New Member - Anxious/Need advice

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KatieBDZ

KatieBDZ

Member Since 2020
Hi all,

I discovered this forum when trying to do research after my cat Arya was recently diagnosed with diabetes on Friday 2/14. She ended up losing 6 lbs and had DKA which led to a transfer to an emergency vet where she's been since Friday. She has not been discharged yet because they are still stabilizing her insulin levels. She also has the complication of fatty liver disease. As I understand it her blood glucose levels have been in the 300s and shes getting lantus. She's been eating well but before this she was eating dry food only and the vet now has her on a dry bland food I was told. I want to switch her diet but I'm very concerned about figuring out the right dose of insulin and that she keeps eating for both the DKA and fatty liver disease, any advice and other tips for what to expect/do when she gets home would be greatly appreciated. I'm very nervous especially with her complications. I did get the Alphatrak 2 for at home testing.

Thank you for any help!
Katie
 
The perscription dry foods are too high in carbs. The recommended foods are wet and under 10 percent carb. Many on here use fancy feast classic or Friskies pate foods.

So glad you are going to be home testing. I have a video in my signature showing how I test my cat CC at home.
 
Hi Katie, welcome to you and Arya.
There are a number of things you can do for your kitty once you get her home.
Because she has had DKA there are extra things you will need to do apart from testing and giving insulin.

DKA happens when there is not enough insulin, not enough food and an infection or inflammation in the body.
Ketones form and if not treated this leads to DKA.
So the things you will need to do are:
  • Buy a bottle of ketostix from a pharmacy or Walmart so you can test for ketones daily once you get Arya home. You simply get a urine sample from her and dip the test strip into the urine and read the result exactly 15 seconds later. Anything above a trace needs vet attention..
  • It is really important that Arya is eating lots of food as food acts as a medicine with recovery of DKA. She will need about 1 1/2 times as much food as she normally eats. This will help stop ketones forming again.
  • She needs her insulin. I am so glad you are going to be testing as this is so important for a few reasons....it will keep her safe and it will tell us if she is getting enough insulin to keep the ketones away.
  • She will need extra fluids. A good way to do this is to put some warm water into her food (if she will tolerate it) and make it soupy.
  • I would recommend you set up a spreadsheet (we have a great one here) and document all the blood glucose levels in it. I will include a link at the bottom for the SS. If you have any trouble just ask for help and someone will help you set it up.
  • Set up your signature. That will appear at the bottom of all your posts in smaller writing, and will tell us about Arya so we don't have to keep asking you for in information.
  • Ask the vet for antinausea medications such as cerenia and ondansetron to bring home with you. A lot of cats following DKA are nauseated and have trouble eating so it is really important you have some of these meds on hand to use. If a cat is nauseated she won't eat, but will walk away from the food.
  • Check with the vet that any infection she had when she was admitted with DKA has been treated and you have antibiotics to bring home if needed.
Lantus is a good insulin for cats.
This link I am sending you has a lot of information for new members. I would recommend you print it off for reference later. There are several links within the link for you.
Ask lots of questions. DKA takes time to get over. We are very happy to help you. We have quite a few DKA kitties arrive here.
Ask lots of questions.
Here is the link
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
Bron
 
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Also here is a link to food charts. Choose the list for your country.
Look for foods that have carbs less that 10%. Canned food.
There is no need at all to buy the prescription foods that the vets sell. They are no better and do nothing magical to help.

Also look for some higher carb food around 13 to 14% carbs (medium carb) for your hypo box and some around 18 to 20% (high carb) also for your hypo box. Mark these ones with the number of carbs on the top of the can with a texta and put them in a seperate place to your normal low carb food.
In the beginning Arya will need extra food as I mentioned and if you can find some low carb food that has extra calories that would be very suitable in the beginning.

.http://www.felinediabetes.com/FDMB/threads/links-to-food-charts.174182/
 
I just tried APPAWS cat food 4 ingredients not sure the carbs but has to be low because Dre doesn't go up at all--TIKI is very low too but fancy feast classics are cheap and they like it
 
Hi everyone thank you for the thoughtful responses and all the information! I will work on setting up a SS and reading everything. For food I picked up soulistic pates - chicken and tuna, duck and tuna, chicken and salmon, chicken and pumpkin and chicken and lamb. I'm going to have a diabetic dry food as a backup only because she needs to keep eating for the DKA and fatty liver as told by my vet so I'm nervous about transitioning her (she's only ever eaten dry food and that's what shes eating there too). For higher carb options I got moist and tender tuna and beef and midnight delight. I also got pure bites freeze dried chicken breast for a treat for shots/blood glucose checks. I'm picking her up today but the vet said she still has ketones present but it's resolving and will continue to resolve with the insulin so they are still releasing her..this makes me nervous since you said even trace amounts require vet attention.
 
The vet is releasing her, so they must think she is doing well enough. You can test for ketones at home and make sure her level doesn't rise again. Most people use Ketostix, which you can buy at any pharmacy, very inexpensive. They test urine. I got a blood meter because my cat is a shy pee-er, but the strips are a bit expensive. You are doing great, and did well getting all your ducks in a row.

Here's a link that tells you all about Ketones and has tips on getting a urine sample.
 
Think that Bron may have linked the wrong article. The CRD thread is for cats with Chronic Kidney Disease (CKD). I did not see any mention of kidney disease in the original post.

Maybe she meant this one instead? This is the one that contains information for setting up our standardized spreadsheet and setting up the signature, as well as some basic info on using the forum.
New? How You Can Help Us Help You!
 
Thank you! She is home now, the vet was really pushing the prescription diet and stressed that she needs to eat a lot since she has the DKA plus the hepatic lipidosis. Also she is on 4 units of lantus which seems very high to me..she said if I test and she's above 300 do the 4, if she's below 200 do 2 units.
 
She does need to eat a lot...calories are like medicine when it comes to DKA and HL.....but it sure doesn't need to be that prescription junk.

As far as the dose goes....4U is a HUGE dose for so early in her diagnosis. Lantus also shouldn't be used on a "sliding scale" like that (4U if over 300, 2U if under 300)...it works best when given at the same rate both AM and PM.

What is her current weight?

When do you plan on giving her insulin? It should be at times when you can give every 12 hours.
 
I echo Chris...she does need to eat a lot.
Try and get the SS up and running otherwise private message @Chris & China (GA) and she will set it up for you. She is a whizz at setting them up in no time. It is really important we get that set up quickly so we can see what the BGs are and if the dose of insulin is correct.
Did you get the Ketostix to test the urine for ketones?
That needs to be done at least once a day at the moment if she still has ketones.
Encourage her to eat as much as you can. Any food at this point is ok. It doesnt matter if it is higher carb or dry food.....the most important thing is she is eating. We can worry about getting her onto low carb later.
 
One way to grab a urine sample to test for ketones is to use a soup ladle under the butt. The directions for reading the urine strip is very explicit on the Ketostix so make sure you follow them to the T. Glad to hear that Arya is home. Vet visits can be stressful on the little ones. By being on this forum, you are at the right place. Experienced people can help you along this journey.
 
Hi all I got my spreadsheet up..I'm still new at testing the blood glucose so doing my best (also will have to go back to work tomorrow) but always testing before the shot. As you can see they vet keeps telling me to do the 4 units at night and then in the morning she is too low and I'm skipping the dose so I think that's too high, they told me when I called this morning that they think she had insulin resistance at the beginning and is just responding now I told them I will call tonight before her shot (after taking blood glucose) but that it has to be less than the 4 units since that's clearly not working properly. When she was there they started her on 1 unit, then 2 units, then 4 units which they monitored for 24 hours - when she was there they said she wasn't ever getting below 300 which is why they went up to the 4 units and even on 4 she was not below 300. I got her home at around 3 pm on 2/17. Since she's been home she hasn't been able to have the 2 shots 12 hours apart yet. Any advice (see SS for exact numbers but she keeps being too low in the morning)? I also got the ketostix and will try to get a reading today. For food I've been able to get her to mostly eat a low carb dry food I found (tiki born carnivore - 10-11% carbs) with a mix in of some of the higher carb (orijen cat and kitten chicken flavor) but her appetite has improved. She still won't touch the wet food I've been offering but just want to keep her eating for now and get the insulin regulated and then will try more to get her transitioned. Thank you all again!
 
Now a second vet from the same office called me back and said to give her 2 units this morning and 1 unit if she wasn't eating well and said to never skip shots - he said I should only take advice from one doctor or otherwise I'll be going crazy/she won't get regulated..even more confused now!
 
Deep breaths, hold, release, deep breath, hold, release, ..........................

We know how very stressful and worrying this must be for you. Please, understand that we are here for you. We know a lot about feline diabetes and think we can be of great help to you. Sending you some big hugs to help you as you begin this journey with your diabetic cat. :bighug::bighug::bighug:

It took time for your cat to develop diabetes. It will take time for your cat to get better. One saying we have here is "This is a marathon, not a sprint." Give it time. Cats can live successfully, happily for many years with diabetes.

I can certainly understand why you are confused. Conflicting advice from 2 different vets at your vet office is confusing you even more. Telling you to only listen to one vet, not knowing if 1 of the vets is more experienced with treating feline diabetes in a cat than the other vet. They should at least be talking to each other?!?!

Plus, you are trying to learn more here on this forum about how to better treat your diabetic cat.

There was a study done many years ago on lantus insulin, the Roomp & Rand protocol, scientifically based, vet journal published, updated since the original publication. We have 2 protocols we use here for managing cats using Lantus insulin.

The first protocol is TR (Tight Regulation) that was developed and modified from that original R&R protocol. Modifications were made based on the experiences of hundreds of cats here.

SLGS (Start Low, Go Slow) is the second protocol we use here to mange a cat using Lantus insulin.
Take a look at this document, that explains the 2 protocol methods.
Sticky: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

The second vet this morning is correct, with the recent DKA episode you do not want to SKIP shots. That can lead to another DKA episode. Classic setup for ketones forming and then leading to DKA is not enough insulin + not enough food + an infection or inflammation somewhere in a cat's body (UTI, bad teeth).

Getting enough food into Arya and some insulin is more important right now than getting her regulated. The hepatic lipidosis (HL) and the recent DKA combined make it more urgent to get sufficient food and insulin into Arya every day.

Doesn't matter that Arya is eating higher carb dry food right now. Whatever she will eat, and eat well and eat enough of is more important.

Here is a document that talks about the "depot" effect of Lantus insulin.
Sticky: What is the Insulin Depot?

Lantus has a "depot" or storage area. Crystals form underneath the skin and then some of the insulin is slowly released over time. Changing the dose from cycle to cycle or skipping the dose, will let the "depot" storage area drain a bit. That is one reason why you are seeing such wild swings in the BG levels. Skipping shots and changing the dose is doing that.

The 4 units was obviously too much. IMHO, your vets do not understand Lantus insulin use in cats. Raising the dose of Lantus from 1 to 2 to 4 units over the course of 24 hours was inappropriate. It's no wonder that Arya is bouncing all over the place. She is on a roller coaster ride, up and down and up and down.

Even a tiny bit of insulin, like 0.25U may be safe for Arya when the BG levels are low, like they were this morning.
Getting more BG (blood glucose) tests at home will help to see when Arya's onset and nadir occur and will let us see the duration of the Lantus insulin in YOUR cat.

Do you have plenty of Alphatrak test strips? A couple of containers of 50 strips would be appropriate.

The dry food that Arya is eating is probably the only thing that kept here from having hypoglycemic symptoms and is keeping the numbers high with that 4U dose. DO NOT CHANGE THE FOOD AT THIS TIME. You need to stabilize Arya and get her eating lots of food and have the hepatitic lipidosis resolve first.

Hang in there. The first couple of weeks with a diabetic cat can be intense, learning all you can to help your Arya feel better. We understand what that is like. We have all had diabetic cats at one time.
 
Thank you deb - looking at the dosing method info now - do you think the 2 units is ok? My regular vet told me to do 2 units twice a day for a week first just to see where she is at on that before making any other adjustments. Unfortunately I go back to work tomorrow so will only be able to get a +1 number in the morning after the dose and will then be gone for the next 9 hours (I do have a friend coming at 10 am to check on her but that is the best I can do at this time). Also for food - I've been limiting her to eating in the morning (after glucose test, before shot) and at night - to try to ensure that she'll be hungry enough to eat at shot time - do you think I should be offering her food during the day too to try to get her to eat more calories with the DKA/HL? This morning she ate about a half a cup of food like I said but did not receive any insulin - the second vet didn't call me until it had already been 2 hours later than her shot time.
 
KatieBDZ said:
Also for food - I've been limiting her to eating in the morning (after glucose test, before shot) and at night - to try to ensure that she'll be hungry enough to eat at shot time - do you think I should be offering her food during the day too to try to get her to eat more calories with the DKA/HL?
Click to expand...
Absolutely give her more food to eat. She may need twice as much food as a normal cat. DKA/HL cats need to eat more food to help them heal and get better.

KatieBDZ said:
looking at the dosing method info now - do you think the 2 units is ok? My regular vet told me to do 2 units twice a day for a week first just to see where she is at on that before making any other adjustments.
Click to expand...
Not sure on the 2U of insulin. May be enough, may be too much. This is one situation where I don't feel confident of giving you a good answer. Mainly because of the DKA/HL situation. 2U with a low BG pre-test, very little test data may be too much insulin.

I'll tag a couple of people that may be able to help. They may be at work or taking care of other life responsibilities, so you might not get an answer until this evening sometime.
@Sienne and Gabby (GA)
@Wendy&Neko

Are you able to get any more BG tests today Katie? Anything in this AMPS cycle or in the PMPS cycle would be helpful.
 
Thanks I'll switch to other post - sorry for duplication. I just tested her - no insulin this morning but it's been 5 hours out from the shot time and she is at 326 - I'll be able to test her for a few hours before I go to sleep tonight too
 
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