9/24 Oberon PMPS 373, ketones 2.7, possible DKA; +3 404, +6 325

Lisa & Oberon

Lisa & Oberon

Member Since 2020
yesterday: lots of pink and low ketones https://www.felinediabetes.com/FDMB...363-6-363-10-380-pmps-376-3-397-5-391.235775/

Ketones (in blood, not urine) 1.6 this morning; appetite is good and I watered down his food a bit. I'll probably check again at about the +6 BG check. Really hoping he decides to respond to the insulin at some point. Right now it looks like we're heading for another big increase to 5.0 U tomorrow evening.
 
Still hanging out in the pinks... :banghead:

Been thinking about this a bit. I had been hoping that even though his BG was staying high, the insulin he was getting was still getting enough glucose into his cells for him. The ketones make me think otherwise, and that the problem isn't just insufficient insulin production, it's also insulin resistance of some sort (as Wendy also mentioned a couple of days ago). Because at 4.5 U, you would think that his cells would have gotten enough glucose if they were able. Glucose toxicity seems to be the likeliest cause, but I need to rule out other causes. I'll give it until we get to 5 U, and then maybe it's time to see the vet.

I've been holding off on updating the vet at all since I started this back in July... our last chat was when he told me to just check him in the morning and give him 1U if BG was over 300. I told him I'd split it across morning and evening doses, and started following FDMB procedures instead. He has no idea I've been adjusting the dose. I think I've been waiting to update him until I see an effect, so I can show him that what I'm doing is working. I'm a little worried he'll look at the data and think I've been giving too much insulin (Somogyi effect) and need to lower the dose, when from everything I've read here that's exactly the wrong thing to do. But at this point I think I'll need his help to figure out what might be causing the insulin resistance. Maybe I'll see if I can see one of the other vets in the practice instead, just to get fresh eyes on the situation.
 
Aargh. Ketones are 2.7. Dinner's in the middle of cooking. As soon as that's done I'm going to call the ER (my vet just closed, of course) and see if I need to bring him in.
 
While I was on the phone with the receptionist deciding whether we needed to bring him in, he puked up dinner everywhere. That clinched it. They're only doing curbside and they're 15 minutes away, so I dropped him off rather than waiting around. Just got home. Hoping to hear something in an hour or so. My guess is that they'll keep him overnight for fluids and stuff, at least. Can anyone here with DKA experience give me an idea of what to expect?
 
And I just heard back... they think I need an internal medicine specialist and theirs is out for 2 weeks, so they're bouncing me over to another hospital. Gotta go pick him up and head elsewhere. Aargh.
 
I'm so sorry you're going through this with Oberon right now. :bighug: Anything above 2.4 is a definite vet visit, is my recollection.
Sending lots of healing vines to him. Keep us posted on how he is doing.
I tried to search for who has had experience going through DKA. @AliceMeowliss&Cassandra has DKA in her signature, but haven't seen her lately. Possibly @Olive & Paula ? She talks about ketones a fair bit.
 
Update: he's doing well (all vitals stable, hasn't thrown up again; eating well) and the internists at the other hospitals aren't in until morning anyways. So they're going to give him some subq fluids and I'm going to bring him home for the night, then try to get in to see the internist tomorrow.
 
Putting it out to the universe that you get to see an internist tomorrow, and that you get answers as to why he seems so insulin resistant. Healing light sent for Oberon, and calming waves for you and your family. :bighug:
 
Lisa & Oberon said:
Update: he's doing well (all vitals stable, hasn't thrown up again; eating well) and the internists at the other hospitals aren't in until morning anyways. So they're going to give him some subq fluids and I'm going to bring him home for the night, then try to get in to see the internist tomorrow.
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The fluids will help flush the ketones out.
Ask for anti-nausea, anti-vomiting meds (two different things but the meds can be taken together). It is important that Oberon eats. One of the symptoms of ketones turning into full blown DKA is not enough food. (DKA = not enough insulin + not enough food + an infection or inflammation.) Also ask for a couple of cans of A/D and a syringe in case you have to syringe feed. A cat with DKA should be eating 1 1/2 times the normal calorie intake. The A/D is easy to syringe.
 
I've no direct experience with DKA but have seen it on the forum.

Ask for the lab results. And post them when you get a moment (you need to include the reference values).
 
Home now. BG at home 404 (at +3.75) and ketones 2.8 (could be within meter variance; I have no idea about the ketone meter). He's eating a lot now. (I brought food with me to the vet, but they didn't use it; I'll call back to see what they fed him in case it wasn't low carb.)

Vitals at the ER: temp 100.4, pulse 180, resp 48 (high, I know, but he may have been stressed there. I'll check him here when he settles down.) Physical exam was normal; they didn't run any labs.
 
When you see the internist. Ask for the IGF 1 (acro test) and the IAA (insulin resistance test). Normally wait until you reach 6 units, but as long as they draw blood for tests might as well get them now. You been struggling for awhile now. If nothing else, they can rule it out. Don't let them tell you the tests are not reliable or worth doing. They are worth it. It can change how you dose and treat the BGs. Ask them to humor you, for your peace of mind. The tests are sent to Michigan U, the only place in the US that does them.

Keep trying to get food and fluids in. Do you think there is a chance of any infection?

Did they make appt for you?

Hang in there, try to get some rest (easier said than done) tonight so your at your best to talk with internist.
 
Olive & Paula said:
When you see the internist. Ask for the IGF 1 (acro test) and the IAA (insulin resistance test). Normally wait until you reach 6 units, but as long as they draw blood for tests might as well get them now. You been struggling for awhile now. If nothing else, they can rule it out. Don't let them tell you the tests are not reliable or worth doing. They are worth it. It can change how you dose and treat the BGs. Ask them to humor you, for your peace of mind. The tests are sent to Michigan U, the only place in the US that does them.

Keep trying to get food and fluids in. Do you think there is a chance of any infection?

Did they make appt for you?

Hang in there, try to get some rest (easier said than done) tonight so your at your best to talk with internist.
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Good idea, thanks! I'd already started thinking about those tests down the line, but this is a good opportunity.

Working on food and fluids. He got 100 mls of fluids and Cerenia at the ER. I don't see any obvious signs of infection, but maybe his teeth need checking?

They didn't make an appointment for me; at the one place I called there aren't any appts available tomorrow and they said my best bet would be to get in by way of the ER early in the morning, and then the ER vet would transfer care over to the internist. But there's also a second ER practically across the street from the other one that I didn't call since I'd already made the decision to bring him home for the night. They have 5 internists so I'm hoping they might be a better bet. Maybe I'll call them now to lay some groundwork. (Also, I checked the online directory of board certified internists, and these three hospitals are really the only ones nearby that have anyone.)

Resp. rate 26 just now, so that's fine.
 
Wendy&Neko said:
Lisa, I am sorry for the day you and Oberon have had. :bighug::bighug: Did the hospital do bloodwork? Just wondering if they have done that to see if anything is off, or if there is infection. I'm glad he's eating, he needs his calories right now.

Tagging a few others with experience in DKA @Sienne and Gabby (GA) @Staci @Baer & Loki
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They didn't do any bloodwork; initially since she was recommending transfer to another ER she wasn't even going to charge me for the exam, and didn't run any actual tests. Once I decided to do fluids, etc. I did get charged, of course, but meanwhile the bloodwork fell through the cracks. I didn't even really think about it until I'd picked him up.
 
Teeth could definitely be a possibility. Sandy's Black Kitty had really high IAA, and once she got his teeth well and truly fixed, it broke the IAA and he eventually went into remission. In the mean time, she had to deal with a couple cases of DKA.
 
Also, the ER vet suggested that I not feed him or give his morning insulin, in case the other ER needs to sedate him for an ultrasound or something. I really don't think that's a good idea given the ketones, and I sure don't want to mess with his depot right now, but what do you think?
 
If they need to sedate him, the no food makes sense, but I would take some "breakfast" with you for him to eat later. I would give him at least a half dose of insulin. Most cats getting anaesthesia get a half dose. If the other ER needs to, they can always give him Humulin R, a short acting insulin, to help bring down his numbers. Can you phone the other ER vet clinic in the AM?
 
I'm going to call them as soon as I can in the morning, but I have a feeling it won't be nearly as early as I'd like. It's 1 am here now and I'm finally heading to bed. Numbers are coming down (BG 325 and ketones 2.1), and I can still see some of the fluids he got so he hasn't even absorbed it all. (How long does that usually take?) So that's promising. My guess is that I'll get up and do the usual routine at 7, shower, then call the vet. All bets are off if he suddenly starts looking worse, though.
 
Lisa & Oberon said:
I can still see some of the fluids he got so he hasn't even absorbed it all. (How long does that usually take?
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Depends on a number of things, how much was given, how dehydrated he was. Nice to see numbers come down a bit. Good luck tomorrow. :bighug:
 
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