Cat is hospitalized, they stopped giving insulin. DKA concerns??

So my cat Stormy(18M) is newly diabetic. Started Lantus insulin 1u 2x/day Thursday and on Friday he stopped eating and was diagnosed with pancreatitis at my regular vet. Given subq fluids & cerenia injection. She said if he's not eating by Saturday afternoon to take him to emergency vet. I did that and waited 13 hours for the doctor to see him. They hospitalized him for the day today and are giving IV fluids and another cerenia injection. But when I gave his meds last night they told me not to do his insulin. They said they are going to stop giving him insulin for now in case he is having a reaction to it or something. I realize things can change but he has been on this insulin before with no issues. They say he is likely insulin resistant due to multiple factors. They also stopped the 0.4mL Prednisolone steroid he has been on for eating and vomiting. But my worry is that if he still is not eating and not being given insulin, he will go into ketoacidosis. The last time he ate was like 11pm Thursday. I called 45 minutes ago for an update and am waiting to hear back. When they do call back, should I demand he be put back onto insulin? In a nice way of course. But I won't be able to talk to an actual doctor, so that makes me nervous. I don't know much about DKA but I am worried about it even though he is at the emergency vet. Like I know they know what they're doing, but what if they don't for some reason???
Thanks in advance sorry this is so long! Lol

 

What are his numbers like normally?

 

So they actually just called me back, I just got off the phone with them. His numbers are normally around 400 which is the same as before he started insulin. They didn't say what his numbers were today but they said it was "high but likely not DKA-high". They check his BG every 2 hours. She also said they are getting ready to do lab work and bloodwork and I can call back in a couple hours to see if they have results but if not I should hear back from a doctor within the next 4 hours. I asked if they were testing for ketones and she said no that they're just doing bloodwork. But if he were going into DKA there would be some indicators on the bloodwork and they'd treat from there. So she basically just told me not to worry and they are still giving IV fluids and I should hear back relatively soon. Thanks for your response though!!

 

Info on DKA:

Ketones, DKA and Blood Ketone Meters

By way of general info, numbers don't have to be sky high for a cat to go into DKA so it's reasonable for you to be expressing concern to the vets treating Stormy.

Are they doing anything to help Stormy eat (e.g. assist feeding)? Thursday night was a long time ago in food terms.

Sending prayers that he'll be feeling better and eating very soon.

(((Amy and Stormy)))


Mogs
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This is correct. If he's on fluids that will help with flushing out any ketones that might be produced, but his electrolytes may need rebalancing (hope this won't be necessary).

Forgot to ask earlier: Is Stormy getting any pain relief for the pancreatitis (buprenorphine)? It can make the world of difference in the eating department. Here's a very helpful document which covers the treatments that should be considered for a cat with pancreatitis.

IDEXX Feline Pancreatitis Treatment Guidelines

If the Cerenia doesn't do enough to control nausea then they should try ondansetron. (The latter worked far better for Saoirse, FWIW.) Indeed, the two can be used in tandem if required because they have different modes of action.

Another thing that's worth checking for is constipation. I found that anti-nausea meds don't really work if the cat's backed up. (Makes sense: if things aren't moving well then the last thing one feels like is shoving something else into the digestive tract.) While it doesn't do much for cat nausea (see linked document above), a few days' treatment [ETA] with metoclopramide can help 'get things moving' again.


Mogs
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Thank you for that information. I've been really busy and haven't had time to look up much about it. I'm not sure if they are doing anything to encourage eating. I meant to ask but I forgot, honestly. The girl I talked to on the lone though wasn't even the one taking care of Stormy, she told me she hasn't actually been with him at all but she just talked to his ICU nurse. So I'm hoping I'll be able to talk to a veterinarian later tonight.
It was my understanding that when cats are being given fluids for pancreatitis that they shouldn't eat during that. Only after the fluids. But again I forgot to ask so I'm not sure.

Also in reply to your second comment, he is getting buprenorphine I think. I'm like 75% sure he is. The cerenia injection has always worked for him in the past, or at least he doesn't vomit after he gets them. But he HAS had chronic constipation issues for the last 6 months or so (he also has IBS). The last time he pooped (that I know of) was early Friday morning. I guess I'll just make a list of my questions to ask the doctor later tonight.

 

I would suggest you be a serious pain in the backside with this hospital. If they are going to do what amounts to not much and charge you for the time your cat is there, I would be suggesting that if your cat does develop ketones, that they will be paying the bill for the resulting hospitalization.

While frequently numbers are high with DKA, it is not always the case. We've seen cats with numbers in the 200s develop DKA. And Stormy's numbers are high. DKA develops as a result of some underlying infection or inflammation, not enough calories and not enough insulin. Your cat hasn't eaten and hasn't gotten insulin and pancreatitis is an inflammation. This could be a recipe for trouble. They need to do bloodwork to determine if this is pancreatitis (usually a Spec or Snap fPL -- the Snap can be done in house and the Spec is sent out to a lab) so while they are getting blood, they can run labs. You need to know whether Stormy's electrolytes are in normal range. If your cat's lab values are off, this could be an expensive hospitalization. Frankly, I would not be happy with their response. Ketones can develop quite rapidly and can be life threatening. At the very least, they are likely to have a blood ketone meter and they can test your cat to ensure that ketones are not present. (The ketone meter is just like a blood glucose meter only it tests for the presence of ketones.)

This is a Primer on Pancreatitis that one of our members put together. It synthesizes a lot of information.

 

Thank you so much for this in-depth response. I am waiting on the doctor to call me back with an update. My regular vet did bloodwork and lab work on Friday which I think they did the in-house test as well as the one sent to a lab. But that in house test did confirm abnormal pancreas levels. My kitty is at very high risk for DKA in my opinion because he ALSO has a UTI, an ear infection, and an eye infection all going on right now too. The first time I called (about 4 hours ago) I talked to a girl who spoke with Stormy's ICU nurse. I expressed my concern about DKA and how Stormy seems to be at a high risk but she told me there is really no way to prevent it and if it's going to happen it's going to happen and we can deal with it then. Which I don't know if I agree with but she couldn't really give me more info since she hadn't even been in the room with Stormy at all, she just talked to his nurse. So that's why I'm waiting for the vet to call me so I can talk to someone who actually knows something and I can express how very concerned about DKA I am with him. They were also about to do bloodwork when I called so the vet should talk to me about those results too. I will have to ask if they can test his ketones with the blood meter, because I'm really NOT okay with them just not testing him for ketones. I feel like it's something they should be testing for anyway in this situation. Especially since he has at least three other infections going on. I don't care if I have to pay extra, it would put my mind at ease more if they would just test him. But again thank you so much for your response and advice and resources! I really appreciate it.

 

Update: It's 8:30 and I have yet to hear from the doctor so I'm literally about to drive up there. I'm so frustrated. I feel like he could be going into DKA and they wouldn't even know it if the doctor hasn't gotten to his bloodwork results yet.

 

I'm sorry you are going thru this , I'd be really pissed off and go there.
Not giving him insulin or trying to syringe feed him if he won't eat , plus all the other
infections he has is messed up.and not testing for ketones.

Please keep us updated,

 

In case you might need them (and I sincerely hope you don't):

WSAVA DKA Treatment Guidelines

Also, this covers treatment (bit techie but there are some helpful 'plain english' sections on which treatments/diagnostics need to be performed - including treatment for diabetic ketosis, i.e. for a cat that is throwing ketones but not yet ketoacidotic, implication being that progression from ketosis to ketoacidosis is NOT a given).

Improving Success Rates When Treating Diabetic Ketoacidosis

FYI, the author of the above, Stijn Niessen, works in the Diabetes Remission Clinic at the Royal Veterinary College in the UK, a leading research centre for feline diabetes.


Mogs
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Update! Sorry it's long. I went to the vet and I let them know exactly how I felt that I am very concerned and I felt like I was being blown off. After about an hour of waiting the veterinarian came in to talk with me (I am glad it was him and not just a tech tbh). He actually had some time to sit down and talk with me and I really appreciated it. Last night his bedside manner wasn't very good but I know they had a lot going on as well. He was much more personable this time.
He also said he wishes I had gotten the name of the girl I spoke to at first because he didn't want that to happen again (I agree, it shouldn't). But anyway,
He said they did some blood tests and he does not have any ketones right now so that's a relief. He thinks stormy might be making some of his own insulin (I don't know why you'd rely on that rather than just not giving it to him but whatever) and he said things are looking up. He still hasn't eaten though. They still have to do one more electrolyte test (they forgot to do it before) and he wants to start an appetite stimulant and the tech came in to talk to me as well and she said she is going to try and syringe feed him some recovery food. I don't know why they waited til now to start syringe feeding him but whatever. I think he will be okay overnight until I can get him to my regular vet. I trust them way more just because they know his FULL history and that is where he went last time he had pancreatitis. If I pick him up before 7 at the emergency vet, I do not have to pay for another 12 hours. But my regular vet doesn't open til 7:30. And I have a work meeting at 8. So I think I'm going to get him discharged at 7am and take him straight to my regular vet and hope they have room for him if not then I'll take him back to the emergency clinic until I have a chance to talk with my regular vet and get a game plan.

 

Thanks for the update, I'm glad they are finally going to syringe feed him now.
I'm glad you got to finall talk with the vet. Prayers for Stormy
Please keep us posted , you are a great mama Amy.

 

Thank you so much. Here is an update : I went and got Stormy discharged from this vet this morning because I wanted to take him to my regular vet. ALSOOOO when discharging him I found out they had been putting his antibiotic eye drops IN THE WRONG EYE. Like hello??? Did you not notice the green discharge coming out of his eye? Even though I told them it was his right eye about five times. Anyway, My reg vet was not available but her colleague spoke with me. She said she had tried to get records from the emergency vet before I got there, but they were incomplete and so she didn't really know what had gone on. Luckily I had voice recorded my conversation with the vet last night so I was able to play that for her and give her a little better idea. She was NOT happy at all with the whole experience Stormy and I had this weekend. She said she personally would not have stopped insulin, just maybe given a shorter-acting one or something. Apparently this vet used to work at the hospital I went to and she said she knew the management there well. She was so upset with my whole experience, and her own experience trying to get complete records, she said she would call the head of the emergency dept today to speak about it because that's just not okay.
This vet thought stormy needs an ultrasound and to see an internal medicine specialist, so she recommended another emergency vet hospital. She called the ER vet while I was with her and gave him an overview of EVERYTHING that has gone on. So Stormy is there right now receiving fluids again and has an ultrasound scheduled for about an hour from now. He is scheduled to stay there for a couple days. Sounds like tomorrow the internal medicine specialist will contact me and let me know more info. Also the ER vet said he wants to wait until after the ultrasound but then he may restart insulin after that. I have been to this internal medicine specialist before and I really liked him so I feel like here Stormy is in better hands. Of course that is still TBD, but I feel better about it especially since they know most of what's happened this weekend. Hoping things turn out better here! Thanks again everyone for your support

 

I also just maxed out my Care credit so I'm hoping the $3000 i put down is enough lol

 

Sending solidarity! It sounds like you have an advocate with your reg vet and I hope she continues to stay close and help manage things! Thinking of you and Stormy!

 

Hi Amy thanks for the update, giving the antibiotic in the wrong, I would have really gone off on them. I probably would have been arrested.
I'm so happy your vets colleague is on top of everything and she's going to speak to the head of the emergency dept you were at.

Stormy does seem to be in better hands for sure.
Continue to keep us updated, I'll be praying for your baby to be alright
If it's not enough money hopefully they can work a payment schedule out with you.
Just beg them ♥

 

Thank you all for your support!
The vet called around 6 with an update before he ends his shift for the night. Mostly uneventful for now. He said bloodwork taken again looks normal, and no ketones in his urine which is good. His glucose levels are the lowest I personally ever seen them - about 280 so they aren't starting insulin yet (which I think is the right decision in this case). He has been in high 300s or low 400s until today. He still isn't eating though so I'm hoping he will start soon. Vet said he wasn't too worried about that for now but they will do a temporary feeding tube if they feel it's necessary.
His ultrasound was uneventful (which is good). Just showed pancreatitis and some enlarged abdominal lymph nodes which he said could be from the pancreatitis inflammation, or could possibly be cancer. But I'm pretty sure it's not cancer as there were no masses or obvious signs of metastasis. Internal medicine specialist is going to speak with me tomorrow. Thank you all again for your thoughts and prayers

 

Stormy update:
I feel much better about his care now that I have spoken with the doctors here and the internal medicine specialist. The specialist said he still isn't really eating, but not all cats in hospital will eat because it is so stressful for them. He doesn't see eating as a necessity for discharge. They are going to try syringe feeding him about four times a day and see how he does with that. It may cause his glucose to go way up but they're not sure.
They also started him on some fast-acting insulin to try and get his glucose levels down some (they're about 250 rn). The specialist said he has some “debris” in his bladder which can happen with age. Can cause blockages, esp in male cats, but it doesn’t seem to be an issue right now.
They want to keep him here for the next 24 hours to give fluids and monitor him but he MIGHT be ready to come home after that, depending on how he's doing. I may have to continue syringe feeding if he isn't wanting to eat, but I've had a feeding syringe here ready for that since Saturday lol so it's no big deal.
They originally estimated my cost to be at $2900 for two days and that is how much they charged my card for, but he said as of tomorrow morning my charges are only at $1900 so I still have plenty left if he needs to stay longer. (They refund me whatever they don't use). That gives me some relief because I was worried I'd have to pick him up tomorrow whether he was ready or not.

Again, thank you all for your support and thoughts and prayers. It means so much to me. Also I'm really sorry these updates are so long - I have never been good at summarizing lol

 

Also does anyone know if there is a list somewhere on FDMS of recommended feeding syringes?? I bought one on Amazon and it only has two reviews. One good and one bad. So I might want to get a backup syringe just in case that one doesn’t work out.

 

He's a 4 pack. Frienda 4 Pack Large Plastic Syringe for Scientific Labs and Dispensing Multiple Uses Measuring Syringe Tools (60 ml) https://www.amazon.com/dp/B07GGQP7CQ/ref=cm_sw_r_cp_api_glc_fabc_agI.Fb5RD8W1N?_encoding=UTF8&psc=1

 

Thank you!! I have something similar to this that came with his metoclopramide but i was getting really frustrated with trying to get the tiny food chunks through the end of it. I mix by hand so it’s difficult. These aren’t too expensive though so I will probably try them out. Thanks again! I appreciate it

 

I find 60ml syringes way too big to use. I used those 15 years ago for feding Mario through a feeding tune and they were hard to use two handed. I need one that can be used with one hand. I use a 15ml baby feeding syringe but they have not been made for 10 years or so. They have a large diameter tip.

 

I agree, I use a 6 or 10mL oral syringe for syringe-feeding.

 

This post has some links to syringes for feeding, and other tips: Syringe/Assisted Feeding (Video and Tips)

 

Thanks for the update, I'm glad to hear they are syringe feeding him and giving him the insulin and I'm so happy you won't have to worry about the cost.
I hope to hear some better news tomorrow. Will be praying for your Stormy ♥

 

Thank you all so much for all the info!!
I really don't have any more medical-related updates, BUT I GET TO BRING STORMY HOME TODAY!! I pick him up in about 5 hours. Thank you all for your help and support through this. It really helps knowing you are all here for support and advice. I appreciate everyone!!

 

Wonderful Stormy is home. Would you please remove the 911? Thanks.

 

so pleased Stormy is home, and hoping for positive results x

 

So sorry, I tried to take that off a long time ago but I couldn’t figure it out LOL. Got it now though

 

Now that’s he’s home I’m glad to see the 911 gone. Feel good prayers your way.

 

I'm so happy Stormy is home please keep us updated on how he's coming all g
at home ♥

 

Amy down the road you may want to do your signature

 

• when you get a chance ,It would be helpful if you can set up your signature so we don't have to ask you the same questions over again. Members will look at this first .
• It appears after each post in gray, look at mine,

• On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
• • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add any other text, such as
  • Caregiver & kitty's name (optional)
  • DX: Date
  • Name of Insulin
  • 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.


tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people
You can also add where you live in your profile, not your signature

This is at the bottom of every ones post in grey
@Amy I

 

https://felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Amy down the road after everything settles you might want to set up a spreadsheet for Stormy, to track his BG in case you ever need help with dosing.
It's a very good tool. If you need help setting we have a member who will do it for you. Look at mine at the of my post it says Tyler's spreadsheet.

We all use one
@Amy I



https://felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/