Cat care after DKA

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LindyLou

LindyLou

Member Since 2022
Hi all,

My cat came home after a 6 day stay in the ICU with DKA. It was a super scary week, but I am hopeful she is coming out better than before (we learned of an underlying infection). I was encouraged to start this thread (Thanks Bron & Chris, over on the Feline Diabetes Facebook page) about what happens next or additional care while she is recovering. Thank you all in advance!

Lindy
 
Hi Lindy and welcome to you and your kitty to the forum. I am really pleased to see you over here.
I will give you a list of things you need to be doing moving forward for the next few weeks until she (I don't think you ever told us her name) is back to her normal self.
DKA happens when there is not enough insulin, not enough food and an infection or inflammation. So we need to make sure there is enough food, enough insulin and any infection or inflammation is being treated.
Did the vet give you some antibiotics to continue at home for the infection? What was the infection?
Are you home testing the blood glucose ? I would strongly recommend you do. You can buy a ReliOn Premier meter from Walmart for $9 and a box of test strips for $17.88. You also need a box of 100 lancets size 26 or 28 to prick the ear and some cotton rounds. A human meter is fine. you don't need a pet meter.

Here is a plan for you to follow over the next few weeks. Please post daily here for advice and so we can see how things are going.
  • you need to give one and a half times as many calories as she normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed her whatever she will eat as eating any food is better than not eating.
  • Are you feeding a low carb diet (10 carbs and below)? Make sure you also have some medium (11-15% carbs) and some high carb food ( 16% carb and above ) in case it is needed. It is important she eats and eats well, so if she is refusing to eat, give her what ever she will eat, as eating is more important than what she eats at this point.
  • Don't feed for the 2 hours preshot as we don't want the preshot BG food influenced.
  • Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, don't feed and test again in 20 minutes and post and ask for help. If the preshot is below 200 to start with stall, don't feed and post and ask for help. Change the subject line to alert us to 'preshot xxx stalling PLEASE HELP'
  • Test daily for ketones. You will need to buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine sample and follow the directions on the bottle. If you can't collect a urine sample because she is difficult, I can suggest a blood ketone meter you can use which is the same as getting a glucose test, except the strips are more expensive. Put the results of the ketone tests into the remarks column of the SS so we can see. Please report any trace ketones at all. If there is more than a trace of ketones, notify the vet.
  • Give antinausea medication if needed such as cerenia or ondansetron. Ondansetron is better for nausea. Hopefully the vet has sent you home with some. A lot of post DKA cats are nauseated and have trouble eating.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If she will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids if she is not drinking well or looks dehydrated.
  • Test the BG frequently
  • Post daily with updates and ask for help as often as needed.
  • Set up a spreadsheet and add all the BG data so we can help you with dosing. I will post a link to the spreadsheet below. If you have any trouble with it let me know.
  • Set up your signature which will also be in that link. The signature will tell us all about your kitty so we don't have to keep asking you about her.
  • You will also find the hypo kit in that link. Please set that up as well.
HELP US HELP YOU

FOOD CHART
 
Hi there,

Thank you for all of this information! Gordon (and her brother Bill) are named after my old supervisors from grad school ... I knew that was going to name two kittens after them and I didn't care about the gender, so I just picked out the two I wanted to bring home. :)

Gordon did have an underlying infection and is currently on two antibiotics, an appetite stimulant, an anti-nausea medication, and potassium supplement. She got home on Sunday and went back to the vet yesterday for another blood test and a curve. She switched from ProZinc to Lantus. Interestingly, through this curve we learned she experiences the somogyi effect... where her sugar dips low and then hormones send her sugar level into overdrive. We are now trying 1.5 units instead of 2. Overall Gordon looks and feels better than she has in a long time... I think because we are finally getting things under control for her.

She is generally on a low carb food (FF or Friskies pate), right now she is also eating some of the food she had while at the vet that she really likes.

Lindy
 
@LindyLou
Gordon is adorable
To set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.


Here is the link to set up your spreadsheet, if you have trouble setting it up please ask we have a member that will be happy to do it for you
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

It will also explain how it works
 
LindyLou said:
She got home on Sunday and went back to the vet yesterday for another blood test and a curve. She switched from ProZinc to Lantus. Interestingly, through this curve we learned she experiences the somogyi effect... where her sugar dips low and then hormones send her sugar level into overdrive.
Click to expand...
I copied the following that was posted by one of our members
About this , I copied the following that one of our members said
There is actually no such thing as the Somogyi effect. It was a very small study done I think in the 1930s but has never been proven in cats.
What you are seeing with the low and then high numbers is bouncing. Bouncing happens when the BG drops too fast, too low or lower than the cat is used to. This causes the cat to dump stored glucose and regulatory hormones into its system as it thinks it has to save itself. This causes the BG to skyrocket. A bounce can last from 1 to 6 cycles (3 days) and once a bounce starts, there is nothing you can do but wait it out.


Are you home testing @LindyLou ?
Just want to make sure you read everything that Bron said in her reply back to you in post #4

It's always good to tap the word like on the right hand side just so we know you read it :cat:
 
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Hi Lindy,
Diane is correct. There is actually no such thing as Somogyi effect in cats. Don’t know why vets often quote it.
Here is information @Sienne and Gabby (GA) wrote about Somogyi :
Simply put, no.
This is a soapbox issue for me. I'll try to be succinct. The term first appeared in 1938 and was named after Michael Somogyi. It was based on a very small sample of humans and urine glucose was being measured. The "research" (if you can call it that) appeared in a local St. Louis medical publication - not a major medical journal. The results have never been replicated and have been contested in recent years. Consequently, the entire idea of Somogyi in humans is controversial. There's an article in Wiki that is a decent summary as it relates to humans.

With cats, there hasn't been any research let alone research with new insulin such as Lantus and Lev that are pharmacologically very different from what was available in 1938. I haven't a clue why vets continue to contend that a cat is in "chronic Somogyi rebound" when a cat may be bouncing off of a low number or fast drop. With humans, the recommendation is typically to decrease the dose in order to alleviate the problem What we've seen repeatedly is that when a caregiver does this, the cat stays in high numbers (because you're not giving enough insulin) and you end up wasting a good deal of time as a result of working the dose back up.

As long as you are systematically increasing the dose according to the protocol, you won't be giving too much insulin.

Here is an explanation of Bouncing:
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
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