? Introduction: Fat Tony just got back from the ER with DKA

Hey all, my sweet boy Fat Tony just got back from the ER today where he was hospitalized for 4 days with DKA for the first time. It was touch and go there and I was a complete wreck but he's recovered now and eating and drinking like a champ. But his PM reading was 412 so I’m pretty worried.

He was diagnosed with pancreatitis last week and diabetes in April. His BGs have been up and down all along — right now he’s on 1.5U of Lantis. He’s been on Lantis 1U, 1.5U, or 2U the whole time and still hasn’t stabilized.

Readings attached: https://docs.google.com/spreadsheets/d/12DDSSHAoGFPnD8gRNOIwrqw24d9iaSCbfKOrTwlijTE/edit

(I just made this spreadsheet, going to convert to the templates format y’all use soon)

We may not be able to afford to hospitalize him again. I know it's a rough situation, but I'm not giving up on him.

*I'd like to start monitoring his ketones with a blood ketone meter. Does anyone have any recommendations for one?

*And any recommendations on what to do at the very first sign of ketones in the blood (vs full blown DKA)?

*any recs for things that might help stabilize him?

I've read through some recommendations here in the group for pancreatitis but would love any tips you have for a very good boy who may be prone to dka, has pancreatitis, and whose BG is tricky to stabilize. I really want to give it my all for him so he has a fighting chance!

 

The Nova Max Plus and Keto Mojo are both meters I see mentioned here often.

Increase fluids to help flush ketones (having sub-q fluids in the house at all times is a really good idea)

No matter what, he needs insulin. Do not skip!!
Increase his caloric intake at least 150% for now. Food is equal to medicine when it comes to DKA. Even if you have to feed something higher carb than recommended for his diabetes, he MUST eat.
Mix as much water in with his canned food as he'll tolerate and still eat it.

Here's some information on Ketones, Diabetic Ketoacidosis and Blood Ketone meters if you haven't already read it.

 

Hi, I'm so glad you have your Fat Tony back home with you after the DKA scare.
It is really good he is eating and drinking as that can be half the battle.
As Chris said make sure he is eating 1 1/2 times as many calories as he normally does. This is really important as food will help stop ketones reforming and ask for help.
Also making sure he gets his insulin doses is really important. If necessary you can increase the carb content of the food to raise the BG that cycle to give the insulin....but ask for assistance with that.

Also testing for ketones twice a day in the beginning is a good idea. Until you get a blood ketone meter please test the urine for ketones.
Do you have a spreadsheet you can share with us?. It is really important to have one so we can see the BGs and help guide you with the insulin doses.

Post every day for assistance and guidance.

 

What are you feeding him? Diet plays a big part in managing glucose levels.

 

Precision is also a good blood ketone meter.

For p'titis you want to keep a stash of meds at home. Cerenia (pills & injectable) for nausea (also has anti inflammatory properties) and ondansteron (vomiting) can be given together. Pain med such as Buprenorphine (I find liquid easier to give), appetite stimulate. Some say B12 injections helps. Cerenia injectable can be given through subq fluids if doing them, if given slowly it doesn't sting as much.

Be careful on subqs, if any heart issues you need to talk with vet or cardiologist first. Ollie's cardiologist put a limit on how much she could get at a time.

Do not stop meds to early. Relapse can be worse.

Some things that can help: meat baby food, rx canned food called a/d critical care (tasty, easy to syringe feed). High calorie food or kitten food. Syringes for feeding. Just 1 or 2 jars/cans at home if you need them.

 

The things you need for pancreatitis are ondansetron and/ or cerenia for nausea, buprenorphine for pain, if not eating add an appetite stimulant but only along with nausea medication, and feed small amounts often even if he wants to eat a lot. Feeding a lot at one time can cause pain or nausea. That will also help control his bg. If you can’t be home get a timed food dispenser set to go off hourly. You might also need to syringe feed if he won’t eat. What medication was he sent home with? Pancreatitis is so difficult but symptoms can change from episode to episode. Most of the time when I got the nausea controlled Max did well. He rarely vomited. He just became inappetent so when it was suggested to me that he was nauseous it had never occurred to me. He wasn’t diabetic when first diagnosed with pancreatitis but became diabetic a few years later. Once in awhile he would have diarrhea but it never lasted more than a day so I didn’t need to address that but it can also be a symptom. Add water to his food to keep him hydrated. You may need to give sub-q fluids at home if he doesn’t take in enough water. A fountain can help if he will drink from one.
I hope he improves quickly. Being home with you will help.