DKA with Hepatic Lipidosis - Help!

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Shannon and Kumho

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Hi everyone. I'm Shannon, and Kumho is my very handsome and wonderful kitty.

Last Friday, my husband and I had to go out of town to attend a memorial service for my sister, who recently passed away. Our usual pet sitter was on vacation, so we didn't have anyone to give Kumho his twice daily PZI injections. Assuming he'd be okay for just a couple of days, we gave him his morning dose on Friday and left big bowls of dry food and water.

Side note: Since his diabetes diagnosis, Kumho's appetite had been insatiable. He cried for food constantly, but we were determined to limit his food to twice daily (to coincide with his insulin injections). We switched him to EVO dry food (lowest carb dry food available) mixed with Purina Pro Plan wet food. He loved it.

Anyway, back to last weekend. When we got home early Monday morning, we found Kumho to be very lethargic with no appetite. He was drinking lots of water, but he wouldn't eat. I immediately gave him 5U of PZI (one U more than his usual dose).

On Tuesday morning, he continued to refuse food. My husband and I both went to work, but I was worried all day long. When I got home, he was VERY lethargic. I immediately took him to the emergency vet, where he was diagnosed with DKA and hepatic lipidosis.

He was in the hospital until this evening. I picked him up, got the instructions on how to care for him, and took him home. I have been syringe-feeding him every 3 hours and allowing him full access to his regular food. Fortunately, he seems to be eating (albeit slowly), but he hasn't been interested in drinking water. I gave him some tuna water, and he took a few sips, but not much.

I also testing his blood glucose - it was 398 mg/dl. Being a type 1 diabetic myself, I know that this is not a good number. I haven't been able to test for ketones, yet. He has finally had a bowel movement (the first since this all started), and he urinated a short while ago (but he managed to sneak into the shared litter box instead of the new one bought just for him, so no ketones test).

Here's what's worrying me. He's acting really weird. His pupils are dilated and he's sort of stumbling around. He is very affectionate, which is good. He's purring and rubbing against my hand, but he just seems so "off." Is this normal behavior after this kind of episode? Is there anything I should look for?

Kumho is only 6 years old, and I love him dearly. I can't stand to see him suffering in any way. Please help!

Thanks in advance,

Shannon
 
No advice or experience but I see someone that at least knows DKA all to well, I will contact her and have her swing by...hang in there.

Mel, Maxwell and the Fur Gang.
 
Can you call the ER vets? I am thinking you may need to take him back in, but if they treated him yesterday I hope they would be able to tell you what to expect. I think if they send you home for home-care with DKA they should be well enough that you would not see symptoms like that, but I don't have any DKA experience. Hopefully others will be along soon. I would go ahead and call the ER at least and see if they will tell you anything useful over the phone.
 
Hi Shannon, you and Kumho have been on quite a ride, let's see where we are. Kumho is on 4u of pzi 2x a day? and he eats dry food? The vet you took him to was a 24 hr. ER? His eyes, do they look glassy and round? He needs to eat and at this point, give him anything, you should also take his blood glucose again and REALLY try to test for ketones, how long has he been diabetic? My cat has survived DKA four times and he will get through this ..... get back to me. Is there a 24/7 ER near you?

Nancy and Payne
 
Thank you all for your replies. I mistakenly expected to receive emails when people replied to my post, so I wasn't checking the board. Live and learn, I guess.

Anyway, Kumho seems much better today. I spent the night with him in our guest room, and he managed to eat all of the wet food I left for him before bed, AND at 3am, he begged for more, so I gave it to him. He ate the entire bowl!

I was able to test his urine for ketones and he had negative-to-trace ketones, which is fantastic.

Side note: if you ever need to test for ketones, my vet gave me a fantastic suggestion. There is a kid's toy product called Aqua Sand, which is just like sand but doesn't absorb water. The urine just slides right off. I picked some up, and it worked great!

So, this morning, Kumho ate his usual food (wet/dry mix), took 4U of PZI, and now, he's eating again. I will check his BG in a little while (he just got all of his AM meds, so I want to give him some space).

He's even his cranky, old self again, and he's grooming, which is very good.

Thank you all again. I was so touched to see all of your replies and to know that you all care about Kumho. I'm so glad I stumbled onto this group!
 
Nancy and Payne said:
Hi Shannon, you and Kumho have been on quite a ride, let's see where we are. Kumho is on 4u of pzi 2x a day? and he eats dry food? The vet you took him to was a 24 hr. ER? His eyes, do they look glassy and round? He needs to eat and at this point, give him anything, you should also take his blood glucose again and REALLY try to test for ketones, how long has he been diabetic? My cat has survived DKA four times and he will get through this ..... get back to me. Is there a 24/7 ER near you?

Nancy and Payne
Click to expand...

Thank you, Nancy. Let me try to respond to each of your questions in order:

Yes, 4U of PZI 2x daily
He eats 1/2 can of Purina Pro Plan (Ocean Whitefish and Salmon Entree - only 2% carbs) mixed with a handful of Innova EVO Cat and Kitten (8% carbs). He has done really well on this diet (until we left him alone for two days with only the EVO and no insulin - :cry: )
Initially, we took him to the ER vet, but we transferred him to his regular vet the next morning (the ER vet closes at 8am every day)
His eyes were very glassy and round - he looked as if he'd been sedated/drugged
He's eating really, really well. I'm going to check his BG in an hour or so, but I did test for ketones - negative to trace!
He's been a diabetic for about six months (I've been a diabetic for over 20 years - I've survived DKA three times, myself).
There is an after-hours ER vet close by, but since he's doing so much better (and we have a follow-up appointment with our regular vet on Monday), I'm going to spare him the additional trauma of a car ride.

Thanks again, Nancy. I'm so grateful for your advice.

Shannon
 
Joanna & Bix (GA) said:
Can you call the ER vets? I am thinking you may need to take him back in, but if they treated him yesterday I hope they would be able to tell you what to expect. I think if they send you home for home-care with DKA they should be well enough that you would not see symptoms like that, but I don't have any DKA experience. Hopefully others will be along soon. I would go ahead and call the ER at least and see if they will tell you anything useful over the phone.
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Hi Joanna,

Thank you for your reply. The more I think about it, the more it seems as if Kumho had been sedated in some way. He was acting drugged, and now, he's almost normal.

See my long reply for a detailed update - we had quite a night!

Shannon
 
MommaOfMuse said:
No advice or experience but I see someone that at least knows DKA all to well, I will contact her and have her swing by...hang in there.

Mel, Maxwell and the Fur Gang.
Click to expand...

Thank you, Mel! He's doing so much better today! :-D
 
Whew Shannon,

Thank you for updating us! One thing you will soon discover about this board, is from the moment you make your first post here, you become family.

Everyone here will worry and fret over your kitty as if it was one of their very own babies. Especially when we see that red 911 on a post, that makes every heart here begin to race, and the call for the calvery goes out. If we, personally can't help, we will begin the search for our best and brightest in any emergency. The rest of us will stand by to offer hugs and reassurance, until help arrives. Once you have found us, you are never alone in treating this disease again, you now have an extended family that reaches around the world. This board is pretty much staffed around the clock so there is almost always someone around to answer a question, hold a hand/paw, point you in the right direction to find the information you seek, or just be someone to vent to, a shoulder to cry on, or offer a long distant cyber hug.

When the world stops spinning so fast for you and Kumho, take time to read the information here, post questions or just tell us more about you and Kumho and how we can help.

Welcome to FDMB Family of sugarcats and the people who love them!

Mel, Maxwell and The Fur Gang
 
Good morning Shannon, and of course you too Kumho! (I live on the west coast so it is morning)

I am so glad he made it through the night and seems better today .... since you have survived DKA Shannon you know how bad he feels! One thing I would do right now is let him eat whatever he wants, as much as he wants right now .... an unregulated diabetic cat needs lots of nourishment! if you could think about feeding him canned, Fancy Feast pates are a good choice or Friskies pates. Just like you need to keep your carbs down, so does Kumho.

Great that you have a way to catch his urine, you will need to check for ketones quite a bit to make sure they don't rise. I'm sure the last thing you want is for him to go back into DKA .....

I see where you check his blood glucose, do you keep records on that? Do you test before you shoot? We like to say that we wouldn't give insulin to a human child without testing. What are his numbers today?

There is a whole bunch more but we will take baby steps but the important thing is you feed him as much as he wants, as often as he wants. DKA has a component to it that the person/animal is unable to convert nutrients, which leads to a wasting away, which leads to ..... well you get it.

All our hugs and good wishes go out to both of you ((((Shannon and Kumho)))) and as Mel said, once you post we will stay with you. You must explain the meaning of his name ......

Nancy and Payne
(she is hiding because she doesn't like DKA talk ..... )
Oh, also Shannon, could you take the 911 off your post, since we seem to be past that .... go back to your original post, hit edit and remove the 911, thanks!
 
So glad he is doing better! I you want, you can post daily with his BG #s and how he is doing, and that helps people start following along regularly and answering any questions you have, and offering suggestions. If you want you are welcome to come over to the PZI forum, and/or you can post here on Health. Health is always the place to post if you have emergencies, sometimes the PZI forum can be slow, but there are a number of regulars who post daily.

You may find he does better without the dry food in the mix (assuming he is eating well on canned). Even though the carbs are lower (which is disputed I believe with the Evo), they seem to do better overall with canned. If you do make a food change, you may need a dose reduction. I wouldn't do anything too radical with a DKA history, but just be aware you may see a significant drop in BGs if you eliminate the dry.

If you want to get emailed when a thread is updated, you can click on "subscribe topic" at the bottom of the page, or when you are typing a post, there is a check box just below the box where you type that says "notify me when a reply is posted". There may be a way in User Control Panel to make that your default setting, but I'm not sure.
 
Hi Shannon and Kumho (you gotta explain the name!)

How was today? How is Kumho feeling? do you have any questions? It is really hard after a bad sickness but we can help you get his health back ..... I hope you are both doing well.

Nancy and Payne
 
Nancy and Payne said:
Hi Shannon and Kumho (you gotta explain the name!)

How was today? How is Kumho feeling? do you have any questions? It is really hard after a bad sickness but we can help you get his health back ..... I hope you are both doing well.

Nancy and Payne
Click to expand...

Kumho is doing so much better today. He's almost back to his normal self. He's been eating regularly, drinking water, and hanging around (instead of hiding under the bed). He has negative ketones (yay!), and when I checked his BG a few minutes ago, it was 287 mg/dl (not great, but much lower than last night). It's very difficult to check his blood glucose - he hates it. My husband is leaving tomorrow for a business trip (until Thursday), and I've no idea how I'm going to test his BG and give him meds?!?

We go back to the vet on Monday morning for a follow-up, and I'm hoping we'll be able to stop some of the meds.

As for his name ... Kumho and his shelter cage mate, who we also adopted, are both named for auto racing tires. My husband races cars (as a hobby, not a career), and the two most common types of tires for his racing are made by Kumho and Hoosier. So we have a Kumho and a Hoosier ;-) We also have Abby (the tabby), who has been with me for 13 years. She's a crabby old lady, but she runs the show. In addition to the three cats, we have a Yorkiepoo named Monroe. We LOVE animals, and our little fur babies are our children.

Once things calm down (and I'm not stalking Kumho's every move or cheering for every bowel movement), I'll definitely read through the forums to become familiar with the group. You guys are so fantastic, and I only hope that I can return the favor sometime. As a type 1 diabetic, I have lots of knowledge about the disease in humans, but I was horribly unprepared for Kumho's struggle. I won't make that mistake again.

Have you ever tried to do a home A1c test? I'm wondering if it's something that would be valuable for cats?

Thank you all again for everything.
 
Joanna & Bix (GA) said:
So glad he is doing better! I you want, you can post daily with his BG #s and how he is doing, and that helps people start following along regularly and answering any questions you have, and offering suggestions. If you want you are welcome to come over to the PZI forum, and/or you can post here on Health. Health is always the place to post if you have emergencies, sometimes the PZI forum can be slow, but there are a number of regulars who post daily.

You may find he does better without the dry food in the mix (assuming he is eating well on canned). Even though the carbs are lower (which is disputed I believe with the Evo), they seem to do better overall with canned. If you do make a food change, you may need a dose reduction. I wouldn't do anything too radical with a DKA history, but just be aware you may see a significant drop in BGs if you eliminate the dry.

If you want to get emailed when a thread is updated, you can click on "subscribe topic" at the bottom of the page, or when you are typing a post, there is a check box just below the box where you type that says "notify me when a reply is posted". There may be a way in User Control Panel to make that your default setting, but I'm not sure.
Click to expand...

I'll definitely check out the PZI forum. Although, I would really like to try Lantus on Kumho (I always keep lantus on hand for when/if my insulin pump breaks and I need a long-acting insulin). His vet seems adamant that he remain on PZI, but I know that Lantus is more "even," i.e., no peak time. I'll keep him on the PZI for now, but I'm going to bring it up again.

Yeah - I have my doubts about EVO, but he does seem to do better on it than other foods. He mostly gets the wet food with just a small handful of dry to supplement. We'd been giving him this diet since his diagnosis, and he's done so well on it - he gained back all of the weight he initially lost, and his curve numbers were great (until this episode). I know that he really like the taste, too. I'm going to give him a curve next weekend.

Oh, and thanks for the tip about getting emails. I figured it out eventually (duh!), but a sleep-deprived Shannon is pretty useless ;-)
 
MommaOfMuse said:
Whew Shannon,

Thank you for updating us! One thing you will soon discover about this board, is from the moment you make your first post here, you become family.

Everyone here will worry and fret over your kitty as if it was one of their very own babies. Especially when we see that red 911 on a post, that makes every heart here begin to race, and the call for the calvery goes out. If we, personally can't help, we will begin the search for our best and brightest in any emergency. The rest of us will stand by to offer hugs and reassurance, until help arrives. Once you have found us, you are never alone in treating this disease again, you now have an extended family that reaches around the world. This board is pretty much staffed around the clock so there is almost always someone around to answer a question, hold a hand/paw, point you in the right direction to find the information you seek, or just be someone to vent to, a shoulder to cry on, or offer a long distant cyber hug.

When the world stops spinning so fast for you and Kumho, take time to read the information here, post questions or just tell us more about you and Kumho and how we can help.

Welcome to FDMB Family of sugarcats and the people who love them!

Mel, Maxwell and The Fur Gang
Click to expand...

Thank you so much, Mel. I really feel like we dodged a bullet this time, and we'll NEVER make the same mistake again. We're lucky he's doing so well, and I'm so thankful to you and the others on this forum. As I wrote earlier, I hope I can return the favor someday. I'm an expert in people diabetes, but the feline variety caught me by surprise.

As soon as things calm down, I'll post a better profile (and include a photo of Kumho - he's such a handsome devil ;-) )

I'm sorry that any of us have to be here, but I'm so glad that I'm not alone.

((Hugs))

Shannon
 
Hi Shannon and Kumho,
I am so glad he is better, we held a lot of collective breaths! And a double yah! for no ketones! it does sound as if he is on the mend.

Many of us test our kitties by ourselves, and trust me, in time it will be much easier .... does he have a treat he loves? does he like to be brushed? petted? You need to associate drawing the blood and getting his shot, to something good. My Payne LOVES food! So I test (but first I bring the bowl out, cans down and lay everything out so she knows that food is waiting .... so I draw blood, then immediately open the cans and put the food on a big plate (mixed with warm water .... helps a lot!) then when she has her head in the food I give her her shot. There are many links to home testing (even a trick to put clothespins down the back!) that may help.

But you are up to it! We are waiting to hear if Mel (who responded to you) has finally gotten Musette, they were transporting her today. She posted about all her babies, who were all abused, on a thread in Lantus. Go to the insulin support groups, and pick the lantus one and find the Fri. post subject "New kitty tomorrow need suggestions where to start her" there is also a picture of Musette .... (it is a very busy place)

I'm so glad things are better,
Nancy and Payne .....
 
You might want to start a new thread and ask for testing advice. If you can post what parts about it he seems to hate, someone here has surely dealt with the same thing!!!! One thing cats universally seem to hate is being restrained - I found testing a lot easier when I discovered I didn't actually have to hold my cat down - once we got the right routine going, he would just sit calmly for the test. It turned out he didn't mind the test itself, just the part where I was trying to hold him in place. That might not be your issue, so just let us know where the system is breaking down, and I'm sure someone can help! If you start a new thread with that in the title, that will help you get responses to that specific question.
 
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