HELP!!! Time is running out - cat has DKA! :(

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OK, she's pretty level at least. Great that she's eating and drinking OK now! :) It's really going to be a case of waiting out the bounce now until she starts to come back down (that can take up to 6 cycles) but as long as her other signs are good then I think all it will be is a bounce. While she's a bit higher, if you can check ketones whenever you get a chance to make sure she's good on that score too that would help. And get as much sleep as you can while she's higher and safe - now is your chance to catch up a bit! :)
 
I am so thankful you kitty is improving. I have to say wow you are all doing an amazing job. You are all like guardian Angels. What wonderful people we have on this site. I will continue to pray for your kitty.
 
Ketones update: she just urinated and I tested with two brands of strips. CVS ones show the color between negative and trace and the ReliOn ones show negative. I'm not sure if she has ketones or not, but if she does, she is slowly ridding herself of them. Anyway - MAJOR success and had to share!!!! Thank you all. We still have to get her regulated, but wow, I'm so a excited to share with our vet tomorrow.
 
good news....
just keep pushing the fluids, no skipping on insulin... and you said cipro... so I assume there is an antibiotic....

infection + not enough insulin + dehydration can lead to dka.
 
Good job! I know it has been hard work.

Since she is starting to stabilize, you might read over Cat Info and consider what foods you may want to feed, if any, from the food chart. Feeding low carb foods will help bring the glucose numbers closer to normal, rather than increasing the insulin.

 
I been following your posts. So glad Chloe is doing so much better. You have done a wonderful job with her. Prayers and Hugs to you all.:bighug:
 
Hello all- me again...

Last night wasn't too bad. I only was up once to check - I had to risk the fact her numbers were good and that my body desperately needed sleep. She stayed in the mid 100's and ate and drank fantastically.

Today, I followed up with her Dr and he said that we were doing great but that he was concerned with how high she spiked (400's). I have been giving the 3/4-1 unit every 12 hours as instructed and she has been about 80% normal kitty all day, which has been a blessing.

Now, though I noticed her pupils really dilated and her head do a slight jerk to the side (I had witnessed this when she was low before) and nervously did a glucose test to find she is at 72. I know many here say that's ok but Dr really worries with her being below 80 with the issues as of late. Since she had been eating mostly the diabetic food all day (no kibble which is higher in carbs), I figure it's made her drop down. I think that if she was low and acting normal I wouldn't worry so much. But, the fact her pupils are big and she jerks her head every so often worries me. I just reintroduced the dry kibble as her next round of insulin is due in less than an hour and I'm afraid that will make her bottom out completely. I still have so much to learn but I'm having a hard time being comfortable with her being under 100. And, not to mention that she doesn't seem to be staying in one place at all. Thank goodness she isn't getting higher doses of insulin - I'm afraid it would kill her. Could the food be the cause of these highs and lows? I have read many places that cat food is the reason why kitties have diabetes to begin with.

Thank you all again for your wisdom. I'm hoping to have a good night but worry I will be up every hour checking her again.
 
What meter are you using?

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
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I'd think targeting above 100 right now is a good idea. You have a lot of buffer room for those lows. Once she's well, you and your vet can decide if your target can move lower. The spreadsheet mentioned above is a great tool.

My concern is this jerking you described. When a cat has DKA or it is resolving there is the potential for very severe changes to electrolytes. When certain electrolytes are too low or too high there is the potential for muscle spasm, weakness, seizures, heart arrhythmia. SubQ fluids can make electrolytes off balance as well. I'd ask your vet to test them.
 
I think it was @Meya14 who said that you should try to keep Chloe running a little higher than we would usually aim for at the moment so, yes, I think you should try to keep her at least above 80 or even 100 (which I think was what Meya suggested) for now - for most of us (and once Chloe's over the DKA fully it will be the same for you) we have the option of reducing or even skipping a shot when the cat is running lower than we're comfortable with. As Chloe shouldn't really skip shots at the moment, it's going to be a case of letting her have some extra carbs for now to keep her numbers high enough that she can have her insulin every time. There's time enough to start getting her running a little lower later on once you don't have to worry about the DKA.

Because of that, I'm not sure I would withdraw the kibble completely for now unless she's having a bounce day like she did yesterday. You've no doubt read elsewhere on here that generally we don't like dry food for cats, but there are instances where it serves a purpose and I think keeping Chloe high enough to get her shots for now is one of those purposes. The other option which a lot of us use is to feed a high carb (in-gravy type) wet food, but that will depend on whether or not Chloe will eat that at the moment...no matter what, for now, she has to eat plenty so she can have her insulin.

ETA - Cross posted with @Meya14 ;) Thank you Meya :) - I was trying to remember exactly what you'd said without taking too long looking back through the whole thread as Chloe's close to her next shot time!
 
I second the electrolyte tests; too little or too much of some of these can be fatal.
 
Ok Meya and Manxcat - I'm so new to this, the forum, etc so forgive me if I'm being redundant. Again the diabetes seemed manageable, but this whole DKA thing and the various things I've read have thrown me for a complete loop! I'm reading things on the Facebook group that differ, I'm reading so much on different sites that I'm literally becoming discombobulated.

I've reintroduced the dry kibble and she took to it instantly. It must be like me and bread. If I eat a slice, I become addicted and I gain weight. ;) (Another story for another time...). She seems pretty alert but I tested her again and she's down to 61 and closer to shot time. Forgive me, she is NOW an hour out from her shot. I misspoke earlier getting my times confused. So, I'm to assume that she is still coming out of the DKA? I was hoping we were getting passed that, but I realize that my hope might be higher than the reality of it all.

So to be sure I have this straight... I introduce the kibble - done. I give her insulin shot still in an hour? (Lantus and 3/4-1unit) Eventually a lower BG is ideal, but not this soon with DKA? We still follow vet's orders and want her 80+. Per his orders I am to give 1ml of karo, and right now I just gave her 1/2ml. When I gave her more (2ml over a 6 hour period) she spiked up to the 400's and I'm assuming we don't want to go that high if we can help it? She's drinking ok and skin snaps back immediately today so I did not give the subq fluids - should I administer those at this point, or just keep her drinking her water? And for my own heart's sake - bounces are normal?????? Because I'm already tearing up in fear that the last week is going to repeat itself... Forgive me, this has been one emotional roller coaster!!! :'(

BJM - I will give the charting a try. For now, my instinct is to research the death out of something and keep my copious convoluted notes. ;) Thank you for the charting suggestion. I will definitely look into it once I can settle my anxiety that I'm experiencing at the moment!!

Are any of you on the Facebook group? PM me if so.

And again- you are all saints. I am beginning to think we call could have DVM (Diabetic Veterinary Medicine) after our names with all of this!!! Thank you again. <3
 
Yes, to everything you said. You are going to see swings until she is regulated. -That is normal- . To get rid of ketones, insulin is the magic bullet. Definitely if your choice to control high blood sugars is less food vs more insulin, at this point, choose more insulin.

Feed her whatever she will eat that will keep her sugars stable. I'd pick one type of food and stick with it for now, as food changes can lead to those very highs and lows your were seeing.

Really, you are not out of the clear from DKA until a few weeks -AFTER- she no longer has ketones, this is because nausea, dehydration, poor eating, and electrolyte imbalances all take a while to go away. Ketones can resurface if these factors don't resolve.

Don't get too hung up on the numbers, just keep an eye out for hypos. Your numbers won't be stable probably for a while, but that's ok.
 
Chloe'sMom said:
So, I'm to assume that she is still coming out of the DKA? I was hoping we were getting passed that, but I realize that my hope might be higher than the reality of it all.
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She will definitely be getting over the DKA I think and her BG is well under control (possibly slightly too well for the moment). However, it's important that you don't have to skip her shots to stop her slipping back into DKA again which is why you need more of a safety net with her numbers than you would do otherwise.

Chloe'sMom said:
Eventually a lower BG is ideal, but not this soon with DKA?
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That's exactly it! :) Eventually you'll want to aim for her being in normal numbers for a cat, but keeping her in normal numbers now would mean you would have no choice but to skip some shots because there just isn't enough data on her numbers yet for it to be safe for you to shoot at a low level. While a lot of us do shoot low numbers, it just isn't safe to do so until you have a lot of data on how an individual cat reacts to shots at lower levels and with Chloe there just isn't enough data yet to be sure you can do that safely.

Chloe'sMom said:
We still follow vet's orders and want her 80+.
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At a minimum, yes - you ideally want to aim for 100+ as @Meya14 said to give you an extra safety margin.

Chloe'sMom said:
When I gave her more (2ml over a 6 hour period) she spiked up to the 400's and I'm assuming we don't want to go that high if we can help it?
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Not quite that high if it can be helped, no. But if she bounces she might go that high anyway. There really isn't anything you can do about bouncing at this stage - if she drops low, she is most likely going to bounce for now. It's completely normal so please try not to worry about it if it happens (I know, it's impossible not to worry, but knowing that it's normal might help just a bit).

Chloe'sMom said:
I've reintroduced the dry kibble and she took to it instantly.
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At this point I think that might actually not be a bad thing. Dry food takes longer to get into a cat's system than high carb wet and longer to get back out too, so isn't as good as either syrup or gravy food for quickly raising a number under 50 without keeping numbers high for a while afterwards. But for the moment while you're trying to keep her numbers a bit higher, a food that takes longer into her system and longer out might help you to keep her settled at a higher level.
 
The charting is a good way to see the numbers from pre-shot to pre-shot and show you how the insulin is working. It may help reduce some of the anxiety, particularly as you start seeing stable cycles from shot to shot.
 
Ok, thank you guys for clarifying. And I will do my best to relax and not panic too much. ;)

I must also say - that upon ketone testing at 3:30PM EST yesterday, with two different strip brands, one showed NEGATIVE which I was nearly jumping for joy over (ReliOn) whereas the CVS brand showed a color that was slightly darker than negative, but lighter than the trace. Dr made notes of that as well. (Our conversation with the Dr today was via phone, so he didn't actually see Chloe) Speaking of Dr... he said that if she continues to eat and improve he'd like to see her towards the end of the week to do some liver function testing. He didn't indicate why, but any ideas? He is perplexed (as he is with all of this - Chloe has had her Dr and ER Dr and office staff scratching their heads... she only had some of the DKA symptoms, so they didn't rule it as that until her urine showed the ketones - not sure what else the thought was going on) as to why she has lost 2# since Sept. '14 to last Tuesday when I took her in. She had lost nearly a 1/2# (according to his scales - though they were different scales in different rooms) from Tuesday of last week to Friday. That is significant. Maybe he thinks there is a secondary problem? (Oh Lord, I hope not!) When we go in, I will be sure to suggest the electrolyte test as well. Though, I will say that throughout this, (until Sunday) she was getting pedialyte off/on through the days/nights.

Ok, so we are 10 mins from the insulin and I will administer it. Suggestions for how often I should check her glucose throughout the night? He stated before that 3-6 hours after administering it, that was the "danger zone".
 
Elevated liver values would suggest that the weight loss had sent too much fat to the liver at once, causing it difficulty in functioning, ir, possible hepatic lipidosis.
 
How often you need to check tonight will depend really on what her pre shot number is. We would always recommend at least a +2 test as that can be an indicator of how the cycle is likely to go. But if she's starting out still low then you might need to get a +1 and a +2 and then we'll work out from there what you need to do next.

The negative, or below trace, ketones is great news. It sounds as though the vet wants to make sure that everything's progressing as it should and that there's no damage to her liver function. The weight loss could be down to high glucose levels - many diabetic cats lose weight before diagnosis as they aren't able to use the food that they're eating.
 
Yes, at first, they thought she had hepatic lipidosis. The first day I took her to the Dr she was so dehydrated that he wasn't able to get a urine sample. That next 24 hours she slipped into a low - death like state that had us running to the MedVet ER. Had we not, I'm confident she wouldn't be here... :'(
 
manxcat419 said:
How often you need to check tonight will depend really on what her pre shot number is. We would always recommend at least a +2 test as that can be an indicator of how the cycle is likely to go. But if she's starting out still low then you might need to get a +1 and a +2 and then we'll work out from there what you need to do next.

The negative, or below trace, ketones is great news. It sounds as though the vet wants to make sure that everything's progressing as it should and that there's no damage to her liver function. The weight loss could be down to high glucose levels - many diabetic cats lose weight before diagnosis as they aren't able to use the food that they're eating.
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Thank you for explaining. And I'm assuming that the +1 and +2 means the number of hours after the insulin for testing? I'm learning. ;) I was going to wait until that 3-6 hour mark, but that may not be smart with as low as she was an hour ago. In fact, I might test again. I'm nervous of her slipping lower and lower from that 61 that she was at...
 
Yes, +# is the number of hours post-shot.
If you could jot down the numbers in a column that way, and repeat it with new numbers added in later posts, that really helps us see any patterns.

PMPS waas
+? was
... etc.

Lantus hits its peak effect usually between +5 to +7 hours post-shot, which is why your vet said +6 hours post-shot.
 
Nervous is fine - none of us ever want to be completely relaxed about low numbers. But remember, she came back up the other night when she was low and if it happens again, she'll come back up again. Testing a little more often when she's started out low so that you can see quickly if you need to intervene with karo or high carb food is never a bad thing. :)
 
BJM, I need DKA 101. ;) PMPS?

Oh gosh guys... I was just admiring Chloe sleeping and she started twitching really strong. It wasn't a seizure like twitching I don't believe, but it was enough for me to worry. I'm not sure if it was because she was dreaming (she doesn't usually twitch like that), but her little legs just started twitching enough that I had to wake her up to pull her out of it. Going to test BG right now...
 
Ok, maybe it was dreaming... Mama's in a panic, I tell ya! :nailbiting:

BG is 180. Will update with chart. And I'm sorry, someone asked me my glucometer is a Bayer Contour Next (human).
 
That's OK - better to test and find her in good numbers than to wait until later and find she's all the way down in the 40s and needing syrup. :)

My Regan dreams like that just occasionally too - usually she's quiet when she sleeps, but just now and then she'll twitch a lot and even meow in her sleep! Even with no other health problems, she scared me the first few times she did it so I can imagine how you must have felt watching Chloe do that! :bighug:
 
manxcat419 said:
That's OK - better to test and find her in good numbers than to wait until later and find she's all the way down in the 40s and needing syrup. :)

My Regan dreams like that just occasionally too - usually she's quiet when she sleeps, but just now and then she'll twitch a lot and even meow in her sleep! Even with no other health problems, she scared me the first few times she did it so I can imagine how you must have felt watching Chloe do that! :bighug:
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Yes! I'm on such high alert, it's ridiculous. Ha. I have a day of work training on Wednesday that will take me out of the house (I have a home office) for 12 hours while hubby is at work and I'm considering not attending just to keep an eye on her! Thank you for understanding so much what I'm feeling. I swear, I feel like you all are neighbors/friends that I've known for years. I can't stop saying it, but I'm truly grateful. I've never met a community of people so kind and willing to be there for others! I only hope that I can return the favor to someone else in the future! :bighug:
 
Oh I know how you feel - I ended a work contract early so I could stay home with Rosa for her last couple of weeks on insulin because I was having to skip so many shots. And I don't think I could have worked the first few weeks she was diagnosed - I was barely sleeping at all and was so nervous all the time that I wouldn't have been able to concentrate!

It really is like having another family here. That's exactly how I feel about all the people I've "met" on this board. :) And you really will be able to help other people in the future - when I started out here I'd never have thought I could talk anyone through getting low numbers back up or give any sort of advice, but it's amazing how much you learn really quickly and then you start noticing questions that you know the answers to! :) :bighug:
 
:bighug::bighug:Hello everyone. We'be had a busy few days as we've resumed normal life again. Chloe is doing great. The only concern I have with her is her slight shuddering that she is doing. I notice this occasionally when she Is sitting but mainly it is as she is falling asleep. I need to take her in for more tests as the vet isn't convinced that her weight loss was only due to the DKA. He is concerned she may have something going on with her liver. She is slightly playful, but I think she is still regaining her strength. Minus the shuddering or occasional jerking motion, she is at 90-95%! I'm so thankful that she is here and I tell her that daily!! We need to get our bank account to recoup a bit and I will take her for another blood test. Those tests are so expensive when you add in the vet fee, etc. $150-200 later! Just wish I could figure out the shuddering/jerking motion myself. She is eating normally and drinking as well.

Thank you for checking in! I will keep posting updates along the way. I wanted to give everyone a break as I know I was so fearful and need of help for several days. I cannot thank you all enough. :bighug:
 
I'm glad she is doing better. Thanks for the update. Continued prayers and good thoughts to her full recovery.
Is she eating better now?
 
I'm so happy to hear Chloe is doing better now. :) And hoping for nothing worrying to come out of her next blood work when you get it run (and our vet is also at least $150 per visit so I know what you mean about it adding up fast)!! Hopefully Chloe will continue to go from strength to strength and be fully recovered in the next few days. :bighug: :bighug: :bighug:
 
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