5/24 - New member Henry in DKA

[John & Henry]

Hi everyone,

I'll apologize up front for the length of this post but I'm experiencing one of the hardest times I've had in a long time and I need to get it off my chest. My beloved 12 year old all white Siamease mix , Henry is currently in critical condition with DKA.

I had no idea he was diabetic. Although fairly picky he's always loved food and was a small time begger until about 6 months ago when the begging got to a whole other level. I tried to be really discipline about feeding him at the same time everyday hoping he'd cut down on the constant begging. Sometimes it would work, other times he was relentless going straight back to begging immediately after downing a whole can of food (friskies wet food, never dry food). He'd meow to wake me up in the morning (he hadn't done that since we came to an understanding on the topic when he was a kitten). He got mad enough with me ignoring his begging that he would bite me! Usually it was just gently nibbling on my hands, but sometimes he would do it very hard. If only I had realized he was literally starving to death

He's never been overweight but carried a little extra padding topping out at about 9 pounds or so. About a month or two ago I starting to feel his spine poking through his back, but wrote it off to getting older. But very quickly it got more and more prominent. I deeply regret not taking him to the vet at that point. He was bloated and I figured he had worms that was sapping his nutrients so I ordered a broad spectrum de-worming medication (Bayers Drontal). I gave him his first dose exactly 1 week ago today. Recently his spine, tail bone and even his ribs felt like they had lost all their muscle despite still looking bloated and not exactly skinny or sickly. I googled why this was happening and the first result was due to weight loss. It was the first time I realized he was rapidly losing weight even though he was eating more than he ever had in his life. Last Saturday he got on my chest while I was laying in bed, purring and told me "papa, I'm dying".

There's currently a vet shortage in the PNW where most vets aren't accepting new patients and even established clients have a 2+ month wait to get an appointment. Luckily my vet does set aside a few slots for emergency cases but you have to call right at 6am and they fill up within a few minutes. I was lucky to get an appointment for Sunday. The vet thought it was classic hyperthyroidism but unfortunately didn't have an on-site lab, so she had to send them out.

He took a bad turn after returning from the vet. This was the first day he wouldn't eat anymore. He was so lethargic, walking very strange and slow, wouldn't jump up on anything and was sitting in strange places he normally normally never does (in the bathroom and next to his litter box). His normal furniture is my lap. He's so attached to me it's crazy. If I'm sitting 90% of the time he's laying on me. Sleeps on my feet in bed. He's always been clingy with me, but I very much appreciate his affection. I really hit the panic button Sunday night and knew I couldn't wait another day for those test results. I called our local 24 hour emergency hospital and asked if they were able to do on-site blood work and they said they did, but unfortunately they were at capacity and couldn't accept any new patients. Luckily being in a major city there were a couple other 24 hour places, but all were either "on diverson" or had wait times up to 24 hours and you had to wait in your car in their parking lot. Critical reviews of some of these places said their animals would literally bleed to death in the car waiting to be triaged. I kept thinking "is it going to just be quicker to wait for the results from my vet then waiting 24 hours in the car?" But Henry was declining by the hour and I was desperate. I stayed up all night calling and weighing my options. I was seriously considering making the 12+ hour drive to UC Davis. At 6am Monday I tried the 24 hour hospital I had first called and this time they said I could get in with a 8-12 hour wait, but they would triage him immediately and get him in quicker if they thought it warranted. I went immediately and he was assessed as critical and said it would be 1-3 hours but only ended up being about 45 minutes. They did bloodwork and an ultrasound. When they showed me the test results the first thing that stuck out at me was the BG of 334. Strangely the vet didn't even mention the possibility of diabetes and thought it was lymphoma based on the ultrasound (I'll go into more detail on that later) and got me an urgent referral to a specialist hospital to see an oncologist. I took him there immediately and on the drive there my vet that had been waiting for the test results called to inform me that he was experiencing life threatening DKA and needed to be treated immediately.

Luckily I was only 5 minutes away from the specialist hospital and was able to inform them of the gravity of the situation when I arrived. While they didn't respond with the urgency I was expecting (it took the attending almost 2 hours to even call me, and I know they didn't do anything before that because they didn't even ask for the deposit until after I spoke with him, plus he insisted on verify the diagnosis with their own lab before they proceeded even though my vet had immediately sent over the results she had)

4 hours later he called me back and it was a really really grim conversation. This is probably the time to tell you about the results of the ultrasound that made them think lymphoma:

Thickening of the small intestinal walls with disproportionate thickening of the muscularis layer. This is most often seen associated with intestinal lymphoma, but can also be seen with inflammatory bowel bulld disease. Intestinal biopsies would be necessary for a definitive diagnosis.

Hyperechoic hepatomegaly, most often seen associated with hepatic lipidosis. However, this can also be seen with hepatitis or hepatic lymphoma. If further evaluation of this is desired, fine needle aspirates for cytology of the liver could be obtained using ultrasound guidance.
​

He also said they performed an xray and saw a "small unknown mass" near his lungs and some sort of hernia of the esophagus. He said the DKA was so bad he wasn't sure he was going to make it and coupled with the possibility of lymphoma he strongly suggested I consider "humaine euthanasia". I could barely keep it together, but told him to treat his DKA and we could talk about the other stuff tomorrow. If he'd had some sort of proof of something like large cell lymphoma I probably would have acquiesced, but I needed to do some research. He said there was a large possibility he wouldn't make it through the night and I should keep my phone close.

My technical analytical mind immediately kicked in and luckily I have a knack (hobby?) of researching academic medical literature due to my own rare health condition. My assessment thus far:

• I quickly wrote off the finding of the nodule they saw on the xray knowing that "incidentalomas" (as the doctors call them) are very common and rarely malignant. There's a reason doctors hate full body scans because there is a large chance one of these nodules will be discovered and they're usually a nothing burger.
• The esophageal hernia probably explains why Henry has had this condition where if you touch his throat too hard he'll cough and look like he's gasping for air, but he's been doing it since he was a kitten. It does look a little scary but he always gets over it in a few minutes and seems unphased by it. Reading up on the condition indicates it is frequently found in Siamease and is almost definitely congenital.
• Next up is the issue of the Hyperechoic hepatomegaly (aka, an enlarged liver). It is my understanding that hepatic lipidosis is a common comorbidity of DKA and diabetes so it seems that would be more likely the case than lymphoma.
• Finally and the most concerning is "Thickening of the small intestinal walls with disproportionate thickening of the muscularis layer". My research has shown in this case it's impossible to distinguish IBD from lymphoma aside from doing a biopsy. I've seen some sources say it is more likely to be IBD but one study (with a small sample size) indicitated it's about 50/50 which isn't great odds but certainly not a reason to jump straight to euthanasia.

The internal medicine specialist who is now handling his case hasn't mentioned any concerns about these issues. But certainly something I will have investigated (biopsied) when/if the DKA resolves .

I was very relieved not to get the dreaded midnight call last night and this morning she said he was doing slightly better but "not out of the woods". While I've been writing this novel she called to say he's improved even more this evening and actually ate some food! That info brought me to tears since they said it wasn't possible to place an E-tube due to him being too sick for anesthesia. I worry a bit about the forthcoming bills since I was quoted $1800-$2000 per day of hospitalization (which seems very much above what I've seen others pay for the same circumstances) but it'll be worth every penny if I get my little buddy back purring in my lap.

While I've so got much to learn about administrating insulin and taking BG readings I'm so thankful for this community and the wealth of information provided here. I look forward to talking with you all. If you made it to the end of this thank you for taking the time to read it.

I'm interested in any advice or your take on my situation.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum. I am so sorry you and Henry are going through this.
I am very glad he is at the vet getting the care he needs.
I have to go offline for a while but will be back in an hour or two to answer your questions and help you. I just wanted to let you know we have seen your email.
Once Henry comes home we can certainly help and support you as he recovers.
Be back soon, Bron

 

[Bron and Sheba (GA)]

You have certainly been through a lot and its terrible that he wasn't taken in and treated earlier.
I've read through your email and would like to comment on a few things.
It does sound as if he is responding well to the treatment for DKA which is wonderful. The fact he is eating some food is very encouraging. It can be expensive to have them in ER for some days but is always worth it. Don't even think of euthenasia.....
We get a lot of DKA kitties here after they have been discharged from hospital and we can help you with the recovery. More about that later......

Hepatic lipidosis happens when the cat is not eating enough food, and it is a serious condition. Cats need to eat every day and if they don't, hepatic lipidosis can happen. The treatment is to get them eating again........

DKA happens when there is not enough insulin, not enough food and an infection or inflammation. You need to ask the vet did they pick up an infection or inflammation as it needs to be treated.

Finally and the most concerning is "Thickening of the small intestinal walls with disproportionate thickening of the muscularis layer". My research has shown in this case it's impossible to distinguish IBD from lymphoma aside from doing a biopsy. I've seen some sources say it is more likely to be IBD but one study (with a small sample size) indicitated it's about 50/50 which isn't great odds but certainly not a reason to jump straight to euthanasia.

This can be dealt with after Henry recovers from the DKA. You would be wise to get a biopsy as the treatment for lymphoma and IBD is different. We have people here who can help you with that.
Now to the DKA and what you can do now to get prepared for Henry's return home and what you will need to do when he gets home.

Before Henry comes home this is what you need to do

• buy Ketostix for testing ketones. Can be bought from Walmart in the US or a pharmacy.

• Ask the vet for antinausea medication such as cerenia and ondansetron for you to take home. Most post DKA kitties are nauseated for a time so make sure you get some, even if he seems to be eating well.

• You may also need an appetite stimulant. Always give the antinausea medication first before the appetite stimulant.

• Ask the vet about giving sub Q fluids at home

• Get a range of canned food for when they get home including some higher carb foods...I'll give you a link to food .

• Set up a spreadsheet and the signature before the cat comes home so you are ready to go as soon as he comes home.

• Buy a human glucose meter, much better than an an alphatrak meter, cheaper to run and our dosing methods are based on the human meter. A good one is the ReliOn Premier meter that you can get at Walmart....more about this later

• Ask for a copy of the path results from the ER.

Once you get Henry home, this is what you will need to be doing for a few weeks as he recovers. Most vets do not give much information about treatment once home.

• you need to give one and a half times as many calories as Henry normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If Henry 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, don't feed and test again in 20 minutes and post here and ask for help.

• Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all. You test the urine for ketones and follow the directions on the bottle. You can also use a blood ketone meter if you don’t think you can collect a urine sample daily.

• Give antinausea medication if needed

• 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..

• Ask the vet about subQ fluids which you can give at home...we can show you how.

• Set up a spreadsheet......very important, and test the BG frequently

• Post daily with updates and ask for help as often as needed.

Here is a link to how to set up the spreadsheet and the signature. Also the hypo kit.
If you have any trouble with this let me know and i will get someone to help you with it.
HELP US HELP YOU

FOOD CHARTS Look for foods with carbs 10% or less for the low carb and 11-16% for medium carb and 17-23% and above for high carb. Get some medium and high carb food and mark the top of the tin with the number of carbs in it. You may need the higher carb if the BG drops.

As mentioned above the ReliOn meter is a good, inexpensive meter and can be bought for $9 from Walmart. You will also need a box of 100 test strips which cost $17.88 and a box of lancets size 26 or 28 from Walmart. Also some cotton rounds to hold behind the eat to prick and then hold to stop bruising.

Here is a link to hometesting links and tips

Please let us know how Henry is coming along as we always worry until we hear.
I am going to tag @Hendrick Cuddleclaw who has recently been through DKA with his kitty and who is now doing fabulously.
Bron

 

[Hendrick Cuddleclaw]

Hi @John & Henry, welcome to the club. Just reading your ordeal, it's like all the emotions of when Hendrick was hospitalized for DKA come flooding back. So glad to hear you got him in when you did! You literally saved his life, once they are in the DKA downward spiral things can go south very very quickly. Look, I know right now you are kicking yourself for missing the signs, not getting him treated for diabetes sooner, etc etc. I know exactly how you feel, but try to let it go and focus on what you can do going forward and learning from your mistakes.

The fact that he ate something is fantastic news and very encouraging!! DKA makes kitty super nauseous as the ketones in the blood are basically like poison, making kitty feel very sick, no appetite, no energy. Hendrick is close to Henry's age (10 years old) and spent two nights in the hospital. Your costs so far are SUPER reasonable imo, by the way. Here in my city, the only ER vet initially quoted me over $8,000 for Hendrick's treatment for DKA but that was based on a 5-night stay. Ultimately, it was $3400 for two nights but I'd pay it again in a heartbeat.

After getting out of the hospital and getting home you will have more work to do and you must remain vigilant. Henry will need at least 150% of his normal calories, plenty of water, and to get started on insulin. Checking for ketones is key. These are things that will keep the DKA away.

We used a blood ketone monitor called the Nova Max Plus:

https://smile.amazon.com/Max-Blood-Glucose-Monitoring-System/dp/B00FN51XDA/ref=sr_1_12?crid=3GSCFW8JTBBYR&keywords=nova max&qid=1653475388&sprefix=nova max,movies-tv,59&sr=8-12

 

[Hendrick Cuddleclaw]

more info on DKA here:

https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

 

[Suzanne & Darcy]

Hi John. I read through your story. Wow. My boy Darcy also had DKA and was hospitalized for a week. He did get hepatic lipidosis as well. We were able to place a feeding tube (E-tube) after a few days of treatment when he was more stable (and his very high fever had come down) and I believe this saved his life. The ER vet was able to put him on this special “slow feed” machine to very gradually and constantly get food into him through the tube. Then, when I brought him home, I was able to feed him very easily. He also had those same hyperechoic findings on his ultrasound. I put him on a supplement called Denamarin to speed the healing of his liver.

I purchased a blood ketone meter called the NovaMax Plus. The ketones are tested using blood drop from an ear prick in the same way that we test blood glucose.

I can imagine the panic and horror and feelings of helplessness, anger, despair, etc. that you mist have been through while trying to get people to help Henry. We all care here, and we are with you and here for you 100%

 

[Suzanne & Darcy]

Oh, about the inflammation in the muscularis layer. This can either be IBD or small cell lymphoma. When it’s in the muscularis layer there’s no way to biopsy that except via a laparotomy (which is a major surgical procedure) where they cut a good size incision in the abdomen and take samples for pathological analysis. The muscularis layer cannot be accessed via an endoscopy. I would definitely caution you about doing a laparotomy at this time. I have been through this procedure with a cat before. I will say that the two diseases are treated similarly, although not exactly the same. Prednisolone is the first line of treatment and if it’s small cell lymphoma then Leukeran, which is the chemo drug for SCL. I have had (and currently have) cats with both IBD and SCL. We have gone different routes from the laparotomy for biopsy and diagnosis and just doing ultrasound and starting Prednisolone and then later adding in the Leukeran when Prednisolone alone was no longer sufficient. My cat had fantastic quality of life on Leukeran for several years. Sometimes the pred has to be kept up for life and sometimes the pred can be discontinued after the Leukeran has suppressed the SCL.

This is, of course, putting the cart before the horse because first you have to get Henry through this crisis and start to get him into better BG numbers. I just thought I would share a bit about this now.

 

[Diane Tyler's Mom GA]

As mentioned above the ReliOn meter is a good, inexpensive meter and can be bought for $9 from Walmart. You will also need a box of 100 lancets size 26 or 28 from Walmart cost $17.88. A

I think Bron meant 17.88 for 100 test strips for the Relion Premier Classic Meter
I'm praying for you little guy

 

[FrostD]

I am so sorry you're going through this. Everyone else covered pretty much everything, but one thing I will add - even if it is small cell lymphoma, it is typically a very "slow burning" cancer. So to put it succinctly - no, I would not consider it a factor in deciding whether or not to euthanize.

As Suzanne mentioned, biopsy is the only way to confirm but I would not do that with an unstable cat.

Once he's clear of the DKA, you'd have a few options. You could try a novel protein diet (novel meaning just novel to him) for some time and see if that helps - if it does, that means IBD. SCL does not respond to novel protein.

It seems there's different approaches, but what I was told (since I also cannot do biopsy) is that next step is a steroid. Prednisolone is the drug of choice for both IBD and SCL, but does affect BG. For that reason, some choose to use budesonide as it usually doesn't affect BG - but is contraindicated if there are liver problems as it is heavily metabolized in liver. Then if still no response over some time, the assumption is SCL and chemo drug.

 

[John & Henry]

Firstly an update this morning: Henry continued to eat throughout the night and the vet said his numbers are continuing in the right direction (acid/base has improved) but his electrolytes are still low. She said he's starting to act like a cat again! Thank you all for the thoughtful information. I wrote my first post late last night and just got up to see all these messages.

its terrible that he wasn't taken in and treated earlier.

I agree and feel so guilty. He was eating fine and wasn't really acting sick until a day or two before I took him to that first vet appointment, but I should have went in as soon as I was starting to feel his backbone. I actually had taken henry in 5+ months ago due to his extreme hunger problem and vommiting. I'm not sure what tests they ran but they didn't find any problems that concerned them... I'm now really questioning that vets judgement and he has subsequently went out of business which is strange since all the vets in this area are overwhelmed with business right now. I realize cats are so tough that they usually don't show signs of being sick until they're in the crisis stage. I lost my first cat to cancer which showed no signs of being sick and by the time he did it was too late for the vet to save him

Hepatic lipidosis happens when the cat is not eating enough food, and it is a serious condition. Cats need to eat every day and if they don't, hepatic lipidosis canhappen.

He's been given 2 cans/day of friskies wet food (shreads) of different flavors his whole life. Before his ravenous appetite appeared he would usually only consume about half the can. Is it possible the
hepatic lipidosis occurred because his body wasn't utilizing the nutrients properly due to the diabetes?

DKA happens when there is not enough insulin, not enough food and an infection or inflammation. You need to ask the vet did they pick up an infection or inflammation as it needs to be treated.

The vet had mentioned this and said they were going to do urine cultures, but hasn't mentioned it since. I will ask her next time she calls. They also mentioned it may had been due to the possible lymphoma.

So I already have some lancets and a novamax plus meter that does glucose and ketone from when I was doing the keto diet, seems I'll need to get some fresh strips since these are expired. I'll pick up some cotton balls too.

I'll get to work setting up a spreadsheet and creating a signature. I'll be sure to ask the vet for:

• the antinausea meds
• An appetite stimulant.
• SubQ fluids
• A supplement to speed the healing of his liver (Denamarin)
• The pathology reports

You could try a novel protein diet (novel meaning just novel to him) for some time and see if that helps - if it does, that means IBD. SCL does not respond to novel protein.

How will I know if he's responding since I've never really seen signs of IBD before? Looking back now I realize he would frequently go poo within an hour or so of eating (and the smell would be horrible) and while he's been a "pukey" cat most of his life (interestingly that mostly stopped in the last 6 months) those are the only two possible symptoms of IBD I've been able to identify. If the IBD improves would it be reflected on the ultrasound?

I'll check out the food chart and get some high carb/low carb options. I've tried a few different foods with him over the years and some he'll just straight up ignore but was interested in others. Friskies wet food has been the one he seems to like the most. I think I saw the carb content was around 8%

Your costs so far are SUPER reasonable imo

Thank you for this. It makes me feel like I'm not getting taken to the cleaners. I'm happy to pay the going rate but was worried the prices I was quoted were well over double most I've seen. To be fair I've read this hospital is one of the only practices on the west coast to be unionized and I do feel good about supporting a practice that supports their employees. Since today will mark day 3 I'm guessing we're around the $6k mark. Again, totally worth it.

We were able to place a feeding tube (E-tube) after a few days of treatment when he was more stable

Do you think they'll still want to do this now that he's eating on his own?

Thank you @Suzanne & Darcy for all the info about SCL & IBD. Fingers crossed its the latter and I'm happy to hear it's normally small cell.

I hope I've covered most of your replies and I thank you all so much for the support and information. I'll be implementing all of it. Friends and family really don't get how much these little flufe balls mean to us, but he's literally like a kid to me (especially since I don't have any human spawns) so it means a lot to have this community that understands.

Time to start reading all the guides around here. One additional question tho: should I ask the vet about using a certain kind of insulin or just use whatever they recommend?

 

[FrostD]

Firstly an update this morning: Henry continued to eat throughout the night and the vet said his numbers are continuing in the right direction (acid/base has improved) but his electrolytes are still low. She said he's starting to act like a cat again! Thank you all for the thoughtful information. I wrote my first post late last night and just got up to see all these messages.


I agree and feel so guilty. He was eating fine and wasn't really acting sick until a day or two before I took him to that first vet appointment, but I should have went in as soon as I was starting to feel his backbone. I actually had taken henry in 5+ months ago due to his extreme hunger problem and vommiting. I'm not sure what tests they ran but they didn't find any problems that concerned them... I'm now really questioning that vets judgement and he has subsequently went out of business which is strange since all the vets in this area are overwhelmed with business right now. I realize cats are so tough that they usually don't show signs of being sick until they're in the crisis stage. I lost my first cat to cancer which showed no signs of being sick and by the time he did it was too late for the vet to save him



He's been given 2 cans/day of friskies wet food (shreads) of different flavors his whole life. Before his ravenous appetite appeared he would usually only consume about half the can. Is it possible the
hepatic lipidosis occurred because his body wasn't utilizing the nutrients properly due to the diabetes?



The vet had mentioned this and said they were going to do urine cultures, but hasn't mentioned it since. I will ask her next time she calls. They also mentioned it may had been due to the possible lymphoma.

So I already have some lancets and a novamax plus meter that does glucose and ketone from when I was doing the keto diet, seems I'll need to get some fresh strips since these are expired. I'll pick up some cotton balls too.

I'll get to work setting up a spreadsheet and creating a signature. I'll be sure to ask the vet for:

• the antinausea meds
• An appetite stimulant.
• SubQ fluids
• A supplement to speed the healing of his liver (Denamarin)
• The pathology reports

How will I know if he's responding since I've never really seen signs of IBD before? Looking back now I realize he would frequently go poo within an hour or so of eating (and the smell would be horrible) and while he's been a "pukey" cat most of his life (interestingly that mostly stopped in the last 6 months) those are the only two possible symptoms of IBD I've been able to identify. If the IBD improves would it be reflected on the ultrasound?

I'll check out the food chart and get some high carb/low carb options. I've tried a few different foods with him over the years and some he'll just straight up ignore but was interested in others. Friskies wet food has been the one he seems to like the most. I think I saw the carb content was around 8%


Thank you for this. It makes me feel like I'm not getting taken to the cleaners. I'm happy to pay the going rate but was worried the prices I was quoted were well over double most I've seen. To be fair I've read this hospital is one of the only practices on the west coast to be unionized and I do feel good about supporting a practice that supports their employees. Since today will mark day 3 I'm guessing we're around the $6k mark. Again, totally worth it.



Do you think they'll still want to do this now that he's eating on his own?

Thank you @Suzanne & Darcy for all the info about SCL & IBD. Fingers crossed its the latter and I'm happy to hear it's normally small cell.

I hope I've covered most of your replies and I thank you all so much for the support and information. I'll be implementing all of it. Friends and family really don't get how much these little flufe balls mean to us, but he's literally like a kid to me (especially since I don't have any human spawns) so it means a lot to have this community that understands.

Time to start reading all the guides around here. One additional question tho: should I ask the vet about using a certain kind of insulin or just use whatever they recommend?

Sorry on my phone so to pull specific quotes would be a pain...

Yes it's likely the hepatic lipidosis was because he wasn't getting enough calories total - so while "by the can" he was, as you already mentioned diabetics often need more food to compensate. My cats intake was about double when he was unregulated.

Yes any improvement would be visible on ultrasound. I'd be hesitant to put him under too many times for ultrasounds while he's in a fairly unstable state, unless hes a good cat that they don't need to anesthetize. How often does he vomit? What is stool consistency? Did they by chance run a GI panel? Sometimes those results can help you mean one direction vs another

The feeding tube all depends on how reliably he eats. We've had cats that got home and back to not eating. A lot of people are scared by the tubes but honestly if there's any question about getting him to eat, I would do it. They're not too bad once you get used to it (so I hear). Eating is absolutely key for a post DKA cat. It's very encouraging he's eating on his own.

Lantus or its generics/biosimilars (if you are in the US, most people are able to find Semglee or "insulin glargine", the generics, pretty cheaply). Under no circumstances accept Vetsulin/Caninsulin. ProZinc isn't a bad option, but I much prefer Lantus/generics in a post DKA cat - they are more gentle in the vast majority of cats, thereby allowing you to increase the dose more safely and hopefully get regulated more quickly (also key for post DKA cat).

 

[FrostD]

Be sure to get detailed info on what they gave him and when - meds, insulins, etc. Many times they have to combine fast and long acting insulins to get it under control, but the fast are not safe to use at home. And sometimes they overshoot then intervene with IV glucose...so it's a bit of a mixed bag what you get upon discharge. The more info you have the better we can help

 

[Suzanne & Darcy]

Do you think they'll still want to do this now that he's eating on his own?

If he's eating really well, then probably not! This would be GREAT if he is eating normally (of course, he has to eat 1.5 times more food than normal.) I would find out exactly how much he is eating (if anyone is tracking how many ounce cans he's eating.

 

[Hendrick Cuddleclaw]

omg that is great to hear John! (about the eating)

I too have no offspring, just wasn't in the cards for us I guess. But the six cats my wife and I care for keep us busy!

 

[Bron and Sheba (GA)]

One additional question tho: should I ask the vet about using a certain kind of insulin or just use whatever they recommend?

It is true that Lantus is a very good insulin for cats which is a depot insulin. With Lantus it takes 5 days for the depot to fill initially so the full effect of the dose is not felt until then. DEPOT INSULIN.
HOWEVER with DKA they most likely have him on an in and out insulin, where the full effect of the dose is felt in every cycle from the beginning. So if they send you home on Caninsulin/vetinsulin or Prozinc I would continue with that for a couple of weeks while Henry gets past any ketones appearing. That is the main concern once he gets home …apart from making sure he eats enough and gets his dose of insulin….to keep ketones out of the picture. Once he is well past any ketones appearing we can get him changed over to Lantus.

 

[Hendrick Cuddleclaw]

we started Hendrick on Lantus then moved to a biosimilar/generic called Basaglar.

 

[Bron and Sheba (GA)]

Under no circumstances accept Vetsulin/Caninsulin. ProZinc isn't a bad option, but I much prefer Lantus/generics in a post DKA cat - they are more gentle in the vast majority of cats, thereby allowing you to increase the dose more safely and hopefully get regulated more quickly (also key for post DKA cat).

While I agree that Lantus is an excellent insulin for cats, I don’t agree with this for DKA cats when they first come home from hospital unless the cat has been started on Lantus while in hospital and has been monitored for ketones while the swap over has been done. If the cats comes home and then starts on Lantus, the depot has to fill initially over the next 5 days meaning the full dose of insulin is not being felt and there is a danger that ketones can appear. We often have kitties come back on Caninsulin or vetsulin and then once everything has stabilised, we do the swap over to a better insulin such as Lantus.

 

[John & Henry]

Thanks for the info on differences between Vetsulin vs Lantus. I will keep it in mind when I talk to the vet. Hopefully they have him on Lantus and I won't have to worry about transitioning.

How often does he vomit? What is stool consistency? Did they by chance run a GI panel?

Well prior to the last month or two he would vomit 2-5 times per week on average. Sometimes more, sometimes less. For the last couple months I'd say the average was closer to once per week. When I took him to the vet about this, they didn't find any problems in the bloodwork (again, I'm not sure what they tested and I don't think that vet was very competent since they've subsequently went out of business). Stool consistency has been normal/solid, but the smell has been so bad the last 6 months. It would permeate the whole house when he'd go. I don't think they did a GI panel but I'll ask about that.

 

[FrostD]

What Bron said makes sense to me for when he first comes home. With any luck they have him on Lantus plus a fast acting insulin, worth asking next time you chat with them.

Those symptoms could be either, so it's really up to you. If it were me, I would try novel protein until he's well past the DKA. Two reasons - (1) his liver is already a bit compromised for now, so I would not want to do budesonide yet and (2) prednisolone often affects the dose of insulin required, so you'd be in the situation of "not enough insulin" in the DKA recipe. I am no vet or oncologist, just based on what I know that's what I personally would do.

https://www.ibdkitties.net/ibd-or-cancer/

 

[Diane Tyler's Mom GA]

I'll pick up some cotton balls too.

Such great new about Henry ,you want cotton rounds , instead of cotton balls
They look like this

 

[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 20 seconds until it stops
Get 26 or 28 gauge lancets
Take a look at the lancets ,you will see one side points up, that's the side you want to poke with
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
A video one of our members posted
VIDEO: How to test your cat's blood sugar

 

[John & Henry]

you want cotton rounds , instead of cotton balls

Gotcha. Will do

 

[John & Henry]

A quick update on Henry. Just got off the phone with the IM vet and she said he is doing pretty well. Still eating but it sounded like she wished he was eating more. She didn't think the feeding tube would be necessary anymore. Electrolytes are getting better but they're still flushing ketones from his system. I really wish there was a mychart type app for vets so I could see the numbers. She also said they're in the process of transitioning him from short acting insulin to long acting just like you guys had talked about, although she didn't mention what brand. I let her know I've been studying up on all that I'd need to do and had a meter ready to go.

I really miss the little bugger and I'm sure he misses me too. While he's not a skidish cat he's probably so confused being in a strange place, hooked up to tubes without his human. While I've been very close with all 3 cats I've owned throughout my life, Henry is extraordinary affectionate towards me. Normally if I had been gone for a couple days the other two I've had would straight up ignore me for a few days after I'd get home, but not Henry. He'll come running up and rub all over me. I'll pick him up and he'll just purr and rub his face all over mine. I was away from him for a month one time and when he saw me the intensity of his greeting was like nothing I've seen from a cat before. It was a dog level reunion.

Get 26 or 28 gauge lancets

Thank you for all the detailed info on drawing the blood. That diagram is very helpful.

So I actually have a whole bunch of lancets but I had taken them out of the original package and put them in the case with the meter so I'm not sure what gauge they are. I'm pretty confident they're the smallest gauge they make since I've never been a fan of needles myself. Is it possible they could be too small and I'd need to get a larger gauge?

Also, I have one of those pens that holds the lancet (not really sure what this is called) where you can set the depth that it penetrates the skin. Is that not useful in this case and it needs to be done freehand?

 

[Bron and Sheba (GA)]

ust got off the phone with the IM vet and she said he is doing pretty well

That's great news

Electrolytes are getting better but they're still flushing ketones from his system. I really wish there was a mychart type app for vets so I could see the numbers. She also said they're in the process of transitioning him from short acting insulin to long acting just like you guys had talked about, although she didn't mention what brand. I let her know I've been studying up on all that I'd need to do and had a meter ready to go.

If they are doing the transition to a longer acting insulin before discharge, that will be easier for you. If it is Prozinc it is still an in and out insulin but if it is Lantus it is a depot insulin. BOth are OK insulins for cats although I personally prefer Lantus.

So I actually have a whole bunch of lancets but I had taken them out of the original package and put them in the case with the meter so I'm not sure what gauge they are. I'm pretty confident they're the smallest gauge they make since I've never been a fan of needles myself. Is it possible they could be too small and I'd need to get a larger gauge?

The 26 and 28 are bigger needles and are easier to get blood when you are new at it

lso, I have one of those pens that holds the lancet (not really sure what this is called) where you can set the depth that it penetrates the skin. Is that not useful in this case and it needs to be done freehand?

I always used one of the gadgets to hold the lancets. I found it easier but others like to do it freehand. Up to you.

Even though he is eating now, still make sure you get some antinausea medications to take home.

 

[Hendrick Cuddleclaw]

we started out with a lancing device but the loud click it makes in the cat's ear was no good for Hendrick, he would jolt every time, and we were really struggling. Multiple failed attempts with no blood droplets at all. Then we tried freehand and that made a huge difference for us, combined with all of Diane's help and those great pictures, and all the tips and tricks like using a smidge of vaseline -- this is key -- and warming the ear first (we actually use a usb-c rechargeable hand warmer now, used a sock with rice in it at one time but got tired of having to go to the kitchen to microwave it)

 

[Roxana & Henry]

@Hendrick Cuddleclaw Can you please send a link to the usb-c rechargeable hand warmer you have? That is amazing news I need that. I found this on amazon but seems big are there any smaller? You find the best gadgets/tricks. Keep them coming

 

[Hendrick Cuddleclaw]

@Hendrick Cuddleclaw Can you please send a link to the usb-c rechargeable hand warmer you have? That is amazing news I need that. I found this on amazon but seems big are there any smaller? You find the best gadgets/tricks. Keep them coming

that looks pretty much the same as the one we got. No, could not find any that were any smaller than that, seemed to be the smallest we could find.

https://www.amazon.com/gp/product/B09BQYT1X2/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&th=1

 

[John & Henry]

Thanks for the tip on the USB hand warmer, just bought one.

Just got off the phone with Henry's attending. She said his electrolytes are still off a bit but said he's eating very well now and hopes to be able to discharge him today! I'm so excited to see him.

I'm setting up his spreadsheet right now. I've got a large shopping list and I'm about to go pick the things up. Couple quick questions: I've read Walmart has the best deals on syringes, unfortunately there isn't any Walmarts near me. Would getting them at a place like Walgreens be highway robbery? There is a target close to me. Also, the glucose strips for my meter are a couple years expired. I will of course get some new ones, but would using the old ones for the time being give really bad readings? I'll probably have more questions, but those are the main ones I can think of right now.

I'd really like to thank everyone for all the info, tips, tricks & support. It really means so much

 

[Hendrick Cuddleclaw]

John that is such great news about Henry!

I have heard that expired strips can give bad readings, yes

I have zero experience buying syringes brick-n-mortar. We tried a bunch of different brands but were all ordered online.

just make sure wherever you get them, you get the right kind. You know what kind you're looking for? u-100 3/10cc with half-unit markings for Lantus/insulin glargine.

These are the ones we use, after trying a ton of different brands and having issues with many:

https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct


Great info on syringes here with several brands listed:

https://felinediabetes.com/FDMB/thr...info-proper-handling-drawing-fine-dosing.151/

 

[Angela & Cleo]

Thanks for the tip on the USB hand warmer, just bought one.

Just got off the phone with Henry's attending. She said his electrolytes are still off a bit but said he's eating very well now and hopes to be able to discharge him today! I'm so excited to see him.

I'm setting up his spreadsheet right now. I've got a large shopping list and I'm about to go pick the things up. Couple quick questions: I've read Walmart has the best deals on syringes, unfortunately there isn't any Walmarts near me. Would getting them at a place like Walgreens be highway robbery? There is a target close to me. Also, the glucose strips for my meter are a couple years expired. I will of course get some new ones, but would using the old ones for the time being give really bad readings? I'll probably have more questions, but those are the main ones I can think of right now.

I'd really like to thank everyone for all the info, tips, tricks & support. It really means so much

Great news. The type of syringes depends on the type of insulin.
If Prozinc you'll need U40 whereas Glargine requires U100.

 

[John & Henry]

just make sure wherever you get them, you get the right kind. You know what kind you're looking for?

Actually I have no clue. I figured they were all pretty standard besides the gauge and needle length. It seems that assumption is very wrong. I've been looking and all the differences are dizzying. I've found some of the U-100 3/10cc 31g on Amazon for decent prices with next day delivery, but only one that also has the 1/2 unit markings and they're almost $10 more than the ones without the 1/2 unit markings, which I wouldn't mind paying a little extra and give me time to order from that link you provided, but now that I've read @Angela & Cleo 's comment:

The type of syringes depends on the type of insulin.
If Prozinc you'll need U40 whereas Glargine requires U100

I feel like I should wait to see what kind of insulin they've put him on. Would it be safe to assume the vet will probably give me a couple to get started?

 

[Angela & Cleo]

Actually I have no clue. I figured they were all pretty standard besides the gauge and needle length. It seems that assumption is very wrong. I've been looking and all the differences are dizzying. I've found some of the U-100 3/10cc 31g on Amazon for decent prices with next day delivery, but only one that also has the 1/2 unit markings and they're almost $10 more than the ones without the 1/2 unit markings, which I wouldn't mind paying a little extra and give me time to order from that link you provided, but now that I've read @Angela & Cleo 's comment:



I feel like I should wait to see what kind of insulin they've put him on. Would it be safe to assume the vet will probably give me a couple to get started?

My Vet sent me home with a box of syringes which I paid for at "checkout" lol. But if you're concerned maybe a quick call to the clinic would be worthwhile to find out what exactly they are sending you home with and I would also ask for the meds @Bron and Sheba (GA) mentioned in post#3.
Sounds like you are on your way! I'm impressed. Keep asking questions and let us know when you get your sweet kitty home.

 

[John & Henry]

My Vet sent me home with a box of syringes which I paid for at "checkout" lol. But if you're concerned maybe a quick call to the clinic would be worthwhile to find out what exactly they are sending you home with and I would also ask for the meds @Bron and Sheba (GA) mentioned in post#3.
Sounds like you are on your way! I'm impressed. Keep asking questions and let us know when you get your sweet kitty home.

Yeah, sounds like I should give them a call. Now I'm looking at sharps containers and not sure what size to get. Do the needles usually unscrew from the syringes or do you have to dispose of the whole thing in the container? It seems like a smaller sized container would be better especially for traveling but if you gotta fit the whole syringe in each time then maybe I should just get the big 5 quart sized ones?

 

[Angela & Cleo]

Yeah, sounds like I should give them a call. Now I'm looking at sharps containers and not sure what size to get. Do the needles usually unscrew from the syringes or do you have to dispose of the whole thing in the container? It seems like a smaller sized container would be better especially for traveling but if you gotta fit the whole syringe in each time then maybe I should just get the big 5 quart sized ones?

Lol I used an old coffee can then brought the can with me to the next follow up vet visit 2 weeks later and asked them to dispose of them and give me my can back.

 

[John & Henry]

Lol I used an old coffee can then brought the can with me to the next follow up vet visit 2 weeks later and asked them to dispose of them and give me my can back.

Alright. Maybe I'll just wait on that for now then. Do the needles normally unscrew/disconnect from the syringe so they can be disposed of separately?

 

[Angela & Cleo]

Alright. Maybe I'll just wait on that for now then. Do the needles normally unscrew/disconnect from the syringe so they can be disposed of separately?

To be honest, I don't know. I carefully put the cap back on and then into the can.
I've since bought a sharps disposal container and take it to my local pharmacy for proper disposal per NYC Sanitation regs.

 

[Hendrick Cuddleclaw]

Alright. Maybe I'll just wait on that for now then. Do the needles normally unscrew/disconnect from the syringe so they can be disposed of separately?

no, but you can clip them off with this, which is what we do:

https://www.adwdiabetes.com/product/1246/bd-safe-clip-needle-storage-device

We also have this:

https://www.adwdiabetes.com/product...sharps-container-5-quart-transparent-red-each

And a smaller one:

https://www.adwdiabetes.com/product/6947/bd-nestable-sharps-container

 

[Hendrick Cuddleclaw]

and btw, you are well within your right to request a Lantus script for Henry you don't just have to be at their mercy far as what kind of insulin he gets. You hold the syringe!

 

[Roxana & Henry]

Thanks for the tip on the USB hand warmer, just bought one.

Just got off the phone with Henry's attending. She said his electrolytes are still off a bit but said he's eating very well now and hopes to be able to discharge him today! I'm so excited to see him.

I'm setting up his spreadsheet right now. I've got a large shopping list and I'm about to go pick the things up. Couple quick questions: I've read Walmart has the best deals on syringes, unfortunately there isn't any Walmarts near me. Would getting them at a place like Walgreens be highway robbery? There is a target close to me. Also, the glucose strips for my meter are a couple years expired. I will of course get some new ones, but would using the old ones for the time being give really bad readings? I'll probably have more questions, but those are the main ones I can think of right now.

I'd really like to thank everyone for all the info, tips, tricks & support. It really means so much

I am a newbie as well and made many mistakes and I will share so people can learn from them. My vet wrote me a prescription for U100 insulin syringes but never said which type and had no clue there are people ones and pet ones. So I went at Walgreens and did not pay that much (20 something for 100) I was super happy only to show up next day at the vet to show me how to use them and they tell they are no good they are people ones. They gave a free pack but not the ones with the 1/2 unit markings. I then finally got smarter after joining this site and ordered the Ulticare ones from Chewy - they need prescription but send them in two days which was why (sure there are cheaper out there but i needed them fast). A piece of advice, try to stick with the same brand because the 1/2 unit from my vetriject was not the same as the 1/2 unit in my ulticare. And everyone here recommending Lantus is absolutely right. Two vets recommended it including a feline specialist (highest chances of remission). The third is regular vet not specialized in diabetes and they only prescribe prozinc. I saw in a Facebook feline diabetes group that Lantus has a savings card on their site and you can buy the first 6 vials for 99 each (a vial lasts up to 6 month) . I will try that next time. Good RX will save a bit but not a lot. Many people here order from Canada. I am sure you are overwhelmed as many of us were prior to joining this site but it gets better. So happy your baby is feeling better. And what a beautiful name (I am not biased at all lol).

 

[John & Henry]

no, but you can clip them off with this, which is what we do:

Ahhh, very useful. I'll be getting one of these. Thank you

you are well within your right to request a Lantus script for Henry you don't just have to be at their mercy far as what kind of insulin he gets. You hold the syringe!

Haha, true. I'll definitely ask for it.

@Roxana & Henry Thanks for relaying your struggles on getting the correct syringe. That's is very helpful and I'm glad I didn't just run to Walgreens like I was planning. This board is such a great source of information.

I saw in a Facebook feline diabetes group that Lantus has a savings card on their site and you can buy the first 6 vials for 99 each (a vial lasts up to 6 month)

Ohh, excellent. That seems like a great deal. I realize they need to be kept refrigerated, but how long do they generally stay good for?

And what a beautiful name (I am not biased at all lol).

Lol, I noticed that too. Diabetic Henry's of the internet unite!

 

[Roxana & Henry]

So the Lantus vial lasts up to 6 months when maintained properly. Use only if the insulin appears clear and colorless.
It is in the link @Hendrick Cuddleclaw posted.
How long will my insulin last?

• The manufacturers of Lantus and Basaglar recommend discarding the insulin after 28 days of use. However, with proper handling and refrigeration, many Lantus and Basaglar users have been able to use a vial/cartridge/pen for six months and longer. Some use pens and vials to the last drop

 

[John & Henry]

So the Lantus vial lasts up to 6 months when maintained properly. Use only if the insulin appears clear and colorless.
It is in the link @Hendrick Cuddleclaw posted.
How long will my insulin last?

• The manufacturers of Lantus and Basaglar recommend discarding the insulin after 28 days of use. However, with proper handling and refrigeration, many Lantus and Basaglar users have been able to use a vial/cartridge/pen for six months and longer. Some use pens and vials to the last drop

Gotcha. There was a bit of a reading comprehension problem on my part as I thought your post had said "get your first 6 vials for $99" which is why I was wondering if they would last long enough to use. After re-reading what you actually said "get your first 6 vials for $99 each" it makes a lot more sense.

 

[Roxana & Henry]

Also, recommending Free Style Libre 14 days sensor. I use it and scan the heck out my Henry and when numbers are funny I do a quick ear prick with AT glucometer. It is good to show trends over 24 hrs period you can scan when you want and data is sent every 15 min so you can download to your computer and check when his nadir was easily. It has its flows (glucose measured from interstitial fluid not glood so sometimes is a bit off) but it is wonderful when used in conjunction with the ear prick (you won't need to do as many only when the libre is weird). There is a facebook group on it with videos and tips. People are applying it by themselves. Costs about 45 dollars at Walgreens with good rx or someone said they ordered it free from Abbot's site. Lasts 14 days if you apply a onsie on the cat or something to cover it so they do not pick at it (you don't need to do it but it is an option). For foods, it is not only the carbs that matter but also phosphorus content (as kitties get older their kidneys can't handle as much phosphorus). I had no idea, learnt it here and passing it forward. here is a great post on it
Post on treats : https://www.felinediabetes.com/FDMB/threads/list-of-low-carb-healthy-treats.9172/

Hope I did not overwhelm you with too much info. Do the best you can and take each day at a time and reach out to this forum. I am learning every day new info. People here are wonderful and very helpful. Hope Henry comes home soon.

 

[Roxana & Henry]

Gotcha. There was a bit of a reading comprehension problem on my part as I thought your post had said "get your first 6 vials for $99" which is why I was wondering if they would last long enough to use. After re-reading what you actually said "get your first 6 vials for $99 each" it makes a lot more sense.

It may be 10 vials not 6 . Here is the link. I have not used the savings card yet but will with my next purchase. Just hoping Walgreens will not protest that it is for a cat. Someone in facebook diabetes group recommended it so I assume it does work. Not all pharmacies will take prescriptions for Lantus for pets for Walgreens does and they did accept the Good RX so probably will accept this too.

https://www.lantus.com/sign-up-for-...rd&gclid=CJLnmuqt_vcCFdLdDQodfbAFhA&gclsrc=ds

 

[Diane Tyler's Mom GA]

Lantus or its generics/biosimilars (if you are in the US, most people are able to find Semglee or "insulin glargine", the generics, pretty cheaply)

If your get a script for lantus you can also buy the generics such as glargine Or Basaglar
Ask if they have a box of 5 pens
They will last you a year or more depending on the dose
Call around and see if they have this , they might also have a discount card you can use
You would use the pen just like a vial, I'll post a pic ,you just take the top off the pen and stick the syringe in the rubber stopper and draw out your insulin
Keep in the fridge , they will also have the expiration dates on them .
One pen could last 6 months The expiration dates are most will be 2023 or 2024. Last OK at them
. Most all of us buy the pens
I also like the pens because the insulin is inside the plastic covering, in case you ever drop it it's less likely to break like a vial

Just stick the syringe in the rubber stopper and draw out your insulin

 

[Diane Tyler's Mom GA]

Here is a saving card for basaglar for 5 pens
Check it out just put in where it says set your location
https://www.goodrx.com/basaglar

 

[Bron and Sheba (GA)]

@John & Henry
What is the latest update with Henry?

 

[John & Henry]

Hi all,

Sorry to not have updated sooner, its been an exhausting week with hardly getting any sleep and I finally feel like I can breathe a sigh of relief. So I picked him up late last night. Vet said his electrolytes were still off a bit and BG was in the 300s but the acid/base of his blood was good. He was very excited to see me and kept begging for food all the way home. Vet prescribed cerenia for nausea (1/4 of a 16mg tablet, once per 24 hours), also buprenorphine for pain but I forgot where she said the pain was suspected to be from (pancreatitius?, I'll have to ask). She called in an Rx for a Lantus pen that I picked up on the way to get him but wanted me to use syringes to administer the insulin. She gave me U100 3/10cc 29g 1/2" syringes and did a demonstration with saline for me and my wife. I told her how I was ready to go with the BG/ketone meter and she seemed a little dubious as to how useful the information would be aside from charting a 24 hr every 2 hour BG curve which she said I should do occasionally. I don't really agree with that assessment and I've been closely monitoring him since we got home. She wanted me to start with just 1 unit of insulin every 12 hours. She also wanted me to keep him exclusively on Purina proplan DM (a prescription diet) 1-2 cans per day. I don't feel that this is enough given he has lost so much weight and needs to gain. She said to feed him 30 minutes before the shot. When we got home I have him a whole can of the Rx food and he ate ravenously but only ate about 1/2-2/3rds of the can but then started begging me for food even though he could have went back and eaten more (which he actually did, he would go back and pick at it every 10 minutes or so, but still didn't finish more than 2/3rds). Here's what his numbers look like I've charted so far: PMPS: 313 ketones: 2.3 (that really worried me. +2.5: 286 +5.5: 231 AMPS: 203 ketones: .7 (this was really encouraging it went down so much overnight and the BG was so much lower) +3: 229 +6.5: 304

Checking the BG has been a bit of a challenge for me. The first 3 took me about 4 sticks before I was able to get a suitable bead I could feed into the meter quick enough. Complications include: him shaking his head when I do the stick, his fur absorbing the blood so I can't get enough blood. Strangely he seems more comfortable with the actual poke than me gently trying to "milk" out enough blood to run the test, and the blood either drying too quickly or not getting enough out or both. I started using Vaseline and that seems to really help with it not absorbing into his fur. The last time I did it, I got it first try, so hopefully my luck will improve as my skill level increases. I think these lancets are 31g but I ordered some 28g ones that'll be here tomorrow. Hopefully that'll help too. When I held a flashlight up to his ear just to see what the vains looked like, I noticed what seemed to be areas of blood underneath the skin on/near the "sweet spot" from the images in this thread, so it makes me wonder if this is how they were testing him in the hospital?

He was acting so hunger last night and not finishing that Dx diet that I broke down and gave him a can of his favorite friskies turkey and giblets shreads (I'm guessing this stuff is like the McDonald's of the cat food world). He ate about 2/3rds of the can. I read that it's supposed to be low carb and his BG actually went down a couple hours after. I just want to get some meat back on his bones!

He's been so attached to me since he's been home. Constantly on my lap purring or curled up to me in bed. He's been super cool about the actual insulin shots. Not so much as a flinch. The vet told me to administrator them to the scruff on the back of his neck (which I've read here really isn't the optimal spot) but it's probably easiest for a beginner like me. I wish he'd drink more, but he might be sneaking laps when I haven't been looking. She didn't give me any subQ fluids and I didn't want to seem bosey or a Dr. Google and request them, but it does worry me he's not getting enough fluids.

Well, I think I've got most of the important details down here, I've probably forgot something but I'll add if I remember anything else. He's scheduled for an appointment with her on Wednesday.

 

[John & Henry]

Oh, already thought of something to add and maybe the most important detail. He's been walking strange. The vet mentioned that neuropathy is possible from high BG (although is 300s high enough to cause this?) which can cause strange gait/back legs stop working. He also wasn't able to jump up to where his food is (the only other time his happened was the day before he went to the hospital) I of course put his food and water on the ground. I'm just wondering if it's due to the fact we was in a cage at the hospital for 3 days or neuropathy or just general weakness from being sick? I'm really not sure. Hopefully it gets better. He has (barely) made the leap up to my lap several times now so his hindes are working in some capacity.

 

[Bron and Sheba (GA)]

Hi John, I’m so glad to hear that Henry is home and doing OK so far.
I can’t see the spreadsheet. Have you got it up and running yet? It’s important we can see the BG data to help you with the dose.

That is great he is eating well. Make sure he is eating plenty.
There is no need to stay with the Purina food. Any low carb food is fine. And remember that if he won’t eat the low carb, any food is fine at this stage.
Can you list the ingredients and % of the friskies you fed so we can see how many carbs please?
I’m surprised the vet thought the ketones information would not be useful
Read through the plan I gave you in post three and try and make sure you adhere to that.

It’s possible he has some neuropathy from the diabetes. It’s common and will improve with treatment.
There is a medication which meant of us give to help it called Zobaline from lifelink.com but I would concentrate on just getting him over the recovery. of the DKA at present.