? How to prevent DKA with kitty that had it twice

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Mathilda and Maverick

Mathilda and Maverick

Member Since 2020
Maverick is currently back at the ER with DKA. He was there pretty exactly 1 month ago with DKA, pancreatitis, possible bowl inflammation, possible triaditis, jaundice, and elevated liver values. He has a history of liver failure in the past (not sure if he had DKA back then also).
Anyhow, he was very bad last time and we almost lost him. This time I caught it very early tanks to ketone home test strips. He's now been at the ER for about 10h and are about to get discharged. On the scale he was a +2, but all his other values were normal except for chlorine that was somewhat low, and cholesterol that was somewhat high. He's been on fluids now for about 6h and they want to discharge him because he is eating and doing clinically well (as he did already before I took him to the ER). The problem seems to be that he is not regulating on the insulin and has been consistently high lately. I asked for them to prescribe me a bag of fluids so I can give him that in case he gets dehydrated or tests positive at home for ketones again, but they refuse.
What should I think about from now on in terms of feeding, or other precautions to avoid him getting DKA again?
I'm not really sure what suggestions I'm asking for, all I know is that Maverick is a really complicated case and being $10000 deep for only this month, we really can't afford him getting sick again. The ER vet is suggesting we consult an internal specialist, but we really can not afford that right now, and I am not interested in putting him through vary invasive diagnostics.
 
Hi Matilda and Mavrick.
I am so sorry Maverick has been back in the ER withDKA. Well done catching it early.
I would ask again if they will give you a bag of fluids to give sub Q fluids. That would be very helpful if ketones reappear to help flush them out.
I know he is eating at the moment but I would make sure they give you some antinausea medications such as cerenia and ondansetron in case he stops eating. It would be good if you could have both medications as they work on different pathways and can be given together if needed. And sometimes when one won’t work, the other one will..

Once you get home it is really important that you dont miss any insulin doses. I can’t see your spreadsheet at the moment. I’m going to ask @Bandit's Mom to have a look and see if she can fix it for you.
Is he still having Lantus?
Can you ask them what insulin and dose they were giving him in the ER please?
If needed he may need some higher carb food to ensure the insulin doses can be giving so make sure you have some higher carb food at home.

The most important thing is he is eating (as well as the insulin being given) so make sure you have a good selection of food for him.
He will need to eat 1 1/2 times the number of calories he normally eats.
That will mean lots of snacks through the day and evening to ensure you get those calories into him.

You will need to post every day and we can help you with the insulin dose.

Make sure you have a good supply of Ketostix at home as well. I would test twice a day in the beginning to make sure that no ketones are appearing.

Keep asking questions. We will help you with Mavericks recovery.
 
Matilda, I can see the SS that @Bandit's Mom has posted.
You don’t mention in the SS or your signature whether you are doing TR or SLGS dosing Methods.
Here are the two methods for you to have a look at.
With DKA in the picture you would be better doing the TR as we can adjust the dose more quickly.
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I also notice you are giving a different dose in the morning to the night time. Lantus works best if the same dose is given consistently as giving different doses can mess up the depot..What is a depot https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
How many hours before you collect Maverick? If I know, I will try and be online to help you when you get home.
 
Hi Mathilda,

I'm sorry to hear that Maverick is having ketone issues again. Well done catching them quickly.

Given Maverick's history of pancreatitis, I'd suggest asking them to confirm whether they tested him for this again (it can wax and wane so retesting is wise). If positive for pancreatitis then I'd suggest asking them for some buprenorphine to give at home should he need it to help him keep eating steadily.

As you know, the three factors that contribute to the development of DKA are:

  • Not enough food (calories) + not enough insulin + infection / inflammation / other systemic stressor.

Have they managed to identify any underlying condition in Maverick's case (e.g. UTI / dental issue / resurgence of pancreatitis / other)? If something is present then treating it would help reduce the risk of Maverick generating ketones.

Bron and Sheba (GA) said:
I know he is eating at the moment but I would make sure they give you some antinausea medications such as cerenia and ondansetron in case he stops eating. It would be good if you could have both medications as they work on different pathways and can be given together if needed. And sometimes when one won’t work, the other one will..
Click to expand...
I'd also suggest asking for an appetite stimulant to use at home should one be needed.

On fluids, would it be worth approaching your regular vet about them if the ER continue to refuse to prescribe them?

When it comes to asking for any/all supportive meds I'd suggest trying to make the case that it's the holiday period and having the appropriate treatments immediately to hand would mean that you could respond straight away to help Maverick.
Bron and Sheba (GA) said:
If needed he may need some higher carb food to ensure the insulin doses can be giving so make sure you have some higher carb food at home. The most important thing is he is eating (as well as the insulin being given) so make sure you have a good selection of food for him. He will need to eat 1 1/2 times the number of calories he normally eats. That will mean lots of snacks through the day and evening to ensure you get those calories into him.
Click to expand...
Is Maverick underweight at the moment? If yes, then helping him to regain the weight may help him to become more stable ketone-wise. Feeding grub at a slightly higher carb level in order to support his getting enough insulin as Bron suggests above may also help him to regain a bit of weight. It might also be an idea to find some foods that are more calorie-dense for him to eat while he's recovering (e.g. kitten food).

Wishing Maverick a speedy and solid recovery. (((Maverick)))


Mogs
.
 
You might have a better chance getting the sub q's, cerenia, and bupe from your regular vet as opposed to the er vet.

I'm so glad you are testing both ketones and bg at home. I would say work on getting the numbers back into the greens. Give the 0.5 both shots, but in a day or so consider raising to 0.75.
 
Bron and Sheba (GA) said:
Matilda, I can see the SS that @Bandit's Mom has posted.
You don’t mention in the SS or your signature whether you are doing TR or SLGS dosing Methods.
Here are the two methods for you to have a look at.
With DKA in the picture you would be better doing the TR as we can adjust the dose more quickly.
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I also notice you are giving a different dose in the morning to the night time. Lantus works best if the same dose is given consistently as giving different doses can mess up the depot..What is a depot https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
How many hours before you collect Maverick? If I know, I will try and be online to help you when you get home.
Click to expand...

Hi, thank you so much for your help! I'll start to answer here because I'm freaking out and I did not have the ability to go online before now.
So, Maverick came home at 1AM today. The ER doctor was completely useless- the only thing he wanted to do was transferring him over to a internal medicine specialist they work with, which I denied do to the price of just consultation. I wanted them to make sure to flush the ketones out but he said they couldn't do anything as Maverick did not show the clinical signs they normally see in cats with ketones. So he discharged him, saying most ketones "should be flushed out by now" this was after about 5-6h with fluids, and he didn't want to do continues insulin and refused to prescribe me a bag of fluids. He was never tested for UTI even though I requested it and he was not retested for ketones before discharged.

I am aware that Lantus works better with consistent dosing but my reg vet kept on telling me to do the different, the ER vet told me to keep at consistent .5 and .5.

I was just able to test Mavericks ketones again and he is way worse than yesterday before admitted to the ER. I do not know what to do as the ER is no help and I do not have fluids.

ETA. I have not followed any protocol yet, but think I should be doing TR, right? I'll review and print those instructions out today. Maverick has been very hard to regulate, but as insulin is so important now, seeing his chart, do you think .5 morning and night is enough? before when we increase, he seems to go up in values a few cycles before somewhat settling- do you think thats risky now with the ketones in his body?
 
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Mathilda and Maverick said:
Hi, thank you so much for your help! I'll start to answer here because I'm freaking out and I did not have the ability to go online before now.
So, Maverick came home at 1AM today. The ER doctor was completely useless- the only thing he wanted to do was transferring him over to a internal medicine specialist they work with, which I denied do to the price of just consultation. I wanted them to make sure to flush the ketones out but he said they couldn't do anything as Maverick did not show the clinical signs they normally see in cats with ketones. So he discharged him, saying most ketones "should be flushed out by now" this was after about 5-6h with fluids, and he didn't want to do continues insulin and refused to prescribe me a bag of fluids. He was never tested for UTI even though I requested it and he was not retested for ketones before discharged.

I am aware that Lantus works better with consistent dosing but my reg vet kept on telling me to do the different, the ER vet told me to keep at consistent .5 and .5.

I was just able to test Mavericks ketones again and he is way worse than yesterday before admitted to the ER. I do not know what to do as the ER is no help and I do not have fluids.
Click to expand...
I feel like it doesn't matter that I'm catching it early when I can't do anything and not even the ER is listening or caring
 
JanetNJ said:
You might have a better chance getting the sub q's, cerenia, and bupe from your regular vet as opposed to the er vet.

I'm so glad you are testing both ketones and bg at home. I would say work on getting the numbers back into the greens. Give the 0.5 both shots, but in a day or so consider raising to 0.75.
Click to expand...

Thank you! I'm trying my hardest but the vets are really giving me a hard time so I'm feeling very helpless. Maverick has even more ketones now than before going into the ER.
I will try getting it from the regular vet, but the ER vet got everything wrong and wrote some crazy soap notes my reg vet will get and I think that kills my chances of getting her to prescribe me some. Someone gave me a website where I can buy it without prescription, but it wont arrive before 7-9 days and probably later because of the holidays.

I probably should, but think I'll need to feed him more if so as he has repeatedly dropped down to lower than safe to shoot before on those doses.
 
Critter Mom said:
Hi Mathilda,

I'm sorry to hear that Maverick is having ketone issues again. Well done catching them quickly.

Given Maverick's history of pancreatitis, I'd suggest asking them to confirm whether they tested him for this again (it can wax and wane so retesting is wise). If positive for pancreatitis then I'd suggest asking them for some buprenorphine to give at home should he need it to help him keep eating steadily.

As you know, the three factors that contribute to the development of DKA are:

  • Not enough food (calories) + not enough insulin + infection / inflammation / other systemic stressor.

Have they managed to identify any underlying condition in Maverick's case (e.g. UTI / dental issue / resurgence of pancreatitis / other)? If something is present then treating it would help reduce the risk of Maverick generating ketones.


I'd also suggest asking for an appetite stimulant to use at home should one be needed.

On fluids, would it be worth approaching your regular vet about them if the ER continue to refuse to prescribe them?

When it comes to asking for any/all supportive meds I'd suggest trying to make the case that it's the holiday period and having the appropriate treatments immediately to hand would mean that you could respond straight away to help Maverick.

Is Maverick underweight at the moment? If yes, then helping him to regain the weight may help him to become more stable ketone-wise. Feeding grub at a slightly higher carb level in order to support his getting enough insulin as Bron suggests above may also help him to regain a bit of weight. It might also be an idea to find some foods that are more calorie-dense for him to eat while he's recovering (e.g. kitten food).

Wishing Maverick a speedy and solid recovery. (((Maverick)))


Mogs
.
Click to expand...

Thank you! They did some testings yesterday but I do not think it included pancreatitis. I asked them to check UTI but they ended up not doing it. The ver was very incompetent and suggested transferring to internal medicine specialist, I denied for several reason of which two are their horrific reliefs and their pricing. All I wanted was them to flush out the ketones but they failed that also, discharging him after only a few hours on fluids- he's now home and just tested for moderate ketones. Maverick is doing pretty good clinically, he is a tired but not lethargic, he's having big appetite, and he is steadily increasing in weight. He has been going aside to sleep much today, and he has been drinking water which he doesn't normally do this way. Even though I'm completely soaking his feed. He's not at his ideal weight yet though. We do have appetite stimulant and use as needed but haven't needed it in the past 2 weeks.

I just got the reg vet to give me a bag!! How much would you recommend giving him today?
 
UPDATE: Maverick is home as of 1AM this morning. The vet only gave him fluids, did not retest for ketones and he is still high on ketones. The vet opted for transferring him to a Internist Medicine Specialist which I denied for several reasons- he said theres nothing they can do then. He was never tested for UTI even though I thought he would be. I was able to get a hold of a fluid bag. I'm freaking out knowing he still has DKA and do not know what to do as my reg vet do not have app openings, ER vet won't do a anything, and holidays are coming up. I do have a app at the regular vet Saturday but fear it will be too late. Maverick still does not show much of clinical signs, he has good appetite, but more tired- I wouldn't call it lethargic yet, and he shows some different behaviors as he does when he's not feeling good as drinking more. He was sitting with his mouth open which I also take as a red flag. I'm worried sick, Is there anything I can do at home tonight? I'll try to get an app at the regal vet tomorrow anyways. Should I feed him more, more insulin, give him more water? How much fluids should I give him and how often? I feel like you guys are the only ones to help me right now so I can't even tell you how much I appreciate all your time and help!
 
I don't have the experience to help you, but I'm tagging @Wendy&Neko who appears to be online and may be able to help. If you think it's an emergency (and high ketones may just qualify for that) you might change the title of the thread to include the "911" tag. (See "Thread Tools" at the very top of the thread.)
 
Bron and Sheba (GA) said:
Hi Matilda and Mavrick.
I am so sorry Maverick has been back in the ER withDKA. Well done catching it early.
I would ask again if they will give you a bag of fluids to give sub Q fluids. That would be very helpful if ketones reappear to help flush them out.
I know he is eating at the moment but I would make sure they give you some antinausea medications such as cerenia and ondansetron in case he stops eating. It would be good if you could have both medications as they work on different pathways and can be given together if needed. And sometimes when one won’t work, the other one will..

Once you get home it is really important that you dont miss any insulin doses. I can’t see your spreadsheet at the moment. I’m going to ask @Bandit's Mom to have a look and see if she can fix it for you.
Is he still having Lantus?
Can you ask them what insulin and dose they were giving him in the ER please?
If needed he may need some higher carb food to ensure the insulin doses can be giving so make sure you have some higher carb food at home.

The most important thing is he is eating (as well as the insulin being given) so make sure you have a good selection of food for him.
He will need to eat 1 1/2 times the number of calories he normally eats.
That will mean lots of snacks through the day and evening to ensure you get those calories into him.

You will need to post every day and we can help you with the insulin dose.

Make sure you have a good supply of Ketostix at home as well. I would test twice a day in the beginning to make sure that no ketones are appearing.

Keep asking questions. We will help you with Mavericks recovery.
Click to expand...

Thank you! As of now, I am so incredible upset because it doesn't seem like it matters that I caught it early as I think the ER greatly failed in helping Maverick in the proper way. He has been very tired today, and just tested for moderate ketones with the home testing. I was finally able to get a bag of fluids so I'll have it in about 1 hour. How will I go about safely flush the ketones out at home? Is that possible in a timely manner to help my kitty? He is currently on cerenia and I have 3 more tablets, he's getting 1/4 a day but I'll definitely ask for the other ones and make sure I always have them.

He is still on Lantus. The reg vet wanted me to do .5 in the morning and .5 at night- the ER suggesting to do .5 morning and night. With the high number he had lately and the DKA, I personally think it may be good to increase to perhaps .75, but the issue is that he previously been too low to shoot several times at night on higher doses. But I'm thinking as he's eating better now I may be able to feed him more often and that may limit that problem? Otherwise, how do I handle it if he's too low to shoot- I'm thinking under 150?

He is on PPP D/M pate right now, 1.5 can/ day. Is that ok? All the vets has said to give him only 2 times/day but I've learned thats crazy and wrong, so when the numbers been lower I've fed him more times, but with high numbers I'm still worried to feed him several times/day.

Is there any way to mess up Lnatus insulin? I'm worried I'm doing something wrong that cause the effectiveness of lantus to decrease.
 
JanetNJ said:
You might have a better chance getting the sub q's, cerenia, and bupe from your regular vet as opposed to the er vet.

I'm so glad you are testing both ketones and bg at home. I would say work on getting the numbers back into the greens. Give the 0.5 both shots, but in a day or so consider raising to 0.75.
Click to expand...

I was able to get the fluids! Will pick it up here shortly!
 
Again, I'm a newbie and I can't give advice, but I've read advice here saying to feed high carb food and adjust insulin to keep BG within reasonable limits. Don't withhold insulin.

from Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

Treatment
If the cat is bright, alert, and well-hydrated, the cat will not require intensive care. Your cat will require insulin, food, constant access to water, and close monitoring for signs of illness such as vomiting, anorexia, and lethargy.
 
Pookie said:
I don't have the experience to help you, but I'm tagging @Wendy&Neko who appears to be online and may be able to help. If you think it's an emergency (and high ketones may just qualify for that) you might change the title of the thread to include the "911" tag. (See "Thread Tools" at the very top of the thread.)
Click to expand...

Thank you I appreciate it! I might do that. Am I doing this right to post updates in the tread, or should I make an ETA in the initial post about updates- if that is possible?
 
Pookie said:
Again, I'm a newbie and I can't give advice, but I've read advice here saying to feed high carb food and adjust insulin to keep BG within reasonable limits. Don't withhold insulin.

from Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

Treatment
If the cat is bright, alert, and well-hydrated, the cat will not require intensive care. Your cat will require insulin, food, constant access to water, and close monitoring for signs of illness such as vomiting, anorexia, and lethargy.
Click to expand...

Thank you so much for your time and helping, I truly appreciate it! He has definitely been more quiet today, but not quite lethargic, so I do think he's fitting into this category and that why the ER vet felt they can't do anything. Maverick is not regulating on the insulin and I think thats a huge problem, but I also think I'm doing things wrong or can do things better to help him, so I'm so grateful for all expertise and help here!
 
I'd start a new thread using the 911 prefix and say something like "Ketones, Help needed!" and then copy over one or more of your posts that summarizes where he is today.

The 911 prefix generally gets prompt attention, although there don't appear to be a lot of people online right now.
 
Bron and Sheba (GA) said:
Matilda, I can see the SS that @Bandit's Mom has posted.
You don’t mention in the SS or your signature whether you are doing TR or SLGS dosing Methods.
Here are the two methods for you to have a look at.
With DKA in the picture you would be better doing the TR as we can adjust the dose more quickly.
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I also notice you are giving a different dose in the morning to the night time. Lantus works best if the same dose is given consistently as giving different doses can mess up the depot..What is a depot https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
How many hours before you collect Maverick? If I know, I will try and be online to help you when you get home.
Click to expand...
 
JanetNJ said:
You might have a better chance getting the sub q's, cerenia, and bupe from your regular vet as opposed to the er vet.

I'm so glad you are testing both ketones and bg at home. I would say work on getting the numbers back into the greens. Give the 0.5 both shots, but in a day or so consider raising to 0.75.
Click to expand...

Another question: Before when I increase doses, he seems to spike higher in values for a few cycles, do you think it's risky to increase now when he has ketones in his body in case he'll spike?
 
Mathilda and Maverick said:
Another question: Before when I increase doses, he seems to spike higher in values for a few cycles, do you think it's risky to increase now when he has ketones in his body in case he'll spike?
Click to expand...
That's new dose wonkiness, I wouldn't worry about it. It's having enough insulin that's important. I would definitely shoot no lower than 0.5 tonight.

It's really late here I've sent an SOS out to some experienced folk.
In the meantime
Make sure he eats, feed him regular snacks he needs more calories, keep him hydrated, you can add water to his food, and do not reduce his insulin dose.

If the insulin is clear and had no floaties/milky appearance it's most likely fine.
 
Tonight I would make sure you give him the full 0.5 units of insulin. Mogs has given you the formula for DKA and that is part of it. You also want to feed as many calories as you can into him.
 
Mathilda and Maverick said:
Another question: Before when I increase doses, he seems to spike higher in values for a few cycles, do you think it's risky to increase now when he has ketones in his body in case he'll spike?
Click to expand...
He needs the insulin to get rid of the ketones. It is not the insulin making his ketones rise. Raise the dose with the next shot. Do you know how to give sub q's? Get as much food into him as he will eat. If he won't eat hand feed him or assist feed him. How is he behaving? How much does he weigh?
 
JanetNJ said:
He needs the insulin to get rid of the ketones. It is not the insulin making his ketones rise. Raise the dose with the next shot. Do you know how to give sub q's? Get as much food into him as he will eat. If he won't eat hand feed him or assist feed him. How is he behaving? How much does he weigh?
Click to expand...

Ok, I'll do .5 tonight. I do know how to do the fluids and just got ahold of a bag. Do you thing 50 or 100 is good for today? the vet said no kore than 100/24h. Luckily he's still eating, Ive been giving him feed 3 times today, will give more in about 1h. Should I get up and feed him through the night also? He just want to lay down sleeping at a specific spot, but will come when I call its feeding time so he's still attentive. He's was 10.86lbs at the vet yesterday. When healthy he's around 12-13lbs.
 
Gill & George said:
That's new dose wonkiness, I wouldn't worry about it. It's having enough insulin that's important. I would definitely shoot no lower than 0.5 tonight.

It's really late here I've sent an SOS out to some experienced folk.
In the meantime
Make sure he eats, feed him regular snacks he needs more calories, keep him hydrated, you can add water to his food, and do not reduce his insulin dose.

If the insulin is clear and had no floaties/milky appearance it's most likely fine.
Click to expand...

Thank you!
So the spike because of NDW is not as serious as a spike from no insulin? Should I shoot even higher tomorrow morning or is that to increase to quick? I just realized I've treated the insulin pen wrong by shooting in air so I'm getting a new one tonight to be on the safe side, it is still clear though.
 
My cat had DKA, and that was when she was diagnosed with diabetes. She continued to have trace ketones in her urine for about two months after the DKA episode. She's now totally fine with no ketones in her urine. What made Ruby's episode dangerous was the fact that she basically stopped eating for two days and lost a lot of weight. So if your cat continues to eat well you might avert a serious situation. Keep feeding him, and also add water to the DM as much as you can to make sure he remains hydrated through his food as well as through the subQ. And give him insulin as consistently as possible, and don't skip doses unless his preshot number is low (this depends on the protocol you choose). I don't recall if you've been given any appetite stimulants like Cerenia or Mirtazapine. Having those on hand to give to Maverick will also help in case he stops eating. UPDATE: Sorry just saw in your sig that you have the stimulants.
 
PerfumedCatMom said:
My cat had DKA, and that was when she was diagnosed with diabetes. She continued to have trace ketones in her urine for about two months after the DKA episode. She's now totally fine with no ketones in her urine. What made Ruby's episode dangerous was the fact that she basically stopped eating for two days and lost a lot of weight. So if your cat continues to eat well you might avert a serious situation. Keep feeding him, and also add water to the DM as much as you can to make sure he remains hydrated through his food as well as through the subQ. And give him insulin as consistently as possible, and don't skip doses unless his preshot number is low (this depends on the protocol you choose). I don't recall if you've been given any appetite stimulants like Cerenia or Mirtazapine. Having those on hand to give to Maverick will also help in case he stops eating. UPDATE: Sorry just saw in your sig that you have the stimulants.
Click to expand...

This was Mavericks situation the first two times he had DKA also, he stopped eating. I think I did catch it early this time, but the high ketones still in his body freaks me out and I'm hoping I can prevent him from getting so bad again. I'll be giving subQ, does it matter if I do that before or after insulin? We do have both of those meds on hand. He's getting the cerenia daily now, and the other just as needed, but hasn't needed it for about 2 weeks now.
 
Mathilda and Maverick said:
This was Mavericks situation the first two times he had DKA also, he stopped eating. I think I did catch it early this time, but the high ketones still in his body freaks me out and I'm hoping I can prevent him from getting so bad again. I'll be giving subQ, does it matter if I do that before or after insulin? We do have both of those meds on hand. He's getting the cerenia daily now, and the other just as needed, but hasn't needed it for about 2 weeks now.
Click to expand...
I might do them in different locations. I'd do 0.75 starting with the next shot.
 
Hi there:cool:
I got an sos from Gill -
I'm up the road from Davidsonville, in Baltimore. Gonna take a few minutes to read up on you details and will be back.
Hang in there!
btw, which er did you take him to?
 
Sandy and Black Kitty said:
Hi there:cool:
I got an sos from Gill -
I'm up the road from Davidsonville, in Baltimore. Gonna take a few minutes to read up on you details and will be back.
Hang in there!
btw, which er did you take him to?
Click to expand...

Hi! Thank you! I took him to the AAVEC in Annapolis. I'm at currently debating if to increase the does to 0.75 or not tonight. I'll also give him 50 subQ tonight, and debating whether to give him that before, right after insulin or wait a few hours.
Edit: 0.75 instead of 0.5 tonight, he's been on 0.25 for the past couple weeks.
 
Wendy&Neko said:
Tonight I would make sure you give him the full 0.5 units of insulin. Mogs has given you the formula for DKA and that is part of it. You also want to feed as many calories as you can into him.
Click to expand...

I understand now its important with lots of calories with the DKA, however it just hit me that he has history of pancreatitis and it is not ruled out that he doesn't have it this time (I wish they tested for this yesterday but they didn't). Can increased food and calories be dangerous if he now has pancreasitis?
 
So that you understand the mechanics of the way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown it's own stored fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA. So you must find that balance where he gets enough insulin to convert the calories he eats into energy and deliver that energy to the cells of his body.
Mathilda and Maverick said:
Can increased food and calories be dangerous if he now has pancreatitis?
Click to expand...
Pancreatitis is something I have no personal experience with so I don't know the answer to that. I will put out an sos to find out. I do know that Pancreatitis is definitely inflammatory and painful and a stress to the system. Combined with not enough calories and not enough insulin it opens the door to ketone formation.

Since lantus is a slow acting insulin in this case adding an additional shot of a fast acting insulin can be a great help. A few questions-
What is your availability to monitor his BG?
Are you using a meter calibrated for humans ?
What does he eat?
approx how many calories each 24 hours??
When does he eat?
Can you count on him to eat?
 
Ok, thanks!

I have a ReliOn for humans and a Freestyle Libre 14 days sensor. And I can monitor his BG most times of the day and night.
He eats 1.5 can of PPP D/M pate watered down. Its 176 kcal/can so 264kcal/ 24h, I'm not sure how many calories that is.
Ive been feeding him morning, night, and t times during the day the past day. Earlier morning/night per vet recommendation, but been adding snacks in the day when BG hasn't been in 300s.
He has been vary good at eating, but tonight he was a little harder to fee, he left some, it may be because I added lots of water and he got fed more frequently. But he does seem less energetic tonight so I think I'll give him the appetite stimulant tomorrow
 
With pancreatitis a cat needs nausea medication, pain medication, sometimes fluids and an appetite stimulant. You want to feed small amounts often. You want to get him to eat plenty of calories, just not all at once because that can make him feel yucky.
 
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Mathilda and Maverick said:
Ok, thanks!

I have a ReliOn for humans and a Freestyle Libre 14 days sensor. And I can monitor his BG most times of the day and night.
He eats 1.5 can of PPP D/M pate watered down. Its 176 kcal/can so 264kcal/ 24h, I'm not sure how many calories that is.
Ive been feeding him morning, night, and t times during the day the past day. Earlier morning/night per vet recommendation, but been adding snacks in the day when BG hasn't been in 300s.
He has been vary good at eating, but tonight he was a little harder to fee, he left some, it may be because I added lots of water and he got fed more frequently. But he does seem less energetic tonight so I think I'll give him the appetite stimulant tomorrow
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are the numbers for today from the relion or the libre?

why the ppp dm?
264 calories is pretty good - 300 would be better.
When did you last test his urine and what was the result? Please document all tests on the ss. Take a look at my Black Kiitys ss, around the middle of June 2008 and you can see one way to document the ketone test results. I placed them in the cell corresponding to the +hour since the previous shot. that way they are clearly visible.
 
Mathilda and Maverick said:
Hi! Thank you! I took him to the AAVEC in Annapolis. I'm at currently debating if to increase the does to 0.75 or not tonight. I'll also give him 50 subQ tonight, and debating whether to give him that before, right after insulin or wait a few hours.
Edit: 0.75 instead of 0.5 tonight, he's been on 0.25 for the past couple weeks.
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Sometimes giving subq fluids can drop the BG. Every cat is different (ECID). I would definitely not give it as the same time as his shot and would try to do it after he has onset so you can see how much he drops by then....usually +2. The subq fluids can still drop his BG later in the cycle after you give it so pick a time when he’s fairly flat with some room to drop.

Subq fluids never dropped my kitty’s BG but I have seen several others where it consistently did.
 
Sandy and Black Kitty said:
are the numbers for today from the relion or the libre?

why the ppp dm?
264 calories is pretty good - 300 would be better.
When did you last test his urine and what was the result? Please document all tests on the ss. Take a look at my Black Kiitys ss, around the middle of June 2008 and you can see one way to document the ketone test results. I placed them in the cell corresponding to the +hour since the previous shot. that way they are clearly visible.
Click to expand...

Numbers from today are only from the region, nearly every numbers from the past week in the sheet is from the meter. I realize they measure different often so I'm mostly just using the freestyle now to see what things are trending so I don't have to prick him all the time.
The vet fed him this when first at the ER and I didn't want to change before he is somewhat regulated. I'll offer him more tomorrow and see if he'll eat.
Last time I tested was today noon, and it was moderate, perhaps a little more. Thank you, I'll take a look at your SS. The vet claims that ketones in the urine will be elevated as they flush out so he expect it to look worse before it gets better- is that true? If so, how long can I expect testing to be positive?
 
Marje and Gracie said:
Sometimes giving subq fluids can drop the BG. Every cat is different (ECID). I would definitely not give it as the same time as his shot and would try to do it after he has onset so you can see how much he drops by then....usually +2. The subq fluids can still drop his BG later in the cycle after you give it so pick a time when he’s fairly flat with some room to drop.

Subq fluids never dropped my kitty’s BG but I have seen several others where it consistently did.
Click to expand...

Thank you! Thats great to know! I ended up giving him .5U tonight, and he got tons of water in his feed all day, he doesn't seem dehydrated- should I wait until the morning to give him the subQ so I can monitor closely how his bg is reacting to it? It may not be a good idea to both increase the insulin and give fluids overnight the first time, or what do you think?
 
tiffmaxee said:
With pancreatitis a cat needs nausea medication, pain medication, sometimes fluids and an appetite stimulant. You want to feed small amounts often. You want to get him to eat plenty of calories, just not all at once because that can make him feel yucky.
Click to expand...
Thank you! Is 4 meals a day a good strategy or is it better with more smaller feedings?
 
Mathilda and Maverick said:
Thank you! Is 4 meals a day a good strategy or is it better with more smaller feedings?
Click to expand...
I would feed before the dose of insulin and give small meals throughout the cycles ...just a teaspoon or two each time, maybe each two hours.....but not feeding for the two hours before the shot is due so the BGis not food influenced.. I would also try and give some food during the pm cycles as well. What ever he will eat at the moment.
 
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