Lethargic after coming from Vet - Just diagnosed w/Diabetes

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mjamesb80

Member Since 2013
Hi!

My cat, Kramer, wet to the vet for decreased eating. Over a short period he became very critical.
He stayed at the emergency vet for 5 days.

Now - Feeding tube and insulin shots

My worry - After day 2 at home, he will not eat on his own. I'm still feeding through the tube 3-4 times a day.
I suppose I expected him to act a little more playful like he was 2 weeks ago.
Am I worrying too soon? Does this sound common for his condition?

It is Monday and I'm supposed to take him back to the vet on Thursday for a glucose curve.

He is throwing up a little bit. I don't think it's everything I give him. Vet prescribed meds to help ease the stomach.

I haven't seen him drink anything. I know the feeding tube food is mixed with water so maybe that is enough for him..?
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

mjamesb80 said:
Hi!

My cat, Kramer, wet to the vet for decreased eating. Over a short period he became very critical.
He stayed at the emergency vet for 5 days.

Now - Feeding tube and insulin shots

My worry - After day 2 at home, he will not eat on his own. I'm still feeding through the tube 3-4 times a day.
I suppose I expected him to act a little more playful like he was 2 weeks ago.
Am I worrying too soon? Does this sound common for his condition?

It is Monday and I'm supposed to take him back to the vet on Thursday for a glucose curve.

He is throwing up a little bit. I don't think it's everything I give him. Vet prescribed meds to help ease the stomach.

I haven't seen him drink anything. I know the feeding tube food is mixed with water so maybe that is enough for him..?
Click to expand...

I am sure many others will have questions and info for you, but there are a few things many will ask.

1. what insulin are you giving, what dose, and how often are you giving shots?
2. what food are you feeding in the tube, how much water in it?
3. what meds did the vet prescribe, what dose for each and have you noticed changes since starting them?
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Hello, and welcome to FDMB,

Did the vet say that your kitty had any ketone problems at all..?
Are you testing your kitty's urine for ketones? You can buy test strips for this at any pharmacy ('Ketostix' or 'Ketodiastix). Any reading above 'trace' levels is a reason to go straight back to the vet ASAP.

Most of us here test our cats' blood glucose levels at home. If you are willing to do that then it would give you a huge amount of information about how the insulin is working in your cat's body, and whether the dose is too low or too high, etc. It will also save you a lot of money in vets bills.... Many folks here use an ordinary glucose meter made for humans (doesn't need to be animal-specific). If you're willing to learn to test we can help you with that.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Hi, there!

I have one more question to ask: When you say he became "critical" was it from DKA (diabetic ketoacidosis) or hepatic lipidosis (fatty liver) from not eating? Depending on which could also depend on how long it takes for him to feel better and start eating on his own.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

1. what insulin are you giving, what dose, and how often are you giving shots?
2. what food are you feeding in the tube, how much water in it?
3. what meds did the vet prescribe, what dose for each and have you noticed changes since starting them?
Click to expand...

Answers:
1. Lantus - 2 ml - 2 times a day
2. Science Diet md - 1.5 cans mixed with 1.5 cans of water
3. Just anti nausea medicine - not sure of the name. He seems to have thrown up a little less.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Elizabeth and Bertie said:
Hello, and welcome to FDMB,

Did the vet say that your kitty had any ketone problems at all..?
Are you testing your kitty's urine for ketones? You can buy test strips for this at any pharmacy ('Ketostix' or 'Ketodiastix). Any reading above 'trace' levels is a reason to go straight back to the vet ASAP.

Most of us here test our cats' blood glucose levels at home. If you are willing to do that then it would give you a huge amount of information about how the insulin is working in your cat's body, and whether the dose is too low or too high, etc. It will also save you a lot of money in vets bills.... Many folks here use an ordinary glucose meter made for humans (doesn't need to be animal-specific). If you're willing to learn to test we can help you with that.
Click to expand...

I remember the vet saying he had ketones.
I am not testing for ketones currently.

I plan to purchase a glucose meter today and begin keeping records.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

KPassa said:
Hi, there!

I have one more question to ask: When you say he became "critical" was it from DKA (diabetic ketoacidosis) or hepatic lipidosis (fatty liver) from not eating? Depending on which could also depend on how long it takes for him to feel better and start eating on his own.
Click to expand...

The vet was certain that he had both last Monday (7 days ago), but she had to get him out of the first so we could treat the second.
We are still treating it with the feedings. I hope he is getting enough foods. I suppose I should give him a little more water through the feeding tube also as I have not seen him drink any over the weekend.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Hello there - sorry you are having issues. However I have a few questions..

2ml?!!! I am hoping you mean 2 units. 2mls is 1/5 of the vial and would be a serious overdose in most cats. if it is 2mls (thats 2 *1ml syringes full!!!) please call your vet asap and confirm!

Can you smell acetone from Kramers breath (nail polish remover?) if so please go back to your vet immediately.

Also when can you get those ketone strips? Can you pick them up while you are getting the meter today? (fyi walmart relion meter is good and cheap)

Wendy
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Please get the ketone test strips and let us know what the test result is.
If it is over Trace he will need to go back to the vet.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

aaah...so sorry you and your kitty are having to go through this. When you get the keytone strips,
get some gravel you would use in a fish tank. Have him pee on the gravel, so you can test the urine.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

There are 2 medications, one of which is usually prescribed for nausea/vomiting: Cernia (maropitant) or Zofran (ondansatron). If your vet has prescribed anything else (e.g., Reglan/metoclopramide or Pepsid/famotadine), it's likely to be less than effective at controlling the nausea. There's a good chance that Kramer won't eat on his own until the nausea is adequately addressed. With a kitty that's recovering from DKA, you need to be getting at least 1.5 times the usual amount of calories into him. This may mean feeding every hour or two. There is an excellent assist feeding group on Yahoo that I would urge you to look into. They have all sorts of information and videos that will make assist feeding much easier for you.

Lethargy is always a symptom that I find worrisome. This is why people are encouraging you to test for ketones. Ketones can become life threatening and if more than trace levels are present, they can't be managed at home.

Did Kramer have any sort of infection or inflammation that set this chain of events off? Often, pancreatitis will set the ball in motion. If, in fact, Kramer is still recovering from pancreatitis, he may be in pain. Pancreatitis is incredibly painful and medication (e.g., buprenorphine) will help him to feel a lot better.

Our concern here is that infection + not eating + not enough insulin is a recipe for ketones. However, if Kramer is getting too much insulin, he may be lethargic. Please follow up on your plan to get a meter and ketone strips (Ketostix) so you can be sure you are keeping your kitty safe. The Walmart brand, ReLion, is one that many people here use. The strips are comparatively inexpensive and readily available.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Wendy&Tiggy said:
Hello there - sorry you are having issues. However I have a few questions..

2ml?!!! I am hoping you mean 2 units. 2mls is 1/5 of the vial and would be a serious overdose in most cats. if it is 2mls (thats 2 *1ml syringes full!!!) please call your vet asap and confirm!

Can you smell acetone from Kramers breath (nail polish remover?) if so please go back to your vet immediately.

Also when can you get those ketone strips? Can you pick them up while you are getting the meter today? (fyi walmart relion meter is good and cheap)

Wendy
Click to expand...

Thanks Wendy!
I'm sure it is 2 units. I am new at this. It is a very small amount in the syringe.
I'll check on the breath later today.
I'll look for those ketone strips today when I go to Walmart.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

mjamesb80 said:
The vet was certain that he had both last Monday (7 days ago), but she had to get him out of the first so we could treat the second.
We are still treating it with the feedings. I hope he is getting enough foods. I suppose I should give him a little more water through the feeding tube also as I have not seen him drink any over the weekend.
Click to expand...

From what you're saying, it sounds like the vet cleared up the DKA and now you're mainly dealing with the hepatic lipidosis? If that is the case, then it can take some time for a cat to gain back its appetite, so don't worry if he hasn't started eating on his own just yet. And dealing with recovering from a DKA on top of it, your poor kitty's system might take a bit longer to heal. I agree with the other posters that it's imperative that you check for ketones to make sure they're not adding to the complications and DKA isn't rearing its ugly head again.

For the water, the reason Kramer might not be drinking on his own is because he's getting enough water with his food when you feed him through the tube. I wouldn't worry too much about this and giving him more water is always a good idea. With my own previous cat who recovered from hepatic lipidosis (it took him a month before he started eating on his own again), I blended the wet food with water (and I think KMR in the beginning), plus I would do a water flush of the tube after each syringe of food to help ease the food through the tube and into his system. I also fed him many, many small meals throughout the day (I think about 6 to 8 times) as too much food at once would cause him to vomit (he wasn't on any other anti-nausea or appetite stimulant medication, so this might be different for you). Before ending up with hepatic lipidosis, he was a cat that was "healthy" at about 22 pounds, but he ended up dropping all the way to 14 pounds, so he also needed a lot more calories than normal to help regain some of his weight back.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

I would suggest that you join this Yahoo group for more help. http://pets.groups.yahoo.com/group/Feline-Assisted-Feeding/ , if he is newly diagnosed with diabetes , don't worry, my kitty stopped eating for a while when we first found about her diabetes, until she's regulated on insulin.

syringe feeding I don't know if that what you mean ? I had experience with, I blend food in the food processor to make it liquid like a milk shake, think liquid and I feed her 4-6 (5ml) syringes every 2 hours. I was told not to mix with water by the vet as my cat was losing lots of weight. it's liquid enough when you blend in the food processor anyway.


Please join the group above for more help, many experienced people are there to help you, you just join and add a post, and you will get all the help you need. Good luck

Aseel & Noni
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

I normally help members with feeding tubes and am very active on the assist feeding group Asoolty linked to. When Maverick almost died in 2008 they saved his life. He would have died if I had listened to his vet. Please join this group right away and post an intro. They are the assist feeding/feeding tube experts. FDMB are the diabetes experts. Please keep the FDMB group posted on everything. I have a horrible stomach bug and I can't be online as much as I'd like to be. I promise you, you are in amazing hands with FDMB and the FAF group. I'd trust either group with all of my kitties over any vet.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

When you post on FAF - post what you are feeding, how much and how often. Also what medication he is taking and how much and how often.

Maverick almost died from FHL and recovered with a feeding tube. He was diagnosed with diabetes the year after he recovered from FHL.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Hello. I did not read every entry in the thread so excuse me if I am redundant. It is okay if your cat has not eaten yet. My cat almost died from DKA in early December. Hospitalized for four nights. Came home insulin dependent and with an etube in place for about 2 1/2 weeks. She did not drink water for days on her own. She did not start eating independently for over a week. She had a tough time tolerating the etube feedings. I had her on Ondansetron 2mg twice a day and Pepcid original strength 10mg 1/4 tab twice a day. The cerenia did not help much with her queasiness. That is more for vomiting. I blended my can of prescribed wet DM with a jar of Beechnut babyfood(no fillers or onion) and blended it for 5 minutes until it was hot. I then poured it into a small fine mesh strainer and pressed with a spoon to get the gritties out. I never had a clog. I had the etube removed and I requested an appetite stimulant to help transition her to independent eating. Worked like a charm. Wish I had done that sooner!! Just make sure it is the Cyproheptadine. My vet tried to push me into keeping the etube, but my cat was eating fine. Are you on the yahoo FAF group? Did this help? I hope so.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Just popping in to see how Kramer is doing. Did you get those strips?
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

mjamesb80 said:
Hi!

My cat, Kramer, wet to the vet for decreased eating. Over a short period he became very critical.
He stayed at the emergency vet for 5 days.

Now - Feeding tube and insulin shots

My worry - After day 2 at home, he will not eat on his own. I'm still feeding through the tube 3-4 times a day.
I suppose I expected him to act a little more playful like he was 2 weeks ago.
Am I worrying too soon? Does this sound common for his condition?

It is Monday and I'm supposed to take him back to the vet on Thursday for a glucose curve.

He is throwing up a little bit. I don't think it's everything I give him. Vet prescribed meds to help ease the stomach.

I haven't seen him drink anything. I know the feeding tube food is mixed with water so maybe that is enough for him..?
Click to expand...
you should be flushing the tube with water anyway to prevent clogging.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Kramer is doing much better. Feeding tube is now out.

Several trips back to the Vet.

I purchased test strips for his glucose and it still seems high.

Here's a summary of what has been going on:

1/12/13 Kramer doing better on feeding tube & receiving 2 unite of insulin every 12 hrs.

1/17/13 Kramer has gained weight. Liver responded well to treatment. Only 1 enzym has increased, ALT, and it has decreased from last week. Glucose curve shows insulin should be reduced to 1 unit every 12 hrs.

1/23/13 Glucose curve (at Vet) shows low glucose levels. Insulin discontinued.

1/29/13 Glucose curve (at Vet) shows high glucose levels. Insulin continued at 1 unit every 12 hrs.

1/31/13 Glucose curve (at Vet) began at 539 pre insulin, and dropped to 73 at 5 PM. Insuline continued at 1/2 unit every 12 hrs.

2/1/13 Glucose curve (at Vet) began at 462 pre insulin. Then 520, 440, 502, 398. Continue with 1/2 unit every 12 hrs.

2/8/13 Glucose curve (at Vet) began 699 pre insulin. Then 661, 540, 495, 515, 450. Owner will continue to spot test at home.

2/16/13 Glucose curve (at Home) began 515 pre insulin. After 1 unit, 419, 287, 295, 414
Notes: drank lots of water throughout the day, ate about 1/3 of a can of before each insulin.

After sending the 2/16/13 notes to the vet via email, they suggested 1 unit every 12 hrs and then do another curve next weekend (at home).

I spot tested on 2/20/13 at 6:55 PM...glucose was 413 (ate canned food at about 5:00 PM)
Gave 1 unit of insulin at 7:20 PM (ate dry food at 7 PM)...glucose was 329 at 9:28 PM

Note: The internal medicine doc has left our clinic. They are having to correspond with a doc at the state university regarding his condition.

I feel like the glucose is still too high. What do you think?
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Yes your right the glucose is still too high, but part of the problem could be the dry food. Almost all dry food is too high in carbs for a diabetic cat.

Haven't read through all your posts so going back and doing that now before commenting further.

Mel, Maxwell, Autumn & The Fur Gang
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Okay I think I have caught up some...so going to just have to ask since I'm not seeing it in any of your posts since he started eating on his own without the feeding tube...

What canned food are you feeding and what dry food? With our diabetic kitties we try to stay under 10% carbs, and closer to under 8%, few few dry foods fall under that classification so that could be one of the major problems with his numbers staying high. As well as not all canned food being created equal some is great for a diabetic cat, I have two of them along with 12 non-diabetics, mine all eat what my diabetics do, which is just plain Friskies pate style canned which is between 6-8% carbs.

Mel, Maxwell, Autumn & The Fur Gang
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Thanks for taking the time to reply.

He used to eat Purina Indoor dry food. I will say that we have a dry automatic feeder. Initially we mixed in a lot of the new Hills Prescription with whatever was already in the feeder to get him used to the new food. I would say it is now mostly Hills Prescription Dry mixed with Nature's Variety Dry.

I got a bag of dry Hills Prescription MD (Dry), Hills Prescription MD (Canned), Wellness (Canned), and Nature's Variety Instinct (Dry)

The idea was the start with the expensive Hills Prescription and then slowly mix in the other (which I felt was cheaper and still decent quality).

Here are some numbers to compare:

Purina Dry:
Protien: 30
Fat: 9.5
Fiber: 4.8
Moisture: 12
Carb: ~42.7

Hills Dry
Protien: 51.1
Fat: 21.8
Fiber: 6
Moisture: ?
Carb: 15.1

Hills Canned:
Protien: 52.8
Fat: 19.4
Fiber: 6
Moisture: ?
Carb: 15.7

Wellness Canned:
Protien: 11.5
Fat: 11.3
Fiber: .25
Moisture: 78
Carb: ~1.5

Nature's Variety Dry:
Protien: 50
Fat: 22
Fiber: 2.8
Moisture: 10
Carb: ~14.2
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

A wonderful member figured all the carb counts of various foods. Here is the page for dry foods: http://binkyspage.tripod.com/dryfood.html As you can see, Hills MD and Purina are both 13%. Nature's Variety is at the very bottom of the page and is 7%. We try to stay under 8 - 10% with many cats doing best in the 5-8% range. So the Nature's is the best, but there still are issues with dry food. This vet explains why here: www.catinfo.org

It sounds like you are testing at home now? We would not want you getting rid of the dry until you can monitor carefully at home. When we completely quit the dry and started the wet, Oliver dropped 100 points overnight. If we hadn't been testing, we would have given him the usual dose and he would have hypoed.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Its great that he is doing well and even better that you are home testing! Can you set up a spreadsheet so we can see and help advise?

Also if you are home testing please transition him off the dry. Its not doing Kramer any good. Moving to canned may help him into remission and at least help him get regulated. As Sue said, you want to feed under 10% carbs, 5-8% is even better.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Hi,

Update: Kramer is still on an all canned food diet. Glucose has been dropping to around 150 during the day after a 1 unit shot in the morning. The glucose is usually in the mid to upper 300's before his first shot in the morning.

I took him to the vet today for a checkup and would like some quick advice.

Vet: Blood Glucose is a little high at the vet. We could possible just adjust the insulin dosage. We could do a recheck of the ultrasound to make sure there is no insulin resistance such as an infection or inflammation anywhere.

Should I do this? I hate to spend the unnecessary money.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Do you mean you are only giving insulin 1 time per day? Insulin works best done twice a day, at approximately 12 hour intervals.

If you did mean 1 unit, only in the morning, consider giving 0.5 units every 12 hours instead.

Also, I would suggest you read the AAHA guidelines and print them out to discuss with your vet. Vets have to know so many animals and so many conditions, it is difficult to keep up with everything. These guidelines are for contemporary management of diabetes.
 
Re: Lethargic after coming from Vet - Just diagnosed w/Diabe

Welcme back! I was wondering how Kramer was doing!

The lantus is twice a day correct?

Are you only feeding the Hills m/d? If so, its 14% carbs so its too high which could be an issue.. Are you still home testing?

I wouldnt do the ultrasound yet - to really know whats going on home testing is key. Please set up your spreadsheet ( info was in my prior post) and lets have a look and see whats going on. And if you can home test, we can change him to a lower carb diet (5-8% is good)

Wendy
 
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