Ketoacidosis--Please help!

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Lauryn Harriman

Lauryn Harriman

Member Since 2020
Hi everyone,

My husband and I have had a very rough day. We have been treating our cat for diabetes for 10 months now. He went into Ketoacidosis last April--he was truly on death's doorstep--but we were able to save him by taking him to the vet and having them treat him for 3 days and $3500... 10 months of twice daily insulin injections and apparently we are here again. I should say he was doing magnificently before this slip (healthy, beautiful coat, etc).

He had been acting off for the past few days and we were finally able to get him in today. He truly is not where he was the first time we went through this with him. He is still responsive and a bit feisty (his personality is full feisty/sassy), and I truly was not expecting to get this news today. Her recommendation was to either pay $1800 more in care (which we can't afford) or that it may be time to say goodbye. He has a UTI and they want to do numerous tests, manage glucose, ketones, electrolytes, IV fluids, Vitamin B, etc.

Honestly, I was resigned that we were going to have to put him to sleep, but I just found this message board today and I'm really hoping there is something we can do at home to treat him. He is eating and drinking on his own. He does not seem like he has given up. Before I found this forum I asked that we get the prescription for the antibiotic he needs at least--I think I was still really really hopeful and just kind of praying for a miracle in my own way. This is such a horrible call to make especially when you are making it because of money.

Through this amazing website I have seen a couple threads where people have pulled their cats through this on their own, and frankly we want to give it a try even if it doesn't work I want to give what I can to help him survive (even if we don't have the money this time around).

SO
Can someone talk me through this? Give me a list? Tell me what to ask the vet? Etc? We are a bit at a loss and know nothing about this, but we want to give it all we've got!

Thank you in advance for anything you can help with!
Lauryn (and Ramesses the tuxedo cat)
 

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Welcome, sorry it’s under these circumstances. As you know the best place for Ramesses is at the vet. DKA is very serious. Do you have the antibiotic? He needs that, SubQ fluids, lots of calories (AD food is good for that. It’s easy to syringe if necessary) and insulin. I have no experience with ketones, so I hope as others wake up, they will be around to give you more info. Where are you located?
 
Hi Sharon,


We don’t have the antibiotic, no, but we’ll have it in the next hour. We decided to at least pay for that ten minutes before closing time and we live thirty away.

He is ravenously hungry which is an improvement from yesterday. He wouldn’t eat for the vet. But has been interested in food ever since he’s been home. I just don’t know how much to feed him without triggering the diabetes. Can I feed him more food and insulin without messing up everything? I’m out of my depth if I’m being honest.

my husband did give him pedialyte last night and he has been drinking a TON of water.

We’re in Portland, Oregon USA.

thank you for your help!
Lauryn
 
Food is medicine for him now. So is insulin. They are your best weapons against ketones; cats usually get into their worst trouble when the ketones make them feel too lousy to eat (vicious circle), so the fact that Ramesses wants to eat right now is wonderful!!!!

Clarification: is he in actual DKA or is it just high ketones detected at the vet?
 
I believe he is dka, sadly. They gave him nausea meds yesterday and he ate a lot of food on his way home from the vet. He is still interested in food and has been asking for it for the last 15 hours since. We gave him some tuna water to encourage the fluid which he loved. He is upbeat and his wide-eyed semi cranky self.
 
Lauryn Harriman said:
I believe he is dka, sadly. They gave him nausea meds yesterday and he ate a lot of food on his way home from the vet. He is still interested in food and has been asking for it for the last 15 hours since. We gave him some tuna water to encourage the fluid which he loved. He is upbeat and his wide-eyed semi cranky self.
Click to expand...


Well... that is really surprising (in a good way!), usually by the time they get to DKA, they are in really really rough shape. Let's hope that either it's a misdiagnosis, or an extremely mild version (numbers juuuuuust blipped over some borderline). Normally, DKA does require fairly intensive vet care. If he's still active and eating on his own, and is about to have an antibiotic on board, it might be possible to bring him out of this with home care, but I don't want to sugar-coat things.

Tagging @Sandy and Black Kitty , who has had some experience with DKA recovery, hopefully she will be available to offer some insights.

In the meantime, the "recipe" for ketones/DKA in a diabetic is: not enough food, not enough insulin, and some triggering stress (like the UTI). The first and third are being addressed with food and (soon) an antibiotic, now we need to worry about making sure he's getting the insulin he needs.

What kind of insulin do you use, and what dose? Do you ever home-test his blood glucose, and if not, would you be willing to learn to do it?
 
Lauryn Harriman said:
He has a UTI and they want to do numerous tests, manage glucose, ketones, electrolytes, IV fluids, Vitamin B, etc.
Click to expand...
Did they test his ketones? It sounds like they have not tested his ketones yet. You can test them yourself. Many members here test ketones with inexpensive ketostix you can get at the pharmacy. They test urine. You have to catch him when he's peeing, because the urine needs to be fresh. I think it would be a very good idea for you to get a test. I can't help wondering if his symptoms could be from the infection rather than ketoacidosis, or if his ketones might not be horribly high, as your cat doesn't seem quite his normal self, yet does not have major symptoms.
 
Hang in there and hang in here... I

Can you tell us about his insulin therapy? What insulin are you giving your cat? How has he responded ?

Are you checking his urine or a blood for the presence of ketones? This is your first line of defense.

The way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.




 
Hi again everyone,

so he definitely does have Ketoacidosis, but they did say we caught it very early (unlike last time). I ordered the litter to collect a sample and we bought the tests to both check blood sugar and the ketones. We’ve been rushing around trying to do and get what he needs. We started the antibiotic this morning and have tested his blood sugar once. It was “high” about two hours after eating and after his insulin (I gave him the insulin to him right after he finished eating).

we bought the nausea meds and the sub-Q fluids so we are about to start that. Typically, he takes one unit of vetsulin twice daily. He has been consistent and doing amazing until recently. The last curve we had our vet draw looked “beautiful.” That was back in mid November.

we bought the ReliOn strips and blood test. We’ve been adding some tuna water to his water to encourage him to eat. Guys, we are shooting from the hip here, but honestly whatever we can do is better than nothing because we have been planning to put him to sleep tomorrow. I don’t want him to be in pain or feel like we are torturing him, but I want to give it all we got.

How much pedialyte should we be giving him? Does anyone know? I’m not currently having to force-feed him. He ate about 85% of his food this morning.

Sandy and Black Kitty said:
Hang in there and hang in here... I

Can you tell us about his insulin therapy? What insulin are you giving your cat? How has he responded ?

Are you checking his urine or a blood for the presence of ketones? This is your first line of defense.

The way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.
Click to expand...
 
We just started tracking his blood today. We use vetsulin. And he’s currently on one unit twice daily.

He tested as “high” this morning (10:30).

Nan & Amber (GA) said:
Well... that is really surprising (in a good way!), usually by the time they get to DKA, they are in really really rough shape. Let's hope that either it's a misdiagnosis, or an extremely mild version (numbers juuuuuust blipped over some borderline). Normally, DKA does require fairly intensive vet care. If he's still active and eating on his own, and is about to have an antibiotic on board, it might be possible to bring him out of this with home care, but I don't want to sugar-coat things.

Tagging @Sandy and Black Kitty , who has had some experience with DKA recovery, hopefully she will be available to offer some insights.

In the meantime, the "recipe" for ketones/DKA in a diabetic is: not enough food, not enough insulin, and some triggering stress (like the UTI). The first and third are being addressed with food and (soon) an antibiotic, now we need to worry about making sure he's getting the insulin he needs.

What kind of insulin do you use, and what dose? Do you ever home-test his blood glucose, and if not, would you be willing to learn to do it?
Click to expand...
 
Nan & Amber (GA) said:
How many hours after the shot did you get the 564?
Click to expand...


I gave him a shot at 7:45 when he ate 85% of his food. Got the “high” rating at 10:30. Then let him eat the last 15% of his food and gave him another insulin shot. We got the 564 rating at 12:30.

I will be the first to say I don’t know what I’m doing, but I figure that if I’m getting a “high” rating he probably needs more insulin. Please tell me if I’m wrong...
 
Some good news for you: vetsulin is a pretty good insulin to be using to recover from DKA, because it is fast-acting and can bring numbers down quickly (later, there are some other insulins that might be better for him longer-term, but let's get past this crisis first). The question now is dose, whether 1U is right for him right now, and that will probably take some discussion back and forth, and some more data from blood glucose tests. Congratulations on getting your first tests, by the way-- amazing job to get that up and running so quickly!!!!

Because we're all in different time zones here, we have our own way of telling time, in hours since the shot. So for today, what you have for BG data would look like:

AMPS (morning pre-shot BG): no data
+2.75: "HIGH"
+4.75: 564

We also use a common spreadsheet template to record data-- you can see that most of us have links in our signatures to our cats' spreadsheets. They're really helpful, not just for you to keep track of data, but also it means anyone giving advice can see your cat's history at a glance.
FDMB SPREADSHEET INSTRUCTIONS

Probably more insulin is needed, but let's wait for some of the more experienced DKA and/or vetsulin users to weigh in before deciding on the next shot. And let's see where his BG is at the next shot time, in case there are surprises.

We recommend getting a BG reading before every shot (to see if it's safe to shoot), and then more as needed to monitor between shots. You will probably be testing fairly frequently right off the bat in this situation-- DKA recovery is pretty much jumping in the deep end!-- [ETA: I also missed that you had given a second shot! Ignore the following advice and keep testing this afternoon!] but I think you can give him a break the rest of the afternoon with him so high.
 
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And a second dose of insulin on top of the first dose means you want to test more.
You have given 2 doses of insulin, within the space of 1 hour and 45 minutes of each other.

How many units of insulin the first time at 7:45? How many units of Vetsulin, insulin the second time? at 10:30?

Does this look correct? Need to know the dose of insulin given at +2.75 hours
AMPS (morning pre-shot BG): no data 1 U vetsulin
+2.75: "HIGH" ? U vetsulin
+4.75: 564
 
Hi and welcome. You are getting lots of great advice.

Are you offering food frequently?
Food is like a medicine with ketones and DKA and it’s very important that your kitty (not sure if his name, did I miss it?) is getting 1 1/2 times as many calories per day as he would normally get.
What are you feeding?

At this point it doesn’t really matter if the carbs are higher than normal.. the most important thing is he is eating and eating more than he normally would.
It is GREAT he is eating on his own and hungry. That is a big plus!

If you can get the spreadsheet up and running we can help you with the insulin dosing as that is just as important as food. You will need to test before EVERY SHOT and again DURING the cycle to see how low the insulin is taking your kitty.

How much subQ fluids did the vet say to give?
Did the vet ok giving the sub Q fluids?
It is important to give the subQ fluids in the scruff of the neck and the insulin in a different spot away from the subQ fluids site. Also give the subQ fluids AFTER the nadir (the lowest part of the cycle... usually after +6 of the cycle).

Do you have some higher carb food and honey or karo at home as you will need those if the blood glucose level drops low?

Also check for urine ketones twice a day at this point... very important.

Sounds as if you are getting well organised and have caught this early. keep posting and we will do our best to help you through this.
Bron
 
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Just seeing you gave a second dose of insulin during the same cycle.
This is not advisable. Please don’t give a second dose of insulin during the same cycle.
As Deb said you will need to test much more frequently and make sure you have some of the high carb food and honey available in case of low numbers. Dont wait til the numbers are low to get the supplies. Get them now.
 
Just a reminder with Vetsulin you want to test, feed him, then wait 30 minutes and then give the vetsulin.
It can be a good idea to feed your cat 20 - 30 minutes before giving insulin. This ensures there is food on board for when the insulin starts to work. So, the sequence would be: 1. Test BG. 2. Feed. 3. Wait 20 - 30 mins. 4. Give the insulin shot

I'm really praying that he is going to pull through, :bighug:
 
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Spreadsheet is updated. See signature.

Just tested 5 minutes ago and he's at 552.

Understood on the extra insulin. We won't do it again. We have honey on hand in case the BG gets low - thanks for the tips.

For what it's worth he when he was first diagnosed he was on 2U Vetsulin 2x daily. The vet reduced it to 1U after about 2 months of treatment because it made his numbers too low. He has always been on vetsulin.

The doctor did OK subQ fluids. 200mL today, every other day which we will be starting.

We are taking him to the vet tomorrow for a check-in to see if there's been any improvement.
 
Besides having the SS (spreadsheet) link in your signature, there is some other useful information that will help us help you better.

Go to your user id profile.
Add to your "Signature", your first name and cats name age and sex. diagnosis date, insulin used, meter used for testing.

In fact, I think you want to increase the dose of insulin tonight. With DKA, you need to get those BG levels down as well as keep your cat hydrated and well fed. Are you able to home test during the night time? Even setting an alarm could be helpful.

Please let us know the most recent BG levels. And how long it will be until you will need to do the pre-shot BG tests. And give the PMPS dose of insulin.

Hand feed if necessary. Get extra calories in your cat. Forget about the carbohydrate level of the food for now.

Food and plenty of it is more important. Plus fluids to flush out any ketones.
When did you do the last urine ketone test?
 
Thanks- we've been hand feeding and giving some pedialyte, tuna-water, and free access to water.

We haven't done a ketone test ourselves but we will soon. Just got the strips so we'll be doing that soon-ish.
Gave the 200mL per the vet's recommendation at around +6.5. He took it like a champ but looked like a hunchback for a short time.

BG is at 570 as of +8.5. Pre-shot would be in 3.5 hours. PMPS dose is usually 1U, but i imagine we'll need to up it given the BG results we've seen today.

My husband can do some night shift BG monitoring to keep things on track.

Thanks again everyone...
 
You might consider upping the dose to 1.5 to 2U of Vetsulin.

Not sure which would be better for Ramesses.
There are risks with a higher dose of insulin.
But there are also risks if he is not getting enough insulin, that the DKA and ketones could get worse.

With those very high BG levels, there is very little risk of hypoglycemia with taking the dose up to 2 U. But the risk is still there.
Vetsulin is one of the in-and-out insulins. So the effects rarely last more than 12 hours.

Be sure to give the dose of insulin as far away from the fluid injection site as possible. That is so the fluids do not interfere with the insulin absorption.

Took another look at Ramesses SS. His BG levels really have not come down at all during this AM cycle. Not even with the 2nd dose of insulin. We need to get his BG levels out of that black color range and down more quickly.
I suggest 2 units for the Vetsulin for tonight's dose in the PM cycle.
I can't stay up that late to help you. Your PM injection time is in the middle of my night.
 
I'll be up until around 3pm EST. I'll keep an eye out. I agree with Debs advice to up to 2 units 2x a day. I don't know much about DKA, but I'm happy to check in and try to help. Sounds like you have all the good DKA advice already!
 
PMPS is HIGH.

Waiting 10 more minutes before doing 2 units. We'll give that a shot. Seems like he definitely needs more insulin. We'll check on him during the night.

Thanks team for all the help. I'll keep the spreadsheet updated for our kitty.
 
Lauryn Harriman said:
Yes, we literally just got it. It’s at 5 (trace). Looking up what that means. But my husband is checking again because that seems too good to be true.
Click to expand...
That’s really good news.
We have to keep checking the ketones twice a day still, to make sure they are not increasing.
Keep up the feeding as much as he will eat, the antibiotic, fluids and monitor the BG levels during the cycles so we can see what the insulin is doing.
Well done!
 
Congratulations on your first successful ketone test!
Do not let 24 hours go by without at least one Ketone test, preferably two. My Black Kitty once went from negative to large in exactly 24 hours. Any reading above “trace” warrants a call to the vet.

I can’t comment on dosing as I don’t have any experience with vetsulin. I will say that finding the right balance of calories and insulin to bring enough food energy into his cells is key to stopping his body from breaking down its own protein and fat stores, the byproduct of which is ketones.

You are going to be in a state of somewhat intensive care until your kitty gets on the other side of this.
Hang in there and hang in here :cool:
 
I think Deb had a good plan with the dose increase. You need those levels to start coming down. Huzzah about the trace ketones, but as others have said, keep testing. You are taking great care of Ramesses!
 
We just tested again and the reading is still at “high.” Even with two units. Not sure what to do but keep an eye on him and check him every two hours. I’m hopeful with the ketones though. We’re going to the vet tomorrow, so I’m hoping they’ll have insights and see his state as hopeful.
 
There is nothing you can do about the BG at the moment. Just keep feeding and giving oral fluids and test the urine when you get the opportunity.
I am not a Vetsulin user so can’t help there. Hopefully @Deb & Wink will be around before the next dose.
 
I’m so glad Ramesses is feeling better! I hope his BG comes down soon. What antibiotic is he on? It usually takes a few days for that to really kick in, and when it does that should help with the BG number. You’re doing a great job!!!
 
BG has been High all night. Going to try for a urine sample in the next hour-ish to check the ketones again. He still has an appetite though.

He's on Clavamox, 2x daily for antibiotic.

Should I stay the course with the 2U for the AMPS insulin dose? Or should I consider upping a bit? I expected his BG to dip below HIGH at some point last night but it didn't.
 
Lauryn Harriman said:
BG has been High all night.
Should I stay the course with the 2U for the AMPS insulin dose? Or should I consider upping a bit? I expected his BG to dip below HIGH at some point last night but it didn't.
Click to expand...

IF the AMPS BG test is also too high, you will need to increase the dose. You are going to need to up the Vetsulin insulin dose again for the AM dose. I'd suggest you increase from 2U to 3U.

You will need to monitor very closely. Suggest testing every 2 hours minimum. Frequent BG tests are absolutely essential when you are trying to treat DKA. Since you are trying to treat DKA at home, those tests are even more essential. Absolutely critical.

How old is your insulin vial Lauryn? When did you first pierce the rubber seal on the stopper? Date when that was done? Do you have the 10ml vial or the Vetpen?

Are you thoroughly mixing the Vetsulin? Vetsulin changed their directions for prepping the insulin for withdrawal back in 2013. They now say you have to shake the vial to mix the suspended particles in well with the suspension liquid. Are you doing that? And then you have to wait a bit for the foamy part or air bubbles to subside, and then roll the vial a little bit to mix gently once again, if you had too much foam. Are you doing that?

Prep for Vetsulin PDF document

If BG's are still in the black color coded range on the SS (spreadsheet), you will need to increase the next dose also. The PMPS dose may need to increase from 3U to 4U if you do not start seeing any lower BG readings. We want to see BGs reading down in the RED or PINK or YELLOW colors. Even lower would be good.

It is also possible to dose Vetsulin more frequently than every 12 hours. We do not know what the duration of Vetsulin is for Ramesses. That makes it more difficult to suggest what you can do. For many cats, Vetsulin lasts 8-10 hours. You could dose more frequently, but I'm not sure how often. It could be dosed every 8 hours. It really, really depends on how Ramesses body is reacting to the dose.

And if the antibiotic is helping him. Plus how good his appetite remains.
 
I see from the SS that you are using one of the Relion meters. Get plenty of test strips for it, 150 to 200 test strips would not be too many right now.
 
Vetsulin is a 10mL vial. It's probably 2 months old and we first pierced the rubber in mid January, probably January 20th. So, the shelf life is ok, but technically we should replace the bottle because it's been more than 30 days since the first puncture.We typically start a new bottle every 4-5 weeks, it's possible this one perhaps has lost some effectiveness.

We have been mixing according to the instructions you mentioned.

When we see the vet today we will grab a new bottle and ask about the dosing.

Ketones are negative! Appetite is strong. Personality is back.
 
Well, better than "HIGH"! Let's hope that means he'll start coming down now (esp. with the antibiotic just starting to take effect, hopefully).

Always good to check on the status of the insulin when getting these kinds of numbers. Sounds like yours is OK, though.

Lauryn Harriman said:
Ketones are negative! Appetite is strong. Personality is back.
Click to expand...

Hooray!!!!!
 
BG is still high. We did 2.5 units. I was admittedly really nervous about overmedicating him. Ugh. Maybe we should have. I'm checking him hourly now to see where we end up. Seeing the vet in six hours.

Please continue to send good vibes. Still hopeful, but worried about when the clavamox will start working and getting us where we need to be. May take another urine sample before the vet just to see where we're at. He is ravenously hungry.. I'm feeling bad that I can't feed him all the time. Anyway, we're truly doing our best. He is now pretty feisty about all the poking which I take as a good sign.
 
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