DKA Help!

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TuxedoKitty

TuxedoKitty

Member Since 2017
Hi all. Thanks in advance for your help.

We have a 9 year old male kitty. He has been receiving asthma pumps 2x a day since November. Other than this, he has enjoyed good health.

This week he began to act lathargic and was drinking a lot of water. We made a visit to our primary vet Friday where they took blood and took a chest X-ray. They noticed dehydration and treated with fluids. They noted some concern in his X-ray, but nothing major.

While waiting for the blood results over night, he began having a coughing fit and trouble breathing. We took him to the 24/7 emergency vet where they did an expediated chest X-ray. They treated with oxygen and a diuretic to assist with fluid in the lungs. They also noted an enlarge heart. We were told to schedule an appointment with a cardiologist. Since he was stable, we took him home and observed him carefully.

Throughout Saturday he had increased respiration rate and was mellow, but eating and drinking small amounts. The primary vet called to explain that his blood work was normal except for a minor increase in blood sugar levels. The primary vet attributed this to stress and recommended a temporary switch to low carb food. He also encouraged us to make a cardio appointment, which we did.

Winchester began to become very lethargic again in the evening and we returned to the 24/7 vet. At this time, the 24/7 vet reviewed his blood work from Friday and noted the high blood sugar AND ketones. She diagnosed him with DKA.

Because of his breathing and heart concern, he cannot reveive IV fluids. He is on feeding tube and receiving fast acting insulin. Also, a diuretic and one other medication to assist with fluid in the lungs. It has been 12 hours since his first insulin injection. He is still not eating or drinking. Blood sugar is leveling out. Ketones are still present. He looks so, so sad.

Any and all advice is appreciated! Our number one question right now: how long does it typically take for a cat to recover from DKA?

Also, how will we manage diabetes, asthma, and heart disease??
 
My cat had dka,was in er for 2.5 days and to fully recover took weeks. kitties are diffrent tho might take longer ?
 
So sorry to hear of Winchester's troubles!

I don't have personal experience with DKA, but I think racn1320's experience was pretty typical-- some cats take more or less time to stabilize at the vet's, most do take a few weeks to recover their strength after a serious DKA episode. They are very sick kitties, but they can recover fully if treated. It's good that he has the feeding tube to assist with feeding-- getting food and insulin into him are absolutely critical in helping him feel better.

There are some folks around here who have dealt with heart and asthma issues along with diabetes-- hopefully some of them will be able to offer some specific advice once you get through this DKA crisis. The basic story is usually: manage the other issues first, manage diabetes around it, but there are definitely things you can do to simultaneously manage all the conditions. For example, one thing I hope someone with knowledge can weigh in on is related to the choice of asthma medicine-- are the treatments he's been receiving steroids? Steroid-based medicines can actually affect blood sugars and exacerbate feline diabetes, but I think there might be some alternatives out there that do not.

Job 1 now, though, is the DKA. Hope he starts feeling better soon!
 
Poor Winchester! He sure is a handsome guy. Like Nan said people that have cats with other issues manage them first and the diabetes second. @DebG has a kitty with asthma and FD and can give info on those two issues. Hope Winchester is feeling better soon.
 
First and foremost is treating the DKA and the respiratory issue. There is no one answer as to how long it will take.

My Smokey did not have DKA, however he had all the others and pancreatitis. He was a long term diabetic, unregulated and tried 3 different insulins. When the pancreatitis flared up is when we found out about the asthma and enlarged heart. We saw the cardiologist and heart disease and a previous heart attack was diagnosed.

Smokey did well on albuterol inhaler for the asthma. However, if he needed steroids I would have used them and adjust insulin accordingly. Steroids affect glucose and can cause diabetes. But if they need them, so be it. You work around it.

He was on meds for pancreatitis as well as insulin for diabetes. Cardiologist added heart meds and aspirin to our daily routine. My vet called in the meds to a compounding pharmacy. I used liquid meds as it was easy to administer for both of us. Cerenia for pancreatitis was a pill. The aspirin was liquid given twice a week. He got 3 heart meds that were mixed together as one med given twice a day. Lasix for fluid was given twice a day. Lasix can make the insulin less affective.

It can be managed. Keeping a record of what to give when is key. Fine a routine that you can stick to easily. Some meds had to be given with food and some 2 hrs after eating or before eating. Since Smokey had to eat every 3 hrs around the clock, it was tricky in the beginning.

His insulin had to be every 12 hrs with his largest meals, so that's where we started. His meds where spread out and given based on those 2 times.

It was overwhelming at first, the home testing and insulin we already had down as it was not new for us. It was just the timing of the other meds we had to figure out.

You can do it. People here have experience and can offer tips. Hang in there.
 
So many thanks for all your insights!

Winchester has only ever been treated with inhaled steroids (Flovent). We were under the impression that since the steroids did not enter the blood stream, they would not cause diabetes. We chose not to use oral steroids specifically to avoid diabetes. Is this accurate? Will he be able to use inhaled steroids as a diabetic cat? They were mostly effective in controlling his asthma.

As of this morning, he is in still in the hospital. Breathing has been okay and not required oxygen. His potassium levels are okay with supplements. He had a few bites of tuna, but is still receiving fluids and food via a feeding tube. Ketones are now gone. Blood sugar has been between 200-300. An ultrasound was completed and they found a slightly "brighter' liver and some concerns with his pancreas.....but nothing that is a "game changer". Does all this sound typical?
 
Yong said:
Good news that ketones are gone! I can't answer for the other part of the update though :bighug:
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Same, other than that I don't think it's unusual for the pancreas to be "irritated" during/just after DKA-- I've heard some caregivers say they got advice to watch for signs of pancreatitis which never materialized after a DKA. Not surprisingly, pancreatitis and diabetes seem to go hand-in-hand in kitties, it's pretty common, but what's going on now may (with luck) just be transient.

Really glad the ketones have abated! That is huge, and will go a long way to helping him to feel better and start eating again. When do they think he can be released from the hospital?
 
The doctor said that he probably will NOT be well enough (potassium, etc.) to go home today. So, maybe tomorrow?

He still isn't eating. The doctor said that they would release him if his levels are normal and if he not eating....but we would need to feed him via feeding-tube at home. (More adventures in pet parenting.)

His spirits seem better. We were able to visit with him in a private room yesterday. He was walking around and was much more alert.

I have many questions bouncing around in my head:
Will he be able to remain on his flovent pump to treat his asthma?
Is it possible that the "heart disease" was just related to his diabetes? Could diabetes somehow cause the fluid in his lungs?
If he also has heart disease, what medication will he need treat it? Can he take that with his insulin?
Could a (wet-food only) improved diet send his diabetes into remission?
How do we financially figure this out (current vet bills are at $7,000)?

Thanks again for all of your help. This board has been super helpful during this difficult time!!
 
TuxedoKitty said:
Will he be able to remain on his flovent pump to treat his asthma?
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You have to treat other significant medical conditions and dose the insulin around them.

TuxedoKitty said:
need to feed him via feeding-tube at home.
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This isn't as bad as you think. I did it for several weeks many years ago and was surprised at how well my kitty tolerated it.

TuxedoKitty said:
If he also has heart disease, what medication will he need to be on to treat his heart disease? Can he take alongside his insulin?
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There are many people here who give heart meds along with insulin. You can post for help once you know more.

TuxedoKitty said:
Could a (wet-food only) improved diet send his diabetes into remission?
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It might not put him in remission but a low carb wet food diet is best for all FD kitties.

There's lots of help here for you going forward. :)
 
FYI - my guy went into DKA two months post FD diagnosis. It took him a few weeks to recover his strength at home. Once your boy is home get a urine ketone testing routine going. Easier than you think.
 
Thank everyone! Things are continuing to slowly improve. We are hoping we can take him home later today with his feeding tube in place. He's still not eating. Maybe being at home will help? We are not moving to a an e-tube at this time because we do not want to stress his heart with sedation.

So now begins the adventure of insulin therapy. All advice is welcome! We are complete newbies at this.

Additionally, what suggestions can be made for when we need to travel? Do we cancel our plans? How do we find qualified care givers? Do we have to board him? We are in Brooklyn... any contacts would be appreciated!

And, finally, how do we pay for all of this?! We have already paid $7,000 since Saturday. Another bill will be due today. Yikes!
 
He is home! Yay!

He is eating small amount of wet food and drinking some water. We are supplementing with clinicare via feeding tube. We have started on 1 unit of Lancus everything 12 hours. He is also taking an oral antibiotic (he had a mild fever two nights ago due to a mild IV site infection) and a branchodialoator (to treat his asthma) and a RenaKare gel (to aid in electrolytes). We are testing for ketones.

We go back to the vet tomorrow for updated blood work and to (hopefully) have his tube removed.

Am I missing any major items?

Thanks again for your help!
 
Hooray Winchester is home! :bighug:

Food, water, and insulin sound like the major items to me but I have no experience with DKA.

I think you should at least setup your Signature now, be sure to include those meds and his DKA event date as well :): http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

For your travel, could you ask one of the Vet techs from the clinic? You could try posting on the Community & Off Topic thread if anyone is in Brooklyn. I feel like such a dense population must have at least 1 other member from here!:p

Were you home testing?
 
Great ideas. Thanks!

Vet did not recommend home testing. But, I see that most forum members do. It is something I will inquire about tomorrow when he goes to his primary vet for his check-up. A lot to consider.
 
Unfortunately, we hear a lot of Vets that don't recommend home testing :(. Would just ask them, would they give insulin to a human baby/toddler without monitoring BG? No different for our fur babies. Better to know they are safe to give insulin. Recent example, if I wasn't home testing my boy and shot blindly, I probably would've killed him last night.
 
Yong said:
Unfortunately, we hear a lot of Vets that don't recommend home testing :(. Would just ask them, would they give insulin to a human baby/toddler without monitoring BG? No different for our fur babies. Better to know they are safe to give insulin. Recent example, if I wasn't home testing my boy and shot blindly, I probably would've killed him last night.
Click to expand...

Makes a lot of sense. Thanks!
 
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