Cat in DKA - terrified and need support

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Lemi’s Mom

Lemi’s Mom

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Hi all,

My 11-year-old cat was diagnosed with diabetes a few months ago. She started on her insulin (Vetsulin, 1 unit, twice per day) and a special diet. Her hunger increased and she was always begging for food, but she otherwise seemed fine. We brought this up to our regular vet and he seemed unconcerned.

Over the past month we felt like she was extra skinny and losing a lot of weight. We started feeding her more but she still seemed so thin. But otherwise she was her normal self.

it’s a busy time— we are getting ready to move in the next few days and my husband and I were so busy that we didn’t notice until tonight that she hadn’t been bugging us for food like she usually does. She was fine and her appetite was normal this morning. She had thrown up a couple of times throughout the day, but we assumed that she had eaten too fast. She was under the bed and wouldn’t come out for her food. We had to drag her out and she was so lethargic, she couldn’t stand on her own, and her eyes were hazy. We rushed her to the emergency vet and they diagnosed her with DKA.

she is there now for her treatment. They’re giving her fluids, doing ultrasounds, monitoring her glucose everything that I’ve read is standard treatment for DKA. It was expensive and I maxed out my credit cards to make sure that she can get the treatment that she needs. I thank god I had those funds available. We were able to say good night to her before we left and she seemed more alert than when we first noticed that something was wrong. She popped her little head up a bit and her eyes were a lot clearer. She still seemed tired though.

Right now we just can’t stop crying and worrying about our poor little girl. I’m sure the vet was being responsible and covering her bases but the stuff about resuscitation, notifying us if things go south, and the possibility of the E word were just so terrifying and hard to hear.

I would really appreciate support and advice from this forum to help us get through the next few days. I just feel so guilty and so scared. I can’t stand the thought of losing her. I’ve thought about it so many times but it can’t be now, please god it can’t be now.
 
Hi and welcome to the forum. I am so sorry you are all going through this. It is very frightening but she is in the best place at the moment. And don’t blame your self. Cats are very good at hiding how they feel. Don’t consider euthanasia…vets always seem to mention it and it is most distressing. We hear this a lot.
We have quite a few cats arrive here having been admitted to the ER with DKA. It sounds as if you got her there pretty early so hopefully she will be ok with a few days in ER?
Questions to ask the vet:
How are her electrolytes? (They get out of kilter with DKA)
Does she still have acidosis?
Are the ketones reducing in her urine/blood?. (Cats with DKA will have ketones in the urine/blood)
Is she eating at all for them?
Are they giving her any antinausea medications?
What is her blood glucose?

I am going to give you a list of things you can do to get ready for when she comes home and then a list of things you will need to do once she is home. We help a lot of cats during recovery from DKA as we find vets rarely give much information about care once they come home and it is really very important how they are cared for.

So here are the things you need to do before she comes home.
  • Buy a bottle Ketostix for testing ketones. Can be bought from Walmart in the US or a pharmacy.
  • Ask the vet for antinausea medication such as cerenia or ondansetron. Ondansetron is better. Most post DKA kitties are nauseated for a time. Make sure you don’t leave the ER without them.
  • May also need an appetite stimulant. Make sure you give the antinausea medication first before the appetite stimulant.
  • Ask the vet about giving sub Q fluids at home
  • Get a range of low carb canned food for when she gets home including some higher carb foods. Look at the FOOD CHART. She will most likely be picky and may not want to eat once she comes home so have a variety of foods for her because it is really really important she eats well to keep the ketones away.
  • Set up our spreadsheet and the signature before the cat comes home. You will find the information in this link HELP US HELP YOU. If you have any trouble setting up the SSI will ask @Bandit's Mom help you.
  • If you don’t have a glucose meter I would buy one …preferably a human glucose meter over an alphatrak meter.
    Get a copy of all the path results from the ER
  • Try and get sleep before she comes home as you will be busy for a couple of weeks with her.
Once she gets home here is a list of things you need to be doing :
  • 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,
  • 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, dont feed and test again in 20 minutes and post and ask for help.
  • Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
  • Give antinausea medication if needed
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids
  • Hopefully you have set up the spreadsheet so we can see it and test the BG frequently
  • Post daily with updates and ask for help as often as needed.
Please keep us updated with information how your dear kitty is progressing. We will be waiting to hear from you.:bighug:
 
Hi and welcome to the group, my kitty had DKA and almost died, he was in the hospital for a few days. So I totally know how you feel, I was kicking myself so hard for letting it get to that point!!

As Bron mentioned, the at-home care after a DKA episode is critical to keeping kitty out of DKA. Cats can recover and then go back into DKA if the at-home after-care isn't appropriate. Extra food and water, if the vet said only feed twice a day like mine did -- well I am here to tell you do not do that right after DKA. My vet didn't tell me this. Right after DKA is time for about 150% of normal calories, feed kitty as much as kitty will eat as often as they will eat. And extra water to help flush those ketones out.

Good luck I am hoping Lemi will be ok!
 
I would also ask for a different insulin, preferably Lantus or Prozinc. Vetsulin is not a great choice for cats and tends to be somewhat harsh and difficult to work with (it’s much better suited to dogs).

As Bron said, Blood glucose (BG) monitoring with a hand-held meter as well as ketone monitoring will be crucial at home and will help you collect the data that will help you best care for your kitty and head off another DKA episode. Knowledge is power. Lots and lots of food will also be important.

It’s common for cats to be weak and wrung out after DKA and to look like absolute heck. My cat was a lump of fur who couldn’t stand up right after DKA. Just prepare yourself for how bad kitty might look but understand that that’s not uncommon and it’s not always hopeless. Vets always seem to bring up the “E” word and sometimes it’s warranted, but many cats *do* survive DKA and go on to live many more healthy, happy years.

Please come back and post updates. We care.
 
Thank you all so much for the resources and the support! @Bron and Sheba (GA) i will definitely get all of that set up and ready for her. Wow, that is really amazing and comprehensive advice. This forum is incredible.

The overnight vet just called us and it sounds like she is hopefully on the right path. Her electrolytes, blood sugar, anemia, and pH have improved. No cancer cells have been detected and her chest X-rays look good.

They set her down on the ground and she was able to walk a few steps. She got up and went to the litter box after she peed on herself. They haven’t tried feeding her because she is getting an ultrasound today and they want to keep her stomach empty for that, but she did get up and drink water by herself. I am very anxious to hear the results of the ultrasound.

They sent us a picture and she looks like her sweet self, with bright beautiful eyes. They say that she still seems a bit dull but more responsive than last night. We are going to visit her later today.

The biggest concern that I have is with her weight. She was overweight before diagnosis (11 pounds), 8.5 pounds at diagnosis in March (which is a healthy weight for her size). She weighed 5.5 pounds last night. She’s a long haired cat so it was difficult to really see how skinny she was getting. I knew that she was skinny but I didn’t realize how drastic it was and my heart is broken. She will definitely eat to her heart’s content during the recovery process but gosh that was so hard to hear.

thank you all again for the advice and support. I’ll keep you updated as we get through this ❤️
 
In the very beginnings of our diabetic journey, my cat had DKA as well, plus hepatic lipidosis and needed a feeding tube. It was very scary and required quite a bit of time in the hospital, but she is still here with me six years later. :) Try to hang in there! Wishing your kitty a full recovery.
 
Lemi’s Mom said:
The biggest concern that I have is with her weight. She was overweight before diagnosis (11 pounds), 8.5 pounds at diagnosis in March (which is a healthy weight for her size). She weighed 5.5 pounds last night.
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i am very glad to hear it sounds like she is recovering.

As far as the weight loss... I know your focus is on the DKA right now but that weight loss continuing after she was put on insulin, and the fact that she was still always hungry, means that the diabetes was not being managed. After she gets out of this DKA situation you will want to revisit how to manage her diabetes and get her to what we call regulation. A regulated diabetic cat has a quality of life that is very much the same as a non-diabetic cat. They don't experience weight loss from the diabetes and with the diabetes regulated they don't walk around feeling like they are starving.

When diabetes is not being managed properly, the cat's body can't actually make proper use of the food, so they can't gain weight and they are always hungry. I highly recommend you look at a better insulin (I am a big fan of Lantus it really helped my boy) and work to achieve the right amount of insulin so kitty feels better and can gain some weight back.

And related to DKA -- the right amount of insulin also keeps DKA away. DKA is caused by a buildup of Ketones to a toxic level and with the diabetes managed properly, with the right insulin at the right dosage, you will keep ketones at bay -- along with the right amount of food and water of course.

-Kyle
 
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Hendrick Cuddleclaw said:
i am very glad to hear it sounds like she is recovering.

As far as the weight loss... I know your focus is on the DKA right now but that weight loss continuing after she was put on insulin, and the fact that she was still always hungry, means that the diabetes was not being managed. After she gets out of this DKA situation you will want to revisit how to manage her diabetes and get her to what we call regulation. A regulated diabetic cat has a quality of life that is very much the same as a non-diabetic cat. They don't experience weight loss from the diabetes and with the diabetes regulated they don't walk around feeling like they are starving.

When diabetes is not being managed properly, the cat's body can't actually make proper use of the food, so they can't gain weight and they are always hungry. I highly recommend you look at a better insulin (I am a big fan of Lantus it really helped my boy) and work to achieve the right amount of insulin so kitty feels better and can gain some weight back.

And related to DKA -- the right amount of insulin also keeps DKA away. DKA is caused by a buildup of Ketones to a toxic level and with the diabetes managed properly, with the right insulin at the right dosage, you will keep ketones at bay -- along with the right amount of food and water of course.

-Kyle
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Thank you so much for this advice, I will definitely talk to the vet about switching her insulin. We brought up the weight loss and hunger to our regular vet but he seemed so unconcerned about it. I am considering changing vets because they provided us with very little guidance on how to handle everything. But looking through this forum, it feels like par for the course. Our poor kitties.
 
We just got back from visiting her today. We could only see her for 15 minutes so she could get back on her insulin drip. Her blood sugar levels are slowly coming down according to the tech who brought her to us. Her breath still smelled very strongly of acetone. She was still weak and tired but she looked around a bit and was receptive to pets. We got a couple of light “acks” out of her too. It was just so scary to see her this lethargic and out of it. She’s been receiving care for about 15 hours at this point so I just keep telling myself that it’s still early on. Hoping for good news soon.
 
Good to hear an update on Lemi. All sounds positive.
While I agree Lantus is a much better insulin for cats, unless the vets do a swap over to Lantus at the ER for at least 3 days while monitoring everything, I would stay with the Vetsulin until ketones are well in the distance of the rear vision mirror. This is because vetsulin is an in and out insulin which means the full dose you are giving works straight away. Lantus is a depot insulin and in the beginning it takes 5 to 7 days for the depot to fill and the full effect of the dose to be felt. With DKA we want to make sure Lemi is getting enough insulin all the time as insulin is one of the things that keeps ketones at bay. And it is ketones we need to make sure don’t reappear.
Once Lemi is eating well and ketones have not been around for a couple of weeks, then I would think about swapping to Lantus.
I will put a link to a depot insulin so you can understand what it is.
 
Bron and Sheba (GA) said:
WHAT IS AN INSULIN DEPOT
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Bron and Sheba (GA) said:
Good to hear an update on Lemi. All sounds positive.
While I agree Lantus is a much better insulin for cats, unless the vets do a swap over to Lantus at the ER for at least 3 days while monitoring everything, I would stay with the Vetsulin until ketones are well in the distance of the rear vision mirror. This is because vetsulin is an in and out insulin which means the full dose you are giving works straight away. Lantus is a depot insulin and in the beginning it takes 5 to 7 days for the depot to fill and the full effect of the dose to be felt. With DKA we want to make sure Lemi is getting enough insulin all the time as insulin is one of the things that keeps ketones at bay. And it is ketones we need to make sure don’t reappear.
Once Lemi is eating well and ketones have not been around for a couple of weeks, then I would think about swapping to Lantus.
I will put a link to a depot insulin so you can understand what it is.
Click to expand...

thank you so much!!
 
The hospital called again with the results of the ultrasound. Some good news, some bad news. They noticed some irritation/sludge(?) inside of Lemi’s intestine and want to take a biopsy in a few weeks to determine whether it is lymphoma or IBS. They didn’t see any large tumors or masses, but small cell lymphoma is a possibility. But they said that the intestinal issue is likely the reason for her drastic weight loss, not the diabetes. However, giving her a steroid to treat this problem could worsen her diabetes.

The course of action is that we will visit an internal specialist in a month. In the meantime, we will see if she can put on weight with extra food/calories. I’m very worried about the costs but I will do what I have to do. We do have pet insurance so I will be submitting a claim soon to see if we can get some funds back. Her anemia levels have also gotten a bit worse and we are waiting to see if she will need a blood transfusion.

They also want to see if they can transition her to Lantus/Glargine over the next couple of days. The overnight vet is going to make the call based on how she’s doing. They are still working on getting her levels under control but it sounds like she is improving.

Now, for the good news. She was vocal during her ultrasound and the vet laughed talking about how she was much more vibrant than she has been. They also gave her an appetite stimulant and she ate food right after. They’re going to keep feeding her every few hours and my fingers are crossed hoping that she’ll keep eating. It’s been a tough 24 hours but hopefully I will be able to sleep a bit easier tonight.
 
I’m so glad she is eating. That is brilliant..
don’t give a steroid for the intestinal issue until
You have a definite diagnosis. If after a biopsy she needs a steroid we can work around that. Some diabetic cats need to take them.
We do see big weight losses sometimes with diabetes. My Sheba lost a lot of weight the original time she was diagnosed with diabetes and she put it all back on and more.
Keep sending updates please!
 
Bron and Sheba (GA) said:
While I agree Lantus is a much better insulin for cats, unless the vets do a swap over to Lantus at the ER for at least 3 days while monitoring everything, I would stay with the Vetsulin until ketones are well in the distance of the rear vision mirror. This is because vetsulin is an in and out insulin which means the full dose you are giving works straight away. Lantus is a depot insulin and in the beginning it takes 5 to 7 days for the depot to fill and the full effect of the dose to be felt. With DKA we want to make sure Lemi is getting enough insulin all the time as insulin is one of the things that keeps ketones at bay. And it is ketones we need to make sure don’t reappear.
Once Lemi is eating well and ketones have not been around for a couple of weeks, then I would think about swapping to Lantus.
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I agree strongly with all of this. Apologies for not stating that clearly in my earlier post (thanks Bron for pointing it out). It sounds like the vet plans to do the insulin switchover at the hospital, which is great. They have tools and are much better equipped to monitor and manage the insulin change in a DKA situation. I just went through something similar with my diabetic cat and it can be daunting (and risky) to do at home.

Glad to hear Lemi is doing a bit better. Even baby steps are steps in the right direction.

If it hasn’t already been done, I’d also ask the vet about a thyroid panel. Hyperthyroidism can also have the symptoms you describe and sometimes cats will have both diabetes and hyperT. But you might have to wait until she’s past the DKA, as that can impact thyroid results.
 
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JL and Chip said:
I agree strongly with all of this. Apologies for not stating that clearly in my earlier post (thanks Bron for pointing it out). It sounds like the vet plans to do the insulin switchover at the hospital, which is great. They have tools and are much better equipped to monitor and manage the insulin change in a DKA situation. I just went through something similar with my diabetic cat and it can be daunting (and risky) to do at home.

Glad to hear Lemi is doing a bit better. Even baby steps are steps in the right direction.

If it hasn’t already been done, I’d also ask the vet about a thyroid panel. Hyperthyroidism can also have the symptoms you describe and sometimes cats will have both diabetes and hyperT. But you might have to wait until she’s past the DKA, as that can impact thyroid results.
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They did run a thyroid panel and she was normal!
 
Gabby was another of our DKA survivors. When she was diagnosed with diabetes, she was in DKA, had pancreatitis, and hepatic lipidosis. My vet and the emergency/ICU vet where she was hospitalized both warned me that some cats don't survive. She did and thrived for 6.5 yrs. It sounds like Lemi's electrolytes are slowly getting back to where they need to be. Next time you visit, think about bringing a piece of your clothing so she has something that smells like you. It helps to offset the strangeness of her being in the hospital.

In addition to the information that Bron provided, this is a link to our post on ketones. There are several links there, as well, if you're up for the reading. One thing to consider is whether you will want to test for ketones either in urine or blood. Urine tests are a "stick" that you dip into your cat's urine. Blood tests are done with a blood ketone meter -- it's like a glucometer except the strips test for ketones not glucose.
 
We just got an amazing update from the vet this morning! She called and said that Lemi is a completely different kitty than she was when she was admitted. She is up and walking around, eating great, taking big poops in her litter box, all good stuff! The vet also said that she loves her bed, which I can only interpret that she is being her cozy self. I can’t describe how elated I feel right now.

she’s not out of the woods in terms of her electrolytes, but they’re hoping to get them stable and they will likely send us home with some supplements. They are also transitioning her to glargine later today. We are going to visit her after the insulin transition and I am so excited to see her!
 
What great news!

Did the vet ever figure out what caused Lemi to develop ketones? Was there an underlying infection? (That's typically the trigger.)
 
Lemi’s Mom said:
They noticed some irritation/sludge(?) inside of Lemi’s intestine and want to take a biopsy in a few weeks to determine whether it is lymphoma or IBS. They didn’t see any large tumors or masses, but small cell lymphoma is a possibility. But they said that the intestinal issue is likely the reason for her drastic weight loss, not the diabetes. However, giving her a steroid to treat this problem could worsen her diabetes.
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Small cell lymphoma is a very slow moving disease, you have time to wait for diagnosis before starting any treatment. One of the symptoms of it, or IBD is weight loss. If you get a chance, see if the clinic has run a test of her B12 levels. A good number of IBD or SCL cats have low B12 and need supplementation. Also, any GI condition could be contributing to her anemia and if so, it will resolve with treatment. The prognosis for IBD or SCL is quite good. A large percent of cats treated for SCL go into remission. My current SCL kitty has passed her 6 years since diagnosis.

As far as the steroid goes, there is a steroid called budesonide that is locally acting, ie. mostly in the GI system. In many cats, it does not impact blood sugars. My Neko was on it and it didn't impact her numbers at all.
 
We had a wonderful visit with Lemi today. She was so excited to see us, purring like a motorboat, full of energy, and trying her hardest to walk around despite having her IV cast in we left feeling really happy and especially grateful for this forum and the amazing hospital we left her with!

We met with the vet during the visit and she let us know how Lemi was doing. She’s still eating lots, which is awesome; I’m not sure if they had her on appetite stimulants but she is a big eater so I wouldn’t be surprised if she wasn’t. They were still working on getting her electrolytes back to normal. She also mentioned that Lemi had pancreatitis, which we hadn’t heard before. I’m guessing that’s the underlying cause for the DKA, but I will ask more about it tomorrow. She was also concerned about Lemi’s anemia and mentioned that she might need a transfusion if her cell count gets too low. We also talked about her calorie requirements and the vet’s recs were in line with this group’s

The vet called again tonight and talked to my husband, and we got even better news. Her electrolytes have balanced out and she polished off a whole can of food! They started her on glargine around 6pm tonight. No mention of the anemia. I’m crossing my fingers that we’ll get her home this weekend but we will see!

As for prep, I have purchased lots of food for her. I also purchased a dual glucose/ketone monitor and test strips so that I can start tracking her levels. I’m still researching lancets so if anyone has recommendations I would greatly appreciate it! This thread was so super helpful to me: https://felinediabetes.com/FDMB/thr...and-diabetic-cats-a-primer-on-ketones.239971/

We have another cat so tracking urine samples would be tricky, so I’m hoping the blood tests go well. She’s very good at taking her shots so I think we’ll be able to get a solid routine down.

I haven’t gotten around to the spreadsheet yet as I’m in the middle of moving and things are nuts, but it’s the top of my priority list. I also have a running list of questions to ask the vet at discharge, which I am really really hoping is soon!
 
Great to hear everything is going so well. I’m so happy for you. Yes the pancreatitis could have been the inflammation we were wondering about. With DKA there is always an infection or inflammation present.

The lancets you need are size 26 or 28. And you will need a holder for the lancets.

I’m going to ask @Bandit's Mom to set up the SS for you as you are busy with moving etc. she is a wiz with them and can do it in a couple of minutes. She will contact you.
Don’t forget the signature. And please say DKA in the signature. It’s easy to set up.
 
Which blood/ketone meter did you buy?

I too found a blood ketone meter to be invaluable and, with multiple cats, easier logistically than urine ketone tests. Just know that you typically have to purchase two different types of test strips — one for BG testing and one for ketone tests. That catches some people off guard.

Great news on Lemi’s ongoing improvement.
 
I am honestly a bit envious of what a great ER vet you have there! We had a good one in my town but they closed last year and for a time, anyone with an ER vet situation during off hours like overnights, weekends and holidays would have to drive over an hour to another city in WNY.

They sound super thorough there, and also quite familiar with both treating DKA and the after-care at home that is so critical to prevent kitty from having another DKA episode. Good stuff but where are the pics of Lemi!??! :bighug: :p :woot:

(btw, upload feature is broken, just drag and drop a pic into a post or copy/paste)


We used a blood ketone meter, the Nova Max. Got it on Amazon, strips are like $2 a piece though! Luckily most people only need to test once or twice a day, if that.


Link: https://www.amazon.com/gp/product/B01G5OE0QY/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1



{edit} Here is a pic of my boy Hendrick in January of 2022 when he was also hospitalized for DKA. He would come home this day. My niece worked at the ER vet at the time and took this pic for me

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Dbabz4 said:
I’ve been following this thread because our cats are in parallel situations. Can you or OP please name the brands you picked? I want to do that route too
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There are quite a few ketone monitors on the market now. Popular ones around here (at least in the past) have been the Nova Max Plus and the Precision Xtra.

I got the Precision Xtra because I could get it faster (I needed it immediately and couldn’t find one in a store) and because it had a good reputation. I also liked that the strips were individually wrapped so I didn’t have to worry about contaminating the other strips or how long the vial of strips had been open. I could also source them for about $1 a strip, which was less than some other brands. But honestly, I’d use either of those two brands without hesitation.

Kyle (@Hendrick Cuddleclaw ) already provided a link to the Nova Max. Here’s a link to the Precision Xtra:
https://www.amazon.com/gp/aw/d/B00JIK6CIW/ref=ox_sc_saved_image_4?smid=AA6LPO6W3PUU5&psc=1
 
Hi everyone,

first, thank you soooooo much for all the resources and guidance and support over the past few days!! Lemi is home and doing amazing! She is so excited to be reunited with us and her brother that I don’t even think that she’s realized that we’re in a new apartment haha. I will post a more detailed update (with lots of pictures) tomorrow but I am just so exhausted lol. Today was moving day + coordinating with the vet to bring her home sooo it was nuts!

I bought the Precision Xtra meter with glucose and ketone test strips! She has been sent home with Lantus, a potassium supplement, and an appetite stimulant. I know there’s a long road ahead but my husband and I are ready to tackle this feeling so grateful for this community and the amazing animal hospital that took care of her!
 
Thanks for the update. I’m so glad she is home. Follow the routine on post 2.
What’s happening about the spreadsheet and signature? Do you need help ?
 
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