GA High Ketones - what now

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Sorry I haven’t updated sooner. It was a very long night with a lot of waiting. Yes, I took him to emergency vets. Basically they told me that he needed bloodwork, urinalysis, and hospitalization. They said he will probably be hospitalized for 48 hours. Unfortunately I don’t really know the results of anything or how he is doing. I left the ER office at 3:30 came home and crashed. I just woke up and called for an update. Just as the doctor started talking he said “I have to go, there is an emergency. I leave here at seven so the vet who is taking over for me will call you when she can.” So at this point I’m just waiting and don’t know much.

This vet did seem very concerned with his weight loss, which I’ve brought up to my vet multiple times. My vet keeps telling me that once we get his blood sugar in control then he will start to put on weight. Since we started insulin he has continued to lose weight. This doctor thinks there is another condition going on that is aggravating his diabetes. He says that his numbers aren’t terrible and that he should be gaining at this point or at least maintaining his weight. He wants to do an ultrasound but it wasn’t included in last nights estimate because he said they have a traveling person who comes in once a week to do the ultrasounds. Someone from the office is supposed to call later today with that estimate and to figure out the timing to get it done. Hopefully I will hear back from his office soon with an update.
 
It has been a long and emotional day with ups and downs. This morning the vet said there hadn't really been much of a change, then the vet in the afternoon said that she was starting to see some improvements which got me super excited, but I just got off the phone with the vet tech who first saw Bisbee last night and he flat out said that he doesn't "see any improvement" and that Bisbee is in the same condition as when I brought him in. He is still very lethargic and has no energy.

They say that he hasn't eaten anything since 1 teaspoon of tuna at 9:15 this morning. The put a freestyle libre on him and he has been pretty much staying between 240-260. They took him off lantus and are using Humulin R.

His kidney levels are normal but his liver enzymes are off. There is protein and blood in the urine. They also said his Bilirubin is higher than it should be (not sure if that was blood or urine).

I asked if his ketone levels had come down at all. He said they only run those about every 24 hours. He has is schedule for tonight around 10:00 pm.

I need to make a decision if I want to add on the ultrasound. The traveling guy will be there tomorrow moring and Thursday morning. My bill so far is $2,700.00. I'm just worried that I can approve it and spend another $500 to get it done, but that he might not pull through this. With the fact that we haven't seen any improvement even though his first dose of fluids and amoxicillin was close to 30 hours ago.
 
Kristi....I'm chatting with the director of DCIN about the possibility of helping you and she's asking some questions. She's forgotten her sign on information for here so she's talking to me on Facebook.

Can you tell us what meds he's on now? Did they do a culture on the urine?

He should be having zofran, pepcid, ciproheptadine,,IV fluids, amoxi or clavamox.
 
Hi Kristy - I’m so sorry you’re dealing with this. My cat was hospitalized for several days with DKA and one of the most important things is that he gets food. They were hesitant to syringe feed her because they didn’t want her to become food averse and need a feeding tube. After talking it over with them, I decided to insist they syringe feed her. If she didn’t eat, she’d need a tube and have to have it put in when she was very ill. If they syringe fed her and she didn’t want food on her own after, well, at least I was making that decision for a cat who had a fighting chance due to the nutrition. I think syringe feeding saved her life, she did not improve until they did that. Is the ER vet willing to try that to get Bisbee some food in his system? Or at least try a more aggressive approach than offering tuna.

Also: I remember Noodles bilirubin being through the roof because she wasn’t eating — it affects their liver function.
 
Kristy, you are on an emotional roller coaster right now. Hang in there.

Humalin R is a very fast acting insulin. That should help to bring Bisbee's blood glucose down quickly. But he needs the blood ketones flushed, and subq fluids help with that.

They need to force feed him. Syringe feed him, get some food into Bisbee. ASAP. Or are they doing a glucose drip for nutrition?

So they can't do a simple ketone urine strip test more than once a day? Or are they checking blood ketones?
There are hand held meters that can test for blood ketones. Test strips for the blood ketone meters cost about $1-2 each. Test only takes a minute or 2 to do.

Or there are the less expensive ketone urine test strips. You'd think that a vet clinic would know how to express a bladder and get a little bit of urine out onto a urine ketone test strip.
 
@Deb & Wink I wonder if they are only testing for ketones when they do bloodwork. Noodle had 1-2 CBCs run a day when she was hospitalized (my bank account still flinches...), but they checked her BG more often I think and probably her ketones too. Maybe with Bisbee on the Libre they’re not testing his BG so not doing ketones at the same time like others might?
 
Patricia & Noodle said:
@Deb & Wink I wonder if they are only testing for ketones when they do bloodwork. Noodle had 1-2 CBCs run a day when she was hospitalized (my bank account still flinches...), but they checked her BG more often I think and probably her ketones too. Maybe with Bisbee on the Libre they’re not testing his BG so not doing ketones at the same time like others might?
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Yes, maybe. But ketones need to be checked more than once a day, if Bisbee is still really high with the ketones. You don't need a CBC to check for ketones. Yes, you do need the CBC to check the electrolyte levels. But why only check for ketones once a day? Perhaps they have forgotten the need, since they are using the Libre freestyle to check the BG levels?

Plus, he needs to be fed. Desperately. Why aren't they feeding him? would be one question I have if I were Kristy.
 
My heart is aching for your Bisbee and you Kristy
I hope you push for what Deb said to force feed him and check for ketones way more often and cubs fluids
I just get so upset when I hear about a sick kitty. You have to light a fire under their a*s
Praying for some better news for your kitty:bighug::bighug:
 
Kristy & Bisbee said:
It has been a long and emotional day with ups and downs. This morning the vet said there hadn't really been much of a change, then the vet in the afternoon said that she was starting to see some improvements which got me super excited, but I just got off the phone with the vet tech who first saw Bisbee last night and he flat out said that he doesn't "see any improvement" and that Bisbee is in the same condition as when I brought him in. He is still very lethargic and has no energy.

They say that he hasn't eaten anything since 1 teaspoon of tuna at 9:15 this morning. The put a freestyle libre on him and he has been pretty much staying between 240-260. They took him off lantus and are using Humulin R.

His kidney levels are normal but his liver enzymes are off. There is protein and blood in the urine. They also said his Bilirubin is higher than it should be (not sure if that was blood or urine).

I asked if his ketone levels had come down at all. He said they only run those about every 24 hours. He has is schedule for tonight around 10:00 pm.

I need to make a decision if I want to add on the ultrasound. The traveling guy will be there tomorrow moring and Thursday morning. My bill so far is $2,700.00. I'm just worried that I can approve it and spend another $500 to get it done, but that he might not pull through this. With the fact that we haven't seen any improvement even though his first dose of fluids and amoxicillin was close to 30 hours ago.
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It’s quite normal for them to take a ketone kitty off their basal insulin and use a bonus insulin like R. I hope they can get him to eat but I would ask if they will let you come in, in a mask and gloved, and put you in a private room with him so you can try and get him to eat. It’s possible his liver enzymes are off if he hadn’t eaten. Yes, there are other reasons why they could be but I wonder.

Sending more prayers.
 
Chris - Right now the only meds he is on is Clavamox. They are using Humulin R for insulin and doing sub-Q fluids. They have not done a urine culture. Last night the vet did say that he thinks Bisbee could have a vitamin B12 deficiency. He wanted to do a Cobalamin Folate test but after finding out that they have to send it out and we wouldn't have results right away and that it was $277 I opted out of doing it. The vet was okay with just assuming that he does have a B12 deficiency and he said that he will give him B12 in his fluids along with an appetite simulant. I will double check with him tonight and see if he followed through with that.

Patricia & Deb - I get to talk to the vet in an hour from now. I will push for syringe feeding. I'm not 100% positive but I'm pretty sure the ketone test they are doing tonight is just another dipstick urine strip. I was so frustrated last night when I found out that they charged me for a $97 for urinalysis that used urine from a sample that I brought in and one dipstick test strip. I sure thought I was going to get more information, but it was the same urine strips I had been using at home and didn't tell me any more information than what I already told them. I bought 50 strips for around $25 so I agree with you that they should be able to test more frequently than every 24 hours. I'm really starting to second guess if they know how to treat a cat with DKA.

Marje - I will definitely ask if I can go see him! Hopefully they will let me. If he does pull through this I'm a little concerned about how to transition him back to Lantus being that it takes awhile to build up and switching him from Vetsulin to Lantus last week could have played a role in all of this. I guess we will cross that bridge when we get there. On a side, your Gracie is adorable. I also have a Gracie but she is white and gray.
 
I finally was able to talk to the vet around midnight when he had a break between emergencies. Unfortunately, it isn't looking good. There has been no improvement at all in his eating energy level. His ketone levels are still high and there is still glucose in his urine. His BG ran between 220-240 most of the day but they did get two readings in the 190's during the evening but then it went back up. I was very happy to hear that they are doing more than what has been relayed to me. I asked about syringe feeding and he told me that they offer food every four hours and if he doesn't eat then they syringe a little in him. When I asked about giving anti nausea medicine he said they already have been giving him something. He also was given something for the b12 deficiency and has been given two different types of appetite simulators.

He still feels there is something else going on because Bisbee hasn't put any weight back on since we started treating his diabetes in early April. He thinks something else was going on first like Irritable Bowel Syndrome, Lymphoma, pancreatitis, etc. He painted a very bleak picture. He didn't bring up the ultrasound so I asked if that was still something he thinks should be done. At this point he doesn't think it needs to be done. He said the treatment for a lot of the stuff they would be looking for would require the same treatment plan that we are doing but it doesn't seem to be working in Bisbee. He said if they found a tumor or something that required surgery or further diagnostics that Bisbee probably isn't strong enough to do that right now. He flat out said "I don't think it will turn out well whether we do the ultrasound or not do it. He has deteriorated to the point that return will be hard." I asked what would you do if it were your cat and he said "start thinking about euthanasia ." He said I can come in anytime throughout the night to do it but he also said that if I wanted to give him some more time to turn around then that would be okay also.

I don't think I'm ready to give up yet. I read that some cats are hospitalized for 4 or 5 days to get over this. I'm hoping the vet is wrong and that Bisbee just needs more time. I asked him to increase the frequency of syringe feeding throughout the night, which he agreed to do. I also made it very clear to him that if Bisbee take a turn for the worse or is in any pain, to call me no, matter what time it is and that I would come down and agree to euthanize him.

For those of you that have been through this. How long was it before you saw improvements? Do you think he needs more time or should we already have seen some slight improvements at this time. He was perfectly fine on Sunday. On Monday he didn't come for breakfast which I thought was strange so I found him. I got him to eat with some encouragemen and coaxing from me. I was finally able to get urine around noon and discovered the ketones. I took him to my regular vet who gave fluids around 2:30. I gave him fluids again around 9:00. He has been in the ER since about 11:30 Monday night and there has been no change.
 
I’m so sorry things are not better. I have not had a DKA kitty but I have seen many here. And many are told a bleak picture by the vet. . I would not give up yet. Vets talk about euthanasia far too soon in my experience. We have had cats here recover from DKA that the vets did not think would pull through many times.
He has only been There for a short time so far. They often don’t make much or any progress in the first 24 hours.
You are his advocate. Don’t be talked into anything you are not comfortable with.
I would give him a few more days to turn the corner. It’s a horrible illness and it takes time for the cat to get on top of it. :bighug:
 
Hi Kristy. I just copied this that I found that someone had posted, maybe this will help you some when it comes to the cost , Prayers for Bisbee




Look into this,
CareCredit is the best. I am so grateful to have mine. We originally applied for it when my husband needed dental surgery, but it turned out we didn't need it. Now I use it for the kitties exclusively. Any medical charges go on that card. If you charge $200 and above, you have 6 months to pay it off WITHOUT INTEREST. So it's same as cash. You can spread out your payments so it's easier for you to manage. If you charge over $500 (I believe) you get 12 months to pay it off without interest - if you pay off the entire amount during that time. The interest is pretty high afterwards, but it's very convenient for large ticket items like dentistries, that way you can manage it easier and there's really no catch. And you can apply online. LOL, I know I sound like a CareCredit rep but I can't sing its praises enough. Working at a vet hospital I have seen how it has helped people get their pets the care they need without too much worry. Good luck. I'm sorry you're dealing with all of this!!!!! :bighug:
 
@Kristy & Bisbee :bighug:

I'm still so sorry you're going through it. Noodle's experience was 5+ years ago now, but she was in the hospital for 5 days, she'd probably been declining for a while, though, it just hadn't registered to me what was going on. She did not show improvement until they began syringe feeding her (maybe day 2 or 3?). I know when she was there she was on IV fluids and anti nausea meds at the very least, we went home with anti nausea (cerenia), appetite stimulant, and medication to help her liver heal. She lost a LOT of weight while she was untreated and I was feeding her at least 2x what she'd normally get once we got home.

Since they're already syringe feeding her, would they commit to giving her as much as possible vs a "bit" when they attempt? Noodle did start eating on her own after a day (ish) when they got her started with syringe feeding.

Have they tested for pancreatitis? It can be done with a blood test instead of an ultrasound and would indicate being a lot more aggressive with anti-nausea (most here treat with cerenia + odenestron/zofran) and supporting with pain medication like buprenex, too.
 
I'm heart broken to say that this is the message I was hoping I wouldn't have to write. Bisbee is no longer with us. When I called for his morning's update they said that he was declining fast and that his body was starting to shut down. They said they did everything they could but there was really not much left to do because he didn't show any signs of improvement and continued to decline. He was also becoming more and more jaundice so they said his liver was shutting down.

Looking at our itemized bill it looks like they tried to give him a fighting chance but it just wasn't in his cards. He had to many things going against him. Here is what the they did and what they gave him- syringe feeding every hour throughout last night, IV fluids, IV Fluid Bolus, vitamin B12, vitamin B complex, dextrose, KCI, Rebound Recuperation Formula, Cerenia, Mirataz, Entyce, and Humulin R.

I was worried that I was giving up on him to fast but when I saw him I was at peace knowing that it was time.

Thank you guys so much for your support, guidance, and kind words. It is amazing what I have learned from this experience. When he was first diagnosed with diabetes I was overwhelmed and scared. I spent hour reading over sticky notes and different threads about dosage, types of insulin, home testing, charting stuff on a spreadsheet, how to feed a low carb diet, ketone testing, cheapest place to order Lantus and so much more. Thank you all for taking the time to help educate us that are new to this because my regular vet sure wasn't as supportive or helpful through all this as I would expect. I am truly amazed at the contradicting information I received from my vet and what I learned on here. When I asked for an Rx for the Lantus Solo Pens he said no at first. Not until I showed him the charts and diagrams, from this site, that showed how to use it and a list of reasons why it is better than a regular vial did he agree to it.

Again, thank you all!
 
OK Kristy, I am so very sorry, my heart is breaking for you
You did everything you could and more
Bisbee was so lucky to have you as his momma
He is no longer suffering and is at peace probably up there with all the other kitties, back to being a kitten again
Every time I read a kitty has passed I just can't help but getting teary eyed.
Please take care of yourself, we all feel like we have known Bisbee for a long time
My heart goes out to you
Fly high sweet Bisbee cat_wings>o:bighug::bighug:♥♥
 
Kristy & Bisbee said:
I'm heart broken to say that this is the message I was hoping I wouldn't have to write. Bisbee is no longer with us. When I called for his morning's update they said that he was declining fast and that his body was starting to shut down. They said they did everything they could but there was really not much left to do because he didn't show any signs of improvement and continued to decline. He was also becoming more and more jaundice so they said his liver was shutting down.

Looking at our itemized bill it looks like they tried to give him a fighting chance but it just wasn't in his cards. He had to many things going against him. Here is what the they did and what they gave him- syringe feeding every hour throughout last night, IV fluids, IV Fluid Bolus, vitamin B12, vitamin B complex, dextrose, KCI, Rebound Recuperation Formula, Cerenia, Mirataz, Entyce, and Humulin R.

I was worried that I was giving up on him to fast but when I saw him I was at peace knowing that it was time.

Thank you guys so much for your support, guidance, and kind words. It is amazing what I have learned from this experience. When he was first diagnosed with diabetes I was overwhelmed and scared. I spent hour reading over sticky notes and different threads about dosage, types of insulin, home testing, charting stuff on a spreadsheet, how to feed a low carb diet, ketone testing, cheapest place to order Lantus and so much more. Thank you all for taking the time to help educate us that are new to this because my regular vet sure wasn't as supportive or helpful through all this as I would expect. I am truly amazed at the contradicting information I received from my vet and what I learned on here. When I asked for an Rx for the Lantus Solo Pens he said no at first. Not until I showed him the charts and diagrams, from this site, that showed how to use it and a list of reasons why it is better than a regular vial did he agree to it.

Again, thank you all!
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I’m so sorry Kristy , I’m sure Bisbee knew how much his momma loves him . You did everything you could for him
 
Kristy. :bighug:

Lighting a ring of candles in memory of your beloved Bisbee.
candle.jpg
May some good memories of him bring you comfort in the days ahead.
 

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