New Member - Christina & Kitty Cat - 9/13/20

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Christina & Kitty Cat

Christina & Kitty Cat

Member Since 2020
Kitty Cat has been throwing up everyday for the last 3 days, twice within an hour early this morning, didn't eat breakfast.

Kitty Cat (M/8yo) was diagnosed with diabetes on 9/1/20 and I started insulin on 9/4/20. This forum has been super helpful while I try to research everything at home.

He used to be overweight at 16lbs, and suddenly dropped to under 7.5lbs in the last few months. I missed all the warning signs thinking it was good he was losing weight and drinking A LOT of water. Then he wasn't eating all his food and I took him in to get checked out at a new vet. I have no pet insurance and I'm currently unemployed due to COVID so the price and news really hit me.

He's currently on 1 unit of Lantus 2x a day (9am/9pm) and eating Hill's w/d wet food portioned for an ideal weight of 10lbs. After reading through this site, I made sure to get a monitor right away and test at home. He seemed to start getting better though his numbers were still all over the place. He wasn't having diarrhea anymore, he started eating more, took a few sips of water after not drinking for days, never vomited before.

Then 3 days ago he started vomiting, his poop got super hard and dry, he was constipated, excessively cleaning his butt, but still eating so I continued insulin as usual. This morning at 6am he vomited, and then again at 7am. Now he won't eat so I'm skipping his 9am insulin.

Is vomiting normal or a side effect of the insulin? Do I need to take him to the emergency hospital? (It's Sunday so vet is closed.) I'm so worried about him but also don't have the funds to go to the hospital every time something happens so I'm not sure what to do now. Any advice/support appreciated!

Concerns: Vomiting, constipation, didn't eat breakfast

Tried putting this spreadsheet in my signature but it kept saying it was spam so posting here:
Kitty Cat's BG & Insulin Spreadsheet
 
Christina -

If your cat has been unable to hold food down for 3 days, you need to get Kitty in to see a vet. There are several other housekeeping issues but they can wait. When a cat doesn't get enough calories, there's a risk for liver problems. Likewise, if there is some other medical issue, the risks for diabetic ketoacidosis (DKA) increase. What I can tell you is that this is not a typical reaction to insulin.

If your cat is, in fact, constipated, the vet may need to give an enema or make some other suggestions. If your vet isn't open, you may need to get Kitty seen at the emergency vet.
 
I found out my vet group has another branch with Sunday hours so I gave them a call. The dr is currently in an appointment but will call me back after. I'm assuming it was a tech that answered the phone because she said she's not very experienced with diabetes so can't give advice, but will have the dr call me back.
Friday 5pm he drank a little and then threw up mostly water (it was clear). Saturday 3:30pm he threw up mostly brown liquid. He was was fine to eat dinner at 9pm and breakfast at 9am afterwards. It's just today that he threw up mostly solids and won't eat. It's now 2 hrs past breakfast and I still can't get him to eat anything. Is it okay that I skipped his insulin? His bg was 369 at 6am right after the first time he threw up. Then 414 at 9am when he's supposed to get his shot. So I'm worried about it going higher but also don't want to give insulin if he has no food in his stomach.
I haven't tested for keytones before. I will buy the strips now. Will any strips do? Looking at this one from Amazon.
 
You should be able to get ketones test sticks (I used Ketostix) from any human pharmacy. The answer as to whether it's OK to skip insulin depends on whether he has ketones. Insulin does more than combat the carbs in his food. A half dose is typically safe - it's what diabetics undergoing anaesthesia and cannot eat can usually get. Plus he's quite high. However, with Lantus, if you shoot a couple hours late, it means your next shot is also later. You can get back on schedule by 15 minutes a shot or 1/2 hour once per day.

May I ask why the w/d food? It's very high in carbs. Not a good choice for a diabetic. As long as there was no other medical reason for the w/d, there are lots of cheaper commercially available foods that are low carb and suitable for diabetics. What was he eating before? Also wondering if a fast food transition upset his tummy.
 
I’m with Wendy. Most of us feed our diabetic cats fancy feast pate which is low in carbs and very good quality. Most vet prescribed foods are high in carbs and have nothing special about them other than the price tag. When you do talk to the vet, ask about anti nausea meds. If he’s nauseated, he won’t eat without meds like Cerenia or ondansetron. I’d also be a little worried about dehydration from all the vomiting. This happened with Minnie a lot and now we know it’s because she has IBD in addition to the diabetes so he may have another underlying condition as Sienne and Wendy suggested and a trip to the vet may be necessary.

in the meantime, can you try giving him some baby food? Minnie would almost always eat that even when she wouldn’t eat anything else. Added bonus is that it has a lot of moisture in it. Gerber is a good brand. Something like their chicken or turkey. Off any other brands, make sure it has no onions or any spices added. It should be just the meat.
 
Thanks for all this info everyone! It helps to calm my nerves a little since I was a wreck this morning.
I asked the vet the day of the diagnosis to give a food recommendation and she prescribed hills w/d either dry or wet (I chose wet), and 2 other prescription options. But I notice it has flour and corn. I wanted a grain free diet since thats what all of the internet said to do, but my vet prescribed this food and I went along. My cousin is currently studying to be a vet and also had very strong opinions about keeping him on the prescription diet and NOT going grain free.
He was previously eating Purina cat chow naturals dry food which contains corn and rice. I made the switch on 9/4 as soon as it came in the mail. I didn't ease him into the new diet as slowly because I thought this new food much be so much better. But he still tries to get into the cabinet where his old food is.
Vet gave him Cerenia the first visit for nausea, but he hasn't thrown up before then. But so far since I got the diagnosis 2 weeks ago, he's thrown up I think 7 times now. (4 of those in the last 3 days)
He ate as normal up until this morning. He's drinking more and more water today which I'm not sure if I should be happy or concerned. He's staying close by to his litter box today (not in it, just a few feet away) which is odd for him but he's been trying to poop for hours with little luck. He took a few licks of food so far.
Since it's been almost 4 hours since he was supposed to get his first shot, I'm assuming I should wait until his nighttime shot.
Vet hasn't called yet so I'm just stuck waiting for now and keeping a really close eye on him.
 
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Christina & Kitty Cat said:
Then 3 days ago he started vomiting, his poop got super hard and dry, he was constipated, excessively cleaning his butt, but still eating so I continued insulin as usual. This morning at 6am he vomited, and then again at 7am. Now he won't eat so I'm skipping his 9am insulin.
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Christina & Kitty Cat said:
Concerns: Vomiting, constipation, didn't eat breakfast
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Hi Christina,

I see you've already had some good suggestions from other members regarding testing for ketones, DKA, etc.

High ketone levels (and possible concomitant dehydration) can be one cause of nausea.

Constipation is another possible cause of nausea, vomiting and reluctance to eat. Given that Kitty Cat has been having problems with constipation very recently, my best suggestion to you is to get him checked out by a vet ASAP to see whether there is a stuck stool or any other obstruction in the gut. If the vet finds no obstruction or if they administer an enema to 'free things up' then a couple of days' treatment with metoclopramide (Reglan) can help restore normal gut motility. On top of that, you will probably need to start some form of preventative treatment for the constipation (NB: do not start this before the vet confirms that there are no obstructions in the gut!). The website felineconstipation.org has very helpful information.

Another possible cause of nausea and vomiting may be pancreatitis. If only to rule it out, when you take Kitty Cat for a check-up, I suggest you ask the vet to run an on-the-spot Snap fPL test for pancreatitis. The following resource is very helpful:

IDEXX Pancreatitis Treatment Guidelines

The above document also contains information on all the standard treatments for cat nausea and appetite stimulation. These can help a cat to eat better, but if constipation is present then none of these treatments tend to work until the constipation has first been addressed. Should pancreatitis be present then pain relief needs to be prescribed alongside anti-nausea and appetite stimulant meds.

Note: Some vets prescribe metoclopramide to treat nausea but it does not provide any noticeable anti-nausea benefit in cats because they have very few of the receptors it targets - see the IDEXX document above. Ondansetron and Cerenia are appropriate treatments for nauseated felines. Famotidine can also help with hyperacidity in the stomach (usually the cause of cats throwing up foamy, watery vomitus after several hours without any food). Lots more helpful info here:

Nausea, Vomiting and Inappetence - Symptoms and Treatments


Christina & Kitty Cat said:
Friday 5pm he drank a little and then threw up mostly water (it was clear). Saturday 3:30pm he threw up mostly brown liquid. He was was fine to eat dinner at 9pm and breakfast at 9am afterwards. It's just today that he threw up mostly solids and won't eat. It's now 2 hrs past breakfast and I still can't get him to eat anything. Is it okay that I skipped his insulin? His bg was 369 at 6am right after the first time he threw up. Then 414 at 9am when he's supposed to get his shot. So I'm worried about it going higher but also don't want to give insulin if he has no food in his stomach.
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Christina & Kitty Cat said:
I haven't tested for keytones before. I will buy the strips now. Will any strips do? Looking at this one from Amazon.
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Bearing in mind that Kitty Cat didn't get any insulin this morning, is spending at least part of the day running in fairly high numbers and is having difficulty eating, as a safety precaution I'd recommend testing for ketones as soon as possible: should ketones be present then they need to be addressed straight away, and higher levels constitute a medical emergency. You should be able to pick up urine ketone test strips locally from Walmart or any pharmacy. Here is helpful information:

Testing Your Cat for Ketones

Tips for Collecting Urine Samples

The sooner you can grab a test, the sooner you can either breathe a sigh of relief or get prompt, appropriate help for Kitty Cat.

I hope he feels better very soon.


Mogs
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Getting test strips at the pharmacy now! Hope he pees soon with all the water he's been drinking.
I didn't see lab results after the first visit but I checked back at the first email from the vet:
"There are changes in Kitty Cat's bloodwork that are consistent with diabetes: Kitty Cat has high blood glucose, and there is glucose in his urine, as well as ketones, which are more concerning. His high liver values could be due to his diabetes or another pathology (eg. hepatic lipidosis or other disease). He has slightly low neutrophils, a type of white blood cell; decreased neutrophils can be seen in infection/inflammation/other reasons."​
So it's mentioned that there were keytones in his urine at the time of his test which was 8/31 (Results came in on 9/1). The vet hasn't asked to see him in person again after the first visit. Was something supposed to be done about the keytone situation? What do they do when there are keytones present?
 
Christina & Kitty Cat said:
I wanted a grain free diet since thats what all of the internet said to do, but my vet prescribed this food and I went along. My cousin is currently studying to be a vet and also had very strong opinions about keeping him on the prescription diet and NOT going grain free.
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Go with your gut (and the internist) - stick with low carb and grain free. Your cousin has no doubt had lectures from the pet food manufacturers who are more than happy to provide the "expertise" to teach up and coming vets on nutrition. :rolleyes: If you don't want to feed Fancy Feast (I didn't), there are lots of other options. This food list is one source to look at - you want food with carbs under 10%. Actually the website catinfo.org where I liked that list is a good read - written by a vet nutritionist.

OK, thanks for that update on ketones. You do want to test at least daily for a while and not skip insulin if at all possible. Even if it means feeding higher carb food. You need to get something into him. Try to water down his food as well, to help flush out any ketones. Sorry but more reading for you: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters and this one is a good one just for overall background. What is Feline Diabetes?
 
One thought for consideration -- the W/D may not be agreeing with Kitty. She could be having an allergic reaction. It's truly junk food when it comes to ingredients. FWIW, my diabetic was very sensitive to beef and anything with gluten. She'd puke it right back up.

I would try to see if Kitty can hold down some baby food -- stage 2 of either Gerber or Beechnut. The ingredients are a protein and broth -- no veggies. It's gentle on the stomach. Otherwise, pick any of the foods that are below 10% carb from the food chart that Wendy linked.
 
He's eating!!!! I just tested him again, BG is 359, down from 414 5 hrs ago when he usually eats breakfast and gets 1 unit insulin). Should I give him 1/2 unit now while he's in the eating mood? I don't actually have half unit lines on my syringes.
Wendy&Neko said:
However, with Lantus, if you shoot a couple hours late, it means your next shot is also later. You can get back on schedule by 15 minutes a shot or 1/2 hour once per day.
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Do you mind explaining this more, I'm a little confused. If I give him insulin now (5 hours after it was supposed to be), does his next dose need to be 12 hours from now, and each shot after that gets moved back 15 mins until it goes back to the normal 9am-9pm schedule?
 
Getting Fancy Feast Classic Chicken Pate now which he has had before and liked. Hopefully that will get him to eat some more today. Shame I have all this prescription food left that was so darn expensive, but I don't want to keep giving it to him if it's not helping the situation.
 
return the food to the vet and get your bill paid down or money back. smh Tell him kitty refuses to eat it.
or donate it to a local shelter.
 
Definitely get your money back from the vet on the food. The fact that he's eating is fantastic though!

As far as the shot schedule, maybe an example will help. It's best to give Lantus as close as 12 hours apart as you can. Say your shot time is 7AM/7PM. If you end up shooting late at 9AM (as an example), then you can do the PM shot at 8:45, then the next morning at 8:30. Or you could shoot at 9PM tonight at 8:30 tomorrow morning. Then the shots after that can be moved up the same way and it'd take you 4 days to make up those two hours.

As for tonight, if you are 5 hours late now, you have two options. First is to give the full dose now (or soon), and then go back to your regular schedule tomorrow morning, so about 19 hours later if my math is right. Or you can wait until tonight and give the shot at a time that suits you. Since you've gone more than 12 hours without a shot, you can shoot earlier if you want. Whether or not you are seeing ketones might influence the decision.

1/2 unit marked syringes are best. About 2/3 of the way down this Sticky Note on Insulin Care and Syringe Info from the Lantus forum, you'll see descriptions and brands of popular syringes that have half unit markings.
 
I think a once-over by the vet would be a very good plan. Then you'd be able to try something to help the constipation. (NB: It's not safe to start home treatments for constipation until a kitty's been examined by a vet to make sure there's no obstruction in the gut.)

With the liver issues and inflammation flagged up from the last vet work-up those, too, suggest it could be worthwhile checking whether pancreatitis might be an issue.

How's Kitty Cat's hydration?





Mogs
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THANK YOU FOR ALL THE READING MATERIAL EVERYONE! This is all so helpful, I really appreciate it and will be going over everything as quickly as I can.
I keep finding him at the water fountain today so hopefully I get a good pee sample soon.
I ordered the food from Chewy so I doubt the vet will help me out. I also bought First Mate Chicken as a backup after watching this video but I see from the chart that it has 19% carbs. I haven't opened it yet so I'll try to return that one.
I looked up hills w/d in the chart and it says 25% carbs, but on hill's website it says 6.2% so I must be reading this wrong?
 
Wendy&Neko said:
this Sticky Note on Insulin Care and Syringe Info from the Lantus forum
Click to expand...
This is totally not what I learned when I was watching videos on how to do this!
  • Never shake or roll your vial, cartridge, or pen.
  • Do not inject air into cartridges or pens. Cartridges and pens are designed to work on a negative pressure principle.
  • If you draw up too much insulin in the syringe... squirt excess either into the air dramatically like they do on TV or into a paper towel... anywhere but back into vial/cartridge/pen. There is a silicon coating inside the syringe. It may contaminate the insulin vial with silicon.
I watched this video on preparing a syringe with insulin which directed I roll the vial to mix and warm it, inject air into the vial, and re-inject the excess insulin into the vial.

I'm so stressed that I'm doing everything wrong for him. I'm hoping that being on here now and getting all these second opinions will help save him.
He's really chowing down on the fancy feast, the cleanest bowl I've seen in a long time. Still waiting for him to pee so I can test for keytones. Also still no call back from the vet.
 
Critter Mom said:
@Wendy&Neko -

Could you help Christina with advice on dosing if Kitty Cat switches quickly to FF low carb from the Hill's w/d?
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yes please! Any advice is greatly appreciated. He didn't really want to eat the w/d today, but as soon as I opened the FF can, he went crazy. Though I feel like he always likes whatever's "new" + the sound of a fresh new can. I'm giving in small spoonfuls right now but he's almost done with a 3oz can already. Should I be mixing w/d with FF for a gradual change or just stick with FF since he seems to accept it more already?
 
The video you watched on injecting a cat was for for Prozinc insulin - not Lantus.

Chewy should take back the food you bought from them.
Critter Mom said:
Could you help Christina with advice on dosing if Kitty Cat switches quickly to FF low carb from the Hill's w/d? I see from his SS that he has been in fairly high numbers but such a diet change would represent a significant drop in carb load.
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With possible ketones in the picture, I'd rather stick with 1.0 unit for now and see what happens. It's a fairly typical starting dose for a cat, especially with an ideal weight of 10 lbs.

As for food, I think I'd stick with the FF for now. Probably less ingredients. Make sure to add a spoon or two of water to the food, constipated cats need lots of fluids to soften things up.
 
Wendy&Neko said:
The video you watched on injecting a cat was for for Prozinc insulin - not Lantus.

Chewy should take back the food you bought from them.

With possible ketones in the picture, I'd rather stick with 1.0 unit for now and see what happens. It's a fairly typical starting dose for a cat, especially with an ideal weight of 10 lbs.

As for food, I think I'd stick with the FF for now. Probably less ingredients. Make sure to add a spoon or two of water to the food, constipated cats need lots of fluids to soften things up.
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Ahh thank you so much!! I need to be more mindful that there are different types of insulin. I will contact Chewy, if I can return it, I'd be so happy. Every dollar is counting here. I have been adding water to his food so hopefully results show more over time. Still waiting for him to pee...
 
Christina & Kitty Cat said:
I looked up hills w/d in the chart and it says 25% carbs, but on hill's website it says 6.2% so I must be reading this wrong?
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The 6.2% figure is the carb content 'as fed'. When comparing foods here the % of calories from carbs is used in the chart. The Hill's website 'dry matter' % is a close-ish approximation to the figure in the food chart.

On some food manufacturer websites they list the dry matter % for macronutrients such as protein, fat, and carbs. The dry matter values are used when comparing foods rather than the 'as fed' values because the moisture content varies from food to food.

Glad that Kitty Cat is eating. Fingers and paws crossed over here that he'll keep it down this time! :nailbiting:


Mogs
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Critter Mom said:
The 6.2% figure is the carb content 'as fed'. When comparing foods here the % of calories from carbs is used in the chart. The Hill's website 'dry matter' % is a close-ish approximation to the figure in the food chart.

On some food manufacturer websites they list the dry matter % for macronutrients such as protein, fat, and carbs. The dry matter values are used when comparing foods rather than the 'as fed' values because the moisture content varies from food to food.

Glad that Kitty Cat is eating. Fingers and paws crossed over here that he'll keep it down this time! :nailbiting:


Mogs
.
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Thanks so much for this explanation!

Just got off the phone with the vet. I mentioned everything going on and she thinks it might just be that he's not agreeing with the new food. I said I gave him FF and he ate it right up after refusing the w/d. Asked if it would be okay to continue with the FF but as expected, she called FF "junk" and advised trying a different prescription diet. Sorry, don't mean to bash the vet, just sorting my thoughts here. My gut is saying not to listen. Just to be super duper sure, this is the fancy feast classic chicken we're all talking about right?

Vet also advised $530 ultrasound on Wednesday (today is Sunday) which I was going to get eventually anyway, have just been holding off because of the cost. + $45 recheck exam. They said I have to bring in my own insulin for them to administer. Instructed 1/2 dose in morning with small amount of food, and then bring him right after to keep for the whole day since he can't eat before ultrasound. Not sure what the misc item is. Breakdown here.

Family is telling me to hold off on the ultrasound to see if he gets any better with some more time on the insulin. Would it be the worst thing to wait if he seems to be getting better?
 
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Again sorry but the ONLY thing special about that "script" food is the price. Marketing agents working for huge companies that make this stuff have done and ARE doing a marvelous job of selling it to every vet that graduates from vet school. UNLESS your cat has IBD or similar issues I would never TRY to feed it to my cat. I was sold 12 cans for 40 bucks and Zoe wouldnt go near the stuff. If they wont eat it what good is it??? I have even heard (not confirmed) your vet gets a kick back for every can they sell. :mad:

OK OFF SOAP BOX... for now:p
j
 
Christina & Kitty Cat said:
My gut is saying not to listen.
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You can always tell your vet your cat won't eat vet food and you don't like the quality of it. There are options to Fancy Feast, though many people here feed it because it's cheap and low carb. The classic pate you linked is fine. I wouldn't even feed vet food for IBD! Too many of them have gums which many IBD kitties can't handle. My one exception to vet foods is a/d or royal canin recovery which are good when you need to assist feed.

Not sure why you'd have to take in insulin. Anytime my cats have had an ultrasound, they don't eat after midnight and get dropped off in the morning, and get scanned then and home in time for dinner, if not within a few hours. My current vet (pre COVID) let me be there while the ultrasound was being done, to reassure kitty. So we'd be there less than an hour. Neko actually had ultrasounds when she'd eaten food. The difference is whether they need to do anaesthesia. When I was there it was never needed. Neko did need some sedation if I wasn't there, but never full on anaesthesia for an ultrasound.
 
Wendy&Neko said:
Not sure why you'd have to take in insulin. Anytime my cats have had an ultrasound, they don't eat after midnight and get dropped off in the morning, and get scanned then and home in time for dinner, if not within a few hours. My current vet (pre COVID) let me be there while the ultrasound was being done, to reassure kitty. So we'd be there less than an hour.
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Vet said to bring him in the morning after a little bit of food and then they'll have to keep him there for a while. I asked how long and she said it depends on when the specialist comes in to do the ultrasound so I'm pretty confused/nervous about it. I'm not sure if they're planning on just keeping him in his carrier until whatever time the specialist gets there.

Update: Kitty Cat projectile vomited probably everything he ate and drank today, slipped in the vomit and flipped over, landing in his vomit. I rinsed him down which he didn't appreciate but I'm just panicking now. I'm terrified, I'm sure he's also terrified. Just checked BG and it's 343, not unusual for him. But now I know he's not going to eat dinner. Won't even take a treat after bg check. I will give insulin as normal since his number is still high. Is there anything over the counter I can give him for nausea??? I will call vet as soon as they open tomorrow to try to get him checked out.
 
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FINALLY ABLE TO TEST FOR KEYTONES. Photo here. I think it's closest to "small". Vet said it was "traces" before so it's getting worse? He also pooped a little. I really thought he was getting better until today so I'm so scared and frustrated now. Hoping vet sees him right away tomorrow. If they wont see him tomorrow, I'll go to a hospital.
 
Did you hold it exactly 15 seconds before checking against the scale? It can darken with longer time.

Insulin tonight should help.
 
Update: He's at the vet now, they redid his blood test, gave him fluids and anti-nausea. They suspect DKA and want him to go to a hospital which I am willing to do, but dr. warned it can cost $2k+. Does anyone have experience with DKA? My family is saying he's suffering and I need to consider putting him to rest. But if he has a fighting chance, I will do everything I can. He was still so energetic this morning.
 
Hi Christina,

A cat can get very sick when it's in DKA. It is treatable in a hospital setting and a cat can make a full recovery.

The hospital can provide intensive care for Kitty Cat. They can give IV fluids to help flush out the ketones and to properly hydrate him. With intensive monitoring they will be able to safely administer insulin and dextrose to get blood glucose levels back into a better range, and correct Kitty Cat's electrolyte balance, thereby restoring normal metabolic processes.

Keeping you both in my prayers. Please keep us updated.

(((Christina and Kitty Cat)))

:bighug::bighug::bighug:


Mogs
.
 
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