Kitty just DKA ..... what is she?

[nancy and payne]

I'm not sure if this is where I need to be but I have a very complex cat .... and she doesn't seem to fit in anywhere else ohmygod_smile I don't know if any of you have followed our saga? being Dx a little over 5 months ago and going into DKA 3x then. We have tried a lot of things to bring her #'s in line but we keep fighting ketones and DKA, last Sunday being our 4th. DKA, then Thursday she was DK_

One thing that stuck out this last time is the amount of insulin she needed .... on Mon.-Tues. she had 45uR in the IV plus 20u Lantus. Now I know she was fighting DKA/ketones but that's 65u in 2 days!! and her #'s never dropped below 200! Thurs.-Fri. she had about the same but her ketones never went away!? The vet believes she has pancreatitis also but he feels better with something to go on. And maybe .....

We had changed insulin and her daily intake was cut 1/2 and R was dropped from her regimen .... it is my and some others belief that the cut in her insulin coupled with the inflammation from the pancreatitis caused the DKA ..... ??

We also changed how she got her shot. We had found that she responded well to t.i.d. but Lantus can't be given like that so we went to 12/12. It almost seems as if the high insulin somehow protects her. I have read about high insulin cats and she doesn't seem to fit the typical. What does she sound like? BTW her name is Payne, spelled that way to be nice

If this makes no sense, I'm sorry. I'm tired, it's late and this week has been _ _ _ _! Any suggestions would be much appreciated.

Nancy and Payne (who wants this all to stop!)
we have gone back to our old regimen ...... she is a little girl, 11 lbs.

 

[Blue]

I cannot access your spreadsheet; can you set the permissions so that anyone with the link can view it?
I and others can reply when the dosing and BG numbers are visible.

Added:
I did look at an old ss, and the last notes are dose of 4u and comments going to TID ProZinc??
If you are suspecting a high dose kitty in your Payne, you should consider switching to Levemir, and NOT going to TID ProZinc.

For pancreatitis, I have also had issues with Shadoe; we use Pepcid BID along with SQuids and bupe for the pain, as it is very painful. I am hoping you would be doing the same,but I have zero experience on DKA. Many others here can help with that serious issue.

The dosing in your post differs greatly from Payne's old ss, but since I can't see your ss now, the 20u Lantus and 45uR mentioned is not anyplace on the ss.... can you say more about the 20uLantus?

 

[Carolyn and Spot]

One thing to bear in mind is that when a vets office is treating dka or ketones, there will be glucose in that IV drip as well as R. You can't take the dosages they gave and translate it to anything you would do at home because it's not at all like how you'd treat at home. When a *diabetic* cat comes in throwing ketones, or in dka, or in any other kind of life threatening undiagnosed IM condition, the very first thing they do is plug in an IV with R because of its short action, and they also add glucose to it. It seems counterintuitive, but it's how it's treated. Vets generally do not rely upon, or even use, long acting insulins in situations like this because it will interfere with their eradication of the ketones, and could very easily hypo the cat.

Insulin
Some guidelines recommend a bolus (initial large dose) of insulin of 0.1 unit of insulin per kilogram of body weight. This can be administered immediately after the potassium level is known to be higher than 3.3 mmol/l; if the level is any lower, administering insulin could lead to a dangerously low potassium level (see below).[1][5] Other guidelines recommend delaying the initiation of insulin until fluids have been administrered.[9]
In general, insulin is given at 0.1 unit/kg per hour to reduce the blood sugars and suppress ketone production. Guidelines differ as to which dose to use when blood sugar levels start falling; some recommend reducing the dose of insulin once glucose falls below 16.6 mmol/l (300 mg/dl)[1] but other recommend infusing glucose in addition to saline to allow for ongoing infusion of higher doses of insulin.[9][5]

http://en.wikipedia.org/wiki/Diabetic_ketoacidosis

To understand what is going on, you need to understand what happened. Ketones are caused by insufficient insulin. That could mean Payne wasn't getting enough insulin, or it could mean Payne wasn't using her insulin effeciently.. regardless, that's the first cause. DKA = ketones + insufficient food + infection/illness The food part comes in when the DKA makes them inappetant. That's why we're always telling people to try to force their cats to eat when they're sick. An illness or infection can make a cat inappetant and it can also make the insulin not work and bring on ketones. Voila, DKA. Just that fast in many cases.

Now, if she really does have pancreatitis (up to 50% of diabetic cats do), which would require the fPLI test to diagnose properly, that could absolutely bring on ketones and DKA. Pancreatitis hurts their tummies, and makes them not want to eat. Additionally, it makes their bg's too high because the pancreas is in crisis, along with several other organs. Pancreatitis is essentially pancreatic fluids leaking from the pancreas into the abdomen, where it literally eats the surrounding tissues. Very painful. I saw your other thread from Thursday and where Sienne says to get that test, she's absolutely correct. You can not diagnose pancreatitis without it. If you look up the values that were elevated when your vet said these values indicate pancreatitis, you will find many things can cause those values to be elevated. It's an educated guess, but it's still a guess.

Things you need to know: do not fear hypo with the vehemence that you fear DKA. Do not worry about your cat hypoing when you've got a bottle of Karo and cans of high carb canned food. I see a lot of people lose their cats to DKA because they feel hypo kills faster. It sure does, but not on this site, and with proper guidance and proper knowledge. Once your cat has had DKA, your cat will be DKA prone the rest of its life. If your cat has pancreatitis, you haven't seen the last pancreatitis attack either. So this is why it's important to get her tested for pancreatitis and learn to recognize the signs of an attack coming so you can be prepared with fluids, pain meds, nausea suppressants, pancreatic support and increased insulin and head off ketones and DKA before they happen.

Your SS: here's why no one can see it. You're posting what we call the "ccc" link. If you look at your URL, it has ccc in it. You have to go to the Publish This Page section of your SS and get the link they give you there to Share it. It'll have "pub" in it and not "ccc". ie:
The link you want to give us will start out looking like this: https://spreadsheets.google.com/pub?hl= ... hetcetcetc
The link you gave us looks like this: https://spreadsheets.google.com/ccc?key ... hetcetcetc This is the link YOU use to edit your ss and we are not able to access your account so we can't see it.

Hope this helps, (((hugs))) to you and Payne

 

[Cheryl & Whiskers (GA)]

Hi Nancy,

I'm sorry, I know you and Payne have been thru a lot. Many of the Acromegaly/IAA/Cushings cats do need higher doses of insulin. Has you vet check for any of these diseases? It appears you gotten several good suggestions here, I really hope that some of it will help you
and Payne. You sure deserve a break. :YMHUG: :YMHUG: :YMHUG: