HELP! DKA kitty, preshot 147

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Chloe007

Chloe007

Member Since 2019
Link to previous thread:
http://www.felinediabetes.com/FDMB/...g-unwell-unsure-what-to-do-about-shot.226108/

Oscar just had a preshot of 147 (checked three times) and was due for his shot at 6. His vet told us to feed him and check again in an hour, so he's already been syringe fed.
Not sure what to do. Low number came out of nowhere, he's been in the mid 200's all night prior (updating SS now)

Not sure if I should still give him his full 4u...I know insulin is very important right now
 
How is Oscar eating? It sounds like you're syringe feeding. Do you have a higher carb food you can use to assist feed? Also, can manage to be off schedule? And you are correct -- insulin is essential to keeping ketones away and so is food!
 
Hey guys I'm so sorry, we tried again at syringe feeding and it's been taking a while and then I came here after to update, forgot I made this thread, saw I couldn't reply to the other (without checking all the replies first, totally my fault) and promptly fell asleep for an hour.
No worries though- he came right back up after eating. He's running in the 300's right now, but he did eat a good amount so, eh. Will keep checking and hopefully it comes back down. These numbers were all so unexpected...no idea why he came down like that this morning, it definitely had me worried.

…..in better news, we got a ketone test today. We're at trace!! Hoping this is a good sign! He also seems more alert today, he's responding better to things around him, and moving himself around a bit more. Also why syringe feeding is taking longer, he's getting a little fight in him!
 
Ok BG is up to 413 now, getting concerned. He has eaten quite a bit today, but still...need him to come back down. Is there anything else I can do right now? I mean, I shouldn't stop feeding him if he will take it right?
 
Chloe007 said:
…..in better news, we got a ketone test today. We're at trace!! Hoping this is a good sign!
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Fantastic! Well actually, I'm sure you'd rather see NO ketones but that is better than the 80 reading you had the other day.

No, don't stop feeding Oscar. He needs to eat about 1.5 times as much as normal to recover from the DKA.
 
Blood glucose is going to keep going up. Partially in response to the higher carb recovery food.
But he needs to eat that food, to help him get better.

What time is PMPS tonight? I know you live in the central time zone.

The only other thing I know you can do, is to give Oscar a "bolus" or bonus shot of fast acting insulin, like Novolin R. An absolute teeny tiny dose, like 1 or 2 drops or 0.1U. I've never done that or guided anyone that needed to do that. So I can't help you with that.

You may want to call the vet and ask about doing that. Have them guide you.

I do think that Oscar may need more insulin tonight. We'll have to keep a close eye on his BG levels.
 
Does anyone know if I can crush and turn the Famotidine into a liquid I can syringe him? He's having a real hard time taking the pill. He just hides it in his cheek until he's done (will even keep it there while eating) and spits it out once he gets back in his bed.
 
Call your local pharmacy or the vet's office to ask about the famotidine.

I also suspect that Oscar may have you need off of the AMPS number.
 
Chloe007 said:
Does anyone know if I can crush and turn the Famotidine into a liquid I can syringe him? He's having a real hard time taking the pill. He just hides it in his cheek until he's done (will even keep it there while eating) and spits it out once he gets back in his bed.
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Yes, I've done that with pills for my cats in the past. Crush them, add them to a large feeding syringe, add water and mix well.
Or hide them in a tiny piece of pill pocket.
Or hide them in a tiny piece of cheese or meat.
Or put them really, really far back in Oscar's throat, massage his throat to get him to swallow.
 
Deb & Wink said:
Blood glucose is going to keep going up. Partially in response to the higher carb recovery food.
But he needs to eat that food, to help him get better.

What time is PMPS tonight? I know you live in the central time zone.

The only other thing I know you can do, is to give Oscar a "bolus" or bonus shot of fast acting insulin, like Novolin R. An absolute teeny tiny dose, like 1 or 2 drops or 0.1U. I've never done that or guided anyone that needed to do that. So I can't help you with that.

You may want to call the vet and ask about doing that. Have them guide you.

I do think that Oscar may need more insulin tonight. We'll have to keep a close eye on his BG levels.
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Yeah he's still going up right now...430, I really hope this doesn't set us back with the progress we've made on ketones. I'm thinking of doing fluids again tonight, we were technically supposed to wait until tomorrow as s per vet instructions, but I think it helped us last night and I feel like I'd rather try everything than not do enough. Would an extra 50ml or 100ml hurt him at all, do you think?
Vet is 100% against us using R. I won't have vet support with that if we decided to go that route :/
 
Chloe007 said:
Yeah he's still going up right now...430, I really hope this doesn't set us back with the progress we've made on ketones.
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Prozinc is NOT a depot type insulin. It's possible to give more of the Prozinc and raise the dose quicker to control the higher BG numbers.

I'm thinking of doing fluids again tonight, we were technically supposed to wait until tomorrow as s per vet instructions, but I think it helped us last night and I feel like I'd rather try everything than not do enough. Would an extra 50ml or 100ml hurt him at all, do you think?
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No, I don't think that 50ml of fluids would hurt him. As long as he doesn't have heart issues. As long as the fluids are not pooling in his extremities. Fluids help to flush out the ketones.

Vet is 100% against us using R. I won't have vet support with that if we decided to go that route :/
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Darn. Ok, but darn.
 
What about giving the Prozinc insulin more often than every 12 hours?
What about dosing the Prozinc 3 times a day? At 8 hour intervals?
What about a smaller dose of Prozinc to bring those numbers down?
You'll have a bit of overlap.
Between one dose and the next.

Or dosing as needed, to bring those BG numbers down?

What does your vet say about doing that?

Risky. I've never done it. Or guided anyone trying to do it.
It would take some intense monitoring.
You'd need plenty of test strips for your glucose meter.

Do you have another person to help you Chloe?
 
Chloe007 said:
Does anyone know if I can crush and turn the Famotidine into a liquid I can syringe him? He's having a real hard time taking the pill. He just hides it in his cheek until he's done (will even keep it there while eating) and spits it out once he gets back in his bed.
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Can you get blank gel caps to stuff it into? I see to remember it tastes foul. Maybe coat it in butter. More important, why is he getting famotidine? It's not going to help with nausea.

Royal Canin Recovery is 3% carb, so not causing high numbers. It is also only 183 calories. At 13 lbs, following Dr. Lisa's formula, and multiplied by 1.5, and assuming he's an ideal weight:
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70 or 13.6x13 x 1.5 = 265 calories per day. Plus or minus depending on his metabolism.

Recovery is nice to feed because it's soft and easy to syringe feed. But looks like you'll need more than 1 can a day. The other option is another higher calorie food and using a blender or Magic Bullet to get the texture you like. Just be warned that cats cat build an aversion to food they are syringe fed. My hepatic lipidosis kitty wouldn't eat chicken for months after getting Recovery.
 
Hello! Sorry i just saw the tag on your previous thread, about my cat having a feeding tube. Glad to see you haven't had to go there yet, but do keep it as an option if your kitty won't eat, it definitely saved mine. Your experience sounds exactly like what I went through with Kitty 2 months ago. I hope Oscar recovers soon!
 
Wendy&Neko said:
Can you get blank gel caps to stuff it into? I see to remember it tastes foul. Maybe coat it in butter. More important, why is he getting famotidine? It's not going to help with nausea.

Royal Canin Recovery is 3% carb, so not causing high numbers. It is also only 183 calories. At 13 lbs, following Dr. Lisa's formula, and multiplied by 1.5, and assuming he's an ideal weight:
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70 or 13.6x13 x 1.5 = 265 calories per day. Plus or minus depending on his metabolism.

Recovery is nice to feed because it's soft and easy to syringe feed. But looks like you'll need more than 1 can a day. The other option is another higher calorie food and using a blender or Magic Bullet to get the texture you like. Just be warned that cats cat build an aversion to food they are syringe fed. My hepatic lipidosis kitty wouldn't eat chicken for months after getting Recovery.
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I'll try the butter and see how that goes, if I remember correctly it's prescribed for the pancreatitis. I'm not sure beyond that.
For the Cerenia, they wanted me to bring him in for a shot of it first (wish they would have just done that when I asked, while we were there) and with them being so far, I don't really feel comfortable packing Oscar up and taking him all that way while he's still pretty fragile. He seems okay with the nausea, he's not sitting over his water bowl anymore, just drinking normally now. I'm not really seeing any nausea symptoms since I stopped the appetite stimulant...but if it gets worse again I'll figure it out and make sure he gets it.

I have recovery food, friskies pate, fancy feast gravy (would like to avoid this, has upset his stomach in the past) and friskies gravy lovers. What if mixed some gravy into his recovery food?
 
Deb & Wink said:
What about giving the Prozinc insulin more often than every 12 hours?
What about dosing the Prozinc 3 times a day? At 8 hour intervals?
What about a smaller dose of Prozinc to bring those numbers down?
You'll have a bit of overlap.
Between one dose and the next.

Or dosing as needed, to bring those BG numbers down?

What does your vet say about doing that?

Risky. I've never done it. Or guided anyone trying to do it.
It would take some intense monitoring.
You'd need plenty of test strips for your glucose meter.

Do you have another person to help you Chloe?
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I think I'm going to just start by raising his dose and see how it goes, I'd like to avoid doing anything too different with dosing as there will be a period tomorrow where it's just my boyfriend with him (don't worry, he's well trained and has been here the entire time/going through it too). But if things don't change soon, I'll probably start by trying every 8 hours. Idk, I'll see how tonight goes. I think I'm going to try 4.5u, I don't want to raise too dramatically as I'm worried this could be a bounce of sorts with that 146 earlier.
Shot time coming up soon, will keep everyone posted.

I do have help, but things are going to start getting tricky. I can quit my job need be but I can't quit school and there will be times he's under the watch of others (boyfriend and mom). I'll always have it planned out where I'm the one giving the meds etc, so they're essentially just watching and feeding him and testing his urine, and I'll never be gone longer than 4 hrs at a time, but yeah... I'm kind of trying to figure everything out right now.
 
Chloe007 said:
What if mixed some gravy into his recovery food?
Click to expand...
It's not carbs you want, it's calories. So look for a food with a higher fat count, or higher calories on Dr. Lisa's list.

Cerenia is also available in pill form and that one definitely tastes horrid. You can also get pill shooters or pill guns that help you put the pill further back in their mouth, so harder for them to spit out. Make sure you give some water before and after pilling.
 
Wendy&Neko said:
It's not carbs you want, it's calories. So look for a food with a higher fat count, or higher calories on Dr. Lisa's list.

Cerenia is also available in pill form and that one definitely tastes horrid. You can also get pill shooters or pill guns that help you put the pill further back in their mouth, so harder for them to spit out. Make sure you give some water before and after pilling.
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Maybe that's been my problem, not syringing water before and after. Shoot. Seems obvious now.
Will look for high calorie foods.
 
Hi Chloe,
You may want to compare the Libre to your hand held meter that you test the blood droplet with. I found that when I used the Libre on Freckles the high numbers were sometimes off by as much as 200 points when compared to my glucometer, so I did not rely on it for accurate numbers. Just sharing my experience and yours may work better, but it might be worth a check.
 
Chloe, great news that the ketones are down to trace!! Well done.
Oscar could be bouncing from the 146 AMPS. Can you update the SS so we can see latest numbers please.

Hills a/d is 183 kcal per 5.5 Oz can,(155g)can.
 
Judy and Freckles said:
Hi Chloe,
You may want to compare the Libre to your hand held meter that you test the blood droplet with. I found that when I used the Libre on Freckles the high numbers were sometimes off by as much as 200 points when compared to my glucometer, so I did not rely on it for accurate numbers. Just sharing my experience and yours may work better, but it might be worth a check.
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Thank you! I have been and in lower numbers it is almost exactly the same (earlier 146 was 145 on my meter) and about 20-30 points off in higher numbers (413 was 430 on my meter)
 
Chloe can you update the SS please? .
I would be cautious increasing the dose while you are introducing sub Q fluids. I know you don’t like higher numbers but you had a 145 at AMPS yesterday and you were worried about shooting it. If he’s bouncing now from that blue and you raised the dose you might get lower numbers than you want...and we don’t want to be in a position of having to skip a dose.
The ketones are down to trace so what you are doing is working. That’s the most important thing.
I would concentrate on getting higher calorie food into him and insisting that the vet give you some cerenia tablets so that any nausea is treated and he has a chance to eat on his own. Just say you are not going to put him through going back to the vet so they can give you the tablets.
 
Deb & Wink said:
Back to medical school tomorrow?

Was very glad to hear you have a helper. Your boyfriend.
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Not tomorrow, but Monday. Tomorrow I have a shift at the bar....not even 100% I'm going because I'm so nervous to leave him (not unattended, but nonetheless) however, not going would mean no job. At least until I find something else. I'm really stressed about all this right now :/
 
Bron and Sheba (GA) said:
Chloe can you update the SS please? .
I would be cautious increasing the dose while you are introducing sub Q fluids. I know you don’t like higher numbers but you had a 145 at AMPS yesterday and you were worried about shooting it. If he’s bouncing now from that blue and you raised the dose you might get lower numbers than you want...and we don’t want to be in a position of having to skip a dose.
The ketones are down to trace so what you are doing is working. That’s the most important thing.
I would concentrate on getting higher calorie food into him and insisting that the vet give you some cerenia tablets so that any nausea is treated and he has a chance to eat on his own. Just say you are not going to put him through going back to the vet so they can give you the tablets.
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SS updated. Did what you said and called the vet, I'm going to pick up Cerenia in the morning. I did end up raising his dose, not by much, probably a little under .25u because I was getting nervous raising him. Would it be unsafe to still do fluids tonight? Do fluids lower BG? I didn't realize that.
Looking at the chart to find a high calorie food I can pick up
 
I’m glad you are getting some cerenia. That could make a big difference to Oscar.

Yes, subQ fluids can lower the BGs. I have seen CGs note this on Fdmb.
Have you given any fluids yet today? Can you note in the SS when you give the subQ fluids please?

If you haven’t given any subQ fluids today I would be inclined to only give 50 mls because you raised the dose and we don’t know how low this dose will takeOscar. I’m thinking more of a low Preshot next cycle and having to skip, than low nadir. However the fluids are important flush out the ketones. See what others think.
 
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Chloe007 said:
Does anyone know if I can crush and turn the Famotidine into a liquid I can syringe him? He's having a real hard time taking the pill. He just hides it in his cheek until he's done (will even keep it there while eating) and spits it out once he gets back in his bed.
Click to expand...
We always used this for our ferrets. Standard procedure is dissolve in water and give orally with a syringe. They aren't time release, so I don't think crushing or cutting effects them at all.
 
Bron and Sheba (GA) said:
I’m glad you are getting some cerenia. That could make a big difference to Oscar.

Yes, subQ fluids can lower the BGs. I have seen CGs note this on Fdmb.
Have you given any fluids yet today? Can you note in the SS when you give the subQ fluids please?

If you haven’t given any subQ fluids today I would be inclined to only give 50 mls because you raised the dose and we don’t know how low this dose will takeOscar. I’m thinking more of a low Preshot next cycle and having to skip, than low nadir. However the fluids are important flush out the ketones. See what others think.
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He last had 100mls last night around 9:00pm. I decided to do a little less than 50mls just now at 11:00pm.
 
I haven't used that product, but I have used Carnivore care. It's a powder you add water too to make a liquid for assisted feeding, or add to wet food for a calorie bump if a cat is eating on its own. It's mixes very smooth and is awesome if you have to do assisted feeding. It's mostly egg protein, easy to digest and packs a lot of calories into a small amount. You might want to consider it. Link is to a small size, but there are other sizes available. It's formulated for big time carnivores, like cats and ferrets, rather than dogs. It has added taurine and no sugar. We always used this for ferrets that needed assisted feeding, and I've used it with cats who needed help as well.


Ingredients
Dried Whole Egg, Poultry Meal, Fish Oil, Tricalcium Phosphate, Silicone Dioxide, Calcium Carbonate, Choline Chloride, Biotin, Taurine, Hydrolyzed Yeast, Sodium Benzoate, L-carnitine, L-Ascorbyl-2-Monophosphate (Vitamin C), Vitamin E Supplement, Niacin Supplement, Zinc Sulfate, Potassium Iodide, Vitamin B12 Supplement, Manganese Sulfate, Copper Sulfate, Riboflavin Supplement, d-Calcium Pantothenate, Vitamin A Supplement, Thiamine Mononitrate, Folic Acid, Pyroxine Hydrochloride, Vitamin D3 Supplement
 
Chloe007 said:
Would something like this be good for Oscar?
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it does contain dextrose which is a sugar so I'd avoid it. Also, although it sounds like something that would add a lot of calories, it's only 2400 calories for the entire 16oz bottle. It's actually about 25 calories per teaspoon so to make much of a difference, you'd have to use quite a bit
 
Hi! I was tagged in a previous post as I have been through a DKA with Alice.

I just wanted to pop in and add, I saw the possibility of shooting 3x/day mentioned. This is actually what I did post-DKA to regulate Alice. She was on a lente insulin (NPH), and after a few days of shooting every 8 hours I was able to switch her to a depot insulin. I am not at all familiar with ProZinc personally so I don’t know how this would work.... and if you have a heavy work/school schedule, TID can be hard, but it really did help Alice and me, at least.

Also, someone mentioned perhaps that 146 was a bounce? What about the concept of “feeding the curve” ? Let me rustle up a link....
 
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Hey guys sorry I wasn't able to update today, I had to work a shift at the bar and my boyfriend was at home caring for him. I hope I didn't worry anyone, and I'm about to update his SS.
I'm happy to report Oscar is doing really, really good... considering.
Lots of big steps today.
First negative ketone test!
First time eating dry food on his own (only a little bit....but still!).
He's meowing at us again, acting silly at times (rolling over on his back, and meowing at us for belly rubs).
He's starting to not be so wobbly when he walks.

We've still got a ways to go...but I'm finally feeling like there's a light at the end of this tunnel.
 
@Wendy&Neko

Whenever you find a minute, I noticed that your Neko had lymphoma and Oscar's primary vet is concerned he may have it. He's always had IBD, and based on some radiographs where his liver and stomach both looked enlarged as well as his new battle with pancreatitis, it's something they definitely want to look into once he's recovered from the DKA. She also mentioned that his bowels feel thick, if that makes sense?
The next step it seems, will be ultrasound. I'm not sure if this is meant to be diagnostic or simply the next step, and I'm mostly wondering what I should expect once we get the ultrasound and what will be next.
Do cats usually go on chemo for this?
 
The ultrasound will measure thickness of bowels in different places, and see if any lymph nodes are larger. If the bowels are thicker than normal, it can be IBD and/or lymphoma. You need to have a biopsy sample taken and analyzed for definitive diagnosis. Depending where thickening is, biopsy can be taken via endoscopy (less invasive) or needs surgical biopsy. Neko didn’t have a proper diagnosis because her heart could not take anesthesia. Internal medicine vet said severe IBD or small cell lymphoma and we treated as SCL. Chemo consists or a steroid and chlorambucil. Neko was on daily budesonide for steroid, her heart precluded prednisolone. Budesonide did not impact blood sugars thankfully. Chlorambucil was once every two weeks, with anti nausea meds day of chemo and a few days after. A majority of kitties go into remission from SCL on this chemo protocol. Neko had too many things going on with heart and kidneys plus SCL.

Good to hear you seeing some of the old Oscar. Give that tummy a rub from me.
 
Just read your question about fluids. I tried to separate insulin and fluids by time and location. I liked giving fluids after nadir, when her numbers were going up anyway. And I would side shoot insulin since fluids went in the scruff. The only time I saw any impact on numbers was when fluids were unplanned (done at vet), before nadir and too close to insulin shot location.
 
Good news that Oscar is doing better and better each day.
Hugs all around, for you, for your boyfriend stepping in to help, and for the sugardude himself, Oscar.
:bighug::bighug::bighug:
 
He's starting to eat his Dr. Elsey's on his own, also goes nuts over treats when offered (friskies party mix). Not sure how long I should keep giving him the junk treats, but if it's helping get his appetite back should I keep offering some?
He's also taking his syringe feedings better, like he's actually wanting to eat and I'm just helping him out. This morning I got a half can into him in just one sitting, which was nice so we could take a little break. Planning to do the other half can at shot time. Then I'll keep offering his dry food throughout the night.
He's getting diarrhea (not too bad yet) from all the wet food, which has always been a problem for him.
Ketone test appears negative :)
 
Quick question- at what point can I feel like Oscar has "pulled through" with the DKA? What needs to happen before I feel like we're safe?
 
I don’t think there is a particular point to say he’s pulled though, but a week without any ketones is a good start. And then another week.
He needs to be eating normally and his blood work normal I would think.
No lethargy.
And he needs to be getting the correct dose of insulin so keep monitoring that closely.

But in saying that all the little steps are great... negative ketones, starting to eat on his own.
 
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