Choco and I are Newbies!!! 911 DKA

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marleesan71

marleesan71

Active Member
Hello everyone. My name is Maria and my cat Choco was recently diagnosed with diabetes. Choco was a 22lb medium haired black kitty and now he's down to 17lbs. I know that is a much healthier weight but I am now feeling his spine and that's not good. At the vets office last week, his blood sugar reading was in the mid 300's. I just started testing him myself yesterday and so far have only had to give him one shot of insulin (Lantus) because he was at 254. This morning and also tonight he was at 245 so I did not give him any insulin because I was told not to give him any unless he was over 250. He didn't really have an appetite tonight although when I first put his can of food out he was licking at it. I force fed him about a syringe full and then he ate a piece of turkey lunch meat. I am concerned about him because he is just acting very "blah". He is just kind of laying around and although he is fine to get up and walk (he's not wobbly), he doesn't really seem too interested in doing much more than laying down. I can tell he does not feel good by the look in his eyes. I did take his sugar level again a half hour after the first time I took it and he had that little bit to eat and the reading was 240. I need to do the curve test one day this weekend so any advice on what I should be doing would be great! I also picked up some keytone strips tonight (after going to six different stores;O) so I guess when I can catch him urinating then I can test those as well. I'm really tired, stressed, a little confused and a lot worried about Choco.

Update: I just checked his blood again (this is 3 hours since the first test at 7:15) and his number is now 229. I'm not sure if that's a good or bad thing.
 
Re: Choco and I are Newbies!!!

First off congrats on testing Choco at home, that is probably the very best thing you can do for him.
Second you are on a great insulin, Lantus is a wonderful insulin for kitties, but can you tell us what dose you are giving and how often, Lantus is usually given twice a day 12 hours apart.
Third....Breathe, you are now in the very place you never wanted to be, but will be so happy you have found.

Also what are you feeding Choco right now, you said can so I'm assuming you are feeding him a canned wet food diet, but it is helpful for us to know exactly what kind of wet food, some is better than others.

My own diabetic kitty was 485 when he was dxed back in October, but with a switch in his diet to all canned food below 10% carbs, and a few weeks on Lantus my boy has been in remission and off insulin after only a little over a week of shots. Not all cats are that lucky but it can happen and Choco wasn't all that high when he was dxed.

I'm sure others will be along shortly to give you even more tips and a ton of links to read over.

Mel, Max & The Fur Gang
 
Re: Choco and I are Newbies!!!

Hi Mel, and thanks for responding. I think I could handle this all much better if Choco wasn't feeling so crummy. So to answer your questions, he is on .5 units (very small amount) only when he tests over 250. I'm sorry if I'm saying anything wrong but the syringe says units and it's the first tiny line closest to the needle so I think I said it right. I am testing him 12 hours apart and am now feeding him Fancy Feast Classics. He was doing fine eating his food up until tonight. Is it a good thing that his reading has dropped from 245-220 in 3 hours or should I be worried? I also need to do this curve test. Any suggestions? Thanks again!!!

Maria and Choco
 
Re: Choco and I are Newbies!!!

Hi Maria and Choco,

You are doing great with testing and diet. And a good insulin. It does take a while for Lantus to work - it builds up a shed: viewtopic.php?f=9&t=150. You can get a lot of good information on how Lantus works on our Lantus forum: viewforum.php?f=9

It is important that Choco eats. Sometimes it helps to warm up the food in the microwave until nice and stinky. You can also sprinkle some Parmesan on it.

To do a curve, you test every 2 hours between the am and pm shot during a day. You might want to wait a few days. It takes Lantus a while to work in some cats.
 
Re: Choco and I are Newbies!!!

Hi Maria!
Kuddos for already testing, did Choco have ketones at the vets? In the beginning our
babies will feel like **** but as everything comes together he will perk up. Try and tempt him
with food, he needs to eat .... you are doing well getting food in him. Once the insulin kicks
in, he should eat. Yes, there is a lot to learn and you will get there. I am a newbie also and I
realized today as I was throwing the sock in the microwave, drawing the insulin and trying not
to prick myself with the lancet, it does get easier. (my Payne was Dx'd 10/11)
Nancy and Payne (who heard the word ketone and is not happy grumpy_cat )
 
Re: Choco and I are Newbies!!!

You are fine on the drop it is nice and easy, and you are on a great starting dose. Insulin is measured in units so you are correct. With Lantus it needs to build up a shed, or basically a reserve in his body before it becomes really effective, so Choco may feel a little crummy until his sugar comes down a little more. But he should rebound pretty quickly. You have him on a really good diet as well, so give yourself a pat on the back.

My Max was a mess when I adopted him, and I adopted him because he was a diabetic and his previous owner had to go to a nursing home, and the family was going to just have him put to sleep. So I stepped in and adopted him.

Max felt pretty lousy too in the beginning, but if you saw him today you wouldn't know him from my other 10 kitties. Max was felt so crummy he wasn't even grooming himself and since he was a long haired kitty had become so matted that he had to be shaved, in some places clear down to his skin. His a big kitty, long legged and long bodied, when he came to live with me he only weighed 10.5 lbs, today he is a nice hefty armful at 15 lbs which is just about perfect for him. So it gets better, it really does.

Since we have 11 cats atm I'm not about to try to keep everyone on a different diet, so everyone here eats what Max eats, but with our furry horde I tend to feed Friskies pate flavors http://binkyspage.tripod.com/canfood.html from this list that are below 10% and I can't even begin to tell you how much better my non-diabetics are doing on the new diet, so if you have any other cats you can just feed them the same thing too, and not have to worry about who gets into what.

There is also a section of this board for just Lantus users the folks there all use your insulin and would love to help you with whatever questions you might have on how it works and how to adjust doses etc. As well as that section has some great sticky notes on how to read the syringe, and handle and store Lantus. If you haven't already wander over there and have a read.

Plus you can always post questions here as they pop in your head and someone is usually around to help out. It can be very scary and completely overwhelming in the beginning but before long you will find it as routine as brushing your teeth.

We also have a wonderful tool here for setting up a spreadsheet that is color coded and will allow you and us to see trends on how well the dose is working for Choco. I'll see if I can find you the link and post it for you. But if you want to see how Lantus works at least for Max you can always click on his spreadsheet in my signature. Now I don't test him very often anymore since he is in remission, but you can look at his very early numbers and see how he dropped.

As far as a curve goes, they are pretty easy once you get the hang of testing. You just test like you would before giving insulin, except that you get a reading every 2 hours for one cycle or between his morning shot and his evening shot. With Lantus you are going to want to base whether you need to increase or decrease based on the nadir of that curve or the lowest point. But we can help you with that when the time comes.

The only time you need to be concerned with hypo is when you start seeing really low numbers like low 50s or 40s. Sonce he is just starting on insulin you may want to get a couple spot checks in on him, and when Max was still on insulin I always tried to get a spot check in right before I went to bed, but then again I'm a worry wart.

Mel, Max & The Fur Gang
 
Re: Choco and I are Newbies!!!

I will be back shortly with details, but...

Choco is in DKA and hopefully Maria has him on his way to the ER vet for treatment.

DKA costs ~$1K/day to treat. If you can donate, click "How to Donate" in my signature line. If you can't donate, please send fundraising and wellness vibes for Maria and Choco.
 
Re: Choco and I are Newbies!!!

Tons of prayers and healing vibes for Choco and Maria.

Maria is an amazing lady who fosters kittens and cats for Kitten Associates and many other groups, KA is the group that Robin started and I work with. (www.coveredincathair.com and www.kittenassociates.org) She's always giving her time, love and money to the cats that she rescues, any help that we can give her now would be greatly appreciated.
 
Re: Choco and I are Newbies!!!

Sending tons of prayers and purrs for Maria and Choco, we will keep all our fingers and paws crossed that the money can be raised swiftly and that Choco makes a full recovery.

Mel, Max & The Fur Gang.
 
Choco%2Bon%2Bbench.jpg
Healthy Choco

DKA Choco
Choco%2BDKA%2B2.jpg


He's at the ER and all hooked up to everything he should be hooked up to. The cost estimate for treatment through Monday morning is $1800 to $2700. Robin, the keeper of Covered in Cat Hair and Kitten Associates, is starting fundraising as well.
 
I want to THANK everybody for their wonderful advice and donations. Choco is DKA and currently at Southern Crescent Emergency Clinic in Fayeteville Georgia. I'm sure you can imagine how I felt when the vet looked at me and said Choco was in bad shape and that he needed to be hopitalized for a few days due to his keytones being too high. As the vet was talking, all I could think about was how I was going to come up with the money to pay for a weekend stay at the emergency vet. If I did nothing, he would suffer and die. I have been down this road before so I knew I was looking at a cost far greater than I could ever afford. My heart sunk and along with the sadness came anger towards myself. I felt like a complete failure to my child. I couldn't fight back my tears and for a split second, I thought the only loving option would be to put him to sleep so he wouldn't suffer. That thought literally lasted for a split second because there was no way that was happening. I got myself together and put my brain into motion. I remembered hearing about Care Credit so I called my wonderful friend Robin with Kitten Associates and after I had a break down with her, she told me how it works. The emergency animal clinic let me use their computer and I was approved!! Unfortunately, it wasn't even enough for the deposit that I had to give them before they would even start helping Choco. :O( This is where 3 amazing ladies stepped in and set up a fundraiser for Choco. Thank you is not enough to show my gratitude towards Robin, Venita and Jennifer but it's all I've got to give. It is simply beautiful and amazing how complete strangers open up their hearts to care for one another and these precious babies. Thanks again!!!
 
You can count on me for a donation. I was just puzzled because nothing inthe thread suggested DKA. But from experience I know a cat can get high ketones even if the BG isn't high.The second time Nomad went into DKA his BG was only 240. I always advise people now to test for ketones in addition to home testing for BG.

DKA is treatable but very expensive. The money I spent on Nomad's first DKA episode was supposed to go towards a cruise. I tell Nomad he is a lot better than any cruise or vacation. We have our paws crossed in our household for Choco!
 
Jan, it was Jennifer this morning who suggested that Maria take Choco to the vet because he was meatloafing and not eating. I was focused on the not-too-high numbers. Just another case of paying attention to the whole cat. cat_pet_icon
 
Hi Janelle, and thank you so much for your donation! I too am confused about the bg and keytone situation. I did however get the keytone strips so if he makes it through this, I will also test for both. Choco was actually at 240 right before I brought him to the regular vet today. The vet really didn't have an answer as to why the BG was where it was but the keytones were so bad. Nomad went into it twice?!?!? Oh boy. ;O/ I will have to agree with you about our babies being better than any cruise or vacation. :O) Thanks again Janelle.
 
just remember that some cats are prone to ketones even at numbers in the 200s...French Fry (GA) was one and there are others but my memory for such specifics is poor. Insufficient insulin (as opposed to high bgs, there is a subtle diff), insufficient food and/or infection. With French Fry, Anne actually had to increase the carb levels in her food a bit to keep her from bouncing around.....

Jen
 
i am so sorry this is happening. truly hope that your kitty makes a swift and complete recovery! being at ER with round the clock intensive care is what is needed, what must be, so rest assured that choco is right where he needs to be right now. may he be home with you soon. (you might be doing some intensive nursing care for him yourself when he gets home, so rest up now, k?)

i am puzzled though and wonder if you can help clear up some details, it is important for us to know all the details of what went on this week so we can help you understand what happened so that you can prevent it from ever happening again. i know this whole feline diabetes thing has an awfully steep learning curve, so much info that must be absorbed so quickly, but it WILL get easier and one day, trust me, you'll be totally comfortable managing his diabetes and the whole thing won't take but a couple of minutes a day to keep him in perfect health. please believe us, do not get too stressed out, just take this time while he is being cared for at ER to read and learn, there is a ton of information all over this board and ask questions! that's why we are here, to help the overwhelmed new person with their questions. k? pc_work
okay questions: you wrote this above "So to answer your questions, he is on .5 units (very small amount) only when he tests over 250." those are the instructions your vet gave you? :shock: hmmm....what did your vet say when you brought him back in DKA a week later (or doesn't s/he know yet, you went straight to ER vet not reg vet)? but i am also confused because you stated you just started testing him, yet (am i understanding post correctly?) he has only had one shot of 0.5 units of insulin all week? so then how did you know his BG wasn't over 250 earlier in week? (you see why i'm confused?) and did your vet talk to you at all about urine testing while you were learning to home test BG? :-|
after choco is well again and you have had some time to learn a good foundation, maybe it would be a good idea to have a talk with your vet, educate him/her so that this does not happen to the next cat diagnosed at that clinic. you walked in with a cat that had severe weight loss, symptoms, and a BG over 300, yet were sent home with some very inadequate directions imho. if you had posted a week ago what your vet's directions were, well i for one, and plenty others too, would have jumped all over them as very dangerous, a recipe for ketone troubles.
i hope to see a post from you very soon letting us know that choco is getting better and asking any questions you have from your reading so we can help.
every cat is precious, but diabetic cats are even more so, you'll see, the bond that develops is something so very very special. this might sound weird, but imho, you are lucky to own one. :smile:
~jojo

ETA: sigh, oh i'm a very slow typist and see there was some new posts to this thread while i was typing away there. okay so your reg vet does indeed know that choco is in DKA now, and he didn't have a clue why? geez, the no insulin all week but one shot wasn't a clue? like jen said a meter does not have to have high numbers for a cat to have ketones, not at all (a few threads away from this one i just asked someone that stopped insulin because cat is testing at 145 to test for ketones, cat is not eating well at all). ketones are produced in a diabetic cat due to lack of adequate insulin being shot. add in lack of adequate calories being taken in and possible infection and you have the recipe for DKA. testing for ketones daily is a must in the newly diagnosed diabetic cat, none should leave that office visit without those instructions being drilled in by vet. (see another reason i am confused by everything here is that your vet choose an very good insulin, gave you instructions for a dose almost unknown in vet med, so must have done some research, yet told you not to shoot unless over 250, total contradiction to any lantus dosing research. it just doesn't make sense to me, not adding up right).


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"I was just puzzled because nothing in the thread suggested DKA."
actually there were red flags all over every post maria did. in the interest of board education if ever anyone sees a newly dx'ed diabetic cat's owner post saying one word about cat not looking good (ie: "feeling blah") and/or reduced appetite and/or withholding insulin due to odd instructions from vet, the immediate post back has to ask if there has been a ketone test done in past few hours. the newly dx'ed are at highest risk of going into DKA and daily ketone testing is a must that for some weird reason is often overlooked in instructions from vet's office that needs to be corrected the second owner joins board and posts. thanks!
 
ps. maria i hope you don't take my questions the wrong way, you are in NO WAY to blame for choco being in DKA! you do understand that right?
i am questioning the instructions you received which feel like to me as though one took someone that has lived in the desert their whole life and dropped them off in middle of ocean with a flotation device full of holes and said 'see ya next month on shore! have a nice swim, kthxbia!' and then wonders why they drowned.
we want to help build you a good strong boat and teach you to sail so your experience in the water is pleasant, fun even.
~jojo
 
Jojo and Bunny I agree with you about the importance of ketone testing. I always recommend to new members that they also test for ketones. My cat also had a relatively low BG the second time he developed DKA. DKA istands for Diabetic Ketoacidosis. THere are at least ten risk factors besides high blood glucose that can trigger DKA in human diabetics. I assume the same also applies to cats and dogs. Ketoacidosis can also be triggered in nondiabetics by overdoses of certain drugs, alcoholism, starvation and physiological stress. DKA is one type of ketoacidosis. I once had. Another board member debated me at length that other things besides diabetes can't cause ketoacidosis. However it is also possible for a person or cat to get high ketones for other reasons not directly related to diabetes although it is less common.

Besides the urine stix for testing ketones, there is also a meter called the precision by Abbott that tests for serum ketones. I use it but it doesn't seem to be very popular on this site. The meter gives a number value that varies from 0 to 10. Many other people who have used it complain they don't know what the numbers mean. There is a table in the owner's manual and on the Abbott web site that gives ranges for people. The levels for cats is similiar. I think serum testing is more accurate.. Serum PH, serum ketones and other values from the blood work is what hospitals use to diagnose DKA or KA (Ketoacidsis).

Sorry I am babbling on. The point is that DKA and KA iare medical conditions that are more complex than many people realize. There is no way Maria could have predicted this. Many vets also. miss the symptoms and send the cat home just saying they have neuropathy or fatigue. I am glad Tucker's Mom picked up on this.

I agree that the vets directions to give insulin only at 250 or above is weird. Maybe this vet was paranoid about the cat going hypo. At the opposite extreme on another thread a vet had prescribed six units of prozinc twice a day and told the owner not to test BG. Between these two extremes there has to be some common sence and standards of care? Some of the things vets have done would be a multimillion. dollar malpractice case if the cat were a human.
 
Good Morning All,

I do want to answer all the questions that have been asked but I didn't get much sleep last night and am still half a sleep writing this so I respond as soon as I wake up and get functioning. I do however want to give a quick update on Choco. The vet seemed very happy with his progress thus far. His last BG was 253 but at some point did get down to the 190 area. His potassium got a little low so they added some to his fluid bag. His next BG will be at 9:00 and they will check his keytone level again at 3:00. His mood seems to getting back to the "regular" Choco that I know and love. He is up and moving around, purring, talking and rubbing on everybody's hands. The vet said it's just still too early to know if he's going to need anything more than this weekends hospitalization. I guess I'll get clearer picture of how well he is doing later today when his keytone results come back. Thanks again for everyones advice and donations! I will get back to answer the questions that were asked in just a bit. :O)
 
Jojo, Jan, Jen, and all other who want a complete history of this situation. This is what I know about it.

Jennifer (Tucker's Mom) and I have been helping Maria with Choco. Maria is a foster Mom with Kitten Associates, a rescue for which Jennifer is a Board member.

Choco's diabetes came to our attention on Friday, January 28. Maria approached Jennifer about it because of their relationship through Kitten Associates. We also were told that Choco would need a dental procedure because of a bad tooth. Jennifer asked DCIN to help Maria financially because she uses so much of her own financial resources for the fosters she cares for for Kitten Associates and other rescues. Jennifer gave Maria links to the FDMB and DCIN.

On that Friday at DX, Choco tested at 369 and the vet recommended wet food. Maria changed Choco to Fancy Feast classic. The vet discussed ProZinc with Maria, but agreed to prescribe Lantus because the Lantus resources here on the FDMB (including the number of persons using it) are greater.

The vet prescribed Lantus on Monday, and DCIN shipped a pen to Maria from Texas, which was delivered to her location on Tuesday and which she acquired on Wednesday. DCIN also shipped testing equipment that Maria received on Wednesday. I offered to put Maria in touch with a woman in her hometown who could teach her hometesting, but Maria was able to successfully test Choco from the start.

On Monday, after Maria got the script from her vet, she wrote Jennifer and me:

Dr. M. did say that we should go ahead and get him on the insulin with the diet change and then look at dealing with his teeth because although he does look like he may have a cavity, she's seen worse and really wants to get his numbers to where they should be.
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I am not aware that Maria's vet gave her a starting dose or dosing instructions, but did ask Maria to do a curve on Choco, which Maria was prepared to do on Saturday.

In our email communication with Maria, Jennifer and I frequently recommended the FDMB. Tuesday is the day, though, that the Board crashed.

Jennifer and I discussed dosing on Wednesday morning and agreed on .5U if Choco tested over 250. Marie had told Jennifer she was uncomfortable shooting a low 200 number. I told Maria:

The FDMB is starting to move to a lower starting dose because some cats have needed a dose decrease after starting at 1U.
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(note from Rebecca, founder of FelineDiabetes.com and FDMB: Please don't use terminology like this. "The FDMB" hardly has a consensus on this and I personally disagree with much of what is touted by more vocal members of the FDMB. This is an OPINION, not a recommendation, not backed up by scientific research, and may even be a minority opinion. Doesn't matter. It is not a position of the FDMB. The position of the FDMB is listen to your vet, do your own research, and be very cautious about advice being given by non-veterinarians. Again, I refer to Janet's excellent post at: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=973
Jennifer and I suggested a 250 shoot/no shoot line based on Maria's comfort level. We intended to suggest moving that line down after maybe a day of readings and data on his reaction to the .5U. We provided links to information about treating hypos and to Jojo's hypo toolbox.

Maria called me Thursday evening because her first test of Choco's BG level was 254. I advised that she shoot, which she did. I advised BG tests at +2 and +4. After +2, when Choco tested 300, Maria wrote:

He is acting kind of lethargic but is able to walk around and he did jump on the bed. I'm worried that his numbers are so much higher now. Should I be?
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I replied:

Some cats get a food spike, a higher number after eating. Because it takes Lantus about 2-3 hours to onset, a higher number in the 2-3 hours after shooting and eating is not unusual, especially in the early going.
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Maria replied:

Okay, I will check again around 11:00 (+4) at what point do I need to be concerned? He is still acting "strange" to me. He is not wanting to move around too much and you can tell in his eyes that he is not feeling well. He did eat after I gave him the insulin but when I put the food in front of him just now, he wants nothing to do with it which may be nothing more than he is not hungry. I guess I just need to know what kind of numbers are too high and what kind of symptoms warrant taking him into the vet.
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At this point, Jennifer questioned whether Maria had ketone test strips and advised that Maria buy some. I agreed with ketone testing and provided a link to the Pets with Diabetes Wikia article on ketones. I said:

Although [ketones] seem unlikely given the two numbers we have on Choco, it's always wise in the early going to check for them.

You say " I guess I just need to know what kind of numbers are too high and what kind of symptoms warrant taking him into the vet." Given you are just starting out, Choco is going to be lethargic for awhile. My Maxwell was a dishrag for about a month until we got up to a dose that made him feel better. The symptom that warrants taking him to the vet, and immediately, is anything above "trace" on the ketone testing strip.

Please give the insulin a week, and yes, you may see high numbers, until the numbers might warrant a vet visit.

Because he has the bad tooth, and infection + high blood glucose + dehydration + inappetance can lead to ketones, you might ask the vet about getting a course of Clindamycin to knock down any infection in his mouth. Also, be sure he is well hydrated; you can add water to his wet food. Make sure he eats at least enough for his ideal body weight. (15 calories per pound of ideal body weight a day.) If he is hungry and wants more, let him have it. Unregulated diabetics do not well process the needed nutrition from their food and can be, literally, starving. If he does not eat well, find something he will eat, even if it is human tuna in water or all meat baby food (with no onions).
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Jennifer and I both referred to the FDMB, specifically to the stickies on the Lantus forum. Maria registered and did some reading here Thursday night.

On Friday morning, Maria told us that Choco tested at 145 and that she did not shoot. She later corrected herself and told us the reading had been 245. She said she would spend the weekend reading the FDMB. We did not hear directly from Maria on Friday night as she had begun posting here. As she reported in her first post here, Choco's PMPS was 245, she did not shoot, and three hours later his blood sugar remained relatively stable, going down to 229. However, she continued to express concern about his behavior and lack of appetite. She also indicated that she had gone to six pharmacies and finally found ketostix, and would test him as soon as she could.

Saturday morning, Maria repeated her concerns about Choco's lethargy and inappetance in an email to Jennifer. His BG level that morning was 218. Jennifer recommended that Maria shoot insulin because the numbers were high enough to do so, but because Choco did not eat breakfast, that Maria should try to measure a .25U dose, again cautious because of little data on his reaction to insulin. Jennifer suggested some medical reasons why Choco might have a bellyache, such as the change to the new food. Jennifer wrote:

Your blood sugar numbers are not terribly high, this really could be just a belly ache or something. You may find the folks on FDMB have more thoughts about this than V and I do, collectively on the board folks have dealt with so many different things the knowledge from so many can really be helpful when we're stuck. I'd suggest you post again on the board.
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At 10am on Saturday morning, Choco's BG level was 240, but because of his inappetance and lethargy, she took him to the vet. The rest of the history is pretty much on this post and in Choco's blog page, which I have linked to.

Above, Jojo said:

i am questioning the instructions you received which feel like to me as though one took someone that has lived in the desert their whole life and dropped them off in middle of ocean with a flotation device full of holes and said 'see ya next month on shore! have a nice swim, kthxbia!' and then wonders why they drowned.
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(From the urban dictionary... kthxbai ...Variation of 'kthxbye' - the internet bastardization of "OK, thank you, goodbye". Generally used with contempt, or for hasty exit.)

Maria, Jennifer, and I were in frequent contact with each other, and Maria was not left on her own with a flotation device full of holes. Consistent with the way we handle newbies here at FDMB, Jennifer and I were giving Maria information in small chunks and allowing her to absorb that information before moving onto additional information. We provided insulin and testing supplies in a timely manner, and Maria used those tools in a timely fashion. Jennifer and I recommended the FDMB in almost every email, and Maria did post here in a timely manner--27 hours after she started Choco on insulin.
 
Maria,

I am so glad to see that Choco is getting back to being himself. Very glad.

I have written Choco's history as I know it. If I have something wrong or if there is more information (for example, the vet's dosing advice), I am sure you will correct/fill in. I was pretty wordy, but I wanted to give all a full picture.

Venita
 
Maria,

Has the ER given you a measure of Choco's blood pH? I understand that a blood pH above 7.5 to 7.45 is not DKA, but a Ph below those levels is. There is a fine line, I understand, between the presence of ketones and diabetic ketoacidosis.

Also, because you know that Choco has now has ketones, you will have to ever vigilant about their possible presence, even if his BG levels are relatively low. You should always catch and test the "liquid gold" when you can.

Here is the link to the article on ketones from the Pets with Diabetes Wikia, in case you have not yet had the time to read it.
 
Venita, had to go searching because I can never remember the level of blood pH.......
The normal pH for a feline is 7.4 and is necessary for the normal function of many enzyme systems. When pH drops below this value the cat is referred to as being acidotic.

Whenever Mishka has thrown ketones I always ask what her blood pH is. When I first got her her blood pH was 6.9.....

http://zimmer-foundation.org/sch/cbc.html
 
I'm concerned about the potassium also being a little low. When low, lethargy and not eating are the first signs with Tucker. The potassium could have gone low due to the clinic giving fluids, but in the future it would be something I'd want to monitor.
 
Jen, usually everything is monitored and supplemented as needed with a kitty at a 24/7 ER facility. So much better than being at a regular vet office that closes for the night. They usually put in a main line to be able to check everything. Choco sounds like he is improving but Maria is going to have to check urine, once he is home, every chance she can and not go by bg readings alone. I've learned with Mishka, if she doesn't want to eat, her butt goes in....immediately. I won't even wait around for her to pee.
 
Hi all,

First, I want to say thank you to Venita for posting what she did because it probably answered a lot of the questions being asked. If anybody still has questions, I will be more than happy to answer them. I just called the vet to check on Choco and at 9:00 am his GB was down to 174. They decreased his Dextros (I'm not sure how to spell it) and increased his insulin. They will be checking his GB again at noon and then his keytones at 3:00. The vet tech is in love with him. She said she was rubbing on his belly and he just laid on his back purring as loud as he could purr. She said he is a real lover boy. :O) I will be going to visit him around 3:30-4:00 so I will update again later today. I will also ask about the PH level as well as the potassium situation. Are there any other questions that you all feel I should ask the vet when I visit today? I wanna take my little notebook in prepared to get all the answers I need. :O) Thanks everybody. Y'all are the best!!!
 
You are in the best place ever for your DX cat and you are home testing Hugsssssssssssss Great. If you have a question that needs asking fast just put Advice in your subject line that always works for me. Sending Prayers Tons of Beautiful green healing light for your Choco. Glad he is on the way back to being his old self Bless you for all the work you do and saving our fun friends Don`t forget to Breath that was the hardest part for me....Hugsssssssssssss Kath
 
Thank you Kath. I will take your advice and type advice in the subject line next time I have a question. Great idea! I'm going to see Choco in a few and I hope he'll be happy to see me. :O)
 
He will be happy to see you. You can bring him an old unwashed t-shirt or pillow case for him to sleep with. Something with your scent on it, so he won't feel so alone when he misses you.
 
Re: Choco and I are Newbies!!!

marleesan71 said:
...it's the first tiny line closest to the needle ...
Click to expand...

Just checking the dose measurement here:

On my syringes (ReliOn from Walmart), 0 is the first line from the needle tip (anything below that is left in the syringe after shooting), the 2nd line is 1/2 unit, and 1 unit is the next line.

Are your syringes marked in whole units, or half units?

And after reading this, are you sure you are measuring 1/2 unit?

Edited to add: Venita went over this with her, and "1st tiny line" is actually 2nd line on syringe. (to my crappy vision, they're ALL tiny lines!!!)
 
Re: Choco and I are Newbies!!!

BJM said:
marleesan71 said:
...it's the first tiny line closest to the needle ...
Click to expand...

Just checking the dose measurement here:

On my syringes (ReliOn from Walmart), 0 is the first line from the needle tip (anything below that is left in the syringe after shooting), the 2nd line is 1/2 unit, and 1 unit is the next line.

Are your syringes marked in whole units, or half units?

And after reading this, are you sure you are measuring 1/2 unit.
Click to expand...

Maria's syringes do have 1/2 unit marks. She said it was the first tiny line (which are the 1/2 unit lines), not the first long line. She and I went through that measurement in some detail when she started.
 
I think the most important thing is that there was a safety net in place. As some other members know too well, DKA can creep up unexpectedly even when the BG is relatively low. The second time Nomad had a bout of DKA his BG was only 240. He didn't show any classic signs of DKA but keep staring and walking aimlessly around. He also acts that way when he goes hypo. I borrowed a neighbor's precision meter and his serum ketone level was 4.5 which is very high. His PH had started to drop and was at 7.2. Which means he was already becomming acidic. Many other factors besides high BG can trigger ketosis and cause ketones levels to rise rapidly. In Nomad's case he had a skin infection and had been thrown up a few times before the incident which probably contributed to him being dehydrated. I bought a precision meter after that and do serum testing now on a regular basis. There has been some debate in the past about serum vs. urine testing. Whichever method. Is used, the most important thing iis to test for ketones. Nomad's second DKA bout was only one day in the ER vs. Five days when he was first diagnosed. The moral of Nomad's story is you can't assume just because the BG is under 300 or even 250 that they are safe from DKA. My exception to the rule is looking at me right now.

We all have our paws crossed for Choco and I am mailing a cotribution today.
 
oh now i understand. when i wrote that 'kthxbia' (which btw as a frequent ICHC viewer doesn't have quite the negative connotation as the link you posted ventia) i was under impression that all advice was from the vet as i stated in my post last night over and over. you can understand my confusion and dismay when i thought a vet had given guidelines of such a high no shoot cut off number in conjunction with such a low dose for a newly dx'ed diabetic cat, knowing how they have insulin resistance on a cellular level and especailly knowing that the cat had a bad tooth/oral infection. i was thinking last night that once questions were answered the next step was going to be suggesting new vet, that's where i was headed with my post last night. we usually see vets giving too high a dose rather than too low in those first posts here, hence all my questions/confusion. we have seen improvements in vet med with the treatment of diabetic cats, especailly in areas of diet and home testing, but there is still a need for more knowledge out there, obviously, or this peer reviewed board would not even need to exist.

"I am not aware that Maria's vet gave her a starting dose or dosing instructions, but did ask Maria to do a curve on Choco, which Maria was prepared to do on Saturday."

maria may i inquire as to what vet's original dosing instructions were?

moving forward, what are the thoughts about when he comes home? a newly dx'ed diabetic cat after coming home from hospital from a DKA episode is vulnerable to going back into DKA, it is a critical time.

it is a real good sign that he is up and about and purring up a storm!
kudos to you for getting him to vet so quick (and to jen/tucker for recognizing the issue so quick). things look very promising.

you asked what questions you should ask? (i hope i didn't miss you time wise, i typed all this out earlier and lost entire long post when i hit post, sigh, retyping the fast short version now). i would ask how the food intake is going and when they think he might be discharged. oh before i forget, please get a copy of all the blood work, in fact full ER chart and treatment sheets to keep at home when he is discharged. they will send copy of everything to your regular vet, but it is important to have your own copies. (if you need help understanding anything you see in chart i would be happy to offer my services as translator). i would ask some current status questions like how is his pH level and K (potassium) levels are and what results came of that 3 o'clock ketone recheck. i would ask if he is on Ab's (antibiotics) for the tooth and if they are planning on sending him home on Ab's. (if so you might want to prepare by picking up some probiotics to ward off diarrhea from Ab's and pepcid, regular pepcid (famotadine) not pepcid complete, to help w/ any upset tummy from same. him having upset stomach and not eating is something you don't need when he comes home). i would ask if they had gotten a good look at oral cavity and if ER vet thinks that tooth needs to be exacted as soon as cat is stable after this DKA episode, like is it so bad that it is going to interfere with eating or infection so massive that needs to be addressed right away or if not all that bad and Ab's are going to buy time, can deal with it later? dang, i've forgotten the other things i had in first version of this post and hope not posting too late and you already left....
but anyways, have a good visit with your boy, sure he is gonna be happy to see you! :smile:
~jojo
 
Dyana-I did bring him a blankey that I slept with all night. :O)

Janelle-I will definitely be keeping a closer eye on him and checking his keytones every other day (at least that's what the ER vet suggested) as well as his BG everyday before I give him his insulin. THANK YOU SO MUCH for the donation!!!

JoJo and All,

I have some great news! The keytone check they did at 3:00 showed no signs of keytones! The vet said he is responding very well. I brought him some Fancy Feast just in case they were allowing him to start eating and she let me give him a half a can to start off (she didn't want to give him a whole can at first). Choco went to town on that food, smooshing it all over his face. He was a hungry boy! :O) You could clearly see he wanted more but the vet said he needed to wait a couple more hours for the rest. :O( The vet suggested I bring his insulin and after he was eating she watched me give him his shot to make sure I was doing it correctly and I was. :O) I asked about the PH level but she said she did not check that because she said when they are experiencing the ketoacidotis, their acid level is always high. His potassium level was back to normal and I guess I was so excited about the keytone level that I forgot to as about his BG. ;O/ I will ask when I call to check on him in a bit. He was all over me just wanting to be loved and you could tell he was ready to go. I will be picking him up in the morning around 7:30 and taking him to my regular vet. Looks like he will be home sometime tomorrow and I couldn't be more excited!

JoJo, I did not get your posting until I got back. I hope I answered most of your questions. You're kind of scaring me about "after coming home from hospital from a DKA episode is vulnerable to going back into DKA, it is a critical time." Is there something more I can or need to do besides checking his BG and using the keytone strips?
 
that is wonderful maria! :mrgreen: i love that he ate with such gusto it was all over his face, awww! :mrgreen:

i don't mean to scare you, just make you aware. please post the dosing advice vet gives at discharge so everyone can see it and comment if they notice something that makes them nervous (like not enough insulin), k?
btw, you know you can call for an update on his condition at 3 am if you want to, i worked at ER vet hospital for many years, owners can call whenever they want, at any hour, as often as they need, for updates. it is part of hospital staff's job to provide detailed updates on a patient's condition. usually you'll get to talk to a tech for just quick status updates, but if you have questions you can ask to talk to vet, like if you want to know about the 'exactly how bad is that tooth, is it abscessed?' thing and 'can you tell me if he is on Ab's and will he be going home on same Ab?' so that you can prep.
but i'm very happy that it doesn't look like you are going to need any help in the 'getting enough calories in' department when he gets home, was all ready to give you suggestions for a shopping list of stuff to try to tempt him to eat, sounds like sure got no worries there!
question: have you ever given SQ's to a cat? (just in case vet wants to have you do that when he gets home) or is that something that we should start providing you w/ links and tips on how to do?
cause no more ketones, eating very well, BAR (med speak for bright/alert/reactive), sounds like someone is prolly gonna be coming home soon. :smile:
hey ya know tonight is a good time for you to kick off your shoes, put feet up, and settle in for some good reading (start w/ the FAQ's here, and the sticky's at top of Lantus LSG if you have not read them already. or reread, it will take a few readings for so much info to start to sink in) and of course start a thread of ANY questions you might have from your readings, we're here to help. and then a good night's sleep, he *might* be home tomorrow night and you'll be too busy watching every tail thump and ear flick on your boy to focus to reading. (very very normal to 'hover' over a pet first night home after being in ER). sound like good plan for tonight?
~jojo
 
Well, I am just a newbie also but we have fought DKA 3X and have fought elevated ketones at
home 2X and once was today. Maybe all the talk about ketones lately ...... but for the first time in
2 months this morning after her first shot, she showed trace ....
Remember ..... this is what works me me and my cat, I am not an expert but I am also not in
emergency right now with a very sick cat.

If your cat has ever had DKA .... you tend to check for ketones 3X a day, watching for them to rear up,
because once you see trace you are already on your way up. While Payne seemed fine, her eyes get
big with ketones and I knew. Today her BG were in the 200's, so you can not always tell by the #'s.

We waited a half hour and checked again and she had moved into small .... not good. Now remember,
this works for me and my cat, I gave her a shot of quick acting insulin and fed her well. I then give her small, frequent and mostly raw food. We checked urine and blood every half hour and within an hour
her ketones were moving down. Within 2 hours her ketones were back to none. I believe I have some control, if I catch it early, whether you use strips or a meter, and you can only know that if you test.
(just because I believe I have some control doesn't mean I do ....)
Good luck and you can do this, you just need to be really observant and test, test!

Nancy and Payne (never happy about ketone talk but especially not today :)
 
Great new everybody, CHOCO IS HOME!!! He is currently sitting underneath my desk just relaxing.

When he was checked at the ER yesterday at 3:00, he showed no signs of having any ketones. I don't believe they tested him again after that.

My vet has said that she wants him to have 2 units of Lantus instead of .5 units twice a day. Does that sound okay??? She said I could do a curve test at home in about a week or two. She said it was great I was testing his BG and keytones (well, I'm checking the keytones now) at home and am aware of the signs to look for so hopefully we will not have another crisis. Other than that, my vet didn't really say much other than he looked a lot better. I do have all the BG readings and blood work from the ER as well as all the other paperwork (which I do not understand most of) so if you all have any a questions about something that he would have been tested on, let me know and I'll look it up and post it. I will post the BG readings below.

2/5/11-2/7/11
BG
4pm-301
9pm-231

1am-190
5am-263
9am-174
12pm-249
4pm-279
8pm-266

1am-326
6am-288

I do have a question about the stinky breath that he had when all of this was going on. The vet said he had that stinky breath because something about there was acid inside his body. His breath doesn't stink as bad as it did but it still has that distinct odor. Does anybody know if this is normal or if it will go away after a couple of days? I worry about this odor because I've gone through two other senior kitties in kidney failure that had this same smell.

He had a half a can of Fancy Feast at the ER this morning so I thought when we came home this afternoon I thought he might want to eat the other half but he had no desire. He sniffed it and that was about it. He was very thirsty going back and forth to the sink to drink. He is still kind of mellow but not laying around with his head down so I'm going to chalk it up for now to just being tired from the last couple of days. I will watch him closely and post more when I have more questions (because I know I will:). Please feel free to ask me anything becaue I really need help with him. I don't want this to ever happen again so I want to make sure I'm doing everything I possibly can to try and prevent it. Thank you guys SO MUCH!
 
Hi Maria. Welcome home CHOCO!!!

You might want to check out the stickies on the Lantus Insulin Support Group, including the one on Tight Regulation Protocol, which suggests dosing guidelines, including a starting dose. You might also want to check out the brand new sticky about the Lantus Land Emergency Fund. Choco's DKA stay this weekend definitely was an emergency, so perhaps you fit into that fund's criteria for assistance. I am not sure how you request assistance, but perhaps there is information on the Yuku group the sticky refers you to.

The stinky breath that is associated with ketoacidosis smells like nail polish remover. Is that what his breath smells/smelled like? Or is it just regular old cat yucky breath smell? That could be because of his bad tooth, plaque, and gingivitis. Was the ER vet able to get a look at or make any comments about the tooth? Did your vet say anything about putting him on an AB like Clindamycin for oral health?

Gotta run!! Scritches to your boy.
 
Hi Venita,

My vet nor the ER vet said anything about putting him on any AB for his oral health. I will bring that up to my vet.

I will definitely look into the information you have just given me. I need all the assistance I can get.

Hope your day hasn't been too hectic. :O)
 
Hi Jennifer. Choco is doing really well. I just woke up from a nap and he was laying on my pillow right beside my head. That was a really good sign.

Jennifer, any thoughts on my vet wanting him on 2 units of Lantus instead of .5? I'm going to post the question on here and see what kind of response I get. My vet admits that she has never dealt with Lantus before but after reading some article about it, that is the dose she came up with. She said he is a bigger kitty (17lbs) and he needs a little more. I'm going to go do some reading and post. Just thought I'd ask your opinion. Thanks!
 
Just wanted to share a quick update. I just caught Choco urinating (yay:) and was able to test him with the keytone stick. There was no sign of keytones but his glucose was over 2000. It was the showing the same at the ER and my vet explained why but of course I can't explain it back and make it sound right. Basically, when he starts getting regulated, the glucose in his urine will decrease is the way I understood it.

I was just reading some of the info from where Venita told me to go and it looks like for every kg, they should be getting .25 units. So with Choco being 17lbs, I used the conversion calculator and it shows him being 7.7kg. Now math is my worst subject but if I add that up right, it does equal to right around 2 units. Is that what everybody else see's?
 
if you are using the weight calculations, it is for maximum starting dose (if I remember correctly). I think that 2 units is a huge jump up from 0.5 but would like to know what lantus users say

as for the urine test...glucose builds up in the blood when there isn't enough insulin to metabolize it. At renal threshold (approx 250-270), the kidneys start to filter it out of the blood and dump it into the urine. Glucose laden urine sits in the bladder inbetween urinations, so there is little way to know how the urine glucose levels correspond to blood glucose levels.

if you are getting zero urine glucose, that doesn't mean that the cat doesn't need insulin necessarily.

Jen
 
Others may differ here, but in light of the DKA, I think going a little more aggressive on the dose is warranted. Just make sure you are testing before every shot and at least once mid cycle to make sure Choco doesn't go too low. 2u sounds like a good dose to me, considering the situation.
 
Um, oh by gosh, I just tested him at 393. The highest he's been at home was 300 and that was after the one and only insulin shot I gave him and he had eatin. Is this cause for concern??? I did have him eat and gave him his insulin shot (2 units). He seems fine. He is pretty much going wherever I go in the house and hanging out where before when he was sick, he just wanted to go in the bathroom and lay there.

Also, should I be starting a new post when I have these questions? I just thought by keeping it going here, everybody could read all the history and I wouldn't have to try and explain everything over. Thanks!
 
Jojo,

You asked me earilier if I know how to give SQ fluids and yes I do. I had two other senior kitties years ago go through kidney failure and had to give them fluids.
 
Yes, I would definitely post a new thread. Maybe DKA/Lantus dose needed or something. This thread is really long .

Have you post over on the Lantus forum? viewforum.php?f=9 For your health questions, definitely post here. But on the forum they all use your insulin and should be able to help you figure out the dose.

Eventually they will want a spreadsheet: Setting up a spreadsheet but for now you can just post the numbers since you got home with him.

If you need help getting the spreadsheet up, just ask.
 
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