GA URGENT HELP NEEDED - DKA possible

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HanselSphynx

Member Since 2024
Hi All,

I will try to condense the history of my cat Hansel as it's been a wild ride.

9yo male Sphynx named Hansel
3kg yesterday, 2.5kg today (vomited last night and this morning)
11 units Toujeo insulin twice daily
Fed Royal Canin Diabetic dry food, Fancy Feast classic pate wet food x 4 times a day (have had him on this exclusively the last week as it seemed to be better at keeping his weight)

- Aug 2023 diagnosed with diabetes for the first time, took three rounds of insulin increases to get to stable on 3 units Lantus SoloStar insulin.

- A couple of months later he had a diabetic crisis and ended up hospitalised with suspected DKA but it turned out to not be ketones, I forget the term for his condition but it was basically the same treatment of insulin and fluid. He returned home a week later on 6 units of insulin, and very briefly had hypo numbers leading to a slight adjustment to 5. Following increased glucose numbers of 20-30, we increased the doses each weekly curve as they weren't coming down overall. I will post his numbers below from the last few weeks.

- We have tested for everything (infections, ultrasounds etc), and only now are waiting on a test for acromegaly which he shows no signs for. We also consulted with a diabetic specialist and have now switched to Toujeo insulin - we are up to 11 units twice daily.

- Last night / this morning he vomited food and now has ketones in his urine. 0.8 "fort" on my little pee stick test. He is now with my vet for fluid and anti-nausea medication, but this is the end of the road for us when it comes to emergency care. The last year has been devastating for us, not only with his out-of-control diabetes, but we have another cat who was in heart failure and now gets regular chest drains. I do not want my cat to die in hospital, so we will be treating him at home and will call a mobile vet when the moment comes.

- I see this as our last-ditch effort. How can we manage this at home? I test his BG multiple times a day so I have that at my disposal, but our vet didn't seem to think increasing his insulin would be helpful and that this is it.

Numbers below including weights and water intake (water is spread across 3 cats so it's a family total, I also add water to his every meal). We generally feed - test - insulin:

CURVE Thursday 14/12 2.67kg 300mls
12:20am 27.8
8am 23.0 - 9 units
10:25am 22.7
12:20pm 24.3
2:40pm 28.4
6:30pm 20.3 - 9 units
11:40pm 24.4

Friday 15/12 2.705kg 300mls
8am 26.7 - 9 units
7:40pm 25.3 - 9 units

Saturday 16/12 2.855kg 175mls
8am 12.8 - 9 units
6:30pm 22.7

Sunday 17/12 2.730kg 300mls
8am 28.6 9 units
2:30pm 23.8
7pm 30.2 - 9 units

Monday 18/12 2.805kg 360mls *discovered drinking in toilet
8am 19.9 - 9 units
2:50pm 26.1
7:55pm 28.3 - 9 units

Tuesday 19/12 2.730kg 450mls
8am 20.7 - 9 units
6:55pm 22.9 - 9 units

Wednesday 20/12 2.775kg 350mls
7:50am - 22.3
10am 27.9 - 10 units
6:55pm 28.7

CURVE Thursday 21/12 2.790kg 450mls
8am 23.9 - 10 units *initially went through
10am 22.3
12pm 19.1
2pm 25.0
4pm 23.5
6pm 30.7
8pm 32.3 - 10 units

Friday 22/12 2.775kg 345mls
8am 28.2 - 10 units
11:45am 24.8
7:15pm 23.2 - 10 units

Saturday 23/12 2.81kg 240mls
7:50am 23.8
8:10am 10 units
3:10pm 20.6
7pm 21.5

Sunday 24/12 2.79kg *est 340mls
7:50am 29.1 - 10 units
6pm 23.2 1 RC
6:30pm 10 units

Monday 25/12 2.81kg
8am 27.0 - 10 units
5:15pm 24.7
6pm 10 units

Tuesday 26/12 2.715kg 240mls
8:10am 28.0 10 units
8:10pm 26.3 10 units

Wednesday 27/12 2.765kg 425mls
8:10am 24.3
7pm 23.1

CURVE Thursday 28/12 2.63kg 225mls
7:45am 30.1
9am 10 units
9:45am 24.2
12pm 17.5
2pm 23.8
4pm 21.7
5:30pm 20.4 - 10 units
9pm 26.2

Friday 29/12 2.725kg 350mls
9am 15.1 - 10 units
7pm 29.2 10 units

Saturday 30/12 2.78kg 350mls *peed on couch
8:10am 15.1 - 10 Units
7:15pm 29.7 - 10 Units
10pm 18.3

Sunday 31/12 2.695kg 500mls
8:20am 26.3 10 units
3:40pm 21.5
6:10pm 27.0

Monday 1/1 2.825kg 300mls
8:55am 25.4 - 10 units
3:30pm 24.0
6:30pm 27.7

Tuesday 2/1 2.795kg 400mls
7:40am 23.7 - 10 units *missed some insulin
3:20pm 31.2
6:40pm 25.3

Wednesday 3/1 2.835kg 300mls
8:05am 31.6 - 10 units
3:30pm 13.8
6:05pm 24.3
6:20pm 11 units

CURVE Thursday 4/1 3.01kg 250mls
8am 7.3 - 11 units
10am 13.1
12pm 20.3
2pm 20.5
4pm 16.7
6pm 7.8
8pm 8.6 - 11 Units
10:10pm 12.6

Friday 5/1 2.93kg 425mls
7:25am 31.1 - 11 units
2pm 26.8
6:35pm 24.8 1 FF

Saturday 6/1 2.86kg 250mls
7:50am 30.2 - 11 units
1:25pm 18.1
7:20pm 25.3 - 11 units

Sunday 7/1 3.06kg 270mls
7:30pm 29.9 - 11 units *some insulin missed
2:30pm 15.1
6:20pm 23.0
7:05pm 11 units

Monday 8/1 2.985kg 260mls
7:30am 21.9 - 11 units
2:25pm 18.8
6:30pm *vomited
7:20pm 21.3 - 11 units

Tuesday 9/1 2.53kg *vomited overnight
8am 25.7 - 11 units

Advice would be appreciated - while he didn't want his breakfast this morning, it just doesn't seem like it's the end. But if it is, I would rather try what I can while he is comfortable at home :(
 
Update from the vet -
Have got a good amount of fluid into him, has eaten a bit of food and kept it down with nausea meds. Seemed a little flat, checked electrolytes and was low in potassium - potassium given and now has perked up. Glucose stable at around 22.0, began short-acting insulin. Will continue for the rest of the day and will be discharged in 3-4 hours.

I have hypokal tablets at home for my other cat, would these be useful to help with the low potassium due to increased fluids? Also, should I add Lectade to his food instead of water?
 
I'm sorry Hansel is so sick. I'm glad he is in the ER and receiving treatment he needs currently.

Many of us here can't help you because we just don't have the knowledge or experience. Someone that has been tagged or with the expertise you need will hopefully come along soon.

I know how you feel and it is a terrible feeling. You aren't alone in this. I just wanted you to know why no one has given you any advice yet.
 
HanselSphynx said:
Update from the vet -
Have got a good amount of fluid into him, has eaten a bit of food and kept it down with nausea meds. Seemed a little flat, checked electrolytes and was low in potassium - potassium given and now has perked up. Glucose stable at around 22.0, began short-acting insulin. Will continue for the rest of the day and will be discharged in 3-4 hours.

I have hypokal tablets at home for my other cat, would these be useful to help with the low potassium due to increased fluids? Also, should I add Lectade to his food instead of water?
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I was just going to ask you if they were giving a bolus (fast-acting) insulin. It seems to me Toujeo is not a good choice because it is not very potent and you can see how much more insulin he needs. You are giving it twice a day but it’s a 16-hour duration insulin. It also seems they raised his dose of Lantus really fast.

In order for a cat to have DKA, infection has to be present. Are they giving him antibiotics? How about ondansetron and cerenia to control the vomiting? Is he eating on his own regularly and, if so, how much compared to what he normally eats when he’s well? You will need to confer with the vet about potassium supplementation when you take him home. Potassium has to be kept within a certain range and this has to be done with a vet.

If you take him home, it’s going to be necessary to get fluids and lots of calories in him. If he has DKA, he needs about 1.5x his normal calories plus you’ll have to continue to have his electrolytes monitored. You will also have to stay on top of the ketone testing. Do you have any labs you can post?
 
Thank you for your response. His lantus was increased quickly initially as he was in the hospital and they were struggling to get it down, but once at home we only increased every weekly curve test at a mimimum. His response to toujeo has been the same as Lantus unfortunately.

I don't know if they are giving him antibiotics as they seemed just to be resigned to this being the end if we aren't taking him to the emergency vet. So is it possible he is not in DKA, just high ketones? He is on anti-nausea meds but I don't know what ones, so far no more vomiting.

How would I monitor electrolytes? I don't have any labs sorry, basically my vet is expecting me to bring him home for euthanasia so I don't think they are going to give me any help or advice going it on our own.
 
HanselSphynx said:
His lantus was increased quickly initially as he was in the hospital and they were struggling to get it down,
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Lantus doesn’t work that way. It’s not the insulin to use to get the BG down quickly. Were they increasing his dose by a unit every week?

You’ve paid for his treatment so you are due all his lab results. I would be stunned if they are treating him for DKA without labs. You should ask if he’s on antibiotics.

The vet has to monitor the electrolytes with blood draws. Can you take him to a different clinic? It sounds like these vets are not up on treating DKA or diabetes. We’ve had some really, really sick cats with DKA in this forum survive it even when they’ve had to go home for home treatment.
 
I was just typing when Marje posted. I agree with what she has said.
I think you need to ask them what the diagnosis is so you know what you are dealing with.
And many vets suggest euthanasia far too soon in my opinion. I have seen many cats in this forum live for years after euthanasia was suggested by the vet
 
Yes it was increased about every week. They are not necessarily treating him for DKA, just supportive treatments for the day as they are not set up for DKA patients.
I don't believe they are doing bloods because they are just assuming there isn't much that can be done if we aren't going to the hospital. They are just a regular vet, not an emergency hospital. We are not going to take him to the hospital as we can't afford to do so again, we've spent about $15k in the last year and along with the stress on my cat, I just cannot send him there again.
 
Bron and Sheba (GA) said:
I was just typing when Marje posted. I agree with what she has said.
I think you need to ask them what the diagnosis is so you know what you are dealing with.
And many vets suggest euthanasia far too soon in my opinion. I have seen many cats in this forum live for years after euthanasia was suggested by the vet
Click to expand...

I agree, I was told my heart-failure cat needed to be euthanised 6 months ago but is still playful and happy to this day with medication and chest drains when needed. I have done everything I can for my cats when I've known it's not their time, but I fear I don't have the knowledge to turn this around with emergency vet care not being an option anymore.

There isn't a definitive diagnosis, he has ketones in his urine and vomited a couple of times. They won't go forward with anything but the fluids and some short-acting insulin there as they aren't equipped for anything more.
 
Will they send you home with antinausea medications? Ask them. They should be able to give an injection for cerenia ( nausea) on discharge.
And ask for cerenia and ondansetron tablets. They will most likely have to give you a script for the ondansetron and you collect it from a pharmacy.
Do you have Ketostix at home to test the urine for ketones? You will definitely need those. You can get those at Walmart or a pharmacy
And you will need to be feeding lots of food to him. 1and 1/2 times as many calories as normal.
 
Bron and Sheba (GA) said:
Will they send you home with antinausea medications? Ask them. They should be able to give an injection for cerenia ( nausea) on discharge.
And ask for cerenia and ondansetron tablets. They will most likely have to give you a script for the ondansetron and you collect it from a pharmacy.
Do you have Ketostix at home to test the urine for ketones? You will definitely need those. You can get those at Walmart or a pharmacy
And you will need to be feeding lots of food to him. 1and 1/2 times as many calories as normal.
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I am hoping they will when I pick him up this evening. I actually have Odansetron tablets on hand at home from my other cat.

I do have the urine sticks at home which is how I first caught it, how often should I try testing it?

I forgot to also note that I am in Australia.
 
I've had a response to my facebook post about adding a fast-acting insulin like Mixtard to get his sugars right, but previously the specialist I had my vet consult with only really uses a combination with dogs. I'm not sure if my vet will dispense it for me, and I am unsure how to use it in combination :(
 
HanselSphynx said:
I am hoping they will when I pick him up this evening. I actually have Odansetron tablets on hand at home from my other cat.

I do have the urine sticks at home which is how I first caught it, how often should I try testing it?

I forgot to also note that I am in Australia.
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I am in Australia too!
Where are you? I’m in Sydney
I would test twice a day with the Ketostix at the moment.

I would not use the Mixtard insulin without a lot of experienced guidance. You could run into a lot of trouble with nadirs.
Do you think you could set up a signature and spreadsheet so we can find out more information?
I’m out and on my iPhone but will send you the link to both the signature and spreadsheet below.
Do you have lots of different foods to offer him when he gets home.? It’s important he eats lots of food and often to combat the ketones.
You will need to start the food tonight
 
Hello and welcome. I had a kitty who had acromegaly, though not on as high as dose as your Hansel. Some of the studies I've seen say that around only 35% of cats show clinical signs of acromegaly on diagnosis, meaning most don't. My girl's only signs were her raving hunger and higher dose.

I agree with Bron's comment about setting up a spreadsheet if you can. I have a few questions based on the data listed on your first post. First of all, there seem to be several days (more properly nights) were only the one dose was given instead of two. Such as 16/12, 20/12, 23/12. Was any insulin given on the 27th? Our spreadsheet gives us a visual representation of dosing and blood sugar data, which I find much easier to analyze.

A question about the Toujeo - how are you injecting it? With the pens?

Note: for some higher dose cats or those with recent DKA, we will use a faster acting insulin, but it's usually Regular insulin, not Mixtard. What fast acting insulin are they using at the clinic, what is the dose, and how often are they giving it? The Regular insulin is also commonly used at vets when dealing with DKA.
 
Thank you, I will try to get to the spreadsheet and signature when I can.

Sorry, I accidentally deleted some of my insulin numbers but he is definitely getting 2 doses a day.

We’ve just got home from the vet. Their fast acting insulin only dropped his numbers slightly from 25 down to 22, now he is home I’ve tested him and he’s 17. The ketones have also gone which the vet seemed surprised at.

He ate a bit with them, but they think he really needs more fluids if we want to keep going. It’s not really an option for us to keep going back, so even though the ketones are currently gone, the dehydration concerns me.

I’ve offered him wet food, he leapt up to get it but wouldn’t eat any and is now just laying down.

We’ve also just given him his evening dose of insulin, increased to 12 units since it’s been a week since the last increase. We use a toujeo pen. The vet also said fast acting wasn’t an option for us at home as his dose would be 1/4 which is impossible to give with a pen/syringe, and they’d given it intravenously.
 
I gave Neko as small as a drop of Regular (R) insulin in my regular U-100 syringes, though my typical R dose was more like 0.25 units. You don't want the fast acting insulin to drop the numbers more than about 5.5 mmol/L (100) points, or the steep drop can cause bouncing, and even higher numbers.

Glad to hear the ketones are gone. Any chance the vet could show you how to do subq fluids at home. Here is a video showing how to do it. How to Give Subcutaneous Fluids (Video)

Can you give him some ondansetron? Showing interest in food but not eating sounds like nausea. He needs to get food in him. At this point I'd eat him anything he'd eat.
 
If he jumped up at the food and then wouldn’t eat, that sounds like nausea. Did you get any antinausea medication from the vet ? You will need it.

The other option for fluids is sub Q fluids which you can do at home. A lot of vets in Australia are not up to speed with letting caregivers give the fluids at home. But please push for them. We can show you how to do them. My vet was hesitant at first but then was completely on board with me giving them.
At the moment give him whatever he wants to eat. It doesn’t matter if it is not suitable for a diabetic cat. Eating is more important than anything and he must eat to combat the ketones.
 
Yes I have ondansetron from the vet. She said the injection they gave should last 24 hours so I wouldn’t need to give anything till the morning?
I’m just grabbing more food options now including chicken to make broth to help entice him.
I asked about subQ fluids and she said it wouldn’t do enough…
 
HanselSphynx said:
Yes I have ondansetron from the vet. She said the injection they gave should last 24 hours so I wouldn’t need to give anything till the morning?
I’m just grabbing more food options now including chicken to make broth to help entice him.
I asked about subQ fluids and she said it wouldn’t do enough…
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I disagree. The sub q fluids will make a difference. Go back tomorrow and ask them to either show you how to do it or get the equipment you need from them and we can show you. We have a lot of cats who have sub q fluids and it makes a big difference.
Cerenia and ondansetron work in different pathways so you can give the ondansetron tonight. It is safe to do so. Try roast chicken or Parmesan cheese to tempt him to eat. Whatever you think he might eat.. try it.
 
Bron and Sheba (GA) said:
I disagree. The sub q fluids will make a difference. Go back tomorrow and ask them to either show you how to do it or get the equipment you need from them and we can show you. We have a lot of cats who have sub q fluids and it makes a big difference.
Cerenia and ondansetron work in different pathways so you can give the ondansetron tonight. It is safe to do so. Try roast chicken or Parmesan cheese to tempt him to eat. Whatever you think he might eat.. try it.
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He’s refusing everything, all wet foods / dry foods / cooked chicken / broth. Nothing is working. He’s so weak, I don’t know if he can make it through the night like this. I’ve given him some ondansetron but he’s just not interested. Lying down, going to his water but not drinking.

latest glucose 20.1
 
Give the ondansetron 30 or 40 minutes to work and try again. Is there any food he really likes?
have you tried putting some food into his mouth?
do you have a syringe you could try syringing some food into him? You might have to blitz it and add water to get it to go into the syringe. I will send you a link to syringe feeding.

have you tested for ketones since coming home?
 
Bron and Sheba (GA) said:
Give the ondansetron 30 or 40 minutes to work and try again. Is there any food he really likes?
have you tried putting some food into his mouth?
do you have a syringe you could try syringing some food into him? You might have to blitz it and add water to get it to go into the syringe. I will send you a link to syringe feeding.

have you tested for ketones since coming home?
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Yes, normally all foods :( I did try some syringe feeding earlier, but he didn’t really want to drink it and let most of it fall out. I’ve had to do this for one of my cats in the past, I’m conscious pushing too hard can make him want to vomit.

I haven’t tested for ketones as they tested right as we discharged, so only 4 hours ago now. He’s had one accident since coming home, so I also haven’t been able to catch it.
 
Bron and Sheba (GA) said:
If you can catch a pee I would test it.
Keep trying to feed him.
Did they test for pancreatitis?
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I have him set up with a smorgasbord of food, water and sieve tray litter so I can catch urine.

He’s been tested for pancreatitis and had an ultrasound, it’s all be ruled out in the past.
 
I'm so sorry, I m heartbroken for you,I had been praying that you could turn it around.
Take care of yourself.

Fly free little one.:rb_icon:
 
Sending you love. Thank you for loving your cats the way you do. Be kind to yourself, please. You tried everything.
 
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HanselSphynx said:
Thank you for your replies. We said goodbye this morning
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I’m so very sorry for your loss. Unfortunately your journey sounds exactly like mine and I lost my beautiful boy unexpectedly on Monday after urine testing showed a trace of ketones. Then things deteriorated rapidly after getting him to a vet on fluids and insulin. May our babies RIP. I’m gutted as I’m sure you are and I don’t understand how this could happen. My thoughts are with you x
 
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