? day 3 DX : DKA? KB in vet's hands for now

I made a bit of a ramble with a bit of background in the About Me. Were I not dog tired at 3am, I'd be happy to do so again but as it is <looks for smelling salts> , I'm going to hope you refer there and add the bits I'll babble on here and be ever so grateful if you do <BCG>

I fell in love with a testing tutorial I saw earlier and made use of the force-feeding tips in another just tonight. The wit and care of the humes who stroll and patrol here astounded me. I hated the reason we were all thrown together, but loved the gathering of support and knowledge I was witnessing.

ONTO THE BUSINESS!

KB is 4-5 yo, neutered 2yrs. Met him at 25lb, tapered to a steady 18-20 until he began losing weight. 15lb a week or two ago but I should weigh him again. No other issues other than a wheeze(?) I met him with. This comes and goes, the vet has never responded to my mentioning it. Lungs and heart always get good reports. I intend and hope to remember to get ALL the info and in as much detail as possible when I speak with or see the vet again tomorrow.

The problem is, I don't know if or how worried I should be.
I stupidly don't have any numbers or info from his testing at time of DX. I'm embarrassed I walked out of there without such basic and obviously important details. This isn't the only disaster on my current horizon, but that's no excuse. I believe "off the charts" was used. My mother, who actually took the call confirming what was wrong with him, thinks the vet said a number in the 500s. We all knew it was scary bad but we can manage this, right? Sure!

3u novolin/12 hr, I'm told. Vet didn't want to do it citing I'd want to start my own routine with it and should wait. I'm not sure he had any on premises? I'm not sure what's reasonable. I accept this, though it's a long way to go 'til 10pm, I'm think. NOW I'm thinking *******should've dosed him and checked his level again? TOLD me to get a meter, start watching it like a hawk? I don't know. I feel inadequate and that hindsight, eh? She bites.

We get home. He's not thrilled. This is not unexpected. I coax some bites into him and leave him to mostly his own devices (sluggish, dazed seeming) until 10pm. I give him the dose, no jitters, no worry I've done it wrong; all seemed fine and for 20m it seemed like my cat was coming back to me. It was as if a cheesecloth had been removed from his head and he could hear and see again. He was back to not liking the tv and its sounds, something we worked through when he was more feral. I found this reasonable and still felt good about this new insulin game.

However. this morning I greeted a dopey, lethargic cat who i THOUGHT had eaten more of his food than had been. We have a semi-larcenous canine. After his 2nd shot, 10am, he barely moved. He's not the least bit interested in anything I offer. I waste time being scared and doing research on what to do, to buy, where to buy, the 100 etcs I know you know better than I.

Somewhere in there I do call the vet. He says skip tonight's dose IF I can't get him to eat, keep trying to get him to eat and if he seems totally out of it, to use sugar water. (I was chuffed to find the karo sold out when picking up the rx, not a tip the vet gave but something I read here ; )

He does not eat, I do not dose. Eventually I get him to lick some whip cream. I feel like I should probably be smacked, but I was so desperate for SOMEthing to appeal to him. He had but the tiniest of licks. A spoonful of milk was another thing he accepted. This was around 10/11pm, no way was I administering but desperately wishing I had that monitor under my belt already. I decide whatever his problem is or isn't, he DOES need food so I dothe force-feed with Frskies and a generous-enough syringe. He accepts this not happily but without too much fuss. I'm wondering if I should lower his dose, or if it NEEDS to be this high for some reason? I'm scared he's hypo, close, or ugh, I just don't KNOW anything. This could be normal "hey, I just started being treated and this is what it can look like" business but if there's something I could or should be doing, I'd like to.


My once 20/25lb cat has shrunk to a 15lb or so cat losing alarming amounts of hair and drinking/peeing entirely too much. It seems stupid now that it wasn't more obvious earlier on. Getting an appt took weeks. 3 of em. During which he lost more hair, he's the proud owner of a 2" wide racing stripe that starts behind his shoulders and goes a bit into his tail. There are other spots, too. No lesions, just healthy skin and patchy regrowth. He became less and less interested in eating. I switched his food, that didn't last long. I began adding wet, Friskies, that also didn't last long. And now this, my poor guy's an anorexic now?

I managed to get 2 and a half or so 10ml (I think?) syringes of liquefied catfood in him. He seems the tiniest bit perkier. I'm not sure he loves me as much after the second round of feeding, lol, but I know he'll forgive me. I saw him drink a bit. Last I saw, he was lounging near the water bowl. Pee last night was nearly half of what it had been. Today he only went once. No poop but I wouldn't really expected it. He made his last deposit en route to the vet, per his MO. Sadly, I held back food that night, after 1/2am, knowing I was going to that appt.

Come 10/11am I've got to decide if I go ahead with his dose, lower or keep at 3u. Is this something I can and should do, as long as I'm able to get the food into him? It's not necessarily likely that I can get a hold of the vet in time, though not impossible. Also, I'm hoping to solve the riddle of meters/strips etc tomorrow. Car health and store stocks willing <crossesfingers>

If you waded through all this, I applaud you! If you tried, I still applaud and appreciate you.
Any input would be gratefully received. MY Sweet Kitty Boy and I thank you all for just being here <3

 

My first recommendation is to go to a pharmacy or Walmart and get a glucometer and start testing your cat. Novolin N is a relatively fast acting insulin that can drop blood glucose (BG) numbers like a rock. 3.0u is a whoppingly large dose. I'm concerned that KB's numbers dropped into a low range. Without testing, you have no way to know if your cat is in safe numbers.

Next, talk to your vet. Ask for a different insulin. The American Animal Hospital Association's guidelines for the treatment of diabetes do NOT recommend Novolin N for cats. It is not well suited for a cat's metabolism due to it having a fast onset, harsh nature, and insufficient duration (i.e., it's out of your cat's system after about 8 or so hours). The two insulins that are recommended are Prozinc and Lantus.

Also, get the information you need from your vet. Were ketones present at the time your cat was diagnosed. Are there any medical issues?

In the meantime, reduce the dose. Depending on what kind of food your cat is eating, the starting dose should likely be not more than 1.0u. A diabetic cat should be on a low carbohydrate (less than 10% carb), canned food diet. If KB is not on a low carb diet, 1.0u is fine. If he's eating a low carb diet, 0.5u is recommended. It is quite likely that your cat's BG numbers were inflated at the vet's office due to stress. It's much easier (and safer) to start out at a lower dose than a higher dose and worry about number plummeting.

In the interim, there is information on using Novolin in on the board devoted to that insulin. You may want to take a look at the introduction and the beginner's guide. (The intro also discusses another insulin as well as Novolin N.)

You may also want to take a look at this note on how to get started here.

 

HI! Welcome!

did they look up his nose to see if there's a blockage? like a deviated septum or small growth?

Just call the receptionist and ask them to email you a copy of the lab reports. A diagnosis in the 500's is not uncommon at all.

super high starting dose, and not a good insulin. Ask for Prozinc or Lantus. The starting dose should NOT BE MORE THAN 1 UNIT TWICE A DAY. Many cats don't need 3 units and you are running the risk of hypo which CAN BE DEADLY. Better to start low and gradually raise it as needed. WE CAN HELP YOU WITH THIS. But again, ask to switch to a longer acting insulin. The cheapest place to get prozinc is Chewy.com It's $105 and the vial can last 4 -6 months if kept in the refridgerator. Lantus can be bought at any pharmacy because it's a human insulin. Most by the pen which is a smaller vial and use syringes with it rather than the pen dispensor. There are many prozinc and lantus users on this site.

It sounds like he was going way too low. This dose is TOO HIGH. please don't shoot more than one unit at a time. it's literally a few drops. I have a feeling your vet has more experience with diabetic dogs which are dosed by weight... THIS IS NOT how cats are dosed. plus because cats have a quicker metabolisim than dogs Novolin only lasts 6 - 8 hours in the system and drops them hard and fast, so their numbers are like a roller coaster. This is why we suggest switching to lantus or prozinc which both last 10-14 hours. always have some high carb gravy food and honey/karo syrup on hand in case your cat crashes like that. Hypos can kill. Here is our info on what to do. http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/ Might be a good idea to print it out and have it on hand in case of emergency....

YESSSSS lower to NO MORE than 1 unit. Once you learn how to test we can see if the dose needs to be raise, and by no more than .25 units at a time. I have a video in my signature showing how I test my cat CC at home.

My cat was overgrooming her belly... it was one of the things that prompted me to bring her in. I think they are just anxious because they don't feel well. She stopped doing it the first week on insulin.

Friskies is a fine food to feed as long as it is the PATE version. No gravy. Most of us feed fancy feast classic or friskies pate food. I am concerned your cat may be developing ketones. It's really important that she eat. Ketones can lead to ketoacidosis which can get deadly FAST. I strongly suggest you get some urine strips from the pharmacy, or a blood ketone meter. Anything above a trace is an emergency requiring a vet visit. Try fancy feast, try fortiflora or tuna on top... ANYTHING. Call the vet and see if there were ketones when she was diagnosed. syringe feed if you must. You can also call the vet and ask for an appetite stimulant.

 

I agree with the others. Please lower the dose to 1/2 unit if eating low carb or 1 unit if eating dry food High carb). And ask the vet for a better insulin line Lantus or Prozinc.

 

Welcome to fdmb! You found a good safe place to get help. PLEASE listen to the advice already given. The people here know what they are talking about. We care a great deal about you and your precious kitty.

PLEASE let us know how kitty is doing currently.

Jeanne

 

Wow, so much good info here! I got another syringe of the pate puree into him before crashing myself. So far, no dose this morning but many have confirmed what I was thinking: this sounds like a lot (his dose)!

I'm currently waiting on a call back from the vet. And we're in the window when I should be administering. Overnight, just the one pee spot. No vomiting. Any recs on how much food I should have in him before giving him a 1u dose?

I'm a little scared of the novolin now! I def prefer it's price but sounds like.. ay ay ay. I feel like I keep making the wrong decisions at his expense. I'll def be looking into this but this was a rough month already, I'm close to tapped out with emergency expenses... but this is an imp thing. Doubly so bc the poor guy can't TELL me what he's thinking/ feeling.

It's a steep learning curve here! But I feel like I'm in good company. I can't express how comforting it is to have found such a great and caring group

Waiting on the vet, I'll also ask for his records.
Waiting to pick up my order from Walmart (ick, ick, ick, lol)
Waiting for the food to warm a little.
Digesting all this!

 

Waaait a minuet here. We ALL have made wrong decisions it happens to the best of us. THATS how this site came to be. We are a community of dedicated cat lovers, who happen to be tied as one, to this disease. You have landed in a SAFE place. We can guide you into making better lasting decisions. IT'S GOING TO BE OK.
jeanne

 

You have no experience so you are looking to the expertise of the vet. No one can fault you for THAT!! Unfortunately this vet doesn't seem to have much knowledge of feline diabetes. The price of Novolin cheap which is probably why he perscribed it. Chewy.com sells ProZinc for $105, but kept in the refrigerator it lasts 4-6 months. So really, it's not terribly expensive. $20/25 dollars a month.

 

ProZinc does sound a little more approachable than I previously thought.

He has a 4pm appt I absolutely DREAD putting him through and I'm waiting for the labs they did the other day. There's a neat bag of new tricks waiting to get picked up and I'm pretty sure I need a TARDIS to do everything needing doing.

He's had a syringe of food, going for the second after a short breather (for him and me both ). I'm thinking no dose this am as we're getting out of the window ...though, does that matter when he's been off the nov for a full 24h? His last dose was yesterday at 10:30am.

Hopefully, this afternoon or evening I'll have the labs AND a shiny new toolbox of testing supplies to better help him ..and to help me help you help him - gosh, that's a lot!

 

If hes tested at the Vet and has vet stress (as most cats do) his numbers will be elevated. The vet may give him a higher dose due to that number (hope not but its happened) . So dont get too freaked out.

Let your vet know you intend to be an active hands on care giver.

 

Considering he was probably hypo yesterday I think it's OK you wait and start again LOWER tonight. Don't forget to ask for an appetite stimulant.

 

ooh, I think they're already dreading me But less work for them, right? I'm nowhere near out of the woods, barely know what woods I'm in but the gratitude I feel for this community is humbling.

Thank you all, for everything you have done and esp for everything you will do. You are all amazing <3

 

whew! That's what I was thinking but it feels better hearing it seconded. The vet tech wasnt clear and I didn't want to push her for fear of being told to give him the full 3u again. No way was that happening!

He's still pretty out of it but fighting off the force-feedings better today. I'm taking that as a good sign but wishing I could get more into him. Appetite stimulant is DEF on my vet list, are there any side effects or contraindications involved?

 

And so are YOU!

 

Not that I know of. Ask them to test for ketones while he's there too. Anything over a trace and he will need an IV drip.

 

I agree ask for the test. It will relieve your mind .

 

Are there any updates on how KB is?are you asking for cerenia as well as an appetite stimulant.. you need to give the cerenia first before the stimulant.
Have you tested for ketones?

 

I'm sorry for not being quicker on the update. There are a handful of metaphoric fires I'm putting out atm, one being my extremely hypertensive mother. I'm just exhausted! KB seemed to tank en route and they kept him, which I expected and feared. They did NO tests in front of me saying it was clear he was in a bad spot. I think I'm not assertive enough in these situations, too afraid to be a bother or pain in the ___ -all of which is stupid, I know, but in those moments I seem to blank out. I think I've asked everything I need and realise later I'm an idiot who should have pushed harder for an answer.. Blegh, enough of me.

Yesterday I did receive the labs they ran on the 30th. I don't understand it enough to share the info. I don't think the bulk of it is even DM specific. I can post a pic, can't make the linking trick work with this browser setup for some reason but for what's it worth I'm stuffing it in here in case it makes more meaningful sense to someone else.

Asking about a ketone test was brushed aside with "it's clear he's in a bad way and we're going to do everything it takes" yada yada, and twice with stories about the crazy/wonderful/expensive regime they use at Purdue. I DO really like this vet, I travel a little further because in the past I like the staff and felt they took good care of my furry ones. The locals have massively disappointed me. I might be losing faith with the current. I want to think he dumbs down his speech for patients' owners. I'm sure some DO prefer or need things simplified or whitewashed.. that's just not me and definitely not in this specific case.

So, I leave not knowing anything really. I was told they're putting him on glucose and probably(?) a low dose of insulin too. As I write this, I'm less and less sure I'm remembering correctly, so take that lightly.

I didn't even know what day it was when he said they'd want to keep him over the weekend. Monday, Friday? I can barely tell up from down lately lol. It wasn't until the sad drive home I realised this includes the 4th which I noted the hours list as "observed". I assume this means closed. I'm hoping it doesn't also mean unstaffed/unattended. At the time, I was told "maybe you can bring him home on Sunday", which I know IS fully staffed because they use Sunday for emergencies and special needs.

I called this morning to see if there's been any improvement and I hear he's "about the same" ...my heart sinks. Maybe this is the norm, it's not UNreasonable to me that it would take awhile to recover, but I had hoped to hear he was a little perkier after 18h of fluids, or a line like "his numbers are looking better and...[insert mystery reassurances]" but no. No one has said the words hypo or DKA, but that's what this is, right? Argh, I want to cry or scream, maybe both simultaneously. Instead, I just keep calm and hopeful.

I just want my cat back. I'm not in the least squeamish about the realities I knew coming in OR the ones I'm learning as I travel this road. I'm prepared (mentally/emotionally) to do this! (The physical aspects I'm working on; toolbox, knowledge base, etc)

It feels like there will be a bit of comfort when I can see his numbers and begin actually helping him, in real time rather than waiting for obvious distress and being at the mercy of mollycoddlers who ADD to his stress -.-

Meanwhile, I'll keep trawling through this resource-rich environment and arming myself with the tactics and know's necessary to wade this quagmire while believing this is just a horrible storm and my KB comes home soon. I mean, we've got a new normal to find, let's get to it! XP

I may call again later though I feel like I'm harassing them and get little enough out of it. That's on me. They've repeatedly invited me to call as often as I want. I think they allow visitations, too, or for extended stays. They've let me do that in the past with my Chloe who had a horrible head injury.

Looong story for a lot of nothing.

 

Awwwwww (((((Anna))))) First of all beating yourself up over things out of your control isnt necessary or productive. (Although I DO know how you feel. I tend to do the same)
Right now Kitty Boy is exactly where he needs to be. You're doing your best under extreme conditions. You know you can come here to vent anytime right? Thats what family is for. USE US.

I'm sending many kitty cat prayers for Kitty Boy to pull through this episode and you both get back on the right path.
jeanne

 

I wanted to give this so many likes I just had to be a weirdo and give it it's own announcement

 

Hi Ana just wanted to say believe me we all know how Overwhelming this can be there was so much for me to process all at one time BUT You are doing Great . Ana if you want to call the Vet you call I’m sure they are used to this . I used to feel the same way about calling then I said to myself hey I’m worried it’s my cat I’m calling . In the mean time prayers for you and Kitty Boy

 

Big squishy hugs to everyone! I hope this pre-4th day/night (any aussies? It's already tomorrow!) ...err, point is I hope "it" finds you and your loved ones, furred, scaled or 'nude', happy and hale.

Dr called, I'm calling him "Landypants", but only in my head and bc I nickname everything. He had a slightly better report than I got from the techs earlier in the day. He's still refusing food but did eat a little on his own, said he seems brighter but still pretty sick. He is moving about a bit. He's still being giving fluids, and insulin 2x. I deliberately didn't ask the dose as I felt I'd end up "fighting" him, I'm just going to trust they know what they're doing. I did mentally highfive myself for rem'ing to THINK about asking. Highfiving is NOT a thing I do XP

Keytones: he said they found the tiniest traces but judging by how sick he is, he thinks the sample may have been contaminated & reading low. He snatched a sample from that initial cage he was put in interim and says they're testing & retesting etc, meanwhile he's getting all flushed out and re-hydrated. He repeated the "hopefully sunday" forecast, by which I shall be a LOT better prepared and able to monitor him.

When I pick KB up, I plan to ask for an appetite stimulant (and to try to con a few of those oral syringes for feeding while I wait on post ). I read vetsulin, while maybe not as 'good' as the prozinc or lantus, was more comparable in cost to this novolin and wondered if this is true. Somewhere above, a reasonable sounding suggestion was made involving (prozinc, I think?) ordering from chewies. I've obviously got some homework yet to do but a change seems necessary.

If for some reason I can't swing an immediate change and Landypants still says 3u, I'm torn between pretending compliance and going quietly off-piste or- "arguing" with him. Fairly certain the latter will get me nowhere but marked as irritating and troublesome. (They'd be RIGHT but it's neither here, there OR helpful) He seems pretty into his 3u prescription and sticking to it! ..which only makes me groan.

Last random thought I had regarding the novolin debacle: if it's only lasts 8h, shouldn't that be the admin sched? Waaaaay less of it but 3x? NO WAY am I going to do that, or anything radical, on my own or without some handholding so please don't fear for the safety of any felines in my hands. I'm just thinking aloud in a room full of folks much more in the know

An aries girl, I'm going to bump my head into this wall until it falls, solved or we make friends. Simple as.

 

Ana as Bron mentioned please don’t forget to ask for nausea meds to go with the appetite stimulant. I had to do the same for my cat I had Cerenia and Ondansetron .

 

Well if 3 units proves to be too much Hes in the right place to counter it.sigh I really feel for you!
AND YES you just remember the price tag of this hospitalization. YOU CALL AS MANY TIMES AS YOU DAMN WELL WANT!
Prayers continue!
j

 

excellent tip, Dusty & Roe! Landypants sure isn't advance arming me well. It would've been nice to have appetite stimulant and the meter the day of DX. Getting caught in a nausea stage and being ahead of it sounds like a dream.

"AS MANY TIMES AS YOU DAMN WELL WANT!" has a lovely ring to it I'm even wondering if I could barge on in tomorrow for a visit. KB's only known 3 humans until all this and one of em passed away last year. He's never had an overnight and an empty office sounds pretty great to me!

 

I would

 

Make sure you get hold of all the lab results when you leave with KB. We need to know if there were any ketones at all in the picture as that can make a difference with the insulin dose.
Definitely ask for cerenia ( antinausea med) as well as appetite stimulant.
I think it would be perfectly reasonable to ring again and ask how he is. I would! please keep us updated.
sending lots of healing vines.

 

I've got my growing list of 'demands' and it feels good, Bron! I will def drag back those labs and also be doing my own occasional/regular(?) urinalysis on him going forward. Weeeee, literally!

Thanks beyond measure to all those here and esp those picking me up and helping me along. I hope one day I can help another in the way you've done for me. Since finding this group, I feel so much more relieved. I know you all know what I mean, we all were outsiders at one time, dancing in near ignorant bliss until ~P O W~ right in the kisser!

I think I missed the night crew, I don't feel good about using the emergency line for a check-in but if no one's answering the phones tomorrow, I sure will! I'm lucky to have a vet who, pre-covid, HAD generous hours + weekends but this holiday, ugh!

Many thanks and lots of gooey love

 

IF you r cat gets 8 hours of duration, you could shoot every 8 hours with Novolin. However, most of us do not want to be on an 8 hour shot schedule. Remember, if you shoot every 8 hours, you have to build your testing around an 8 hour shot schedule. Chances are, you'll never sleep

Prozinc is a better choice than either Novolin or Vetsulin. Often, the shorter acting insulin is used when a cat is hospitalized, In fact, they are more likely using Novolin R (not Novolin N). It gives the vet greater flexibility as R is out of a. cat's system after about 4 hours.

 

Thanks, Sienna. And I do value my sleep! I've got some flexibility there but it hasn't sunk in yet how the sequencing and timing will go. When to test or feed, how long to wait etc. I've a copy/paste tome somewhere needing a good sort through

10 had been my chosen golden hour, later is better than early for me, though I didn't then know testing was an option. Im thinking I should switch to 11 when he comes home and testing will be very much a part of our lives.

 

We are all rooting for you and for the quick recovery of your cat.

 

Praying for him.

 

Cant wait to her how Sweet Kitty Boy is this morning!

 

There's a NEW and weird recording actually allowing messages so I'm just waiting on a callback. MY hope is to try and see him. Either way, my plan is tomorrow he comes home and we begin our new adventure in earnest. I just hope the vet agrees

My mind is riddled with food facts and figures from a heavy duty study sess, trying to get my ducks in a row. He already was 50/50 Friskies (pate lately) and he's no lover of the crunch just a lord of the graze. He'll be sad to lose his never-empty bowl but "we'l live" and that's what counts.

Finding him some variety and figuring out a what a good (afforadable) medium carb looks like. The more I learn, the more I feel like holding off until I know more: should I be shooting for higher proteins or fats and how does phosphorous figure in?! The mind spins... On the helpful front, many of his fav flavours are listed in the low carb range. I saw a lot of options in the in the med/high categories, too, but I'm less sure how to apply them or what I'm looking for. It's quite a numeric spread and I'm betting a small rise makes a big difference.

I know I'll have this all down pat in no time, but i don't want to be caught empty handed when I'm finally seeing his numbers and judging what he needs!

On a brighter note, I wonder if this 4th will be less concussive than the past? KB handles the barrage better than my poor pooch. Maybe everybody's fur friends can have a bit of break this go round.

Stay safe and have a fun (if sultry) Saturday!

 

HA! Good luck with that! I think you'll do fine. Heck you already are. My mantra was 10% or lower carb of ANY food he would eat which means Fancy Feast pates. They were his favorites.

 

Novolin drops a cat hard and fast.
Snackage is allowed for the first half of the cycle, especially around +2.

 

Also, can you update your signature? It tells us in a glance what the insulin, meter, and current situation is.
It saves precious time not having to read through this entire thread. It's starting to get long.
How about starting a new thread once KB is home, linking this thread to the new one.

 

I've been cringing at the length and holding off the update since I don't have a meter, or cat, in my hands yet. Holding out hope for an insulin switch, too. Update is very much in my plan as soon as I have these infos.

I thought I'd need to change the title again, in the least, but I'll def follow your suggestions and make a new post with links post-homecoming. Thank you!

 

Please, please, please get a meter before tomorrow. A human meter works just fine and can be bought at a human pharmacy. The AlphaTrak that the vet will try to sell you uses crazy expensive strips. I think a lot of people in the US use the Relion Prime. I'm in Canada. Someone will chime in about the Relion meters.