Need help --- cat just got back home after 2 DKAs (new member)

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Hao

Member Since 2023
Hi,

Hello to everyone on the forum. My cat Mai (10 years old) had a dka about 17 days ago and I rushed him to the ED. He did well the first night and then everything got worse. We transferred him to a critical care hospital where he got most of his treatment for the last 15 days (in the ICU). I have been reading on the forum, esp about all the successful stories after getting help from each other. His recover is a bit long, but I would really appreciate if those of you who have experiences can take a look and give me some advices.

It was really bad for a while. His electrolytes were very messed up, glucose and ketones all very high, and one point had very low blood pressure and body temperature. Luckily after the most scary moment when he did not respond to multiple doses of the most common blood pressure treatment, he responded to the only other medicine. Then he took a few days to stabilize, and after about 3-5 days his vitals went back to normal. At one point, even his ketone went down to normal. We let him stabilize for a few days and he got two blood transfusion due to low PCP level (red blood cell). During that time, he also had an NG tube for continuous feeding. At one point, he had one good day when he actually ate some treat and tried some food.

Then he had another DKA while at the ICU about 5 days ago. The doctor believes that this happened because after he stabilized, we switched him to the long-lasting insulin without him getting regular meals. He was not eating and was relying on the NG tube for food. Luckily this time tho, while the glucose level at one point went up to 700, and the ketone went back to 8-9, he did not have any electrolytes or blood pressure issues.

We put an e-tube in him about 3-4 days ago and while his ketone did not go down completely to normal (at ~3), the doctor believes this is due to hepatic lipidosis (a liver issue associated with DKA) and to recover from this he just needs some time with regular feeding and getting regulated.

So we just got back home late this afternoon, after 17 days in the hospital, which include 15 days in ICU and lots of $$$. I am feeding him a fixed amount of food calculated by the doctor 4 times per day and giving him 2 doses of long-lasting insulin (1 unit every 12-hours) per day until the next follow-up, which is in a week.

What breaks me now is that he seems worse now than the night I took him to the first ED. He is still tired and lethargic. He walks slowly and you can see how weak he is. He is not interested in much of anything except sleeping. He also goes immediately to hide at places where he typically doesn't go.

I wonder how long did it take your cat to recover? Not fully but at least becomes kind of energetic so I feel like his quality of life is there? I understand my cat was probably sicker than most but for those of you who had similar episodes, how long did take yours to show signs of recovery? And for the rest of you (so happy that most of the cats do not have to go through this much btw), do you think it is normal that he is behaving like this today?

I really do love him. He was there for me for a decade when I was moving around the country. I am willing to do everything for him, both financially and effort wise. But I just want to be sure that he does have a chance to "recover" because if he will always be like this, I am not sure if I am doing all of this for my benefits or his.

Thanks to everyone in advance!
Hao
 
Hi and welcome. You and Mai have been through a tough time.
Yes we can help you with Mia’s recovery.
Just a few questions first and I will post this and then write more.
What insulin are you giving …is it glargine (Lantus)?
What is the food you are feeding him?
Did the vet send him home on antinausea medication such as cerenia or ondansetron?
Did he have an infection to begin with a. And what was it treated with?
I’ll be back
Bron
 
Hi again.
Mai is sure to be feeling weak as he has been in hospital for 17 days and it will take time to recover from that alone. Post DKAe kitties recover at different rates. It depends on how well they are eating, if there are any lingering ketones, if they are getting antinausea medication and if they have had the infection or inflammation treated properly.
Post DKA kitties are often nauseated and done want to eat, so I am glad you have a feeding tube in place. That will make things much easier for you both. I am a bit concerned the vet said only feed 4 times a day though.
The following what is needed to ensure Mai recovers from DKA.
  • you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals before the insulin dose.. Food is like a medicine and helps keep ketones away. If Mai won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating. At the moment you have the feeding tube in which is good.
  • 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. This is really important. 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 such as ondansetron or cerenia…ondansetron is better.
  • 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…you will be able to do this through the feeding tube.
  • Ask the vet about subQ fluids
  • We recommend you start testing the blood glucose so you can see exactly what is happening. We also recommend you get a human meter to do the testing. We can guide you with this…just ask.
  • Set up a spreadsheet and test the BG frequently. I am going to tag @Bandit's Mom to help you with the SS as you will be very busy with a Mai.
  • Post daily with updates and ask for help as often as needed.
 
Hi and welcome. You and Mai have been through a tough time.
Yes we can help you with Mia’s recovery.
Just a few questions first and I will post this and then write more.
What insulin are you giving …is it glargine (Lantus)?
What is the food you are feeding him?
Did the vet send him home on antinausea medication such as cerenia or ondansetron?
Did he have an infection to begin with a. And what was it treated with?
I’ll be back
Bron

Thank you for getting back to me! I really appreciate it!
1. He is getting Lantus. I am using 100u/ml and 1 unit every 12 hours.
2. Currently I am relying mostly on the e-tube. He doesn't seem to care much about any food yet. The recipe for the e-tube is directed by the doctor. I basically combine 2 cans of Hills Glucosupport and 1 bottle of Royal Canin Renal support in a blender with no water. Then I feed him 50ml and 4 times per day.
3. Yes, I got Ondansetron 4mg tablet, which the doctor is asking me to do it every 12 hours. I also got mirataz to rub on his ear every 24 hours.
4. He had an UTI when he first got to the ED but I think that was treated with anti-biotics.
 
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Hi again.
Mai is sure to be feeling weak as he has been in hospital for 17 days and it will take time to recover from that alone. Post DKAe kitties recover at different rates. It depends on how well they are eating, if there are any lingering ketones, if they are getting antinausea medication and if they have had the infection or inflammation treated properly.
Post DKA kitties are often nauseated and done want to eat, so I am glad you have a feeding tube in place. That will make things much easier for you both. I am a bit concerned the vet said only feed 4 times a day though.
The following what is needed to ensure Mai recovers from DKA.
  • you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals before the insulin dose.. Food is like a medicine and helps keep ketones away. If Mai won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating. At the moment you have the feeding tube in which is good.
  • 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. This is really important. 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 such as ondansetron or cerenia…ondansetron is better.
  • 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…you will be able to do this through the feeding tube.
  • Ask the vet about subQ fluids
  • We recommend you start testing the blood glucose so you can see exactly what is happening. We also recommend you get a human meter to do the testing. We can guide you with this…just ask.
  • Set up a spreadsheet and test the BG frequently. I am going to tag @Bandit's Mom to help you with the SS as you will be very busy with a Mai.
  • Post daily with updates and ask for help as often as needed.

Again, thank you very much for asking these questions to help him!

Basics: He does have lingering ketones but it has been static at ~3 for the last a few days when he was in the ICU. The doctor believes this is now due to his liver issue which needs time with consistent food and insulin. I decided to get the e-tube since he is not eating much and I want to give him the best chance in recovery.

1. The doctor told me she calculated the food intake amount. Though I am not sure if it is 1x or 1.5x the amount he normally needs. He is getting 4 meals per day, at 8am, 2pm, 8pm, and 2am. Each time he gets the blend of 50ml. His insulin injections are at 8am and 8pm.
2. I think I might have given him a fur shot on the very first shot last night but I read through many peoples' tips. I am mostly confident the shot this morning definitely went in.
3. In terms of testing for blood sugar and ketones, I asked the doctor specifically about this. I was going to get the device that allow me to take blood from his ear. The doctor however, recommended me to hold off on this. Mai will have his first follow-up with an internalist in a week and the current doctor (a criticalist) wants me to discuss options with the new doctor. She (the criticalist) seemed to be concerned with the accuracy and safety of me getting blood from his ear for testing. She recommended something called the freestyle libre instead? And for ketone strips, she asked me to not do it this week until the first follow-up since he still has some lingering ketones and she thinks that is just going to freak me out. I indeed freaked out anyway last night and ordered some on Amazon.
4. I got the antinausea and appetite stimulant as mentioned above.
5. In terms of water, I am giving him 5ml before each e-tube feeding and 5ml after. His food is also very liquidie (I know this is probably not a word, but I basically did not get any sleep trying to monitor his first night at home and I honestly do not remember what is the right word at the moment lol.)
6. Will ask about subQ today.
7. I was planning on doing all of these right away but the doctor was pretty adamant on waiting until after the first follow-up with the internalist, who she described as more of an expert for long-term management.

Again, thank you so so so much for responding to my post and taking your time to go through all of these questions.

Hao
 
Hi Hao,
I am very glad you have ordered the ketones test strips. It is very important to know if there are any ketones in the urine because if there are any ketones, the dose of insulin may need to be increased and the amount of food increased. It is food and insulin that will help keep ketones away.
I disagree with the vet about testing only from the next week and that the ear testing is not accurate.
The ear testing is very accurate and is the best way you can keep Mai safe. While the freestyle libre is an option, especially in the beginning while you learn to test…it is about $100 for 2 weeks which a lot of people cannot afford. Then you have to have another one attached becomes they only last 14 days.
So it is fine to have the libre attached in the beginning but I would encourage you to look at hometesting after that. We can help you with that and what test meter to buy.
Most vets do not encourage hometesting for whatever reason….I don’t know why because it is the most sensible thing to do and will keep Mai safe.
That is good you have the antinausea meds and the appetite stimulant. Most post DKA kitties are nauseated when they first come home. Some can eat well straight away but a lot struggles the early days. Can you tell me how many calories are in each of the cans you are combining in the blender? Does it have the information on the can?
It sounds as if you are doing a good job with Mai. I would just like to see you getting the testing of the blood glucose under way sooner than a week and if you can let us know the results of all the ketone urine tests you do, that would be good.
I am going to ask @Bandit's Mom if she will set up a spreadsheet for Mai so that you can start adding the BG data when you start to get it. She will contact you.
Keep asking lots of questions. You will probably have a very busy couple of weeks looking after Mai until things starlet to settle down and he returns to his former self.
Can you tell us which country you are in please?
I am just heading to sleep (I am in Australia) so I will look in on you when I wake up
Bron
 
Hello @Hao and Mai! Welcome to FDMB! :)
You are in great hands with Bron who is our go-to person for DKA kitties.

I can help set up your spreadsheet and signature. Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.

I basically combine 2 cans of Hills Glucosupport and 1 bottle of Royal Canin Renal support in a blender with no water.
Btw, Hill's M/D Glucosupport (both wet and dry) is too high in carbs for a diabetic cat. Why is he on renal food?
 
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