Diagnosed 2 weeks ago & re-admitted with DKA (New Member UK)

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Annie & Kozmo

Annie & Kozmo

Member Since 2020
Kozmo has was diagnosed with FD two weeks ago, and today he's been readmitted to the vet hospital with DKA (we've been monitoring his urine for ketones due to high BG levels).

Blood test results appear normal apart from 28.9 BG.

Our vet is prepared to consider prescribing Lantus once Kozmo's BG is under control with Caninsulin. We're going to need as much help as possible when he gets home, please.
 
Annie & Kozmo said:
Kozmo has was diagnosed with FD two weeks ago, and today he's been readmitted to the vet hospital with DKA (we've been monitoring his urine for ketones due to high BG levels).

Blood test results appear normal apart from 28.9 BG.

Our vet is prepared to consider prescribing Lantus once Kozmo's BG is under control with Caninsulin. We're going to need as much help as possible when he gets home, please.
Click to expand...
I should have added that he was diagnosed on 11 June 2020 (with low ketones) and released to our care on 15 June with 1 Ul Caninsulin twice daily and advised no home monitoring required and to bring him back in two weeks for a review. I quickly stumbled upon FDMB and our BG monitor (plus keytone test strips) arrived shortly thereafter.

We've struggled to obtain blood for testing but also know it must be done!
 
Hello Annie! This thread section doesn't get a lot of traffic so I've posted in the Feline Health forum to redirect here and get more eyes on your post. I don't have any personal experience with DKAs.
I'll ping some people who either have experience or may know of someone who does.

@Sienne and Gabby (GA)
@Chris & China (GA)
@Wendy&Neko
@AliceMeowliss&Cassandra
@Bron and Sheba (GA)

I know Alice had DKA once or twice but I can't think of anyone else off the top of my head.
 
Oops. Forgot to hit send.

Have the lab results shown anything such as an infection or inflammation?
DKA = not enough food + not enough insulin + usually something else going on.
The lab reports from the vet ER might show what the "something else" is.
DKA cats need an increase in insulin, an increase in food (1 1/2 times what they usually eat and higher carb is fine – the insulin can be temporary adjusted around that), and fluids. Lots of fluids to help flush out the ketones. Make the food soupy as the cat will deign to eat.

If you could start a post in Feline Health - (Welcome & Main Forum) more eyes will see it.

And thanks Jeanne for alerting.
 
Hi Annie and Kozmo....I’m so sorry Kozmo has DKA but it’s good he is being treated and hopefully you will have him home again soon.
I’m going to ask a moderator @Wendy&Neko if she would be happy to move this thread over to the main health page where there are a lot more people and we can keep an eye on you better there.

I see @Red & Rover (GA) explained how DKA occurs, so the way to treat DKA when you get Kozmo home again is to make sure he is getting enough food, enough insulin and any infection or inflammation is being treated.

As I explained on the Fb page...it will be better to keep him on caninsulin until the ketones are well and truly gone as we don’t want them to reappear. Then you can think about changing over to Lantus which is a much better insulin for cats but not when they have ketones. You don’t want to be doing the swap over when there are ketones in the picture. You can get the script for Lantus now though.

There are things you can do now to prepare for his return home. It sounds as if you have ketostix or similar strips for testing for ketones at home. Is that correct? You will need those because you will be needing to test at least once a day in the beginning for ketones.

With the food....it is very important that he is eating. If he is nauseated he won’t want to eat so you will need to ask the vet for some cerenia and ondansetron (both antinausea tablets) to take home to give him. A lot of DKA cats are nauseated for a while when recovering (some lucky ones aren’t) so it is really important to have these antinausea meds on hand to give each day as food is like a medicine to recovering DKA cats.

With the actual food, make sure you have plenty of variety at home as he may be picky. Have some higher carb foods as well as the low carb.
He will need to be eating 1 1/2 times as much as he normally eats to help keep the ketones away. And if he will only eat dry food, while not ideal, it is better that he eats that then nothing, so don’t worry if you have to do that.
And lots of fluids to flush out the ketones.

Make sure that any infection or inflammation is being treated by the vets. Ask them if they found any infection/inflammation.

The dose of insulin will need to be adjusted if ketones are still there. You will need to be monitoring the BG often.

The first week home will be very busy for you but it should ease off as he improves.
If you post here each day we can help you. We have DKA experienced people here.

So to recap:
  • Make sure you have Ketostix to test for the ketones
  • Ask the vet for cerenia and ondansetron.
  • I would ask that Kozmo gets a cerenia injection on discharge so he’s covered for the first day home.
  • Get in a variety of food for Kozmo
  • He will need to eat 1 1/2 times as much as normal when recovering.
  • Get plenty of sleep while he is in hospital so you are not too tired when he comes home
Please keep us posted and sending many get better vines to Kozmo
Bron
 
Post has been moved to Feline Health for more eyes on it.

Taking a quick look at the spreadsheet, it's also important to get some tests during the day and night, after the shots, if you can, as well as testing before each shot - to make sure it's safe to give insulin. If you have any particular issues with testing let us know. We've all been there.

Did your vet talk to you about the possibility of giving subq fluids at home?
 
Panic said:
Hello Annie! This thread section doesn't get a lot of traffic so I've posted in the Feline Health forum to redirect here and get more eyes on your post. I don't have any personal experience with DKAs.
I'll ping some people who either have experience or may know of someone who does.

@Sienne and Gabby (GA)
@Chris & China (GA)
@Wendy&Neko
@AliceMeowliss&Cassandra
@Bron and Sheba (GA)

I know Alice had DKA once or twice but I can't think of anyone else off the top of my head.
Click to expand...
Thank you Elizabeth!
 
Bron has given a ton of excellent advice. It's especially crucial to try to figure out what the trigger for DKA was-- almost always there's some infection or inflammation they are hiding. How are his teeth? Any chance of a UTI? Pancreatitis?

How is Kozmo doing today? Did they give you any idea of how long he is going to need to be hospitalized? Sometimes they will let you bring him something like an old t-shirt for familiar smells, it can make them more comfortable when they're there. The rules may be more strict with COVID-19, though :(.

Hope your beautiful boy is feeling better very soon!
 
Bron and Sheba (GA) said:
Hi Annie and Kozmo....I’m so sorry Kozmo has DKA but it’s good he is being treated and hopefully you will have him home again soon.
I’m going to ask a moderator @Wendy&Neko if she would be happy to move this thread over to the main health page where there are a lot more people and we can keep an eye on you better there.

I see @Red & Rover (GA) explained how DKA occurs, so the way to treat DKA when you get Kozmo home again is to make sure he is getting enough food, enough insulin and any infection or inflammation is being treated.

As I explained on the Fb page...it will be better to keep him on caninsulin until the ketones are well and truly gone as we don’t want them to reappear. Then you can think about changing over to Lantus which is a much better insulin for cats but not when they have ketones. You don’t want to be doing the swap over when there are ketones in the picture. You can get the script for Lantus now though.

There are things you can do now to prepare for his return home. It sounds as if you have ketostix or similar strips for testing for ketones at home. Is that correct? You will need those because you will be needing to test at least once a day in the beginning for ketones.

With the food....it is very important that he is eating. If he is nauseated he won’t want to eat so you will need to ask the vet for some cerenia and ondansetron (both antinausea tablets) to take home to give him. A lot of DKA cats are nauseated for a while when recovering (some lucky ones aren’t) so it is really important to have these antinausea meds on hand to give each day as food is like a medicine to recovering DKA cats.

With the actual food, make sure you have plenty of variety at home as he may be picky. Have some higher carb foods as well as the low carb.
He will need to be eating 1 1/2 times as much as he normally eats to help keep the ketones away. And if he will only eat dry food, while not ideal, it is better that he eats that then nothing, so don’t worry if you have to do that.
And lots of fluids to flush out the ketones.

Make sure that any infection or inflammation is being treated by the vets. Ask them if they found any infection/inflammation.

The dose of insulin will need to be adjusted if ketones are still there. You will need to be monitoring the BG often.

The first week home will be very busy for you but it should ease off as he improves.
If you post here each day we can help you. We have DKA experienced people here.

So to recap:
  • Make sure you have Ketostix to test for the ketones
  • Ask the vet for cerenia and ondansetron.
  • I would ask that Kozmo gets a cerenia injection on discharge so he’s covered for the first day home.
  • Get in a variety of food for Kozmo
  • He will need to eat 1 1/2 times as much as normal when recovering.
  • Get plenty of sleep while he is in hospital so you are not too tired when he comes home
Please keep us posted and sending many get better vines to Kozmo
Bron
Click to expand...

Thanks Bron, we've spoken to the vet re Kozmo and they're keeping him for another night of observation and fluid. They've increased his dose of Caninsulin from 1 Ul to 2Ul and they want to make sure he doesn't go too low. They said not to worry about ketones, however, we have a heap of strips to home test his urine and we will certainly be doing so when he comes home. Kozmo hasn't ever been a big eater and he's fussy, so over the last two weeks we've stocked up on various foods to try and tempt him. He was ravenous when he came home last time and I hope he's the same again.
 
Nan & Amber (GA) said:
Bron has given a ton of excellent advice. It's especially crucial to try to figure out what the trigger for DKA was-- almost always there's some infection or inflammation they are hiding. How are his teeth? Any chance of a UTI? Pancreatitis?

How is Kozmo doing today? Did they give you any idea of how long he is going to need to be hospitalized? Sometimes they will let you bring him something like an old t-shirt for familiar smells, it can make them more comfortable when they're there. The rules may be more strict with COVID-19, though :(.

Hope your beautiful boy is feeling better very soon!
Click to expand...

Honestly, this forum is a godsend. Apparently, Kozmo's blood test results were unremarkable (apart from high BG level) and showed no sign of infection. Kozmo has severe arthritis in his pelvis - he was run over by a car as a kitten and he has a steel plate keeping his pelvis together. It looks like it's dislodged because his back legs are skewed badly. We're wondering if that type of inflammation is the cause, though to be fair it's been that way for many years.

Two weeks before Kozmo was diagnosed with FD (ie one month ago), he underwent a procedure to determine the source of the constant infection of his right ear under general anaesthetic. They couldn't find anything but they did send him home with a second one-week course of Prednidale with the first being one week prior to the procedure. This appears to be the trigger for his FD.

They're keeping him in for another night of observation and fluids as they've increased his Caninsulin from 1Ul to 2Ul.
 
I’m glad Kozmo is feeling better.
I don’t understand vets who say don’t worry about the ketones.....we’ve heard that before.
I’m so glad you will be monitoring them as they are really really important.

I agree with @Red & Rover (GA). Make sure you ask about how he’s eating at the vet. Food is so important in the recovery of DKA. And A/D is a good food to get from the vet.
Are they giving him cerenia each day do you know?
Post as soon as you have him home so w can help you.. Don’t forget to ask for an injection of cerenia on discharge, hopefully they will give it.
 
Red & Rover (GA) said:
Is he eating for the vet? If so, what are they feeding? And how much overall is he eating.
You may want to ask for a couple of cans of A/D. Calories are so important in a DKA cat and A/D is easy to make into a slurry and syringe if syringe feeding may be necessary when he's home.
Click to expand...
Bron and Sheba (GA) said:
I’m glad Kozmo is feeling better.
I don’t understand vets who say don’t worry about the ketones.....we’ve heard that before.
I’m so glad you will be monitoring them as they are really really important.

I agree with @Red & Rover (GA). Make sure you ask about how he’s eating at the vet. Food is so important in the recovery of DKA. And A/D is a good food to get from the vet.
Are they giving him cerenia each day do you know?
Post as soon as you have him home so w can help you.. Don’t forget to ask for an injection of cerenia on discharge, hopefully they will give it.
Click to expand...

Kozmo's home! No cerenia and no script for Lantus, however (!) we've left her with printouts of papers that I found here in the forum and if we can provide proof that Caninsulin isn't working so well for his BG levels (ie his spreadsheet) then she'll consider prescribing Lantus. She's only ever had one other cat with FD and Prozinc was prescribed. I don't have a problem putting Kozmo on Prozinc but it's been unavailable in the UK for some months and once it's available again, we don't want to take the chance it'll happen again.

Kozmo ate a good portion of boiled chicken breast (in it's broth) when he arrived home and we administered 2 Ul Caninsulan shortly after (11am) as requested by the vet. His BG was 17 just before we collected him from the vet and they fed him to raise his levels, then we fed him again (as requested). We're trying to get him back onto our 8am and 8pm schedule and they said to shoot at 11am (done) then 10pm tonight, 9am tomorrow morning then 8pm in the evening.

They're happy for us to home test and run our own curves. We'll be checking his urine for keytones every day until you tell us not to. We've also purchased a different BGM - we were using Sonicare Safe-Accu (.6) and we've changed to Braun Omnitest 3 (.3) so we shouldn't have too many problems extracting blood now.
 
Annie & Kozmo said:
Kozmo's home! No cerenia and no script for Lantus, however (!) we've left her with printouts of papers that I found here in the forum and if we can provide proof that Caninsulin isn't working so well for his BG levels (ie his spreadsheet) then she'll consider prescribing Lantus. She's only ever had one other cat with FD and Prozinc was prescribed. I don't have a problem putting Kozmo on Prozinc but it's been unavailable in the UK for some months and once it's available again, we don't want to take the chance it'll happen again.

Kozmo ate a good portion of boiled chicken breast (in it's broth) when he arrived home and we administered 2 Ul Caninsulan shortly after (11am) as requested by the vet. His BG was 17 just before we collected him from the vet and they fed him to raise his levels, then we fed him again (as requested). We're trying to get him back onto our 8am and 8pm schedule and they said to shoot at 11am (done) then 10pm tonight, 9am tomorrow morning then 8pm in the evening.

They're happy for us to home test and run our own curves. We'll be checking his urine for keytones every day until you tell us not to. We've also purchased a different BGM - we were using Sonicare Safe-Accu (.6) and we've changed to Braun Omnitest 3 (.3) so we shouldn't have too many problems extracting blood now.
Click to expand...
I have never had a cat with DKA and I hope I never do, but i can't believe a vet that would tell you not to worry about ketones. Ketones is probably the biggest worry anyone that has a diabetic cat will have. If this vet has only seen 1 diabetic cat she must not have a very big practice. Lantus is the number 1 insulin for cats, not Caninsulin. I do believe most of the time Caninsulin is used for dogs and not cats. I know I am in the US and you are not, but all of these things just don't sound right to me, does anyone else see red flags.
 
Teresa & Buddy said:
I am in the US and you are not, but all of these things just don't sound right to me, does anyone else see red flags.
Click to expand...
Lantus is not licensed for use in cats in the UK, only recently Prozinc and unfortunately there is a supplier shortage going on over there. They use a cascade system where you have to first prove that Caninsulin and Prozinc are not effective before they can consider Lantus.
 
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Panic said:
Lantus is not licensed for use in cats in the UK, only recently Prozinc and unfortunately there is a supplier shortage going on over there. They use a cascade system where you have to first prove that Caninsulin and Prozinc are not effective before they can consider Lantus.
Click to expand...
I know some of the other countries are different than the US, however I had no idea how different. The 1st insulin that Buddy was on was Prozinc and I felt that it was a good insulin, when I mentioned Caninsulin because it was cheaper I was told NO, not for cats. One of the main reasons I changed to Lantus was because I could get Lantus from Mark's marine pharmacy much cheaper than I could buy Prozinc from the vet. But since that time, more than 1 vet has told me that Lantus was best for cats.
 
Hi Anne and Kozmo. I am so glad Kozmo is home! Wonderful!
Are you feeding him before the shots and waiting 1/2 hour before giving he caninsulin?
Also I noticed you got +3 in the am cycle that was quite a bit lower than the preshot and then didn’t test again......always test again if the BG is lower than the previous BG.
When you test for ketones, can you post the results here for us to see please, and also record it in the remarks column of the SS?
For now I would try and get a ketone test in twice a day for a few days so we can see how he is going.

With food, you need to be offering small amounts frequently except for the 2 hours preshot.
With DKA food is like a medicine and it helps greatly to stop the ketones from reappearing. So keep those frequent meals going throughout the day and night,
I’m sorry they didn’t give you any cerenia. Hopefully you won’t need any.
Make sure he is drinking well and if he will tolerate it, add some warm water to his snacks, just a bit to add to the fluid intake.

Please keep posting with how he’s going as we will be watching closely.
 
Annie & Kozmo said:
They're happy for us to home test and run our own curves. We'll be checking his urine for keytones every day until you tell us not to. We've also purchased a different BGM - we were using Sonicare Safe-Accu (.6) and we've changed to Braun Omnitest 3 (.3) so we shouldn't have too many problems extracting blood now.
Click to expand...
Hi Annie, (waving to you from Surrey!),

I see you've had some fab advice (especially from the wonderful Bron). I'm just adding a couple of wee things.
Because Kozmo has had DKA he will always need some monitoring for ketones. Some cats are more prone to developing them than others. And since Kozmo has had DKA this indicates that he is one of those who is more prone to them.
Since you're now getting more used to hometesting blood glucose (yay, well done you!) you could consider getting a blood ketone meter so that you can test the blood ketone level rather than the urine. Blood ketone tests are more accurate than the urine test strips, and they give test results in 'real time' rather than the slightly retrospective result that a urine test gives you. This can be important in kitties that may be more prone to ketones, because once ketones are present the situation can escalate quickly. The meter's accuracy also offers greater reassurance if you get a negative ketone result.
Some UK folks use the 'On Call GK Dual' meter (available on Amazon and some other places). It's called "Dual" because it tests blood glucose as well as ketones (using different strips for each), but most folks who have it just use it for its ketone testing function, and use another meter to test blood glucose. The test strips for the ketone meter are more expensive than most blood glucose test strips, but, once the period of initial recovery from DKA is over you'd be testing for ketones much less frequently, just as a precautionary measure, and any time that your kitty seems a bit 'off' or is not wanting to eat.

I see that your kitty was prescribed steroids? As you say, this may have been the trigger for the diabetes. ...Steroid induced diabetics are much more likely to go into remission, so it is great that you are hometesting blood glucose, as you should be able to monitor and 'see' if/when his insulin requirements decrease.
It's great that your vet is willing, in due course, to prescribe a human insulin. Lantus and levemir are both great insulins for cats. (Note: there is no 'best' insulin; it's a matter of what works best for the kitty, and 'every cat is different'). Meantime you're using Caninsulin. That's fine. It's not the easiest insulin to work with, but there are ways of working with it to get the best out of if. And some cats do just fine on it, with some going into remission.

What was Kozmo eating prior to his diabetes diagnosis? Was it a higher carb food?
I see that he's eating the new Katkin food now. How is he enjoying that? (I'm thinking of trying it for my kitty crew and would be interested in your - and Kozmo's - opinion of it.)

Reassuring hug to you. :bighug:

Eliz
 
What was Kozmo eating prior to his diabetes diagnosis? Was it a higher carb food?
I see that he's eating the new Katkin food now. How is he enjoying that? (I'm thinking of trying it for my kitty crew and would be interested in your - and Kozmo's - opinion of it.)


Eliz[/QUOTE]

Eliz, I’ve been meaning to let you know about our experience with Katkin. As you know, Kozmo has been unwell lately and I think it would be unfair to base my opinion on his current eating habits, however, the food looks and smells nice (I kind of expected a smelly mess ‍♀️) and Kozzie actually did enjoy small amounts of it until he lost his appetite with DKA.

We had signed up for a two week sample pack and KatKin actually called to find out how we were going with the new diet before the full subscription kicked in. I think that’s a lovely service.

We still have pouches in our freezer and I’m thinking about getting them out again now that Kozmo is showing interest in food again (yay!).

One remarkable item that arrived in the well-packed I’ve box is a bottle of secret sprinkles. We call them magic sprinkles. I could sprinkle these on a glittery frog and I’m sure Kozzie would lick them off! I’m guessing they might be crushed freeze-dried chicken pieces but no matter what it is.... it’s wonderful!

So... my verdict is that we’re prepared to go the extra mile to reintroduce these pouches to Kozmo’s diet.
 

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