Hi everyone. It’s been a tough December. Before I give you all the particulars, I need urgent help with my kitty Morrisot (Morrie). Morrie was diagnosed on 12/3-4. We stayed her in Bexacat on 12/10. On. 12/13 went to vet for 3 day checkup she was still losing weight and her ketones were going up. Vet said switching her to insulin. I went to get her Lantus and vet said to give 1 unit every 12 hours and to start that evening. Gave 1 unit at 7pm on 12/13 ( even though she had taken Bexacat at 7am as those were the directions). Gave another 1 unit at 7 am on 12/14. By noon on 12/14 she just did no look good. Borrowed a co-workers AlphaTrack and her BG was 22! I am diabetic so I luckily had glucose gel in my house. We kept giving her gel and feeding every 1/2 hour and got her BG to 70. I stopped giving her any insulin after that 7am shot. Kept checking her all weekend and BG stayed around 70-100. Called vet they said keep doing and no insulin what you are doing and gave an appt 12/13 at 9am. Here tones on 12/13 were now at 5.5 so they admitted her to the ER hospial for insulin therapy. All this time she looked good and acted normal. Today her ketones were down to 0.8 and her BG stabilized after removal of the dextrose IV. She now has a Libre. When I got home today at 4:30 pm her BG was 158, we noticed she had a head tilt and seemed wobbly. We fed her and BG came up to 178, checked again at 6pm and she was still showing same symptom. Gave her honey and fed her and BG now at 198. Why is she showing hypoglycemia symptoms if BG is over 150? What can I do to help her?
12/19/24 New Member Kitty just home from EM Hospital showing strange symptoms
- Thread starter Morisot
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Bron and Sheba (GA)
Very Active Member
I’m sorry no one saw this post sooner.
it sounds like your kitty had DKA. Is that correct.?
Can you ask the vets to send you the lab results please and then post them. You will need to copy and paste on this page
Is she eating ok?
Do you have some Ketostix at home to test her urine for ketones? You can buy them at a pharmacy
If her BG is 158 or 188 she should not be hypoglycaemic.
Is the head tilt to one side?
it sounds like your kitty had DKA. Is that correct.?
Can you ask the vets to send you the lab results please and then post them. You will need to copy and paste on this page
Is she eating ok?
Do you have some Ketostix at home to test her urine for ketones? You can buy them at a pharmacy
If her BG is 158 or 188 she should not be hypoglycaemic.
Is the head tilt to one side?
Bron and Sheba (GA)
Very Active Member
Was Morris put on antibiotics in the ER?
It is possible Morris has an inner ear infection or it is something neurological. I think if I were you I would ring the ER hospital and ask their advice. If she did have DKA don’t skip any doses of insulin.
We can help you with caring for her at home after DKA but you need to get the present problem sorted out first.
Please let us know how you get on..
It is possible Morris has an inner ear infection or it is something neurological. I think if I were you I would ring the ER hospital and ask their advice. If she did have DKA don’t skip any doses of insulin.
We can help you with caring for her at home after DKA but you need to get the present problem sorted out first.
Please let us know how you get on..
i will get the test results tomorrow. I did call the ER dr and she thinks Morisot might be low on potassium. she is eating and drinking normally. We have realized that she tilts her head to look at us- the problem is more like her chin is down toward her chest it almost looks like a horses neck- or like her neck is too weak for her head. she is walking around now still holding her head down.
my kitty had eDKA from the Bexacat. as the sugars are at 158-200 range that is why the ER vet thinks it’s not hypoglycemia, but potassium as she wants eating well in the hospital. I ordered a ketone monitor and it will be here tomorrow.
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Bron and Sheba (GA)
Very Active Member
If her chin is down on her chest that does sound like low potassium. Make sure you get that followed up tomorrow.
I’m going to give you more information on looking after a post DKA cat at home below.
I’m going to give you more information on looking after a post DKA cat at home below.
the er vet thinks it is low potassium as she wasn’t eating well in the hospital. she is eating well now and so the vet thinks it may come back up on its own? but we will bring her to our regular clinic in the morning for a potassium test just in case.
The vet said not to give her insulin unless her sugar went over 300 and stayed there as insulin makes her sugar crash. I will get the results from the ER and post tomorrow. we will do whatever it takes, we just want her well. she is only 7
Bron and Sheba (GA)
Very Active Member
If she is showing symptoms such as hanging her head I think she needs a supplement. Please do get the vet to check he potassium levels tomorrow. Potassium is often low after DKA
I totally disagree with this.
A cat that has had DKA must have insulin as that is what helps keep the ketones away. If you don’t give insulin, that will allow the ketones back into the picture.
Can you tell me what type of insulin she is on and what is the dose please?
She is still such a young cat. You must be so worried about her. We get many DKA cats here and can help you.
Bron and Sheba (GA)
Very Active Member
Here is information about looking after a post DKA cat
- 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 SS so we can see. Please report any trace ketones at all.
- Give antinausea medication if needed such s ondansetron or cerenia
- Give appetite stimulant if needed after the antinausea medication if needed
- 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. Link to how to do that below
- Post daily with updates and ask for help as often as needed.
Bron and Sheba (GA)
Very Active Member
Link to the spreadsheet, signature and hypo box.
HELP US HELP YOU
Link to suitable foods for a diabetic cat. There is no need to feed expensive prescription foods. Look for foods that are 10% or under carbs
FOOD CHART
HELP US HELP YOU
Link to suitable foods for a diabetic cat. There is no need to feed expensive prescription foods. Look for foods that are 10% or under carbs
FOOD CHART
thank you i will get the spreadsheet all set up and posted asap
Bron and Sheba (GA)
Very Active Member
Can you tell us what type of insulin and dose she is on?
JL and Chip
Very Active Member
Insulin moves potassium out of the bloodstream into the cells, so perhaps the ER vet is concerned not only about dose of insulin being too high and triggering hypoglycemia (given the 22 BG reading, although I question whether that’s related to starting insulin on the same day Bexacat was given?), but also about the insulin driving potassium levels in the blood even lower.
In hospital, they can give potassium IV and manage the level (too high is bad too) while at the same time hydrating, giving insulin, managing BG, and managing electrolyte levels. If her head is resting on her chest and she’s wobbly, and with no clear idea of how low her potassium was, I’m concerned.
lf in doubt, it’s never a bad idea to call the ER and/or consider taking her back.
In hospital, they can give potassium IV and manage the level (too high is bad too) while at the same time hydrating, giving insulin, managing BG, and managing electrolyte levels. If her head is resting on her chest and she’s wobbly, and with no clear idea of how low her potassium was, I’m concerned.
lf in doubt, it’s never a bad idea to call the ER and/or consider taking her back.
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Bron and Sheba (GA)
Very Active Member
We have had a few cats on bexacat who have ended up with DKA. I would not give it to my cats.
JL and Chip
Very Active Member
yes tge u-100 syringes. the er even doublechexked to ensure we knew what line we need to go to
believe me- i’m letting all my friends know about this side effect. the bexacat
Bron and Sheba (GA)
Very Active Member
Thanks @JL and Chip. I missed that.
I’ve had a few balls up in the air tonight!
@Morisot are you still giving 1 unit Lantus twice a day to Morrie?
Bron and Sheba (GA)
Very Active Member
That is pretty normal and nothing to worry about.
Did she have a dose of insulin?
no since i brought her home from the er hospital they toldThanks @JL and Chip. I missed that.
I’ve had a few balls up in the air tonight!
@Morisot are you still giving 1 unit Lantus twice a day to Morrie?
me to hold off until sugars are more stable as she was crashing in the er when they gave her insulin (to get rid of the ketones)
on the dextrose drip she would go down far too low.
no the er told me to hold off until she stabilizes a bit more. said if she goes above 300 and it stays there for a few hours then give .5 unit as she is very sensitive to the glucose. they said they would rather have her high for a bit than crash
Bron and Sheba (GA)
Very Active Member
This concerns me greatly.
DKA happens because there is not enough food, not enough insulin and an infection or inflammation. So it stands to reason the way to combat it is to give food, insulin and treat the infection or inflammation.
I don’t want to scare you but if you are not giving insulin to Morrie you are running the very real risk of her getting increased ketones and then back into DKA.
There are several smaller doses that can be given than 1 unit. We go all the way down to a drop of insulin with cats. The sugars are never going to be stable unless she gets insulin. and while you are waiting the ketones will increase again.
Do you have these syringes?
U100, 3/10 ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings?
These are the syringes you need. The larger U100 syringes (5/10, and 1 ml) are too big to measure small amounts.
Bron and Sheba (GA)
Very Active Member
@JL and Chip are you still around?
Would value your opinion on withholding insulin until the BG stabilises as the vet suggests.
Would value your opinion on withholding insulin until the BG stabilises as the vet suggests.
noo do. it have the syringes with the 1/2 unit markings. I will ask in the morning for some. we are bringing. her in to the vet in the morning for her head hanging down problem and will go over with them what all the er vet said. thank you! i didn’t know they made syringes with 1/2 unit marks
JL and Chip
Very Active Member
I’m just signing off for awhile … but basically I’m conflicted. DKA warrants some insulin, but the symptoms of low potassium concern me. The ER vet apparently focused on crashing the BG, not the potassium consideration, but sometimes they “simplify” the guidance rather than give non-medical people the full reasoning or details.
My Charlie’s potassium, already low at the time, crashed him pretty hard with only a small dose of Lantus. It wasn’t expected (or typical per my IM vet) but it’s always in the back of my mind since it was a pretty dramatic experience. But then I fought ketones and DKA with RK, so I know what a difference insulin made in her ketone readings.
So yeah, conflicted and still pondering.
I’d like to see the bloodwork and also know if anemia is a factor.
Bron and Sheba (GA)
Very Active Member
Your vet probably won’t have the syringes with the 1/2 unit markings. You can get those if you live in the US from Walmart or from a pharmacy.
Please ask your vet to check the ketones when you go to see him in the morning. We’ll be interested to hear how you and Morrie get in.
In that meantime offer lots of food to help combat the ketones.
Please ask your vet to check the ketones when you go to see him in the morning. We’ll be interested to hear how you and Morrie get in.
In that meantime offer lots of food to help combat the ketones.
Thank you all for your help and guidance. i just spoke with the er vet again. she sent over all the paperwork to my regular vet and said to see her first thing in the am to check the potassium. and also to make decisions on the insulin. from her on. Morrie did have insulin this morning. so we will only be missing one dose but skipping tonight. Morrie is alert and eating and drinking and using the litter box. she is tired and her head is still down. i am feeding her at least double what she used to eat. i will watch her thru the night and bring her in right away in the morning. I will post again when we return from the vet.
i will make sure to pick some up! thanks
Bron and Sheba (GA)
Very Active Member
Take your insulin with you when you go to the vet in the morning in case he wants to give it there.
I can see you love her very much. Lucky girl
Bron and Sheba (GA)
Very Active Member
Would you mind removing the 911 now please?
SmallestSparrow
Very Active Member
This is probably over but fwiw my MD (and prior user of Bexacat)take. I think @JL and Chip is onto something re the concern or potssium (K) shift with insulin. Not knowing what it was it’s possible the vet was more concerned about hypokalemia (with its risk of death) vs dka (yes also risk of death but a bit slower). I have the same anxiety trying to regulate my hypokalemic cat. This cats symptoms sound exactly like hypokalemia. If it’s so low they thought to with hold insulin it needs tablets at the very least.
I won’t badmouth SGLT2 as they have a very limited population they may help when nothing else will. I do think they are used in the wrong set of cats sometimes, or not followed closely enough. I will note this: I followed Methos’ BG when we stopped the Bexacat to see if he was in remission before starting Lantus. It took 7 or 10 days or so for Methos to climb above 250 and he was in the 90-100 range I think for several days. So this may have been a factor but I also see why the vet didn’t want to withold insulin when stopping Bexacat. But I think they should have insisted you get a meter that day and test. My vet insisted I have a ketone meter when he started Bexacat so I had a glucometer (it did both) when he switched.
I won’t badmouth SGLT2 as they have a very limited population they may help when nothing else will. I do think they are used in the wrong set of cats sometimes, or not followed closely enough. I will note this: I followed Methos’ BG when we stopped the Bexacat to see if he was in remission before starting Lantus. It took 7 or 10 days or so for Methos to climb above 250 and he was in the 90-100 range I think for several days. So this may have been a factor but I also see why the vet didn’t want to withold insulin when stopping Bexacat. But I think they should have insisted you get a meter that day and test. My vet insisted I have a ketone meter when he started Bexacat so I had a glucometer (it did both) when he switched.
sorry I didnt know I could do that
I did bring it along - she gave what she called a "drop" but she was very impressed with all of the things I learned from all of you last evening. We are going to go back to doing insulin - she said she would watch this last dose and see the reaction, but figures we will start at .5 unit BID. (I think that means 2x a day)
UPDATE! Morisot was acting normally last night although her glucose was hovering between 200 and 250. She was eating, drinking, peeing and pooping. She doesn't seem to be cognitively affected, as she is walking around keeping to her normal schedule. I read her glucose every couple of hours through the night. We were waiting at the door of the vet this morning at 6:30am - one look at her and they said, yes this looks like potassium... Anyway, she is still at the vet, they wanted to keep here there while they worked on the potassium and assess her other electrolytes, BG, ketones etc. Probably will be on an IV most of the day. Her potassium was low - and they believe it is causing the head thing. Her ketones were still lower the same as when she was discharged from the ER hospital yesterday 0.8. They are going to email me all her test results today so I can upload them tomorrow when I am home from work. I told them I am not adverse at all to do subQ hydration at home, if they think it would help. My own ketone meter comes today too! Thanks again to all of you
Bron and Sheba (GA)
Very Active Member
Thanks you for the update. I’m very glad your vet has admitted her and is checking the electrolytes and ketones.
And excellent the ketones have not risen.
You might want to ask for an antinausea medication such as ondansetron or cerenia (ondansetron is better) just in case she is nauseated when comes home. I know she has been eating but with Christmas coming up you want to have everything at home in case an issue arises.
Dot forget to have a hypo kit set up with some higher carb food and honey or Karo in case of low numbers.
Looking forward to hearing another update.
And excellent the ketones have not risen.
You might want to ask for an antinausea medication such as ondansetron or cerenia (ondansetron is better) just in case she is nauseated when comes home. I know she has been eating but with Christmas coming up you want to have everything at home in case an issue arises.
Dot forget to have a hypo kit set up with some higher carb food and honey or Karo in case of low numbers.
Looking forward to hearing another update.
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SmallestSparrow
Very Active Member
I’d say see if you can get both cerenia and ondansentron (which will probably be picked up at a human pharmacy). So you have both available (you can never have too many meds for nausea or diarrhea as the holidays approach. If you’re going to do sub q try to get extra needles and tubing and maybe an extra bag if you haven’t done it before. Just in case you have trouble setting up the line and need a new one—because holidays. I’m so glad your kitty is getting better.
JL and Chip
Very Active Member
@Morisot I’m glad to hear you were at the vet first thing this morning and that they are treating, monitoring, and taking this seriously.
You are correct — BID means twice a day, so you would be giving the insulin shot every 12 hours.
Please come back with more updates and let us know how things are going. There’s a lot to learn and more than a few nuances to feline diabetes and everything else you’re dealing with, but we’re here to help and support you.
You are correct — BID means twice a day, so you would be giving the insulin shot every 12 hours.
Please come back with more updates and let us know how things are going. There’s a lot to learn and more than a few nuances to feline diabetes and everything else you’re dealing with, but we’re here to help and support you.
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