At the ER

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Kristin and Dewey

Kristin and Dewey

Member Since 2020
I am at the ER with Dewey now. I assume he is in DKA. He was normal this morning and ate all his food. His bs was in the 400s the way it has been and I planned to increase insulin tonight to 3.5u. By +3 hours he vomited all his food and was dry-heaving and having liquid diarrhea every few minutes. Checked BS and was in 300s. Tried to check ketones but meter kept giving errors. I scooped him up and took him to the ER and now I am waiting to see what the dr says. Needless to say I am sick with worry and feeling guilty because I couldn't go in with him due to COVID. Please say a prayer for us!
 
Kristin I’m so sorry to hear that! I just want to say I know the feeling having had to rush Minnie to the ER twice during covid19 and the first time with similar symptoms. It could be something to do with his GI tract so try to stay positive until you hear from the vet. And you did the right thing as he’s in the best place to heal now

sending lots of love, positivity and healing thoughts to you and that ball of fluffy fur that is Dewey :bighug:
 
Thank you all for the prayers and comments. Dewey is staying at the hospital for now. The dr thinks it might be pancreatitis. She plans to do an abdominal ultrasound. She said he was relaxed and comfortable and very loving. She is an internal medicine specialist and said I could work with them to regulate him. She has seen many diabetic felines and is used to working with it. I miss him and worry but at least I will have some good guidance. I will update you when I know more.
 
Happy to hear Dewey is in great hands and being taken care of :bighug:. Hospitalization can really turn a cat with Pancreatitis around much more quickly than struggling at home, so although it is sad when they have to go in and stay, it is much better in the end. I hope you are able to go home and get some rest tonight. My thoughts and prayers and healing vibes are being sent your and Dewey’s way!
 
Update: Dewey is home! No ketones, ultrasound showed moderately enlarged pancreas that she felt looked more like resolving or chronic pancreatitis. She saw 2 small nodules in the pancreas that could possibly be cancer :nailbiting: and if not ruled out with further data a biopsy could be done. He also had an ileus and enteritis. He ate like a champ last night and this morning and had a normal stool there. They placed a Freestyle Libre (I am so excited about this!) and it is working great so far. He doesn't seem bothered by it at all and completely ignores it. They gave him a bath and a little trim because he had poop all over him from the awful diarrhea. He looks so handsome but so skinny. One liver enzyme was high and she isn't sure what is causing it (liver looked normal), WBC and Lymphocytes are up slightly, BG in 300s, and all other labs look OK. She sent home Cerenia for nausea, Visbiome probiotic twice a day, and something to stimulate appetite as needed. He had some diarrhea this afternoon but it wasn't like yesterday. I have an appointment to bring him back on Friday.

I want to thank you for the support. This is truly a great group! :bighug: I feel like I have found a vet I can trust and that is a huge weight off my shoulders. I am choosing not to dwell on the cancer possiblity at this point since I can't do anything about it. If she recommends a biopsy I will have it done. I was going to post pics but couldn't figure out how. Does anyone know how to do it?
 
Kristin and Dewey said:
She sent home Cerenia for nausea, Visbiome probiotic twice a day, and something to stimulate appetite as needed.
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Points out of 10 to your vet!!! So many times I've seen reports here of vets who send DKA and pancreatitis patients home with no supportive meds for the convalescent period (been there myself, too). It can make the world of difference to recovery if one is armed with the necessaries to address 'hiccups' immediately they arise, instead of having to delay response while waiting for the vet to issue the required prescription(s).

For general information, pancreatitis flares can lead to out-of-whack liver values. Hopefully this will resolve by the time of Dewey's next bloodwork.

Following on from the recommendation above, if Dewey were not to find Denamarin an agreeable liver supplement, Hepatosyl Plus for cats is an alternative liver supplement you could try if one is needed.

Wishing Dewey a speedy recovery from the diarrhoea!


Mogs
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Unfortunately the CGM lasted only one day before falling off. We went back and got another one but it never worked. Got a third on put on today and it never worked, either, so I am done with those. It is too bad because I was so excited to get all that data. It would have been great to see trends. Oh well, sigh. The dr saw Dewey today and said his pancreas looked a little smaller but not normal. We are switching him to Lantus 1u tonight for better coverage. She wants me to do a glucose curve on Thursday and call her with the results Friday. Then a week later she will see him again and do another ultrasound. She said something about diabetic food and I told her the food he was on was Tiki Cat and it has 0 carbs....she seemed surprised. She is good but not THAT good :D. I will read up on the Lantus page tonight and give you an update soon. :cat::cat::cat:
 
Kristin and Dewey said:
Unfortunately the CGM lasted only one day before falling off. We went back and got another one but it never worked. Got a third on put on today and it never worked, either, so I am done with those. It is too bad because I was so excited to get all that data. It would have been great to see trends. Oh well, sigh. The dr saw Dewey today and said his pancreas looked a little smaller but not normal. We are switching him to Lantus 1u tonight for better coverage. She wants me to do a glucose curve on Thursday and call her with the results Friday. Then a week later she will see him again and do another ultrasound. She said something about diabetic food and I told her the food he was on was Tiki Cat and it has 0 carbs....she seemed surprised. She is good but not THAT good :D. I will read up on the Lantus page tonight and give you an update soon. :cat::cat::cat:
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I read somewhere in this website that somebody said 0 carbs food may not be the best for diabetic cats. They suggested about 3-5% carbs, if I remember it correctly.

update: here is the link
https://www.felinediabetes.com/FDMB/threads/feeding-lowest-zero-carb-vs-lower-carb-foods.144220/

They talked about 3% vs 7% carb.
 
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Kristin and Dewey said:
Unfortunately the CGM lasted only one day before falling off. We went back and got another one but it never worked. Got a third on put on today and it never worked, either, so I am done with those. It is too bad because I was so excited to get all that data. It would have been great to see trends. Oh well, sigh. The dr saw Dewey today and said his pancreas looked a little smaller but not normal. We are switching him to Lantus 1u tonight for better coverage. She wants me to do a glucose curve on Thursday and call her with the results Friday. Then a week later she will see him again and do another ultrasound. She said something about diabetic food and I told her the food he was on was Tiki Cat and it has 0 carbs....she seemed surprised. She is good but not THAT good :D. I will read up on the Lantus page tonight and give you an update soon. :cat::cat::cat:
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When my Cat had the Libre on it was put on with surgical glue did they use the same with Dewey ? I also fed Tiki cat and one she really liked was Weruva paw licken chicken it looks like shredded chicken lol
 
Dusty & Roe said:
When my Cat had the Libre on it was put on with surgical glue did they use the same with Dewey ? I also fed Tiki cat and one she really liked was Weruva paw licken chicken it looks like shredded chicken lol
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I think the vets always want to sell you food, when you are feeding something they like & will eat they want you to give them something else. Hold on, I know it gets scary, but there are lots of us here that have kitty's that get pancreatitis and sometimes pretty bad, but most of the time with a lot of prayers and medicine we make it through. Hoping, your guy keeps improving and you can get some rest.
 
Kristin and Dewey said:
Unfortunately the CGM lasted only one day before falling off. We went back and got another one but it never worked. Got a third on put on today and it never worked, either, so I am done with those. It is too bad because I was so excited to get all that data. It would have been great to see trends. Oh well, sigh. The dr saw Dewey today and said his pancreas looked a little smaller but not normal. We are switching him to Lantus 1u tonight for better coverage. She wants me to do a glucose curve on Thursday and call her with the results Friday. Then a week later she will see him again and do another ultrasound. She said something about diabetic food and I told her the food he was on was Tiki Cat and it has 0 carbs....she seemed surprised. She is good but not THAT good :D. I will read up on the Lantus page tonight and give you an update soon. :cat::cat::cat:
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Awe cute pics of Dewey, one suggestion, in your signature you might want to say that you switched to Lantus on 7-31 . I see you put it on your SS in the remarks column but it might not be seen, you can also add it on your SS in that brown cell where you have Vetsulin Also if you can add your meter you are testing with to your signature.:cat:
 
On carb % of food: I think it's not an "always", it's a "sometimes" that cats do better on food in the 3-5% range than 0%. So it's just something to keep an eye on-- if he likes the Tiki and does well on it, no worries! But if you are getting puzzling BG numbers, switching bumping up the carbs a tad is a (non-intuitive) option.

Bummer about the Libre. That's one of the frustrations people have had-- some cats just can't seem to keep the monitor on them. My Amber never had to have one, but she did have to have a pain patch a couple times, and they always had a terrible time keeping it stuck to her-- something about how oily her skin was naturally, I think.
 
Panic said:
Curious, I thought I saw that it's not a good idea to switch to a depot insulin while recovering from illnesses such as DKA/pancreatitis due to the depot taking 3 days to fill. Anyone have info on that?
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I didn't know about that. Maybe because he is doing so well it is ok? Or maybe it is since she thought it might have already been resolving when I brought him in? I still have the Vetsulin if he has trouble.
 
Kristin and Dewey said:
I didn't know about that. Maybe because he is doing so well it is ok? Or maybe it is since she thought it might have already been resolving when I brought him in? I still have the Vetsulin if he has trouble.
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Yes I saw it mentioned recently but don't remember who said it or if it would apply in Dewey's case. I believe it involved ketones being present though.

@Bron and Sheba (GA) @Nan & Amber (GA) was it one of you?
 
Panic said:
was it one of you?
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maybe... I think of this as kind of a situational thing, really, rather than a hard-and-fast rule. Since Dewey is eating well and doesn't seem to have ketones presently, I think the benefits to Lantus in general far outweigh any disadvantage in this case. When cats come home in more precarious situations (for example, when they come home before being truly stabilized) and you need all the help you can get, having a non-depot insulin is probably better.
 
Nan & Amber (GA) said:
maybe... I think of this as kind of a situational thing, really, rather than a hard-and-fast rule. Since Dewey is eating well and doesn't seem to have ketones presently, I think the benefits to Lantus in general far outweigh any disadvantage in this case. When cats come home in more precarious situations (for example, when they come home before being truly stabilized) and you need all the help you can get, having a non-depot insulin is probably better.
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Gotcha, I wanted to double-check for Dewey's safety and since dose was lowered from 3 to 1u I wasn't sure. :)
 
Panic said:
dose was lowered from 3 to 1u
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:banghead:
I'm sorry, I missed that, yikes!

We usually do a 1 to 1 (or close) switch in dosage when switching insulins. Was there a reason why the dose was lowered so much? Looking at Dewey's spreadsheet, he sure doesn't look like a cat that needs that much less insulin, he's still spending almost all his time in ugly numbers.

Double-checking: did you switch syringes when you switched insulins? Lantus is a U-100 insulin, and the syringes should have an orange cap. They'll be different from the Vetsulin syringes (U-40, red cap).
 
Nan & Amber (GA) said:
:banghead:
I'm sorry, I missed that, yikes!

We usually do a 1 to 1 (or close) switch in dosage when switching insulins. Was there a reason why the dose was lowered so much? Looking at Dewey's spreadsheet, he sure doesn't look like a cat that needs that much less insulin, he's still spending almost all his time in ugly numbers.

Double-checking: did you switch syringes when you switched insulins? Lantus is a U-100 insulin, and the syringes should have an orange cap. They'll be different from the Vetsulin syringes (U-40, red cap).
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Yes I switched to U 100 syringes. I am not sure why it was lowered. I was just so happy about the insulin change that I didn't question it. I just figured it was the way it was done. I am calling her with a glucose curve 1 week post change and hopefully she will increase it then. I don't know, one more thing to worry about it. :nailbiting:
 
I'll have to do some digging to refind it but I believe it said switching to a depot insulin you would maintain the dose or give .25u less? I think? Will have to check when I'm on my computer. But I don't think I'd wait, that depot takes a while to fill and you can end up months behind by dropping the dose back.

Thoughts, Nan?
 
Panic said:
I'll have to do some digging to refind it but I believe it said switching to a depot insulin you would maintain the dose or give .25u less?
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That's the usual. With Dewey's numbers where they are, I don't see much reason to put in that 0.25U safety margin.

Kristin and Dewey said:
I don't know, one more thing to worry about it. :nailbiting:
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Not sure it's a worry so much as an inconvenience. I doubt Dewey is in any danger, it's just a pain to, as Elizabeth says, have to slowly adjust the dose back to where you were.

Of course, your vet probably isn't thinking in terms of slowly adjusting dose by 0.25U at a time the way we do!

How would you feel about going your own way on the insulin dosing from your vet? I do think Dewey would probably be better off with the 3U sooner rather than later, but you'd have to fess up to your vet when you did the curve.

A lot of us here trust our cat's to a vet's care for everything but FD, and just do all our insulin dosing etc. on our own. Just seems easier for everyone that way :).
 
Panic said:
Yes I saw it mentioned recently but don't remember who said it or if it would apply in Dewey's case. I believe it involved ketones being present though.
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I'm a bit rusty but I think the insulin choice when DKA is in play would depend on the status of the individual cat.

IIRC, when a cat is hospitalised for DKA typically vets use fairly aggressive insulin therapy (ETA: with short acting, hard hitting insulins) to drive down BG levels and help to restart normal metabolic function. This aggressive therapy is possible at the vets because they can administer glucose intravenously to prevent the cat from hypoglycaemia.

Speculating a bit here but if the cat is in hospital long enough, normal metabolism has been restored and it has been is restabilised on Lantus then presumably the cat would be able to continue on this basis upon return home. It might depend on the general state of the cat's BG regulation prior to the DKA episode. For general information, insulins like Caninsulin may not be that great duration-wise but they are good for yanking down high BG levels. Lantus on the other hand is not great at pulling down high numbers but it is good at keeping numbers down. Perhaps if the DKA kitty was very well regulated on a low dose of insulin prior to the DKA episode then perhaps their BG regulation might recover faster afterwards and Lantus (or similar) would do the trick? If a cat had not been so well regulated prior to the episode, or if there was an infectious process present to knock it out of good regulation then maybe an insulin other than Lantus could be a more appropriate post-DKA treatment choice, even temporarily?

Hopefully other members with more knowledge and experience will be able to advise further.


Mogs
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Critter Mom said:
IIRC, when a cat is hospitalised for DKA typically vets use fairly aggressive insulin therapy to drive down BG levels and help to restart normal metabolic function. This aggressive therapy is possible at the vets because they can administer glucose intravenously to prevent the cat from hypoglycaemia.
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Isn't it a separate type of insulin they use in those cases, a very fast-acting insulin that they only use in the ER, not just a typical in-and-out insulin?


Critter Mom said:
For general information, insulins like Caninsulin may not be that great duration-wise but they are good for yanking down high BG levels. Lantus on the other hand is not great at pulling down high numbers but it is good at keeping numbers down. Perhaps if the DKA kitty was very well regulated on a low dose of insulin prior to the DKA episode then perhaps their BG regulation might recover faster afterwards and Lantus (or similar) would do the trick? If a cat had not been so well regulated prior to the episode, or if there was an infectious process present to knock it out of good regulation then maybe an insulin other than Lantus could be a more appropriate post-DKA treatment choice, even temporarily?
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So if kitty had already been on a depot insulin like Lantus it wouldnt be an issue because theoretically the cat would still have some of the depot (I guess depending on how long the cat was in the ER? I don't know how long it takes to fully deplete a depot). Because if a cat had ketones you would want to keep full-dosing as much as possible, but a depot would take a few days for them to actually get "full dose" as the depot fills.

And right, would it be possible that an in-and-out insulin is a better insulin choice in general, even if the cat had originally been on Lantus - due to the depot being depleted? Hm!
 
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