7/12 Sabrina amps 249, +9.75 58....dka protocol?????

[milfordcollector]

Good evening Lantus Land!!!! I haven't updated Sabrina's ss for quite a while but need some advice from experienced eyes regarding the recovery from DKA. She was hospitalized from last Saturday 7/5 through Wednesday 7/9. The vet sent me home with amoxil, sub Q fluids(150ml per day), Tumil-K, anti nausea if needed, appy stimulant, & denamarin. The vet started her Lantus back up Wed.(1U) morning at 10am........needless to say her bg #s didn't warrant a shot Wed. night I tested her ketones in the afternoon...1.7. Now no shot til Thursday morning amps(+23.75) 1U..ketones 1.0....she hung out between 42-58 all through the day & +12 93....(no pm shot) Friday started @ 269, amps 278 .75U, ketones 3.5.....ended @ +14.50 79, no shot again. Today ambg 225, amps 249 .5U, ketones 3.5, now at +9.75 58......no pm shot so far...............I'm so confused......will sub q bring down the bg, I have her on FF kitten turkey, & prescription DM....she has an adversion to food so I've been syringe feeding her, tried all tricks stinky cheese, tuna, cooked chicken.....whatever I can think of :? I just ordered more test strips(ketone, blood) for my meter but the earliest I'll possibly get them is Tuesday........................SUGGESTIONS, ADVICE, OR JUST SUPPORT IS GREATLY APPRECIATED...........Thanks Cindy & Sabrina cat_pet_icon

recap: 7/9
amps(At vet, no reading) 1U
+4.75 90, ketones 1.7
+11.25 54
+16.50 151

7/10
+23.75.....amps 173 1U.....fed & waited 1/2 h before dosing
+3 86, ketones 1.0
+3.75 50
+4 45
+4.25 42
+4.5 52
+4.75 50
+5 54
+5.25 57
+6 43
+6.25 54
+6.5 52
+7 58
+7.5 50
+8.25 46
+9 45
+9.75 55
+12 93..............exhausted, can't do this to her & I anymore.........we rested all night, no shot I-)

7/11
ambg 269........fed 2syringe purina dm
amps 278, ketones 3.5 .75U
+1 257
+2.5 211
+3.75 170
+6 135
+9.5 82
+12 81
+12.75 96
+13.50 98
+14.50 79.......................again no shot tonight

7/12
ambg 225...........fed 2syringe ff kitten turkey
amps 249 , ketones 3.5 .5U
+1.5 228
+3.5 162
+5 92
+9 51
+9.75 58
+11.25 107...................so far no shot tonight................... ohmygod_smile

 

[julie & punkin (ga)]

i'm not an expert on this cindy, but you want to get the insulin going and in her. if you can't shoot 1.0u or 0.75u, go to 0.5u or 0.25u, but some insulin is really important. along with the food, which you obviously already know.

107 is shootable if she's eating. you can shoot over 50ish, but in your case, i'm not certain. are you able to syringe enough in her?

let me get some eyes on her that have more experience with DKA.

 

[Sienne and Gabby (GA)]

Cindy:

How are you measuring ketones? Basically, trace levels of ketones can be handled at home. If ketones exceed a trace level you need to contact your vet immediately. Even with low numbers, it's possible for ketones to appear.

Ketones are the result of food not being metabolized which is what happens when insulin isn't helping glucose get into the cells or there's not enough insulin available to do the job. Instead of protein being broken down, fats are being metabolized. Once they appear, the electrolytes can quickly get out of balance which can cause a life threatening situation. Ketone bodies are a by-produce of that metabolism. Ketones can appear if there's not enough insulin, a cat's not eating, and there's an infection present.

Julie is correct in that you need to make sure that Sabrina is getting insulin. Even if you have to feed higher carbs, you want to make sure that Sabrina is getting insulin since that's one of the ingredients that will help keeping ketones at bay. I've been known to tell people (only somewhat in jest) that I don't care if you have to feed your kitty a hot fudge sundae, if that's what you're cat will eat and it will allow you to get insulin in, that's what you do. (Just please don't feed your kitty chocolate -- save that for you!) Food and insulin are hugely important. Giving fluids helps to "dilute" the ketones. So, either administering fluids or adding water to Sabrina's food will help.

There really isn't a protocol for handling DKA. As I keep harping, food, insulin and water are good. Making sure you test for ketones whenever it's feasible until you're sure that Sabrina is back to herself is also important. If you see that she's lethargic, not behaving like herself, if you smell an acetone-like (nail polish remover) odor on her breath, she's staggering, test her BG and test for ketones -- especially is you notice an acetone-like smell or lethargy. Keep in mind that if you're urine testing for ketones, those levels are not as up-to-the-minute as compared to testing for ketones in the blood.