? Arya: 2/23 PMPS 234 +2 388, 2.75u, slight pos trace ketones, DKA dosing advice?

KatieBDZ

KatieBDZ

Member Since 2020
Yesterday's post: http://www.felinediabetes.com/FDMB/...360-increase-post-dka-hl.226012/#post-2531880

Good morning all,

Just wondering if I should continue to stay the course on Arya's current dose? Happy not to see a black number this morning but ketones test at 530 was a very faint positive for trace. She continues to eat well and drink well and generally is acting very happy and normal. My mom is going to check her PMPS BG and give her the PM injection today as practice but probably will not be able to test much after that (I will get in another +3 I think). This morning I can get up to a +5 I think. Also starting tomorrow I will only be able to get an AM +1 in before work. Just wanted to be clear/honest about my BG testing capabilities for today/going into the work week if that at all played a factor for help on dose. She will have some supervision Monday though during the day.

Other questions - when can I begin to try to transition her food and when is she considered recovered from DKA/HL? I just want to give her the best chance I can of remission but I also want to continue to make sure she is healthy/eating enough obviously. Thank you all hope everyone has a great day!
 
I'd try removing the dry food as soon as possible.

If she refuses to eat the wet food without the kibble, you can try mixing it together and each day add a little less...Dry food will continue to keep her BG numbers high. Please continue to get as much fluid into her as possible - another benefit of wet food - moisture/liquids help with kidney function.

Which dosing method are you going to follow? SLGS or TR? Please read through the stickies and select one - it's important as we all use those methods to help you with information about how long to hold a dose, etc.

Glad to see you'll be able to get in more tests. Good work!
 
Sue and Luci said:
I'd try removing the dry food as soon as possible.

If she refuses to eat the wet food without the kibble, you can try mixing it together and each day add a little less...Dry food will continue to keep her BG numbers high. Please continue to get as much fluid into her as possible - another benefit of wet food - moisture/liquids help with kidney function.

Which dosing method are you going to follow? SLGS or TR? Please read through the stickies and select one - it's important as we all use those methods to help you with information about how long to hold a dose, etc.

Glad to see you'll be able to get in more tests. Good work!
Click to expand...

After reading through them I think the TR makes sense for her and is close to what I've been doing, I just can't really get in any more tests during the week other than +1 in AM and up to +4 in PM..is that ok? Im hoping to get one WFH day a week where I can get more in and obviously weekends I can too.

I've looked at the food charts a bunch - is there any wet food you'd particularly recommend for a picky eater? Also should I be worried about changing her diet and being somewhat limited on testing for the week? Thanks!
 
Hi Katie
Stay with the same dose of insulin.
Try and get a ketone test in twice a day at the moment if you can, especially if there is a hint of any ketones.

At the moment she is still recovering from the DKA and HL so we need to keep doing all the things we have been doing up until now, to ensure the ketones are kept away.

With the food.... continue as you are with the same food at the moment. You can offer some of the new low carb food as you have been doing but please don’t change it all yet to low carb. To do a swap over you are going to have to be testing frequently as the BGs will drop and the insulin dose will have to be adjusted.

Also we don’t want to decrease the dose of insulin at the moment. Ayra needs this much insulin to keep the ketones away. And if you swap the food over to low carb, the dose will most likely need to be decreased.
With DKA the priority is to get Ayra to eat as much as possible, make sure she is getting enough insulin and fluids and she is taking her antibiotics to get rid of any infection.
Read through the yellow stickies about the dosing methods, but at the moment there is no rush for you to decide. We need to get her over the DKA/HL recovery period first.
Does all that make sense?
 
The issue with removing all the dry food and switching to wet is the reduced carbs - so you have to be careful and transition slowly - once all the dry food is gone you can begin TR as no dry is allowed on that method...also watch her BG's as simply removing the dry food can cause quite a drop in those numbers.

I had good luck with good ole Fancy Feast - however I have to hit up a couple of different stores for different flavors - and I can never give Luci the same flavor two times in a row!

I find that chewy.com and amazon both have wet cat foods and both have excellent return policies - I've tried a variety of wet foods and some Luci will eat and some she just will not eat! I've gone to the pet stores but haven't ever found one in there that she liked except for Weruva in the pouches - which she gobbled up until I bought a whole case - and then I guess she saw it and simply refused to eat another bite - wth! That's a cat for you...

I have found that using the food chart from Dr. Pierson was my best ally for finding a variety of wet foods to try - and it's really trial and error finding the one's they'll eat and that are also good for them. @Bella's Mom has to use special foods for Bella - so you might want to see what she has to say/recommend for that as well.
 
@Sue and Luci,
Hi Sue. Ayra has only very recently come out of hospital following DKA and is still recovering from both DKA and HL and as recently as just over a day ago had moderate ketones in her urine, so our priority at the moment is to keep the ketones at bay.
To do this we have to make sure she is eating 1 1/2 times what she normally would eat and she is getting sufficient insulin to combat the ketones and drinking plenty of water.
So at this point we are ok with her eating the dry food because she will eat it well. Once the threat of ketones reduces we can think about low carb food.
Does that make sense?
 
Bron and Sheba (GA) said:
Hi Katie
Stay with the same dose of insulin.
Try and get a ketone test in twice a day at the moment if you can, especially if there is a hint of any ketones.

At the moment she is still recovering from the DKA and HL so we need to keep doing all the things we have been doing up until now, to ensure the ketones are kept away.

With the food.... continue as you are with the same food at the moment. You can offer some of the new low carb food as you have been doing but please don’t change it all yet to low carb. To do a swap over you are going to have to be testing frequently as the BGs will drop and the insulin dose will have to be adjusted.

Also we don’t want to decrease the dose of insulin at the moment. Ayra needs this much insulin to keep the ketones away. And if you swap the food over to low carb, the dose will most likely need to be decreased.
With DKA the priority is to get Ayra to eat as much as possible, make sure she is getting enough insulin and fluids and she is taking her antibiotics to get rid of any infection.
Read through the yellow stickies about the dosing methods, but at the moment there is no rush for you to decide. We need to get her over the DKA/HL recovery period first.
Does all that make sense?
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Hi - ok yes this makes sense thank you - I just want to try to get her as healthy as possible as quickly as possible but I also of course want to do it safely and to make sure she is fully recovered from the DKA/HL first. She does seem to be doing well/much better than when I first got her home. I will try to get the two ketones tests in a day as I can - should I be doing one in morning one at night? It's harder because she gets offended now when I put her in her litter box whereas before she'd just go for me lol. How long will the DKA/HL recovery period be and how will I know she's recovered? Is it necessary to do a follow up ultrasound like she got in emergency vet or blood work? She has 5 days (after today) left on her antibiotic - it's called Zeniquin. Thank you!
 
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KatieBDZ said:
Hi - ok yes this makes sense thank you - I just want to try to get her as healthy as possible as quickly as possible but I also of course want to do it safely and to make sure she is fully recovered from the DKA/HL first. She does seem to be doing well/much better than when I first got her home. I will try to get the two ketones tests in a day as I can - should I be doing one in morning one at night? It's harder because she gets offended now when I put her in her litter box whereas before she'd just go for me lol. How long will the DKA/HL recovery period be and how will I know she's recovered? Is it necessary to do a follow up ultrasound like she got in emergency vet or blood work? She has 5 days (after today) left on her antibiotic - it's called Zeniquen. Thank you!
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All cats are different and recover at different rates. We know she is improving as she is eating much better and you comment she seems better.
Having the ketones disappear and not return will be a big indicator that she is improving.

I don’t know what the ultrasound was so I can’t comment on that really. It was most likely to do with the HL. You would need to be guided by the vet on that.
Did you tell us what the antibiotic was for? It would be worth while following up on that to see that the infection has gone completely. That is important.
With the blood work, the vet may want to follow up with the HL.
You are doing a really good job looking after her. You can’t rush it though. She had both DKA and HL and she’s doing well.

With the urine tests try and get one morning and one night if possible but we understand Ayra needs to cooperate.
 
Bron and Sheba (GA) said:
Ayra has only very recently come out of hospital following DKA and is still recovering from both DKA and HL and as recently as just over a day ago had moderate ketones in her urine, so our priority at the moment is to keep the ketones at bay.
Click to expand...

Yes, I'm sorry I didn't mean to muddy the waters...I wasn't fully aware of her history. Thanks for the clarification! :)
 
Bron and Sheba (GA) said:
All cats are different and recover at different rates. We know she is improving as she is eating much better and you comment she seems better.
Having the ketones disappear and not return will be a big indicator that she is improving.

I don’t know what the ultrasound was so I can’t comment on that really. It was most likely to do with the HL. You would need to be guided by the vet on that.
Did you tell us what the antibiotic was for? It would be worth while following up on that to see that the infection has gone completely. That is important.
With the blood work, the vet may want to follow up with the HL.
You are doing a really good job looking after her. You can’t rush it though. She had both DKA and HL and she’s doing well.
Click to expand...

Ok thank you he told me to follow up on Monday so I will ask him then about those issues. She is eating some of her Orijen fit and trim dry food mixed with tiki cat chicken broth now so maybe I will continue to try that for added moisture while she is still eating the dry food. Her +2 was 419 should I continue to get in any tests?
 
Sue and Luci said:
Yes, I'm sorry I didn't mean to muddy the waters...I wasn't fully aware of her history. Thanks for the clarification! :)
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Thank you sue for your help sorry if I didn't provide enough information I'm still learning/struggling myself but like I said just want to get her as healthy as I can and am not totally clear on everything yet.
 
KatieBDZ said:
Ok thank you he told me to follow up on Monday so I will ask him then about those issues. She is eating some of her Orijen fit and trim dry food mixed with tiki cat chicken broth now so maybe I will continue to try that for added moisture while she is still eating the dry food. Her +2 was 419 should I continue to get in any tests?
Click to expand...

That broth is a great idea. And small amounts of the canned food to get her used to it is ok (about what you have been giving) but we don’t want to change the diet until you can monitor and we aren’t getting ketones popping up.

yes keep testing as much as you can please. We want to know as much as possible about her BG numbers.
 
I agree with making any food transition slowly. Because of the history of DKA/ketones, you do not want to upset any of the delicate balances you've been watching. Aside from numbers dropping if you make an abrupt transition to low carb, canned food, a quick transition can cause a stomach. upset. The last thing we want to see is that Arya doesn't want to eat because she's having GI troubles. Dr. Lisa's site has information on transitioning a cat to a canned food diet.

There isn't a specific amount of time that it takes for a cat to recover from HL and DKA. My kitty was like Arya and had both when she was diagnosed with FD. Once she started eating, the HL wasn't an issue. She was lucky and I never saw another ketone once she was home. That's not always the case. Some cats are sensitive to developing ketones for some time which is why we push getting ketone tests. There have been cats here who will range from trace to small ketones for seemingly no good reason. There's no way to know if they didn't drink as much, eat as much, their insulin dose was a fraction off, etc. We've had cats that needed to be rehospitalized, as well. (I suspect that there was an underlying infection/inflammation that was never completely resolved and it flared.) This is one of those "every cat is different" (ECID) things. Just be vigilant with testing for ketones. The ketone testing is preventative versus being caught off guard. If I had one word of wisdom it's to look for any change in behavior, especially lethargy.

An US would show an enlarges liver. However, I would presume there would be other signs. Blood work for liver issues would be elevated. Was Arya refusing to eat prior to diagnosis? I think when Gabby was diagnosed they sent out all of her GI labs to TAMU (Texas A & M University) which is one of the major diagnostic veterinary labs. That was also some time ago.
 
Sienne and Gabby (GA) said:
I agree with making any food transition slowly. Because of the history of DKA/ketones, you do not want to upset any of the delicate balances you've been watching. Aside from numbers dropping if you make an abrupt transition to low carb, canned food, a quick transition can cause a stomach. upset. The last thing we want to see is that Arya doesn't want to eat because she's having GI troubles. Dr. Lisa's site has information on transitioning a cat to a canned food diet.

There isn't a specific amount of time that it takes for a cat to recover from HL and DKA. My kitty was like Arya and had both when she was diagnosed with FD. Once she started eating, the HL wasn't an issue. She was lucky and I never saw another ketone once she was home. That's not always the case. Some cats are sensitive to developing ketones for some time which is why we push getting ketone tests. There have been cats here who will range from trace to small ketones for seemingly no good reason. There's no way to know if they didn't drink as much, eat as much, their insulin dose was a fraction off, etc. We've had cats that needed to be rehospitalized, as well. (I suspect that there was an underlying infection/inflammation that was never completely resolved and it flared.) This is one of those "every cat is different" (ECID) things. Just be vigilant with testing for ketones. The ketone testing is preventative versus being caught off guard. If I had one word of wisdom it's to look for any change in behavior, especially lethargy.

An US would show an enlarges liver. However, I would presume there would be other signs. Blood work for liver issues would be elevated. Was Arya refusing to eat prior to diagnosis? I think when Gabby was diagnosed they sent out all of her GI labs to TAMU (Texas A & M University) which is one of the major diagnostic veterinary labs. That was also some time ago.
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Hi so yes on diagnosis she was only eating treats (which she became obsessed with) but was not really eating her regular food for about 2 days. She also lost 6 lbs in about a month - hence the vet visit which led to these diagnoses. She had very high ketones and BG so my vet immediately sent me to ER vet. Since she's been diagnosed though even in the hospital she has had a strong appetite. She had one elevated liver enzyme which led to the US and they said her liver was large and bright - they aspirated and then diagnosed with HL after the results of that. But even when I brought her in all vets were amazed at how well she was presenting - active, eating, alert..my vet said with her diagnoses he would have expected to see a dying cat and it was like she didn't read the playbook (he speculated it could be due to her young age). If it wasn't for the HL the ER vet wanted to release her after one day. Going to take this as a positive but it does make me worry I may miss if she's not feeling well - will continue to do the ketones tests, make sure she's eating, drinking and getting her insulin and hope this is good!
 
The fine needle biopsy/aspiration is the gold standard for an HL diagnosis. It doesn't sound like she was jaundiced, though. She may have been on the cusp of it being more critical. The rule of thumb I've always head was that you don't want your cat to be not eating for 3 days. In any event, keep in mind that it's not so much quantity of food that's important -- it's calories. The more calorie dense the food, the less you need to feed. And grazing is fine.
 
Sienne and Gabby (GA) said:
The fine needle biopsy/aspiration is the gold standard for an HL diagnosis. It doesn't sound like she was jaundiced, though. She may have been on the cusp of it being more critical. The rule of thumb I've always head was that you don't want your cat to be not eating for 3 days. In any event, keep in mind that it's not so much quantity of food that's important -- it's calories. The more calorie dense the food, the less you need to feed. And grazing is fine.
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Yes she was not jaundiced. And thank you - good to know! Right now she's probably getting a little over 500 calories a day (while weighing aprox 9.9lbs) but she lost so much muscle along her back so I'm hoping she starts to gain that back and a little more weight..it makes me feel so bad when I pet her and I can feel her spine/ribs/pelvis :(
 
KatieBDZ said:
Her +2 was 419 should I continue to get in any tests?
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It would be great if you could get a mid cycle test, somewhere in the +5 to +7 range, just to give us an idea how much she’s dropping.

I fostered a HL kitty from the local shelter. Once he started eating on his own, after two weeks of me assist feeding all his food, he was fine. I felt I opened a million cans of different food to find something he would eat. What worked was something completely different from what he was used to, and associated with being sick.

500 calories a day is awesome!
 
I'd change your title to the PMPS number, DKA and " dosing advice pls" or something so folks know what you are waiting on or asking about ...
This post should bump you up to the top of the convos too
 
That's a good BG.. .not sure about being worried but I don't have dosing advice. Are you hesitant because it's the lowest you have shot? You can stall- don't feed and retest to see where the numbers are heading in the meantime...

Seeing who is around...
 
Good stuff...wasn't sure with her medical history if there were other concerns at play :)

Hope that little furbaby surfs safely overnight.
Congrats on your lowest PS number
 
Wendy&Neko said:
Don't stall, this is plenty high enough to shoot, as long as you can get a test in a few hours.
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Thank you yes just nervous because it's the lowest I've actually shot and she was at 500s yesterday so it just feels fast! Also it was my mom who got the BG/shot was having her practice without me to see if she could do it so it added to the nerves but I will be able to get a +2 and +4 tonight hopefully that's good
 
Si am cat mom said:
Good stuff...wasn't sure with her medical history if there were other concerns at play :)

Hope that little furbaby surfs safely overnight.
Congrats on your lowest PS number
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Thank you! Yes just nervous because it's the lowest I've shot and she was in 500s yesterday so it feels abrupt but happy she's responding and if you all tell me it's ok :)
 
i suspect she paddled around the yellow longer than she is used to today and is bouncing. can you get a ketones test tonight?
 
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