? Home care post DKA

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Camcat, Jul 12, 2020.

  1. Camcat

    Camcat Member

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    Hi everyone, my little girl Cam had a bad episode of DKA last week. She was at the emergency vet for 9 days, and also had pancreatitis and a urinary tract infection. Link to previous post is here: https://www.felinediabetes.com/FDMB/threads/dka.231835/

    Tonight is her first night home. She's eating on her own (small bits at a time), and is very sleepy. She's on 2 units of Prozinc twice a day. She's also on potassium supplements (her levels went very low during her time at the vet hospital), and Clavamox for 14 days. I will get the full write up and records later tonight or tomorrow. I will post as soon as I get them.

    Does anyone have any advice for home care after DKA? I have lots of food - healthy food, yummy food, kmr, feeding syringes. I test her glucose with a Precision Neo, and her blood ketones using a Precision Xtra.

    @Bron and Sheba (GA) @jt and trouble (GA) @Dusty & Roe @Panic @Nan & Amber (GA) @tiffmaxee
     
    Last edited: Jul 12, 2020
  2. Panic

    Panic Well-Known Member

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    I did not get your ping for some reason but was able to follow over from your last post! So glad to hear she is eating on her own (I hope you're doing alright too!)

    No personal experience with DKA care but you'll get some good advice soon! Keep us updated!
     
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  3. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Lovely to see she is home!
    That is really good she is eating on her own. Did you get some cerenia in case she gets nauseated/stops eating?

    The really important things you are going to need to do every day are:
    • Try and get Cam to eat 1 1/2 times as many calories as she normally does. This is because the food is needed to stop the ketones forming again. If her body doesn’t get food, she will start to use the protein and fat in her body for energy and the byproduct of that process is ketones.
    • Offer small meals frequently during both cycles, except for the 2 hours preshot.
    • Make sure she is getting enough insulin. Keep the SS is up to date and test frequently.
    • Don’t skip doses if at all possible. Post and ask for help. We can increase the carb content of the food if needed to make sure she gets the insulin.
    • Give extra fluids in the food if she will tolerate them
    • Make sure she gets her antibiotic until finished.
    • Test twice a day for ketones at the moment and record in the SS remarks column and on the thread.
    • If you are unsure about anything post and ask for help.
    We will be watching so tag us if you are unsure about anything or if you are worried about anything.

    Welcome home Cam :cat::bighug:
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    We’re you given nausea medication and if so what? After 9 days at the ER the pancreatitis might have subsided but I’d want some just in case. As Bron said while she needs extra calories don’t give large amounts at once even if she seems eager to eat. Welcome home Cam. Your mama is so relieved.
     
  5. Camcat

    Camcat Member

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    Thank you all! Since she seems to be okay eating on her own, no anti nausea meds for now. But, I'm going to watch her closely and see how she goes, and will def. get some if she stops wanting to eat. She's going back to the vet on Tuesday to get her potassium levels checked. In terms of food, she only wants small amounts at a time, and only the yummy stuff right now (FF w gravy - though she has a buffet of FF gravy and pate, M/D wet food, buffalo blue dry food, and greenies treats). I'm supplementing her food with Tiki Cat broth pouches, which she seems to really enjoy. Ketones were 0.6, so high end of normal. Will retest in the AM. She's quite sleepy -- been taking some high quality naps between snacks (lots of mouse chasing dreams). She's happy to be home - motor has been running.
     
  6. Camcat

    Camcat Member

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    Hi All,
    Restful night, but I think Cam may have had a hypo overnight. Her +3 hours was 254 and then her +9 hours was 63 (on a human meter), which is in the good range, but it may have been lower at +6. Not sure. She did not want to eat - even the yummy stuff. I managed to get her to lick a little bit of maple flavored lysine gel off my finger (I thought it had sugar in it, after reading the ingredients, it didn't!). I'm going to give her some KMR via syringe. I'm not going to push more feeding now, but I may have to syringe feed her in a couple of hours as her next shot is coming up. I'm going to get some anti nausea medicine ASAP. Side note: I think she caught a cold during her last 24 hours at the emergency vet. She's been sneezing quite a bit. Should I be worried?
     
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  7. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I’m glad you are going to get some antinausea meds. Ask for some cerenia and ondansetron. Both can be used together if needed as they work on different pathways. It’s really important she eats.
    I’m sorry she may have caught a cold.
     
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  8. Camcat

    Camcat Member

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    I syringed a little KMR into her mouth, much to her disgust. But, I think it helped a little because shortly after that she started to eat a little bit on her own again. She's up and about walking around now. BG too low for shot. I'm going to try and encourage her to eat more. Left msg for vet about anti-nausea meds. Ketones okay still (0.6).
     
  9. Whitney and Jonas

    Whitney and Jonas Member

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    I can't help at all, I just wanted to say I'm so happy that Cam is home and healthy!! Sending you both so much love and well wishes <3
     
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  10. Camcat

    Camcat Member

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    Dosing question. Dr. wants 2 units. Her am shot was supposed to be at 7am but she was too low. Finally got her numbers up again with higher carbs food and snacks, and she's eating more on her own now. She's at 212. Thinking about giving her 1 unit - is this okay? Or should I wait longer? I don't want to wait, but I also don't want to give her a dose that is too low. Prozinc. Thanks for your help. (I'm EST so right now it is 12:45 for me).
     
  11. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    I ECHO Whitney's comment. Please give Cam some scritches from all of us!:bighug:
     
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  12. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I wouldn't wait longer, and I wouldn't skip. On dose, I'm not sure-- you don't want to reduce too much after a DKA, but maybe this one time if you aren't comfortable with the 2.0U.

    Since you're shooting late, you'll have to shoot later tonight too. I'm not familiar enough with ProZinc to know how much later, I think you don't want the interval between shots to be less than about 11hrs, though.
     
  13. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Ack-- just realized you're a full 6hrs post-shot-time now. Maybe you do have to take the skip, it'll be so hard to get back on track.

    Sorry...
     
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  14. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    It's great that her numbers have fallen since she's gotten home :), but it does make the post-DKA a little trickier. You don't want to be in the situation you were in this morning very often; skipping shots is not recommended at this delicate stage.

    So, the options are: do everything you can to shoot 2.0U, including carbing her up in her regular meals, or else reduce the regular dose and cross fingers it's enough insulin. I'm not sure which is the correct path in this case, but hopefully others will have more to say on this.
     
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  15. Camcat

    Camcat Member

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    I caved and gave her the 1 unit. Figured it was best not to wait too much longer. Will monitor throughout the afternoon.
     
  16. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    OK, have to say I'm relieved to hear that she won't be going 24hrs without insulin!

    I'm sorry you're going to get off-schedule like that, though. Hopefully some Prozinc people can weigh in with the limits of how early you could safely shoot tonight. It does help that Prozinc is an in-and-out insulin (I'm most familar with Lantus, where it's a definite no-no to create a lot of shot overlap).
     
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  17. Camcat

    Camcat Member

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    Thanks - yeah I didn't want her to go without insulin either. IT's 5 hours late due to her low numbers (1pm here), but better late than never. I can do the shot every 10-12 hours, so I should be able to shoot again around 11pm/12am safely.
     
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  18. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    For what its worth I think you made the right decision with 1 unit. ;)
     
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  19. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I’m glad you have some insulin even though it’s 5 hours late. As Nan said skipping is not a good option post DKA. You might need to feed higher carb food for her regular meals so you can shoot the dose.
     
  20. Camcat

    Camcat Member

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    Ugh. I goofed today and I'm scared. She had a vet appointment at noon. They wanted to recheck her potassium levels (they are on the low end of normal still). Still trying to keep a high-ish dose of insulin, I gave her 1.75 for her AM shot, with the intention of giving her snacks throughout the morning and monitoring her closely. AM shot 11 am. Left for vet at 11:30. Vet (at a vet hospital) took FOREVER to get her back to us. We waited until 3pm. They said her BG was a little low (showing 88 on their tester) and recommended switching to 1 unit of insulin. We got home at 3:30pm and tested immediately. She was starting to hypo (44 on human meter). She was still scared and angry from the car ride, so did not want to eat. We immediately gave her a some nutritional gel (basically corn syrup), and squirted a small amount of sugar water, and then KMR into her mouth. Checked her every 15-30 mins and saw her BG was rising. She took a nap and later on found a bit of an appetite so we continued to encourage her to eat (she still only wants small amounts of the unhealthy stuff - FF gravy at a time, and broth pouches). Took her BG for PM shot and it 'HI' (above 500 on human meter). I think she's bouncing (and/or combination of higher carb food). Gave her 1.5 units (0.25 reduction from her AM shot which caused hypo. And also because I thought 1 unit was too low given her high BG reading). Ketones 0.6 (high end of normal, but was 0.2 this AM). Going to keep monitoring her closely overnight. I'm so mad at myself and worried for her.
     
  21. Camcat

    Camcat Member

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    Thank you, I do appreciate that. I am constantly second-guessing myself!
     
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  22. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    How are things now?
    I don’t think I would reduce the dose to 1 unit from 1.75?with DKA so recently in the picture.
    It’s frustrating when they keep them longer at the vet when they are diabetic cats!!
    How is her appetite?
     
    Last edited: Jul 15, 2020
  23. Camcat

    Camcat Member

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    Just took her +4 and it's 196 (quite a drop). So, maybe not bouncing? She followed me to the kitchen and wanted a snack - few bites of ff gravy and some water. Will test her again in an hour. +6 is usually her nadir, hopefully this snack will keep her from falling any lower.
     
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  24. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    That is quite a drop. I’m glad you fed her.
    See you in1 hour.
     
  25. Camcat

    Camcat Member

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    Forgot to post this earlier. Here is her bloodwork from today.

    Also vet said to stop Clavamox bc it is bothering her stomach and she probably doesn’t need it since she was on an antibiotic while at the hospital (he is the main vet (internist) who has been watching her; Clavamox was prescribed by the weekend vet). Got some anti nausea and appetite stimulant - will try it a bit later. Will post the names shortly as I don’t have them in front of me.
     

    Attached Files:

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  26. Camcat

    Camcat Member

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    202, holding steady. She had a few more bites of FF gravy. Will test again in an hour for the nadir.
     
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  27. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    That’s good she’s slowed right down
    I will tag @Marje and Gracie to look at your lab results
     
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  28. Camcat

    Camcat Member

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    Thank you! BG is rising, 252.
     
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  29. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Was that ketones 0.6 this evening?
    Has she eaten this evening ?
     
  30. Camcat

    Camcat Member

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    Yes, it was last night at 11pm when I got the 'Hi' blood reading. She seems okay this AM. BG 289. She has an appetite. I'm going to test the ketones again shortly.
     
  31. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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  32. Camcat

    Camcat Member

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    Ketones up slightly from 0.6 (high end of normal) to 0.7. She's sleeping now, so I will test her again in a few hours. Prozinc should start kicking in within the next hour.
     
  33. Dusty & Roe

    Dusty & Roe Member

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    I Glad to hear Cam is eating Yay Cam
     
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  34. Camcat

    Camcat Member

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    Update: Ketones back down, to 0.3 @ 5:30pm. Woo hoo!! Gave 1.25 mg metoclopramide (anti-nausea) earlier today (@ 11:30am), and she's been eating pretty great ever since! She still has a cold though - lots of sneezing and sniffling. Hope that doesn't interfere with the progress.
     
  35. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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  36. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    FYI: Some cats go lower after a vet visit. Some do not. Testing a couple of times after the vet visit is a good habit to start.
     
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  37. Camcat

    Camcat Member

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    Question: How long before cats recover/return to their "normal" selves after DKA?

    This is her third day home, and other than eating a bit better, she is still very tired and sleeping a lot. She perks up a couple times a day and walks around some. But other than that, she's in the bedroom, on the bed, resting. We bring food to the bed, and she'll eat. Her BG is okay (other than yesterday's scare), and ketones seem okay on Precision Xtra. Is this normal? Should I be worried? She has a cold - nose is stuffy and she's sneezing. Maybe that's it? The vet wants us to bring her back in tomorrow for more potassium testing if she's not doing better. What causes low potassium after DKA? Could it be something else?
     
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  38. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Sounds like poor baby has a cold. I would let that practice know she caught it there. Poor little kitty kitty.:(
     
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  39. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I have never had a cat with DKA, but caregivers report that it can take a few weeks before they fully recover. It just takes a lot out of them. It would probably be more surprising if she weren't sleeping a lot, but I'm glad she's going in for a re-check anyway. Gotta keep on top of things in this phase!
     
  40. Camcat

    Camcat Member

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    Update: her appetite has waned since this early this evening. Gave an anti-nausea at 8pm, and appetite stimulant at 10:30pm. Ketones 0.4 @ 10:30pm. She had a few licks of food at 10:30pm, gave her 1 unit of insulin. Vet said appetite should improve 1-2 hours after stimulant. Fingers crossed!
     
  41. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Every cat is different in its recovery from DKA. This is only her third day home from hospital and she is battling a cold as well poor love.
    The nausea is very common. Keep up the antinausea meds and offer small meals or snacks frequently. It’s really important she eats as much as possible. Let her eat whatever she will eat at the moment. Even dry food.
    Try not to reduce the dose of insulin because she needs it to combat the ketones. If she’s not eating a lot offer her higher carb food do you can still give the dose.

    DKA messes up the electrolytes in the blood and it’s not uncommon to see DKA kitties come home on a potassium supplement for a while. Always follow your vets direction on potassium dose.
     
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  42. tiffmaxee

    tiffmaxee Well-Known Member

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    Sounds like she either caught a cold or has herpes from stress. Poor baby. Which appetite stimulant were you given?
     
    Last edited: Jul 18, 2020
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  43. Camcat

    Camcat Member

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    I have some lysine gel that I have been giving her, it seems to be helping. I was given Mirtazapine and Metoclopramide. So far they seem to be working, and her appetite is good. She seems to be a little more active each day. This evening her bg (454) and ketones (0.9) are edging up - hope that's just because she's been eating a lot. Hoping both will come down in the next few hours as she approaches her nadir.
     
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  44. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I’m glad she is eating well but please keep an eye on the ketones. We don’t want them rising
    Is she getting some extra fluids ?
     
    Last edited: Jul 18, 2020
  45. Camcat

    Camcat Member

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    Ketones came down overnight; am reading is 0.6. In terms of fluids, I'm adding water to her canned food, and giving her Fancy Feast broth pouches. Should I ask for subq fluids, too? I saw some posts on FDMB about those.
     
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  46. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Sorry to be late seeing this. Besides the labs indicating issues with DKA, the thing that stands out to me is she is really anemic. Her HCT on this lab is 22% and normal is closer to 40%. Once the HCT gets below 20%, more drastic measures are necessary. Has any vet mentioned this or a reason why she might be so anemic? Is she bleeding (as in blood in stools, etc.....but that would still have to be alot of blood).
     
  47. Camcat

    Camcat Member

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    Hi, thank you for looking at the lab results.

    The vet mentioned she was anemic, but didn’t say anything more about it. The vet was more concerned about her potassium levels - they had gotten very low while she was hospitalized and he didn’t want them going back down. I will call the vet tomorrow and ask about the anemia.

    This might be a dumb question, but it is iron anemia? Or B12 (if such a thing exists for cats)? She is not having any bleeding that I can see - nothing in her stools or urine. Do you know if there is any kind of at home supplementation I can give her? She had pancreatitis 6 months ago and the vet who saw her then gave her a B12 shot. I’m wondering if it’s related. I’m taking her back to the vet on Monday for a check up and will post the new blood work then.
     
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  48. tiffmaxee

    tiffmaxee Well-Known Member

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    You can start her on B12 and B Complex but if her HTC is that low it needs immediate attention. Did he suggest supplementing her potassium? You want it at least 4.0 but honestly the anemia is more of a concern as Marje mentioned. I’d want a recheck Two weeks after this bloodwork. It looks like it was taken in house. I’d want it sent to the lab where you know their machines are well calibrated.
     
  49. Camcat

    Camcat Member

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    You are correct, the tests were done in-house. I will ask about having the tests done off site. For the low potassium, I am supplementing with potassium gluconate (Tumil-K) 2 mEq every 8 hours.

    I’m hoping the anemia test is wrong - she does not have white gums or display other symptoms of feline anemia that I saw on google. I’ll get some B12 and a b complex tomorrow.

    Thank you again!
     
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  50. tiffmaxee

    tiffmaxee Well-Known Member

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    I don’t know if I would start B Complex until you get the labs. If you do it’s a very tiny amount, 1/16 of what’s in the capsule, You would give with food as it can cause am upset stomach. I have use Jarrow’s B Rite. It now contains phosphorus which isn’t what you want to give a cat but it’s a very tiny amount. I’m hoping that value is not right. It would be surprising and as you said her gums are pink. If it is right you need to find the cause.
     
    Last edited: Jul 18, 2020
  51. Larry and Kitties

    Larry and Kitties Well-Known Member

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    What is color and consistency of her feces? Black/very dark is indicative of of an uper GI tract bleed. The blood turns black because the it gets digested.
     
  52. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    How are things going?
     
  53. Camcat

    Camcat Member

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    Hi, pretty good actually. She's getting stronger every day and is even playing now. Lots of purrs. She's a happy kitty. Her appetite is pretty good still. Ketones good, BG little high but it's bc I'm feeding her the higher carb food. Going to vet on Thursday for repeat blood work, but I'd say she's almost back to her normal self.
     
  54. Camcat

    Camcat Member

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    Currently they are soft (a bit mushy) and light-medium brown. Smelly.

    Before, she had a bout of pancreatitis in January and her stools never quite went back to normal. Diahhrea at first (I used probiotics and digestive enzymes to try and firm them up, and it worked gradually. I'm not sure, but I don't think the digestive enzymes really helped. It was more the probiotics.). But, even after they firmed up, they remained much lighter and softer than before the pancreatitis. Occasionally (once every few weeks/or months) she did have a small, black, coal-like stool, but she hasn't had one months now. It sounds like this could have been blood -- in the small intestine/upper GI (if I've read correctly). I could not figure out what was causing them (food, treats, stress).
     
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  55. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m glad she’s feeling good. Without EPI digestive enzymes usually aren’t needed. Here’s hoping the labs reflect what you are seeing at home. Please don’t forget to get a copy and let us know. :bighug:
     
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  56. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I’m so glad she’s feeling better. Please let us know how the vet visit goes. Are you still testing for ketones?
     
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  57. Camcat

    Camcat Member

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    I will, thank you. Yep, still testing twice a day. So far so good. I put the ketones in the notes of the SS spreadsheet, and also started recording them in a separate tab of the file. Looking good, at 0.1 tonight.
     
    Last edited: Jul 22, 2020
  58. Camcat

    Camcat Member

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    Hi All, good vet visit today. Potassium is 4.5, so we are reducing the supplementation frequency from 3x a day to 2x a day. The vet gave me B12 injections for her anemia. He also tested PCV (26%) and TS (8). I've attached the lab work and the report.
     

    Attached Files:

  59. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I’m glad the vet visit went well and the potassium is responding to the supplement. I am going to tag @Marje and Gracie to comment on the lab results.
    Just looking at the SS it looks like you are feeding a couple of times in the early part of the cycle then not til late in the cycle. Am I reading that correctly? I would offer some snacks more often during the day/night if you can manage it as food is so important at the moment.
     
  60. Camcat

    Camcat Member

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    Yes, I think that's right. Didn't notice I was doing it. I do leave food out so she can nibble if she wants (will stop this when everything is back to normal). The reason I focus so much on the early cycle feeding is because that's when her BG drops the quickest and I'm attempting to slow it down. I will offer her more food throughout the day and cycle, though. Thank you for catching!
     
  61. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Normally it is best to feed during the first half of the cycle, so you are right. But with DKA we want Cam to eat as much as possible. Just leave the 2 hours Preshot free of food. You are doing well!
     
  62. tiffmaxee

    tiffmaxee Well-Known Member

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    The potassium is coming up nicely. You want it around 5 and it’s 4.5 which is in normal range.
     
  63. Camcat

    Camcat Member

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    Hi Everyone, had another check up today for Cam. She's doing pretty good. HCT is coming up nicely. Will need to continue potassium supplementation, and get an SDMA test done in another month as her BUN is high and may indicate a kidney issue. Labs attached.We are driving back to NYC from NC next weekend - we have to go back for work. Wish us luck! Hopefully all will be okay.
     

    Attached Files:

  64. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Good luck and Godspeed!
     
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  65. tiffmaxee

    tiffmaxee Well-Known Member

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    Was anything said about the low potassium? It should at least 4. Good luck returning home.
     
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