other 3 cats.

I haven't had a long conversation with Steve yet about the other things we need to do, like when and how to check his glucose. It has been an overwhelming week and paying for 5 days in the hospital and 2 days of urgent care is overwhelming as well--but like everyone here he is one of our fur kids and we will figure it out.

I appreciate any feedback and comments! I have been reading threads here this week and feel better prepared because of that but know we have a LOT to learn :)

My husband said they didn't talk to him about BG testing. Why? Do they think it is too early after a DKA? I am shopping for the testing supplies and ketone strips and I will ask my husband to pick them up this afternoon or get delivered from Amazon. Thank you all :)
Tommy and his fam
 
Welcome to this side of the Board! You've got my post from the welcome forum. Please let us know if you have questions and how we can help.
 
I do have a question and hope it is okay to ask here. How do you poke their ears with the lancets? does it take much pressure? I'm guessing very little. I did read to use a cotton ball on Dr. Lisa's page. I'm going to send my husband some video links. If anyone has some to share that would be so helpful!

Also, why didn't the hospital ask us to do glucose testing and check ketones? They seem so thorough about many things but I'm confused on this. He has a re-check in 1 week. Thank you!
 
This link on home testing is from the Feline Health and FAQ board. Some people like using the lancing device. Personally, I liked free handing. You want to poke close to the edge of the ear -- you do not want to poke the vein otherwise it will look like a scene from CSI.

I wish I had a rational answer to your question. Some vets will tell people not to home test -- they will be torturing their cats, their cat will hate them, etc. I would like to think this is the explanation. There are many vets who tell people to bring their cat in on a weekly basis for the vet to test or come in for a monthly fructosamine test. That gets pricey and fructosamine tests aren't necessary if you are home testing. The other reason that vets don't tell you to test is because many people refuse. They get tired of asking. That was the case with my first vet. She got very excited when I told her I was testing and had a spreadsheet. (Then she told me I was testing too much and I told her unless she wanted to give me her home phone number so I could all her 24/7, we were going to have to agree to disagree.)

I think if we surveyed the entirety of FDMB you'd hear something very different than what vets tell you about home testing. Some cats literally come running to be tested. They purr when you're testing. There are a couple of reasons why. As you begin to test, always give your cat a treat. It doesn't matter if the test is successful. You want testing and treats to be associated with one another. Positive reinforcement is very powerful. The treat can be food, some members have brushed their cat, whatever works. Many people find having a special place to test is also useful. Again, it's a matter of association. You are giving them your undivided attention. That goes a long way for many of our kitties.

Others will likely have more to say on the subject.
 
Along with the videos Sienne provided as reference, JanetNJ, another member also did a wonderful video of BG testing with her kitty C.C. The video is available at

You don't need a lot of pressure. Some of us use the lancing device while others, Janet included, poke free hand. If you choose to use the lancing device, it is often necessary to remove the cap from the poking end so that only the lancet is visible. With the cap on the device, it can be difficult to get a good poke because the devices are meant to be used on fleshier parts of the body and sometimes the lancet doesn't actually meet the ear without some pressure being applied.

There seems to be a large population of vets who do not recommend home testing for BG or ketones. While we wish all of them would instruct their clients to home test, I think many of them are either not up to date on current treatment recommendations which do promote home testing, or they think it will alienate the cat or that the care giver will not test as required so they prefer to recommend in office testing. Why even fewer vets mention ketone testing is a real head scratcher especially with a newly diagnosed kitty who has obviously not been able to properly utilize their food intake and get the nutrients they need for some time.

I started off with a special testing place and brushies for a reward afterward but at this point in time, I can test my girl anywhere. When I ask her if Mommy can test her, she has a little ritual dance she does of prancing in front of my face ensuring I get a few swipes of her tail and then promptly sits down to present which ear she wants tested. I never thought in a million years she would be so co-operative but a calm "can do" attitude on your part and lots of love, some kind of treat and patience will win most cats over in a short time!
 
Hi again,
After DKA it is really important that Tommy is eating well.
How is his appetite?
If he is not very hungry, or is refusing food, he may be nauseated and you will need to get some antinausea medication from the vet such as cerenia and ondansetron. He needs to be eating about 1 1/2 times the calories he normally eats at the moment. After DKA food is like a medication as it is necessary, along with the insulin and fluids, to stop ketones reforming.

I am so glad you are going to test the blood glucose levels because it is also very important Tommy is getting enough insulin and the only way to know this is to be testing the BG. It takes away all the guesswork and keeps Tommy safe.

He also needs fluids so if he will let you, add a bit of warm water to his food.

And as previously mentioned the daily testing of ketones in the urine as this is your first line of defence.

So at the moment this is what you need to be doing:
  • Give Tommy frequent small meals. Withhold food for the 2 hours before the next shot so that the preshot number is not food influenced
  • Test the BG levels before EVERY insulin shot and during the cycle to see how low the insulin is taking Tommy and put the numbers in the spreadsheet.
  • If the BG level is under 200, don't feed, stall and ask for help. And test again 20 minutes later. We don't want you to skip a dose if at all possible.
  • Mix some warm water in with the food
  • Test the urine for ketones daily and put the result in the remarks column of the SS and also post it here.
  • Ask any questions at all, we are happy to answer them all and help Tommy..
 
Thank you all for the responses! The testing kit and ketone strips will come from amazon tomorrow and this is where we are right now:

My husband is taking care of Tom until Monday morning and he is following the vets instructions. He gets either anti nausea or an appetite stimulant--I'm not sure which. Also, a potassium supplement, I believe. The vet said to give him his food and shots at 11 am and 8 pm but because of work Steve gave him his food and insulin at 8:30 this morning at tonight at 8:30 . Lantus acts for 12 hours, doesn't it? My brother is keeping an eye on him and knows to give him honey or maple syrup ( what we have right now!) in case he is lethargic or seems confused. I texted my hubs and asked him to add about a tablespoon of warm water. Tommy loves wet food so much he won't mind it at all :) Steve is giving him the shot while Tommy eats as that is what the vet said to do. So far he told me Tom hasn't noticed at all. They kept him at the hospital until his appetite was back so he seems to be eating pretty well but is tired from the whole ordeal this week.

-So when we test in the cycle, is that about half way between shots and food?

-Ketone strips--while he is peeing or in the litter after he pees? I'm thinking while he pees! He looks so proud in his photo ( April of this year--he was a little chunky)--he may be embarrassed with the ketone strips!

-For the testing I ordered some freeze dried turkey treats to arrive with the strips and testing kit! I'm hoping it will help with his comfort level.

Thanks again to everyone!
Tommy and his Fam
 
Charlene Byrne said:
The vet said to give him his food and shots at 11 am and 8 pm but because of work Steve gave him his food and insulin at 8:30 this morning at tonight at 8:30 . Lantus acts for 12 hours, doesn't it?
Click to expand...

Yes Lantus lasts for 12 hours and giving shots at 11am and 8pm is not a good idea. The shortened cycle between am and pm shots could act like a dose increase and then the lengthened time between pm and am would act like a dose decrease. Lantus doesn't work well that way. It works best with consistent dosing as close to 12 hours apart as possible. Ideally you would have no more than a 30 minute deviation in time (either 15 minutes per shot or 30 minutes on one shot) in any given day. Is that possible with DH or brother's schedules?

As for the ketone checking, it needs to be fresh piddle for the most accurate readings. Some folks are able to use a plastic spoon or a small ladle under kitties butt to grab a sample. The other alternative is to try some plastic wrap crumpled up in the box where kitty prefers to pee and hope kitty pees and you get a small sample to test.

Testing wise, Lantus often peaks in action between +4 and +7 hours post shot so testing in that time frame is optimal for determining nadir in most cats. That said, some cats hit nadir later. Randomly testing will help you find the nadir (lowest point in cycle).
 
Thank you, Linda! I will tell my husband that 12 hours apart it the best thing to do with the Lantus. That is what he did yesterday and today. Maybe he misunderstood the tech regarding the times--i will check in with him in a while and ask him to read the instructions to me ;)
I like the idea of the plastic wrap. That's a GREAT idea. We will just need to catch him since we have 3 other cats but it shouldn't be too difficult.
Take care and thank you!
 
Sounds like you are getting well organised.
Your signature is great! Looking forward to seeing the spreadsheet. Don't forget if you can't get it sorted, someone will help you.

Apart from feeding at shot time, it is important that Tommy eats regularly during the day and evening, except for the two hours before preshot time BG level is done.
We want him to eat well as that will help keep the ketones away.
Vets often say just to feed at shot time but that is old thinking with the old type of insulins.
With Lantus we recommend feeding before the shot and a couple of times during the first half of the cycle.
But with Tommy recovering from DKA he needs to eat more than he normally would so give him extra feeds.
I'm glad he likes wet food and the extra water. That makes getting extra fluids into him easy.
 
Thanks, Bron and Sheba! How much should he be eating or should we offer food and let him eat until he is full? Maybe a tablespoon at a time? We are using the fancy feast classics for now--I want to add in some more variety once we get a little more stable but 1 thing at a time :) I think he had a total of 1.5--1.75 cans of fancy feast yesterday. I'm thinking that's not nearly enough now..
 
For a kitty that's post-DKA, you want to be providing about 1.5 times the amount of calories your kitty was generally eating.

This is an approximate formula for calculating daily calories in general: Required calories per day = [13.6 X optimal lean body weight in pounds] + 70 So, you'll want appreciably more calories than this calculation.

Right now, given the recency of Tommy's hospital stay, the key elements for avoiding the return of ketones is enough insulin, enough food, and no infection or inflammation. Those three issues are what generally causes ketones to form. Please keep in mind that ketones can crop up even is a kitty isn't in high numbers -- it's more likely but we've had cats develop ketones with numbers in the 200s or lower.

You don't need to feed a tablespoon at a time. Giving Tommy 1/4 of a can or so every few hours is fine. You just don't want to give food 2 hours prior to shot time once you start testing. If you feed too close to when you're testing at pre-shot, it may influence the numbers and you'd be shooting based on an artificially inflated number.
 
Thank you for your response, Sienne and Gabby! When we took him to the vet about 3-4 months ago he was 9.4 pounds and I thought he was feeling sort of thin-ish. The vet said his weight was "healthy." So, I calculated calories for 10 pounds considering he used to be quite a bit heavier--maybe 14 or 15?. 276 calories would be his maintenance calories--I found fancy feast classic calories on catinfo.org and it looks like they range from about 85-95 a can.

Should we aim for 3.5--4 cans or possibly more than that? I think he had about 1.5 or 2 Friday and his appetite was better yesterday and more so today, DH said.
 
I am so glad Tommys appetite is improving. A lot of cats recovering from DKA struggle with their appetite..
If 276 calories is the maintenance amount and we want him to have 1.5 of that, than 414 calories would be the 1.5 amount.
That would be 4.6 cans a day using 90 calories a can......if my math is correct.
If he will eat that amount, that is great.
Just make sure you withhold the food for the 2 hours preshot so the BG isn't food influenced.
Tell DH he is doing a fabulous job!
 
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