DKA--cat is at the vet now, how to best manage from home?

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equine99

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So Snowflake has been diagnosed diabetic for the last 3 months, is 14 and has had a small heart murmur since birth.

I came home like 30 min ago and did her test as usual before giving her dinner (and then i was going to give her her shot) but she wouldn't eat anything even though she should be hungry by now. So I opened up her absolute favorite--fresh canned tuna, and she wouldn't touch it, she just kind of sniffed it. She tried and failed to jump up on the kitchen counter twice, and now she's just lying down, not curling her tail at all. I tried putting some food on her paw hoping she would eat some by licking it off to clean her paw, and she could have cared less that there was a glob of food on her paw--didn't even try to shake it off. I picked her up and held her for a while and even while doing that and petting her, her tail had no movement. Now she's lying down, her second eyelid is half way up, seems to be breathing fine, but is totally out of it. bg was 286 so she is definitely not hypo. I tried playing with her laser toy and she looked at it briefly but barely turned her head.

I can't afford an emergency vet, especially if they're just going to do a bunch of tests only to tell me that she's dying. I don't know what to do other than hold her and make sure there's food out, and hope she eats something overnight? Is there anything else I can do?
 
Re: I think my cat is dying?

I should also note that as far as I know she doesn't have anything else wrong with her other than the diabetes and the heart murmur, so I don't know why she seems to have been hit by whatever this is so suddenly.
 
Re: I think my cat is dying?

Kathryn, I have no input for you other than just being here with you until someone who knows something can give you some advice.

Can you syringe-feed her some food pureed and mixed with a lot of water to just get some nutrition in her?

Suze
 
Re: I think my cat is dying?

Also, you might want to cross-post this on the ProZinc forum so that others who know this insulin can help you out.

Suze
 
Re: I think my cat is dying?

Kathryn,
Is there an emergency vet number you can at least call? You said that her 2nd eyelid was half closed....what do her gums look like?
 
Re: I think my cat is dying?

I'll look online for a number--I should probably call and at least see how much it would be. I just tried using a syringe to get some water into her at least and she barely fought me but didn't swallow it. and her gums look pinkish.
 
Re: I think my cat is dying?

OK, pinkish is good. If they get very pale or grey, you need emergency help right away. Call the number. She was okay when you left earlier? Did she eat okay then. The BG number means she isn't hypo.
Do you see any evidence anywhere that she may have eaten something that made her vomit? Anything toxic she may have gotten into? Can you tell if her abdomen or stomach are tender to the touch?
 
Re: I think my cat is dying?

Good luck, Kathryn. My prayers are going out to you and Snowflake.

Suze
 
Re: I think my cat is dying?

Thank you. I just got back and the vet said she was severely dehydrated and constipated. With an $800 deposit, they're going to run blood tests and give her iv fluids and let me know what they find. He said her kidneys are really small, so she could have kidney failure :( Also said she'd probably need to stay on iv fluids for another day or two, depending on what the tests said. ughhhhhhhh. I love her to bits and don't want to have to put her down, but I also don't want to spend thousands of dollars if it's only going to give her a few more months of a rough life :\
 
Re: I think my cat is dying?

I will pray that it's just the constipation and dehydration, and nothing else, and that you and Snowflake have many more quality years together.

Go get some sleep...she's in good hands now. (((HUGS)))

Suze

PS: Maybe someone here will have a good suggestion on how to prevent dehydration and constipation in the future. But you might want to remove the 911 icon since this is no longer an emergency.
 
Re: I think my cat is dying?

I'm glad you ended up taking your cat to the ER for treatment :YMHUG: Vet bills are expensive but there are some organizations that offer help: http://www.felinediabetes.com/vetbills.htm Your own vet may offer financial payment plans of some sort.

FYI, the after hours voicemail message for your vet should tell you who to call/where to go for emergencies. You can also find a local vet ER from these web sites and put the info on your fridge or easy to access spot for future reference:

http://acvecc.org/members.php
http://www.veccs.org/index.php?option=com_hospitals&nationid=1&Itemid=193
 
Re: I think my cat is dying?

Kathryn,

I'm so glad you took her to the ER, as hard as it is to take them in and expensive sometimes it is the absolute best place for them to be....Since last Sunday night I've been sitting right where you are at now....My little Musette has been hospitalized at the ER for what actually sounds a lot like the same thing, she was fine, heck she was better than fine she was fantastic on Saturday, gave me a long run of beautiful green numbers then by Sunday morning she wasn't eating and spiraling downhill quickly. Tuesday they put in an e-tube to feed her through.

And currently she seems to be both OTJ and in DKA in the same breath, and no one can figure out why...but when I took her in she had high Ketones, elevated liver values and dehydrated...sometimes we don't know what goes wrong or why and all we can do is just get them into an ER and pray like crazy. As sick as Musette is right now she is worth every penny spent on her, and I have to hope that one it is all over with that I will have lots and lots of more time with her.

Holding both you and Snowflake in my heart and prayers and hopefully both of our baby girls will get to feeling better very quickly.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Re: I think my cat is dying?

HI Kathryn, I sure hope your baby is doing better this morning. Subq fluids done at home can help prevent dehydration and is a staple treatment for ckd (chronic kidney disease). Subq's aren't hard to learn (especially since you are already doing insulin shots) and my cat enjoys the treat she gets while fluids are being administered. Keeping my fingers crossed for you. Jan
 
Re: I think my cat is dying?

Well, the vet said she has DKA. I'm just kicking myself for not checking for ketones, I guess I just thought I should get her regulated and then worry about that--I thought wrong. I told him about the home testing and dose adjustment I did and I could instantly tell he's one of those vets who isn't onboard with home testing.

He said she probably has a bladder or kidney infection, but that her kidneys are functioning correctly, and was a big talker--I think he was used to being able to talk over people and was surprised that I understood what he was talking about. Kept trying to talk me into more and more tests. I think I finally got through to him that I just can't afford to runs barrage of tests that only may possibly tell us something.

So he has her on an IV to give her fluids and has also put her on something he called a "regular" insulin that is supposed to be fast acting and short lived, and he's giving her antibiotics. I have to pick her up in fifteen min and have to decide whether to transfer her to another vet and keep her on iv fluids or to take her home. He's said he thinks she needs to stay at a vet on fluids for 2 to 3 days, but I'm strongly leaning towards giving her today at the vet on fluids and then taking it from there at home. It's killing me that he's charging me $22 per bg test, when I know I can easily do it at home for under $1/test.

Does what he's doing sound reasonable?
 
Re: I think my cat is dying?

If she is in DKA she needs to remain hostitalized, that can turn deadly quickly. So far their treatment plan sounds correct...the 'regular' insulin that they are using is probably Humulin R which is a very fast acting insulin and unless you have experience with it, not one to be used at home. She probably does need several days of fluids to flush out the ketones..and she needs to be eating on her own or have a feeding tube placed before you can even think about treating at home...Ketones would be one thing to handle at home, but if she is still in DKA and not eating on her own, she needs to be in the care of a vet.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Re: I think my cat is dying?

I would change your subject and ask for specific ketone help.

There are people who have dealt with ketones and know exactly what is possible at home and what is not. It does sound like the vet is doing the right things. The "regular" insulin is likely a fast acting one that should help keep the bg levels lower. The fluids will help flush the ketones. You can do them at home when she is stable, but I would get some specific advice on when, what you need and how to do it. Some needles are easier to work with than others, etc. I know Lu (Grayson and Lu) in PZI has dealt with this for months. I'll see if she will chime in.

Here is some info on ketones: ketones
 
Re: I think my cat is dying?

Grayson didn't go DKA, but had Moderate ketones and I treated him at home w/ sub q fluids, and jacked up insulin.

I'm out of pocket right now, but will get back with you in a little while.

Lu-Ann
 
Re: DKA--cat is at the vet now, how to best manage from home

Hi Kathryn,
I'm happy that you rushed her in, and that they were able to figure out quickly what it was. If it's DKA, it would have been fatal had you not brought her. Same thing happened to Bob, and it isn't something that can be treated at home. Once they get the ketones under control, you can deal with the treatment, which may include sub-q fluids. For right now, she needs what they can do for her. ECID, but Bob was there for three days.
Sending healing thoughts and prayers for your sweet girl,
Carl
 
Re: DKA--cat is at the vet now, how to best manage from home

Hi Kathryn -

Sorry to stop in then bail, but I'm accessible now.

Like I said, Grayson did not get to the point of DKA - his ketones were MODERATE at their highest. I called the ER vet 4 times overnight, and opted to go to my vet first thing in the am. At that time, he was still eating... so I knew I had a little bit of time. Also, no sign of infection. The vet school ER told me that usually when they see ketonic cats, they've not eaten for days, and therefore the hospital stay and other treatment. Nancy & Payne have also had DKA 4x. She's on Prozinc, but doesn't post regularly. She may be able to offer wisdom to that extent that I don't have.

I treated Grayson at home: Subcutaneous fluids, increased the insulin, and he was on an antibiotic for about 5 days, although there was no sign of infection in his bloodwork. I gave him 100 mL lactated ringers 2 times a day. He got these with food, so he was very tolerant of the fluids. Iused the needles in the yellow wrapper, not pink. These were slightly smaller, and therefore took longer, but were smaller to insert into the scruff. You need to insert the needle chisel side up to go in easier and less painfully. We jacked up Grayson's insulin... VERY fast. you can check his spreadsheet - this first event happened Feb 23rd of this year. Keep in mind, Grayson has since been diagnosed with insulin resistance, so I kinda doubt you'd get to the 4.5 units or the 6 units I eventually got to.

The R insulin, which they're probably using at the vet, helps to decrease the BG quickly. It's a short term, fast acting insulin that is used in conjunction with your Prozinc - Nancy does this... her spreadsheet is very enlightening. Also, if you're getting spikes at 12 hr cycles, you may need to change from BID to TID - dosing every 8 hours (if that's an option) - that will help hold his insulin level steadier (can't do this if he has a late nadir).

I continued fluids until the beginning of May, although they were once a day, then every other day most of the time.

Bag of fluids was about $12. It lasts 10 doses. Giving fluids was not difficult. If your baby isn't food motivated, a second person to assist would be helpful. I did Grayson alone. With his face in a bowl of food, I could've done just about anything to him!

Think of the fluids as flushing out the nasty ketones out of his system. It didn't take too long to see a difference - I've noted ketones and fluids on my SS, so please take a look.

One thing about doing the fluids, is timing - it's best to do at least 2 hours before or after your shot...... mid cycle would be best. If you go this route, your vet can show you how to do fluids. If you need help, just PM me and I'll walk you through it.

Hopefully the time at the vet is very helpful. PLEASE contact Nancy & Payne, as she's probably one of the most experienced on keeping Payne DKA-free.

Good luck!
Lu-Ann
 
Re: DKA--cat is at the vet now, how to best manage from home

Once you get kitty back home, the secondary monitoring tools in my signature link may be helpful adjuncts to monitoring him, especially the urine testing for ketones and glucose. There are some urine test strips for bacteria too, though you may need to find them online or get them from a vet.
 
Re: DKA--cat is at the vet now, how to best manage from home

While the ketones are scary enough...the other thing is her needing to eat...did the vet say if she is eating on her own yet? If not are they syringe feeding her?

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Re: DKA--cat is at the vet now, how to best manage from home

last night was the first time that she refused food, so I don't think that's their biggest concern right now. he said they haven't offered her food or water yet, but he'll start her with babyfood when he does. Really hoping she doesn't have to go back to the emergency vet tonight--it was $22 per blood test and $25 per shot given! makes me sick to think about spending $50 for that teeny tiny amount of time/effort, that frequently throughout the night.
 
Re: DKA--cat is at the vet now, how to best manage from home

If she is in DKA and not eating on her own, then she needs to stay under veterinary care for now...or you are going to have to be able to feed her one way or another at home...either she eats on her own, you can get enough food in her with an oral syringe or she needs a feeding tube..Cats unlike humans can fast and burn their own fat, when they start breaking down their own fat it clogs up their liver, they have to eat. If she isn't eating on her own and they aren't feeding her you are running not only the risk of DKA but Fatty Liver as well.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Re: DKA--cat is at the vet now, how to best manage from home

So the most expensive part is the emergency vet, from 6pm to 8am. If I took her home after my vet closes and then took her back to him in the morning, would that probably be an okay compromise? I'll have him show me how to do subQ fluids and then return her to him in the morning? I'm already $1200 into this, excluding the $500-600 I spent on her 3 months ago at initial diagnosis/test strips etc.

Also, at 6lbs, she doesn't have a lot of fat left to burn :\
 
Re: DKA--cat is at the vet now, how to best manage from home

Don't you have a 24 hour vet hospital in your area? Most places have this, and it's a much better alternative than the overnight only emergency vet. Do a search or ask the vets where one of these places are and then take the cat there
 
Re: DKA--cat is at the vet now, how to best manage from home

We don't have one that I know of. I picked her up from the vet 5 hours ago and he showed me how to give her subQ fluids, and when doing that we gave her 100cc's. When I got her home she immediately wolfed some wet food down, which is great because I tested her right after and she was 53! She's been in the 47-55 range since we got home 5 hours ago, and has been eating a little bit at a time. I fed her some chicken breast, and some treats just in pieces. So, I'm going to take her back in to my regular vet in the morning and I think she'll probably go back on the iv but might not need insulin for a good while, depending on how much her eating picks up.
 
Re: DKA--cat is at the vet now, how to best manage from home

Also, I meant to respond sooner but we had a black out and so no wireless internet! very very windy here tonight!
 
Re: DKA--cat is at the vet now, how to best manage from home

Kathryn,
Very happy for you and her that you were able to bring her home. I'm sure you'll both sleep better tonight:-)
Please keep us posted on what the vet says tomorrow.
Carl
 
Re: DKA--cat is at the vet now, how to best manage from home

Well, it's the morning now. When I went to sleep her bg was 57, and when I woke up there was less food in her bowl and she was at 300! NOt a great number but I think that's a good sign that she ate during the night. So I just gave her 0.4 u and will be taking her to the vet soon. Even just off the bat, she seems so much more awake and alive now. I got out of her toys and she showed interest and even batted at it once, which I take as a good sign. I still think I want her to go back on the IV for today, but let's see what the vet says.
 
Re: DKA--cat is at the vet now, how to best manage from home

This sounds very encouraging, Kathryn. I am so glad you both could be at home together and that she did well.
 
Re: DKA--cat is at the vet now, how to best manage from home

The eating is a REALLY good sign, and the low BGs - nice! Good job getting her through this.

One thought... 100 mL subQs might be a little much for such a little girl. Grayson is about 12-13... but you may want to do 50-75 mL just to be on the safe side - but ask your vet. They should know what's safe for such a little thing.

Good luck - sounding like it's more under control. You've done well with her!!!
 
Re: DKA--cat is at the vet now, how to best manage from home

Thanks for all of the advice and feedback! I took her in this morning and the vet checked her over and said she was much better and didn't need to go back on the iv today. He sent me home with directions to give her 100cc's of subQ fluid in the morning and then again whenever she's absorbed most of it/probably at night. He also gave me some antibiotics to give her because of the probable kidney and/or UT infection.

I had to come into work right after dropping her off at home, but I'll be back by noon and will give her her fluids then (if I can get her to sit still...). Might do 75cc's instead of 100 just because 100 was a lot for such a tiny kitty. She was 5.95 lbs when I brought her into the emergency vet wednesday night and this morning she was 6.2, which is a great improvement. Most of my team at work also has pets so they've been kind enough to let me work from home for the rest of the day, so I'll monitor her bg more carefully then. One thing that came up--so the last few days leading up to this, it didn't seem like her insulin was doing anything at all, and the vet said it's most likely because she was so dehydrated that the insulin wasn't actually circulating through her system. Going forward, if we see insulin not having any effect, a good question might be if the cat is dehydrated.
 
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