Bailey with DKA twice

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kat117

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I have 4 babies, all 4 legged, and 3 of them turned 9 years old on Jan 31st. Bailey has been the unhealthiest from the litter, developing urinary crystals in 2008. Last November, I noticed several changes with his appearance, appetite, drinking intake, etc. He was soon diagnosed with Diabetes (Nov. 27th), although not overweight at all, so this was very shocking. In addition to Diabetes, he also had ketones in his urine, thus diagnosing him with Diabetic Ketoacidosis (DKA). I began him on insulin immediately and was advised to hospitalize him due to the severity of his condition. Unfortunately, I didn't have the financial ability to do this and tried to manage with at home care. Since November, I have changed his insulin to Lantus since there was no improvement, purchased prescription diet foods (Hills C/D and M/D), gave sub Q fluids at home on several occasions, and tried to enhance his appetite with medications and GNC supplements.

Although he seemed to be doing well, he quickly turned for the worse two weekends ago. Visiting the vet, his weight had decreased to 6.3lbs, his temp was only 96 and I was advised to send him to Blue Pearl ED vet clinic. He spent 53 hours there and I had to charge $1,800. They would like to run diagnostic testing for another $730, but I haven't approved that yet due to lack of funding. This testing will inform the doctor what the underlining condition Bailey must be suffering from.

He was released from the clinic with his ketones down to zero. One week later, now his level is at +1. He's eating very well and his weight is up to 7 lbs, but you can tell he's not feeling well. I'm totally confused as to what next steps I need since he seems to be prone to DKA and I can't afford to put him in the 24 hour facility several more times if this continues. He's on 3 units now 2x a day of NPH. He was on Lantus, but after the hospital trip he was put back on NPH.

Any recommendations on what to do? Has anyone been able to regulate this at home? My vet spoke to me about thinking about putting him down since it seems he won't regulate. I'm not to that point yet, but how many times can I continue this. It's only been one week?

Needless to say, Bailey is a HUGE part of my life. Any assistance you can provide would be greatly appreciated by Bailey and me. Thank you.
 
Hi there

I'm very sorry that you and Bailey have been going through all of this!

I can tell you that DKA is very expensive to treat. But without a bit more info we can't tell you what has been going wrong.

For example, has he been tested for infection? Has he been eating well? how are his teeth? Do you test blood glucose levels at home?

Ketones usually need a combination of factors..insufficient food, insufficient insulin and or infection. Often untreated/newly diagnosed cats are at risk for DKA but that doesn't explain why the ketones came back.

FWIW, Humulin N is not the insulin of choice for cats, let alone those prone to DKA. It doesn't last nearly as long as lantus (ie wears off quicker) so I'm confused as to why he would be put on it instead of lantus.

Can you give us some more details?

Jen
 
There are many cats here that have had DKA. As you can see from my signature, my cat has had it twice. If you explain more about why the Lantus didn't work that would be a good starting point. When you mentioned he was at 1.0 with ketones, do you mean this was his blood serum level? While 1.0 isn't great it is not in the danger zone yet. Do you test for ketones at home or was this the number you got when last at the vet's office?

Using a short acting insulin alone will only make the situation worse. Do you have any BG numbers you can give us? Your cat is only nine years old and unless there is some other really serious medical condition you should be able to get him regulated.

Give us more info. And wie will give you all the help you need... and then some. :-).
 
Thanks for the replies. Bailey was on NPH for about one month and we changed to Lantus to try to regulate him. He was also on that for about one month, but since he was hospitalized I was told NPH was closer the insulin they used during those two days. That's why he's back to NPH. I don't test at home yet, but his last glocuse curve was on Monday and the highest reading was 376. When he was tested last night, it was 476 (the highest since he was first diagnosed) and the ketones were also tested there by blood serum.

Yes, both docs are confused as to why he he's having some many problems.

Not sure what the underlining problem is, but I haven't run any of the extra tests due to funds. I was only told he had an infection, but not sure what exactly. They did run blood work (like crazy) and I had his results, but I'm not sure what to look for. The most alarming results were low potassium, so he's on pills now to raise it.

He is on tumil-k and enrofloxacin daily. He is eating very well and gained weight since he left the ED. He's now 7 lbs, so that's a good sign, right?

He's eating Hills M/D, low carb fancy feast, and low carb 9 lives. I'm suppose to get him soley on M/D, but for the time being I need his weight up so he's on all 3 foods.

Any thoughts?
 
Do you still have some lantus left? If you do, I would go back to that. First you should go out and get a glucose meter. There are many inexpensive ones and sometimes you can even get them for free. Without testing the BG, you will have no idea if the lantus or any other insulin is effective. I would also suggest monitering the cat for ketones at home. There is a serum meter that can do this or urine strips. Since your money is tight you may want to go with the urine testing strips for now.

The other thing you will hear from many others besides me is changing diet. A wet food ( canned food) diet lower in carbs can lower a cat's BG quite a bit. When I switched Nomad from dry food to wet food his BG went down an average of about fifty points.

If you still have some lantus and can get a blood glucose meter, we can help you take it from there. I can get you more help from the lantus support group.
 
Hi I was hoping by now you would have gotten some more responses. If you still have some Lantus it is usually good for at least two months. Since your vet just switched you back to NPH only recently, I am hoping you still have some. If not, can you get a script from your vet for it again? You can go to Walmart, K-.Mart or any drug store chain and get a low 0ost meter, strips and urine stix to test for ketones. If you can get those supplies and come back on line, we can help you from there.

Even ijf you are stuck using the NPH insulin for a while,. It is still important to do BG testing. I am hoping you come back and don't give up on your kitty. I guess I have a soft spot for DKA kitties since Nomad has been thru it twice.
 
They use Humulin R when treating DKA because it is very short acting, and N is just a tad longer lasting. But that doesn't mean it is at all appropriate for regulation.

How are his teeth?

Are you testing blood glucose levels at home?

Jen
 
Hi Kat, how is Bailey? I know what you're going thru, Mithras was diagnosed at the end of Nov and had DKA and they warned me he may not survive even the next few hours but he did, but was skin and bone, and it cost me a fortune, and the vet did warn me this could get expensive and if i wasnt willing to make the effort as well to care for him, i should end it there, which was just a horrific thought. they put him on 2 x 2 units caninsulin but it never seemed enough to me, but they were hesitant to increase as it was com,ing up to xmas and i was meant to be going on holiday (had to change flights at huge expense again) anyway he ended up being an emergency case on new years day night - possibly the most costly night to go to cat hospital! then as i had to fly on jan 4th (couldnt get out of it) he had to stay in hospital for 2 weeks. i got home, they'd left him on the low dose, weighed him, he'd lose more weight, had to re admit him as an emergency - DKA - the next day. That was mid Jan. Since then his dose has doubled to 2 x 4 units, he's much better, though still v diabetic and i had a scare this evening as his BG appeared to have fallen too low..but the reason im saying all this is because it IS doable. i know its expensive, im lucky that i had money saved for work on my flat, but thats gone, so if i have another emergency, well i dont know how i'll pay but i'll figure it out. can't the vets let you pay back monthly?? maybe he just needs more insulin to stop the ketones? i finally got a glucometer just over a week ago and though i feel terrible doing that to the cat, i feel a bit more secure being able to test him so i know what's going on.
I really really hope he gets better. I know here in the UK there are charities that help you if you're on state benefits, which wouldn't help me unfortunately, but it may be worth seeing if there's any financial help somewhere? typically my cat insurance hadn't kicked in when Mith got ill :(

x
 
Thanks Jen for the follow-up. What exactly are you asking about his teeth? They are similar to my other kitties, with some plaque on them and his vet pointed that out. But nothing was mentioned beyond that.

I was told switching to Lantus won’t assist with DKA at this point.

I’m waiting on the home testing supplies, as my friend to mailing it to me.

Kim
 
Thanks to all for the responses. Bailey seemed to do ok over the weekend, one minute he is very playful and loving and then other times he seems to be back to drinking excessively. He had two drinking episodes over the weekend. He’s been on 3u twice a day of NPH, as his vet is still recommending that. We are waiting on the ED vet since she was out of town for a few days.

I’ve spent greater than one month’s salary thus far and I’m not sure how much more debt I can handle. I have applied for financial assistance once and was denied since he had already left the ED. I’m looking into others now.

I do still have Lantus at home and Bailey is on mostly wet foods: Fancy Feast & 9 Lives (both low carb) and dry M/D. I was told to keep him consistently on M/D, but based on the research here it seems that’s higher carbs than the others. At this point, we just want him to eat and gain weight which he is.

He has also consistently eaten well over the weekend. Please keep us in your thoughts/prayers. Kim

FYI - I have tried several times to upload a picture of him, but it won't go through.
 
I ask about his teeth because infected teeth can be a hidden source of infection and therefore is one possible culprit

I mention lantus because if he's not getting proper duration from the Humulin N, he's at greater risk for DKA

I know this is expensive, I just can't help but feel that there is a missing puzzle piece and if we can find it, things will be easier. Hometesting blood glucose levels would definitely help!


Jen
 
As the mom of a cat that has also had DKA twice, I disagree with your vet that putting your cat back on Lantus will not help the DKA. Quite the opposite, at least in my opinion. The NPH insulin lowers the BG more rapidly but it also rises again rapidly. This rapid rise that can contribute to DKA. you get an insulin curve that looks like a roller coaster ride.

I can relate to DKA being expensive. Nomad's first episode was almost three thousand dollars. I caught the second one early because I was testing for BG and ketones every day. The second episode was only five hundred dollars.
I don't understand your vet's logic in putting the cat on NPH insulin only. In the average cat that insulin would only last six to eight hours. That leaves your cat without insulin for four to six hours if you give every twelve hours.

Hopefully some other people who have ex-DKA kitties will post here.I hope you do decide to give the lantus a try again. As you can see by visiting the insulin support groups here, very few people use Humulin-N.There is a very good reason for that...it simply isn't a very good insulin for cats.
 
I think when J.D. was DKA, they were giving him Regular insulin (R), which is a fast acting insulin, throughout the day. When he was starting to get ready to come home (after about his 6th day in hospital), they were deciding with me which insulin to give him when he came home with me. I think we tried PZI for about a month, and then I did some research, found this board, and asked to try Lantus, and the vet agreed. And we've been on Lantus, and then Levemir, ever since.

That's my .02 cents.

I don't think the fast acting insulins are going to work too well because they don't last for the whole 12 hours between the two shots given per day.
 
Jen - Bailey's doc said she doesn't think his teeth are a major problem.
Dyana & Janelle - I've asked about Lantus several times and from I understand, NPH gives more overall consistent readings than Lantus. I don't know what to do and hate to go against what I'm being told. The ED internist still didn't call back.
He has another curve tomorrow.
As a side note, he seems to be doing really well today :) Very playful, talkative, eating well.

Not sure if I have already mentioned, but I also give 150ml of saline daily. He was on 100ml, but we increased to 150 on Thursday. Between work and him, I'm exhausted! :smile:

Kim
 
Kim

Would you like to learn more about humulin N so you can make a better informed decision? I know it is very tough going against your vet, but this advice makes no sense and could put your cat in harms way.

Jen
 
Humulin works well for some diabetic dogs. Some vets treat diabetic cats the same as diabetic dogs. Cats metabolize insulin twice as fast as dogs and people.I have never seen any studies showing that NPH insulin is better than lantus in treating cats.

I would encourage you to research on your own.You are the one who ultimately has to decide what is best for your cat.Your vet might not be up to date on the latest treatment for diabetic cats.
 
I know some dogs that were prescribed Humulin-N. This is the insulin that my vet's office seems to prefer for dogs.Thank God they realize it is not the insulin of choice for cats.
 
Vetsulin was originally designed specifically for dogs.There was some problems with it and I believe it was discontinued in the US.I haven't heard of any vets at least in my area using Cannsulin either.

A few vets do also use prozinc,lantus and levemir for dogs but it is usually dosed once a day.
 
Thanks for all the comments. Those who have treated DKA, what diagnostic tests did you run to determine the underlining problem with your baby? They are recommending ultrasounds, blood work and a liver biopsy.

Bailey is up to 7.2 lbs!!!

Kim
 
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