At home care post DKA/ICU

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Britt118

Britt118

Member Since 2020
Hi all,

Sounds like I'll be bringing Eddy home from the ICU today after his DKA event. Woohoo! I just talked to his new Dr that took over today and he should be able to come home after his abdominal ultrasound.

I have about a zillion questions regarding at home care. The two most important being BG tracking and diet.

I will likely purchase a Relion today as I won't be able to get an Alphatrak for a few days still. I am considering the FreeStyle Libre, also. What are people's thoughts/experiences with that?

He was eating Hills z/d wet prior to all this which I will not be giving him anymore (high carb). I had planned on Fancy Feast pate as I've heard it's good for diabetes. He also has his IBD and CKD that I need to consider. The vet mentioned Purina OM and DM. Are there any food gurus that know a great option for a diabetic cat with IBD and CKD? His IBD results in constipation.

I have renal K gel (potassium) to give him (1 tsp BID) so hopefully he will eat that in his food.

This isn't specific to diabetes, but are there probiotics that won't cause an IBD flare up (apparently Fortiflora may cause IBD flare)?

Insulin shots. He will be getting Prozinc 1u BID. I understand now that if he doesn't eat, that means no shot, correct? Also - I will be giving the shot around 7:30 AM/PM. Is it alright to give him a mid day meal?

What happens if for some reason he has to miss a shot?

It doesn't sound like he will be coming home with his NG tube as he is eating well, and I don't think I'll be doing sub c fluids either.

Thank you so much to all of you for taking the time to read this and comment. I appreciate it so much as this is overwhelming and I just want to take the best care of Eddy when he comes home ♥️ I can't wait until I'm a pro and then can offer others advice!
 
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Okay here are my answers:

IBD probiotics - visbiome is the best. It’s human and you can order it online. Minnie gets 1/3 of a capsule mixed in with food.

IBD diabetes friendly foods to try - Ziwi Peak and Rawz are the 2 I like the best because you can get novel proteins and they’re human quality

ReliOn is great I switched to it from Freestyle, but not he libre. The libre only lasts for about 2 weeks and it needs to stay on to work. A lot of cats manage to get it off

great news btw!!! :bighug::bighug::bighug:
 
Aleluia Grugru & Minnie said:
Okay here are my answers:

IBD probiotics - visbiome is the best. It’s human and you can order it online. Minnie gets 1/3 of a capsule mixed in with food.

IBD diabetes friendly foods to try - Ziwi Peak and Rawz are the 2 I like the best because you can get novel proteins and they’re human quality

ReliOn is great I switched to it from Freestyle, but not he libre. The libre only lasts for about 2 weeks and it needs to stay on to work. A lot of cats manage to get it off

great news btw!!! :bighug::bighug::bighug:
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Thank you so much!
 
Hi Britt

Britt118 said:
Insulin shots. He will be getting Prozinc 1u BID. I understand now that if he doesn't eat, that means no shot, correct? [...] What happens if for some reason he has to miss a shot?
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Before you take Eddy home, ask the vet for guidance on dosing if Eddy isn't eating (see next point) and what to do if you get a preshot BG that is lower than usual. Skipping doses isn't as straightforward for ketone-prone cats in general, doubly so if a cat is recovering from a DKA episode.

HUGELY IMPORTANT:

Please, please, please make sure the vets give you a good supply of anti-nausea and appetite stimulant meds to take home with you. The most common reason I've seen here for post-DKA cats to relapse during convalescence is if they're still a bit queasy and can't eat consistently. Cats need insulin AND calories to keep ketones at bay. If you can tackle any nausea and/or appetite problems really promptly the recovery process can be much smoother.

Britt118 said:
I did just read through the FAQ section which has a lot of this info also. Whew. So much info
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If you check back on one of your earlier threads I put a subset of key links that are most relevant to where you are at the moment. If you bookmark that thread it might help you find key bits 'n' pieces quickly.


Mogs
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Critter Mom said:
Hi Britt


Before you take Eddy home, ask the vet for guidance on dosing if Eddy isn't eating (see next point) and what to do if you get a preshot BG that is lower than usual. Skipping doses isn't as straightforward for ketone-prone cats in general, doubly so if a cat is recovering from a DKA episode.

HUGELY IMPORTANT:

Please, please, please make sure the vets give you a good supply of anti-nausea and appetite stimulant meds to take home with you. The most common reason I've seen here for post-DKA cats to relapse during convalescence is if they're still a bit queasy and can't eat consistently. Cats need insulin AND calories to keep ketones at bay. If you can tackle any nausea and/or appetite problems really promptly the recovery process can be much smoother.


If you check back on one of your earlier threads I put a subset of key links that are most relevant to where you are at the moment. If you bookmark that thread it might help you find key bits 'n' pieces quickly.


Mogs
.
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Found it - thank you so much!

The vet is sending him home with Cerenia which he has been on and has been successful, and I have Mirtazapine at home, so hopefully those will both work if needed!

I'm taking the day off tomorrow to fully read through all of this info and put all the kits and supplies together and whatnot. ♥️
 
Britt118 said:
The vet mentioned Purina OM and DM.
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The OM diet would provide fibre but too many carbs. The first four ingredients of the dry are carbs. Not great for a diabetic cat.
The DM is nothing special. You can find better, higher quality ingredients in other cat foods. Ale listed a few and I'm sure others will add to her recommendations.
If your vet insists, buy a can or two to try. You can always tell the vet that your cat stopped eating them on a regular basis and return for a refund. The manufacturers guarantee that.
 
He's home!! Doesn't seem very happy with me and also doesn't want to eat. I had the Dr remove the Ng tube because she said he was eating great for them. Worried I'll have to skip his first shot back home tonight.
 

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Oh wow, that is A Look, for sure!

Please don't skip a shot unless advised to do so. It's extremely important that he gets insulin right now, in these early post-DKA stages. They can be very delicate at this point.

Give him some time to get settled back in. How long until you would usually shoot?
 
Whew. Okay, thank you both! I will give him his shot. It's supposed to happen right about now. I did call the hospital and they too said to give a shot, and if he's still not eating by tomorrow morning, they can place an NG tube. We did JUST get home and he may still be feeling the effects of what they gave him for his ultrasound. He also had a small constipation episode upon getting home. I gave him his 2 ml lactulose Poor guy. Now I have to go poke him :/
 
Britt118 said:
Found it - thank you so much!

The vet is sending him home with Cerenia which he has been on and has been successful, and I have Mirtazapine at home, so hopefully those will both work if needed!

I'm taking the day off tomorrow to fully read through all of this info and put all the kits and supplies together and whatnot. ♥️
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This will all have to be given to him via the tube. So you’ll need to crush them and add to the blended food

Edited: urghhh I’m sorry this whole time I thought we were talking about the same tube Minnie had, but she had a traqueal one placed and it stayed for 2 weeks. My vet would not send her home without a back up in case she refused to eat. I suggest you get the tube back in if he continued not wanting to eat. Don’t chance it.
 
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Cerenia is very bitter. If he won't eat it in something like a pill pocket or other disguise, you might want to see about getting some empty gel caps, size 3, 4, or 5 are good. Larger size means smaller gel cap. You can buy them online at Amazon and a few other places. You can even buy them meat flavoured. :woot:

I second Ale on the Visbiome. I get the packets and do 1/20th twice a day. A packet lasts more than a week.

Other food options include raw or home made cooked or raw. I used the FoodFurLife EZComplete premix and made my own low carb, low phosphorus (for kidneys), novel protein (for IBD). Some of the Natures Variety Instinct are also novel protein and low carb.
 
Wendy&Neko said:
Cerenia is very bitter. If he won't eat it in something like a pill pocket or other disguise, you might want to see about getting some empty gel caps, size 3, 4, or 5 are good. Larger size means smaller gel cap. You can buy them online at Amazon and a few other places. You can even buy them meat flavoured. :woot:

I second Ale on the Visbiome. I get the packets and do 1/20th twice a day. A packet lasts more than a week.

Other food options include raw or home made cooked or raw. I used the FoodFurLife EZComplete premix and made my own low carb, low phosphorus (for kidneys), novel protein (for IBD). Some of the Natures Variety Instinct are also novel protein and low carb.
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Thanks for the info! So many food options. I'm just hoping he will eat something now that he's home. I'm considering trying out a Weruva low carb/low phos at some point.

He used to eat his Cerenia in a soft treat relatively well until he decided one day to stop eating soft treats. I tried pill pockets and any other soft treat I could find. The vet actually discharged him with Zofran instead of Cerenia and I'm a little nervous about it, because I've read it may cause constipation which he already has and takes lactulose for....
 
Do you know what food proteins his IBD reacts to? I stay away from Weruva now (other cat) just cause I have to avoid fish, and chicken. :rolleyes: But Neko ate a couple of the Weruva when she went off raw.

Zofran is a good choice, and not bitter so easier to give. The problem with it is it doesn't last long and you may need to dose 2-3 times a day. I didn't notice a lot of constipation problems with Zofran (ondansetron) but always make sure to add plenty of water to food.
 
Hey all - I think I can ask this. I did my first home testing this morning with the Relion Premier Classic and the first reading was 130 and the second 134. He didn't eat prior to his shot last night but ate overnight (most of a can of fancy feast, not sure what time). He gets 1u of Prozinc. Should I give him his shot?
 
I'm not sure the rules for lower dosing for DKA kitties but he still will need his shot, maybe half? Ugh I wish someone more experienced was online this early. Can you stall feeding for 20 min and see if his BG goes up? Normally we want to see new diabetics over 200 for full dose but again - DKA kitties need their insulin.
 
Panic said:
I'm not sure the rules for lower dosing for DKA kitties but he still will need his shot, maybe half? Ugh I wish someone more experienced was online this early. Can you stall feeding for 20 min and see if his BG goes up? Normally we want to see new diabetics over 200 for full dose but again - DKA kitties need their insulin.
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I could do that....I did just give him a little bit of food, I'm not sure if that changes things.
 
That may inflate the numbers a bit since he ate - let's see what it says. It may be wise to give a half dose and feed higher carb food to be safe. Sorry I don't have experience with it but I know he can't skip.
 
The front desk at the vet said to have him eat a full meal and then give him his shot. He didn't eat a full meal, just partial. The only high carb food I have is fancy feast gravy lovers - not sure if that is TOO high carb? I'm just waiting for a call back from the vet - hopefully she calls soon. I just don't know whether to no shot, half shot, or full shot.....this is hard.
 
The spreadsheet is just today's number basically because he was diagnosed 9/3, I started insulin 9/5 (just one shot), the he was in the ICU for DKA. Maybe I will do a half shot, since he only ate a little bit. Still waiting to hear back from the vet.
 
Sorry it took so long to read this. Unfortunately I don't have any experience with DKA but it looks like you already received good advice. Even though you gave half the dose, I would recommend testing a few more times throughout the day to make sure he does not drop too low.
 
Lisa and Witn (GA) said:
Sorry it took so long to read this. Unfortunately I don't have any experience with DKA but it looks like you already received good advice. Even though you gave half the dose, I would recommend testing a few more times throughout the day to make sure he does not drop too low.
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Thank you! I definitely plan to test throughout the day (more ear pokes :/ )
 
Panic said:
How are you and Eddy doing this evening, Britt? Did your even get back with you?
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Thanks for checking in! We're doing alright. Struggling to give him his Zofran (he spit it out AM and PM) but he hasn't vomited and is eating (grazing). Still a little wobbly on his back leg - not sure if he's still regaining his strength or if it's neuropathy.

Both vets contacted me so I feel a little better now. And we have an appt with a new vet who specializes in feline diabetes next Monday! (I'm keeping his internal medicine specialist from the hospital as his IM and considering this new vet as his general).
 
Britt118 said:
We did JUST get home and he may still be feeling the effects of what they gave him for his ultrasound. He also had a small constipation episode upon getting home.
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Sedatives and anaesthetic agents can indeed cause constipation.

Not sure if I've mentioned it before but a couple of days treatment with metoclopramide (Reglan) can help restore normal gut motility (get vet to to check to make sure no intestinal blockages before this or other anti-constipation treatments begin). Other helpful info at felineconstipation.org. If constipation is an issue it needs to be addressed promptly because anti-nausea meds don't tend to work properly until it's sorted.


Britt118 said:
Finally saw the labs from 9/3 (vet visit two days prior to ICU admission). Says ketones 1+. No one told me. Also borderline low potassium.
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Not good that you weren't informed, Britt. :mad:

That's a bad miss on the ketones.


Mogs
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Critter Mom said:
Sedatives and anaesthetic agents can indeed cause constipation.

Not sure if I've mentioned it before but a couple of days treatment with metoclopramide (Reglan) can help restore normal gut motility (get vet to to check to make sure no intestinal blockages before this or other anti-constipation treatments begin). Other helpful info at felineconstipation.org. If constipation is an issue it needs to be addressed promptly because anti-nausea meds don't tend to work properly until it's sorted.



Not good that you weren't informed, Britt. :mad:

That's a bad miss on the ketones.


Mogs
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Thank you! I'm going to peruse the website today.
 
I've got an appointment with a new vet who was recommended to me as one with an interest in feline diabetes and complex medical issues. I emailed him Eddy's labs this morning and he ALREADY reviewed them and called me. I feel such a relief to know Eddy will be in good, competent hands!
 
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