Still symptomatic despite good numbers? Recent DKA

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alayna

alayna

Member Since 2019
Frankie's been consistently in the blues since the beginning of November, but he's still drinking and peeing quite frequently. Not emptying his water bowl per se, but it's still different from his normal, and I'm changing the pee pad more often than normal. Last time on insulin and while in remission he did not drink at ALL while he was eating wet food. I'm worried about his kidneys. Is this common in kitties who are perhaps still sensitive or recovering from DKA? It's been 2 full weeks so I'm not sure why that would still be an issue. He was in critical care from Oct 24-Oct 28, received IV fluids and was syringe fed until he started eating normally.

Here are all of his recent labs for anyone who might want to take a look. He has no other symptoms, as perky as usual.
 
I have to go out in a few minutes but I wanted to comment on a few things.

It is risky to be skipping shots so soon after a DKA episode. Insulin helps keep the ketones away

Are you testing every day for ketones in the urine.? This is extremely important as this tells us how Frankie is going. Please get a ketone test asap and post the result.

How is his appetite? Are you feeding extra food. Post DKA kitties need up to 1 and 1/2 times the normal amount of food to combat ketones reappearing.

I notice you are not testing the BG at night at all. Cats often drop lower at night so it is important that you test at least once every pm cycle. A before bed test will tell you if it is likely to be an active cycle. If the before bed test is the same or lower than the pretest you will need to test again later in the cycle to keep Frankie safe.

How long before the next insulin dose is due?
 
Bron and Sheba (GA) said:
Are you testing every day for ketones in the urine.? This is extremely important as this tells us how Frankie is going. Please get a ketone test asap and post the result.
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I can test him tonight. His last home test was 10/29.

Bron and Sheba (GA) said:
How is his appetite? Are you feeding extra food. Post DKA kitties need up to 1 and 1/2 times the normal amount of food to combat ketones reappearing.
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His appetite is beautiful. He's eating 1.5x the amount he usually eats.

Bron and Sheba (GA) said:
I notice you are not testing the BG at night at all. Cats often drop lower at night so it is important that you test at least once every pm cycle. A before bed test will tell you if it is likely to be an active cycle. If the before bed test is the same or lower than the pretest you will need to test again later in the cycle to keep Frankie safe.

How long before the next insulin dose is due?
Click to expand...

This hasn't really been a possibility lately with lots of tests at school, but I can try to get one before bed tonight. I usually dose him at 8, so 3 and a half hours from now for me.
 
alayna said:
I'm confused, why would he go hypo overnight if he didn't get any insulin? Or are you just suggesting that if I do give insulin tonight?
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I see Bron mentioned above that it's risky to be skipping shots soon after a recent
DKA Episode. I think you should post and ask for help when you test AMPS and PMPS and ask about how much to shoot so you won't have to skip since his recent DKA
@alayna

I'm going to tag @Deb & Wink
and ask her to look at your Spreadsheet and dosing ok
 
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alayna said:
Frankie's been consistently in the blues since the beginning of November, but he's still drinking and peeing quite frequently. Not emptying his water bowl per se, but it's still different from his normal, and I'm changing the pee pad more often than normal. Last time on insulin and while in remission he did not drink at ALL while he was eating wet food. I'm worried about his kidneys. Is this common in kitties who are perhaps still sensitive or recovering from DKA? It's been 2 full weeks so I'm not sure why that would still be an issue. He was in critical care from Oct 24-Oct 28, received IV fluids and was syringe fed until he started eating normally.

Here are all of his recent labs for anyone who might want to take a look. He has no other symptoms, as perky as usual.
Click to expand...


@Marje and Gracie
Hi Marje do you think you can have a look at the labs Thank you Marje
 
alayna said:
I can test him tonight. His last home test was 10/29.



His appetite is beautiful. He's eating 1.5x the amount he usually eats.



This hasn't really been a possibility lately with lots of tests at school, but I can try to get one before bed tonight. I usually dose him at 8, so 3 and a half hours from now for me.
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What ate your dosing times , is it 8AM and 8 PM
Where do you live
 
Do you think you can quickly add the lab results into the SS, as well as the reference ranges, if they are different than on the SS? You have two different labs, one recently from Oct. 21st and the previous from June 4th. It helps to have them in your SS so people can easily see the trends. Latest potassium looks on the low side, which may need additional monitoring, as does the specific gravity of urine this time around, but that may be due to a few different reasons . BUN being lower than normal is not usual for a cat with kidney issues, did your vet comment at all about that?
 
I agree with Bron, please do keep checking for ketones, skipping shots is not ideal with past history of DKA. It looks like the last labs had higher white blood cell count, which may indicate an infection, so even more important to keep monitoring the ketones.

The recipe for DKA is not enough insulin + inappetance + infection or other systemic stress

Here is the info page for more info https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/
 
His total bilirubin is high in the serum chemistry. I would ask the vet about that since his other liver enzymes are normal. He consistently has had a low serum potassium level and I would also ask the vet about some supplementation for a short time. While FDs can have a bit lower potassium level as the exogenous insulin can cause cells to uptake potassium into the cells but his is lower than it should be even with that as a factor.

He’s not concentrating his urine which is understandable because he just got fluids. But he wasn’t concentrating it last summer and that might be due to all the water he was consuming. I’d keep an eye on that. I’d also ask the vet if a urine protein:creatinine ratio should be done to ensure the protein in his urine is insignificant. And, of course, there are ketones in his urine.
 
I'm not sure if anyone here or if. your vet discussed what the issues are with DKA. The basic "recipe" for DKA is some source of infection or inflammation + not enough insulin + not enough calories. As a result of this combination of factors, your cat's electrolytes go out of whack and cause metabolic acidosis. Electrolytes have a very narrow normal range and if they are too far outside of normal range, it can be a life threatening situation. We are very cautious with a kitty that is recently recovering from DKA because it is very easy for some cats to fall back into ketoacidosis. No one wants that to happen to. your kitty or your bank account.

Because insulin is one of the key components to keeping Frankie out of DKA, you keep hearing people telling you that skipping shots is not a good idea. And, they are right. Getting insulin into Frankie is critical especially if you're seeing even trace ketones in is urine. What you may need to do is use food, even high carb, to buffer the effect of the insulin. Obviously, it's great that Frankie is eating. Just be careful is he doesn't seem to want to eat or become lethargic. Likewise, because ketones can rear their ugly head, monitoring Frankie is also important. Getting a ketone test whenever you can would be ideal While ketones are more apt to occur if numbers are high, I would not be complacent because Frankie's numbers are looking great. Please do try to get a test before you go to bed every night. This isn't because of the DKA. You want to be comfortable going to bed knowing that Frankin's numbers aren't bottoming out.
 
Christie & Maverick said:
It looks like the last labs had higher white blood cell count, which may indicate an infection, so even more important to keep monitoring the ketones.
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He was actually given a long-acting antibiotic at the vet when he was hospitalized Oct. 24-28, after those labs were done. I am currently waiting for him to urinate for a ketone test though.
 
Here is a link to his DKA progress thread if it helps.

111 PMPS. I guess what I really want to ask is, if he ends up being negative for ketones tonight, should I shoot anyway? Maybe 0.25 or even less? His food is low carb wet. I can't stay up all night to monitor but I can check him right before bed.

Should I continue to give him tiny doses of insulin despite low numbers regardless of ketones? I was under the impression that the 2 weeks since his DKA was enough of a buffer to start dosing him regularly. I guess if that's not the case, how long would you guys suggest that I keep giving him insulin?
 
I would feed him some higher carb food during the pm cycle to try and keep the BG high enough to be safe and try and get a few BGs during the cycle. Post any BG tests you get and I will online during the next several hours off and on.
I would get a +1 to start with. :)

I would leave food out for him after you finally go to bed. If the numbers are dropping please set the alarm to get up and test again. We all want Frankie to be safe.
 
@Bron and Sheba (GA) - Thanks

Alanya --

One of the most helpful aspects of this board is that members will not abandon you in a critical situation. Bron was most likely checking in throughout the night (she's in Australia) to see a test beyond your +2 and to make sure you and Frankie were OK. To be honest, we consider trace ketones in a recently DKA cat a critical situation. Trace ketones can develop into large ketones within hours.

With most of the longer acting insulins, like Prozinc, the +2 may not tell you the whole story. If your +2 is lower than your pre-shot number, then you absolutely need to stay up and get a few more tests to insure Frankie's numbers don't drop too low. However, you have no idea how his numbers typically run during the PM cycle. Many cats visit lower numbers at night. Given meter variance, your PMPS and +2 are essentially the same number so there is a good chance that Frankie was in green numbers at nadir.

I know there's a lot of information to absorb. Treating DKA is not that different in cats than it is in humans so your pharmacy books may help. I also know that we're asking a lot when it comes to your time and energy. We want Frankie to be safe and healthy. Would it be easier to shift Frankie's shot time so you can get additional PM tests?
 
I'm going to be out of town from December 12th-23rd, and I was planning on leaving him with my parents... Do y'all think he'll be okay to be without insulin by then? I'm just feeling frustrated because I was so hopeful about his numbers and potential remission and now all of a sudden I'm feeling lost again. I'd hate to have to board him for that amount of time. Of course I would leave glucometer, insulin, ketone strips etc. with my mom just in case. And I'm still confused as to why he's drinking and peeing like his numbers are bad. Could it be the trace ketones? He's been symptomatic pretty much all month, besides his perkiness and appetite looking good.
 
We can’t tell you how he will be on12 December at this point but unless he has gone into remission you will not be able to stop insulin. That would be extremely risky and could very likely bring on another DKA illness.
All you can do at this point is keep doing what you are doing... monitoring him, give the insulin and test for ketones daily.

I would plan to either bring your mother up to speed with testing the BGs and urine and giving the insulin or have a plan B for him to go somewhere else where he can continue the treatment and monitoring. Your mother could post here and we would help her daily.
If your mother is willing to do it that would be the best option... we have many many older carers who manage their diabetic kitties beautifully so age is no barrier.
 
Bron and Sheba (GA) said:
unless he has gone into remission you will not be able to stop insulin.
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Right, that's what's frustrating is that I can't possibly find out if he's in remission if I just have to keep giving the insulin regardless of his numbers. That's why I initially stopped giving it, because I wanted to see if he was potentially going into remission, but apparently that was a huge mistake, which I'm paying for :confused:
 
alayna said:
Right, that's what's frustrating is that I can't possibly find out if he's in remission if I just have to keep giving the insulin regardless of his numbers. That's why I initially stopped giving it, because I wanted to see if he was potentially going into remission, but apparently that was a huge mistake, which I'm paying for :confused:
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The thing is with feline diabetes you can’t force or rush the process or progress of it all. It’s a marathon not a race. Some cats go into remission quickly and some don’t. You might be one of the lucky ones but you need to make sure you go about it by following the numbers of the BG, giving insulin, testing and getting advice here. We have helped many carers get through the post DKA stage; and with ketones in the picture making sure they are not still lurking in the background waiting to pounce again.

We can tell when cats who are on insulin are ready to go on an ‘off the juice’ trial. So don’t worry about not knowing when he’s ready to stop insulin. First we need to make sure that the ketones are way behind in the rear vision mirror.
Does that make sense?
 
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Bron and Sheba (GA) said:
The thing is with feline diabetes you can’t force or rush the process or progress if it all. It’s a marathon not a race. Some cats go into remission quickly and some don’t. You might be one of the lucky ones but you need to make sure you go about it by following the numbers of the BG, giving insulin, testing and getting advice here. We have helped many carers get through the post DKA stage; and with ketones in the picture making sure they are not still leaking in the background waiting to pounce again.

We can tell when cats who are on insulin are ready to go on an ‘off the juice’ trial. So don’t worry about not knowing when he’s ready to stop insulin. First we need to make sure that the ketones are way behind in the rear vision mirror.
Does that make sense?
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That makes sense, thank you so much! I'll just continue to give him small doses and keep checking to make sure everything is okay. I appreciate your guidance.
 
106 +3 (he did eat a little bit after this measurement) and I tested his urine again, honestly I could not tell if it was negative or trace, my boyfriend and I decided it was somewhere in the middle. Still drinking and peeing more than usual. Appetite and energy okay.
 
Negative for ketones at Frank's +6 today, still drinking and peeing an unusual amount but nothing alarming. His AMPS was a little bit higher than usual this morning so I felt okay giving him a larger dose. He had a small meal after his +6 measurement, I've been feeding him anywhere between 4-6 times a day (200-300 calories, 2-3 3oz cans) depending on whether or not he's hungry/asking for food.
 
Caught him in the midst of drinking a ton of water and got 108, so I guess I know it's not directly related to his BG. (unless I'm misinformed in that regard) I'll just have to bring him soon to have some new labs done in case it is his kidneys. His last labs were taken while he was actively in DKA so I don't really trust them to be representative of his current state.

I know it's not immediately alarming for cats to drink water while eating only wet food, but Frankie usually never drinks water on wet food, so that's why I'm concerned. Still no other symptoms besides drinking and peeing.
 
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