GA DKA feedback/guidance (Final update: RIP Mimi)

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My cat when he was diagnosed had severe DKA. Since my husband and I are both nurses, in order to save on costs, keep my cat happy, we chose to treat at home with the vets guidance. The main thing with DKA is the body is "starving" due to lack of insulin and burning fat which throws their metabolism out of wack and causes dehydration.

The key to treating DKA is Insulin + High carb foods + fluids + electrolytes + nausea control/appetite stimulant.

Ideally, you should NEVER reduce insulin during DKA especially if they are not eating, because lack of insulin is the cause. The body is not able to use carbs/protein as energy without insulin. The cat should be syringe fed every hour with high cal/higher carb wet food to maintain calories. Subq fluids (lactated ringers - which has electrolytes) and a potassium supplement given orally should be done at least daily, sometimes 2x/day depending on intake. You can do these at home, it's not much more complicated than learning to give insulin.

If she doesn't get the calories to stop her body from burning fat, the DKA will get worse. Insulin may need to be increased as well.
 
Just got home from the vet: Mimi got a appitate stimulant for 10 days, antibiotics and a litter of lacted ringers for three days via IV. Hopefully with all that, we'll see improvement. Also, when would be the best time to give her the fluids?
 
I just gave in the AM, it really doesn't matter, whatever is convenient. The fluid pouch absorbs in about 15 minutes, and really doesn't affect their movement or anything. Just be sure to shoot insulin in someplace other than the scruff for a few days after you stop the lactated ringers as it can decrease absorption.

You might have to give fluids for longer than 3 days if intake doesn't improve. As soon as my cat started eating again, I made a "soup" of wet food, extra water, and some dry food for carbs (carbs are OK in DKA), which gave him extra fluid too.

Keep feeding and giving insulin. If she goes low, better to feed more, than to reduce insulin. You might want to call the vet and get a potassium supplement orally as well, because the loss of fluids and insulin itself can reduce potassium and yours was already low. There is potassium in lactated ringers.

Try to keep a stable dose of insulin until she is better. Cats prone to DKA require a basal (constant) supply of insulin. Your spreadsheet has a lot of changes, holding of insulin which is not great for cats who are insulin dependent (prone to DKA without insulin).

Once she is better, you might want to ask your vet for a switch to lantus/levemir, as prozinc has a stronger peak and that might be why your numbers were swinging so much. Lantus/levemir are "peakless" or at least have much less of a peak.
 
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Thanks for the advice. I figured she will be on fluids for more than 3 days. I will be giving her a higher carb food and trying the "soup" when she starts eating on her own. Right now she has an IV, the vet showed us how to hook her up to the fluids.
 
I tried giving the fluids through the IV, but I think the IV isn't working, her paw was swelling up. I'm going to give it subq. The rate I was told for the IV was one drip every 15 seconds. Would it be the same rate for subq? I tried calling the vet, but they are closed already?
 
Just what do you by
memopad85 said:
I tried giving the fluids through the IV, but I think the IV isn't working, her paw was swelling up.
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Who is giving the IV? That is not something you do at home. Sine times the IV catheter gets mis-inserted and the fluid goes sug-Q in the leg vice into a vein.
SubQ fluids are given as bolus, usually abut 50 to 100 ml in a couple of minutes
 
Mimi stayed at the vet over night on Thursday, so the vet put the IV in and left it in for home use. They did show me how to connect the fluids this morning when I took her in for a recheck. It was working fine then, but at home, her paw swelled up.
 
For subQ, hang the bag so you can see the bag markers, inject needle shallowly into her scruff. Open the roller about halfway, and let it run until you see the fluid left in the bag at the right measurement (ie. 50-100ml). Do you know the total ML you were suppose to run through the IV? Did the vet give you needles for subQ?

Remember to choose another site for insulin (maybe flank) for a few days after you stop subQ.

For her paw, put a warm towel around it. Ask the vet if you should remove the IV.

 
memopad85 said:
Mimi stayed at the vet over night on Thursday, so the vet put the IV in and left it in for home use. They did show me how to connect the fluids this morning when I took her in for a recheck. It was working fine then, but at home, her paw swelled up.
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I'm new to all of this and don't have any real advice, but my cat's paw/foot was pretty swollen after her IV was removed Thursday. They said it was because she liked to tuck her front legs under when she laid down while it was in. It went down in about 24-36 hours.
 
She was supposed to get between 250-300 through the IV. I do have needles to do subq. Thanks for the video. I'll be calling the vet on Monday to give them an update, and to let them know about the IV.
 
memopad85 said:
Mimi stayed at the vet over night on Thursday, so the vet put the IV in and left it in for home use. They did show me how to connect the fluids this morning when I took her in for a recheck. It was working fine then, but at home, her paw swelled up.
Click to expand...
You either gave the IV too fast or the end of the catheter slipped out of the vein.
 
I think the catheter slipped out the vein because the drip rate was already set at the vet this morning when they were showing me. When I connected the bag to the IV, it was dripping at the proper rate, 1 drip every 15 seconds, and then my niece noticed her paw swelling.
 
Split up the total then, give half in AM and half in PM. 300ml is too much to give all at once subQ. The fluid will move out of her paw as she walks around. Warm compresses help. Not a huge issue.
 
Can be and usually is the same. However, things can be added to IV fluids like Dextrose which should not be given subQ. Common fluids that can be given both IC and subQ are LRS (lactated Ringer solution), 0.9% saline, Plamalite,and Normasol. Concentrations of saline higher or lower than 0.9% can be given IV but not subQ.
 
Its the same fluid, I just gave her 100 ml lactated ringer subQ. It was fairly easy to do, just had to keep Mimi from not moving too much.
 
Is she eating, or are you having to syringe feed her? Try to aim for at least 6oz (1 can) of food/day if you can get it in her. More is better.
 
Still having to syringe feed her. The appetite stimulant hasn't worked yet; last time she was given the appetite stimulant it took about 3 days before she started eating on her own. Right now giving her 1/4 canned of wet food 3 times a day (5.5 oz can); that's all we can get in her. I'm hoping the appetite stimulant kicks in soon so I can give her the "soup" you mentioned @Meya14
 
Update: Mimi's BG this morning was at 187, her gums look more pink as opposed to looking yellow the last few days. Had to force feed her still. She does look a little better. @Meya14 She still has a fluid pouch; we gave her 100 ml subQ yesterday around 4pm and the fluid pouch is about half its size. I read that if the cat still has a fluid pouch, to not give her any more fluids until the body absorbs all the fluids. I'm holding off from giving more fluids subQ. Let me know if that's the right move.
 
Yeah, let it absorb. If you want, you can give the subQ on one side of the scruff, then to the other for the next dose if there is still a little left. You don't want too much fluid absorbing all at once if there is a large pouch left, cause you could overwhelm the kidneys. I'd check again at about 4pm and if most of it's gone, give the next dose. She should be urinating now with the feedings and extra fluids. Keep feeding, and you can add extra water to the food. Seemed as max got better hydrated and more active, the SubQ was able to absorb better. I think we did 2X a day for a week, and then a dose every other day for a week. He was better after about 2 weeks. The first week all his intake was force-feeding, subQ.

Fluid requirements for (normal, non-diabetic) cats is about 30-45ml/kg/day. So for example, a 12lb cat would need 163ml-244ml per day. I aimed for 300ml/day for max due to his size (16ish lbs) and due to increased fluid loss from DKA.

Consider getting an anti-nausea med with the appetite stimulant.

The less yellowness in her gums is a good sign, means her bilirubin is probably going down in response to the increased calories.
 
Please remember to give the insulin shot to your kitty in a different location than you are using for the subQ fluids. The fluids can affect the absorption rate of the insulin and you'll get wonky numbers.
 
On a side note, you may want to ask your Vet about testing her again/treating her for hypothyroid (her lab was low). Could be a reason she is prone to these episodes.
 
Mimi went downhill overnight. Yesterday she was livelier, looked more alert and took down her food/medicine without too much trouble. This morning, she looks lethargic, took much longer to feed her (it was MUCH tougher to force her mouth open to feed), groans when we touch her/pick her up, and her gums look yellow again. We did giver her fluids subQ yesterday and the fluid pouch absorbed in about 6 hours, much quicker than the day before. I gave her another 50 mL this morning, but had to stop because she was groaning and moving around. Not sure what to do; I was hopeful after she showed signs of improvement yesterday, now today she's going backwards. She does urinate, but we haven't seen her poop yet (unless she pooped somewhere else besides the litter box, she has done before). I'll be calling the vet later on this morning to give them an update, but I don't think they'll be able to tell me much. Any other suggestions?
 
I am not really very good with test results but I see that she has raised ALT but the other liver values are okay except for raised bilirubin. Could you ask the vet what this might mean.

I am wondering if she also have hepatic lipidosis or some other form of liver disease such as cholanghepatits/ pancreatitis. I feel intensive feeding is very important at this point and you need to find a way of getting a lot of calories into her. I would ask the vet for ongoing anti nausea medication and or an anti vomiting such as ondansetron or cerenia. So not just the appetite stimulant I think you already have.

What food are you giving? When my cat was very poorly and jaundiced I got hold of royal canin instant support sachets. I would then make one up daily and feed it to him over the course of the day in a syringe. First I got them from the vet and then online. This was before he had diabetes though. http://www.vetuk.co.uk/royal-canin-...n-convalescence-support-instant-sachets-p-254

If they suspect the jaundice is caused by liver disease then you might want to ask about destolit (called something else I think in the US) and antibiotics.
 
Final update: Mimi got worse throughout the day today. She became very lethargic, her gums turned more yellow, she was breathing heavy and she was just groaning whenever we touched her. We took her into the vet and the vet said there wasn't much else that we could do, we did our best. My niece decided to have Mimi put to sleep; she didn't want Mimi to suffer any longer.

It was hard to have to put her to sleep, much harder to see my niece cry since Mimi was her first pet. Even now as I type this, I hear my niece crying in the next room. Even though Mimi had a short life (she would have been 7 years old this spring), she had a wonderful life and helped my niece through a lot of hard times (my niece's therapist at that time recommend to get her a pet to help her get through some dramatic life changes).

Although it was only a few months of caring for a diabetic cat, I did learn a lot from this forum (and before Mimi became a diabetic, I had no idea cats could get diabetes). I am glad I came across this forum and I want to thank you all for all the support, advice and knowledge. I really do appreciate everything you guys have done. If I ever have family, friends, co-workers, or come across a random person who have a newly diagnosed diabetic cat, I will make sure to recommend this forum to them.

Once again, thank you guys so very much, words cannot express my gratitude.

RIP Mimi 01/26/2015
 

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My deepest condolences on the loss of your beloved Mimi.

candle.jpg

Lighting a ring of candles, in memory of your sweet Mimi.

It's never long enough, 7 years or 17 years. So sorry that it was Mimi's time to cross over to the Rainbow Bridge.
 
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