4/7/24 New Member - kitty in hospital with DKA

[Megan Rizzo]

Hello all,

I am a new member, my cat’s name is Mr. Cutesy. He is 8 years old. I took him to the vet on 4/2/24 for losing weight and increased thirst. He was diagnosed with diabetes there. The vet prescribed us meds to be delivered and we had a plan when meds were finally delivered to meet up and the vet show me how to care for my cat.

yesterday, my cat was declining. Vomiting, not eating, lethargic. I checked for ketones in his urine and it was through the roof so I brought him to the emergency vet. He is staying at the ER vet for 2 nights due to DKA. I will get him tomorrow. He is starting Lantus insulin today. I have the ReliOn meter for home, but I also have 2 Freestyle Libre2 sensors if that’s easier as we adjust his dosing. I switched his food to Fancy Feast classic pate for when he comes home.

Thankful for the Facebook group and this forum to gather as much info as possible! We are complete newbies and I didn’t even have a chance to have his new meds delivered before he went into DKA.

All help is appreciated and accepted! Thank you so much!

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

There is a ton of information about Lantus and how to use it in the sticky notes at the top of the Lantus board. Did your vet not test your cat for ketones when he was diagnosed? In addition, did the vet not mention that you can get Lantus (glargine) at any pharmacy? It's a human insulin and is widely available. This is a link to information on ketones. It will be helpful once your cat is home. Some of the basics to be aware of:

• ketones develop usually because there is an underlying infection or inflammation + not enough insulin + not enough calories.
• you will want to either get Ketostix at the pharmacy or a blood ketone meter. The Ketostix are dipped into your cat's urine and the patch at the end turns a color indicating if ketones are present and to what degree. A blood ketone meter tests your cat's blood and provides a numeric indicator regarding ketones.
• If you're not started already, you will want to start home testing. We can link information if you need to learn how. Most people here use the Walmart Relion meter. The strips are the most economical around.
• With a cat that is recently in DKA, you will want to feed your kitty approximately 1.5 times more than he usually eats. Making sure your cat is eating is important. If he's being picky while at the vet hospital, ask for an appetite stimulant before he comes home.
• getting water into your cat is also important. You'll want to add some water to his food. It helps to dilute the ketones.
• If you have any questions about giving insulin, please post and ask for help. Getting insulin into a post-DKA cat is critical.
• Please add information to your signature that your cat was recently diagnosed with DKA.

Thanks for getting your signature set up. That's helpful! You will also want to get a spreadsheet set up so you can track your cat's progress. The instructions, along with other helpful information is in this post on helping us to help you.

 

[Megan Rizzo]

I truly don’t think my vet tested for ketones when I brought him in. Which now that I’m learning more, makes me quite angry! I thought Lantus was only available by prescription? I did order the Lantus on chewy so it arrived and the emergency vet hospital is using that with him today. The syringes did not arrive yet, but I’m going to go to Walmart to get them so I’m prepared for when he comes home tomorrow.

Is it safe to assume ketones developed because he didn’t have enough insulin?
I already have a ketone stick tester, that’s what prompted me to take him to the emergency vet. I checked his urine for ketone and it was extremely bad. So when he gets home I should keep monitoring that?
I do have the ReliOn meter and everything ready for when he’s home. I also have the freestyle libre2 in case the sensor is easier as we get him adjusted. But I have both ready for when he comes home.
is there a guide to how much fancy feast pate to give him ? Like one can 2x/day (of course you mentioned more after DKA).

I’ve attached his spreadsheet but I haven’t done anything yet at home to add to it, also unsure how to actually do the sheet. I’m adding his DKA DX now.

Thank you so much!

Welcome to FDMB.

There is a ton of information about Lantus and how to use it in the sticky notes at the top of the Lantus board. Did your vet not test your cat for ketones when he was diagnosed? In addition, did the vet not mention that you can get Lantus (glargine) at any pharmacy? It's a human insulin and is widely available. This is a link to information on ketones. It will be helpful once your cat is home. Some of the basics to be aware of:

• ketones develop usually because there is an underlying infection or inflammation + not enough insulin + not enough calories.
• you will want to either get Ketostix at the pharmacy or a blood ketone meter. The Ketostix are dipped into your cat's urine and the patch at the end turns a color indicating if ketones are present and to what degree. A blood ketone meter tests your cat's blood and provides a numeric indicator regarding ketones.
• If you're not started already, you will want to start home testing. We can link information if you need to learn how. Most people here use the Walmart Relion meter. The strips are the most economical around.
• With a cat that is recently in DKA, you will want to feed your kitty approximately 1.5 times more than he usually eats. Making sure your cat is eating is important. If he's being picky while at the vet hospital, ask for an appetite stimulant before he comes home.
• getting water into your cat is also important. You'll want to add some water to his food. It helps to dilute the ketones.
• If you have any questions about giving insulin, please post and ask for help. Getting insulin into a post-DKA cat is critical.
• Please add information to your signature that your cat was recently diagnosed with DKA.

Thanks for getting your signature set up. That's helpful! You will also want to get a spreadsheet set up so you can track your cat's progress. The instructions, along with other helpful information is in this post on helping us to help you.

 

[Ale & Bobo & Minnie (GA)]

Yes you need prescription for Lantus and any insulin really.

it’s usually best for diabetic cats to he several small meals throughout the day. Most of us feed the larger meals around shot time and 3-4 smaller meals or treats in addition. It’s easier on their pancreas and it helps avoid big sugar spikes. A good rule of thumb for total daily calorie intake is 20x ideal body weight. I’d feed more now because of the DKA as already mentioned.

Here are the ReliOn syringes you want:

Testing:

You want the Relion "THIN" lancets (less than $2). "Thin" is thicker than "Ultra Thin" or "Micro Thin". Once your cats ears "learn to bleed", you can use the 30 gauge lancets.

As you poke, the body will start to grow more capillaries into the area to "heal the wound", so even if you don't necessarily get a good blood sample, in the long run it'll get easier and easier. After o

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.


Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!


You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!


It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well


For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number


Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!


There are more testing tips here:


http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

[Megan Rizzo]

I thought Lantus was prescription only. I have a vile that the ER VET is using now, and I have more refills to use at Chewy where it was cheaper than the online vet pharmacy. I saved your picture and I’m going to Walmart today to get the syringes so I’m prepared tomorrow when he comes home, thank you!

I do have the ReliOn thin lancets already!! I have been messaging with Chris Ronkoski and he helped me so much when I was panicking yesterday!!

thank you so much for your tips!! A low carb treat would be the baked chicken?


I’m just nervous keeping him stable once he comes home. I’m hoping the vet will tell me how often to check his blood sugar and how much insulin to give each time.. but also the food dosing as well. We didn’t even get to that point with my regular vet, but I’m thinking she’s not equipped for this as she didn’t check for ketones and left him with a high blood sugar for over a week waiting for delivery!

Yes you need prescription for Lantus and any insulin really.

it’s usually best for diabetic cats to he several small meals throughout the day. Most of us feed the larger meals around shot time and 3-4 smaller meals or treats in addition. It’s easier on their pancreas and it helps avoid big sugar spikes. A good rule of thumb for total daily calorie intake is 20x ideal body weight. I’d feed more now because of the DKA as already mentioned.

Here are the ReliOn syringes you want:
View attachment 69788

Testing:

You want the Relion "THIN" lancets (less than $2). "Thin" is thicker than "Ultra Thin" or "Micro Thin". Once your cats ears "learn to bleed", you can use the 30 gauge lancets.

As you poke, the body will start to grow more capillaries into the area to "heal the wound", so even if you don't necessarily get a good blood sample, in the long run it'll get easier and easier. After o

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.


Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!


You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!


It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well


For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number


Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!


There are more testing tips here:


http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

[Larry and Kitties]

have more refills to use at Chewy where it was cheaper than the online vet pharmacy.

Try using a GoodRx coupon at a local pharmacy and get generic glargine. Lantus is the trade name for the original manufacturer of glargine

https://www.goodrx.com/insulin-glar...100-units-ml&quantity=1&slug=insulin-glargine

 

[Sienne and Gabby (GA)]

Larry's point is well taken. Glargine is now reasonably priced. Most of us use the pens (5 pens in a box) and use a syringe to draw off the insulin from the pen. The vials contain less insulin than the total of the 5 pens. I tend to like the pens since they tend to not break if you drop one whereas the vial will be a mess of glass and insulin if you have an accident.

You do need a prescription for almost all insulin in the US. However, you can walk into any pharmacy with a prescription and get glargine/Lantus or other insulin (Prozinc is the exception since it's a pet only insulin). If you had to wait for insulin to be delivered from Chewy, that's irresponsible. Your vet should have run a full blood panel to rule out any underlying infection or condition, included ketones in the labs, and given you a prescription that you could have taken to any pharmacy rather than wait for insulin to be delivered.

 

[Bron and Sheba (GA)]

With the food…offer your kitty something every couple of hours. Hopefully he will eat a good meal before the doses of insulin but don’t worry too much if he doesn’t because you can keep offering food. The insulin doesn’t onset for 2 hours so you have a couple of hours to make sure he is eating.
Eating is more important than what he eats at this point. Hopefully he will eat low carb food but if he doesn’t, let him eat what ever he will eat. We can sort out the food later. We just need to make sure he eats plenty of food now as food will help stop the ketones.

And do not skip any doses of insulin as insulin also helps keep ketones away. If you are concerned at all about if you should give the dose because the BG is not high enough, stall, don’t feed and post and ask for help. And test the BG 20 minutes later.

Test daily for ketones in the urine. If there are any ketones in the urine let us know as the insulin and the food may need adjusting. You would need to tell the vet if the ketones is higher than trace.

You could try adding a teaspoon of warm water each snack as well. A snack is a teaspoon or 2 of low carb food.

Before discharge please ask the vet for some antinausea medications such as ondansetron or cerenia asa lot of DkA kitties are nauseated when recovering from DKA for a few weeks and this stops them wanting to eat and it is imperative they do eat. Don’t leave without some antinausea medications. Also ask for a copy of the lab results done while in hospital…they can email them to you.

Keep posting and asking for help, support and guidance. We can help you through the recovery period which will be pretty full on for a week or two but well worth it!!

 

[Diane Tyler's Mom GA]

Most members get the generic you can get generic/biosimilar glargine at very reasonable prices using GoodRx coupon. Most members use the generic because Lantus is to expensive.
https://www.goodrx.com/lantus?label...d-pens-of-100-units-ml&quantity=1&slug=lantus
Make sure that the Match your prescription pull down menue says generic glargine 1carton of 5 3ml pens.
There is no wait time test, feed, give insulin
Lantus usually doesn't kick in until 2 hours after the shot

We buy the pens but use the syringes to draw out the insulin because if you use the pen you can only adjust by full units ,we adjust the doses by 0.25 units
If you do switch back to lantus the generic you will need
U -100 SYRINGES WITH HALF UNIT MARKINGS
I can suggest a few if you would like


Also
The 5 pens will last about a year, we use the pens just like a vial, you would just insert the syringe it the gray rubber stopper on the pen and draw out your insulin
Its generic lantus



Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

Just call around for the best price

A member just posted this
Allie was using the Lantus and I just switched to the generic and using the GoodRX I got 5 pens for $81.30 at Walgreens.

GoodRX has a 1-800 number to assist you in using their services to get your pets prescriptions filled if the pharmacy gives you any issues.

I think I found it for you
GoodRx / Customer service

1 (855) 268-2822

 

[Diane Tyler's Mom GA]

The relion box of syringes might look like this also besides the blue box

 

[Diane Tyler's Mom GA]

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not thelancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with
Here is a video one of our members made testing her kitty
She's using a pet meter that has to be coded ,with a human meter you don't have to code it.
So ignore that
I have always used a human meter
VIDEO: How to test your cat's blood sugar

Wishing you all the best with Mr Cutesy Megan

 

[Megan Rizzo]

I definitely feel like we will be seeking a more experienced vet once Mr. Cutesy comes home. I wish I would have known more prior to make sure he would be okay until we started meds, I just had no idea. But she should have known.

One silly question I have: if I have a prescription for insulin for a pet when I take it to a human pharmacy won’t they look at me crazy? Lol also- confirming to make sure I have a paper copy of the prescription correct?

Larry's point is well taken. Glargine is now reasonably priced. Most of us use the pens (5 pens in a box) and use a syringe to draw off the insulin from the pen. The vials contain less insulin than the total of the 5 pens. I tend to like the pens since they tend to not break if you drop one whereas the vial will be a mess of glass and insulin if you have an accident.

You do need a prescription for almost all insulin in the US. However, you can walk into any pharmacy with a prescription and get glargine/Lantus or other insulin (Prozinc is the exception since it's a pet only insulin). If you had to wait for insulin to be delivered from Chewy, that's irresponsible. Your vet should have run a full blood panel to rule out any underlying infection or condition, included ketones in the labs, and given you a prescription that you could have taken to any pharmacy rather than wait for insulin to be delivered.

 

[Chris & China (GA)]

I'm so happy to see you posting here @Megan Rizzo! Many of the people here are the ones who taught me what I've been talking to you about, or have real life experience with dealing with their own DKA cats!

You are doing great and I'm so glad you listened when I told you that he needed to go to the ER immediately. You wouldn't believe how many times people want to try to wait and see.

I'm always available to you because I will be your DCIN Case Manager, but keep the people here updated on how he's doing and listen to their advice. They won't steer you wrong!

 

[Diane Tyler's Mom GA]

One silly question I have: if I have a prescription for insulin for a pet when I take it to a human pharmacy won’t they look at me crazy? Lol also- confirming to make sure I have a paper copy of the prescription correct?

@Chris & China (GA)

 

[Megan Rizzo]

Thank you so much for all this advice!

Antinausea meds… low carb snack with water (I’m gonna do boiled chicken)… keep testing for ketones… and make sure he eats .. I have fancy feast pate waiting for him.

With the food…offer your kitty something every couple of hours. Hopefully he will eat a good meal before the doses of insulin but don’t worry too much if he doesn’t because you can keep offering food. The insulin doesn’t onset for 2 hours so you have a couple of hours to make sure he is eating.
Eating is more important than what he eats at this point. Hopefully he will eat low carb food but if he doesn’t, let him eat what ever he will eat. We can sort out the food later. We just need to make sure he eats plenty of food now as food will help stop the ketones.

And do not skip any doses of insulin as insulin also helps keep ketones away. If you are concerned at all about if you should give the dose because the BG is not high enough, stall, don’t feed and post and ask for help. And test the BG 20 minutes later.

Test daily for ketones in the urine. If there are any ketones in the urine let us know as the insulin and the food may need adjusting. You would need to tell the vet if the ketones is higher than trace.

You could try adding a teaspoon of warm water each snack as well. A snack is a teaspoon or 2 of low carb food.

Before discharge please ask the vet for some antinausea medications such as ondansetron or cerenia asa lot of DkA kitties are nauseated when recovering from DKA for a few weeks and this stops them wanting to eat and it is imperative they do eat. Don’t leave without some antinausea medications. Also ask for a copy of the lab results done while in hospital…they can email them to you.

Keep posting and asking for help, support and guidance. We can help you through the recovery period which will be pretty full on for a week or two but well worth it!!

 

[Chris & China (GA)]

if I have a prescription for insulin for a pet when I take it to a human pharmacy won’t they look at me crazy? Lol also- confirming to make sure I have a paper copy of the prescription correct?

No, they don't care if it's for a human, a cat or a guinea pig. Their job is to fill the prescription. Period. Sometimes you may run into problems with using the GoodRX or the Lantus Savings Card because you're using it for an animal, but a lot of pharmacies have the Lantus Savings card information already programmed into their system so it automatically gives the discounted price.

But that's not something you need to worry about right now. You have enough to last you for months and as long as you're approved as a client for DCIN's Compassionate Assistance Program, we will make sure you always have insulin for him!

 

[Diane Tyler's Mom GA]

@Chris & China (GA)
Thank you Chris

 

[Megan Rizzo]

Thank you so much for all your advice!

When I get the prescription I have to make sure they are for the pens correct? If they write it for the vile I’ll have to get that.

Most members get the generic you can get generic/biosimilar glargine at very reasonable prices using GoodRx coupon. Most members use the generic because Lantus is to expensive.
https://www.goodrx.com/lantus?label...d-pens-of-100-units-ml&quantity=1&slug=lantus
Make sure that the Match your prescription pull down menue says generic glargine 1carton of 5 3ml pens.
There is no wait time test, feed, give insulin
Lantus usually doesn't kick in until 2 hours after the shot

We buy the pens but use the syringes to draw out the insulin because if you use the pen you can only adjust by full units ,we adjust the doses by 0.25 units
If you do switch back to lantus the generic you will need
U -100 SYRINGES WITH HALF UNIT MARKINGS
I can suggest a few if you would like


Also
The 5 pens will last about a year, we use the pens just like a vial, you would just insert the syringe it the gray rubber stopper on the pen and draw out your insulin
Its generic lantus



Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

Just call around for the best price

A member just posted this
Allie was using the Lantus and I just switched to the generic and using the GoodRX I got 5 pens for $81.30 at Walgreens.

GoodRX has a 1-800 number to assist you in using their services to get your pets prescriptions filled if the pharmacy gives you any issues.

I think I found it for you
GoodRx / Customer service

1 (855) 268-2822

 

[Megan Rizzo]

Thank you So much! I am going to have to get better at testing! I only did it one time when he was acting off before going to the hospital!

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not thelancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with
Here is a video one of our members made testing her kitty
She's using a pet meter that has to be coded ,with a human meter you don't have to code it.
So ignore that
I have always used a human meter
VIDEO: How to test your cat's blood sugar

Wishing you all the best with Mr Cutesy Megan

 

[Chris & China (GA)]

If they write it for the vile I’ll have to get that.

You can ask your vet to write you a new script. I will send you the link with the information on the Lantus Savings Card but again, as long as you're accepted as a CAP client with DCIN, we will always make sure you have insulin for him.

 

[Megan Rizzo]

Thank you so much for walking me through yesterday! I knew something was not right but I’m so glad I was able to chat with you to know to even test for ketones. I so appreciate all your help! While money is tight we still want to make sure we are doing everything correctly for him and making his recovery as seamless as it can be for him.

I'm so happy to see you posting here @Megan Rizzo! Many of the people here are the ones who taught me what I've been talking to you about, or have real life experience with dealing with their own DKA cats!

You are doing great and I'm so glad you listened when I told you that he needed to go to the ER immediately. You wouldn't believe how many times people want to try to wait and see.

I'm always available to you because I will be your DCIN Case Manager, but keep the people here updated on how he's doing and listen to their advice. They won't steer you wrong!