Chloe Post DKA

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srk4cats

srk4cats

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I'm going to get a couple midcycles today. I totally messed up last night and gave her a small dose at 10:00 because her number was so high. Her PM dose had been a fur shot. Her numbers are still higher than I would like. I'll call the vet tomorrow if they don't come down below 250. She's eating.
 
Roberta, Chloe is fragile post-DKA and the risk of ketone development is still there. I'm sure after that harrowing episode you'll want to avoid any possible relapse. I believe you said you still have a week off work, correct? I strongly recommend that you do extra testing in this recovery period. I'd aim for three mid cycle tests in the day and at least one more before bed. Stick with the 2 u dose unless she's well under 200 - maybe for anything over 170. She's eating higher carb food to support more insulin. I wouldn't reduce the dose in response to a PS of 187 right now. You should be testing urine for ketones daily.
 
Kris & Teasel said:
Roberta, Chloe is fragile post-DKA and the risk of ketone development is still there. I'm sure after that harrowing episode you'll want to avoid any possible relapse. I believe you said you still have a week off work, correct? I strongly recommend that you do extra testing.
I've been doing extra testing, but it seems that she's always high AMPS and then slowly goes down until her PMPS, which is in the blues. I'm afraid to give her a PM shot of 2 units when she's in the blue, so if I see that she's eating, I'll give her 1.5 u. Should I give her the full 2 u. even if she's under 200?
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It's possible she's dropping quite low at night and bouncing back up in the morning. It might be worth setting an alarm to get a +6 or +7 test overnight a few times to see if that's the case. I understand you not wanting to give a full 2 u on a BG under 200 at PM. I also understand the need to keep the dose up as much as possible post DKA. I think that night time data would be helpful in making further decisions.
 
Kris & Teasel said:
It's possible she's dropping quite low at night and bouncing back up in the morning. It might be worth setting an alarm to get a +6 or +7 test overnight a few times to see if that's the case. I understand you not wanting to give a full 2 u on a BG under 200 at PM. I also understand the need to keep the dose up as much as possible post DKA. I think that night time data would be helpful in making further decisions.
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I think I should keep to the 2 unit dose in the PM even if she drops below 200. She eats a lot and the number zooms back up at +3. It looks like her nadir is the PM reading. If I get up during the night, I'll taking another reading.
 
Set an alarm to get up to test. Don't just rely on if you happen to get up. It isn't fun getting up in the middle of the night but it's necessary to help Chloe.
 
Yep, you want to make sure that she doesn't drop too low. As Kris said, you do need to keep the dose up now, but you also don't want a hypo situation on your hands. I'd set an alarm and be SURE to get up and test NO MATTER WHAT and let us know what numbers you get. We can help you figure out what to do to keep her safe.
 
I was unable to get enough blood this morning after 3 tries. I know she peed just before, but I didn't get a spoon in time. So I fed her and she ate well. How do I get more water into her? And should I give her her full dose this morning?
 
I mix in 2 tablespoons of water with 1 can of FF. I'm not familiar with the food you are using, so not sure how big the can is or how much water to recommend. Just try to mix in as much as you can that she will still eat it.
 
Will you be home to check her today? She needs insulin but it's tough to say what to do with no BG.

Have you gotten ketone tests lately? Sorry if it's on SS. I'm on my phone.
 
srk3cats said:
I was unable to get enough blood this morning after 3 tries. I know she peed just before, but I didn't get a spoon in time. So I fed her and she ate well. How do I get more water into her? And should I give her her full dose this morning?
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Keep a spoon right beside her litter box so you can get urine right away. Needless to say, that's Chloe's pee spoon from now on.
 
Kris & Teasel said:
Keep a spoon right beside her litter box so you can get urine right away. Needless to say, that's Chloe's pee spoon from now on.
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I managed to get a urine sample in a plastic spoon. The strip is about 8 inches long, so I had to pour the urine over it. I'll figure something out about that. Anyway, NO ketones, but got abnormal results for specific gravity/ density, whatever that means. Again got high leukocytes. Of course, glucose was on the high side. This is pretty much the same results I got the last time- pre-DKA.zAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAx(Chico says hello). I'm using One Step Vet-10 strips. I know that leukocytes are white blood cells and indicate an infection, but she was tested in the hospital and they couldn't find any infection.
 
I just caught her eating the dry food for the other cats, AGAIN! The first time, I gave her the Hill's wet food, but she finished that off and went back to the dry food. Is it possible there's something wrong with her teeth that would account for the high leukocytes? She's never had her teeth looked at before. Should I make an appointment?
 
I believe Steph said the leukocytes aren't accurate on the strips. I'm not sure...but I think that was it.
 
Yes, the leukocytes are apparently not accurate for cats. Although do give your vet a call if you're at all concerned. And also about the teeth. They can impact BG as well.
 
Djamila said:
Yes, the leukocytes are apparently not accurate for cats. Although do give your vet a call if you're at all concerned. And also about the teeth. They can impact BG as well.
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I won't worry about it then. She's just gotten out of hospital and I don't want to stress her out again for awhile.
 
srk3cats said:
I managed to get a urine sample in a plastic spoon. The strip is about 8 inches long, so I had to pour the urine over it. I'll figure something out about that. Anyway, NO ketones, but got abnormal results for specific gravity/ density, whatever that means. Again got high leukocytes. Of course, glucose was on the high side. This is pretty much the same results I got the last time- pre-DKA.zAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAx(Chico says hello). I'm using One Step Vet-10 strips. I know that leukocytes are white blood cells and indicate an infection, but she was tested in the hospital and they couldn't find any infection.
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I'm not sure how reliable all those other tests are on that strip. I use Bayer KetoDiastix and they only indicate ketones and glucose. Might be worth buying some of those (inexpensive) so you don't fret about all those other things.
 
Kris & Teasel said:
I'm not sure how reliable all those other tests are on that strip. I use Bayer KetoDiastix and they only indicate ketones and glucose. Might be worth buying some of those (inexpensive) so you don't fret about all those other things.
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Thanks, I'll look it up.
 
The leukocytes panel on the strips is not accurate for kitties. With both my kitties I always got +2 or +3 even when there was no problem. Also the SG tends to read lower than it really is. For an accurate SG the vet would need to use a refractometer which would give an accurate reading. The other panels are good guidelines.


ETA If you get a reading on the blood panel portion that could indicate a UTI. I use the Chemstrips 10.
 
You could try mixing tuna water with some warm water and see if she'll drink that. I give Chuck 1/4 c warm water with a spoon of beech nut chicken & broth baby food too. Anything to make the water taste like a treat and make it more tempting than the regular water. I do this when I'm trying to get a urine sample too. He will usually pee after about an hour or hour and a half. It can be tough catching a sample. I finally got one from Chuck today. I've been trying for 3 days! He was negative too!
When you're having a hard time getting blood... Have you tried using more pressure when poking? Or milking her ear upward and kind of pinching below where you want to poke- like a way to keep the blood trapped up there til you poke? I'm not sure what might work to help get a sample when you're having a hard time. It's kind of trial and error.
Happy to see negative ketones on her test.
 
I just ordered ketone strips from Walmart for about $6. They are very simple and just measure ketones. I'm going to switch to the ultra-thin lancets and try to get Chloe to drink more water. I've tried the pinching etc.
 
564 only 2 hours after her injection! How? I didn't see her eating anything. I'll get up during the night to make sure it's not a bounce.
 
srk3cats said:
I just ordered ketone strips from Walmart for about $6. They are very simple and just measure ketones. I'm going to switch to the ultra-thin lancets and try to get Chloe to drink more water. I've tried the pinching etc.
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The easiest way to get more water into them is to add some to every wet food meal to make a type of kitty "stew". The black number is possibly part food spike if she ate high carb food but mostly a bounce. There's no data from the daytime to know. I hate to nag but you really can't afford to ease up on the testing, Roberta. It's only been a week since Chloe's hospital stay.
 
Kris & Teasel said:
The easiest way to get more water into them is to add some to every wet food meal to make a type of kitty "stew". The black number is possibly part food spike if she ate high carb food but mostly a bounce. There's no data from the daytime to know. I hate to nag but you really can't afford to ease up on the testing, Roberta. It's only been a week since Chloe's hospital stay.
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It's a bounce if ever I saw one. I'm trying to get her back to 7 am shots. I got up a couple times in the night to pee, but I'm so foggy and I don't want to wake up all the cats. I'll get a couple mid-cycles today.
 
How much of the hills md is she eating? If 2 units is dropping her too low at night you might have to increase the amount of food to keep the 2 unit shot. Have you tried crushing a few pieces of kibble and adding warm water to it to see if she'll drink it that way? Could try adding warm water to her dry food (only a few pieces) to see if she will eat it that way. You don't want to do it on a full meal if you don't know she'll eat it. Might end up wasting a whole meal. Try a few pieces first then move up from there if she will eat it with some warm water added.
I agree with Kris that you need more tests. Don't let your guard down yet!
 
StephG said:
How much of the hills md is she eating? If 2 units is dropping her too low at night you might have to increase the amount of food to keep the 2 unit shot. Have you tried crushing a few pieces of kibble and adding warm water to it to see if she'll drink it that way? Could try adding warm water to her dry food (only a few pieces) to see if she will eat it that way. You don't want to do it on a full meal if you don't know she'll eat it. Might end up wasting a whole meal. Try a few pieces first then move up from there if she will eat it with some warm water added.
I agree with Kris that you need more tests. Don't let your guard down yet!
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She was at 61 this morning! She ate quite a bit of Hill's, though. I'm getting frustrated that she won't get regulated. She ate almost a full 5.5 oz can of Hill's and I just did another reading. She's at 158 now. I haven't given her her shot yet. I'm going to check again in another hour and if she's closer to 200, I will give her 1 unit. No, I think I'll just skip her shot this morning because it would put me so off-schedule and I start work on Monday.
 
I didn't this right away. Did you give her insulin? I would give her some but not 2 units! 61 means she's going too low over night. You need to get tests at night. She's probably going to bounce today.
@Kris & Teasel what do you think? She needs the insulin to keep Ketones at bay but hard to tell how much.
Edited to add: the 61 could be a very late nadir but the only way to know that is to get tests overnight.
If you can monitor and steer I think 1 unit would be better than 2.
 
StephG said:
I didn't this right away. Did you give her insulin? I would give her some but not 2 units! 61 means she's going too low over night. You need to get tests at night. She's probably going to bounce today.
@Kris & Teasel what do you think? She needs the insulin to keep Ketones at bay but hard to tell how much.
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How about a half dose (1 u), given that the food has pushed her up? I wouldn't skip post DKA.

Not having a regulated cat IS frustrating, Roberta. Some are easier to regulate than others. Regardless, though, it takes intensive, sustained effort over time to get there.
 
Kris & Teasel said:
How about a half dose (1 u), given that the food has pushed her up? I wouldn't skip post DKA.

Not having a regulated cat IS frustrating, Roberta. Some are easier to regulate than others. Regardless, though, it takes intensive, sustained effort over time to get there.
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Well, I didn't give her any insulin and now she's over 400 midday. I think I'd better move her PM shot to 5 PM, but should I give her 1 or 2 u? Do you think she needs a different insulin?
 
srk3cats said:
Well, I didn't give her any insulin and now she's over 400 midday. I think I'd better move her PM shot to 5 PM, but should I give her 1 or 2 u? Do you think she needs a different insulin?
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I would give 2 units as long as she eats. You can move the shot to 5 since she didn't get insulin this morning.
I don't know if another insulin would suit her better. She responds well to prozinc. Lantus or levemir would give her longer control. I think it would require more testing in the beginning since she's still not quite set on a prozinc dose.
It could be worth posting in the lantus & levemir group to see if they can give some more opinions.
Right now the important thing is to keep testing for Ketones and keep insulin in her system.
Check back often when asking about dosing opinions.
 
Rachel said:
You'll definitely need to test more if you do switch insulins.
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She''s munching on her dry food now. I just got home and caught her in the act. It's 4:30. I'll test her at 5:00. I'm using up the Royal Canon glyco for dry.
 
It would be best to get a +4 tonight, at least. That way you can see if the insulin is bringing her down too quick or not.
 
When I tested her at 7 pm, the meter just read HI. I immediately gave her 2 units insulin and didn't feed her. When I tested her 1.5 hr. later, she had vomited all the dry food and was down to 451. I'm going to test her during the night, I promise.
 
Looks like you got a nice yellow last night! When was the last time you got a ketone test? I didn't see any listed on your SS lately.
 
She tested 'HI' again. Does that mean she's in the 600's? Still haven't caught her peeing to get ketones. Her behavior is normal and appetite is good. Should I continue with 2 units?
 
I would give her 2 units. Get a +4 or later over night test in.
Do EVERYTHING you can to get a ketone test. Put plastic wrap over the litter and check often to see if she peed yet.
Is she getting into any other food during the day? Mid cycles tests are important during the day too. Especially because her numbers are so high.
Have to make sure the insulin is working and not taking her too low.
You don't want to end up back at the kitty ER.
 
StephG said:
I would give her 2 units. Get a +4 or later over night test in.
Do EVERYTHING you can to get a ketone test. Put plastic wrap over the litter and check often to see if she peed yet.
Is she getting into any other food during the day? Mid cycles tests are important during the day too. Especially because her numbers are so high.
Have to make sure the insulin is working and not taking her too low.
You don't want to end up back at the kitty ER.
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Chloe just made a nice solid poop, but I still haven't caught her peeing. I know she's been drinking water. I just tested her at 11:30 and she was 305. I was 106. ouch.
 
I see she had a yellow preshot. That's good.
Please be careful with the 2 unit doses. She could go too low on it. I suggest testing +3/+4 and again +7/+8 to see where she goes on it. If you need to steer with food it's better to do that than let her go too low then deal with the super high numbers in a bounce.
She still needs the insulin to keep Ketones at bay so decreasing might not be the right thing to do yet. UNLESS you can't commit to testing and feeding more mid cycle to keep her numbers up.
Others might have some advice. You could try doing a forum search for post dka cats and see what strategy they used.
 
It's SUPER IMPORTANT that you get a ketone test as soon as possible, Roberta. Since Chloe is post DKA, you need to be really vigilant about getting a test. Keep a spoon right next to her LB and be ready to grab a test at any time.
 
Rachel said:
It's SUPER IMPORTANT that you get a ketone test as soon as possible, Roberta. Since Chloe is post DKA, you need to be really vigilant about getting a test. Keep a spoon right next to her LB and be ready to grab a test at any time.
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I haven't seen her use the litter box at all today and tomorrow I go back to work. I'm hoping I can catch her in the morning before I go. I've got the spoon on standby.
 
srk3cats said:
I haven't seen her use the litter box at all today and tomorrow I go back to work. I'm hoping I can catch her in the morning before I go. I've got the spoon on standby.
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If all else fails I'd add some water to her food, and grab my trusty roll,of cling film. The extra water should help with the pee. And the cling film over the litter should catch some for you just in case she's sneaky.
 
TempestsMum said:
If all else fails I'd add some water to her food, and grab my trusty roll,of cling film. The extra water should help with the pee. And the cling film over the litter should catch some for you just in case she's sneaky.
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I have several litterboxes around the house because I have 2 other cats. I could isolate her, but she hates that.
 
I don't understand what's going on. The past 2 days, her number actually went up after her PM reading. I would think the Prozinc would have kicked in and lowered her numbers by +3.
 
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