Joe is DKA..again after 2 weeks

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Meredith1788

Meredith1788

Member Since 2023
Hello Everyone,
I just joined a few weeks ago when my kitty, Joe, a female 8 year old calico with diabetes came home after having a DKA episode.
She had diabetes for a little over a year ago, and my vet has treated it as if, it’s very simple. We do curves, they tell me how much insulin she needs, and I do it. A couple weeks before her episode she had a check-up. Was told she “looked a little high” but that was all.
Then boom, DKA, was in the ER for a week. I learned so much more about diabetes in that week then ever. I started checking her glocose at home, twice a day when she was discharged.
She started to do a lot better, her glocose readings were 200s and under. Some days under 100s. I thought maybe one day, at this rate, she could go into remission, until Monday.
She wouldn’t eat, I immediately took her to the vet. Glocose reading were 100s-low 200s. But crazy high in ketones. I feel so disappointed in myself even though I don’t know what I’ve done wrong. She’s been at the ER since Monday. Glocose in the 300s, ketones now at 10.
The only thing the vet has told me was she was probably never really stable, and they suspect pancreatic. I’ll do whatever she needs, but I don’t know what to do. If anyone else experienced this let me know please.
 
Meredith1788 said:
Hello Everyone,
I just joined a few weeks ago when my kitty, Joe, a female 8 year old calico with diabetes came home after having a DKA episode.
She had diabetes for a little over a year ago, and my vet has treated it as if, it’s very simple. We do curves, they tell me how much insulin she needs, and I do it. A couple weeks before her episode she had a check-up. Was told she “looked a little high” but that was all.
Then boom, DKA, was in the ER for a week. I learned so much more about diabetes in that week then ever. I started checking her glocose at home, twice a day when she was discharged.
She started to do a lot better, her glocose readings were 200s and under. Some days under 100s. I thought maybe one day, at this rate, she could go into remission, until Monday.
She wouldn’t eat, I immediately took her to the vet. Glocose reading were 100s-low 200s. But crazy high in ketones. I feel so disappointed in myself even though I don’t know what I’ve done wrong. She’s been at the ER since Monday. Glocose in the 300s, ketones now at 10.
The only thing the vet has told me was she was probably never really stable, and they suspect pancreatic. I’ll do whatever she needs, but I don’t know what to do. If anyone else experienced this let me know please.
Click to expand...
Hi Meredith , I'm so sorry for what you and Joe are going through.
I'm going to tag Bron for you who is experienced with DKA
@Bron and Sheba (GA)
 
While waiting for Bron to see the tag can you set up what we call our signature so Bron has some information
It would be helpful if you can do what we call our signature and our spreadsheet
Tap on the blue link
Here is the link so you can set up your signature and spreadsheet or you can just tap on your name up top, then tap on signature add the information below and tap Save
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Click in this blue link and look at post #7 , post numbers are to the right of each post
It will explain how the spreadsheet works
https://felinediabetes.com/FDMB/thr...-sub-q-normsol-injection.283628/#post-3124181

I'm going to ask Bhooma to set up our spreadsheet for you , any BG numbers you have will be helpful
@Bandit's Mom
 
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Hi Meredith,
I'm so sorry you and Joe are going through this again.
Is Joe still in the ER?
If they suspect pancreatitis, get them to do a fPL spec blood test.
Do you know how the electrolytes in the blood are going?
Do they have her on an insulin drip?
Can you tell me the following please
  • What insulin are you using?
  • Were you testing every day for ketones in the urine when she came home last time?
  • What food has she been eating?
  • what type of glucose meter are you using?
  • Are the 10 ketones from a blood meter?
Here is a list of things you can do while Joe is still in the ER
  • buy a bottle of Ketostix for testing ketones. Can be bought from Walmart in the US or a pharmacy.
  • Ask the vet for anti-nausea medication such as cerenia or ondansetron. Most post DKA kitties are nauseated for a time.
  • May also need an appetite stimulant. Always give the anti-nausea medication first before the appetite stimulant.
  • Ask the vet about giving sub Q fluids at home
  • Get a range of canned food for when Joe gets home including some higher carb foods. She will probably be picky so have a variety
  • Set up a spreadsheet and the signature before Joe comes home
  • Get a copy of all the path results from the ER
  • Check if the vets have checked for an infection and if there is one are they giving an antibiotic.
When you get Joe home, you will need to be doing the following

  • you need to give one and a half times as many calories as Joe normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If Joe won’t eat the low carb food, feed her whatever she will eat as eating any food is better than not eating,
  • Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, don't feed and test again in 20 minutes and post and ask for help.
  • Test daily for ketones. This is really important. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
  • Give anti-nausea medication if needed. Post DKA cats are often nauseated and need an anti-nausea for a few weeks.
  • Give appetite stimulant if needed after the anti-nausea medication
  • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids
  • Set up a spreadsheet and test the BG frequently
  • Post daily with updates and ask for help as often as needed.
I am concerned about the Ketones still being so high. Can you ask the vets what treatment they are giving her at the moment and if the electrolytes are still out of wack.
 
DKA doesn't always require that a cat's blood glucose numbers are high. After an episode of DKA, some cats are more prone to developing ketones.

Ketones generally result from a combination of factors. There is an underlying infection or inflammation + not enough insulin + not enough calories. We are very numbers oriented here and we strongly encourage caregivers to home test for blood glucose levels several times each day. At minimum, we ask that you test before a shot so you know that it's safe to give insulin as well as test at least once during both the AM and PM cycles. Especially with a cat that has had an episode of DKA, we suggest that you get Ketostix so you can test your cat's urine at home or get a blood ketone meter to test for ketones. Once ketone levels are beyond trace, it can become an emergency. The good news is you got your cat to the vet quickly.
 
She is still in the ER.
They did do a spec, with it being the ER they are quick to not go into specifics, but they currently can't find anything wrong with her, other then her potassium being low
and some liver enzymes (bilirubin) being high. They are giving her fluids and electrolytes thru IV, and have up the potassium. They want to do an ultrasound.
We are using insulin glargine.
We were not testing for ketones.
She eats Fancy Feast Pates, typically 2 cans a day. Her sugars were low this week, so on some days I fed her up to 3 cans.
I am using CVS Heath Advanced ProHealth Glucose Meter.
The 10 ketones, is what the ER told me, I'm assuming from blood. I tried to call again, but with it being an ER the vets were busy, Ill update when they call me back.
Plan: Resume insulin GRI at 7 mL/hr Resume IVF with KCI at 20 mL/hr Recheck electrolytes and ketones (1:00am) Denamarin (for cats up to 12lbs) 1 tablet PO SID (given at 2:30am) Ketone dipstick; 10mg/dI Electrolyte Recheck: K 2.8 (3.5-5.8), Cl 102 (112-129) Chem17: Glu 307 (71-159), Phosph 3 (3.1-7.5), Ca 7.4 (7.8-11.3), ALT 132 (12-130), Tbil 2.7 (0-0.9), Chol 268 (65-225), Amy/ 307 (500-1500) г/o pancreatitis vs cholangiohepatitis vs hepatitis vs other 1:45am: Added 20 additional mE/L of KCI into the fluid bag for a total of 40mEc/L KCI. Replaced insulin cri @1:30am due to 24 hour expiration and continued previous crit Regular insulin CRI, Novolin-R 5U in 250mL 0.9% NaCl per If BG > 250: insulin rate 10ml/h If BG 200-250: insulin rate 7ml/h IF BG 100-200: insulin rate 5ml/h with 2.5% dextrose in fluids If BG <100: turn off insulin. continue with 2.5% dextrose 2:00am update BEP: Joe is inapp in-hospital and seems lethargic compared to intake, rechecked electrolytes and ketones, ketones are much. improved but moderatly hypokalemic- added additional K to fluid bag (for a total of 40m£o/L KCI). Serum was icteric- repeated a chemistry panel which did show elevated Tbil which was not seen on prey bloodwork at rdvm. Started denamarin and rec AUS for elevation in liver parameters.
Request for Subq fluids and anti Nausea.
 
Thanks for the update. I’m glad to hear the ketones are improving. I see the potassium is still low but they are treating that.
Has Joe been able to eat anything at all yet?
 
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