DKA Situation and Don't Know What to Do

I didn't know my cat Stella, who is around 8-9 years old, was diabetic. Monday night she started acting really weird - very sluggish, wouldn't eat, and she felt like a rag doll when I picked her up. Her eyes also were cloudy and unfocused. On Tuesday, I took her to the vet who told me that her insulin level was 600. The vet said that I needed to bring her to the emergency pet hospital immediately. I brought her to the Emergency Pet Hospital that night and they told me that she believe she has DKA. She also has a lot of fluid in her stomach. They've put her on insulin (Lantus), IV pump, famotidine, unasyn, and cerenia. Today, Wednesday, I went to see her and she looks a little better though she still wasn't eating. The ER vet gives her a 50-70% chance of pulling out of this. They're also putting in a gastric tube today. I don't know what to do. The ER vet keeps suggesting euthanasia but I don't want to give up on her if she can get better. Also, the ER vet is charging $3,000 per night to take care of her and I can't keep paying that. I'm going in tomorrow again to see her and try to figure out what to do. Any thoughts or advice you can give me would be really helpful.

I'm so sorry to hear Stella is hospitalized with DKA. I don't have any personal experience with DKA but I know it can be very expensive to treat. That said, $3000.00 per night astounds me.

If the vet is giving Stella 50-70% odds of recovery, I don't see why the vet would be suggesting euthansia. It is encouraging that Stella seemed a bit better today. Once the feeding tube is placed and she starts getting the nutrition she needs, hopefully she will improve more and soon be on the road to a full recovery. Unfortunately, DKA is not something you can treat at home so until she is stabilized, the vet hospital is the best place for her to be.

I can only imagine how upsetting this must be for you. I'm sure someone with more experience with DKA will chime in soon.

Hi Stella's Mom,

I'm sorry to hear that Stella is having a tough time of it at the moment. Cats can and do pull out of DKA with the right veterinary support. All going well the food, fluids and insulin she is getting at the vets should help flush the ketones out of her system, help her body to use her food properly and restore her system to balance, in which case she should start to feel much better. I have no experience of dealing with DKA in my own cat but other members here may be able to help. (@Meya14 - if you're around, could you have a look at this thread, please?)

Fingers and paws crossed that Stella will feel better very soon.


Mogs
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Have no advise. Sending Hugs and Prayers for you and your sweet Stella.

My cat J.D. was hospitalized with DKA for 8 and 1/2 days. It was this time of year. I had him at the ER and at that time they were only open at night and weekends, and it was Monday morning coming up and they told me I had to take him to a 24 hour vet. I had two choices and both were in opposite directions and in the middle of the night at least 1 hour away. I chose the University of Pennsylvania School of Veterinary Medicine. So at around 7:00am, because the ER closed at 8:00am, J.D. and I traveled in commute traffic in the snow to Philadelphia. He was in critical condition. Every day, I went to go visit him (he's all I thought of). Every day, he got a little bit better. He never did eat at the hospital and they kept saying he could go home as soon as he starts eating. Eventually, they put a feeding tube in and he was released. Oh, how happy I was to have him home. That was in 2005. The bill was about $4,500 to $4,800. That included critical care, ICU, Internal Medicine, lots of exams, xrays, blood work, and two blood transfusions, plus all the stuff they sent me home with to feed him. I thought the price was 1/100th of what a human would be charged in the same situation, so I was pretty pleased.
He dispensed with the feeding tube the next day, once he was home, and lived 9 years as a diabetic and passed away last year at 20 years old.

Just checking in to see how you and Stella are doing today.


Mogs
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Sending lots of good thoughts your way.

Hey - thanks for all the kind words words and support. Thanks sounds cliche but I really don't know how to express how much your kindness has meant to me. I have some hope back now whereas when I initially wrote my post, I was pretty low.

I kept Stella at the ER vet another night (Tuesday night). On Wednesday when I went to visit, the vet tech had told me that she got Stella to eat a little bit out of her hand. And then when I was there visiting, I fed Stella and she ate about half a jar of ham and gravy baby food and drank some water. I thought she looked so much better...she was holding her head up and listening to sounds. She even tried to walk a little bit. However, I just spoke to the vet again and they said that she didn't eat anything after I was there and they had to feed her via the feeding tube they inserted. Stella also has pancreatitis in addition to the DKA so they're trying to get that fixed. However, when I just spoke to the vet on the phone, she freaked me out because now she's saying that it could be cancer too. She said that Stella's glucose levels came down a little bit to 400, but they're still too high. And her protein levels are too high too. When I brought Stella in, her eyes had clouded over, which the vet said wasn't normal for cats with DKA. So now they're not sure if there isn't something else wrong. I don't know what to think. I'm hoping that all of these other ailments are just side effects of the DKA/pancreatitis.

When J.D. was admitted, they thought something else might be wrong too, because usually DKA is a combination of not enough insulin plus not enough food plus an infection or other systematic stress. They did all kinds of tests on him, and never found what caused him to go DKA. He was able to lift his head a little the first time I went to visit him, and the second time he was able to move a little more. By the third day he was laying on his belly rather than on his side. On the fourth day (I think the fourth day was when he had to have his second blood transfusion) he was transferred to Internal Medicine and was sitting up when I got there. He was in a bottom cage, and I sat on the floor next to him with the cage door open, and he slowly walked out of the cage and got into my lap (with a tube attached to each leg). When I went to leave he was starting to groom himself. From there on he slowly got better and better.
I kept bringing food and treats, trying to get him to eat for me, as he wouldn't eat for the vets. He ate just a little bit from me. That's why he eventually came home with the feeding tube. Once he was home, he was happy to eat on his own again.
I'm glad the vets are getting food into him. I wouldn't worry about the talk of cancer, as it is probably just a possible and nothing affirmative. I know I just kept thinking positive thoughts over and over and over and over and over.
I wish for a good outcome for your Stella. I will keep her and you in my prayers.

Healing vines sent to you.

Hi, my Layla was diagnosed with DKA on Oct 22, 2015. When we brought her to ER, her BG was 550 & she spent 3 days in ICU. I do know ketones cause them not to eat. Depending on the kitty, it could take 1 to several days to flush the ketones out. Layla, didn't start to eat till 24th. She was giving an appetite stimulate & we brought ff classic from home. She now is OTJ! Prayers and positive thoughts for Stella

Thanks for the update. I'm glad that Stella is hanging in there and that you have been to visit her. It's awful when our little ones are in hospital; lonely for kitty and bean alike.

Stella's obviously feeling very poorly. That she ate a little under her own steam for you but not the staff at the vets isn't necessarily anything to put too much emphasis on right now because Stella will be finding your presence much more reassuring.

I don't know about specifics when both DKA and pancreatitis are both in play, but my little one has pancreatitis and she was very, very poorly with a bad flare last summer. I don't know how DKA might influence medications that might be suitable but the following things have helped my Saoirse and also other kitties on the board:

* anti-nausea medication - Cerenia (injection effects last for up to 3 days - may help more when vomiting accompanies nausea).

* anti-nausea medication - ondansetron (may take a few days of dosing to reach full effect - good for ongoing maintenance if nausea continues to be a problem).

* appetite stimulant - cyproheptadine or mirtazapine (cypro is gentler than mirt, and does not carry risk of serotonin syndrome - small doses quite effective (e.g. 1/8 of a 4g tablet for a 10lb cat); larger doses of cypro can be too sedating and may lead to somewhat depressed mood).

The appetite stimulant and anti-nausea meds helped me to get Saoirse eating again, but she was pretty lethargic for at least a week. Once she started eating better she improved fairly rapidly. I'm disabled and housebound so I was able to nurse her at home with telephone support from our vets. I think it makes a difference to poorly kitties when they can be near their person(s).

The IDEXX pancreatitis treatment guidelines are a great source of information on pancreatitis. A Snap fPL test is a yes/no test for pancreatitis. A Spec fPL test returns a numerical result which gives some indication of the level of inflammation. Even if pancreatitis is a factor, with the right therapeutic support it is very much a manageable condition. Saoirse and a number of other cats on the board have chronic pancreatitis.

I hope that Stella feels better tomorrow, and that you can get some rest in the meantime.




Mogs
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Sorry I didn't see this thread earlier. DKA is a rough road, but the fact that she is eating is very promising. The feeding tube is a very nice thing to have in place if you take her home before she is 100%.

A few thoughts:

DKA triggers: DKA can be a self-perpetuating cycle. The initial cause is elevated sugar triggered by either not enough insulin or infection, or some other metabolic issue. After that initial hyperglycemia, a vicious cycle of dehydration starts, which further increases the BS. You may never know the actual trigger, usually it's something innocuous or even mild infection. I wouldn't worry about cancer yet.

Protein in urine/elevated kidney labs/elevated liver values: The dehydration in DKA can become so severe that blood pressure drops and the kidneys start to shut down. This is called Acute Renal Failure. Good news is that although there might be some chronic damage with each ARF event, most of the issues resolve themselves once hydration gets back to normal. Similar for liver values once the metabolism gets back to normal. If you have any of these issues, don't get too down about it.

Elevated sugars: The elevated sugars that the vet is seeing is a combination of dehydration and not enough insulin. Often, if lantus/lev is the only insulin used to treat DKA, there needs to be regular increases to get it under control. A DKA cat will require more insulin to overcome the hyperglycemia. Most vets use shorter acting insulins to bring down the sugars a little faster, but this is not done much at home. If sugar drops too fast, fluids could move into the brain, so shorter acting insulins need some experience when used in DKA. If the sugars are still high hydration and insulin are the solution.

Electrolytes: Low potassium is commonly seen in DKA cats and can increase weekness, poor appetite, and can be very dangerous. Monitoring these labs is critical, and if they are low they should be supplimented.

Nausea: An anti-nausea medication is necessary for recovery and eating.

Food: Because the body needs a "substrate" for the insulin to act on, and to help the metabolism get back to normal, a high calorie food is a good idea. Don't worry about carbs too much. The more calories you can get in in any form, the better. Sometimes a medium carb food is necessary if the DKA is still present but BS are going too low. Again, the feeding tube will help greatly with this. Aim for at least 300 calories a day, and 300ml of fluids (including the fluid in the food).

Cloudy eyes: From what I have read, this can happen in cats and has something to do with protein accumulation in the eye, which is a transient thing. It probably will clear up once she's not dehydrated and things get back to normal.

Outlook: My cat max was almost dead when we discovered his diabetes, and his severe DKA. We chose to take him home (no inpatient) and do all the homecare things. He recovered completely after 2 weeks of very intensive home care. He's fine today, with no lasting effects.

Home care:
Blood sugar testing
Insulin
Rehydration - either subQ or feeding tube
Electrolyte supplementation and regular testing
anti-nausea
High cal food - either tube or force feed - 300 calories/day
Pain med for pancreatitis

Hi @Meya14. Thank you yet again for your help. Belated Christmas greetings to you.



Mogs
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All of your well wishes and prayers have worked! I get to bring Stella home from the hospital tonight. I'm excited...but very scared at the same time. She's doing a lot better but she's still really weak. They're keeping the feeding tube in just in case I'll need it - though she ate a whole jar of the baby food for me when I went to visit earlier. Also, I'm nervous about giving her the insulin shots though the vet tech showed me how to do it. I'm going to set up a spreadsheet per the recommendations of this forum (though when I mentioned something to the vet about this, she was critical of home testing because she said that my relationship with the cat shouldn't be all about poking and needles which seemed kind of odd to me).

This is a bit of a random question, but I have another cat, Nikita, who seems perfectly fine but now I'm really worried that she is diabetic also. For those of you that have multiple cats, when you found out that one of them was diabetic, did you go get all the rest of them tested? Is it common for cats from the same household to all be diabetic? Am I overreacting here?

Welcome home Stella!!! WOOHOO!!

Nakita and diabetes. No it's not contagious... Many things can cause it from genes to medications such as steriods. Unless you're seeing heavy drinking/peeing from Nakita, it's likely no worry.

HUGS!

One of the best things you can do for your other cats is get them onto the same low carb food your diabetic eats....that will greatly reduce the chance that they ever become diabetic!!

We hear that from vets a lot..that testing will somehow hurt our relationship with our sugarcats...Let me assure you it couldn't be further from the truth!! The bond you will develop with Stella will be stronger than you could ever imagine!! I always thought I loved China as much as anybody could ....then we started on this journey together and our relationship is amazing!!

Max loves getting his blood sugars taken. It is our cuddle time and he is allowed on the bed which he normally is not. If you make it a positive experience, the cat should learn to accept it. Because you cat is sick now, she'll probably associate all the poking with starting to feel better. One of the first things I did when I got my glucometer was test my other cat, just to be sure, as I REALLY didn't want to deal with a second cat surprising me with DKA. It eased some of my anxiety.

Wonderful news about Stella!

Fingers and paws crossed that now she's back home with her momma bean her appetite will continue to improve. I can understand how nervous you are. Remember to post here if you need any help or just some moral support.

I'd like to add my story about the poking and prodding. I was nervous and quite upset but I helped myself get through it by reminding myself that the pokes and prods were much, much better for Saoirse than the alternative. She probably thought all this new stuff I was doing was stark raving bonkers but in a very, very short space of time she made the connection between my odd new behaviours and her feeling much better. Soon she started purring through the process. (Of course, freeze-dried chicken treats had nothing to do with it ... ) I could not get over the looks of complete trust and faith Saoirse started to give me. As Chris rightly mentions above, caring for a sugar cat can make the bond between both of you stronger than ever. It wasn't long before Saoirse started hopping up to her testing station to let me know it was time to check her blood glucose.

Once you learn to home test, it'll be easy for you to do a quick check of Nikita's blood sugar levels, too. That should help ease any worries you currently have about her. (I checked my civvie, Lúnasa.)

Sending some special 'welcome home' scritches for Stella.


Mogs
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Home testing is hard for sure (I am just learning) But I do not like to think the vet told you it would ruin your relationship with Miss Stella. My Georgie is mad at me at first after I test or try to test him, of course but he forgets later and is back and talking me shortly after. Glad to hear she is back home with you! That is great. Here's to hoping she stays home with you!

Thanks for all of the stories and information...you guys are a treasure trove that I'm so glad I found online. Although I still feel nervous about this whole situation, I feel less nervous than if I hadn't been able to voice my worries to this forum. I was wondering if you guys had any thoughts/advice/similar stories that you wouldn't mind sharing in regard to the following things that have happened to me with this vet.

- I took Stella in for her check-up on Monday and they removed her feeding tube because she ate really well when I had her home and I didn't even use it. The vet took her BG and it was 400 (which was what it was when I took her home with me). She said that it's been staying stable. What I'm a bit concerned about is the amount of Lantus that the vet is having me give her. I give Stella 3 units of U-100 Lantus 2x per day...and that seems like a lot from what I've been reading on this forum. Should I be worried that this amount is too high, especially since I've switched Stella from an all-dry food (Evo) diet to an all-wet food diet (FF and baby food if she won't finish the FF)? I don't want her to become hypoglycemic.
- The vet did took some blood again when we were there to check and said that there no cause for concern except for her white blood cell count, which the vet says is too low. So now I have Stella on Orbax in addition to the Clavamox, two antibiotics at the same time.
- Also, the vet gave me these Ultimed 1/2cc, 12.7mm length, 29gauge insulin syringes that none of the pharmacies by my house carry. They don't even seem to carry any other brands that are even close to those specifications. If I wanted to get a different type of insulin syringe, how do I figure out what to get exactly? I've read other posts from people that have ordered them online, which is what I think I would like to do because these pharmacies around my house don't seem to carry what I would need.
- Also, the vet mentioned that they would want to set up a blood glucose curve for Stella in a couple weeks or so. She said that I would have to drop Stella off in the morning and she would be at the vet hospital all day. From what I've been reading on this forum, these blood glucose curves that the vets do are not all that good to do? Because they're usually not a reliable indicator of the cat's BG levels because the cat can be stressed out from being in the unfamiliar environment which can cause the BG numbers to be off. Should I just tell the vet that I don't want to get a BG curve for Stella? For those of you that have had these BG curves done by the vets, have they been helpful?

I ordered the glucose home monitoring kit from Walmart too. Really anxious about starting that but it must be done. Also, I'm taking Nikita in to the vet tomorrow just to get her checked out. She seems fine (other than constant hissing at Stella) but I'd rather be safe than sorry.

Stella's Mom said:

- I took Stella in for her check-up on Monday and they removed her feeding tube because she ate really well when I had her home and I didn't even use it. The vet took her BG and it was 400 (which was what it was when I took her home with me). She said that it's been staying stable. What I'm a bit concerned about is the amount of Lantus that the vet is having me give her. I give Stella 3 units of U-100 Lantus 2x per day...and that seems like a lot from what I've been reading on this forum. Should I be worried that this amount is too high, especially since I've switched Stella from an all-dry food (Evo) diet to an all-wet food diet (FF and baby food if she won't finish the FF)? I don't want her to become hypoglycemic.

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When did you switch her diet? Before or since the vet visit? The EVO is an acceptable kibble for diabetic cats. Evo is relatively low carb so the transition to wet won't be as dramatic as it would be if you had been feeding an average kibble diet but it's still a reduction so it would be better to be testing before transitioning the food. 3u is a high starting dose but because of the history of DKA, I'd suggest posting this question to the Lantus/Levemir board and get the opinion of the folks very experienced with Lantus. If you post there, put a question mark at the beginning of your title using the drop down box to the left of the title field to let folks know you need some advice.

Stella's Mom said:

- The vet did took some blood again when we were there to check and said that there no cause for concern except for her white blood cell count, which the vet says is too low. So now I have Stella on Orbax in addition to the Clavamox, two antibiotics at the same time.

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I don't understand why a second antibiotic would be added for a LOW white blood cell count. Infections cause an increase not a decrease in WBC counts. Are you sure the vet said it was low?

Stella's Mom said:

- Also, the vet gave me these Ultimed 1/2cc, 12.7mm length, 29gauge insulin syringes that none of the pharmacies by my house carry. They don't even seem to carry any other brands that are even close to those specifications. If I wanted to get a different type of insulin syringe, how do I figure out what to get exactly? I've read other posts from people that have ordered them online, which is what I think I would like to do because these pharmacies around my house don't seem to carry what I would need.

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The syringes most of us use are U-100, 3/10ml. 31 gauge with 8mm needles and 1/2 unit markings. I believe Walmart has some Relion syringes meeting this criteria. Some folks order from ADW. Some vets suggest 1/2 inch needles and that's what your vet has supplied you but most humans use shorter needles and the 8mm work just fine with our cats but I wouldn't get anything shorter. You stand a greater chance of furshots with anything shorter than 8mm.

Stella's Mom said:

- Also, the vet mentioned that they would want to set up a blood glucose curve for Stella in a couple weeks or so. She said that I would have to drop Stella off in the morning and she would be at the vet hospital all day. From what I've been reading on this forum, these blood glucose curves that the vets do are not all that good to do? Because they're usually not a reliable indicator of the cat's BG levels because the cat can be stressed out from being in the unfamiliar environment which can cause the BG numbers to be off. Should I just tell the vet that I don't want to get a BG curve for Stella? For those of you that have had these BG curves done by the vets, have they been helpful?

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I have never had a curve done at the vet's office and most of us home testing don't get curves done at the vet because of the stress elevation of BG levels in a strange environment. It is however sometimes necessary in the very beginning while you learn to test especially when DKA has been in the picture. If you get your glucometer and get proficient at testing before the curve is needed, then perhaps your vet would be OK with you doing it. Testing is not hard but sometimes it takes a bit of practice and it pends on just how co-operative a patient Stella is. We all had anxiety about it but kitties really don't feel it like we would feel a finger poke. You will be a pro at it in no time but be patient with yourself and Stella. And try to make Stella think you are very confident about testing her. These little furballs are amazing at picking up on our stress!

Hi there,

Just wanted to see how it's going. As far as if that is too much lantus, the only way you can tell is by testing frequently - probably 4-5 times a day at least until you know her pattern. Reducing lantus without knowing her BS levels might cause her to go back into DKA. Keeping too high of a dose might lead to hypoglycemia. Testing is the key.

The other thing that is going to help you track her recovery is ketone urine strips. Ketones can redevelop quickly, in less than a day at times, and cats can back slide. By testing 1-2 times a day with ketone strips, you can see if the DKA is resolving or if there is an issue, and treat it early so she doesn't end up back in the ER. These strips are available at any human pharmacy usually in the diabetic supply area.

Also, make sure she's getting plenty of high-calorie food, and water. When max was recovering from DKA, the vet gave us a prescription high-cal food, and I mixed a little water into it to make a "soup". This will prevent dehydration which can lead to ketones redeveloping.

Hope all is well. It's great that she's eating. That's 3/4 of the battle!

Hey - Stella is doing OK today. She's not eating as much as she has been before and she's been hanging around the water bowl a lot which is making me a little nervous. I just bought some Ketone strips and a CVS Advanced Glucose Meter so we're going to start home testing tomorrow (fingers crossed). I have to finish reading the sticky about how to do it.

I took my other cat Nikita into the vet today and had them check her BG and she's fine, thank God. But, because of all my difficulties with Stella, my parents took their cat in to be tested and their cat ended up having a BG of 500! So they have to start their cat on insulin too. It's just crazy.

As far as eating goes, try and offer a variety. If the only food she'll take is dry, don't worry about the carbs until she's back to normal. Ideally, a high cal wet food is best, but right now, whatever calories you can get in her is better than nothing. Cats need the high calories to convert their metabolisms back. Sometimes this means giving higher doses of insulin (you'll know once you start testing) but that is OK right now. Once she is healthy, you can transition the diet to a low carb wet food. Basically, when a cat is in DKA, the body thinks it's starving and starts to burn off fat. When you add lots of calories, and enough insulin to use those calories the body stops burning the fat which is where those ketones come from.

Stella's Mom said:

- Also, the vet gave me these Ultimed 1/2cc, 12.7mm length, 29gauge insulin syringes that none of the pharmacies by my house carry. They don't even seem to carry any other brands that are even close to those specifications. If I wanted to get a different type of insulin syringe, how do I figure out what to get exactly? I've read other posts from people that have ordered them online, which is what I think I would like to do because these pharmacies around my house don't seem to carry what I would need.

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I see Linda has already given you some info on syringes. You could also try searching online for BD microfine 0.3ml demi insulin syringes. They also have the shorter length needles.

I also see that Meya has given you more info about being extra careful about monitoring for ketones going forward. FYI, in addition to the urine test strips there are ketone testing meters available (similar to glucose meters). The strips are pricey for the ketone meters but the advantage of using them is that they can detect the presence of ketones faster than the urinalysis strips because ketones may be present for a couple of days before they start showing up in urine. It's something to consider going forward.

On glucose curves, the vet who diagnosed Saoirse was, like many vets it appears, not an advocate of home blood testing so wanted to do curves. We moved practice since Saoirse was diagnosed to a much more FD-friendly practice. Our current vets support home testing and actually prefer caregivers to run curves at home provided the caregiver is comfortable doing so.

Great news that Stella's eating OK.


Mogs
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Stella's Mom said:

we're going to start home testing tomorrow (fingers crossed). I have to finish reading the sticky about how to do it.

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Not sure which sticky you're reading. Here are two that I found helpful (especially the diagram of the 'sweet spot' in the first one).

Testing and Shooting Tips

Home Testing Tips and Links (with videos)

I recommend warming the ear for a good while before doing the poke. (That's where I went wrong in the beginning. )



Mogs
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Glad to hear that your Stella is doing OK today. You sound like you might also be OK. Sending hugs to both of you
As for the home testing, when we started out we felt very overwhelmed but we hadn't yet found the FDMB. So as you begin this phase of taking care of your furry one, know that we are here to help you when you have questions and celebrate your successes. You can do this.

So I've been watching and reading the links and I still don't quite understand some things about testing.

Since Stella is on Lantus, the process should be test, feed, then insulin within 15 minutes? It usually takes Stella 30 mins or so to eat since she grazes a lot. Is that OK?

I don't understand how often I should be doing testing during the day. I know that I should test at least twice per day since Stella gets Lantus twice a day, but should I be doing any more than that?

You always test before shooting...then feed to make sure they're eating fairly "normally" and then shoot...and yes, we usually do it all within about 5-10 minutes

As long as Stella is eating fairly normally, it's fine to go ahead and shoot.....Lantus has it's onset at about +2 to +3, so it's not as important that they have a certain amount of food on board before shooting

As for testing, again, ALWAYS before shooting, but then if at all possible, it's important to try to get a mid-cycle on the AM cycle...somewhere between +5 and +7 so you learn how LOW the dose is taking her

On the PM cycle, it's very important to get at least a "before bed" test in...Most cats go lower at night, so getting that test right before bed will tell you if you need to possibly set an alarm to test again later in the cycle for her safety.

Thanks for the advice Chris & China. I appreciate the clarifications. Follow-up question: so I just took Stella to the emergency vet because I got freaked out when she started vomitting everywhere. I had fed her around 8:00 pm, given her her Lantus shot, then at 9:45 she basically vomitted all the food and water she'd eaten and drank that day (which was more water than food). So I called the vet and they said to take her BG level, but I was still too nervous so I brought her in (but I brought my glucose meter with me). When they tested her BG, Stella's reading on the vet's meter was 459 and on mine (which is the CVS Advanced Glucose Meter that I just bought tonight) it was 384. Now mine is of course a human meter and I don't know if I was supposed to calibrate any settings or anything before it was used at the vet - the only thing I had set was the date and time. Are there settings that I should have changed? The vet was all "wow, that's a big difference between the two" and was kind of thinking, "well, yeah, because one is for humans and the other is for animals". Anyway, the vet recommended that I get the Alphatrax and then told me again to get the Purina DM food (which I don't actually plan on doing after reading about it here). So, the purpose of this rambling post, is basically just to ask you about my human glucose meter and using it for cat's BG analysis. Are there settings I should change? Should I just figure in the discrepancy now whenever I take home BG readings (i.e., always add +80 to whatever reading I get using my CVS glucose meter)? How do other people handle this?

The Alphatrak meters read about 30% higher than human meters. It's not less accurate, it's just a different measurement scale. Here, our numbers are based on human meter readings, so there's no need to get the Alphatrak. Plus, the strips for that meter cost a small fortune.

The Alphatrak meter reads higher than a human meter but the difference is not always 30%. There is no direct or linear correlation between the numbers on the two types of meters. There is also meter variance on both types. So NO....adding 80 to the CVS meter readings will NOT give you the AT meter equivalent.
I don't know your CVS meter but most human meters these days do not require coding.

The difference in readings between the two meters is because glucose is concentrated in different blood components in cats vs. humans so the human meter reads the sample as if it were human blood. The AT on the other hand reads the sample as cat blood. The reference numbers on this site are all based on human meter readings (unless specifically stated otherwise) so as long as your vet knows you are using a human meter and that the readings will be lower, there should be no issue. It's the pattern of numbers over time that matters rather than individual readings. I've done hundreds of side by side readings using the AT meter and a human meter and found my patterns or graphs have always been very similar but individual readings are another story altogether.

As Meya said, the strips for the AT meter are much more expensive (almost double here is Canada) and they cannot be picked up at the local pharmacy as can human strips which makes the human meters much more convenient as well as economical. The important thing here is to pick one meter and use it and using a human meter is a perfectly good choice using the reference numbers here.

Sorry I need lots of advice because I'm losing all faith in this vet. So brought Stella in again this morning because she threw up again at 5:45am. After we had got back from the vet last night, they just took her BP and gave me some cerenia tablets for her. When we got home, she didn't want to eat but she drank some water. Then this morning she threw up again and I gave her half a cerenia tablet. I tried to get her to eat, but she woukdbt. So I mixed some turkey baby food in water and tried to give her some via a syringe. She swallowed a little bit but not a lot. So she needed to take her insulin at 8:00 am, but I couldn't get her to eat anything so I called the vet. They told me to bring her down and they've checked her out. They said she looks dehydrated and pale. They want to draw her blood again to check her red blood cells to see if she needs a transfusion. They also want to keep her in the hospital for a couple days again. They also told me again that her white blood cells were too low before and they're worried that they're still too low. I told the vet that I can't afford to keep her in the hospital anymore. So the vet is going to run the blood test and put her on some sub-q fluids in the hospital. But what really has made me doubt this vet is that the vet prescribed some more cerenia after I told them that I had just given her half a pill this morning. She also said something about how it didnt matter if Stella's insulin was late by an hour...even though her insulin is now late by 2 hours. Do you think I would just be able to take care of Stella at home? I need to figure out how to get her to eat. Sorry for the frantic nature of this post, but I'm currently still at the vets and I have to decide what to do soon.

Have you or they tested her ketones lately?
She needs to eat. I would talk to the vet about their opinion on placing a feeding tube. Or at least see if they sell Iams Maximum Calorie and would recommend syringe feeding her this food. It has lots of calories per can, and is low carb. If so, ask them for some feeding syringes. The ones with the black rubber stoppers that the vets usually give out, don't last that long, and so ask for several.

I think lots of vets are trained on the other non-depot insulins and don't know that much about how Lantus works.

I wish you The Best Of Luck with this vet appointment.

I'm not sure what to tell you. The Cerenia is for nausea and it may be working but Stella may need an appetite stimulant as well. As for the insulin, she needs it because of the DKA so you want to be able to get some food into her and for her to keep it down. I think the decision here is going to be whether you feel confident in being able to get food into Stella and her keeping it down. Discussing a feeding tube as Dyana suggested is a good idea. If Stella is dehydrated, she may perk up a bit with the sub-q fluids. Not sure why her WBC would be low or why a transfusion is being considered.

I mentioned the feeding tube to the vet and they said that then she would need to be anaesthesized and spend time in the hospital anyway for that. I'm not objecting to the cerenia...I'm appalled at the fact that they wanted to give it to her again after I'd already given it to her this morning. I thought it was harmful to the cat of they got too much cerenia. I'll ask about the appetite stimulant. I still have the cans of CliniCare...do you think that I could use that to syringe fees her?

My cat had tranfusions when he was DKA, but I don't know or remember why they were done.

I thought Cerenia was to stop the act of throwing up (like made for car sickness for dogs) and Ondensetron was to control the feeling of going to throw up, which is nausea. It's confusing to me.

Paws Crossed for wise vets.

I think there is a feeding tube that is more of a temporary tube that goes in/through their nose and they only need to be sedated to install it. I don't know this for sure, but I think that is what J.D. had when he was released from the hospital when he had DKA. It lasted all of 24 hours or so for us, before he pulled it out. It was probably CliniCare that I used in the feeding tube. He wouldn't eat at the vet, and they wouldn't release him unless he ate for them. They finally gave up after almost 9 days of hospitalization and released him with a feeding tube. My story is, I went to get him the next day after he got home and the tube had come out. I was on the phone to my local vet and they were saying that they could try to put it back in, and I looked down and he was chowing away at the food in his bowl, so that was the end of the feeding tube.

There are two ways to do feeding tubes and while a more permanent tube would require anaesthesia, a temporary one can be introduced under sedation. It should get you through the next few days and hopefully with the Cerenia Stella will start feeling better and start eating on her own. I would think the CliniCare would be a viable option.

I thought the Cerenia was for nausea/vomiting but I could be wrong. Another question would be whether some famitodine for stomach acid might help. Excess acid could also be a cause for her inappetance.

The cerenia is for nausea/vomiting. An appetite stimulant really won't help her at this point, remeron, the one mostly used takes about 2 weeks in order to start having an effect. Its a better choice in chronic issues, not acute issues.

In order to take care of her at home, you'll need to have the vet show you how to do subQ fluids at home, and test her electrolytes and give you any potassium supplements if she is low. In addition, you MUST be able to syringe feed at least one 5.5-6oz can of food per day. We did this about every 2 hours a few syringe fulls when max was sick. You must also be able to test her for ketones and blood sugar. Don't wait to learn, it's really pretty simple, and if you try a few times today, you'll have it down by the end of the day.

The reason some DKA cats require transfusions is because when their phosphorous gets outta wack, red blood cells die and there is hemolytic anemia. It can happen.

Low white blood cells can be an indicator of infection. Initially, in infection you'll see high WBC, but after an infection has been around for a while, sometimes the body has trouble replacing all the WBC fast enough, especially when there are other acute illnesses.

So here's my short list for home care:

1. SubQ fluids at home per vet recommendation for at least a week, maybe 2
2. Iams MAX cal or similar food - Syringe feed every 2 hours, MUST feed at least a 5.5oz can/day
3. Cerenia - give this daily BEFORE nausea and vomiting happens
4. Potassium supplements if labs were low.
5. Test at least 4-5x per day for blood sugar.
6. Test at least 1-2x per day urine ketones if possible.
7. Take cat to vet 1-2x per week for electrolyte labs/monitoring
8. Insulin - you cannot skip insulin. If you have to syringe her pure honey in order to give her the insulin do it. If you have to mix honey in her food to give it, do that. DKA recovery can't happen unless there is insulin.

You can do this.

Sorry you're having such a horrible time. Just in case this is helpful and you end up not having a feeding tube, here is a video on how to syringe feed a cat.

I really feel for you. I can tell how worried you are.

I think you need to ask the vet at minimum about an appetite stimulant for Stella. Cyproheptadine is effective but a bit more gentle than mirtazapine. Mirtazapine may be more powerful but it carries the risk of inducing serotonin syndrome. Anti-nausea meds on their own aren't always enough: sometimes a cat needs an appetite stimulant (especially because of the way their metabolisms work - you have to find a way to get food into them).

Cerenia and ondansetron are both effective nausea treatments. From what I've read here I believe that Cerenia may help a little more with vomiting.

On vomiting, I think Linda's suggestion about an acid blocker is a good one. Even some healthy cats who go too long without food in their tummies can be affected by stomach acid irritation and then vomit. If Stella's not getting enough into her tum as well as feeling lousy from the DKA I would imagine any excess stomach acid problems might make things more uncomfortable for her. If pilling is a problem, famotidine and ranitidine can be administered via injection.

I also think it is a very, very good idea to ask your vet about the feeding tube. It could make nursing Stella at home more straightforward because you'd be able to ensure she gets food regularly without the stress associated with assist feeding using a syringe.

There's lots more info about all of the above at Tanya's Site page about nausea, vomiting and appetite. It might be worth going through the page with your vet (it's very well researched and has links to relevant sources).

Keeping you both in my thoughts.



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