Cat recovering from DKA and I am terrified.

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SandraAndChief

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Hi everyone,
I hope this is the right place to post and sorry if it will be very long, I want to be thorough. I am also in what I can only describe as an ongoing mental breakdown since this all happened and I cry every few hours.

The light of my life, Chief (he’s around 14, I adopted him as an adult and the shelter didn’t know his exact age or background, my family thinks he’s older), got diagnosed with diabetes and DKA on the 27th of December after about 2 months of what I now know were clear symptoms of diabetes. And I feel like I am losing my mind.

I’ll give a little background; in mid October, he caught a stomach bug. My parents adopted a kitty from foster care and it turns out she had a tummy issue. Unfortunately I didn’t realize right away and going from their place to mine, I didn’t think I had to change clothes, and by the time I realized the kitten was sick it was too late and Chief caught it. He had diarrhea for about 3 days, but had no other symptoms and recovered well. Then at the end of the month a vet came to see him for a quick check up, we did bloodwork and biopsied a bump on his hip. The bloodwork was good, only Hematocrit and Creatine Kinase were slightly elevated, and his bump was benign. Then, due to the diarrhea he had dealt with, and the fact that Chief has always had a sensitive tummy, I introduced Royal Canin Digestive Kibble (he had been eating the wet food for years) thinking it would maybe help improve his digestion. Then within about a week, I noticed increased thirst, urination, and appetite. Although I recognized the symptoms of diabetes, due to his good blood work merely 1-2 weeks prior, I assumed maybe the change in food was to blame. Over the next few weeks this continued but otherwise his behaviour didn’t change. After a while I noticed weight loss and weakness, but he was still behaving normally. Then around mid December he became a bit less active, and on the 23rd of December I got litter that shows glucose in urine, and of course the granules turned deep blue. On December 25th I took him to the only vet that was open in my city, other than the Vet ER. I told him about Chief’s textbook diabetes symptoms and even brought a clump of litter with his pee on it showing the blue granules. The vet, unfortunately, suggested that Chief was likely suffering from dementia, and that the pee might have been from my other cat “because his recent bloodwork was good and diabetes wouldn’t just come out of nowhere”. I insisted on doing bloodwork and urinalysis, and he suggested x-rays as well. Unfortunately with it being Christmas Day, the results would of course take a while. He prescribed amitriptyline, which I did not give because I didn’t trust this vet after his assessment. The next day was uneventful but he became a bit less interested in food the night of the 26th, and by the morning of the 27th I saw he hadn’t touched his food or water overnight. I gave him a few hours to see if anything would perk him up, but nothing worked so we headed to the ER Vet. There, they redid his bloodwork and urinalysis and got instant results. Not only was he diabetic but in DKA. I almost collapsed. The vet did seem fairly positive and said there was a good chance he would respond to treatment. He spent 4 nights in the hospital, improved steadily and began to eat on his own fairly quickly. His ketones took a while to go down, but eventually they got to 1, which is when they put him on insulin to determine the dose that would work for him going forward. I did visit him everyday with my parents and my husband, and on the 31st we took him home.
He’s taking 1.5u Lantus 2x a day 7am-7pm. The instructions were to only feed him at those times but this has been impossible for me. He almost hurt himself trying to climb to areas where he thought there could be food. He was meowing at me and sleeping in an empty food bowl, after licking it aggressively. He climbed into a box and emerged with a bag of Greenies in his teeth. I couldn’t stand it and I got some freeze dried salmon and treats (all grain free, just meat) and some Weruva Kitty Gone Wild (no starch, or grains) as it has large pieces of fish and I give about 2 tablespoons when he seems super hungry. He still eats a full can of food with his insulin. For his main meals with insulin, I’m feeding what they were feeding him at the hospital- Purina Veterinary Diets EssentialCare for seniors. He likes it heated and I put 1/4tsp Restoralax on top as his ER vet recommended. I don’t know if he has used the bathroom as I do have another cat and they both use both litter boxes, but I do think he may have pooped once since I got him back from the hospital. I am not sure and I’m definitely stressed about this.

Here’s why I’m really freaking out. I got a glucose monitor, although the vets didn’t encourage it, and the readings have been high. The first time I tested he was at 588.6 mg/dL. This was at 11pm, so 4 hours after his insulin. Called the vet, and they said to check again in 2hours. It eventually went down to the 400s and I didn’t retest. It’s very hard to test, even for my mother who is a nurse. He doesn’t bleed easily at all, so we had to poke my poor baby so many times just to get a tiny droplet, if I can even call it that. And we had to do it on his paw pad, as his ear would not bleed at all. I also got keto-diastix, which seem to show trace ketones (it’s a bit hard to tell with the colour change, it’s like between negative and trace. This freaks me out so much. Especially because on the 25th, it turns out there were no ketones in his urine. So somehow between having 0 on the 25th, he had 4+ on the 27th. It makes me feel like something could happen in an instant, and there are so many variables. His glucose also appears high on the sticks. I always test his pee about 1.5hrs after his insulin and dinner.

I am completely losing it. I can’t sleep, I check on him every few minutes and multiple times a night. I check his sleeping position and location and based on that I try to guess how he’s feeling. Now I am having a breakdown because he’s sleeping under the dinner table where he had been sleeping lately. He would sleep there before when he was healthy as well, but now I associate it with him getting sick. He is sleeping comfortably, at times even showing his belly, which I assume means he’s comfy. He hasn’t been upstairs at all since he got back from the hospital and hasn’t cuddled at all, which he usually loves doing and would sleep on my chest multiple times a day. His appetite is good, and he drinks less water than before his diagnosis/DKA, but I do see him at his fountain a few times a day. I also add a tiny bit of water to his food and at this point I only feed him wet food and his freeze dried grain free treats. He also does tend to go to sleep after his dinner/shot. I know this can be a sign of hypo but the doesn’t show other symptoms and every test I’ve done has shown high BG and high urine glucose. He does have a vet appointment in the morning to check in, and will be working with home vets after that ideally, to spare him the car rides.

Does anyone have similar experiences? Does his situation sound bad or is it fairly standard. I guess after DKA it makes sense he wouldn’t be fully himself yet but it’s hard to tell if there is improvement. I desperately want him to get better but I can’t help but have a feeling of hopelessness, which is awful.

Anyway, I appreciate any advice or words of encouragement. Sorry about the length of this post, I just really am spiraling and feel so scared and overwhelmed. Thanks in advance for any input you guys may have <3
 
Hi Sandra! Nicely written post, I’m sorry you’re going through all this. We have all felt similar emotions when we were first getting started, so I understand. Also - kudos to you for staying persistent after that first vet! That’s scary stuff.

A more experienced member will be by soon to help. You’re doing a lot of things right, it will get easier.
 
Hi everyone,
I hope this is the right place to post and sorry if it will be very long, I want to be thorough. I am also in what I can only describe as an ongoing mental breakdown since this all happened and I cry every few hours.

The light of my life, Chief (he’s around 14, I adopted him as an adult and the shelter didn’t know his exact age or background, my family thinks he’s older), got diagnosed with diabetes and DKA on the 27th of December after about 2 months of what I now know were clear symptoms of diabetes. And I feel like I am losing my mind.

I’ll give a little background; in mid October, he caught a stomach bug. My parents adopted a kitty from foster care and it turns out she had a tummy issue. Unfortunately I didn’t realize right away and going from their place to mine, I didn’t think I had to change clothes, and by the time I realized the kitten was sick it was too late and Chief caught it. He had diarrhea for about 3 days, but had no other symptoms and recovered well. Then at the end of the month a vet came to see him for a quick check up, we did bloodwork and biopsied a bump on his hip. The bloodwork was good, only Hematocrit and Creatine Kinase were slightly elevated, and his bump was benign. Then, due to the diarrhea he had dealt with, and the fact that Chief has always had a sensitive tummy, I introduced Royal Canin Digestive Kibble (he had been eating the wet food for years) thinking it would maybe help improve his digestion. Then within about a week, I noticed increased thirst, urination, and appetite. Although I recognized the symptoms of diabetes, due to his good blood work merely 1-2 weeks prior, I assumed maybe the change in food was to blame. Over the next few weeks this continued but otherwise his behaviour didn’t change. After a while I noticed weight loss and weakness, but he was still behaving normally. Then around mid December he became a bit less active, and on the 23rd of December I got litter that shows glucose in urine, and of course the granules turned deep blue. On December 25th I took him to the only vet that was open in my city, other than the Vet ER. I told him about Chief’s textbook diabetes symptoms and even brought a clump of litter with his pee on it showing the blue granules. The vet, unfortunately, suggested that Chief was likely suffering from dementia, and that the pee might have been from my other cat “because his recent bloodwork was good and diabetes wouldn’t just come out of nowhere”. I insisted on doing bloodwork and urinalysis, and he suggested x-rays as well. Unfortunately with it being Christmas Day, the results would of course take a while. He prescribed amitriptyline, which I did not give because I didn’t trust this vet after his assessment. The next day was uneventful but he became a bit less interested in food the night of the 26th, and by the morning of the 27th I saw he hadn’t touched his food or water overnight. I gave him a few hours to see if anything would perk him up, but nothing worked so we headed to the ER Vet. There, they redid his bloodwork and urinalysis and got instant results. Not only was he diabetic but in DKA. I almost collapsed. The vet did seem fairly positive and said there was a good chance he would respond to treatment. He spent 4 nights in the hospital, improved steadily and began to eat on his own fairly quickly. His ketones took a while to go down, but eventually they got to 1, which is when they put him on insulin to determine the dose that would work for him going forward. I did visit him everyday with my parents and my husband, and on the 31st we took him home.
He’s taking 1.5u Lantus 2x a day 7am-7pm. The instructions were to only feed him at those times but this has been impossible for me. He almost hurt himself trying to climb to areas where he thought there could be food. He was meowing at me and sleeping in an empty food bowl, after licking it aggressively. He climbed into a box and emerged with a bag of Greenies in his teeth. I couldn’t stand it and I got some freeze dried salmon and treats (all grain free, just meat) and some Weruva Kitty Gone Wild (no starch, or grains) as it has large pieces of fish and I give about 2 tablespoons when he seems super hungry. He still eats a full can of food with his insulin. For his main meals with insulin, I’m feeding what they were feeding him at the hospital- Purina Veterinary Diets EssentialCare for seniors. He likes it heated and I put 1/4tsp Restoralax on top as his ER vet recommended. I don’t know if he has used the bathroom as I do have another cat and they both use both litter boxes, but I do think he may have pooped once since I got him back from the hospital. I am not sure and I’m definitely stressed about this.

Here’s why I’m really freaking out. I got a glucose monitor, although the vets didn’t encourage it, and the readings have been high. The first time I tested he was at 588.6 mg/dL. This was at 11pm, so 4 hours after his insulin. Called the vet, and they said to check again in 2hours. It eventually went down to the 400s and I didn’t retest. It’s very hard to test, even for my mother who is a nurse. He doesn’t bleed easily at all, so we had to poke my poor baby so many times just to get a tiny droplet, if I can even call it that. And we had to do it on his paw pad, as his ear would not bleed at all. I also got keto-diastix, which seem to show trace ketones (it’s a bit hard to tell with the colour change, it’s like between negative and trace. This freaks me out so much. Especially because on the 25th, it turns out there were no ketones in his urine. So somehow between having 0 on the 25th, he had 4+ on the 27th. It makes me feel like something could happen in an instant, and there are so many variables. His glucose also appears high on the sticks. I always test his pee about 1.5hrs after his insulin and dinner.

I am completely losing it. I can’t sleep, I check on him every few minutes and multiple times a night. I check his sleeping position and location and based on that I try to guess how he’s feeling. Now I am having a breakdown because he’s sleeping under the dinner table where he had been sleeping lately. He would sleep there before when he was healthy as well, but now I associate it with him getting sick. He is sleeping comfortably, at times even showing his belly, which I assume means he’s comfy. He hasn’t been upstairs at all since he got back from the hospital and hasn’t cuddled at all, which he usually loves doing and would sleep on my chest multiple times a day. His appetite is good, and he drinks less water than before his diagnosis/DKA, but I do see him at his fountain a few times a day. I also add a tiny bit of water to his food and at this point I only feed him wet food and his freeze dried grain free treats. He also does tend to go to sleep after his dinner/shot. I know this can be a sign of hypo but the doesn’t show other symptoms and every test I’ve done has shown high BG and high urine glucose. He does have a vet appointment in the morning to check in, and will be working with home vets after that ideally, to spare him the car rides.

Does anyone have similar experiences? Does his situation sound bad or is it fairly standard. I guess after DKA it makes sense he wouldn’t be fully himself yet but it’s hard to tell if there is improvement. I desperately want him to get better but I can’t help but have a feeling of hopelessness, which is awful.

Anyway, I appreciate any advice or words of encouragement. Sorry about the length of this post, I just really am spiraling and feel so scared and overwhelmed. Thanks in advance for any input you guys may have <3
@Bron and Sheba (GA)
 
Hello and welcome. I'm guessing you are in Canada too? We've had quite a few people here who have gone though DKA with their cats.

Sounds like you have been through a lot. :bighug::bighug::bighug: Bron is great at helping out with DKA, but possibly not up yet. I'll give a general overview and answer some of the other questions. First, you fight DKA with food, water, the right amount of insulin, and fighting any infection or inflammation he might have.

The right amount of food is, at this point, what he'll eat. With diabetes and DKA, several small meals a day are fine and what are recommended. Eventually we'll talk about low carb food which is what he'll need to help with the diabetes. Kibble is generally not advised as most of them are horribly high in carbs. I'm happy to hear that wet food had been his previous food and he's OK eating it. If he has a sensitive tummy, it could be an allergy to one of the proteins he was getting. If his appetite is off, not uncommon with DKA, it's likely due to nausea and you should be giving anti-nausea meds. My favourite is ondansetron, though Cerenia can also be a help. Note, ondansetron is expensive in Canada, and is a drug you get at a human pharmacy - the vet will need to write you a prescription to get it. Do shop around pharmacies, I've noticed quite a difference in prices.

Fluids - water down his food if you can. Try to find enticing fluids like chicken stock (plain, no salt, garlic or onions). I used to boil a bit of chicken in water. Some people have used tuna water - again, plain tuna no salt.

Insulin - good to hear the vet started Chief on Lantus, it's an excellent insulin for cats. However, not so happy the vet didn't talk about home testing. What type of blood glucose meter did you get? You want want that requires the smallest blood drop, and the Freestyle Lite is one such option in Canada. You also want to use a larger gauge lancet to start, 26 or 28, until their ears learn to bleed. More tips on testing along with videos in here: Hometesting Links and Tips

And finally, just some information you can provide that will help us work together.
New? How You Can Help Us Help You!
 
Welcome to FDMB.

Your instincts are excellent. I haven't a clue how a vet would not be able to identify diabetes over dementia. I'd be thinking about sending this vet information on continuing education classes on feline diabetes.

If it's any consolation at all, I've been there and done that. When Gabby was diagnosed with diabetes, she spent 3 nights in the vet hospital ICU and was diagnosed with DKA, pancreatitis, and hepatic lipidosis. Two vets, mine and the ICU vet, told me there was a good chance she might not survive. She did. So, your job is to take a deep breath and try to get focused. There's going to be an overwhelming amount of information for your to absorb and even more so given that DKA is in the picture.

We are very aggressive with regard to helping you manage DKA. First, this is our primer on DKA/ketones. DKA is the result of an infection or inflammation + not enough calories + not enough insulin. Most diabetic cats are ravenous until their blood glucose levels (BG) numbers are under reasonable control. It sounds like Chief is in that category. Given the DKA, feed him as much as he wants. A cat that is post-DKA needs at least 1.5 times the amount of calories he would normally eat. While the image of Chief with a bag of Greenies made me giggle, Greenies are way too high in carbohydrates for a diabetic cat. I also can't find the Purina food you're using. There are cat food carb calculators on the web (e.g., ScheyderWeb) and if you plug in whatever values are available, it will calculate the carb content. You want to be feeding Chief low carb food. We consider low carb under 10% although most members feed their cat in the 5% range.

You may also want to make sure the Chief is drinking well. I have always added water to my cat's food. In the post-DKA days, hydration is also important. Cats have a limited thirst drive. Water helps to dilute ketones. In fact, I wouldn't be surprised if the vet had Chief on an IV when he was in the hospital to help with flushing the ketones.

As far as insulin, it sounds like Chief may need more. However, as aggressive as we are about DKA, I'm very reticent to offer suggestions about dosing until you have a spreadsheet set up. We are very numbers driven and determined to keep your cat safe. It's great that you're home testing. The information on setting up a spreadsheet and your signature are in this post on helping us to help you. The spreadsheet allows you to keep track of Chief's progress and lets us follow along. The signature has some basic information about your cat so we don't pester you with the same questions repeatedly.

I'm guessing that the reason you're struggling with getting blood when you test is twofold. First, what gauge lancet are you using? You want to use a wider lancet -- a 26 gauge or so. That will help. It also takes a bit of time for the capillary bed along the edge of your cat's ear to develop. Until it does, it's harder to get blood. Once Chief's ear bleeds more easily, you can switch to a thinner lancet (around a 30 gauge).

Lantus (glargine) is a very good insulin for feline diabetes. It differs from many of the other insulins in that it takes about 5 - 7 days for the insulin depot to stabilize. It is the depot that differentiates it from the other insulins and gives Lantus its longer duration and gentler action. However, it needs to build up and that takes some time. It's not a type of insulin that smashes numbers down and then is gone. There is information about how Lantus works in the yellow sticky notes at the top of the Lantus board. There's also information on the dosing methods we use. It is very helpful reading. Once you have your spreadsheet set up, we can offer some help with dosing.

Please let us know if you have questions. We're here to help.
 
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Hi Sandra and Chief and welcome to the forum. I am so sorry you have been through this. I can’t imagine why a vet would think a cat had dementia, when he had diabetes. I’ve heard a lot of strange things but not that before. It will be scary and overwhelming for a few weeks, especially if you have had Chief in hospital with DKA, but with the correct aftercare, he should fully recover, so try not to stress too much. He is a lucky boy to have you caring for him.
Wendy and Sienne have given you lots of great advice. This is what I would advise you to do for the next few weeks.
  • you need to give one and a half times as many calories as Chief 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 Chief won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating. We can worry about getting him to eat low carb food later if he will only eat higher carb food at the moment. Eating something is the most important thing.
  • 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. This is very important. 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. Wendy has mentioned ondansetron and cerenia.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Chief will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids and if he thinks they are needed.
  • Set up a spreadsheet and test the BG frequently. If you need help with setting up the spreadsheet w can help with that. We need to be able to see all the BG data so we can help with the dosing which is so important with a DKA cat.
  • Set up the signature and tell us all about Chief. How to do that and the spreadsheet are in the link you were given above called Help Us Help You
  • Post daily with updates and ask for help as often as needed.
 
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