09/01 Fistuk hospital update

Fistuk & Shelly

Fistuk & Shelly

Member Since 2023
https://www.felinediabetes.com/FDMB/threads/08-26-fistuk-amps-358.281045/#post-3099668

Good that I called to ask for update bc otherwise don’t know when it would have come!

Fistuk’s electrolyte are balanced. But his BG is high so ketones didn’t come down much. They didn’t check today! She said they’ll check tomorrow.

also the vet said that they use short term insulin now. Their BG measure with pet AT is 540.

I really wonder!! How come it got so so much higher. Is it stress? Yesterday he was 18.9 with a freestyle human meter when the local vet checked him first at am +2

now he’s at the hospital and they’ll treat him their way and I sure hope it’ll be ok.

Also good that insisted on coming to visit him so I’m on my way there now.
 
Thank you Shelly for the update. We have all been wondering how he was. So it sounds as if he just has high ketones and not DKA if his electrolytes are ok. That is good.
You might ask for a copy of the blood tests already done. I would ask them to do a ketone test today.
Is he eating well do you know?
 
Bron and Sheba (GA) said:
Thank you Shelly for the update. We have all been wondering how he was. So it sounds as if he just has high ketones and not DKA if his electrolytes are ok. That is good.
You might ask for a copy of the blood tests already done. I would ask them to do a ketone test today.
Is he eating well do you know?
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I did ask her to do a ketone test today but she said it won’t change their course of treatment and they’ll check tomorrow. I will insist while I’m there

I didn’t know what’s the difference between just high ketones and DKA but your comment makes me understand a little about that. I must say I did wonder about the diagnosis that the hospital gave last time we were there. I don’t if they checked his electrolytes yesterday but I’ll make sure again once I’m there.
She said he’s a little bit low in chloride (did get it right) so they’re adjusting the solution
 
Hi Shelly, so glad you posted, been thinking about Fistuk all day.

shellys said:
Their BG measure with pet AT is 540.
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shellys said:
also the vet said that they use short term insulin now.
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That's good, we had been wondering if they would, it's usual to do that.
shellys said:
also the vet said that they use short term insulin now. Their BG measure with pet AT is 540.
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As you know they can shoot up, and if hes stressed at being at the vets that wont help either. But it is true that where the pet and human meters differ most is when bg is high. They read much higher with a pet meter, but the tr protocol allows for that difference and was developed using human meters, so try not to worry about that.

George's BG shoots up when we go to vets, 150 to 200 pts. And when I've tested with human meter at vets the reading with my human meter and the lab test hasn't differed by much. 20 to 30 pts if I remember.

Good luck with the visit today.:kiss:
 
Gill & George said:
Hi Shelly, so glad you posted, been thinking about Fistuk all day.




That's good, we had been wondering if they would, it's usual to do that.

As you know they can shoot up, and if hes stressed at being at the vets that wont help either. But it is true that where the pet and human meters differ most is when bg is high. They read much higher with a pet meter, but the tr protocol allows for that difference and was developed using human meters, so try not to worry about that.

George's BG shoots up when we go to vets, 150 to 200 pts. And when I've tested with human meter at vets the reading with my human meter and the lab test hasn't differed by much. 20 to 30 pts if I remember.

Good luck with the visit today.:kiss:
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They’re not willing to hear about TR or the meter I’m using. They’re locked in their way
 
shellys said:
Yes which is partly what’s worrying bc they decide on a course of treatment based on that
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They should bear that in mind, most vets know that bg can be inflated due to stress.
shellys said:
They’re not willing to hear about TR or the meter I’m using. They’re locked in their way
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That's fine smile and nod. We have all done it at one time or other. I was just reminding you so that you don't worry.

See what they say, hope the nicer vet deals with you.
 
Bron and Sheba (GA) said:
Shelly did he have an infection when he was in hospital last time with DKA? What was it and how did they treat it?
I would ask them if they have checked to see if he has an infection now while you are there.
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From notes on ss, was on AB
**NOTE the readings between Aug 7-12 in bold are from Libra body sensor** Reported that Fistuk was doing quite a lot better but wanted to keep him there for another day or two in order to get him off the IV gradually. Decided to take Fistuk back home and keep treatment at home!! He couldn't be happeir. When I first saw him at the hspital for a visit he was walking around with curioutiy, didn't hesitate to jump on the sofas even though he kept on falling. seemed more alert but allarmed by the neon lights and the noise around. Receoved antibiotics Vetoquinol 1.5 twice a day for 7 days.

 
Bron and Sheba (GA) said:
Shelly did he have an infection when he was in hospital last time with DKA? What was it and how did they treat it?
I would ask them if they have checked to see if he has an infection now while you are there.
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Don’t know about last time but yesterday I did asked them to check this so I’ll ask
 
Gill & George said:
From notes on ss, was on AB
**NOTE the readings between Aug 7-12 in bold are from Libra body sensor** Reported that Fistuk was doing quite a lot better but wanted to keep him there for another day or two in order to get him off the IV gradually. Decided to take Fistuk back home and keep treatment at home!! He couldn't be happeir. When I first saw him at the hspital for a visit he was walking around with curioutiy, didn't hesitate to jump on the sofas even though he kept on falling. seemed more alert but allarmed by the neon lights and the noise around. Receoved antibiotics Vetoquinol 1.5 twice a day for 7 days.
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Yes. And I think it was the right decision to take him back home. I have him the SubQ as vet instructed. I continued the antibiotics for 4 days and then stopped. He received tTOO MUCH I
Antibiotics from vets since he was a kitten. I was naive! Now his gut doesn’t take it anymore and he gets diarrhoea

I did give him SubQ but he started resisting more and more. Until it feels quite impossible.
o downloaded a course yesterday from that behavioural vet about how to administer meds. One thing I’m already picking up is that I will try administer it with a syringe I’m a quick way bc that time it takes seems to make a difference to Fistuk
 
shellys said:
I didn’t know what’s the difference between just high ketones and DKA
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Unregulated diabetic cats' bodies produce ketones as a byproduct of the diabetes, and as long as these don't build up too much or go on for too long, usually no big deal. DKA is the condition that happens when they DO build up too much, for too long, to a toxic level which makes kitty extremely thirsty and nauseous and can be fatal.

Glad to hear your kitty is doing ok, electrolytes balanced and is eating. My boy Hendrick had DKA and was hospitalized, but he pulled through after a few days! Sending cuddles and pats for Fistuk!
 
A quick few things
Asked to Ch eco ketones myself with meter since they don’t. 4.1 mmol/L
No infection
DKA was given bc it’s easier to write!!! (Wtf) can only determined if acidosis is rules out with gas test which they didn’t and can’t now bc it needs fresh blood. She they actually don’t know! If high ketones or DKA
 
He’s very! Very angry. Not sure how good this is for healing. Managed to give him some food
Managed to take screenshots of electrolytes but need to get to computer to up load them. Had to trick my way into getting it!
 
So I'm back home and have few answers ...

First of all Fistuk is very angry. I managed to calm him a bit with a Jin Shin Jyutsu technique but as soon as the assistant came to take him back he was angry again.

The vet was extremely tired. She's overworked. they have lots of cases. She knows Fistuk doesn't like her(she said) and it doesn't look helpful.

Inflammation - they tested. There isn't

DKA or high ketones - I asked why they gave this diagnosis, she said.... wait for it.... bc it's easier to write. I hope you didn't fall off your chair.
She said the only way to rule out DKA is to rule out the acidosis which you can do with gas test. I asked if they did that last time - no. I asked she do it now - she can't. they need fresh blood so it's already too late! The blood test now will not show. They should have tested when he just arrived.

Ketones - I asked that she bring the meter so I test it myself. I needed to know and not wait till tomorrow. So it's down to 4.1 (6.1 yesterday when arrived).

I asked the receptionist if she has access to the lab results and she pulled it out. I asked that she send it to me she said she couldn't , need the vet to write a repot.... so i asked to take a picture of the screen and she let me. So there are pics. They're not great but hopefully you'll be able to make out from them what's going on:

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Hi there :cool:
Glad to see your update.

The recipe for ketone development is:

  • not enough insulin
  • not enough calories
  • infection/inflammation ( for example bad teeth & gums) or other systemic stress)

The way DKA develops is that when there is not enough energy from food (calories) making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.

Glad to hear that they are using a fast acting insulin. Are they still giving him Lantus?
 
I’m feeling unsettled. I parked that feeling last night as I was just too tired and thought it influences my feelings.

but this morning I feel again like something’s wrong. Seeing Fistuk so angry is quite unusual. Yea, he can get angry when he’s harassed by a vet but it’ll relax. He was just walking around making sounds of anger. Even when I came to him. I wasn’t steered by his anger. I have him as much as I could a safe space to express it. But I know the vets at the hospital are busy and don’t have time for ‘patience’. Is keeping him there still the best option? I’m now entirely sure. I know his ketones were still high yesterday when I measured him so that’s not good. And I can’t think of an alternative.
 
If he still has ketones and there are a couple of other things out of kilter, I would leave him there until things are more under control. He is getting IV fluids there which he needs and I am sure they are doing blood tests and keeping an eye on things.
Is he eating OK?
 
Bron and Sheba (GA) said:
If he still has ketones and there are a couple of other things out of kilter, I would leave him there until things are more under control. He is getting IV fluids there which he needs and I am sure they are doing blood tests and keeping an eye on things.
Is he eating OK?
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I think he’s eating ok but def not like at home. They’re leaving a play of food for him. Fistuk was never a great eater so at home I just go after him and feed him with a spoon which he eats happily. I fed him while I was there
 
shellys said:
I don’t know if short term insulin works the same.
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Short acting insulins like R are not depot insulins like the L insulins. They are in-and-out insulins and are usually used in the case of emergencies (like DKA) when you need to bring down blood sugar quickly. They can also be used along with long acting insulins and we have had people here with high dose kitties who use both R and Lantus/Levemir - with proper guidance from people with experience with using R like @Wendy&Neko.

I hope he comes back home soon.
:bighug::bighug::bighug:
 
shellys said:
can you have a look at the blood results I use loaded yesterday ? I see the BG was 19 (342) on the day I brought him in and yesterday the vet said it was 30(540£! But it was with AT meter. This is. Huge difference in one day. And I wonder if they monitor him every couple of hours or less :/
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I did see them :-)

There can be quite a difference between human and pet meters. Kit (Mikanmama) did a comparison of the human and pet meters when she was switching from a pet meter to a human one and recorded both readings in Mikan's SS. Take a look at her SS from Mar 9 to 12, 2023. The difference in higher numbers was as much as almost 200 points.
https://docs.google.com/spreadsheet...aTgkJtoWF-da7_I0Fik9xC-BY/edit#gid=1182885903
 
shellys said:
I didn’t think to ask how much they give him. I told them I give him 4 units.
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Next time you get a chance, see if you can get the data from what doses of insulin they have given (both Lantus and R would be ideal), and when. Plus any BG tests they have done. That will be essential when Fistuk comes home.

Could you translate into English the names of the entries from the labs that are out of range. I could figure out the glucose and cholesterol.
 
Wendy&Neko said:
Next time you get a chance, see if you can get the data from what doses of insulin they have given (both Lantus and R would be ideal),
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They gave him 4 units like I do. Will ask about the short term
I was thinking perhaps it’s good that I give him short term too when his BG spikes so high?
Wendy&Neko said:
Could you translate into English the names
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Will do. Need to take hubi to work and then will sit on it xx
 
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