3/24/24 - New Member

Hi everyone, my name is Sofia and I have an 11 year old female diabetic cat named Hazel. I'm here because I'm desperate and I feel lost and I don't know what to do. Hazel was diagnosed with diabates on December 15th, 2023. She was started on 1.5 units of vetsulin twice a day and only eating purina DM. She was doing great. She had an appetite increase, and became quite insatiable, but she did lose a bit of weight, and dropped to 11 pounds but the vet was fine with it. In February of this year, she did a blood glucose curve and the vet was satisfied with the results and said to keep giving her 1.5 units twice daily.

In early March her hunger decreased a bit, but I didn't think anything of it. I thought it was a sign that the diabetes was becoming regulated. She remained fine for a bit, eating a little bit less than her normal amount, still getting her shots twice daily but sometimes they couldnt always be exactly 12 hours apart. sometimes 9 or 10 hours apart. Anyways, in the second week of March, she became very lethargic and vomited two days in a row, so we decided to take her to an ER late at night, where she was diagnosed with ketoacidosis.

I did not know of this complication prior and I feel very guilty for not taking the steps to fully educate myself. The vet did not let me know that this complication existed, did not tell me to home test for glucose or for ketones. She was in the ER for two days, we couldn't afford it so we had to move her to my primary vet. In total, she was hospitalized for 7 days. She was on constant drip insulin, electrolytes, with a potassium supplement, appetite stimulant, nausea medication, etc. It took about 4 days just for her electrolytes to improve. By day 5, her ketones were at zero, and her electrolytes were restored, and by day 6 and 7 they switched her over to subcutaneous insulin instead of IV and they said her glucose was responding well.

She was discharged yesterday, and they sent me home with keto stix to test her urine. They also said she should receive 2 units now. They told me her ketones measured at trace before she was discharged. She ate a small amount of food last night, got her 2 units, and went to sleep and woke up fine. Now here is my nightmare, I tested her urine at home with the strips today at around 12pm, about 5 hours after her first meal and insulin dose, and it read at the highest amount. Her glucose also read at a very high amount. How is this possible? I called the vet immediately and told them the ketones are reading at the highest value. They asked me if she's lethargic, can she get up and walk around, I said yes she's walking around the whole house, she jumps up onto beds and couches fine, she just tired and is napping for most of the day and had a small breakfast. They advised me to feed her her normal dinner amount and if she eats half of it, give her a half dose, and if she eats all of it, give her a full dose, and to test urine again and call them with an update in the morning.

She got very hungry again around 3pm, her first meal was at 7:30am, but she barely ate, she is very very thin. She lost like 3 more pounds while she was hospitalized. I think she hates the purina DM, because i served it and she ate one bite and walked away. but we cooked her unseasoned steamed white chicken breast and she ate nearly an entire cup of it mixed with some fancy feast pate. I know it was less than 12 hours before but she was begging for a meal, so she took about an hour to fully finish the plate but she finished it and got her 2 units. Now she is lying here next to me, napping, stretched out, and purring when I pet her. She seems fine but just really lazy but she's always been kind of a lazy cat so it's hard to tell really. I am just waiting for her to urinate again so I can test it. But what happens if the ketones are still high? The vet told me to take her to the ER if she is too lethargic to move, but that has not been the case all day. is it possible the strip gave a false positive? If not, how can i bring her ketones back down at home? Im just so confused, I dont know why or how they went up again, after being discharged from the hospital less than 24 hours ago. Please, I know I wrote alot and I'm sorry, but I can't lose her, her hospital stay was an insane amount of money and I wouldn't be able to afford that a second time. I just want to understand why and how the ketones went back up and what can I do please, I feel so depressed about this. Thank you for anyone who can help.

 

It is important to measure the ketostix at a certain time after testing. It's usually 15 seconds – after that, the colours continue to darken.

This is what an experienced member has written about DKA:

The following what is needed to ensure a cat recovers from DKA.​

• • you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals before the insulin dose.. Food is like a medicine and helps keep ketones away. If the cat won’t eat the low carb food, feed him whatever he 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. This is really important. 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 as ondansetron or cerenia…ondansetron is better.
  • 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…you will be able to do this through the feeding tube.
  • Ask the vet about subQ fluids
  • We recommend you start testing the blood glucose so you can see exactly what is happening. We also recommend you get a human meter to do the testing. We can guide you with this…just ask.
  • Set up a spreadsheet and test the BG frequently.
  • Post daily with updates and ask for help as often as needed.

And more important reading:
https://www.felinediabetes.com/FDMB...and-diabetic-cats-a-primer-on-ketones.239971/

Yes, it is okay to feed as much as she wants right now. Once you start hometesting (as soon as possible), we ask that you pick up food two hours before the next shot is due. This is to make sure the test number at shot time is not food influenced. (A human meter works just fine and the strips are cheaper.)

Add water to the food. Make it soupy. It helps to flush out the ketones.

 

Thank you for responding to me.. The ketostix turned dark purple as soon as it touched her stream of urine. I wanna make sure I understand your comment correct. So she can have snacks in between the two meals? What kind of snacks? I'm assuming a protein, maybe just like a piece of chicken breast?

What is the best and simplest glucose monitor to use? We bought one from amazon that's supposedly made for cats and dogs, tried using it today and it wouldn't work.

By pick up the food two hours before the next shot is due, do you mean put away her bowl two hours before the insulin shot? or feed her, give her insulin 15 min after she's done eating and then do hours later do the glucose reading? Sorry I'm just confused. Thanks for your help. I'm about to put her water bowl next to her so she can drink more, hopefully she feels like urinating soon after her nap.

 

Any Human blood glucose meter will work. If you have a local Wal Mart store, the Relion brand of meter is inexpensive and so are the test strips. Otherwise, see what blood glucose meters are available at your local pharmacy. You can buy a Human meter online but some brands are only sold online. So if you need more test strips, you have to buy online because you won't find the test strips at any pharmacy. Not good if you run out of test strips and have forgotten to make an online purchase.

The Purina DM, canned and dry, are junk and have no magical ingredient that helps diabetic cats. The cooked chicken is fine but you need to add supplements to it to make it a complete diet. A pre-mix such as https://www.foodfurlife.com makes it super easy to turn cooked meat into a complete diet.

Fancy Feast pate is perfectly fine too A few pieces of cooked chicken added to it is fine but limit the un-supplemented chicken to no more than 10% of the diet.

By "snacks" we mean feed the same food as the main diet. So if you're mainly feeding Fancy Feast, snacks are also Fancy Feast. Most diabetic cats do best with a few meals spread throughout the day.

Yes, don't feed any food 2 hours before insulin injection time. Remove the bowl, treat balls, etc and put them out of reach.

 

Are you still using Vetsulin? If so, feed your cat about 20 - 30 min before you give insulin. Once you have a meter, you'll want to test, feed your cat, wait 20 - 30 min, then shoot. Once the issue with ketones is better resolved, I'd encourage you to consider a different choice of insulin. Vetsulin is no longer recommended by the American Animal Hospital Assn for the treatment of feline diabetes. Since 2018, they have recommended either Lantus (glargine) or Prozinc.

In addition to following the instructions for the Ketostix, make sure you have a box that's not past its expiration date. The strips can be finicky if they are outdated or have been mishandled. They need to be kept in a dry place. For all you know, they were sitting on a loading dock during a rain storm.

In addition to a glucometer, there are blood ketone meters. They work exactly the same as a glucose monitor but you don't have to stalk your cat to the litter box. The down side is that the strips for ketone meters are expensive -- about $1.00 each. You don't need to be testing more than once or twice a day. Precision Xtra and NovaMax are among the ketone meters people use.

The basic recipe for ketones is that there is an underlying infection/inflammation + not enough calories + not enough insulin. I'm glad you were able to get Hazel to eat. For a cat that's recently recovering from DKA, I'm always hesitant to reduce the amount of insulin. Adding water to Hazel's food may also help but getting her to eat as much as possible is important.

There is a huge range of foods you can choose from for your cat. If you read the labels on the prescription food, you'll note there's nothing "prescription" worthy in the food. This is a chart containing information, including the amount of carbohydrates, in most of the canned foods that are available in the US. We consider low carbohydrate as less than 10%. However, most of the members here feed their cat a food that is in the neighborhood of 5% carbohydrate. The Fancy Feast pates are fine. For what you're spending for the prescription food, you can feed your cat a human grade food that is of much higher quality and much lower in carbs.

 

Hi and welcome Sofia and Hazel. I’m sorry you are both going through this.
Have you managed to get another urine test done yet?
At this point let Hazel eat whatever she will eat…as eating is the most important thing she can do as eating helps keep the ketones away. Even if it is not suitable for diabetics…the food can be sorted out later…we just want he to eat and eat often at this point.

Let us know when you get a glucose meter so we can help you with the testing.
I am going to ask @Bandit's Mom to help you set up a spreadsheet for when you start testing so we can see the results of the tests.
So your main jobs at the moment are

• Try and get Hazel to eat often…every couple of hours if possible.
• Test at least twice daily for ketones and tell us the results
• Don’t skip any doses of insulin
• Get the glucose meter sorted out and start home testing the glucose.
  
• Add a teaspoon of warm water to each food if she will eat it like that.

 

Thank you everyone for your replies. Hazel's ketones read high again at around 3am according to the strip. Her glucose also read high but she was eating/snacking every couple of hours. She didn't have a huge breakfast but she got her 2 units of vetsulin at 5:30am. She is kind of reluctant to eat this morning but is very thirsty. She has pretty much been cycling between drinking a ton of water and sleeping and occasionally snacking all night.. my vet opens at 9am and told me to call them to update them.

 

Please let us know how you get on. I am very concerned the ketones are so high and she is drinking a lot. Please make sure the vet does not fob you off. Hazel need treatment. She may need more insulin and another blood test to check her electrolytes and a drip.

I would not ring the vet. I would go into the vet and be there when he opens.

 

We took her to the vet this morning.. they asked me how I want to proceed, if I want to hospitalize her again or if I want to consider her quality of life, I said of course I want to hospitalize her again, clinically she is fine she’s bright and alert it’s just her ketones that are out of control so they said okay, we’ll try again but we can’t guarantee anything because the fact that she came out of Ketoacidosis and went back into it almost immediately is concerning and sometimes it doesn’t resolve. Her glucose read at 342 at around five hours after her dose. They said that’s not that bad but it’s not good either. They said they would contact an internist to see if they have any suggestions and that they would be very aggressive with fluids for 48 hours, run some curves to see how they can adjust the insulin, and then see how she does from there. Obviously I don’t want my cat to suffer or live a poor quality of life but I just don’t believe that this is something that is uncontrollable or unresolvable. I’m really hoping they can make a breakthrough and stabilize her and send her home with a higher insulin dose and maybe that’s what’s missing.

 

hi, sorry to hear she is back at the hospital. Just like you, when my boy Hendrick was diagnosed with feline diabetes nobody at the vet said ONE WORD about the dangers of ketones, the importance of testing for ketones, and how to make sure DKA did not occur. So I had no clue and wouldn't you know it, Hendrick went into DKA and almost died.

Like others have said, to keep DKA at bay you need to feed extra food, give extra water and make sure kitty gets their insulin. You're right that a higher dose of insulin may be needed.

We used a blood ketone monitor, the NovaMAX+. But the ketone test strips are like 2 bucks each! But we felt it was worth it to have an accurate reading and stay on top of the DKA.

 

@Bron and Sheba (GA)

 

Hi Sofia,
It sounds as if your vet doesn’t know a lot about DKA and how to treat it.
Have they done blood tests to check the electrolytes? Please ask them to send you the results and then post them here for us to see.
Do they have her on an IV drip?

DKA sometimes comes back as it has with Hazel when it has not been properly dealt with first time, or the immediate post DkA care at home has not been adequate. This is in no way your fault. The care at home in the 2 or 3 weeks after DKA is very important. The vets should have told you what you needed to do.

It is very very important you start to test the BGs closely. Remind me where you are up to with home testing?
And food is vitally important and needs to be given very frequently. Make sure you have a variety of food at home for her. Remember it doesn’t matter at the moment if she won’t eat low carb food. Eating any food is the most important thing.
And testing at leat twice daily for ketones so we can see how they are going is equally important.
And I would say the dose of insulin needs to be increased.

I would also ask the vet to give you a script for ondansetron which is an antinausea medication. She may need that for a few weeks post DKA. Often DKA kitties are nauseated after they come home for a time.

 

If she is losing weight have them test her thyroid. Thyroid issues have the same symptoms as diabetes eating a lot and drinking a lot. thyroid issues will cause them to lose a lot of weight even if they are eating well. Our old vet had us giving our cat 7 units of insulin twice a day. Well I did not like this and switched vets. THe new vet tested her thyroid and found out she was hyperthyroid. Put her on meds for her thyroid issue and now she only needs a half of a unit of insulin once a day! This has been her treatment now for about 6-8 months. Found that the old vet never tested the thyroid. I have all the lab tested they did and there was never a thyroid test done on her by the old vet.

 

They did test her thyroid back in December when she was first diagnosed and found it was fine, is it worth testing again a few months later? I will ask them to do it if so

 

I would ask them to test again. That way you at least know for sure what is going on with it. And ask them to do the Free T-4 test and no its not free, that is just the name of it LOL

 

@BronandSheba the vet called and they are basically repeating their procedure from her first hospitalization, which was constant drip CRI insulin, electrolytes with a potassium supplement, appetite stimulant and nausea medication. They let me know that she is eating well and ate purina DM both last night and this morning. They said her ketones have dropped from 80 mg/dl to 40 mg/dl at this poiint, they dont want to take her off CRI insulin yet until the ketones are down more. They also said her glucose has been staying in the low 200s so they'll continue what they're doing until the ketones go down and then call me tomorrow with an update. But yes you are right about the homecare, I was not instructed on what to do, only to test urine once a day and give her 2 units of insulin with 2 meals 12 hours apart. The BG meter I got was relion from amazon and its arriving tomorrow.

 

yeah that whole thing of ONLY feeding every 12 hours is a big reason Hendrick went into DKA. Thank goodness I found this group when he was released and followed their guidance to feed, feed, feed and give lots of water and make sure he got his insulin.

 

Good to hear an update and she is eating. That’s a real plus.
The ReliOn meter is good.
We need to get you set up with a spreadsheet. I’ll ask @Bandit's Mom to contact you.
Get organised with everything mentioned before she comes home again,

 

New update from vet: She is more bright and alert than she was yesterday. She is actually eating on her own without appetite stimulant, they let me know they actually didn't put her on appetite stimulant when they rehospitalized her so I was mistaken when I said that before but she is still on anti-nausea medication. They say she is still drinking a lot of water but they see that as a good thing since yesterday she was just laying down and not doing much else. Her ketones are down to almost trace but they are keeping her on CRI insulin until tomorrow then they will switch her back to the injectable.. Her potassium is still low, steady at 2.5 not really moving from there, sodium levels are normal, phosphate is a little high and liver value a little high. They mentioned that sometimes she will try to pee and only a few drops come out- but they did do a urine culture only a few days ago and found no signs of UTI. This was not the case when she was home with me two days ago either, she was peeing a full stream. They said according to their calculations 2 units of vetsulin is still the right dose for her so they're going to keep her at that.. keep her for 48 more hours and watching the ketones

 

So I've tried two glucose meters on myself, I pricked myself with the ReliOn glucose meter and then pricked myself with the Advocate Pet Test glucose meter. The ReliOn gave a value of 127 and the Pet Test meter gave a value of 150. Which one do I go by?

 

You need to choose one and stick with it. It’s normal to get different reading with different meters and there is not a lot of difference between 127 and 150.
Personally I would go with the ReliOn meter. The test strips are probably cheaper with that one also.

 

Good update. Good she is eating on her own. Be sure to ask for antinausea meds to bring home though because you may need them and it’s so important that she continues to eat.
Are they going to give her a potassium supplement?
Try and get some BG readings from them if you can as that will be helpful to see how she has been doing.
How are you going getting the spreadsheet set up.Is @Bandit's Mom helping you?

 

Because the human meter is calibrated for human blood and the pet meter for pet blood the human meter will read lower than the pet meter. That is because the lab and vet machines only use the liquid portion of the blood for testing while the hand held meters use whole blood and the distribution of glucose in the liquid and cellar parts of the blood are different between humans and cats (and dogs). The manuals for human meters say the BG value has been calibrated to yield results equivalent to plasma (the liquid portion of the blood) glucose concentrations

 

Update from the vet:
Her ketones were zero yesterday, trace the day before that, and in low values today. as of yesterday she is back on subcutaneous insulin 2 units twice a day. They say her body seems to be going “back and forth” between DKA if that makes sense and it’s strange. I suggested she needs more insulin and they are hesitant to increase her dose because they worry about hypoglycemia. But I feel like they have no choice if her ketones keep going up on the current dose then that means it’s not enough of a dose right?

her blood glucose curve was also done, basically they fed her at 7am, take the reading right after and it is in 500s which they expect because she just ate. Her “nater” is then around 300s. But then at 7pm they give her another dose and a few hours later she is in the 200s. Is that a good enough of a response? Shouldn’t her low point be lower than that if that’s the right dose,

they said they would put a note to ask the doctor if I could be sent home with anti nausea medication. she is expected to be discharged tomorrow. But what happens if they refuse to increase the dose and keep her on the same dose? Is this something I should take into my own hands at this point and increase her dose?
They said if she can’t get regulated they’ll do an ultrasound to check her organs for inflammation.

 

Did they find an infection or inflammation? Is she on antibiotics?

What are they basing this information on? Are they still testing the electrolytes to see if they are in or out of balance?
Or are they saying this because of the ketone levels?

How much is she eating? She should be getting plenty of food through out the day and night. Check about that.

They should have tested the BG before the food not after. However it would not raise the BG more than 50-80 maximum I would think. Every cycle is going to be different . Some respond better than others so I would not be concerned about that. I would look at the overall picture and see if the BGs are generally coming down and not staying up high.

don’t take her home without some antinausea medications. Jump up and down and make a noise. You will probably need them once you get home and it is much harder to get some once your kitty is home. It is very very important that she eats and eats really well once home and if she is nauseated she won’t want to eat. That’s why you need it. If they say she was eating fine with them…just say that doesn’t mean she will eat at home. Stand your ground.
Ask for all the lab results so you can post them on here. And ask for a print out of the BGs during the stay and the doses of insulin.
Also when she was tested for ketones and the results. All these things are important.
Once you get her home, we can help you with dosing as long a you have some information for us.

Can you get the spreadsheet and signature set up please as we will definitely need those to be able to help you. If you can’t do it let me know and I will ask @Bandit's Mom to help you.
If she is coming home tomorrow, make sure you have plenty of food variety for her, Ketostix to measure the ketones, some honey or Karo in case of low numbers and you have the correct syringes for the insulin. You can do all this while she is still in hospital. Once she comes home you won’t have time for a while.