Help With DKA Kitty

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Sylvia & Millie

Sylvia & Millie

Member Since 2017
Hi Everyone, My girl Millie was diagnosed about a month ago with diabetes. I have been getting use to caring for a diabetic cat. I use strips to test her urine and this past weekend I gave my girl two insulin shots (am & pm) not realizing she had vomited up each meal in my upstairs bathroom. Sunday she stopped eating. Monday she went to the vet. She was diagnosed with DKA. Her BG was all over (from 650 to 45!). She is on fluids, appetite stimulant and something for her liver. She refuses to eat so she is being force fed. She is coming home tomorrow. Her regular vet will not be in so I asked the office to have everything ready for us (especially since I'm not sure what we need). I will call in the morning before going there. I wanted to ask this message board what do I need to care for Millie at home post-DKA? Anyone with this type of experience or advice, please weigh in. I did read online about Milk Thistle and SAM-e being good for liver issues. I think my main concern is getting her to eat and building her strength up. Thanks!
 
Glad to see you made it over here from the Facebook group Sylvia!!

Can you give us some more information? Like what insulin are you using? What food are you feeding Millie?

It's also really important for you to learn to home test her blood glucose....I know it sounds scary, but it's really not nearly as hard as it sounds and there's lots of people here to help you learn how. By testing at home, you'll be able to see how well she's responding and most importantly, keep her safe from potential hypos!!

Since she's recently been DKA, it's also important to get some urine ketone test strips so you can keep an eye on them. They're not terribly expensive and can save her life by letting you know if she's developing ketones again. These are different from urine glucose test strips

In the Facebook group "Files" is a document titled "Getting Started Shopping List" that is really helpful to use when you go shopping
 
Things to get or ask about:

1. Get ketone test strips from pharmacy
2. Ask vet to show you how to do subQ fluids at home, and see if you can pick up a bag and tubing if she's still not eating/drinking well.
3. Ask what her potassium level was and if she needs a suppliment (potassium can get dangerously low in DKA)
4. Ask for an anti-nausea medication to use for a couple days at home if she won't eat.
5. Get some extra feeding syringes.
6. Ask for a "recovery" wet food - these are easier to syringe and higher calorie. If you prefer something from the pet store, kitten foods are usually higher calorie.

Some questions - What insulin is she on? Cats prone to DKA should be on an insulin that acts as a "basal" insulin such as latus or levemir.

DKA happens when there is either not enough calories, or not enough insulin to use the calories. The body burns fat, and ketones are a byproduct of the fat burning. This causes the kidneys to try to eliminate the ketones, but the body loses a ton of water in the process. Skipping insulin shots when a cat is eating poorly can often be the trigger for DKA prone kitties. DKA in a newly diagnosed cat usually has good recovery because there isn't as much underlying causes besides the uncontrolled diabetes. It takes about 2 weeks to fully recover with proper home nursing/vet supervision.
 
Chris & China said:
Glad to see you made it over here from the Facebook group Sylvia!!

Can you give us some more information? Like what insulin are you using? What food are you feeding Millie?

It's also really important for you to learn to home test her blood glucose....I know it sounds scary, but it's really not nearly as hard as it sounds and there's lots of people here to help you learn how. By testing at home, you'll be able to see how well she's responding and most importantly, keep her safe from potential hypos!!

Since she's recently been DKA, it's also important to get some urine ketone test strips so you can keep an eye on them. They're not terribly expensive and can save her life by letting you know if she's developing ketones again. These are different from urine glucose test strips

In the Facebook group "Files" is a document titled "Getting Started Shopping List" that is really helpful to use when you go shopping
Click to expand...
Yes, I did see the "Getting Started Shopping List". It's initially overwhelming but I'm telling myself that I got through my older guy's kidney issues and he's been doing well four years after diagnosis (now 17). I know how important a group of experienced people can be. Thank you.
 
Meya14 said:
Things to get or ask about:

1. Get ketone test strips from pharmacy
2. Ask vet to show you how to do subQ fluids at home, and see if you can pick up a bag and tubing if she's still not eating/drinking well.
3. Ask what her potassium level was and if she needs a suppliment (potassium can get dangerously low in DKA)
4. Ask for an anti-nausea medication to use for a couple days at home if she won't eat.
5. Get some extra feeding syringes.
6. Ask for a "recovery" wet food - these are easier to syringe and higher calorie. If you prefer something from the pet store, kitten foods are usually higher calorie.

Some questions - What insulin is she on? Cats prone to DKA should be on an insulin that acts as a "basal" insulin such as latus or levemir.

DKA happens when there is either not enough calories, or not enough insulin to use the calories. The body burns fat, and ketones are a byproduct of the fat burning. This causes the kidneys to try to eliminate the ketones, but the body loses a ton of water in the process. Skipping insulin shots when a cat is eating poorly can often be the trigger for DKA prone kitties. DKA in a newly diagnosed cat usually has good recovery because there isn't as much underlying causes besides the uncontrolled diabetes. It takes about 2 weeks to fully recover with proper home nursing/vet supervision.
Click to expand...
This is wonderful, thank you!

Millie is on Lantus. We were still trying to get her to the right dosage when she got sick. I will find out what dosage she is on today. Regarding the food. Millie had been on Trader Joe's cat food, as a treat she'd get Spot's Stew chicken kibble. She stopped eating ANY canned food and only wanted kibble. I tried Weruva, FF variety pates, and FreshPet. I tried the slow intro but she would stop eating for days if it wasn't just kibble. I even made fresh chicken and she snubbed it! So I am quite worried about the food part. I will be making my list and getting all the supplies today before she gets home. We have fluids but I need to change to thinner needles especially since Millie is quite petite. Thank you!!!
 
So a lot of attention is paid to food when we have diabetic cats. Low carb food is important, however, eating is more important. If you are feeding higher carb food, you can still get the blood sugar under control, it just might take a higher dose of insulin. This is not ideal, but it beats having a cat go into DKA. As the blood sugar becomes more stable, she may be more willing to try new foods. High blood sugar can make cats feel pretty cruddy. It's possible that she's had low levels of ketones since she was diagnosed. Ketones can cause some significant nausea, so I'm not surprised she didn't tolerate food switches. Best thing now, until she is fully recovered is to feed her whatever she wants to eat, and just adjust the insulin to cover it.

Also, how is your cat's weight? If she is really skinny, a medium carb food might help her gain weight and even out the sugars quicker. You mentioned wild swings of blood sugar (400s to 40s). In humans, this is called "brittle diabetes" and it's caused by not enough fat reserves or frail health. Once a little weight gain occurs, switching to a lower carb food would be appropriate.

There are some low and no-carb dry foods as well that may be worth trying. I know it took me about 6 months to fully switch my cats over to wet. Our issue wasn't our diabetic cat, but rather my 19 year old female that is too slow eating the wet and the other cats get at it. And she wouldn't eat without the other cats, so it was a lose-lose. She eventually adapted.
 
Millie lost a lot of weight. I think she is down to 8 lbs from about 12 lbs. I bought a variety of food (but also want to try the baby food) to try to entice her to eat. I didn't realize the ketones could cause nausea. She was swinging back & forth with her food over the past few months, going from gobbling down a bowl full to refusing to eat for several days. I will try to give her whatever she will eat right now. Thank you for all the information.
 
I am very frustrated. Many times the page I am on doesn't show the 'Start New Thread' option and I don 't know where to find it. Someone sent me a link and I'm looking for it where I can start a new conversation. I'm tech challenged and very tired, help is appreciated.........
 
You have to go to the main page of the forum to see the 'start new thread'
How is she doing this AM?
 
Thank you for asking. She is not in good condition. I force fed her at 8. She looked really bad at 1:30 am so I gave her fluids and fed her again (very little). She was up at 4, using the litter box. I checked and she had pooped (yay, things function), no urine though. I gave her some water via syringe. I will check her BG shortly, a bit nervous because it's the 1st time using the monitor and having to prick her. I'll feed her after that. I'm looking for ideas for supplements to add to her food; she is very weak. I'm sure it will be fine.
 
Hope she perks up soon! Good luck with the testing. Be sure her ear is warm and try milking it by rubbing from the base up toward the prick spot. What kind of supplements are you looking for?
 
Any brand/type of probiotic? I don't know when was the last time, she hasn't since she's been home. She vomited fluid before leaving the vet so I figured she might be a bit dehydrated (they gave her sub cu before releasing her at 8 pm).
 
Did they give you fluids to give her? It's easy to do if she needs them. @Meya14 knows her stuff when it comes to DKA and recovery from it. Read her posts again and see if there's anything you missed that can help. I haven't used any probiotics. I think many here use human probiotics. Let me see if I can find anyone that knows of a good one.
 
I'm not sure that probiotics would help much with the GI issues at this point. The ketones themselves cause nausea and vomiting through the brain, so it doesn't have too much to do with the digestive system directly. An anti-nausea medication is very useful though (cerenia or ondansetron).

For feeding, you want to be getting at least 200-250 calories in her a day. This is about a 5.5 oz can of a higher calorie food wet food. If she will eat dry or treats, you can put those out and let her graze as well. Some higher calorie wet foods include most wellness brands if you can find them around. Calorie count should usually be listed on the cans. It's very important that she get as many calories as she can. Food and insulin is what heals DKA. Feeding should be about every 2-3 hours or so around the clock if possible.

For fluids, cats need about 350ml per day, this includes the 200-250ml that is in a 5.5oz can of wet. So she'll need an extra minimum of 100ml a day mixed with the syringe feeding or drinking on her own.

For insulin, it's very important that you do not skip insulin doses even though she is not eating well right now. If you have concerns that her blood sugar might go too low, it's better to give the dose, and then mix 2-3ml honey with the food every time you syringe (every 2 hours). You want to try to keep the blood sugars between 150-220ish at this point. If they start to go lower than 150, add a little more honey. If higher reduce honey if you are feeding it, or we might have to increase insulin.

It's important to monitor for ketones, this is how you know that what you are doing is working.

Hang in there. It's a lot of nursing care post recovery, but once cats recover they are just fine after. It may take a couple days to see improvement.
 
This is amazing, extremely helpful information. Millie had a mixed day. Still very weak and not wanting to eat. AM BG was 211, evening was 309, she received 1 unit of Lantus. I syringed some recovery food into her at 5pm, at 6 gave her water via syringe as well (20ml), she vomited a little then ran to hide in the bathroom. I am petting and massaging her body in an attempt to stimulate it a bit. She just seems so out of it. I need to buy the ketone strips and see how that is going.
 
So Millie's BG was 211 yesterday afternoon, 309 last night and 344 today. She is on 1 unit of Lantus and recovering from DKA. I gave her sub cos and have been feeding her every 2-2 1/2 hrs. I spoke o her vet today and she said to leave the insulin at 1 u 1x a day. She said she wants to be very careful with her right now. I feel like she should get another dose but I don't know.
 
How often are you testing her? Are you getting a preshot test as well as one mid cycle? If we can get a spreadsheet set up we can better see what's going on and if she needs an increase. How is she acting, any better?
 
We are testing 3 times a day before meals. She is slightly better. Doesn't seem quite as 'dazed', with eyes a little clear. This morning when my husband said hi, she meowed back (they usually chat with each other :-) ). Even though she seems to gag a bit when I bring the syringe with food closer to her, she is not resisting as much and appears to be licking/swallowing the food as opposed to pushing it out with her tongue. I will try to set up a spreadsheet today. We're calling the vet to see if she should be getting shots more frequently.
 
Glad she's doing a little better. If you need help with the spreadsheet, just ask and we'll get it set up for you. As far as insulin shots, you should give Lantus twice/day, not sure why your vet wants it once/day. Let us know what she says.

Has she peed? Were you able to get a ketone test?
 
Yes, Millie did pee earlier and the ketone reading said 40/moderate. Not sure what we can do about the ketones; I guess that is related to the glucose & insulin?

The vet office closed at 3:00 and no call back. The vet did tell us we could email her and I just did. We are going to do the 2nd insulin shot this evening. After seeing what happened to her last week, I'd rather not have her get too little insulin. The 1 unit of Lantus isn't much anyway.
 
She is eating every 2-2 1/2 hours. e gave her sub-cu fluids and I syringe water into her as well. Besides the insulin (which we will give later), I don't know what else to do for her. I am open to any suggestions.
 
Did you tell your vet the result of your ketone test? Try to get another one next time she pees. Be sure to read it at exactly the right time according to the directions. The strip will continue to change color, so if you read it late you may get the wrong result. Keep feeding her and keep us posted.
 
No, I did not tell the vet; she did not tell us to check, it was someone from this board who suggested it. We gave Millie a 2nd dose of 1 unit of insulin at 4:30. At 5:30 we checked her BG and it was 344, up from 311 this afternoon. We are thinking of taking her to an ER vet.
 
Since she's just out of DKA and showing moderate ketones the ER may be the best option. It would be better to stop things before they get any worse.
 
Last night she was walking around and using her litter box. We gave her more fluids, food and insulin. Around 8:00pm we took the ketone count and it was trace/small and her bg was 344. She was OK until this morning. She threw up and her bg is 419. We are getting ready to leave and take her to the animal hospital. Thanks for asking.
 
Millie is at the 24hr animal hospital. When we left her, her bg was 211, her ketones were still present (they didn't tell us the #s). We visited before leaving and this was the best she's been; eyes clear and meow loudly complaining, lol. A 3 day stay is estimated at $4,000+. They mentioned a heart murmur so they want to do an echo and have a cardiologist see her. They also mentioned an x-ray and an abdominal sonogram. Millie's regular vet mentioned the heart murmur but then dropped it when her heart #s were fine. I'm not sure about the need for an echo, x-ray or cardiologist to see her. They said the echo was to make sure they didn't over burden the heart with fluids. The sonogram sounds right. We are in NY and the vets are notorious for milking fur parents. We love her and want to do right by her but we want only what is necessary. I was also concerned because they will not force feed her, which I've been doing and I saw today how it was helping. Any advice on any of this would be wonderful.
 
SylRod said:
Millie is at the 24hr animal hospital. When we left her, her bg was 211, her ketones were still present (they didn't tell us the #s). We visited before leaving and this was the best she's been; eyes clear and meow loudly complaining, lol. A 3 day stay is estimated at $4,000+. They mentioned a heart murmur so they want to do an echo and have a cardiologist see her. They also mentioned an x-ray and an abdominal sonogram. Millie's regular vet mentioned the heart murmur but then dropped it when her heart #s were fine. I'm not sure about the need for an echo, x-ray or cardiologist to see her. They said the echo was to make sure they didn't over burden the heart with fluids. The sonogram sounds right. We are in NY and the vets are notorious for milking fur parents. We love her and want to do right by her but we want only what is necessary. I was also concerned because they will not force feed her, which I've been doing and I saw today how it was helping. Any advice on any of this would be wonderful.
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I gave you my thoughts on your other thread.
 
I wasn't sure if I should start a new thread, so I did. Sorry, I'm pretty anxious right now. I agree with you, thanks. They just said they have to find out the cause of the DKA so they can treat it.
 
SylRod said:
I wasn't sure if I should start a new thread, so I did. Sorry, I'm pretty anxious right now. I agree with you, thanks. They just said they have to find out the cause of the DKA so they can treat it.
Click to expand...
DKA usually arises in kitties who stop eating for one reason or another, are dehydrated (from lack of food, from vomiting, from excessive urination) and aren't getting enough insulin (too low a dose, dosing stopped because of not eating, etc.). Any or all of these factors can occur in a kitty who has no other major health issue going on.

Unregulated diabetes can be a problem in kitties who have cardiac issues, inflammatory conditions and a variety of other problems. In my mind, there's a difference between looking for the cause of "brittle" diabetes versus treating the symptoms of a complication of unregulated diabetes - ie., DKA. The (near?)DKA status is the more pressing issue at this point in time.
 
This is the information I need when talking to the ER/hospital vets, so I can make an educated decision and have an educated discussion. Thanks.
 
I'm glad she's looking a little better! I have no experience with DKA, so have no advice to give. Just wanted to offer prayers for a full and quick recovery. Please keep us posted.
 
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