? [New Member] DKA happening now, on feeding tube; can't afford 4th hospital stay in 2 months

[Princess Tortilla (GA)]

Hi everyone,

My cat was diagnosed with diabetes mid November 2022. She has been hospitalized for DKA 3 times since then and is currently showing signs of DKA again (lethargy, weakness, inappetence, weight loss, ketones in urine showing up on dip stick as "small" or "moderate"-- tested today about 1 hour prior to writing this post).

She's using a freestyle libre 2 and has been averaging 307 mg/dl for the last week or so. We're using 1 unit of Lantus twice a day.

To help with her nutrition, during her third hospital stay, the doctors installed a feeding tube (e-tube). It's been about 5-6 days of using the e-tube. For her first 3-4 days at home, she was eating 50-75% of her meals orally and we finished the remaining 50-25% of the meal with tube feeding. Her energy levels were lower than normal, but the 5 P's were still present.

Since yesterday morning, she hasn't had an appetite and we've had to tube feed her entire meals. She's still peeing and I think I saw a poop yesterday, but she's no longer preening or playing. Maybe she might purr a little if she wasn't so annoyed with me fussing with her feeding tube...

We emailed this update to the doctor and I'm sure she will recommend that we bring her to the hospital. The hospital is 30-45 minutes away from our apartment (a $50 cab ride each way as we don't have a car), and the 3 hospital stays were $5000-9000 each. We can't afford any more hospital stays and don't know what to do. We can't seem to get the DKA under control and don't know how many future stays she might require. Is there anything I can do at home, especially since we have a feeding tube installed?

Other meds:
- Renakare (potassium supplement; other electrolytes looked OK at the hospital. This was the only one they're having us supplement)
- Cerenia (1/4 tablet every 24 hours)
- Mirtazapine transdermal ointment (daily)
- Zofran (haven't tried this yet but am planning to today)

Food:
Per vet's recommendation, we're feeding her Purina DM Wet Cat Food. Pre-diabetes, she was eating Smalls Chicken and occasionally TikiCat cans.

Apologies I haven't yet set up my spreadsheet or gotten the hang of all the lingo and posting protocol on this forum as I've just joined. Really appreciate any help here. Please let me know if there's any other info I can provide.

-TK

 

[Wendy&Neko]

Anything above trace ketones really should be a visit to the vet.

From this information post: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters
The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

You need to get calories into her, more than you would normally feed her. I would definitely suggest you get that ondansetron in her, to help with appetite. With trace level of ketones, people usually give fluids to help flush out the ketones, so fluids are also important. Was she treated with infection or other inflammation (like pancreatitis) at the vet hospital?

That leaves the question of insulin dose in the formula above. When you say she's been averaging 307, what does that mean in terms of range? We determine how to change the insulin dose based on how low it takes the cat. There is a good change the insulin dose is too low. But we cannot help any more on that front without seeing blood sugar data. Details on how to let us see that data, and more, in this post:
New? How You Can Help Us Help You!

There are some organizations who can help financially. Diabetic Cats in Need is one such, tagging @Chris & China (GA) There are other options, including Care Credit, listed in this post: Financial Help Links

 

[Bron and Sheba (GA)]

Hi and welcome to the forum. I’m sorry you have had such a hard time with your kitty and DKA.
I agree with Wendy that if the ketones are small or moderate and your kitty is showing signs of lethargy, not wanting to eat, weakness and weight loss, then she really does need to be seen by the vets as she will need to go on an IV drop and her electrolytes corrected as they will be beginning to get out of balance and once this happens you can’t correct this at home. It will be better and hopefully cheaper to take her in now than wait until she is worse.
I will post this but write more about what you can do once you get her home again.

 

[Princess Tortilla (GA)]

Thank you both so much for the replies. I heard from her vet and she recommended we bump tonight's insulin dose from 1 unit to 1.5 units. I'll update with her historic range when I have a moment to dig into her Freestyle Libre data.
For now I'm desperately trying to get food into her via her feeding tube.

We have a potassium supplement at home that we've been giving her and will continue to do so.

Regarding fluids that are given at the hospital.. what does this mean exactly? We do have a feeding tube placed in her esophagus, so we've been able to put food, water, and medication through there if there are suggestions for that.

The doctors did diagnose her with pancreatitis last time - maybe this is a flare up causing DKA?

 

[Bron and Sheba (GA)]

Wendy has explained what the recipe for DKA, so the treatment (once you get her home from the ER) is to make sure that you are addressing the recipe and taking steps to ensure the recipe ingredients is stopped. You may need to increase the dose of insulin
To do this, this is what I recommend:

• you need to give one and a half times as many calories as she normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed her whatever she will eat as eating any food is better than not eating.
• If you are tube feeding, offer frequent smaller meals and make sure you have supplies of foods you can tube feed easily such as Hills a/d which you can get from the vet.
• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
• Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
• Give antinausea medication if needed. I would definitely start the ondansetron. And she may need the antinausea medication s for some time after coming home again as many post DKA kitties have nausea.
• Give appetite stimulant if needed after the antinausea medication
• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
• Ask the vet about subQ fluids
• Set up a spreadsheet and test the BG frequently
• Ask the ER vets for a copy of any path results and post them so we can see please.
• Post daily with updates and ask for help as often as needed.

Will post this and then answer your most recent post.

 

[Bron and Sheba (GA)]

heard from her vet and she recommended we bump tonight's insulin dose from 1 unit to 1.5 units

Yes I think that is a good idea. Did you tell the vet how low the current dose is taking her?
As she ( please tell us her name) is on the libre, you will be able to monitor her BGs.
We need to get that SS setup as soon as possible. I will ask @Bandit's Mom to help you. She will be online in a few hours time and will contact you.
Do you have some higher carb foods at home in case you need them if the blood glucose drops low? Or some honey or Karo.
At this moment, if she will eat anything at all, let her have that. It doesn’t matter if the food is not low carb at this stage. Getting her to eat any food trumps everything. If she will eat dry food, let her have that. We can worry about the carb content of the food later when she is better. At the moment we need to get her over this crisis.

I would ask the vet if they would be happy for you to give some Sub Q fluids to her once a day. Lots of us do that here for kitties with kidney issues and also post DKA. We can help you with how to do it. You will just need to pick up the supplies from the vet and ask them how much they are happy for you to give her each day. It is usually around the 100 ml mark.

Regarding fluids that are given at the hospital.. what does this mean exactly? We

The fluids they give at the hospital are IV fluids that help balance the electrolytes. The next best thing which you can do at home is the sub Q fluids. Maybe after you get the OK from the vet you could get a taxi to collect the fluids from the vet and bring them to you….it would be cheaper than driving both ways,…just a thought. He will also have to give you needles for the fluids as well.

We do have a feeding tube placed in her esophagus, so we've been able to put food, water, and medication through there if there are suggestions for that.

You can give her some extra fluids via the tube in the meantime, but you don’t want to make her sick. Do you run a little water through the tube before and after the food? Alternate the fluids and the food.
How often are you feeding her via the tube?

The doctors did diagnose her with pancreatitis last time - maybe this is a flare up causing DKA

That is possible. The treatment for pancreatitis is pain medication, antinausea medication and SubQ fluids. It is a supportive treatment until the pancreatitis subsides.
OR the DKA has just not been completely knocked on the head. She needs lots of food, and enough insulin to ensure that ketones are kept away. That is why testing for ketones is so important.
I would test twice daily at the moment for ketones if you can. Whether ketones are there or not is telling us if we have the balance right of the food and the insulin. Fluids also play a part as well as they help flush the ketones away.

 

[Bron and Sheba (GA)]

If she has pancreatitis, she may need a pain medication as pancreatitis can be very painful. Can you ask the vet about getting something for pain?

 

[Bron and Sheba (GA)]

I can see you have the SS setup. That’s wonderful, thank you!
Can you add some of the data from the last few days please, before you put in today’s data. This will give us a bit of an idea of what has been happening with the BGs over the last few days and how low the dose has been taking her …thank you.
Also use the remarks column to add information about how she was/is each day..such as eating well or not, playing, lethargic, etc. this shows us at a glance how she has been and as time goes by all the information is in one place. If doesn’t have to be detailed.
Also put the results of the ketone tests into the remarks column please.

 

[Chris & China (GA)]

Diabetic Cats in Need is one such,

Unfortunately, we're not financially able to do emergency care at this time. With everything that's happened with the economy in the last several years, our donations are down and more people are needing our help with just the basics...insulin, syringes, meters and strips.

I'd check with Care Credit or Scratch Pay, and/or do a Go Fund Me fundraiser if you have friends on Facebook, Instagram or Twitter that may be willing to help (most friends know how much our cats mean to us and are willing to help if they can).

Sorry we can't be of more help.

 

[Bron and Sheba (GA)]

How are things going?
How is Princess Tortilla?
If you feel all your questions have been answered for the time being, would you mind removing the 911 now, so that if you needing more urgent help you can put it up again and we know to answer quickly. Thanks.

 

[Princess Tortilla (GA)]

How are things going?
How is Princess Tortilla?
If you feel all your questions have been answered for the time being, would you mind removing the 911 now, so that if you needing more urgent help you can put it up again and we know to answer quickly. Thanks.

She's still lethargic but I was able to give her food through the tube. We were able to schedule an appointment with her doctor tomorrow for some blood work so I'm grateful we'll be able to pay appointment pricing and not ER pricing. I'll be sure to ask about sub-Q fluids at home - thank you for that suggestion.

Her BG has come down to around 200 for the last few hours, so I'm going to stick with her usual 1 unit dose tonight vs the 1.5 that was recommended by her doc when she was consistently in the 300-400+ range (her Libre reads anything 400+ as just "HI"). Her last hypo event was on 12/31 and happened when her AMPS was 252.

You can give her some extra fluids via the tube in the meantime, but you don’t want to make her sick. Do you run a little water through the tube before and after the food? Alternate the fluids and the food.
How often are you feeding her via the tube?

Yes, I'm giving 54 ml of slurry through the tube at a time, and I flush the tube with about 5 ml of water every ~15ml in addition to about 5-10ml after the feeding is over. Does that sound like the right amount of water? I was mainly doing it to help with clogging. 54 mL 4x/day is her full day's worth of meals. I've had to do 100% tube feeding today and yesterday.

• Give antinausea medication if needed. I would definitely start the ondansetron. And she may need the antinausea medication s for some time after coming home again as many post DKA kitties have nausea.

• Give appetite stimulant if needed after the antinausea medication

I was able to give the ondansetron tonight. In terms of appetite stimulant vs anti-nausea, how do I know which is which? I know ondansetron is anti-nausea, but for the maropitant/Cerenia and Mirtazipine, they both say they're for both nausea and inappetence.

If she has pancreatitis, she may need a pain medication as pancreatitis can be very painful. Can you ask the vet about getting something for pain?

I actually do have some pain medication (Buprenorphine) from her primary care vet who saw her before we had to take her to the ER. He prescribed it for pancreatitis. This was right before her diabetes diagnosis on 11/8/22. Her ICU/Internal Medicine doctors didn't say anything about using pain meds though... I will ask tomorrow. Should I use it tonight? I'm just worried something will happen overnight while I'm sleeping. Does this affect BG at all?

 

[Princess Tortilla (GA)]

Unfortunately, we're not financially able to do emergency care at this time. With everything that's happened with the economy in the last several years, our donations are down and more people are needing our help with just the basics...insulin, syringes, meters and strips.

I'd check with Care Credit or Scratch Pay, and/or do a Go Fund Me fundraiser if you have friends on Facebook, Instagram or Twitter that may be willing to help (most friends know how much our cats mean to us and are willing to help if they can).

Sorry we can't be of more help.

Thank you for the reply and suggestions!!

 

[Bron and Sheba (GA)]

We were able to schedule an appointment with her doctor tomorrow for some blood work so I'm grateful we'll be able to pay appointment pricing and not ER pricing. I'll be sure to ask about sub-Q fluids at home - thank you for that suggestion.

That is good and should be cheaper than the ER.
Hopefully they will check the electrolytes and see if they need to give her some IV fluids at the vet or adjust the potassium you are giving her.

Her BG has come down to around 200 for the last few hours, so I'm going to stick with her usual 1 unit dose tonight vs the 1.5 that was recommended by her doc when she was consistently in the 300-400+ range (her Libre reads anything 400+ as just "HI"). Her last hypo event was on 12/31 and happened when her AMPS was 252.

Have you been able to recheck the ketones in the urine again today?.
Looking at the SS and the BGs you have added (thank you for doing that) it does look as if she could do with an increase in dose, especially with ketones in the urine.
With BGs in the range I can see in the SS I would suggest an increase to 1.25 units.
What was the BG when she had ‘her last hypo event’?

Yes, I'm giving 54 ml of slurry through the tube at a time, and I flush the tube with about 5 ml of water every ~15ml in addition to about 5-10ml after the feeding is over. Does that sound like the right amount of water? I was mainly doing it to help with clogging. 54 mL 4x/day is her full day's worth of meals. I've had to do 100% tube feeding today and yesterday.

What is the food you are feeding her in the slurry?
Do you know how many calories she is getting each day? We need to make sure she is getting 1 and a 1/2 times as many calories as she normally gets. I would ask tomorrow at the vet for some Hills a/d which you will be able to easily put down the tube and clogging should not be a concern.
I think you need to be feeding her more that 4 times a day. I would increase it to 6 times ….3 times a cycle…and see if that helps with the ketones.
Do you have some high carb food in case of low numbers?or honey and Karo?

was able to give the ondansetron tonight. In terms of appetite stimulant vs anti-nausea, how do I know which is which? I know ondansetron is anti-nausea, but for the maropitant/Cerenia and Mirtazipine, they both say they're for both nausea and inappetence.

The cerenia is an antinausea medication and is given once a day. The ondansetron is an anti nausea and can be given three time a day at the the same time as the cerenia as it works on different pathways in the body. The mirtazipine is for the appetite so make sure you always give the antinausea medication first, then wait for it to works and then give the appetite stimulant.

I would ask the vet tomorrow about the Bupe for the pain.
And I would get up every few hours tonight to check how she is going, check the BG and give her some food and fluids.

 

[Bron and Sheba (GA)]

@Princess Tortilla
I can see you have updated the SS to +11 on the am cycle. I would really encourage you to increase the dose to 1.25 units of Lantus at PMPS because of the ketones in the urine. You will need to monitor the pm cycle though. We really need to get those BG numbers down further.
If needed you could feed some higher carb food or add a couple of drops of honey to the slurry if needed.
What do you think? Are you able to stay up and monitor this cycle? I think it is Princess Tortilla’s best chance of getting the ketones down.

 

[Princess Tortilla (GA)]

Have you been able to recheck the ketones in the urine again today?.

No, I haven't. She peed about an hour ago, but I put out too much litter in her box and it all got absorbed... ... She did poop just now which is good. I removed more litter so hopefully I get some liquid to test soon.

Looking at the SS and the BGs you have added (thank you for doing that) it does look as if she could do with an increase in dose, especially with ketones in the urine.
With BGs in the range I can see in the SS I would suggest an increase to 1.25 units.

That sounds good, I agree. Her PMPS climbed back up to 334 so we're considering doing the 1.5... what do you think?

What was the BG when she had ‘her last hypo event’?

Her AMPS was either 234 or 252 (I have 2 scans around her shot time but don't have a record of the exact shot time to line it up with the Libre) and her +4 +5 numbers were between 57-69. I mixed some maple syrup with water and gave it to her orally with a syringe.

What is the food you are feeding her in the slurry?

I'm using Purina Pro Plan Veterinary Diets DM Dietetic Management Wet Cat Food from the vet

Do you know how many calories she is getting each day? We need to make sure she is getting 1 and a 1/2 times as many calories as she normally gets. I would ask to or at the vet for some Hills a/d which you will be able to easily put down the tube and clogging should not be a concern.
I think you need to be feeding her more that 4 times a day. Iwoiod incense it to 6 times ….3 times a cycle…and see if that helps with the ketones.
Do you have some high carb food in case of low numbers?or honey and Karo?

The vet says based on this slurry recipe, it's 0.94 kcal/mL. So, 0.94 kcal * 54 mL serving * 4 servings = 203 calories per day. At the hospital last week, she weighed in at 5.04 kg (~11 pounds). I googled just now and it looks like she should be having between 250-290 calories per day, so this serving size seems to be too small.. I will ask about serving size and the 6x frequency at tomorrow's appointment. I'll ask about the Hill's as well - is there something you like specifically about this food?

 

[Princess Tortilla (GA)]

@Princess Tortilla
I can see you have updated the SS to +11 on the am cycle. I would really encourage you to increase the dose to 1.25 units of Lantus at PMPS because of the ketones in the urine. You will need to monitor the pm cycle though. We really need to get those BG numbers down further.
If needed you could feed some higher carb food or add a couple of drops of honey to the slurry if needed.
What do you think? Are you able to stay up and monitor this cycle? I think it is Princess Tortilla’s best chance of getting the ketones down.

It's currently 35 minutes past her shot time, and her PMPS is at 334. I'm giving one more serving of food to increase her calories and then will give insulin... I am leaning toward the 1.5 units - what do you think? I could stay up for probably an hour post-shot to monitor.

 

[Bron and Sheba (GA)]

It's currently 35 minutes past her shot time, and her PMPS is at 334. I'm giving one more serving of food to increase her calories and then will give insulin... I am leaning toward the 1.5 units - what do you think? I could stay up for probably an hour post-shot to monitor.

I would stay with the 1.25 units if you are not going to be able to monitor closely.
Can you set the alarm to get up a few times?she will need to be fed during the night
I’ll post this then write more

 

[Bron and Sheba (GA)]

Her AMPS was either 234 or 252 (I have 2 scans around her shot time but don't have a record of the exact shot time to line it up with the Libre) and her +4 +5 numbers were between 57-69. I mixed some maple syrup with water and gave it to her orally with a syringe.

BGs of 57 to 69 is OK and is not a hypo. Under 50 on a human meter is considered too low unless she was symptomatic.

The vet says based on this slurry recipe, it's 0.94 kcal/mL. So, 0.94 kcal * 54 mL serving * 4 servings = 203 calories per day. At the hospital last week, she weighed in at 5.04 kg (~11 pounds). I googled just now and it looks like she should be having between 250-290 calories per day, so this serving size seems to be too small.. I will ask about serving size and the 6x frequency at tomorrow's appointment. I'll ask about the Hill's as well - is there’s something you like specifically about this food

There are 163 calories per 5.5 oz can of food according to the website. How many cans are you using a day?
At 5 kg she should be getting almost 2 cans a day when well. So one and a 1/2 times as much calories as normal would be 3 cans.
It sounds as if you definitely need to increase the amount of food you are feeding daily. Food and insulin are the two things that can stop ketones.
I’m not sure the vet will know how much to feed per day…they don’t get much nutritional training at uni.
The Hills a/d is a recovery food and excellent for unwell cats. And it is a liquid so can be put down a feeding tube easily.

 

[Bron and Sheba (GA)]

Here is some information about the Hills a/d canned food.
https://www.myhillsvet.com.au/products/cat-food/pd-ad-canine-feline-canned

 

[Princess Tortilla (GA)]

I would stay with the 1.25 units if you are not going to be able to monitor closely.

Strangely, her BG went down from 334 to 273 after that extra serving of food... we gave 1.25 units and will be monitoring.

BGs of 57 to 69 is OK and is not a hypo. Under 50 on a human meter is considered too low unless she was symptomatic.

Oh, I see. Our guidance from the vet was to treat anything under 60 urgently, so once I saw it hit 57, I gave the maple syrup water immediately. She didn't show symptoms of vomiting or seizures, but may have been a little weak or lethargic, I don't recall exactly or have it noted.

There are 163 calories per 5.5 oz can of food according to the website. How many cans are you using a day?
At 5 kg she should be getting almost 2 cans a day when well. So one and a 1/2 times as much calories as normal would be 3 cans.
It sounds as if you definitely need to increase the amount of food you are feeding daily. Food and insulin are the two things that can stop ketones.
I’m not sure the vet will know how much to feed per day…they don’t get much nutritional training at uni.
The Hills a/d is a recovery food and excellent for unwell cats. And it is a liquid so can be put down a feeding tube easily.

The vet said 2 cans/day but the math doesn't add up with the calories in their slurry recipe (10 mL water blended with one 5.5 oz can of food). I'll ask about this in the appointment but regardless will definitely increase the amount I'm tube feeding.

The Hills food looks great. I'll see if the hospital has some I can take home tomorrow.

Thanks so much for all your help tonight (it's just past midnight here in NYC). I will post tomorrow with updates from the vet appointment!

 

[Bron and Sheba (GA)]

I hope all goes well tonight and Princess Tortilla is improved in the morning. She is beautiful by the way..I love the avatar photo.
If you are able to, she will definitely benefit from some extra food and fluids during the night. And the monitoring of the BG.
The vet should have some Hill a/d. if not another vet should.
I live in Australia so will be awake for another 6 hours if you need to post. And I will look in on the SS.
I will ask someone else to look in on you in the morning when I am asleep. I hope all goes well with the vet appt tomorrow.
Please post an update after the appt as we worry about our kitties.

 

[Liz & Minnie]

Just saying hi and good luck with the vet appointment. I had a similar experience with my Minnie, she was back and forth into the ER 3 or 4 times in the space of a month and had an e-tube....this was back in April 2021. It's a stressful time but once we got through that and the e-tube was removed (by her) and I learned more about managing the diabetes, things have been much easier. You are in excellent hands here. Sending you lots of support.

 

[Chris & China (GA)]

Our guidance from the vet was to treat anything under 60 urgently, so once I saw it hit 57, I gave the maple syrup water immediately.

If that was a number using the Libre, you should know that we've noticed that the Libre isn't very accurate at lower numbers so it's important to re-check with a regular meter. We've had members who used the Libre and got numbers below 60 and when they re-checked with a meter, the number was in the 70's-90's.

The Hills food looks great. I'll see if the hospital has some I can take home tomorrow.

Another option is the Royal Canin "Recovery" food. It's also made for tube feeding and is lower in carbs than the A/D.

Good luck with the vet!

 

[Bron and Sheba (GA)]

Another option is the Royal Canin "Recovery" food. It's also made for tube feeding and is lower in carbs than the A/D.

It actually won’t hurt to have the carbs at 13% (a/d Hills) for a while as we want to get as much insulin into Princess Tortilla as possible at the moment with ketones in the urine.

 

[Bron and Sheba (GA)]

Any news yet from the vet visit?

 

[Princess Tortilla (GA)]

Any news yet from the vet visit?

Just got back from the vet... quite a process today, poor kitty peed in her carrier while in the waiting room and we still need to get her properly cleaned up with her Libre and e-tube attached to her.

Dr. said her BG was 600 when they did the blood test, and right now (~4 hours later) her Libre is reading "HI". We gave 1.5 units of insulin this morning.
Ketones were trace.
Also, she is anemic. She had blood transfusions during her previous hospital stays, but they haven't done enough testing to determine the underlying cause of the anemia.

I also gave her some buprenorphine for pain management about 30 minutes ago, so hopefully that helps with her energy.

Just checked her ketones again (about 4 hours after they checked at the appt) and they're negative.

Re: food - the doctor said she prefers to keep Princess on Purina DM since it's better for diabetic cats and while we're feeding her through the tube, we can give her whatever food is best for her vs what she has the appetite for.

For at-home care, she recommended:

• Continue giving 1.5 units
• Check ketones twice a day
• Continue all anti nausea meds
• Give pain meds as needed
• Can give extra food as long as her stomach can tolerate it

I will update the SS now.

 

[Bron and Sheba (GA)]

I’m glad the vet visit went well. I’m sorry the vet didn’t agree with the hills a/d. It is so much easier to tube feed with and would have been fine for her.
However I’m glad they are happy with everything else.
And fantastic no ketones in the urine. Yay! Keep up the good work.
What did he say about subQ fluids?

 

[Princess Tortilla (GA)]

I’m glad the vet visit went well. I’m sorry the vet didn’t agree with the hills a/d. It is so much easier to tube feed with and would have been fine for her.
However I’m glad they are happy with everything else.
And fantastic no ketones in the urine. Yay! Keep up the good work.
What did he say about subQ fluids?

Thank you for checking in

I'm ok with making the slurry in the blender, so it's not a huge deal. I will say I've gotten so sick of the smell from handling it all day, haha

She said as long as we have the e-tube, we can continue giving her water through there and that should be good for now. We're going back for a check-up in 2 weeks, during which we can hopefully have the e-tube removed, and I can ask about taking subQ fluids home then.

I just updated my SS with some post-AM shot numbers. AM shot was around 11AM. Vet appt was at 12pm, so their blood test was around 12pm... You can see here it's off the charts (screenshot is from LibreView which doesn't graph anything above 350). I'm concerned about that big dip there. Vet reported her BG was 600 at the time of visit (~12pm). Then it dips below 70 as you can see here. I didn't do any scans between 11am and 4pm though. How would you interpret this?

 

[Diane Tyler's Mom GA]

Thank you for checking in

I'm ok with making the slurry in the blender, so it's not a huge deal. I will say I've gotten so sick of the smell from handling it all day, haha

She said as long as we have the e-tube, we can continue giving her water through there and that should be good for now. We're going back for a check-up in 2 weeks, during which we can hopefully have the e-tube removed, and I can ask about taking subQ fluids home then.

I just updated my SS with some post-AM shot numbers. AM shot was around 11AM. Vet appt was at 12pm, so their blood test was around 12pm... You can see here it's off the charts (screenshot is from LibreView which doesn't graph anything above 350). I'm concerned about that big dip there. Vet reported her BG was 600 at the time of visit (~12pm). Then it dips below 70 as you can see here. I didn't do any scans between 11am and 4pm though. How would you interpret this?
View attachment 66078

@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

The reason for the high BGs today could have been because she dropped low during the night . I can’t see any tests after about the +3 mark in the pm cycle, if I look at your graph. It helps a lot of you can transfer some of the BGs into the SS please.
A low during the night could have shot up the BG at AMPS.
The huge drop from +1 to +2 in the am cycle is enough to trigger another bounce and high BGs.
And then there is the stress a cat feels at the vet. That can and does send a cats BG up high during a vet visit. so there are three reasons why she could be showing those high BGs.

The graph is showing she dropped to 70 at around ?+3 today but that is not in the SS.if you could fill in the SS to show those extra Bg recorded on the libre,that would be great and give us more of an idea what is happening.
If she is dropping to 70, you don’t want to increase the dose.

ki think to help stop these early and huge drops in the early part of the cycle…I would recommend giving another smaller feed at +2 to try and slow down these big drops which appear to have happened during the past 2 cycles. So instead of giving 4 feeds a day of the same size, I would suggest giving the two main meals before the shots and then some extra feeds during all the cycles but making them a bit smaller. So for example giving a snack of say half of the main meal size at +2 +4 and +6 and +8 to see if we can even out the BGs a bit. That will also give some extra calories overall. Is that doable? You would also need to give some extra feeds during the night. It shouldn’t go on for too long but we need to get her back to normal.

 

[Princess Tortilla (GA)]

The reason for the high BGs today could have been because she dropped low during the night . I can’t see any tests after about the +3 mark in the pm cycle, if I look at your graph. It helps a lot of you can transfer some of the BGs into the SS please.
A low during the night could have shot up the BG at AMPS.
The huge drop from +1 to +2 in the am cycle is enough to trigger another bounce and high BGs.
And then there is the stress a cat feels at the vet. That can and does send a cats BG up high during a vet visit. so there are three reasons why she could be showing those high BGs.

The graph is showing she dropped to 70 at around ?+3 today but that is not in the SS.if you could fill in the SS to show those extra Bg recorded on the libre,that would be great and give us more of an idea what is happening.
If she is dropping to 70, you don’t want to increase the dose.

ki think to help stop these early and huge drops in the early part of the cycle…I would recommend giving another smaller feed at +2 to try and slow down these big drops which appear to have happened during the past 2 cycles. So instead of giving 4 feeds a day of the same size, I would suggest giving the two main meals before the shots and then some extra feeds during all the cycles but making them a bit smaller. So for example giving a snack of say half of the main meal size at +2 +4 and +6 and +8 to see if we can even out the BGs a bit. That will also give some extra calories overall. Is that doable? You would also need to give some extra feeds during the night. It shouldn’t go on for too long but we need to get her back to normal.

Got it.. I will try my best with the additional feedings and will insert a note in the SS on the corresponding cell to track the BG with the feedings.

Also, I'm happy to report that the buprenorphine has helped a lot - Princess is still relatively low energy, but she's now up and walking around, sitting in different spots, and even purring. I even got her to play with some string for a minute. The prescription on that says to give every 12 hours for 5 days - is that the general length of a pancreatitis flare up or should I double check with the vet about that? I googled and found "2 to 5 days in mild cases to 1 to 2 weeks or more in severe cases"

 

[Princess Tortilla (GA)]

Just saying hi and good luck with the vet appointment. I had a similar experience with my Minnie, she was back and forth into the ER 3 or 4 times in the space of a month and had an e-tube....this was back in April 2021. It's a stressful time but once we got through that and the e-tube was removed (by her) and I learned more about managing the diabetes, things have been much easier. You are in excellent hands here. Sending you lots of support.

Thank you so much for the support! I'm glad to hear things have been going well with Minnie The e-tube is a lot of work but I'm grateful for it.. how long did Minnie use it for?

 

[Bron and Sheba (GA)]

Also, I'm happy to report that the buprenorphine has helped a lot -

Fantastic. Pain can stop them wanting to eat and they feel terrible.

you are very lucky to have the etube as it makes it so much easier if they won’t eat. Don’t let them remove it until she is eating very well on her own

 

[Princess Tortilla (GA)]

Fantastic. Pain can stop them wanting to eat and they feel terrible.

you are very lucky to have the etube as it makes it so much easier if they won’t eat. Don’t let them remove it until she is eating very well on her own

So she got through 40 ml of her 5th feeding and vomited up the slurry 90 mins later she vomited again but it was clear... the first time I figured it was because I was feeding her too quickly or too much food, but the second time I can't tell if it's still because of the extra food or because of something else. Could it be the pain meds wearing off? It has been 8 hours since I gave her the buprenorphine (0.15 ml).

Should I give Cerenia/Maropitant? I've been mixing this with water and putting this through the tube since it's hard to give her pills, but am afraid she'll throw up anything I put through the tube.

 

[Diane Tyler's Mom GA]

So she got through 40 ml of her 5th feeding and vomited up the slurry 90 mins later she vomited again but it was clear... the first time I figured it was because I was feeding her too quickly or too much food, but the second time I can't tell if it's still because of the extra food or because of something else. Could it be the pain meds wearing off? It has been 8 hours since I gave her the buprenorphine (0.15 ml).

Should I give Cerenia/Maropitant? I've been mixing this with water and putting this through the tube since it's hard to give her pills, but am afraid she'll throw up anything I put through the tube.

@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

How long since she has had any cerenia?

 

[Diane Tyler's Mom GA]

@Princess Tortilla I would definitely add DKA 3 times to your signature, it's important members know that. Tap in your name up top then tap on signature add it then tap save

 

[Princess Tortilla (GA)]

How long since she has had any cerenia?

I last gave it about 48 hours ago. I thought I gave it yesterday but used the ondansetron instead. My main concern is putting it through the tube and her throwing up again

 

[Bron and Sheba (GA)]

I last gave it about 48 hours ago. I thought I gave it yesterday but used the ondansetron instead. My main concern is putting it through the tube and her throwing up again

I would give the cerenia to her now via the tube then wait an hour before trying to feed again. Offer a smaller amount of food when you start feeding again to see if she is ok.
I would give her the cerenia each 24 hours routinely at the moment. And you can give ondansetron at the same time as cerenia as they work on different pathways. Ondansetron can be given every 8 hours if needed.

 

[Princess Tortilla (GA)]

I would give the cerenia to her now via the tube then wait an hour before trying to feed again. Offer a smaller amount of food when you start feeding again to see if she is ok.
I would give her the cerenia each 24 hours routinely at the moment. And you can give ondansetron at the same time as cerenia as they work on different pathways. Ondansetron can be given every 8 hours if needed.

Gave Cerenia an hour ago and just heard her throwing up... didn't see any vomit on the floor, just a little spit up on herself. Her BG readings on the Libre are coming up "HI" and I gave 1.5 units ~3 hours ago. Right now she's drinking water out of her bowl

 

[Bron and Sheba (GA)]

Gave Cerenia an hour ago and just heard her throwing up... didn't see any vomit on the floor, just a little spit up on herself. Her BG readings on the Libre are coming up "HI" and I gave 1.5 units ~3 hours ago. Right now she's drinking water out of her bowl

I would say she is bouncing from the 60 at +3 in the am cycle.
It says in the SSremarks column you gave Zofran at 3.30 pm. How long ago was that? If it is 8 hours ago, I would repeat the dose.
We need her to eat if we can.
how long since she has eaten and kept the food down?

 

[Princess Tortilla (GA)]

I would say she is bouncing from the 60 at +3 in the am cycle.

What does this mean? How/why does it happen?

It says in the SSremarks column you gave Zofran at 3.30 pm. How long ago was that? If it is 8 hours ago, I would repeat the dose.

It was about 10 hours ago. I can give more Zofran now, but it would be through the tube and I worry about her throwing up again.

how long since she has eaten and kept the food down?

It's been about 4-4.5 hours since she ate and kept it down. I tried giving her another serving an hour after but that's when she started throwing up.

 

[Bron and Sheba (GA)]

It was about 10 hours ago. I can give more Zofran now, but it would be through the tube and I worry about her throwing up again.

I would give her some zofran now with a little water and then wait 30 minutes before trying to feed a smaller amount…..More on that a bit later

 

[Bron and Sheba (GA)]

It's been about 4-4.5 hours since she ate and kept it down. I tried giving her another serving an hour after but that's when she started throwing up.

Once the 1/2 hour is up after the zofran, I would start off with just giving her 10 mls of food at a time and see if she can keep that down. If she can keep that down for an hour, I would try that again. It’s not much food but better for her to keep something down then nothing, then hopefully we can increase the amount of food.

What does this mean? How/why does it happen?

When a newly diagnosed diabetic cat drops the BG fast, or too low or lower than it’s body is used to, the kitty bounces. Bouncing is common in newly diagnosed kitties and is nothing to worry about. Here is an explanation about bouncing:

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

[Princess Tortilla (GA)]

I would give her some zofran now with a little water and then wait 30 minutes before trying to feed a smaller amount…..More on that a bit later

I gave the Zofran, waited 30 mins, then started giving a little bit of food through the tube 1-2 mls at a time for a total of about 10 mls over the course of 45 minutes. I then flushed with about 5 mls of water. She seems to be doing ok with that. Her BG is still "HI"... very late here in NYC so I will pick this up in the morning.

Thanks so much for your continued help here. Thanks for the info on bouncing!

 

[Bron and Sheba (GA)]

I gave the Zofran, waited 30 mins, then started giving a little bit of food through the tube 1-2 mls at a time for a total of about 10 mls over the course of 45 minutes. I then flushed with about 5 mls of water. She seems to be doing ok with that. Her BG is still "HI"... very late here in NYC so I will pick this up in the morning.

Thanks so much for your continued help here. Thanks for the info on bouncing!

You are doing a fantastic job caring for Princess Tortilla
Are you able to do the 10mls again in 2 hours?

 

[Bron and Sheba (GA)]

How are things going now? I hope she has managed to keep the food down.
I am just about to head to bed in Australia.
I’m going to ask @Bandit's Mom and @tiffmaxee to keep an eye on you. ill look forward to an update tomorrow (my time)

 

[Princess Tortilla (GA)]

How are things going now? I hope she has managed to keep the food down.
I am just about to head to bed in Australia.
I’m going to ask @Bandit's Mom and @tiffmaxee to keep an eye on you. ill look forward to an update tomorrow (my time)

Thank you!

She was able to keep that 10mls down but I didn't give any more after that.

I've worked out a feeding schedule so she's given food every 2 hours: 2 meal-sized portions before shot times and 3 snack portions in the middle of the day for a total of 300 calories per day. I think she will tolerate this amount of food.

I gave the buprenorphine again this morning but unfortunately it doesn't seem to have the same positive effect on her as it did yesterday.. she's sitting very still with her eyes closed and head low

 

[Princess Tortilla (GA)]

Thank you!

She was able to keep that 10mls down but I didn't give any more after that.

I've worked out a feeding schedule so she's given food every 2 hours: 2 meal-sized portions before shot times and 3 snack portions in the middle of the day for a total of 300 calories per day. I think she will tolerate this amount of food.

I gave the buprenorphine again this morning but unfortunately it doesn't seem to have the same positive effect on her as it did yesterday.. she's sitting very still with her eyes closed and head low

Mid-afternoon update here:

Princess is still looking terrible and either sitting in the corner and not moving or hovering over her water bowl and getting her chest soaked. In the past, we would have checked her into the ER by now as we know these are her DKA signs.

I've seen her wobble over to the litter box to pee a little bit, but I haven't been able to get enough liquid to test for ketones today. I've now removed 95% of the litter and hope to have some liquid to test soon.

Her Libre readings keep coming up "HI" which means the BG is above 400, but it's impossible to see the exact number. Yesterday at the vet, it came back in her blood test as 600.

I've been able to keep up with the feedings every 2 hours (she's had 2 meals plus 1 snack so far - about 140 calories). I've been flushing her etube with water during and in-between feedings, but I want to make sure I'm giving the right amount of water. Is there any guidance on that? I want to give her enough fluids but not make her throw up.

 

[Princess Tortilla (GA)]

Does Zofran need to be given on an empty stomach? The bottle says it does, but the doctor said it doesn't. I gave Princess Zofran about 10 minutes after giving her the 2nd snack (25 mls) and she threw up