8/10 Laila PMPS HI (Out of range) Post DKA

[lena7098]

Laila stopped eating on Tuesday and I took her to the emergency vet that night. She had DKA and they kept her there from the night of 8/3 to the morning of 8/8. They stabilized her electrolytes but they did worry at first because her magnesium was low and they said that is a bad indicator. They did raise it as well as the others to normal though. They used a fast acting insulin while she was there and discovered that my Lantus was probably ineffective and I had it too long and that was why she went into DKA. They said she was eating well in there. When I visited she would eat for me, but similar to now she'd eat a little and stop. I did not test BG or ketones before this event at home. She had been on 1/2 U twice a day. When they released her they put her on 1 U with a new vial so she has been on this since Saturday night (8/7) (I'm US Central time). They also put on a Freestyle Libre and I've been taking a lot of readings but many of them are out of range. They said when they released her that the BG was still high and to schedule an appointment with my internal medicine vet this week. She is scheduled to see the vet on Friday (8/13). She isn't eating as well as normal. Before this she ate 4-5 cans a day and now she's getting about 2 cans a day since Sunday. She seems to want the food but just sits beside it or nibbles a little and stops. I'm free feeding right now in hopes she'll eat it. She excitedly ate some dried chicken and tuna treats tonight but pretty quickly it looked like it gave her nausea. I have some ketone strips but don't know how to do it because she won't let me place them under her so I'm not sure how to collect the urine. She's very particular and freaks out about things like that, and noises, and the tv. She can be very feisty when she has the energy to fight things. I'm new here so hopefully I've done this correctly. I started a spreadsheet with the Freestyle data. Oh, she eats FF classic pate. She has IBD as well.

 

[Bron and Sheba (GA)]

I will look at it now and reply. Thanks for starting your own thread. Much better as we can concentrate on Laila
I am going to ask @Marje and Gracie to move this thread over to the main health page though, as you are new and we like you to start over there.
You don’t have to do anything though and you will be notified when it’s moved

 

[Liz & Minnie]

Welcome and I'm sorry to hear what you've been going through. Just writing a bit for now before someone more experienced chimes in. Your s/s and signature all look good to me! And on the plus side I am definitely seeing a curve on Laila's s/s - a nice obvious nadir of 283 at +7 today.

My easy tip on the ketone strips (or at least the way I do it) - I put a small amount of litter in the tray so when she pees there's a big puddle and I dip the strip right in. I haven't seen this method recommended anywhere but it's worked for me (obviously depends on if there are other cats).

Have you ever tested her blood glucose manually/do you have a monitor/strips/lancets etc? For future reference you can also test ketones with a blood sample. If you want to go this route, the meter I use is the Novamax - you can buy different strips for checking blood glucose and ketones. Ketone strips are expensive but you can buy the monitor and strips as a set on https://www.adwdiabetes.com/ And here's a link about ketones though you may have seen already https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

Her behavior also sounds to me like nausea. Did they give you any medication for that? With the recent DKA, loss of appetite and still high BG I would not wait until Friday if it were me - if she's not eating in the morning I would give them a call and let them know what's going on.

I am not an expert at all but I've been through a few DKAs myself, so you have my sympathy. Luckily you have @Bron and Sheba helping you now (it took me so long to write this)! You are in good hands.

 

[Bron and Sheba (GA)]

Hi Lena and Laila and welcome to the forum. I am so glad you have found us. I am sorry Laila has had DKA but you have come to the best place to get help in getting her back to her former self.

• Did the vet give you any antinausea medications for Laila on discharge? it sounds to me like she is nauseated. This is very common in cats recovering from DKA.

I would ask your vet for either cerenia or ondansetron…or both. Ondansetron is often better for nausea. They work on different pathways and can be given together. She may also need an appetite stimulant. But make sure you also get the antinausea meds as they need to be given first before the appetite stimulant.

• It is very important Laila eats and eats a lot. Food helps keep the ketones away. She needs to be eating 1 1/2 times as many calories she normally would.

So you can see how Important it is you get those antinausea medications from the vet as soon as possible.
Don’t worry if she won’t eat her normal low carb food at the moment. Offer her whatever she will eat. Eating trumps everything so even high carb and dry is OK at the moment.

• The other really important thing is insulin…..don’t skip any doses. Insulin also helps keep the ketones away.

If she is too low to shoot….stall dont feed and post and ask for help. And test again in 20 minutes to see if the BG is rising.

• Give extra fluids. You can put teaspoon of warm water in each snack if she will tolerate it.
  
• Did they say she had any infection or inflammation? Did they send her home on any antibiotics? If so, make sure you finish the course.
• are you testing daily for ketones? It is really important that you do this. If you don’t have any Ketostix or DiaKetostix please go and get some from Walmart or a pharmacy and test the urine for ketones. Please let us know if there is even a trace of ketones. You need to tell the vet if there is more than a trace of ketones.

It looks to me as if the dose of insulin needs to be increased. I would increase the dose to 1.25 units at the next dose. Do you have 1/2 unit syringes?
Please ask lots of questions,

 

[lena7098]

The vet did not give the meds but I had left over cerenia and appetite stimulant from my cat that just passed away last month so I gave them yesterday early evening. She did end up eating two cans that I left out overnight and she ate the whole can at the AM shot time. So that seems like progress. I’ve put only a little litter in the box so I can try to get a puddle to test her ketones when she pees. I have U-100 syringes so they only have single unit markings.

 

[lena7098]

I tried to line up the syringe to just below the line instead of at the top of the line this morning, so that’s probably not an extra .25 but maybe a little more.

 

[lena7098]

No in response to the question of infection or inflammation or antibiotics

 

[Bron and Sheba (GA)]

Try and pick up some 1/2 unit syringes if you can. If you live in the US, Walmart have 1/2 unit ReliOn syringes. You need U100 3/10 30 or 31 gauge 6 or 8 mm 1/2 unit syringes.

I am glad Laila is eating better. You may need to continue with the cerenia and appetite stimulant for a while. Offer snacks every couple of hours throughout the day and evening. Withhold the food for the two hours Preshot though so the Preshot BG is not food influenced.

Please let us know when you get a urine ketone result.

 

[lena7098]

I will look at it now and reply. Thanks for starting your own thread. Much better as we can concentrate on Laila
I am going to ask @Marje and Gracie to move this thread over to the main health page though, as you are new and we like you to start over there.
You don’t have to do anything though and you will be notified when it’s moved

Hi, I’m not sure if I should post in here or make a new thread…Laila’s at least had several hours in the 300s so it seems she’s coming down and she’s eaten much more but I’m not seeing her drink water. How can I get her to drink more?

 

[Bron and Sheba (GA)]

Keep posting on this thread. This is your thread.
If you can get those 1/2 unit syringes, you will be able to give the 1.25 units more accurately.
If she will eat when you do…. You can add some warm water to her food and mix it to make it sloppier. About a teaspoon of warm water each snack.

 

[DArcey and Buddy]

Hi, I’m not sure if I should post in here or make a new thread…Laila’s at least had several hours in the 300s so it seems she’s coming down and she’s eaten much more but I’m not seeing her drink water. How can I get her to drink more?

Just wanted to send some love and let you know I’ve been thinking of you and Laila. The post DKA road can be be hard but she is lucky to have you

 

[Bron and Sheba (GA)]

How are things today Lena with Laila? I see the vet raised to dose to 2 units
Are you testing daily for ketones? It is very important you do this. Can you put the results into the remarks column of the SS please?
How is Layla’s appetite today? Is she eating well for you?

 

[lena7098]

Just wanted to send some love and let you know I’ve been thinking of you and Laila. The post DKA road can be be hard but she is lucky to have you

Thank you. Her internal medicine vet saw her friday and doesn’t think the insulin was expired, she thinks lailas ibd caused the DKA and she wants to biopsy. She also told me to up Laila to 2 units over the weekend to see if it helped. Laila seemed a little better this morning but tonight even though she’s in the 200s finally I’m not sure if she’s ok. So it does seem a struggle. How is Buddy doing? Better I hope!

 

[lena7098]

Welcome and I'm sorry to hear what you've been going through. Just writing a bit for now before someone more experienced chimes in. Your s/s and signature all look good to me! And on the plus side I am definitely seeing a curve on Laila's s/s - a nice obvious nadir of 283 at +7 today.

My easy tip on the ketone strips (or at least the way I do it) - I put a small amount of litter in the tray so when she pees there's a big puddle and I dip the strip right in. I haven't seen this method recommended anywhere but it's worked for me (obviously depends on if there are other cats).

Have you ever tested her blood glucose manually/do you have a monitor/strips/lancets etc? For future reference you can also test ketones with a blood sample. If you want to go this route, the meter I use is the Novamax - you can buy different strips for checking blood glucose and ketones. Ketone strips are expensive but you can buy the monitor and strips as a set on https://www.adwdiabetes.com/ And here's a link about ketones though you may have seen already https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

Her behavior also sounds to me like nausea. Did they give you any medication for that? With the recent DKA, loss of appetite and still high BG I would not wait until Friday if it were me - if she's not eating in the morning I would give them a call and let them know what's going on.

I am not an expert at all but I've been through a few DKAs myself, so you have my sympathy. Luckily you have @Bron and Sheba helping you now (it took me so long to write this)! You are in good hands.

Thanks for the ketone reading tip. It worked.

 

[lena7098]

Laila’s vet told me to try two units over the weekend. I’m nervous but trying it since she has the meter on and I can see if I need to apply syrup, etc. the vet thinks that her ibd is the issue and wants to biopsy or start giving her steroids but said to try 2 units first.

 

[Bron and Sheba (GA)]

Those number are looking better, but we don’t recommend going up in whole units. With your lowest numbers being pink, we would have suggested going up by 1/2 unit.
Why do you think she is not OK.?
Is she eating?
When did you last test for ketones?

 

[lena7098]

Those number are looking better, but we don’t recommend going up in whole units. With your lowest numbers being pink, we would have suggested going up by 1/2 unit.
Why do you think she is not OK.?
Is she eating?
When did you last test for ketones?

She’s just having behavior she does when she doesn’t feel well, especially in the evening, and during the day time she still has times that she asks for food then stares at it…so maybe it is the IBD. But yesterday she did stay out of her hiding place for a little bit and did seem interested in the laser toy for about a minute which was progress. I told the vet that y’all said not to go up 1 unit at a time but she said that was wrong. I felt more inclined to go slow like y’all said but since Laila had the monitor I decided I’d go with the vet BUT the monitor stopped working this morning. No Ketones when I checked two days ago.

P.S. Is there guidance about removing the sensor now that it’s not working?

 

[Bron and Sheba (GA)]

and during the day time she still has times that she asks for food then stares at it…so

That sounds as if she is nauseated. Are you giving her any antinausea medication such as cerenia or ondansetron?
How much is she eating a day. It is really important she is eating lots of food.

I told the vet that y’all said not to go up 1 unit at a time but she said that was wrong. I

She is incorrect. It is much safer and better to go up in 1/4 unit increments.

felt more inclined to go slow like y’all said but since Laila had the monitor I decided I’d go with the vet BUT the monitor stopped working this morning.

So you are unable to test at all now?
You will need to either get another libre attached or start home testing yourself. I would get a human meter if you decide to do that. It is much cheaper than trying to use apart meter. It is not safe to have increased the dose and are not testing.

No Ketones when I checked two days ago.

You need to be testing daily for ketones.

there guidance about removing the sensor now that it’s not working?

I have no experience moving the libre.

 

[lena7098]

Laila played today for the first time in two weeks!

 

[Bron and Sheba (GA)]

Laila played today for the first time in two weeks!

Wonderful!
Is she still eating well?
Any ketones? Remember to test daily for them