Ketoacidosis--Please help!

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Feed him as much as you can. I'm not a ketone expert, but everyone says the treatment for ketones is hydration, insulin, and food. Diabetic kitties don't utilize food as well as non-diabetic kitties, and they often need much more food than a normal cat ( sometimes twice as much) since much of the calories are going straight into the litter box. With Ramesses' high BGL and other issues right now, if it were me, I'd feed him every single time he asks for food and leave food out for him while you're out of the house. Low carb wet food won't raise his BGL. All you need to do is pull any uneaten food up 2 hours before when you do your pre-shot test. That way he'll be hungry enough to eat when he gets his insulin, and the pre-test number won't be bumped up be recent feeding.

Just a question-- you aren't trying to make him get by on only 2 meals a day, are you? Too many vets suggest this (I know my vet did, but I ignored him because I used to be a diabetic myself.) Like all diabetics, cats often do better on many small meals a day rather than two big ones. And when the time comes, having food available will help Ramsses if his blood sugar drops too low. Cat's naturally get hungry when their blood glucose drops, and that can keep them from getting a hypo reaction.
 
Juls and Billy said:
Feed him as much as you can. I'm not a ketone expert, but everyone says the treatment for ketones is hydration, insulin, and food. Diabetic kitties don't utilize food as well as non-diabetic kitties, and they often need much more food than a normal cat ( sometimes twice as much) since much of the calories are going straight into the litter box. With Ramesses' high BGL and other issues right now, if it were me, I'd feed him every single time he asks for food and leave food out for him while you're out of the house. Low carb wet food won't raise his BGL. All you need to do is pull any uneaten food up 2 hours before when you do your pre-shot test. That way he'll be hungry enough to eat when he gets his insulin, and the pre-test number won't be bumped up be recent feeding.

Just a question-- you aren't trying to make him get by on only 2 meals a day, are you? Too many vets suggest this (I know my vet did, but I ignored him because I used to be a diabetic myself.) Like all diabetics, cats often do better on many small meals a day rather than two big ones. And when the time comes, having food available will help Ramsses if his blood sugar drops too low. Cat's naturally get hungry when their blood glucose drops, and that can keep them from getting a hypo reaction.
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Great question! Yes we were. They told us not to let him free eat, but we were trying to find a balance between not free eating and letting him eat when he complained.

we’re headed into the vet now, so hopefully she can help/give us different food. All we have is the low carb dry food at the moment.
 
Okay, here's my opinion, and it's something a lot of members here follow. First, there is no need to feed any prescription food from the vet. All you need is low carb canned food. There's a food chart here. Many members feed Fancy Feast Pates. My Billy went into remission on Fancy Feast Pates. I'm going to post this now, hoping you'll see it before you buy expensive food from the vet.
 
Next, I want to address the two big meals thing. I highly suggest you ignore the vet on this one. Even if your kitty is overweight, now is not the time to limit food. Feed him any and every time he is hungry. Especially now with the DKA. I didn't limit Billy's food at all when we were getting him regulated, even though he's a fat boy. Many small meals help the body regulate blood sugar and keep it on more of an even keel. Worked for me when I was briefly diabetic, and absolutely worked for Billy too. As I said, just withhold food two hours before pre-shot test.

I also would like to know what kind of dry he's been eating. Is it a prescription dry? Our vet's office sent us home with Hills M/D, which is high carb and horrible for diabetic cats. I ended up giving it back, unopened, and I was angry at the vet for a hot minute for prescribing it. Interesting fact, the vet told my sweetie we should feed a low carb wet diet, it was the tech that sold him the exact opposite.

If you didn't see my above message in time, it's up to you if you want to feed any food they might have suggested. Let us know the brand of food and we can help with the carb content and see if it's a good choice. Any unopened food can be returned to the vet, I imagine.
 
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One member that I can think of that's dealt with DKA w/i the last 6 months would be @For_Luna . I haven't seen them on in a lil bit but, they do check in every now and again. I wonder if they couldn't offer you some additional advice. Sorry for being nosey:oops:
 
Please, please feed Ramesses multiple times during the day and night. Only feeding before shots is old thinking and definitely not the way to treat DKA. Don’t follow your vets advice if he advocates only feeding twice a day.

The reason ketones develop, simply explained, is when there is not enough food and insulin and the body can’t use the carbs, for nutrients so the body starts to break down proteins and fats and that produces ketones. So getting food/calories and plenty of it, into Ramesses is so important as we need him to be using the carbs in the food for energy not the fats and protein that will form the ketones.
Please reread sandy and black kitty’s post several posts back as it explains it well and she is very knowledgeable about DKA and it’s treatment.

You are so lucky that Ramesses is hungry and willing to eat. Many DKA cats won’t eat and need to be syringe fed for days.

I hope the vet took some blood to check how the DKA was going.
Please let us know how the vet visit goes.
 
Briere Fur Mom said:
One member that I can think of that's dealt with DKA w/i the last 6 months would be @For_Luna . I haven't seen them on in a lil bit but, they do check in every now and again. I wonder if they couldn't offer you some additional advice. Sorry for being nosey:oops:
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I'm sorry you're going through this. We had Luna at the animal hospital for 12 days and got every piece of bad news possible, and she still made it through. It sounds like you have everything covered.

You know what caused the DKA come on; the UTI.
You have antibiotics.
Your cat is eating and drinking.
You caught it early.

Keep testing BG and ketones. If something looks off, call your vet. Our first sign was Luna stopped eating and just looked different. Unfortunately, we caught it really early and her blood test didn't show any signs of infection or DKA.

Call your vet 100 times if you have to. We had to learn to be annoying. The vet's office will have to deal with it.

Listen to the advice on this board but listen to your gut too. You know your cat.

I'm sorry I can't be of more help. By the time our vet figured out what was going on with Luna, she needed to be hospitalized. We didn't do much treating on our own.

Please message or tag me if you have any questions. I hope everything works out for you.
 
Please, please feed Ramesses as much as he wants. He needs the food to combat the ketones from developing further and the more food the better.

In fact right now, I would not worry about carb content, canned versus dry. Or any of the "normal" suggestions we give to diabetic cat owners. Whatever and whenever he wants to eat, feed him.

What did the vet say at Ramesses visit today?

p.s. He needs more insulin. You have GOT to bring those HI BG readings down ASAP.
 
If you want a happy medium between free feeding which is fine or the 2 meals the vet tells you. Try feeding every 3-4 hrs AROUND the clock. You don't have to tell vet.

But those numbers need to come down. You might need different insulin. Subq fluids can also help with ketones. You can do them at home. Try kitten wet food, higher in calories but still under 10% carbs. Also Fancy Feast Savory Centers beef or chicken flavor. Cats really seem to love these.
 
A short acting insulin like the Vetsulin, an in-and-out type insulin, is better right now than a long acting insulin like Lantus or Levimir. Takes too long to build the "depot" when a cat is in DKA.

Agree with everything else Olive & Paula said.
 
Hi everyone!

I wanted to give you a little update. Rammy is up .6 pounds. He was at 11.3 Sunday, and is now at 11.9.

The vet was super impressed by the progress we made and was really positive. She said the BG will come down it just might take a bit. She said not to up the dosage because it will accumulate and the antibiotic will kick in.

Anyway, it was super positive. THANK YOU all! I'm hoping all is up from here, but I'll keep you all updated!
Lauryn
 
Lauryn Harriman said:
Hi everyone!

I wanted to give you a little update. Rammy is up .6 pounds. He was at 11.3 Sunday, and is now at 11.9.

The vet was super impressed by the progress we made and was really positive. She said the BG will come down it just might take a bit. She said not to up the dosage because it will accumulate and the antibiotic will kick in.

Anyway, it was super positive. THANK YOU all! I'm hoping all is up from here, but I'll keep you all updated!
Lauryn
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Vetsulin doesn't accumulated. She's confusing it with lantus. I'm not sure your vet knows a whole lot about treating diabetes. We want to get your cat out of those scary black and red numbers. Your dose is too low. Cats dosage needs change. So glad you are home testing now.
 
JanetNJ said:
Vetsulin doesn't accumulated. She's confusing it with lantus. I'm not sure your vet knows a whole lot about treating diabetes. We want to get your cat out of those scary black and red numbers. Your dose is too low. Cats dosage needs change. So glad you are home testing now.
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hi Janet!

sorry guys! It’s me not her. Honestly this whole thing has been extremely extremely draining and I totally wrote that out wrong. It’s not her, it’s me hahaha. This is all not my forte so explaining what she said is suuuuper hard.

She wants me to send his numbers to her and she will advise accordingly. And she wants me to do a couple full curves for her so that she can tell where he’s at and tell me how to adjust his insulin, so I will be emailing her throughout the week. She does know a lot about diabetes. I’m the one who doesn’t. But there is some syndrome that apparently can tank a cats blood pressure fast and kill them, and she wants to be safe and avoid that at all costs.

On another note, the urgent is still negative for ketones, and the antibiotics seem to really be kicking in! His numbers are trending down which is great! I’ll keep you posted again later today!
 
Lauryn Harriman said:
I’ll keep you posted again later today!
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We'd appreciate that very much. We worry about members when they disappear and wonder if they and their cat are ok. Especially worrisome if the cat is sick, like Ramesses.
Lauryn Harriman said:
But there is some syndrome that apparently can tank a cats blood pressure fast and kill them, and she wants to be safe and avoid that at all costs.
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I think you mean taking a cats blood glucose down very fast? Is that correct? It's called hypoglycemia. With those high black range BG numbers, Ramesses is no where near hypoglycemia. Not even near hypoglycemic numbers in the red, pink, yellow, blue ranges you see on the spreadsheet. It's when a cats BG (blood glucose) levels drop below 100 (<100) and then much lower, <50 that we become concerned.
Lauryn Harriman said:
On another note, the urgent is still negative for ketones, and the antibiotics seem to really be kicking in!
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Good that the urine is still negative for ketones. Things are looking up.

Ketones can develop very quickly, so if a cat has ever had ketones, like Ramesses has, then we suggest you test for ketones daily. Always. To catch the situation as early as you can, and avoid DKA (diabetic ketoacidosis).

Improving symptoms with him on the antibiotics could have helped with the ketones also.
Lauryn Harriman said:
His numbers are trending down which is great!
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Would you be willing to update your spreadsheet, so we can see those lower numbers? Is Ramesses down in the blue or green color coded numbers today?
Lauryn Harriman said:
sorry guys! It’s me not her. Honestly this whole thing has been extremely extremely draining and I totally wrote that out wrong. It’s not her, it’s me hahaha. This is all not my forte so explaining what she said is suuuuper hard.
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Understood. Take your time. Reread what our responses were. It's a lot to understand and can take some time. We can help with that.

Keep asking questions. Think of us as an adjunct resource, sharing knowledge with you that you can then share with your vet. Having a support group like this, as well as your vet can be very useful to diabetic cat owners.

ECID. Every Cat is Different, Every Caregiver is Different, Every Cycle is Different.

Keeping our paws crossed here that Ramesses continues to do well and get better and eats more.
p.s. Prozinc, Lantus, Levimir are the preferred insulins for cats. You might want to see if your vet is aware of the
(2018) AAHA Diabetes Management Guidelines for Dogs and Cats

See page 4, left hand column in that linked document. Vetsulin is recommended for dogs, not cats.
 
Hi all,
I know it's been quite awhile... I apologize for that and I want you all to know that we deeply appreciate the time and support you provided for us. There's been a lot going on in our lives with a separate family emergency (even before the pandemic thing!), and because of all of these factors, we stepped back from the forum and we were consulting with our vet predominately for treatment direction.

This is actually her husband now, (Bob) and I'm stepping in to pilot the home treatment. Ramesses had plateau'd but never really got much better than last time we spoke.

We have been working through things with our vet as best as possible, and even got a second opinion from another vet but they basically reiterated what we were already told. They were concerned about increasing his insulin dosage too quickly, so we were incrementally creeping it up by .5U each week. They were concerned about a Somogyi overswing if we increased too fast. I think overly concerned IMO.

They are very nice and capable vets, but I don't think they are experts in diabetic felines...So I wanted to give you all an update:
  • His BG levels never really got below HIGH, hence the lack of updates to the spreadsheet. We've never been able to make a curve because of this.
  • We finished the antibiotic treatment and he seemed a lot better - 1 course of antibiotics.
  • He still has an appetite and is eating normally.
  • He drinks and pees a ton still.
  • We were on Vetsulin and maxed out at 2.5units 2x daily.
  • We are administering subQ fluids at home every other day. 200mL per vet's recommendation. It really helps hydrate him.
  • The vets think he developed a resistance to Vetsulin. We just switched to Lantus yesterday, and I got one of those pens. He's on 2U 2x daily. Too soon to see how well it's working.
  • He's lost 1lb in the last two weeks, he's down to 10.5 lbs.
  • His ketones are back at "trace" now, so we're looking potentially at DKA again if we don't manage it.

Has anyone switched from Vetsulin to Lantus on the forum? Is it really a 1:1 dosage shift, or should we be upping it?

Personally, I want to up it because I'm sick of seeing the "HIGH" BG. But I understand that Lantus works a bit differently than Vetsulin, so I do want to be careful.

Probably not going back to the vet at this point. We have little left to lose and we're just thankful for any of the time that we have left with him. He's a sweetheart.

Thanks all! :bighug:
Bob
 
Hi Bob, I'm very glad to hear from you.
It may take time but if he has recovered from the DKA we can hopefully get him back to good health.
I'm glad Ramesses is eating well. Continue to feed him as much as he will eat. He needs at least 1 1/2 times as much as he would normally eat at the moment to keep the ketones at bay.

Continue to test every day for ketones. Are you testing with urine testing or a blood ketone meter?
With the swap over of insulins and the trace reappearing, it would probably be prudent to be testing for ketones twice a day. Could you do that?

Yes, lots of people have swapped from Vetsulin to Lantus. It is normally a swap to the same dose..
However Lantus is a depot insulin and it can take 5 days for the depot to fill initially so you need to stay with the same dose for the drop to fill and stabilise.
Also are you using the Lantus pen which only goes up in 1 unit doses?
What you need to get is some insulin syringes ...do not use the Vetsulin syringes..asthey are the incorrect type.
You can buy some suitable syringes from Walmart if you are near one.
They are called Walmart ReliOn 3/10 U-100 30 or 31 gauge 6 mm or 8 mm insulin syringes with 1/2 unit markings. They are $12.58 a box of 100. If you can't get that brand there are other brands such as Uticare, Carepoint, Sure Comfort and B/D.
Make sure they are the above type and make sure you only get ones with 1/2 unit markings on them.

Please try and maintain the SS now as we rely on that to help you even if it is only highs. I know how dispiriting that can be but hang in there, post every day and we will stay with you and help get this boy better!
Make sure you are testing before every shot and try and get a test in about 1/2 way through the cycles.

Are you feeding multiple times during the day as well as before the shots?
What are you feeding him?
He is probably losing weight because he is unregulated and the nutrients are not being absorbed.
I will speak to a couple of others about his insulin dose.
Looking forward to hearing back from you Bob.
Bron :stop:
 
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Switching insulin leaves a ketone prone kitty vulnerable. If he were mine I would increase to 2.5u with the next shot.

when my BK was heading towards his second episode of DKA I was guided by an FD guru on how to use Humilin R (R for short ) a fast acting non depot insulin, along with Lantus.

The idea is that R will help you keep a ceiling over how high the numbers go while you are climbing the dosing ladder to a good Lantus dose. It also gets more insulin into the picture which is critically important when battling ketones.

Note - It’s not advisable to attempt to add R to the mix without the guidance of someone who has experience.

I believe it can help. Let’s see what others think.
 
I agree with Sandy that increasing the dose to 2.5 units Lantus is needed. I would do this at your next shot as more insulin is needed to keep the ketones at bay. This is so important.
Also Sandy's idea of using R insulin to help bring down the BG is an excellent idea.
However, as Sandy said, you would need guidance from an experienced user of R insulin to do this and this can be organised if you would like to do this. We would hope to get Ramesses out of those black numbers.

I think it would be better if you started posting over on the Lantus page now that you are using Lantus and where you will get more experienced Lantus users to help you.
Here is the link. Put 'post DKA kitty' in your subject line to alert people. I will watch for your post.
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
 
My girl switched from Caninsulin (Vetsulin is just a rebrand) to Lantus. We should have switched at the same dose, didn't and took forever back to where we should have been. Ended up going higher in dose. I was lucky I wasn't dealing with ketones. That's my long winded way of saying increase to 2.5. If there is any way you can get later tests in every PM cycle, say at least +2, we'll be able to help you increase the dose faster. He needs to get out of those Highs.
 
Lauryn Harriman said:
OK. Thanks everyone. He's been on the glargine 2.5U for about a week now. Still "HIGH".

No ketones though! I am urine testing.

Still feeding him dry Royal Canin Glycobalance. He loves it. Open to other foods though if switching might help.

I posted here:
http://www.felinediabetes.com/FDMB/threads/post-dka-kitty.227503/
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Glyco balance is about 25% carb. Diabetic cats should eat foods under 10 percent. This may be why his numbers have not come down yet. Definitly change foods.
 
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