New Member - Into 2nd Hospital Stay for DKA since diagnosis

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Lauren & Keller

Lauren & Keller

Member Since 2020
Hi All,

First off, this is my first time posting but have been pouring over posts and comments since the diagnosis and thank you for all the guidance I've taken away thus far. This month has been a doozy.

To get into it - Keller, my 8yr Old Tabby is recovery in the hospital from his 2nd bout of DKA since being diagnosed last month. In mid April, I brought my kitties into their primary vet to get tested for a URI since they were both exhibiting some mild sneezing and Keller was diagnosed as a diabetic the following day (Glucose reading of 520 at vet). My vet prescribed starting with a diet change and holding off on insulin until his next glucose reading in 3 weeks time, unfortunately, Keller went into DKA three days later and spent five days in the hospital with the underlying diagnosis of pancreatitis.

At home treatment: 1U of Lantus twice Daily, Alpha Trk 2 meter, DM Wet Food twice Daily, Ketodiasitx Strips ( I don't have a chart made for him yet)
Out of the hospital Keller regained his appetite and energy but his glucose readings stayed consistently in the 400's and his excessive thirst and urinating remained, fortunately without any Ketones. Last week we went back to vet to get his glucose curve and he was bumped up to 3U of Lantus per day (1 in the morning and 2 in the evening), still no ketones in his urine but did have a UTI and was prescribed Clavamox.

Four days later he started exhibiting disinterest in food, lethargy and signs I now know are consistent with him when he's going into DKA. Now he's entering his third day in the hospital, diagnosed once again with pancreatitis and expected to leave this afternoon. According to the hospital, this is unusual for cats to go into DKA in such a short period of time so they are checking him for other intestinal issues and/or possible food allergies as an underlying reason for the pancreatitis. I've also been asked to try to get the
https://www.freestylelibre.us/system-overview/freestyle-14-day.html
glucose reader that sticks to his skin like a patch but it seems to be only prescription based and not sure if it can be prescribed to animals.

Here a just a few questions that I can gather right now

Any advice on what could cause two DKA visits so close to each other besides a regular diabetes diagnosis?
Could he be resistant Lantus?
Are there specific food allergies/intestinal problems coupled with diabetes that are known to contribute to DKA?
Has anyone successfully used one of these meters before? If so, how did you purchase? https://www.freestylelibre.us/system-overview/freestyle-14-day.html

I'm really trying to wrap my mind around his diagnosis, the two hospital stays and how fast my seemingly healthy cat can take such a turn. Thank you for reading and I would be really grateful for any advice or guidance!

- Lauren & Keller

*******************************************************
More info on Keller that may or may not be relevant:
Keller is an 8 yr. old 14lb (usually 16lb) orange Bengal/Tabby. He's naturally lean, very tall and not overweight. He's labeled as "fractious" at the vet but its definitely more anxiety than aggression. He was diagnosed a few years ago with hyperesthesia, a disorder that isn't super well known but is definite underlying cause of his anxiety.
 
Hello and welcome!

Wow, you guys are really going through the wringer with this :(. Two DKA episodes in a short period of time!

I don't know if anyone knows what makes a cat ketone-prone, but for those that are, here's the "recipe":

not enough insulin + not enough food + an infection or other stressor

Unfortunately, it looks like Keller is prone to ketones. The explanation for why he went into DKA twice in such a short period of time may be no more than the bad luck to get two infections at just the wrong time. We find that the immediate period after a DKA can be pretty delicate, too, with extra care needed to make sure that food and insulin are sufficient to keep ketones at bay.

Answering your other questions as best I can:

Lauren & Keller said:
Could he be resistant Lantus?
Click to expand...

It's possible he may have developed some insulin resistance-- when cats have been unregulated and in high numbers for a while, their body can get used to those numbers and take a while to respond to insulin. Secondarily, while lantus is a great insulin for cats, it's not always the best suited for DKA treatment or recovery, as it's better at keeping numbers low and level than bringing them down in the first place. I wouldn't recommend switching insulins at this point, just noting it as a possible factor.

Lauren & Keller said:
Are there specific food allergies/intestinal problems coupled with diabetes that are known to contribute to DKA?
Click to expand...

Not really as far as I know-- there are some things that are seen more commonly (UTIs, dental infections, pancreatitis), but just about anything that throws a cat "off" can trigger ketones/DKA under the right circumstances.

Lauren & Keller said:
Has anyone successfully used one of these meters before? If so, how did you purchase? https://www.freestylelibre.us/system-overview/freestyle-14-day.html
Click to expand...

I haven't used one myself, but I think the general verdict is: great when they work, absolutely revolutionary when working with difficult cats, but expensive over time and can be really fussy to get working on a cat (you have to shave a patch of fur, which grows back quickly, and the sensor is hard to keep on).

I hope Keller is feeling better and out of the hospital soon! Keep asking questions, we have a lot of people here with experience in DKA recovery as well as home BG testing and insulin dosing. Let us know how we can help you and your extra-sweet kitty!
 
Hi and welcome Lauren and Keller. I am so sorry you are going through this.

First of all, your kitty should have been put on insulin straight away with a BG of 520. If the vet wanted to try a change over of diet first, it is really really important to test for ketones while you are doing the change over to prevent DKA happening. If you are testing and ketones appear, then the insulin must be started straight away.
Once a cat has had ketones he can be more prone to getting them again. Once you get him home it is really important that the ketones are monitored every day at least once a day. I’m glad you have Ketostix.
Ketones form when there is not enough food, not enough insulin and then when there is an infection of inflammation then it can escalate into DKA very easily.

It is not really that uncommon to hear that a cat has had a second bout of DKA especially if it has not been managed properly once the cat comes home the first time.......this is no reflection on the caregiver....rather the vet who has not given proper instructions as to what needs doing.

So this is what you need to do once he gets home.
  • Keller needs 1 1/2 times as many calories as he normally gets. It is really important he eats well. Food is like a medicine to cats recovering from DKA.
  • Feed him before the shots and give him several smaller snacks during the day and night to make up that 1 1/2 times the normal amount.
  • If he is nauseated he will need an antinausea medication so ask your vet for some cerenia and ondansetron. Dont leave the hospital without them.
  • Test every day for ketones
  • It is really important that Keller gets his insulin. Not enough insulin is one of the things that can make ketones reappear.
  • If you are not home testing I would encourage you to start....I think you are doing it so thats good.
  • Set up a spreadsheet so we can see the data and keep it up to date.
  • Lantus likes consistency so the same dose morning and night is much better. If you are giving 1 unit in the morning and 2 at night you would be better giving 1.5 units for both doses. That is the same amount of insulin per day.
  • Encourage fluids.
Once you get him home we can help you a lot. I doubt he is resistant to Lantus, but he is probably getting used to being in higher numbers now and needs to get used to lower ones again. He just needs to be managed better....again no reflection on you at all.
The freestyle Libre has been used by a few people with varying success.
Keller should recover fully from the DKA with the proper care. While he is still in hospital I would get organised for his return.
Set up the SS, get food in for him.......low carb and some higher carb food in case you need it. Plenty of test strips.
DKA happens because there is not enough food, not enough insulin and an infection or inflammation. It has nothing to do with allergies etc.
Big hugs :bighug:
You will be able to manage him once he gets home. He’s a lucky boy to have you.
Keep asking questions and please keep us posted.
We will be here for you.
Bron
 
Lauren & Keller said:
Hi All,

First off, this is my first time posting but have been pouring over posts and comments since the diagnosis and thank you for all the guidance I've taken away thus far. This month has been a doozy.

To get into it - Keller, my 8yr Old Tabby is recovery in the hospital from his 2nd bout of DKA since being diagnosed last month. In mid April, I brought my kitties into their primary vet to get tested for a URI since they were both exhibiting some mild sneezing and Keller was diagnosed as a diabetic the following day (Glucose reading of 520 at vet). My vet prescribed starting with a diet change and holding off on insulin until his next glucose reading in 3 weeks time, unfortunately, Keller went into DKA three days later and spent five days in the hospital with the underlying diagnosis of pancreatitis.

At home treatment: 1U of Lantus twice Daily, Alpha Trk 2 meter, DM Wet Food twice Daily, Ketodiasitx Strips ( I don't have a chart made for him yet)
Out of the hospital Keller regained his appetite and energy but his glucose readings stayed consistently in the 400's and his excessive thirst and urinating remained, fortunately without any Ketones. Last week we went back to vet to get his glucose curve and he was bumped up to 3U of Lantus per day (1 in the morning and 2 in the evening), still no ketones in his urine but did have a UTI and was prescribed Clavamox.

Four days later he started exhibiting disinterest in food, lethargy and signs I now know are consistent with him when he's going into DKA. Now he's entering his third day in the hospital, diagnosed once again with pancreatitis and expected to leave this afternoon. According to the hospital, this is unusual for cats to go into DKA in such a short period of time so they are checking him for other intestinal issues and/or possible food allergies as an underlying reason for the pancreatitis. I've also been asked to try to get the
https://www.freestylelibre.us/system-overview/freestyle-14-day.html
glucose reader that sticks to his skin like a patch but it seems to be only prescription based and not sure if it can be prescribed to animals.

Here a just a few questions that I can gather right now

Any advice on what could cause two DKA visits so close to each other besides a regular diabetes diagnosis?
Could he be resistant Lantus?
Are there specific food allergies/intestinal problems coupled with diabetes that are known to contribute to DKA?
Has anyone successfully used one of these meters before? If so, how did you purchase? https://www.freestylelibre.us/system-overview/freestyle-14-day.html

I'm really trying to wrap my mind around his diagnosis, the two hospital stays and how fast my seemingly healthy cat can take such a turn. Thank you for reading and I would be really grateful for any advice or guidance!

- Lauren & Keller

*******************************************************
More info on Keller that may or may not be relevant:
Keller is an 8 yr. old 14lb (usually 16lb) orange Bengal/Tabby. He's naturally lean, very tall and not overweight. He's labeled as "fractious" at the vet but its definitely more anxiety than aggression. He was diagnosed a few years ago with hyperesthesia, a disorder that isn't super well known but is definite underlying cause of his anxiety.
Click to expand...
Hi Lauren and Keller my cat Dusty is wearing a Libre now the sensor is suppose to last 14 days hers needs to be replaced today so it lasted 9 days . The Vet puts it on yes they shave a spot and the sensor is like a white disc , it’s glued on with surgical glue .If Keller will wear a tee shirt at first that would be ok so not to try to remove it . Dusty removed her shirt and scratched herself up but then to my surprise was fine wearing it . Once it’s on when you want to know her levels you just pass the reader above it . If you upload it your Vet can access the chart . I’m still trying to get Dusty’s sugar level regulated so for me this is one less stressful step for her till I start home testing . Fell free to talk anytime Roe
 
Dusty & Roe said:
Hi Lauren and Keller my cat Dusty is wearing a Libre now the sensor is suppose to last 14 days hers needs to be replaced today so it lasted 9 days . The Vet puts it on yes they shave a spot and the sensor is like a white disc , it’s glued on with surgical glue .If Keller will wear a tee shirt at first that would be ok so not to try to remove it . Dusty removed her shirt and scratched herself up but then to my surprise was fine wearing it . Once it’s on when you want to know her levels you just pass the reader above it . If you upload it your Vet can access the chart . I’m still trying to get Dusty’s sugar level regulated so for me this is one less stressful step for her till I start home testing . Fell free to talk anytime Roe
Click to expand...

May I know the cost (including vet's charge) of putting the sensor and the reader?
Thank you.
 
Dusty & Roe said:
Sure the reader was $64.99 the 14 day sensor was $38.70 the Vet charged $50 to set it up and put it on but the sensor lasted only 9 days some people get more days though . So now I have to buy a new sensor . I’m pretty sure GoodRx has coupons
Click to expand...

Thank you for your reply. So will you put the new sensor on you own, or would you still need to go to vet's office to change the sensor?
 
Nan & Amber (GA) said:
Hello and welcome!

Wow, you guys are really going through the wringer with this :(. Two DKA episodes in a short period of time!

I don't know if anyone knows what makes a cat ketone-prone, but for those that are, here's the "recipe":

not enough insulin + not enough food + an infection or other stressor

Unfortunately, it looks like Keller is prone to ketones. The explanation for why he went into DKA twice in such a short period of time may be no more than the bad luck to get two infections at just the wrong time. We find that the immediate period after a DKA can be pretty delicate, too, with extra care needed to make sure that food and insulin are sufficient to keep ketones at bay.

Answering your other questions as best I can:



It's possible he may have developed some insulin resistance-- when cats have been unregulated and in high numbers for a while, their body can get used to those numbers and take a while to respond to insulin. Secondarily, while lantus is a great insulin for cats, it's not always the best suited for DKA treatment or recovery, as it's better at keeping numbers low and level than bringing them down in the first place. I wouldn't recommend switching insulins at this point, just noting it as a possible factor.



Not really as far as I know-- there are some things that are seen more commonly (UTIs, dental infections, pancreatitis), but just about anything that throws a cat "off" can trigger ketones/DKA under the right circumstances.



I haven't used one myself, but I think the general verdict is: great when they work, absolutely revolutionary when working with difficult cats, but expensive over time and can be really fussy to get working on a cat (you have to shave a patch of fur, which grows back quickly, and the sensor is hard to keep on).

I hope Keller is feeling better and out of the hospital soon! Keep asking questions, we have a lot of people here with experience in DKA recovery as well as home BG testing and insulin dosing. Let us know how we can help you and your extra-sweet kitty!
Click to expand...
Nan & Amber (GA) said:
Hello and welcome!

Wow, you guys are really going through the wringer with this :(. Two DKA episodes in a short period of time!

I don't know if anyone knows what makes a cat ketone-prone, but for those that are, here's the "recipe":

not enough insulin + not enough food + an infection or other stressor

Unfortunately, it looks like Keller is prone to ketones. The explanation for why he went into DKA twice in such a short period of time may be no more than the bad luck to get two infections at just the wrong time. We find that the immediate period after a DKA can be pretty delicate, too, with extra care needed to make sure that food and insulin are sufficient to keep ketones at bay.

Answering your other questions as best I can:



It's possible he may have developed some insulin resistance-- when cats have been unregulated and in high numbers for a while, their body can get used to those numbers and take a while to respond to insulin. Secondarily, while lantus is a great insulin for cats, it's not always the best suited for DKA treatment or recovery, as it's better at keeping numbers low and level than bringing them down in the first place. I wouldn't recommend switching insulins at this point, just noting it as a possible factor.



Not really as far as I know-- there are some things that are seen more commonly (UTIs, dental infections, pancreatitis), but just about anything that throws a cat "off" can trigger ketones/DKA under the right circumstances.



I haven't used one myself, but I think the general verdict is: great when they work, absolutely revolutionary when working with difficult cats, but expensive over time and can be really fussy to get working on a cat (you have to shave a patch of fur, which grows back quickly, and the sensor is hard to keep on).

I hope Keller is feeling better and out of the hospital soon! Keep asking questions, we have a lot of people here with experience in DKA recovery as well as home BG testing and insulin dosing. Let us know how we can help you and your extra-sweet kitty!
Click to expand...


Hi Nan! Thank you so much for your reply.

I picked up Keller today from the hospital at 5pm. He has his the freelibre sensor attached and was given Mirataz to stimulate his appetite and I will be delivered Cerenia tomorrow for nausea.

While I'm happy he's home I am still a little worried about his condition. He seemed curious when getting home initially, feeling well enough to hang around us but increasingly became more lethargic and soon went to the place he likes to hide when he's not feeling well. When it came time to eat, he seemed interested enough to come check it out but took only a few bites before becoming disinterested. I called the hospital to see if I could give him the Mirataz that is next due tomorrow night to stimulate his appetite but was told to hold off and give him the 2U without a full meal since his sensor read HI throughout the night- anything above 500. I also checked his urine for ketones and they came back with a moderate amount. The hospital confirmed that he was sent home with trace amounts of ketones with the hopes that his eating would improve and they would clear themselves out. I don't think this was the case after his last hospital stay.

I'm really hoping that the way he's acting at the moment is part exhaustion from the hospital and his anxiety and not a complete reversal of his condition. I'm thinking that he is prone to ketones and I really wish I had known just how delicate the time after DKA is and that he'd require extra food. I've been trying to be strict about keeping him on the 330 kkcals a day that was listed on his discharge paperwork.

Looks like this will be another sleepless night but at least he's home!
 
I’m glad he is home.
Continue to encourage food. It is so important. It is fine for him to eat whatever he wants. Dry is fine too. The important thing is he eats, especially with moderate ketones in the picture still.
You may have to syringe feed him to get food into him. If he’s coming out and looking at the food and walking away that’s nausea.
Why didn’t they give you cerenia to bring home?
Did they happen to give him a cerenia shot before he left the vets?
Also encourage fluids. Did they send you home with subQ fluids?

Don’t skip the insulin dose with ketones in the picture. Do you have honey or karo if needed.?
I’ll post a link to how to stimulate appetite although if he’s nauseated only antinausea meds will fix that.
 
Bron and Sheba (GA) said:
Hi and welcome Lauren and Keller. I am so sorry you are going through this.

First of all, your kitty should have been put on insulin straight away with a BG of 520. If the vet wanted to try a change over of diet first, it is really really important to test for ketones while you are doing the change over to prevent DKA happening. If you are testing and ketones appear, then the insulin must be started straight away.
Once a cat has had ketones he can be more prone to getting them again. Once you get him home it is really important that the ketones are monitored every day at least once a day. I’m glad you have Ketostix.
Ketones form when there is not enough food, not enough insulin and then when there is an infection of inflammation then it can escalate into DKA very easily.

It is not really that uncommon to hear that a cat has had a second bout of DKA especially if it has not been managed properly once the cat comes home the first time.......this is no reflection on the caregiver....rather the vet who has not given proper instructions as to what needs doing.

So this is what you need to do once he gets home.
  • Keller needs 1 1/2 times as many calories as he normally gets. It is really important he eats well. Food is like a medicine to cats recovering from DKA.
  • Feed him before the shots and give him several smaller snacks during the day and night to make up that 1 1/2 times the normal amount.
  • If he is nauseated he will need an antinausea medication so ask your vet for some cerenia and ondansetron. Dont leave the hospital without them.
  • Test every day for ketones
  • It is really important that Keller gets his insulin. Not enough insulin is one of the things that can make ketones reappear.
  • If you are not home testing I would encourage you to start....I think you are doing it so thats good.
  • Set up a spreadsheet so we can see the data and keep it up to date.
  • Lantus likes consistency so the same dose morning and night is much better. If you are giving 1 unit in the morning and 2 at night you would be better giving 1.5 units for both doses. That is the same amount of insulin per day.
  • Encourage fluids.
Once you get him home we can help you a lot. I doubt he is resistant to Lantus, but he is probably getting used to being in higher numbers now and needs to get used to lower ones again. He just needs to be managed better....again no reflection on you at all.
The freestyle Libre has been used by a few people with varying success.
Keller should recover fully from the DKA with the proper care. While he is still in hospital I would get organised for his return.
Set up the SS, get food in for him.......low carb and some higher carb food in case you need it. Plenty of test strips.
DKA happens because there is not enough food, not enough insulin and an infection or inflammation. It has nothing to do with allergies etc.
Big hugs :bighug:
You will be able to manage him once he gets home. He’s a lucky boy to have you.
Keep asking questions and please keep us posted.
We will be here for you.
Bron
Click to expand...

Hi Bron!

Thanks for taking the time with your reply. I'm kicking myself for not coming on here as soon as he was out of the hospital the first time. I'm really thinking that I was not giving him the amount of food he needed after DKA but rather sticking to the twice a day feeding. Additionally, I don't think the 2U a day was enough for him and possibly the new addition of the 2U in the morning and 1U at night threw him off.

I'm worried now that he's home and still a little disinterested in food but hoping that it can be helped with the anti-nausea medication coming tomorrow. I didn't have time to come on and see that you said to not leave with out it :(
 
Bron and Sheba (GA) said:
Can’t emphasise enough how important it is to get food into him. And he gets his insulin.
Ask any questions you might have.

Appetite stimulant ideas
http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

liver shake to syringe feed
http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

syringe feeding
http://www.felinediabetes.com/FDMB/threads/syringe-assisted-feeding-videos-and-tips.144367/
Click to expand...

Thanks for this - Just replied to you from before not seeing that you responded tonight. Still getting the hang of this. I'll read through now.
 
Bron and Sheba (GA) said:
I’m glad he is home.
Continue to encourage food. It is so important. It is fine for him to eat whatever he wants. Dry is fine too. The important thing is he eats, especially with moderate ketones in the picture still.
You may have to syringe feed him to get food into him. If he’s coming out and looking at the food and walking away that’s nausea.
Why didn’t they give you cerenia to bring home?
Did they happen to give him a cerenia shot before he left the vets?
Also encourage fluids. Did they send you home with subQ fluids?

Don’t skip the insulin dose with ketones in the picture. Do you have honey or karo if needed.?
I’ll post a link to how to stimulate appetite although if he’s nauseated only antinausea meds will fix that.
Click to expand...

Ok thank you - He went out a little bit ago and ate a couple bites but you're spot on with the nausea
I will def get him his favorite foods tomorrow first thing. They told me the Cerenia is coming from a prescription service but he was given some before he left today. I'm not sure why it wasn't given considering they've always given me everything I needed when I walked out. They did not give me SubQ fluids. Is that something I can purchase on my own? How do you outfit the cats so it stays on them and can you do yourself? And I do have honey and Karo!
 
It only takes about 5 minutes to give the subQ fluids. I’ll post a link. You need to mark the bag with a texta with how much you give. It’s usually about 100 mls. It goes through quickly in about 5 minutes but need to ask the vet first if it’s ok for him to have them. They will help flush out the ketones. They will have the bag of fluids, the tubing and the needles there so get them from the vet.
I hung the bag on a coat hanger over a door.
While there ask the vet for some ondansetron for the nausea. It works on a different pathway to cerenia and can be given at the same time as cerenia.
Keep offering lots of food.,. Anything he will eat.
http://www.felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/
 
Bron and Sheba (GA) said:
It only takes about 5 minutes to give the subQ fluids. I’ll post a link. You need to mark the bag with a texta with how much you give. It’s usually about 100 mls. It goes through quickly in about 5 minutes but need to ask the vet first if it’s ok for him to have them. They will help flush out the ketones. They will have the bag of fluids, the tubing and the needles there so get them from the vet.
I hung the bag on a coat hanger over a door.
While there ask the vet for some ondansetron for the nausea. It works on a different pathway to cerenia and can be given at the same time as cerenia.
Keep offering lots of food.,. Anything he will eat.
http://www.felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/
Click to expand...

just watched the video. I'm going to call in the morning ask to pick the fluids and supplies up. He ate a little more dry food about 20 mins ago. I'll keep trying! Thanks so much again Bron - its feels so great know I'm not completely alone in this at moment!
 
Lauren & Keller said:
just watched the video. I'm going to call in the morning ask to pick the fluids and supplies up. He ate a little more dry food about 20 mins ago. I'll keep trying! Thanks so much again Bron - its feels so great know I'm not completely alone in this at moment!
Click to expand...
I’m very happy to help. I know how precious our kitties are to us.
Did he get his insulin?
You might like to post some of the BG numbers to give us an idea too.
Chris probably won’t be on until tomorrow now to help with the SS as she lives in the US but that’s OK.
Every little bit of food helps. How does he seem?
Post any ketone test results too please.
 
Hi Bron,

He's not great - honestly worse than when I took him in for his 1st DKA bout. Has hardly eaten anything today besides bites of Friskies kitten food that is his absolute favorite but bites at best. I finally got hold of my doctor around 2pm and she agreed that we should try SubQ fluids which I received around 4pm. I gave him 75ml around 5PM and he ended up throwing up what he had eaten and a lot of water around 5:30pm. The Cerenia just arrived about 20mins ago (8pm) and I gave .5ml to him immediately, which he ended up throwing up all of 3mins later. I then gave him .3ml little by little so he would hold it down. He hates any medication give orally and is prone to gag it up even when he's not sick. As of right now, he's keeping the medication down and I'm waiting for it to kick in to see if he's interested in food at all. He was also given his normal 2U dose this morning when his meter read in the 400's.

He did experience a dip in BU after the threw up going down to 107 which I have never seen before but now the meter is reading 465. I did also put the fluids quite near the sensor could that have produced the low readings?

He's extremely lethargic and now has a slight bit of drool happening after giving the Cerenia which he's never had before. Ketones moderate yesterday and have gone up to the second highest level on Stix. They confirmed he went home with a 2.7 ketone level The doctors are hoping we can get him back on the right track at home but it's looking like he's for another hospital stay.

Here are his numbers from the last 24 (I promise to get a chart soon, just haven't had time to make)

5/18/20

8:50PM- HI above 500
10:20PM- HI above 500

5/19/20

2AM - HI above 500 (2U Lantus - I work a 5pm - 2am news job)
3AM - HI above 500
3:40AM - 475
4AM - 474
4:30AM - HI above 500
6:20 AM - 497
12:40PM - 477
1:50PM- 460 (2U of Lantus, ate some bites of Friskies)
2:20PM - 467
3PM - 437
5:30PM- 425 (After SubQ Fluids and before throwing up)
5:50PM- 129
6:10PM - 121
6:20PM - 104
6:30PM - 107
6:41PM - 148
6:50PM - 188
7PM - 221
7:10PM- 236
7:20PM - 274
7:30PM- 302
8PM - 373
8:50PM - 435

I have only given him 75ml of Fluids and it looks like it was mostly absorbed - should I be giving more?

Thanks again for checking in
 
He doesn’t sound great does he?
I am very concerned about you keeping hm home if he is not eating and the ketones have gone back up. That is getting dangerous.
I think you should take him back to the hospital. It would be far safer for him.

Then when you bring him home next time, if he is not eating, ask about a feeding tube. That is sometimes necessary with DKA kitties who can’t eat. They only need it for a week or two until they can start eating again. It can make all the difference to their recovery.
And you will need cerenia and zofran (ondansetron) for the nausea. And you have the subQ fluids.
 
I agree... This:

Lauren & Keller said:
Ketones moderate yesterday and have gone up to the second highest level on Stix. They confirmed he went home with a 2.7 ketone level The doctors are hoping we can get him back on the right track at home but it's looking like he's for another hospital stay.
Click to expand...

Is really really worrying-- not sure about the reading yesterday (there are different scales for ketone readings, on some 2.7 is fine, on others it might not be), but the Stix level definitely sounds like more than you want to have to deal with at home.

If the meds kick in and he starts eating, great, but if not, I think Bron's suggestion of a feeding tube is excellent.

Feel better soon, little guy!
 
I agree. I've spoken to the doctors a few times today as well as seeing them at the hospital and they want me to see if the Cerenia helps tonight and if he's not eating then I can bring him after I get off of work around 2:30am.

Would you suggest any more fluids to get him through till then? I only gave him .3ml of Cerenia after he threw it up. Should I try to give him a little more?
 
I'd be nervous about giving more meds, even though he threw up the first batch (you never know how much stayed down), but see what others say, it may be OK with Cerenia.

On the fluids, same. Usually we wouldn't give much more than the 75ml and it's not good to overload them, but if he was really dehydrated this may be special circumstances. Let's see if others who give fluids regularly have an opinion on this.

Sorry I can't help much on these questions :(. I hope he starts eating soon.
 
Lauren & Keller said:
I agree. I've spoken to the doctors a few times today as well as seeing them at the hospital and they want me to see if the Cerenia helps tonight and if he's not eating then I can bring him after I get off of work around 2:30am.

Would you suggest any more fluids to get him through till then? I only gave him .3ml of Cerenia after he threw it up. Should I try to give him a little more?
Click to expand...
how long since the SubQ fluids?
What is the strength of the cerenia.
I think you should ask the vets both those questions really just to be on the safe side.

Are you working at home?
 
Bron and Sheba (GA) said:
how long since the SubQ fluids?
What is the strength of the cerenia.
I think you should ask the vets both those questions really just to be on the safe side.

Are you working at home?
Click to expand...

I am, working on some news shows throughout the night with my last being at 1am. I have off completely off now so want to be able to give him what I can.

I don't have the stuff to make a liver shake but would you suggest making a shake out of some of the pate and water and seeing what I can get into him?
 
Lauren & Keller said:
I am, working on some news shows throughout the night with my last being at 1am. I have off completely off now so want to be able to give him what I can.

I don't have the stuff to make a liver shake but would you suggest making a shake out of some of the pate and water and seeing what I can get into him?
Click to expand...
Yes you can try syringe feeding him with pate and water
I live in Australia so telling me you gave fluids at 5 pm means nothing to me. ;)
Did you ring the vet about giving more cerenia or subQ fluids?
 
I’m glad you are getting some food into him. Keep doing that, little bits often.
7 am was only 6 hours ago. I think that’s too soon to give moe fluids but let’s see what the vet says. Don’t give the Fluids near the Libre, it could effect the BG readings.
Have you been able to test for ketones again?

What are the shows you do in Sydney?
 
I gave the fluids further back this time - are there any side effects too watch out for if its too much fluid?

I work for Bloomberg news and do the Market open in Sydney and then the rest of Asia! Working from home is something really new for me.
 
Lauren & Keller said:
I gave the fluids further back this time - are there any side effects too watch out for if its too much fluid?

I work for Bloomberg news and do the Market open in Sydney and then the rest of Asia! Working from home is something really new for me.
Click to expand...
If the vet ok’d it, it should be ok. The main thing is that the cats heart is ok to take the fluids and the vet would have checked that.
How is the syringe feeding going?

Is the market open on Foxtel?
 
Syringe feeding is going. He really hates it and its hard stressing him out more. I think I've gotten maybe 30ml in him :/ He's keeping it down which is an improvement considering he threw everything up earlier but I was given the direction to give him 3U if he was well fed and 1.5 if he didn't eat. I've been able to get a little food in him so do you think 2U would be ok? His BU is 406 right now
 
He's on the Free Libre meter and he's been getting 2U for the last week but the vet has said that it didnt seem to be enough for him. She's never prescribed 3U to him until today. I will definitely be up all night to monitor him and do have high carb food available, put getting it into him is the hard part.
 
Can you blend some of the higher carb food with water and syringe it?
If you think you can, then you could give a higher dose than 2 units. With ketones and DKA we sometimes give higher carb food do we can increase the insulin.

what higher carb food do you have?
 
We’re at the hospital now. Waiting to hear what his state is. Cannot believe we’re into our 3rd DKA hospital visit in a month
 
I’m very glad to hear you are at the hospital. That is the best place for him at the moment. Oh dear what a terrible time you have had. You must be very stressed and exhausted. :bighug:
When he come home next time we will make sure it all works out and be organised for all eventualities.
I hope they keep him in for at least a day. Ask about an injection of cerenia before he comes home so he has that aboard and make sure you have plenty of cerenia and zofran ( ondansetron) to bring home.. Also ask about a feeding tube if he won’t eat.
Also ask them if they are testing the blood and checking the electrolytes and ketones. That is important with DKA
Please keep us updated. We worry about our sick kitties. :bighug:
 
Just got a call from the doctor - Keller's definitely back in DKA and blood acid level is 4.7. His red blood cell count is also low and told me there is a chance that he may need a blood transfusion later today. Is this a semi common thing with diabetic cats? I'm so sad for my guy.
 
Yes that blood is very acidic. I’m so glad you have him back in hospital. I don’t think he was ready to come home yesterday with those high ketones still.
The low red blood cells may be from all the illness he has just had.
I’ll ask @Marje and Gracie about that. She’s excellent with path results. Marje Keller back in hospital for third time with DKA and has low res blood cells. Only came home yesterday but back today as couldn’t eat and very lethargic.
 
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