Introduction-Minky's Mum DKA

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Sheila and Minky

Sheila and Minky

Active Member
Hi,

I am new to this site and our kitty was recently diagnosed as diabetic. Actually Minky was not eating well and had lost weight. We took her to the vet because I thought she had a broken tooth. It turned out she was diabetic and had ketones in her urine. We ended up having to hospitalize her for 30 hours. With much prayer and doing a lot of different things (force feeding, potassium, insulin, etc.) she has stabilized and is out of the crisis zone from the DKA and possibly hepatic lipidosis. We have been feeding her as much as she wants and whatever she wants because the goal has been to keep her eating. The thing is her sugar levels are all over the place. We are to give her Lantus twice a day but sometimes her glucose on the Alphatrak is mid 100s or even below 100. This is scary to us and we haven't given her insulin in those cases. Because I work it is scary to think of her going low if I am not home. The vet ran a fructosamine test and it would seem she is running high sometimes and low sometimes which is showing as in the normal range on the test. From testing her at home we know she is not controlled or normal. The last two to three days she has been in the 400s. We gave three units Friday night but she went into the 70s so we don't want to do that. I gave some corn syrup to help because it would be several more hours before the insulin was at the end of its life. We thought maybe a pen was bad and thus the high readings or maybe in being new to giving shots, I didn't get it past her fur. We have eliminated those variables but still she is high. I feel overwhelmed because I am tired from the crisis and don't know what I am doing. The vet says to give two units twice a day and not check sugar levels at all until our next appointment (Oct. 8th). She is now on vacation and can be contacted through the vet receptionist, but I know if I don't do what she has requested, she will not be happy and tell me to do what she asked. Sorry for the long post, but I just am at a loss.
 
Hi Sheila,
So sorry that you have to go through all this…
Hang in there, it is scary in the beginning, but you did the right thing by posting here. Soon the most experienced members will write back.

I’m new myself, my vet also wanted me to start with 3U but she was very positive with me thinking to do home monitoring, which of course encouraged me to do so.

Please, do home monitor, it’s the safest for your cat! And it’s best to start low. The more experienced will tell you how low, but I wouldn’t start with 2 units. The vet might not be happy but the cat will be!
 
Hi and welcome to the forum.
I am very glad you have posted as we can help you a lot in getting things sorted out.
First of all, I totally disagree with your vet about not testing the BGs. That is just sticking your head in the sand and hoping for the best.
Because Minky has had ketones it is very important you don’t miss any doses of insulin.
What helps keep ketones away is insulin, food and water.
Are you testing for ketones in the urine or the blood at home? It’s is very important that you do and at this point I would do it daily as testing for them is your early warning system that everything is OK or it’s not OK. And you then have a chance to rectify things before the ketones multiple.
What type of food are you feeding?
Are you testing before every dose is given?
It sounds as if you are using a pen to give the insulin. Is that correct? I would recommend you buy some syringes and then you can still use the insulin from the pen but you can give smaller doses. We recommend insulin is increased and decreased in 1/4 unit increments not 1 unit increments. The syringes you will need are U100, 3/10ml, 30 or 31 gauge, 6 or 8 mm 1/2 unit insulin syringes. It’s very important you get the correct syringes. I will post below how you can get the insulin out of the pen.
So this is what I would recommend you do
  • 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.
  • 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 Spreadsheet so we can see. Please report any trace ketones at all. To test for ketones you will need a bottle of Ketostix from Walmart or a pharmacy and collect a urine sample for Minky and test the urine following instructions on the bottle. Or if you don’t think you can get a urine sample there are blood ketone meters available. Let me know if you want more details about the blood ketone meter. They are used just like a glucose meter.
  • Give antinausea medication if needed such as ondansetron or cerenia.
  • 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…if Minky is dehydrated she may need them
  • Set up a spreadsheet and test the BG frequently. I will give you the link to the spreadsheet below
  • Set up a signature that will tell us all about Minky. If you set up your SS and signature we will be able to help you with dosing. I will contact @Bandit's Mom so she can help you with these if you like.
  • Post daily with updates and ask for help as often as needed.
HELP US HELP YOU this has the SS info, signature, hypo box…make sure you get the hypo box set up asap and other useful info for new members.
 
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Sorry about all these posts. My iPad is playing up and is freezing part way through my posts.
This is the picture how to get the Lantus from the pen to the syringe
upload_2024-9-16_11-12-28.jpeg
 

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Daphne and Aida said:
Hi Sheila,
So sorry that you have to go through all this…
Hang in there, it is scary in the beginning, but you did the right thing by posting here. Soon the most experienced members will write back.

I’m new myself, my vet also wanted me to start with 3U but she was very positive with me thinking to do home monitoring, which of course encouraged me to do so.

Please, do home monitor, it’s the safest for your cat! And it’s best to start low. The more experienced will tell you how low, but I wouldn’t start with 2 units. The vet might not be happy but the cat will be!
Click to expand...

Thank you so much for your support <3
 
Bron and Sheba (GA) said:
Hi and welcome to the forum.
I am very glad you have posted as we can help you a lot in getting things sorted out.
First of all, I totally disagree with your vet about not testing the BGs. That is just sticking your head in the sand and hoping for the best.
Because Minky has had ketones it is very important you don’t miss any doses of insulin.
What helps keep ketones away is insulin, food and water.
Are you testing for ketones in the urine or the blood at home? It’s is very important that you do and at this point I would do it daily as testing for them is your early warning system that everything is OK or it’s not OK. And you then have a chance to rectify things before the ketones multiple.
What type of food are you feeding?
Are you testing before every dose is given?
It sounds as if you are using a pen to give the insulin. Is that correct? I would recommend you buy some syringes and then you can still use the insulin from the pen but you can give smaller doses. We recommend insulin is increased and decreased in 1/4 unit increments not 1 unit increments. The syringes you will need are U100, 3/10ml, 30 or 31 gauge, 6 or 8 mm 1/2 unit insulin syringes. It’s very important you get the correct syringes. I will post below how you can get the insulin out of the pen.
So this is what I would recommend you do
  • 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.
  • 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 Spreadsheet so we can see. Please report any trace ketones at all. To test for ketones you will need a bottle of Ketostix from Walmart or a pharmacy and collect a urine sample for Minky and test the urine following instructions on the bottle. Or if you don’t think you can get a urine sample there are blood ketone meters available. Let me know if you want more details about the blood ketone meter. They are used just like a glucose meter.
  • Give antinausea medication if needed such as ondansetron or cerenia.
  • 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…if Minky is dehydrated she may need them
  • Set up a spreadsheet and test the BG frequently. I will give you the link to the spreadsheet below
  • Set up a signature that will tell us all about Minky. If you set up your SS and signature we will be able to help you with dosing. I will contact @Bandit's Mom so she can help you with these if you like.
  • Post daily with updates and ask for help as often as needed.
HELP US HELP YOU this has the SS info, signature, hypo box…make sure you get the hypo box set up asap and other useful info for new members.
Click to expand...

Thank you so much for responding and for all the help--it is so appreciated!! I am not sure if we can get the syringes because I think we need a script. Our vet is out of town for the next 10 days. Is there a video that shows how to give the insulin via a syringe? I remember vaguely something when I had to do it 4 years ago about pulling the plunger back a bit or something before giving the insulin? I do test before I give the insulin. I would like to see about the ketone blood test; I think it will be hard to get a urine sample as we have three cats, and I work.

Since she had not been eating from the DKA, we are letting her eat whatever she wants. Her favorite food that she will good amounts of is Fancy Feast Seafood Feast in Gravy. She will eat smaller amounts of Fancy Feast Seafood Feast Pate and lesser of amounts of Friskies Mariner's Catch and Iam's Grain-Free Chicken Recipe Pate. She is drinking a good amount of water on her own. She has been out of the crisis zone for about a week so I am nervous about introducing too many new things or restrictions.
 
Si did she actually have DKA? It’s important we know this if she did and I’ll get you to put they in the signature as it can make a difference how we advise you.
Let her eat whatever she will at the moment if eating is a problem. The most important things you can do is make sure she is eating lots of food and she is getting the insulin. Once we can see the spread sheet and ketone results we will know if the dose is correct.
As far as ketones go, we like to see at least a couple of weeks with no ketones before we can relax a bit.

I’ll post some ketone blood meters you can choose from. All are ok.
 
Bron and Sheba (GA) said:
Si did she actually have DKA? It’s important we know this if she did and I’ll get you to put they in the signature as it can make a difference how we advise you.
Let her eat whatever she will at the moment if eating is a problem. The most important things you can do is make sure she is eating lots of food and she is getting the insulin. Once we can see the spread sheet and ketone results we will know if the dose is correct.
As far as ketones go, we like to see at least a couple of weeks with no ketones before we can relax a bit.

I’ll post some ketone blood meters you can choose from. All are ok.
Click to expand...
The vet said she had DKA (had lost 3 pounds in a short period of time, was eating very little, and had ketones in her urine; her electrolytes were really off and she was hospitalized; we are still supplementing with potassium although her electrolytes are back in balance now; she is a little low on her RBC and hemoglobin but they are coming back up). She also possibly had hepatic lipidosis. I will post the spreadsheet in the signature. We have made some mistakes which we clearly see now, but we are trying to learn.
 
Sheila305 said:
The vet said she had DKA (had lost 3 pounds in a short period of time, was eating very little, and had ketones in her urine; her electrolytes were really off and she was hospitalized; we are still supplementing with potassium although her electrolytes are back in balance now; she is a little low on her RBC and hemoglobin but they are coming back up). She also possibly had hepatic lipidosis. I will post the spreadsheet in the signature. We have made some mistakes which we clearly see now, but we are trying to learn.
Click to expand...
We all have had to learn so don’t beat yourself up about it.
Yes it certainly does sound as if she had DKA. So forever more you are going to have to be aware that she is more prone to ketones than other cats. So if she is ever unwell, not eating or generally off, always test for ketones. They are so much easier to treat if caught early.

Do you think she might be nauseated? If she is being picky with the food, she could be nauseated. Many post DKA cats have trouble eating for a few weeks and need help with you giving an antinausea medication. A really good one for cats is ondansetron. It can be giving 3 times a day and works well for nausea. You will need to get a script from the vet and then get the medication from a human pharmacy. Another one is cerenia. The vets will give you this but it is better for vomiting then nausea. But if think at all she has nausea, I would address it and get it sorted out as it is very hard to eat is nauseated, and eating is crucial to her recovery.
Would you mind putting post DKA in the subject line after Introduction Minky’s Mum please. This will alert people who are helping.
Thanks.
 
Bron and Sheba (GA) said:
We all have had to learn so don’t beat yourself up about it.
Yes it certainly does sound as if she had DKA. So forever more you are going to have to be aware that she is more prone to ketones than other cats. So if she is ever unwell, not eating or generally off, always test for ketones. They are so much easier to treat if caught early.

Do you think she might be nauseated? If she is being picky with the food, she could be nauseated. Many post DKA cats have trouble eating for a few weeks and need help with you giving an antinausea medication. A really good one for cats is ondansetron. It can be giving 3 times a day and works well for nausea. You will need to get a script from the vet and then get the medication from a human pharmacy. Another one is cerenia. The vets will give you this but it is better for vomiting then nausea. But if think at all she has nausea, I would address it and get it sorted out as it is very hard to eat is nauseated, and eating is crucial to her recovery.
Would you mind putting post DKA in the subject line after Introduction Minky’s Mum please. This will alert people who are helping.
Thanks.
Click to expand...
I don't think she is nauseated. She just has a preference it seems for certain kinds of food which are higher in carbs :( I updated the title. You have no idea how thankful I am for your help and time! <3
 
 
Sheila305 said:
Iam not sure if we can get the syringes because I think we need a script. Our vet is out of town for the next 10 days
Click to expand...
@Sheila305
If you don't have the syringes with the half unit markings,you can order the half unit markings without a vets script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

The spreadsheet you have is not ours
Here is the link and it will also explain how to use it, it's very easy
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Take a look at this members spreadsheet to get an idea what it looks like
https://felinediabetes.com/FDMB/threads/9-14-tansi-amps104-4-81-7-77-pmps92.294029/

Tap on Tansi's spreadsheet it's at the end of Cindy's signature

Please read all the yellow stickys above Lantus
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/


@Sheila305
 
Last edited:
Sheila305 said:
Our vet is out of town for the next 10 days. Is there a video that shows how to give the insulin via a syringe? I remember vaguely something when I had to do it 4 years ago about pulling the plunger back a bit or something before giving the insulin?
Click to expand...
You will get the syringe ,do not pull the plunger back before you insert it into the pen .Just insert the syringe into the pen and then draw out how much insulin you want to give
@Sheila305
 
 
Sheila305 said:
I meant when I put the syringe in Minky, it seems to me they said to insert it, pull the plunger back a bit, and then push the insulin into her?
Click to expand...
No you don't want to do that, there is no reason to pull the plunger back and then push the insulin in. I would just draw up the dose I wanted to give and then make a tent in the scruff insert the syringe and then inject it
 
Last edited:
Sheila305 said:
She also possibly had hepatic lipidosis.
Click to expand...

Sheila, I’m a big advocate for a specific supplement that protects the liver.
There are many different kinds (to name two of the mostly used are SAME and sylimarin). The one I’m talking about is the amino acid derivative L-carnitine that is usually produced by the kidneys (CKD cats’ and humans’ kidneys aren’t very efficient at it), and that aids in lipid circulation, protecting the liver in some manner that is somehow too technical for my brain to understand.

My other cat Feloro had hyperthyroidism and was first treated with methimazole, which had a massively toxic effect on his liver. It took some time to recover after the I-131 treatment, his liver values were back to normal after more than 1 year with SAME, sylimarin and L-carnitine supplementation, and I do continue to give both of my cats L-carnitine with their food.

With hepatic lipidosis it is important to aid the liver in any way you can. I would recommend that you give Minky SAME, but also l-carnitine. Both can be found on i-herb. In case Minky (he or she?) did not have hepatic lipidosis, they have no harmful effect.
 
Daphne and Aida said:
Sheila, I’m a big advocate for a specific supplement that protects the liver.
There are many different kinds (to name two of the mostly used are SAME and sylimarin). The one I’m talking about is the amino acid derivative L-carnitine that is usually produced by the kidneys (CKD cats’ and humans’ kidneys aren’t very efficient at it), and that aids in lipid circulation, protecting the liver in some manner that is somehow too technical for my brain to understand.

My other cat Feloro had hyperthyroidism and was first treated with methimazole, which had a massively toxic effect on his liver. It took some time to recover after the I-131 treatment, his liver values were back to normal after more than 1 year with SAME, sylimarin and L-carnitine supplementation, and I do continue to give both of my cats L-carnitine with their food.

With hepatic lipidosis it is important to aid the liver in any way you can. I would recommend that you give Minky SAME, but also l-carnitine. Both can be found on i-herb. In case Minky (he or she?) did not have hepatic lipidosis, they have no harmful effect.
Click to expand...
Thank you so much for this. Our other kitty (we have three and they are all full-blooded sisters) was just diagnosed with hyperthyroidism a few weeks before Minky had issues. She is on methimazole as well. We will have to look into this. Everything seems super overwhelming right now. I am really glad Feloro got better--when they are sick, it is so hard.
 
Sheila305 said:
I am seeing the ketone strips but not the machine that uses the strips. Is it the same machine that tests blood sugar?
Click to expand...

Ketone meters are typically able to give both blood ketone readings and blood glucose readings BUT you need a special test strip for each. Meaning, you can’t get a BG reading and a ketone reading at the same time using the same test strip. Some people use the ketone meter only for ketone testing, others use it for both ketone and BG testing. It’s a personal preference. For example, I used a One Touch Ultra for BG testing because I’ve had 4 diabetic cats over the years and was very comfortable with that meter. When ketones came into play, I bought a ketone meter (Precision Xtra) to test for ketones. I could have also used it to test BG but opted not to.

So in summary, to get a ketone reading using blood, you’ll need:
- a blood ketone meter
- blood ketone test strips

If you also want to get BG readings with the same meter, you’ll need:
- blood glucose test strips

Bron gave you some links to various ketone meters. You asked about Amazon — here are links for the Nova Max Plus supplies on Amazon.

Nova Max Plus (meter)
https://www.amazon.com/Nova-Max-Glucose-Monitoring-System/dp/B01G5OE0QY

Nova Max Plus (ketone test strips)
https://www.amazon.com/Nova-Ketone-Strips-Count-Total/dp/B008P0WMI0

Nova Max Plus (blood glucose test strips)
https://www.amazon.com/Nova-Max-Glucose-Test-Strips/dp/B00F4C1XU0

Sheila305 said:
I remember vaguely something when I had to do it 4 years ago about pulling the plunger back a bit or something before giving the insulin?
Click to expand...
That’s probably because, in general, it’s a common practice to “pull back” before injecting something to make sure you haven’t hit a vein (as evidenced if you saw blood in the syringe after pulling back). To be honest, I don’t think anyone does that before giving their cat an insulin shot. I’ve never seen, or been advised by, a vet to do that either. But you can always ask your vet if you’re concerned about it.
 
If you don't have the syringes with the half unit markings,you can order the half unit markings without a vets script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

The spreadsheet you have is not ours
Here is the link and it will also explain how to use it, it's very easy
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Take a look at this members spreadsheet to get an idea what it looks like
https://felinediabetes.com/FDMB/threads/9-14-tansi-amps104-4-81-7-77-pmps92.294029/

Tap on Tansi's spreadsheet it's at the end of Cindy's signature

Please read all the yellow stickys above Lantus
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

If you need help with our spreadsheet just ask we have a member who will do it for you


@Sheila305
 
Sheila305 said:
Thank you so much for this. Our other kitty (we have three and they are all full-blooded sisters) was just diagnosed with hyperthyroidism a few weeks before Minky had issues. She is on methimazole as well. We will have to look into this. Everything seems super overwhelming right now. I am really glad Feloro got better--when they are sick, it is so hard.
Click to expand...

Hyperthyroidism is the “nice” sickness to get, by which I mean that it’s the only one for which there is a cure, amazingly!

Most cats do well on methimazole, but it’s usually best to start low (1.25 or max 2.5 BID, test T4, Crea and liver values in 3 to 4 weeks, adjust dosage).

You have to be aware that at diagnosis, the percentage of cats for which the thyroid adenoma is malignant is very very very low.

As the years pass, the dosage has to be adjusted because the adenoma keeps increasing.
And the probability that it becomes malignant increases as well. There was a study conducted by the worldwide feline hyperT guru Dr. Marc Peterson in which he enrolled more than 2000 cats and followed them for years. It concluded that after 4 years, the % of malignancy increases to something like 20% if I remember correctly. (https://pubmed.ncbi.nlm.nih.gov/25673019/)

I don’t mean to alarm you, but I was so deeply deceived by the vet that was following Feloro at that time that I myself studied hyperthyroidism in cats and I ended teaching her! (And changing vet obviously).
A super useful online group is https://groups.io/g/FelineThyroidManagement/topics
They can guide you and relieve you from this extra burden.

In the meanwhile, you could start them all on SAME, sylimarin and L-carnitine!
 
Daphne and Aida said:
Hyperthyroidism is the “nice” sickness to get, by which I mean that it’s the only one for which there is a cure, amazingly!

Most cats do well on methimazole, but it’s usually best to start low (1.25 or max 2.5 BID, test T4, Crea and liver values in 3 to 4 weeks, adjust dosage).

You have to be aware that at diagnosis, the percentage of cats for which the thyroid adenoma is malignant is very very very low.

As the years pass, the dosage has to be adjusted because the adenoma keeps increasing.
And the probability that it becomes malignant increases as well. There was a study conducted by the worldwide feline hyperT guru Dr. Marc Peterson in which he enrolled more than 2000 cats and followed them for years. It concluded that after 4 years, the % of malignancy increases to something like 20% if I remember correctly. (https://pubmed.ncbi.nlm.nih.gov/25673019/)

I don’t mean to alarm you, but I was so deeply deceived by the vet that was following Feloro at that time that I myself studied hyperthyroidism in cats and I ended teaching her! (And changing vet obviously).
A super useful online group is https://groups.io/g/FelineThyroidManagement/topics
They can guide you and relieve you from this extra burden.

In the meanwhile, you could start them all on SAME, sylimarin and L-carnitine!
Click to expand...
Thank you for this information and encouragement. I had no idea that it increases to that percentage. She has done well on the medicine, but before I put her on it, I had looked at the radiation part. With three cats and her being so close to me, I don't think she would survive the quarantining. I definitely need to learn more though. So much to learn *sigh*
 
Sheila305 said:
Thank you for this information and encouragement. I had no idea that it increases to that percentage. She has done well on the medicine, but before I put her on it, I had looked at the radiation part. With three cats and her being so close to me, I don't think she would survive the quarantining. I definitely need to learn more though. So much to learn *sigh*
Click to expand...

Oh yes I totally agree! It really feels overwhelming! Vet studies are 5 years core and some additional years in practice and then extra some years to specialize. We as pet owner we lack the basis, the core, we just dive in the most complex stuff and it really is overwhelming…
There is no rush though. Hyperthyroidism is not a life or death situation where you have to make snap decisions. If she reacts well to methimazole then that’s amazing!

The quarantine can vary greatly, depending on the protocol followed by the clinic administering the I-131 treatment.
There are the most basic clinics that follow the somehow passé rule of one dose fits all. For them, I believe quarantine is 1 week (some countries like France follow the even older protocol of 2 weeks quarantine).
Then, there are the clinics that try to adapt the dose to the level of T4 -> the higher it is, the more I-131 the cat will receive, and then the longer she will have to be quarantined. Typically they have two doses.
And there are the top notch clinics that follow the protocol developed by Marc Peterson, with fool blood panel with methimazole, then another with methimazole withdrawal, scintigraphy at admission on day 1 and a specific calculation to determine the extract dose the cat should receive. Day one they receive 80% of the dose, day 2 they measure how radioactive the cat is and adapt again the final dose depending on how much the thyroid absorbed from the I-131.
Of course I brought Feloro to a clinic that follows this protocol. He was quarantined for just 2 days, and we were good to take the plane on the third day!
The reasoning is that too many cats were either not cured and needed a second treatment, or they became hypothyroidic if that’s a word. With no follow up, hypoT is fatal for the kidneys, and typically cats were dying from CKD one year after having received a too high dose of I-131. Hence the reason French vets never recommend I-131 treatment.
The clinic I went to does a follow up - even now, 1 ½ years later. It was determined that Feloro developed a subclinical hypoT and he receives a small dose of T4. The French vet learned a lot with us, they never had written a prescription of T4 for a cat ever!
The advantage of hypoT is that T4 supplementation is NOT toxic. Methimazole is. And Feloro didn’t react well at all to it. So it’s a full win for us in my opinion!
 
Daphne and Aida said:
Oh yes I totally agree! It really feels overwhelming! Vet studies are 5 years core and some additional years in practice and then extra some years to specialize. We as pet owner we lack the basis, the core, we just dive in the most complex stuff and it really is overwhelming…
There is no rush though. Hyperthyroidism is not a life or death situation where you have to make snap decisions. If she reacts well to methimazole then that’s amazing!

The quarantine can vary greatly, depending on the protocol followed by the clinic administering the I-131 treatment.
There are the most basic clinics that follow the somehow passé rule of one dose fits all. For them, I believe quarantine is 1 week (some countries like France follow the even older protocol of 2 weeks quarantine).
Then, there are the clinics that try to adapt the dose to the level of T4 -> the higher it is, the more I-131 the cat will receive, and then the longer she will have to be quarantined. Typically they have two doses.
And there are the top notch clinics that follow the protocol developed by Marc Peterson, with fool blood panel with methimazole, then another with methimazole withdrawal, scintigraphy at admission on day 1 and a specific calculation to determine the extract dose the cat should receive. Day one they receive 80% of the dose, day 2 they measure how radioactive the cat is and adapt again the final dose depending on how much the thyroid absorbed from the I-131.
Of course I brought Feloro to a clinic that follows this protocol. He was quarantined for just 2 days, and we were good to take the plane on the third day!
The reasoning is that too many cats were either not cured and needed a second treatment, or they became hypothyroidic if that’s a word. With no follow up, hypoT is fatal for the kidneys, and typically cats were dying from CKD one year after having received a too high dose of I-131. Hence the reason French vets never recommend I-131 treatment.
The clinic I went to does a follow up - even now, 1 ½ years later. It was determined that Feloro developed a subclinical hypoT and he receives a small dose of T4. The French vet learned a lot with us, they never had written a prescription of T4 for a cat ever!
The advantage of hypoT is that T4 supplementation is NOT toxic. Methimazole is. And Feloro didn’t react well at all to it. So it’s a full win for us in my opinion!
Click to expand...
I am curious where you went as that is incredible it was only two days. I read when you come home you have to quarantine for 2 weeks and be careful with the litter. I am so glad that was successful for him. <3
 
Sheila305 said:
I am curious where you went as that is incredible it was only two days. I read when you come home you have to quarantine for 2 weeks and be careful with the litter. I am so glad that was successful for him. <3
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It was a clinic in Madrid, Iodocat. There are just 2 clinics in Europe that offer this type of protocol. I believe there are many more in the US.
If you’re really thinking about it, I really recommend that you join the hyperT group. They have a specific file with all the addresses of the clinics all over the world, gathered from the people that are in the group. Ro and Yasmine are the main moderators, and they are really super knowledgeable.
 
Sheila305 said:
I am seeing the ketone strips but not the machine that uses the strips. Is it the same machine that tests blood sugar?
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I can speak about the Precision Xtra (by Abbott). It can test blood for glucose or for ketones; you use a different strip and the meter recognizes what strip is inserted and tests for either ketones or glucose.
 
Sheila305 said:
Thank you so much for responding and for all the help--it is so appreciated!! I am not sure if we can get the syringes because I think we need a script. Our vet is out of town for the next 10 days. Is there a video that shows how to give the insulin via a syringe? I remember vaguely something when I had to do it 4 years ago about pulling the plunger back a bit or something before giving the insulin? I do test before I give the insulin. I would like to see about the ketone blood test; I think it will be hard to get a urine sample as we have three cats, and I work.

Since she had not been eating from the DKA, we are letting her eat whatever she wants. Her favorite food that she will good amounts of is Fancy Feast Seafood Feast in Gravy. She will eat smaller amounts of Fancy Feast Seafood Feast Pate and lesser of amounts of Friskies Mariner's Catch and Iam's Grain-Free Chicken Recipe Pate. She is drinking a good amount of water on her own. She has been out of the crisis zone for about a week so I am nervous about introducing too many new things or restrictions.
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In the US I’ve ordered syringes both from Amazon and diabetic supply sites without a prescription. I’ve walked into pharmacies in Baltimore and bought them without a prescription a few decades ago
 
Sheila305 said:
I looked up all three you gave me on Amazon but I don't see the meters; I just see ketone strips. I see glucose monitors but it doesn't seem they test ketones. I must be doing something wrong.
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blue is for glucose pink is for ketones. Strips are somewhat pricey for the glucose, definitely pricey for ketones. If there’s a meter with cheaper glucose strips it might be worth buying two different meters. I now use the alpha trak for glucose and since I have two meters if I want to test ketones I set them both up and test one after the other
 

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