Just got through DKA, unsure what the future holds

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jakes

jakes

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Our 12 year old male neutered cat, Martin, was diagnosed with diabetes about a year ago. Up until that point we had just been feeding him low-quality dried food simply because we didn't know any better, but we did some research online and decided to switch to low-carb canned foods. We did not put him on insulin, but we did take him in to have his blood sugar checked occasionally and it seemed like the switch to canned food had helped it enough that he didn't need insulin.

A couple of weeks ago we noticed he was drinking a lot more water and urinating a lot more than normal. Unfortunately we didn't act quickly, and after this had been going on for awhile we took him to the vet to have him checked out. He was in DKA, and the vet gave him lots of fluids and some insulin to try to balance him out. This was on a Saturday, and our vet closes early on Saturdays and is not open on Sundays. Saturday night he was completely lethargic, not even moving, so we rushed him to the emergency clinic. We didn't think he was going to make it - his PCV (red blood cell count) was extremely low due to the DKA, but he recovered and on Monday morning he was discharged to us. We immediately took him to our normal vet, who asked us to start him on 1 unit of U40 PZI insulin twice a day and to get our own meter to keep an eye on his BG.

On Monday night his BG was at 508, so still very high. Our meter (a ReliOn Micro) maxes out at 600, and AM pre-shot today was 600+. 5 hours after we gave him his PZI insulin this morning his BG was down to 348, but then 3 hours after that it was back to 600+. Our vet asked us to increase the dose to 2 units U40 twice a day, so we just gave him his first 2 unit shot about an hour ago.

We're having a hard time getting blood from his ear to test his BG, sometimes having to poke him 15-20 times before we get blood. It's pretty miserable for us and also for him, and he's clearly pretty unhappy right now. I know the vet has told us that stress can increase his BG level, so I'm wondering if the stress of us repeatedly poking him to get blood might be part of the reason his BG is so high.

He's barely eating his canned food, although we have some low-carb dry food (EVO turkey & chicken) that he's willing to eat a lot of. We're worried about feeding him the dried food though because we don't want to bring up his blood sugar even more.

Really we're just trying to figure out where to go from here. We're really worried that we spent all this money and put ourselves and him through all this stress to get through DKA, and that now his quality of life is going to be awful or something else is going to happen and he's just going to die soon :sad: He keeps trying to hide from us, probably because we keep poking him with needles and lancets. This is all very new to us, and it's difficult to adjust to, so I'm really just looking for reassurance and advice.

Thanks everyone :smile:
 
Hello and welcome to you and Martin!! You are in the right place. :-D

First, take a deep breath and try to relax a little. We have all been where you are now, scared for your kitty and in sticker shock from the emergency treatment. However, diabetes is totally something you can manage at home and improve your kitty's quality of life. Many diabetic cats live happily for years after diagnosis, having normal life spans.

It is great that you have a meter and are testing! This is very stressful at first for both you and the kitty, but I doubt it's causing BG to be so high and it gets WAY better. One thing that can help a lot is warming the ear before you poke - you can put rice in a sock and microwave it, or fill a pill bottle with hot water and hold it against Martin's ear (make sure it's not too hot though!). Also, give him (and yourself) a yummy treat each time you test, whether you are successful or not.

Canned food is best, it may take a little time to get him switched over but it's worth it. Some things that can help are: warming the food so it is smellier, sprinkling treats or crushed up dry food on the wet food, or adding water to the food to change the consistency. In the meantime, if he has just had ketones, I would feed him whatever he will eat until he gets a little more stable - if all he wants is dry food then I would let him eat some for now.

Another big thing you can do is test at home for ketones. You can get Ketostix at any pharmacy, and then you need to either collect some urine to dip the strip into, or stick it under Martin while he is peeing. It will change color and tell you if he has any ketones. Some people test their cat every day, most people test weekly or just when kitty seems ill. If Martin is a shy pee-er, you can try putting aquarium gravel in a litterbox - it's non-absorbent and will let you capture some pee for testing.

I do not use PZI, so I will let someone else come along and talk to you about dosing. However, I can tell you that we make dose adjustments in smaller increments than 1 unit - we like to adjust by 0.25 units. To do this, you will need syringes with 1/2 unit markings.

Have I given you a headache yet? :lol: I sincerely hope not. Just take your time with all this and ask lots of questions, that is the best way to learn. Good luck and welcome again to you and your sweet kitty!
 
Only thing I can help with is the ear sticks...I just got a new ReliOn yesterday, and my lancing pen comes with ultra fine lancets (31g). The first couple weeks if you use a larger needle, you will get the blood you need in fewer pricks until your kitty's ears start bleeding better.

Come on over to the PZI forum: viewforum.php?f=24

Cathy
 
DKA is a very scary experience. It sounds like you had some good vet help. Glad you kitty is back home. You are so right - getting him to eat and regulating his insulin is so important.

You might try FortiFlora. It's a probiotic made with the animal digest that makes dry food so irrestible; you sprinkle it on top of the food. Sometimes your vet will carry it. You can also get it over the Internet, but we'd like to see him eating faster than that.

Bigger lancets (25-27 gauge), heating the ear till very warm were both vital to our success. If you want, describe your process and maybe we can figure out some little tweaks you can make to your method.

As far as your dose, as soon as you get some numbers, we can help with that. I am concerned about the increase from one to two units. We tend to increase by .25 or .50 at most, so we don't skip over an ideal dose. With the new dose today, I hope you can get some tests in and see how he is doing. A test 5-7 hours after the shot is really helpful info.

This is hard at first. We all struggled. But the food and testing is so important to help your cat. Keep reading and asking questions. We want to help!
 
You have already gotten so great advice on how to care for your extra sweet guy (what's his name?) so I'm not going to add to the information overload. :-D

But you were also asking about the quality of life after DKA, while I didn't know my sweet Musette at the time she is a DKA survivor twice. You see I adopted her from DCIN (Diabetic Cats in Need) as a diabetic after her original owners were going to have her put to sleep. Not only has she fully recovered from both bouts of DKA she is right now beating the stuffing out of her catnip mousie while I type this.

She was in rough shape when I adopted her late last June but now if you didn't know she was a diabetic you couldn't tell, she is like any of my other cats and I have a few 13 in fact that are mine as well as a foster momma cat and her 2 three-week old kittens.

Now Musette is my second adopted diabetic, Maxwell who i adopted over a year ago again from DCIN is now in remission and completely off insulin, and Musette is down to a mere .4u. Now if diabetes was difficult to manage at home I certainly wouldn't have volunteered to take on 2 more, while having 11 healthy and happy cats. ( We are also looking at adopting a 3rd diabetic, once our foster momma goes home.) But since mine were adopted as already being diabetic, they both just took their first trip to my vet the other day and it had nothing to do with them being diabetic, it was because they are 12 & 13 years old and they needed their senior exams and to have dentals scheduled for both of them. Everything concerning their diabetes I handle here at home with the help of the folks on this board. The only thing my vet has done concerning Musette's diabetes is write a script for her insulin since I had switched it from the one that she was originally but on, and even that I did myself after realizing what she was started on wasn't working for her, so took the information from this board and found one that looked like it would work better for her, and as luck would have it, it was the same insulin that my mother uses for her own diabetes so I was able to get my hands on some before going to the vet's and asking for the switch.

Mel, Maxwell, Musette & The Fur Gang
 
Garland survived DKA as well. She actually tends to get some moderate ketones every 6 weeks or so. We always have to start drastically upping her insulin, give SQ fluids and I let her eat what she wants when she gets them. But her quality of life is great. She is happy and spunky!! A healthy, lovable kitty. I am unfamiliar with PZI, we use Lantus, so im sure the PZI experts will help you with the numbers.

You will figure out the BG testing. It was hard for us at first, but now its a piece of cake. The warmer the ear, the easier it is to get the blood. Also, I aim for the very very edge of the ear, near the tip. Its her best draw spot. Her right ear also is much easier than the left. I actually have a really hard time testing her left ear. You will find what works for you guys. Hang in there!!
 
Hi guys and welcome! You are in the best place to get the most information you can about getting your kitty back to 100% .. I don't have any DKA experience myself, but others here do and will help answer your questions. We also use the relion micro with mocha .. We have found that if we rub her ears, right along the edge, and then sometimes on these very cold MI winter mornings, we warm up a sock that has some rice in it .. hold it on her ear for just a few minutes to get the blood flowing it really helps .. plus, it's a good idea to have a little treat for your kitty at testing time .. mocha just LOVES freeze dried chicken treats .. so she gets one each time we test her ..
 
If you absolutely have to, aim for the vein that runs along the outer edge of the ear.
Be prepared to test quickly, because piercing this vein usually causes a gusher.
Also be ready to firmly clamps some tissue or a cotton ball on the puncture once you have your sample.

And always give a low carb treat afterward, whether or not you are successful. Some folks will test 3 times, and if unsuccessful, stop, treat, and try again at the next shot time.

Another aid is Neomycin ointment with pain relief. Put a dab on the ear a few minutes before testing. Wipe off the excess right before you test. It helps the blood bead up for testing, reduces the annoyance factor of being poked, and aids in healing the puncture.
 
Thank you for taking the time to respond everyone. It's been a busy day with work and taking care of Martin, so that's why I haven't replied sooner.

We've started warming his ear before testing and that seems to help a lot - we're now usually able to get blood with only 1 or 2 tries, which is a huge improvement. I feel so bad poking his ear with the lancet each time and he seems scared of it, but we're starting to establish a routine that works. His ear is so thin that it seems like when I poke him I'm practically putting a small hole through it - am I doing this correctly or should I be doing something differently? He's not bleeding much when I poke him, just barely enough to get blood for the meter.

We've been mixing the canned food with a little bit of the dry and he seems much happier with that than just the canned food alone. He seems to have a pretty good appetite, although I don't think he's eating quite as much as he used to. Hopefully that will improve over time as he starts feeling better. I'll also look at FortiFlora, so thank you for that suggestion.

How often should we be testing for ketones? We definitely want to make sure he doesn't go into DKA again. If we find ketones when we test him is there anything we can do at home or do we just need to get him to the vet ASAP?

We want to give Martin treats after we test his BG but most of the treats I've seen are primarily made of grains and very high-carb. It sounds like freeze dried treats are a good option, so we'll look at picking up some of those.

Assuming we stick with PZI for insulin, are there any suggestions on where to buy it from? I saw http://felinediabetes.com/pzi-sources.htm but it seems like some of the pharmacies listed there only sell to vet offices. Our vet office charges about $110 for a 10ml bottle of U-40, and we're hoping we can find it cheaper online even after adding in shipping. We're in California in case that affects anything.

Thanks again to everyone for your kind words and advice, it's helping make this stressful time a little bit easier for us :smile:
 
Others have given you good practical advice so far, so I'll answer the quality of life issue. My Payne is a complex diabetic kitty, in the first 2 months of Dx. she went into DKA 3x ... remember a cat can't go into DKA without having ketones. So soon after a DKA I would check daily. Also eyes can go glassy, spacey when ketones are high, breath smells like acetone in some. Your goal is to monitor the ketones and not let your kitty head toward DKA.

Payne went down to 7 pounds back then and we had three vets sit us down for the "talk". Quality of life again, she was living in ER and ICU .... but she is a spunky kitty and we always felt we could figure this all out. It took time and constant monitoring but with one big mis-step (changing insulins 4th DKA 1 more talk :)
I believe I finally understand her and the diabetes, it has been almost a year since #4 and I really believe we are done with them.

Today Payne is a hefty 15 pounds and is back to her beautiful, I run the manor kitty. She has two civvies that she bosses endlessly and two dogs that she plays with but especially loves the 100 pound puppy. She is happy and comes for her tests for the snack after. I also feed raw chicken giblets cut up which they LOVE! pure protein. Also turkey meat and poached chicken.

Understanding your insulin and how your kitty responds is the foundation for you getting to the other side of the street. You have a good insulin especially for a kitty who throws off ketones, test, keep an accurate SS and keep asking questions, because the people here will guide you every step of the way.

Nancy and Payne .....
 
I test Garlands ketones about once a week. Unless she is acting weird.

If I notice she seems "off", the first thing I do is whip out my Ketone meter. But if she is fine and acting herself I will only do a spot check once a week as a precaution. I used to check much more often in the beginning though. Now, I can tell just by her behavior, Spreadsheet and eating amounts, how her ketones are doing. It took time to figure her out. You are doing great!!
 
It sounds like things are improving for Martin - good to hear!

It's like the ears "learn" to bleed- I think it is that the capillaries thicken the more they are poked. So keep working at it, it will become easier.

That price is good for ProZinc from the vet. It is not available except from the vet. The other form of ProZinc is PZI BCP, a compounded form of the insulin, is also available and costs less - particularly the first vial which your vet can get you free. There is some thought that a compounded form is less consistent quality than the regular ProZinc, but people have used it here with success. http://petdiabetes.wikia.com/wiki/BCP_PZI

Here is a list of some low carb treats: Lo carb treats

And here is some reading material on ProZinc to help. The document is large and you'll want to take it in small doses: viewtopic.php?f=24&t=32799 It does have info on the bottom on BCP.
 
nancy and payne said:
... It took time and constant monitoring but ...I believe I finally understand her and the diabetes, it has been almost a year since #4 and I really believe we are done with them.
Click to expand...


I think once you've had DKA, or were, as Nancy explained to me, "sitting on the edge of a cliff" with higher than safe ketones, you just have to be dilligent. You know the symptoms, know what triggers it, test as frequently as possible, and be prepared to respond if there's the slightest movement. I don't know for certain that we'll ever be "cured" of ketones, but once the insulin dose is where it needs to be (I'm still working to find that magic number), the diet is well regulated, and you know what to do... you'll be able to keep them in check and respond as needed.

Good luck! We all have the benefit of learning from one another - and that's a GREAT place to be!

Lu-Ann
 
Thanks again everyone. We had difficulty getting blood from Martin's ears again today and his BG was high again - 600+ pre-shot, 345 at +6 from the shot. We've only been at this for a couple of days now so we're hopeful that things will get better as time goes on and we settle into a routine, but right now it's stressful for us and him. Time will make things better though as we adjust to our new normal :smile:
 
Hi, I just wanted to say quickly, because I have to leave for work, that my cat survived DKA (you can read his profile attached to my signature). I don't know much at all about PZI, so you might want to post in the PZI forum as well for advice on dose. It sounds like he may need more insulin, though, with those high numbers. I don't know enough about that insulin to tell you, though. I hope his BG numbers come down, today.
 
Good Luck with Martin. I just found out that my cat Bo is diabetic and has ketones also, it is scary. I hope Martin's numbers come down today.
 
Hi Jake -

Keeping an eye on your posts for Martin thoughout the weekend. If I can help, just say so.

Lu-Ann
 
Thanks everyone. Martin seems to be feeling much better today and his BG levels have improved significantly. Unfortunately we were gone most of the day today due to work so we could only test his BG pre-shot, but it was 406 pre-shot this morning and 331 pre-shot tonight. We'll keep a close eye on it over the weekend to see what it's like throughout the day and to make sure he doesn't go hypo.
 
Hi everyone,

Wow, this morning was sure a surprise. Martin was really feisty and energetic and we had a hard time keeping him in one place so we could test his sugar. Eventually we were able to though and his AM pre-shot BG was 94 :o We're not going to give him his shot this morning since it's so low.

We'll be keeping an eye on him throughout the day and testing his BG occasionally. If it starts to go high again, should we give him a shot when it gets high, or should we wait until 12 hours from now to keep him on his normal insulin schedule?
 
What a lovely surprise! You can wait until he is over 200 and definitely rising to shoot if it won't play havoc with your schedule 12 hours from now. If you do, I would reduce the dose by 1/2 or so. That last dose you gave was too much, since it gave you an unshootable preshot (and most likely low numbers overnight).


If that isn't an option, you can skip and shoot at your regular pmps. HOWEVER, he is apt to be high after 24 hours since the last shot, so you don't want to react to that artificial number. So I would reduce that dose from the last one - by half to be safe if you are not going to be around. A little less than half if you will be around to monitor. If he is starting to react to the insulin, this is a time to play it safe, keeping him in good numbers, while you play with the dose.

Does that make sense?
 
Thanks for the advice. We just got off the phone with our vet and he recommended we check his sugar again in 3 hours and just keep an eye on it throughout the day. We usually give him 2 units PZI, but the vet said we should only give him 0.5 if his BG starts going back up since we don't want him going hypo. Luckily since it's a Saturday we'll be home most of the day, so we can keep a close eye on him and his BG. He's eating really well and I haven't seen him go to the water bowl in quite awhile, which is a huge change from just a couple of days ago.
 
Martin's BG is all over the place - I guess this is the point where we just really need to figure out what dose of insulin works for him. His BG was at 94 at this time yesterday, so we waited until it got a bit higher (283) and then gave him half of his usual dose. 12 hours after that he was back up to 600, and this morning he's at 600 again. I put his spreadsheet in my signature for anyone who might have suggestions about how we can help get him more consistent.
 
How about posting over in the PZI forum? Everyone there uses or has used your insulin and can give you input. You can also check out some of the threads and spreadsheets and see how others are doing. It is busiest on weekends and am and pm. Smaller forum than health but useful and friendly.

http://www.felinediabetes.com/FDMB/viewforum.php?f=24

I post there but will reply here also. I see some possible bounces. When they have been in fairly high numbers and then they get a 94 at the end of a cycle like 3/9, their liver panics and spills glucose. Some cats bounce the next full cycle; some bounce for the next preshot number. Not enough data for Martin to be sure which. But the 94 and the long duration of that cycle definitely says the 2 units is too much. The one unit may not be enough. So maybe 1.5 would keep him in nice numbers. It's all about gathering data and then trying to see trends and patterns.
 
Yeah, he was 600+ this morning and we gave him 2 units of PZI, now at +6 his BG is at 33, so he's hypo. Luckily he's still alert and seems okay, but we fed him and also gave him some corn syrup just to be safe. We'll decrease the dosage to 1.5 units max since he was 600+ this morning and 2 units brought him down to hypo levels. I'll post in the PZI forum a bit later today to get some advice there, it seems like it's just going to take some experimentation to figure out what's right for him. Thanks for your advice and help :smile:
 
Have you tested Martin since you got that 33? That is kind of low, you should retest after a while because the corn syrup will wear off and he might need some more carbs. Just FYI!
 
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