Hospitalized for ketones - Sugars not coming down

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cwareikis

Member Since 2016
My 10-year-old diabetic was hospitalized with ketones yesterday afternoon. He's been miserable since Thursday (vomiting, diarrhea, loss of appetite, tiredness). He has not eaten *anything* since Monday morning. The vet scheduled him for a midnight feeding. We called at 6AM to check on him. The vet said his suagrs are rising, even on the fast acting insulin, and he still has no interest in food.

It's been a full 48-hours since his last meal. I asked the vet about a feeding tube, but he wants to wait *another* 12 hours. This doesn't seem right to me. Despite that his sugars are high, surely he needs to eat *something* after two days, right?
 
I don't have personal experience with ketones, but I know It's very important for your cat to eat! Especially with ketones. I will tag @Sienne and Gabby (GA) as I believe she has experience with this. If it were my cat, I'd insist on a feeding tube or find another vet.
 
Your kitty NEEDS to eat. If a kitty goes more than 24-36 hours without food the body starts to break down stored fat to use as energy, which can lead to fatty liver disease which on its own can be deadly. Your kitty is already dealing with ketones, and is not able to deal with the added burden

http://www.pethealthnetwork.com/cat...iver-disease-cats-not-eating-can-quickly-kill

Normally, when a body is undernourished or starved, the body automatically moves fat from its reserves to the liver to be converted into lipoproteins for energy. Cat's bodies are not designed to convert large stores of fat, so when a cat is in starvation mode, the fat that is released to the liver is not processed efficiently, resulting in a fatty and low functioning liver. As the fat accumulates in the liver it becomes swollen and turns yellow. Because it is not able to process red blood cells efficiently, the yellow pigment that makes up a portion of the red blood cell is released into the bloodstream, causing a yellowing of the eyes. If not treated promptly,hepatic lipidosis can lead to various complications and eventually death.

http://www.petmd.com/cat/conditions/digestive/c_ct_hepatic_lipidosis

You should insist that he have a feeding tube put in immediately.
 
ETA The quickest and easiest feeding tube can be placed through the nasal cavity into the esophagus or stomach and does not require surgery.
 
I will certainly insist that he gets fed somehow. I know he feels awful, and I can only imagine that being malnourished isn't helping.
 
Also is your kitty on SubQ fluids and IV fluids? With ketones the electrolytes are usually out of balance and need to be replaced, plus the extra fluid is necessary to wash out the ketones.
 
My vet never used the term "SubQ fluids", so I'm not sure what that is or if he's getting it. He is receiving IV fluids. All the vet said this morning was that he refused to eat at midnight, and his sugars are rising, despite being on the fast-acting insulin.
 
Usually the fast acting insulins will bring down the glucose levels and they are continued until numbers fall into normal ranges. Have they run other blood work to see if there is anything else besides the ketones going on?

ETA Do you know what type of fast acting they are using?
 
He had bloodwork done just a couple days before his DKA diagnosis (had him at the vet everyday since Friday), which all came back normal, aside from high BG.

So much information was thrown at me, but no, I don't believe they told me what type of fast acting insulin they are using.
 
cwareikis said:
He had bloodwork done just a couple days before his DKA diagnosis (had him at the vet everyday since Friday), which all came back normal, aside from high BG.

So much information was thrown at me, but no, I don't believe they told me what type of fast acting insulin they are using.
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If they did a complete bloodwork a couple of days before the DKA, then they would have seen the ketones in the blood at that time, so this has come on suddenly. Usually DKA is caused by not enough insulin, not eating and/or an infection or any combination of those. How long has your kitty been on insulin, what type of isnulin and how high were the numbers?
 
He uses Lantus (2 units twice a day) and has been diabetic for four years. He has always had pretty high BG in the 300-400 range. We don't test at home simply because he's a difficult one to handle when it comes to that. He hears the meter and runs. He BG at the vet as of last night was around 360.

However, in the last week, we have been lowering/skipping doses due to him not eating or not eating a full meal.
 
cwareikis said:
He uses Lantus (2 units twice a day) and has been diabetic for four years. He has always had pretty high BG in the 300-400 range. We don't test at home simply because he's a difficult one to handle when it comes to that. He hears the meter and runs. He BG at the vet as of last night was around 360.

However, in the last week, we have been lowering/skipping doses due to him not eating or not eating a full meal.
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OK.

First your kitty needs to get better. It sounds like the DKA was caught very early so hopefully the fast acting insulin will bring down the numbers soon. He also needs to be getting some food, even if they have to use the nasal feeding tube, to prevent fatty liver disease.

Once your kitty is home, it would be good if you could try home testing again. Insulin should be given every 12 hours unless the numbers are too low. Lantus is a gentler insulin, and although your kitty needs to be eating it is not as crucial to have a full meal on board in order to give it. We can discuss different methods to get your kitty used to home testing once he is home.

In the meantime I am sending healing energy and ((HUGS)) that your kitty recovers quickly.

:bighug: :bighug:
 
Just visited my kitty at the vet. They brought him to us wrapped in a blanket, so we didn't actually go into the hospital unit. He still looks pretty miserable today. Still refusing to eat, and his sugars are still rising, and the vets are *still* refusing to try a feeding tube. I asked if they would even consider doing so within the next 24 hours and they said no.
 
DKA is an emergency situation so getting your kitty to the vet was the best thing you could do. If your cat is getting IV fluids, there's no need for sub-q (subcutaneous) fluids. In fact, with an IV line in place, any medications that are needed to treat the DKA, such as electrolytes or insulin, can be added directly into the IV line without having to give your cat a separate shot. Typically, the vet will closely monitor lab values as well as BG values. Often, the vet will use a short acting insulin (e.g., Humulin R) as a means of bringing BG numbers down. Usually, when a fast acting insulin is being used, the IV fluid contains dextrose. The vets use a sugar solution both to provide a form of nutrition and to prevent numbers from dropping too low. Chances are that your kitty wasn't eating either because there was an infection that had started or the electrolyes were out of whack which can make you feel pretty lousy. Hopefully, the vet is also trying to get your cat to eat and administering an anti-nausea medication (ondansatron or Cerenia) along with an appetite stimulant (cyproheptadien or mirtazapine).

DKA typically results from an infection or inflammation + not eating + not enough insulin. While skipping shots if a cat isn't eating may be intuitively correct, if you're doing this on a regular basis and your kitty has an infection brewing, DKA can happy very quicly.. Because DKA can happy quickly, literally within a matter of hours, while the labs from Friday may have been good, clearly a lot can change in a short time.
 
Any idea why his sugars would still be rising on the fast acting insulin? The vet was quite optimistic last night. Today, not so much. I'm not sure what to think.
 
How often are the trying to feed him? And if they won't consider a feeding even in 24 hrs from now what is their plan of treatment? Doesn't sound like they will do it ever.

If it's possible I think a new hospital is in order. It sounds like they are only giving insulin and watching him. You can do that at home but he needs advanced care. Can you be more insisting or forceful in your request.
 
I will keep trying. The vet we spoke to at 6am said he'd try again in 12 hours. But the vet on duty at 9am said 24 hours, and would not consider any time before then. I'm no vet, but based on the experiences I'm reading about here, it sounds like they should be force feeding him at this point.
 
cwareikis said:
I will keep trying. The vet we spoke to at 6am said he'd try again in 12 hours. But the vet on duty at 9am said 24 hours, and would not consider any time before then. I'm no vet, but based on the experiences I'm reading about here, it sounds like they should be force feeding him at this point.
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I don't know much of the history here, but for any animal that's not eating they should be trying a lot more often than every 12 hrs.
 
Ask what the long-term (even a week) plan is, and if they don't have a plan - go elsewhere. Looks to me like they are doing little and jollying you along until there is only one decision left to make.
 
Typically when a cats starts assisted feeding (usually with a syringe) one has to assist feed a little every hour or two. Assist feeding a whole meal when starting usually results in vomiting/regurgitation if you can get a full meal in but frequently the cat will resist enough to prevent a full meal in one sitting.
 
Just called the vet to get an update. Everything is pretty much as it was this morning. Suagrs still high, still trying to determine the cause of the DKA, controlling electrolytes, etc. I asked again about force feeding. Again, I was told it wasn't something he would consider before tomorrow because he's trying to control everything else. Understood, but I would still think that eating should be pretty high on the priority list. Just like in a sick human, even if you don't have an appetite, getting proper nutrients will help you recover, right?

The vet, who has been otherwise pleasant and patient, started to get little frustrated. I told him that I was being advised my several other cat parents on a feline diabetes forum that my kitty should really be starting to get some food in him at this point. He asked if "those people went through nine years of veterinary school". I said, "No, but they're pet parents who've been in the same situation", so they're input is just as valid.

He didn't agree to force feed today in that conversation. Minutes later, he called back. He sounded more chipper than he did a minute ago. He told us that he personally attempted to syringe feed a small amount of food to my kitty, and he swallowed it.

I know it's a small victory, but it made me happy to know that they tried what I asked, and that kitty didn't spit out the food.
 
Sorry you're going through this. I don't have any experience with DKA so all I can do is offer support. Personally, I would be calling other vets - asking what their treatment plan would be given the same situation. DKA isn't inexpensive to treat, so I would want to know that they were doing everything possible, not making callous remarks about how they're more qualified than others who live and breathe feline diabetes. You shouldn't have to "pester" them to do something as critical as get food into a cat that hasn't eaten since Monday morning.
 
There's often not a discrete "cause" of DKA in a cat that is unregulated. The lack of enough insulin alone is the cause. If the blood sugars aren't coming down with insulin then -NOT ENOUGH INSULIN IS BEING GIVEN-. Its really as simple as that. Vets sometimes have a pre-conceived idea of how much insulin it -should- take in most animals, however, each cat is different. A severely dehydrated cat is going to need more than a well hydrated cat. A cat with pituitary issues more than if they don't have them. Obese cats more than thin cats, etc. It's imperative in DKA that the dose of insulin continues to be raised until the ketones stop being formed in the blood. The vet should have him on a dextrose drip to make sure his BS doesn't tank if it's a lot of insulin. Ideally, the short acting should be given in the IV around the clock to provide continuous insulin release.

I honestly would remove my cat from that situation ASAP and find a vet that knows how to treat DKA, as there are other concerns such as potassium imbalance and liver disease that can occur rapidly in your situation. Call other vets and ask how many successful cases of DKA they have treated and you'll be able to find someone who can help. DKA has a pretty high survival rate when treated quickly and correctly.
 
I agree with Meya; if it were my cat I'd be looking to find a vet with a much better handle on appropriate and effective DKA treatment. As well as getting sufficient insulin, getting enough calories into the cat is fundamental to successful treatment. As has already been advised above, anti-nausea and appetite stimulant meds are extremely important therapeutic tools.

Sending prayers and healing vibes for your little fella and some :bighug::bighug::bighug: for you; it's so tough when our little ones are poorly and the right veterinary help isn't immediately forthcoming.


Mogs
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Tuxedo Mom said:
From the profile it appears the last time they checked in here was on Wednesday just after their last post. I hope that the treatments were able to pull the kitty through. :nailbiting:
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Me too.
That's really stressful when we don't have any feedback after such a thread.
I wonder if somebody ear anything on FB...
 
Capoo said:
Me too.
That's really stressful when we don't have any feedback after such a thread.
I wonder if somebody ear anything on FB...
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I haven't seen anything mentioned on the FDMB FB page either. The silence makes me very worried. :(
 
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