Maverick has DKA again, large ketones

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Mathilda and Maverick

Mathilda and Maverick

Member Since 2020
Maverick was home tested for ketones at 1:20PM today with negative results. It's now almost 12 h later 1AM here and he just tested LARGE several times. He has had high BG's lately, but been eating very well. He also is treated with Metronidazole since 12/26 for diarrhea. I have not seen him poo today but yesterday it was still diarrhea. He wants to drink much now, and I just gave him 50mls SubQ. Is there anything I can do at home tonight? Last time we took him to the ER for moderate ketones, they just gave him fluids and said it wasn't much more they could do since he still was eating then. He shows interest in food now, but has yet to eat more than licking the "gel" in the can. We are already $12,000 deep this past month and a half so would prefer to home treat if that its possible. What should I do?

ETA: He won't eat his regular food (PPP D/M), but just ate another canned food I had home (Instinct Original Pate Rabbit) so he is still eating.
 
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While we are waiting for a reply Mathilda, have you considered doing Tight Regulation with Maverick? You are testing often enough and TR will help get Maverick into better numbers faster as long as he is not eating dry food.
 
Judy and Freckles said:
While we are waiting for a reply Mathilda, have you considered doing Tight Regulation with Maverick? You are testing often enough and TR will help get Maverick into better numbers faster as long as he is not eating dry food.
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Yes that's what I want to go with, but I have a hard time as my vet and I are not quite on the same page yet and I am frankly very worried to go my own way- it's been a hard time since he was diagnosed. I know it sounds crazy
 
Mathilda and Maverick said:
Yes that's what I want to go with, but I have a hard time as my vet and I are not quite on the same page yet and I am frankly very worried to go my own way- it's been a hard time since he was diagnosed. I know it sounds crazy
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Yes, I understand. My vet was the same way. I felt more alone dealing with just my vet until I found FDMB. I did my research and took the research to my vet and he couldn't argue about the science though. Eventually he just learned to listen to me and "humor me" - while all the while I was getting advice, and great advice it was, from the experienced people on this forum.
 
Judy and Freckles said:
Yes, I understand. My vet was the same way. I felt more alone dealing with just my vet until I found FDMB. I did my research and took the research to my vet and he couldn't argue about the science though. Eventually he just learned to listen to me and "humor me" - while all the while I was getting advice, and great advice it was, from the experienced people on this forum.
Click to expand...

That's where I'm trying to get, the issue is that they do curbside and I just moved here so I never met the vet and only speak with her on the phone. Whenever I call and have questions, I never get to speak to her, but always via a technician so half the message get lost and it's easy for the vet just to repeat herself, there's no dialogue. But I'm trying to do better and if I can get Maverick past this alive, I'll be more proactive in follow the board and my guts.
 
Does Maverick have any other symptoms?
How are you testing for ketones? blood? urine?

Signs of Diabetic Ketoacidosis (DKA)
  • Drinking excessive amounts of water OR no water
  • Excessive urination
  • Diminished activity
  • Not eating for over 12 hours
  • Vomiting
  • Lethargy and depression
  • Weakness
  • Breathing very fast
  • Dehydration
  • Ketone odor on breath (smells like nail-polish remover or fruit)
Causes of Diabetic Ketoacidosis (DKA)
  • Insulin dependent diabetes mellitus
  • Inadequate insulin dosing or production
  • Infection
  • Concurrent diseas that stresses the animal
  • Estrus
  • Medication noncompliance
  • Lethargy and depression
  • Stress
  • Surgery
  • Idiopathic (unknown causes)
Risk Factors for DKA
  • Any condition that causes an insulin deficiency
  • History of corticosteroid or beta-blocker administration
Diagnosis
Laboratory tests performed by your vet are necessary for diagnosis. Depending on how sick your cat is, the testing can be extensive (and expensive). Your veterinarian will determine what tests are necessary. At a minimum, testing is likely to include a number of blood tests and a urine test.

Treatment
If the cat is bright, alert, and well-hydrated, the cat will not require intensive care. Your cat will require insulin, food, constant access to water, and close monitoring for signs of illness such as vomiting, anorexia, and lethargy.

Treatment of cats who show signs illness require inpatient intensive care. The goal of treatment is to correct dehydration, electrolyte depletion, to reverse the high ketones in the blood and the metabolic acidosis that is present, and to increase the rate of glucose use by insulin-dependent tissues.

Veterinary care for DKA involves intravenous (IV) fluids, usually supplemented with potassium, monitoring by observation and urine and blood tests, and sometimes feeding by a tube. Treatment may involve a hospital stay of five days or more and often costs about US$2000. Without treatment, "sick" animals with DKA will die.

Testing for Ketones
Simple urine tests can detect ketones. This is done by collecting a urine sample and inserting a special dip stick into the urine. Some urine ketone strips detect only ketones while other types test for both glucose and ketone levels. Urine ketone strips will detect only some of the ketone bodies produced by the body, not all of them. Strip storage, handling, and testing procedures are similar to those used for glucose test strips. Strip test results are indicated by presence of color changes, indicating presence of ketones, either quantitatively (giving you a number for the ketone concentration) or by descriptive terms (for example, negative, trace, small, or large). False positives may occur if you are also using certain medications or vitamins, or if the strips have been handled or stored improperly. It is extremely important to follow the directions on use of the urine ketone test strips as the time to read the strip is generally within 15 seconds but may vary by brand.

If you wish to test blood instead of urine for ketones, there are four meters that allow for home testing; most members use the Nova Max Plus Glucose and Ketone Testing Meter or the Abbott Precision Xtra Meter. The premise behind blood testing for ketones is the same as that for favoring glucose testing of blood over urine. Some of the meters also do glucose testing with meter-specific glucose test strips. Blood ketone strips can be obtained at
American Diabetes Wholesale.
When to call the vet
In a diabetic, any urinary ketones above trace or trace urinary ketones plus some of the signs listed above, are cause to call a veterinarian immediately. If your vet doesn't offer after-hour emergency care, be sure to have the number and location of a 24 hour emergency veterinarian.

https://www.felinediabetes.com/FDMB/forums/feline-health-welcome-main-forum.28/


Also tagging @Marje and Gracie
 
Judy and Freckles said:
Does Maverick have any other symptoms?
How are you testing for ketones? blood? urine?

Signs of Diabetic Ketoacidosis (DKA)
  • Drinking excessive amounts of water OR no water
  • Excessive urination
  • Diminished activity
  • Not eating for over 12 hours
  • Vomiting
  • Lethargy and depression
  • Weakness
  • Breathing very fast
  • Dehydration
  • Ketone odor on breath (smells like nail-polish remover or fruit)
Causes of Diabetic Ketoacidosis (DKA)
  • Insulin dependent diabetes mellitus
  • Inadequate insulin dosing or production
  • Infection
  • Concurrent diseas that stresses the animal
  • Estrus
  • Medication noncompliance
  • Lethargy and depression
  • Stress
  • Surgery
  • Idiopathic (unknown causes)
Risk Factors for DKA
  • Any condition that causes an insulin deficiency
  • History of corticosteroid or beta-blocker administration
Diagnosis
Laboratory tests performed by your vet are necessary for diagnosis. Depending on how sick your cat is, the testing can be extensive (and expensive). Your veterinarian will determine what tests are necessary. At a minimum, testing is likely to include a number of blood tests and a urine test.

Treatment
If the cat is bright, alert, and well-hydrated, the cat will not require intensive care. Your cat will require insulin, food, constant access to water, and close monitoring for signs of illness such as vomiting, anorexia, and lethargy.

Treatment of cats who show signs illness require inpatient intensive care. The goal of treatment is to correct dehydration, electrolyte depletion, to reverse the high ketones in the blood and the metabolic acidosis that is present, and to increase the rate of glucose use by insulin-dependent tissues.

Veterinary care for DKA involves intravenous (IV) fluids, usually supplemented with potassium, monitoring by observation and urine and blood tests, and sometimes feeding by a tube. Treatment may involve a hospital stay of five days or more and often costs about US$2000. Without treatment, "sick" animals with DKA will die.

Testing for Ketones
Simple urine tests can detect ketones. This is done by collecting a urine sample and inserting a special dip stick into the urine. Some urine ketone strips detect only ketones while other types test for both glucose and ketone levels. Urine ketone strips will detect only some of the ketone bodies produced by the body, not all of them. Strip storage, handling, and testing procedures are similar to those used for glucose test strips. Strip test results are indicated by presence of color changes, indicating presence of ketones, either quantitatively (giving you a number for the ketone concentration) or by descriptive terms (for example, negative, trace, small, or large). False positives may occur if you are also using certain medications or vitamins, or if the strips have been handled or stored improperly. It is extremely important to follow the directions on use of the urine ketone test strips as the time to read the strip is generally within 15 seconds but may vary by brand.

If you wish to test blood instead of urine for ketones, there are four meters that allow for home testing; most members use the Nova Max Plus Glucose and Ketone Testing Meter or the Abbott Precision Xtra Meter. The premise behind blood testing for ketones is the same as that for favoring glucose testing of blood over urine. Some of the meters also do glucose testing with meter-specific glucose test strips. Blood ketone strips can be obtained at
American Diabetes Wholesale.
When to call the vet
In a diabetic, any urinary ketones above trace or trace urinary ketones plus some of the signs listed above, are cause to call a veterinarian immediately. If your vet doesn't offer after-hour emergency care, be sure to have the number and location of a 24 hour emergency veterinarian.

https://www.felinediabetes.com/FDMB/forums/feline-health-welcome-main-forum.28/


Also tagging @Marje and Gracie
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I'm testing with urine strips so I know it will more likely be worse than what I see on the strips.
-He is not drinking excessively, but much more than he normally does.
-His breathing is somewhat increased.
-He is on Cerenia so that would mask the vomiting symptom if he had that symptom.
 
I'm sorry no one else with experience is on the board right now. I found this other information on another sticky on the FDMB.
https://petdiabetes.fandom.com/wiki/Ketoacidosis

When to come to the vetedit | edit source
Trace urinary ketones may or may not be an emergency, depending on the case. If a vet is unavailable, look for some of the other signs or triggers, and try to remedy any you can. Give extra water and food, by syringe if necessary. If it's nearly time for an insulin shot, give one. Continue testing and call a vet when possible.

DKA cannot be treated at home. Veterinary care for DKA involves intravenous (IV) fluids to flush the animal's system of the ketones and when necessary, to replace depleted electrolytes[19][20][21], such as bicarbonate; intravenous or intramuscular fast-acting insulin to bring the blood glucose levels down[22][23]; measured amounts of glucose or force feeding, sometimes by feeding tube, to force the metabolism back from fat-burning to glucose-burning.

Dehydration becomes involved with ketoacidosis, which can mean that subcutaneous insulin injections are not properly absorbed; when this occurs, intravenous treatment with soluble, short-acting insulin is needed[24],along with rehydrating intravenous fluids[25].

Veterinary care for DKA may involve a hospital stay of five days or more and cost, in the U.S., $2,000 or more. Some animals are DKA prone, and may have multiple episodes of the condition.

Veterinarians have sometimes been known to send pets home from a DKA episode while still displaying ketones in the urine due to owner financial constraints -- this can turn into a fatal mistake. Your chances of fixing the problem yourself are slim. If your cat or dog comes back from the hospital and still has ketones showing on urine testing stix, it's usually best to find the financial means to go right back to the vet's as your pet may need to stay in hospital longer.
 
Judy and Freckles said:
I'm sorry no one else with experience is on the board right now. I found this other information on another sticky on the FDMB.
https://petdiabetes.fandom.com/wiki/Ketoacidosis

When to come to the vetedit | edit source
Trace urinary ketones may or may not be an emergency, depending on the case. If a vet is unavailable, look for some of the other signs or triggers, and try to remedy any you can. Give extra water and food, by syringe if necessary. If it's nearly time for an insulin shot, give one. Continue testing and call a vet when possible.

DKA cannot be treated at home. Veterinary care for DKA involves intravenous (IV) fluids to flush the animal's system of the ketones and when necessary, to replace depleted electrolytes[19][20][21], such as bicarbonate; intravenous or intramuscular fast-acting insulin to bring the blood glucose levels down[22][23]; measured amounts of glucose or force feeding, sometimes by feeding tube, to force the metabolism back from fat-burning to glucose-burning.

Dehydration becomes involved with ketoacidosis, which can mean that subcutaneous insulin injections are not properly absorbed; when this occurs, intravenous treatment with soluble, short-acting insulin is needed[24],along with rehydrating intravenous fluids[25].

Veterinary care for DKA may involve a hospital stay of five days or more and cost, in the U.S., $2,000 or more. Some animals are DKA prone, and may have multiple episodes of the condition.

Veterinarians have sometimes been known to send pets home from a DKA episode while still displaying ketones in the urine due to owner financial constraints -- this can turn into a fatal mistake. Your chances of fixing the problem yourself are slim. If your cat or dog comes back from the hospital and still has ketones showing on urine testing stix, it's usually best to find the financial means to go right back to the vet's as your pet may need to stay in hospital longer.
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Judy and Freckles said:
Everything that I've read points to needing a vet to get the ketones down as it can get ugly fast. Here is an older thread about dealing with ketones

https://www.felinediabetes.com/FDMB...is-ketones-have-spiked-in-over-my-head.31350/
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Judy and Freckles said:
Everything that I've read points to needing a vet to get the ketones down as it can get ugly fast. Here is an older thread about dealing with ketones

https://www.felinediabetes.com/FDMB...is-ketones-have-spiked-in-over-my-head.31350/
Click to expand...

Maverick was at the ER Dec 22 for 1/2 day, they gave him IV fluids and did some testing, ketones was then +2. The vet sent him home after about 5-6h on fluids, recommended a 0.25 increase in insulin. I know the DKA can turn super fast, but I'm not sure the ER will be able to do much as he is not showing any for them "concerning" symptoms such as lethargy, vomiting, and anorexia.
Thank you so much for your support and help, I'll check the links out!
 
I'm sorry I couldn't be of more help. You have more experience dealing with DKA that I do so I hope the links are helpful. Sending healing thoughts to Maverick and hope he continues to be symptom free. I'm heading to bed. Please post an update as I'll be thinking of you and your little guy!
 
I would get another 50 mls sub-q fluids into him, 75 if he's a big cat as long as he's eating and otherwise doing okay. Some cats are more prone to developing ketones so it's a good idea to always have fluids on hand.
 
Can you count his resps and tell us what they are please?

I would encourage him to eat as often as you can get him to eat....small amounts...we don’t want him to be sick. What ever he will eat at this point. Doesn’t matter if it is higher carb or even dry. The most important thing is he eats!

How much subQ fluids were you giving him last time?
Does he have any heart issues that you know of?
How much Sub Q fluids did the vet say to give last time?

I would swap to TR as well so you can increase the dose more frequently.
How long since you gave the subQ fluids?
When you get a chance can you catch a pee and test for ketones again please?
How long until the next insulin dose is due?
 
If you get Maverick to the vet or the ER, they need to run blood work. You need a blood ketone level as well as a blood panel that will give you information about his electrolytes.

You can buy a blood ketone meter. Check on Amazon or ADW. It’s more accurate than testing for urinary ketones. Also, check the expiration date on your urinary ketone strips and make sure you’ve been following the instructions exactly. Most cats that are ketotic are feeling sick. Maverick’s symptoms and ketone readings are out of sync. He does need to see a vet, though.
 
Guys, I just now seeing these replies- I didn't get any alerts or anything so I completely missed all this. Maverick is doing ok, ketones luckily seems to be flushed out for this time. I'll go back nd reply to each individually. Thank you so much for all help!
 
Deborah & Muffy(GA) & Wendall said:
I would get another 50 mls sub-q fluids into him, 75 if he's a big cat as long as he's eating and otherwise doing okay. Some cats are more prone to developing ketones so it's a good idea to always have fluids on hand.
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Thank you! His ketones are now negative, but I'm still planning on giving another 50mls tonight. Can I overdose on subQ? He is a big cat but underweight now, used to be 13-14lbs (ideal weight, not overweight) and now he's down to 10.60ish lbs.
 
Bron and Sheba (GA) said:
Can you count his resps and tell us what they are please?

I would encourage him to eat as often as you can get him to eat....small amounts...we don’t want him to be sick. What ever he will eat at this point. Doesn’t matter if it is higher carb or even dry. The most important thing is he eats!

How much subQ fluids were you giving him last time?
Does he have any heart issues that you know of?
How much Sub Q fluids did the vet say to give last time?

I would swap to TR as well so you can increase the dose more frequently.
How long since you gave the subQ fluids?
When you get a chance can you catch a pee and test for ketones again please?
How long until the next insulin dose is due?
Click to expand...

Thank you so much for replying, I know this is late- I kept on going back to the board last night but never got any alerts so I was unaware of all the help posted after 2AM. Maverick is doing better today but I'm still worried.

His reps as of now is 31.
I did feed him small amounts all night and all day, he was a little fussy taking a long time eating to start with but his appetite is great now and he has eaten a lot.
I gave him 50mls last night, I think I'll give him another 50 tonight even though ketones now are negative- or can I give too much?
The vet just generally said to never give more than 100mls/24h. I am not aware of any heart issues, he had liver issues though, not sure if that is a concern as well? I called vet and asked today and they didn't want to give me any advice as they didn't see him and couldn't assess his hydration (my vet wasn't in either).

I also think TR is the way to go, but I'm having a hard time as the vet is not on the same page.
He tested large ketones at PMPS +3 last night (several stcks), at +7 it was moderate to large, then at +10 he tested small. Today at AMPS +7 he was negative, and he was still negative at PMPS. I failed to test the day before so he may have been positive than also, but to me it seems like the ketones flushed out pretty quickly, is that because he still ate and drank so well? and because of the subQ?
 
Sienne and Gabby (GA) said:
If you get Maverick to the vet or the ER, they need to run blood work. You need a blood ketone level as well as a blood panel that will give you information about his electrolytes.

You can buy a blood ketone meter. Check on Amazon or ADW. It’s more accurate than testing for urinary ketones. Also, check the expiration date on your urinary ketone strips and make sure you’ve been following the instructions exactly. Most cats that are ketotic are feeling sick. Maverick’s symptoms and ketone readings are out of sync. He does need to see a vet, though.
Click to expand...

Thank you so much for your advice! For some reason I was unable to see this yesterday. Maverick is doing better today the ketone seems to be gone for this time. I am taking him to the vet on Tuesday, unless he get worse again and I'd need to get him in earlier- but do you still think I'd need the blood work? Poor cat has done blood work at least once each week since diagnosed. Maverick seems to be very out of sync when it comes to DKA and symptoms- perhaps he has higher tolerance? When he had it last he didn't show any "real" concerning symptoms either, but when the ER ran the blood he was +2 on ketones, had mild hypochloremia at 111, and increased cholesterol at 269. I had sticks from two different batches, one newly opened and one opened about 3 weeks ago- both still good dates and following the 15sec. I do think it's weird as how quickly the ketones flushed out also- or is it fast? Here's the timeline: He tested large ketones at PMPS +3 last night (several sticks), at +7 it was moderate to large, then at +10 he tested small. Today at AMPS +7 he was negative, and he was still negative at PMPS.
 
Hi Matilda,
Always check your thread to see if there are replies.. Don’t rely on the alerts.
If you have decided to go with TR can you put that in your signature please so we can see it...thanks. What is your vet not on board about?
I think that with the DKA Maverick will do better on TR as you can increase the dose more quickly.
If you are happy to go with TR and Maverick does not drop into blue numbers overnight, I would increase the dose of insulin to 1.25 units in the morning.
That is really good he has negative ketones today. Keep testing at least twice a day at the moment.
No doubt the extra food and subQ fluids are helping. Keep up with the extra food snacks.
I’m not sure about giving the second lot of subQ fluids in the 24 hours....only because of the increased resp rate...I am a bit concerned with the higher resps rate. I am going to tag @Wendy&Neko to see what she thinks about it.
 
Bron and Sheba (GA) said:
Hi Matilda,
Always check your thread to see if there are replies.. Don’t rely on the alerts.
If you have decided to go with TR can you put that in your signature please so we can see it...thanks. What is your vet not on board about?
I think that with the DKA Maverick will do better on TR as you can increase the dose more quickly.
If you are happy to go with TR and Maverick does not drop into blue numbers overnight, I would increase the dose of insulin to 1.25 units in the morning.
That is really good he has negative ketones today. Keep testing at least twice a day at the moment.
No doubt the extra food and subQ fluids are helping. Keep up with the extra food snacks.
I’m not sure about giving the second lot of subQ fluids in the 24 hours....only because of the increased resp rate...I am a bit concerned with the higher resps rate. I am going to tag @Wendy&Neko to see what she thinks about it.
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Yes, I will from now on- I am so sorry.
My vet has made very clear that she wants me to stick with 1 unit for a full week ( I increased the dose from 0.75 to 1 without consulting with her and she seemed very disturbed by that). I am new to the area, and this is the best vet I've found this far, but she is hard to get a hold of, and each time I'm calling in for questions I can never talk directly to her so that makes the message getting lost half the time. We are also about to change Man diet to novel protein because of potential allergies and IBD, but she's set to have him on these prescribed diets with awful high carbs- I'm questioning it as she has no intention of regulating his insulin in conjunction with increasing his carb intake- but rather wait and see. The wait and see approach obviously puts my cats life at risk so I'm hoping to get to speak to her and come up with a plan with are comfortable with as I do not want to find another vet as she indeed is very read up on his several issues and medical history.
He has been eating small meals several times a day since you first advised me to it and I think that is one of the reasons to why he kept on eating the small meals yesterday. He doesn't seem dehydrated today- her really didn't seem dehydrated yesterday either- but I'm more concerned about a imbalance in the electrolytes now more so than ketones. I will probably hold off with fluids until tomorrow then. Is there any other concerns than the hart if one overdose on fluids? Would it be good to give him 50mls every second or third day for a while now, or should I only give it whenever he seems dehydrated? His diarrhea seems to have improved this weekend so hopefully that will restore his balance some also.
 
With ketones in the picture and post DKA I don’t understand the reasoning behind why your vet would want to stick with 1 unit for a week. It is really important to stay ahead of the ketones and the way to do that is with food and insulin and treating any infection/inflammation.
Let’s see what @Wendy&Neko says about the subQ fluids and increasing the dose. I have given subQ fluids but Wendy has experience with subQ fluids with a kitty with heart issues and may be able to have suggestions about the higher resp rate / subQ fluids.
 
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Bron and Sheba (GA) said:
With ketones in the picture and post DKA I don’t understand the reasoning behind why your vet would want to stick with 1 unit for a week. It is really important to stay ahead of the ketones and the way to do that is with food and insulin and treating any infection/inflammation.
Let’s see what @Wendy&Neko says about the subQ fluids and increasing the dose. I have giving subQ fluids but Wendy has experience with subQ fluids with a kitty with heart issues and may be able to have suggestions about the higher resp rate / subQ fluids.
Click to expand...

That's what I have repeatedly said this week when calling the vet, but as a receptionist takes my message I think much of what I'm saying gets lost. I just wish it was easier. Thank you, I appreciate it! I will try to catch a couple of hours sleep before getting up to check on him again, but I'll make sure to check the tread tomorrow morning!
 
If you want to swap Maverick to a low carb diet that is more appropriate (you will have to monitor the BGs closely when you do that as the BGs can drop 100 points with a change of diet) just tell the vet Maverick won’t eat the prescription food........she can’t argue with that. That is what a lot of people do to get around having to argue with the vet about the prescription diets....and it’s true many cats don’t like them.

It is very frustrating not being able to speak to the vet....most unsatisfactory.
 
Bron and Sheba (GA) said:
but Wendy has experience with subQ fluids with a kitty with heart issues and may be able to have suggestions about the higher resp rate / subQ fluids.
Click to expand...
Yes, it didn't end well. I was told normal resting respiratory rate should be 20-30. Neko's normal was on the low end. She first got fluids because of her kidney disease, but that sent her into heart failure. I stopped the fluids, she recovered. 5 months later the IM vet suggested just a tiny bit of fluids every other day, but it proved too much. I was watching her RR (respiratory rate) daily. When her RR crept up to 26, I knew I had to stop the fluids again. And this was with a tiny bit of Lasix too.

Are you adding water to Maverick's food and making it a bit soupy? That's a good way to get fluid in if you can.

As for dose, I only see the last two days worth of data on 1 unit, that's not enough to say increase tomorrow, but maybe the day after.
 
Hi Wendy,

Wendy&Neko said:
Are you adding water to Maverick's food and making it a bit soupy? That's a good way to get fluid in if you can.
Click to expand...
Is it less of an issue for the heart if you can get the cat to take extra fluids orally? Or do you also have to be cautious about the volume of fluids taken in via the oral route?


Mogs
.
 
Mogs - in all likelihood a cat isn't going to drink as much as you would be giving by sub-q. With humans and heart failure, oral liquids are restricted. If any IV medications are required, the amount administered by IV is factored in. (Humans don't usually get sub-q.)

I would not want to give any sub-q fluids unless you're sure there isn't some sort of cardiac issue. Fluids threw Gabby into heart failure, as well.

So let me see if I understand what your saying:
  • Your cat likely has IBD and the vet wants to try a novel protein diet.
  • The foods the vet is suggesting are ridiculously high in carbs.
  • Maverick has been testing positive for ketones, sometimes at worrisome levels (and they seem to disappear just as quickly as they appear)
  • Your vet doesn't want to adjust the insulin dose despite suggesting a high carb diet
Here's what doesn't make sense to me. Feeding your cat a high carb diet is going to cause Maverick's BG numbers to skyrocket. That's going to happen in a setting of ketones appearing for who knows what reason. The only way to manage ketones is with insulin, food, and fluids. I would encourage you to ask your vet what the rationale is for this approach. I'd also suggest that if your cat ends up in DKA that the vet not charge you for the hospitalization and treatment since it would be due to her treatment plan. (When Gabby was first diagnosed with diabetes, she was in DKA. It was a $3000 hospitalization and that was a lot of years ago.)

I would also let your vet know that there is clearly a problem with your trying to communicate with her. She may be completely unaware that you've been leaving messages. There are some office staff who think they are doing the doctor a favor by not relaying what they believe are unnecessary messages. I would also let the receptionist know that you expect a call back from the vet when she has a break in her schedule but no later than the end of the day. I'd also wonder why the vet isn't taking the ketone issue more seriously. (Ketones can appear suddenly but they typically don't disappear suddenly.)

Another thought -- if you post a new thread and title it something like, "Looking for a vet in XX, state" (in other words, in your city and state) there may be members who have a recommendation regarding a vet.
 
Bron and Sheba (GA) said:
If you want to swap Maverick to a low carb diet that is more appropriate (you will have to monitor the BGs closely when you do that as the BGs can drop 100 points with a change of diet) just tell the vet Maverick won’t eat the prescription food........she can’t argue with that. That is what a lot of people do to get around having to argue with the vet about the prescription diets....and it’s true many cats don’t like them.

It is very frustrating not being able to speak to the vet....most unsatisfactory.
Click to expand...

Thank you, thats good to know! Should I switch little at the time or just make the switch all at once?
 
Wendy&Neko said:
Yes, it didn't end well. I was told normal resting respiratory rate should be 20-30. Neko's normal was on the low end. She first got fluids because of her kidney disease, but that sent her into heart failure. I stopped the fluids, she recovered. 5 months later the IM vet suggested just a tiny bit of fluids every other day, but it proved too much. I was watching her RR (respiratory rate) daily. When her RR crept up to 26, I knew I had to stop the fluids again. And this was with a tiny bit of Lasix too.

Are you adding water to Maverick's food and making it a bit soupy? That's a good way to get fluid in if you can.

As for dose, I only see the last two days worth of data on 1 unit, that's not enough to say increase tomorrow, but maybe the day after.
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That sounds like a terrible experience!
I do add to his food, but am also little cautious as he dropped a lot in weight and needs the calories- when I add too much he seems to be full on the water so it's a fine balance. Maverick has been on the 1Unit now for the last 3 days (6 cycles), and I did end up giving him 1.25 this morning- was that too quick? Now I'm very worried
 
Sienne and Gabby (GA) said:
Mogs - in all likelihood a cat isn't going to drink as much as you would be giving by sub-q. With humans and heart failure, oral liquids are restricted. If any IV medications are required, the amount administered by IV is factored in. (Humans don't usually get sub-q.)

I would not want to give any sub-q fluids unless you're sure there isn't some sort of cardiac issue. Fluids threw Gabby into heart failure, as well.

So let me see if I understand what your saying:
  • Your cat likely has IBD and the vet wants to try a novel protein diet.
  • The foods the vet is suggesting are ridiculously high in carbs.
  • Maverick has been testing positive for ketones, sometimes at worrisome levels (and they seem to disappear just as quickly as they appear)
  • Your vet doesn't want to adjust the insulin dose despite suggesting a high carb diet
Here's what doesn't make sense to me. Feeding your cat a high carb diet is going to cause Maverick's BG numbers to skyrocket. That's going to happen in a setting of ketones appearing for who knows what reason. The only way to manage ketones is with insulin, food, and fluids. I would encourage you to ask your vet what the rationale is for this approach. I'd also suggest that if your cat ends up in DKA that the vet not charge you for the hospitalization and treatment since it would be due to her treatment plan. (When Gabby was first diagnosed with diabetes, she was in DKA. It was a $3000 hospitalization and that was a lot of years ago.)

I would also let your vet know that there is clearly a problem with your trying to communicate with her. She may be completely unaware that you've been leaving messages. There are some office staff who think they are doing the doctor a favor by not relaying what they believe are unnecessary messages. I would also let the receptionist know that you expect a call back from the vet when she has a break in her schedule but no later than the end of the day. I'd also wonder why the vet isn't taking the ketone issue more seriously. (Ketones can appear suddenly but they typically don't disappear suddenly.)

Another thought -- if you post a new thread and title it something like, "Looking for a vet in XX, state" (in other words, in your city and state) there may be members who have a recommendation regarding a vet.
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Thank you!

-Yes, IBD and potential food allergy
-Correct, she's suggesting RC Selected Protein venison or rabbit (15-16% carbs), or Hills Z/D (35% carbs). And these are all lower in calories than what he currently eats so he'll essentially need more of this food, making the carb amount even worse.
-Yes, but doesn't disappear that fast always. 2 times he's been hospitalized for 6+ days (also had other issues then) and was at the ER over the day about 10 days ago. This last time I was able to flush it out.
-Yes, she want to wait and see- hold it for 1 week and change, hoping the food will restore the bowl balance, lower the stress, hence lower glucose levels.

Thats exactly what doesn't make sense to me also. I'm well aware of the costs, and my pockets are empty- Maverick is an average of $200 in vet visits/week now- not including the $850 and $7000 ER stays. My reg vet does not do overnight stay so all they do each time I call in for ketones is to advice me going to the ER, they also never have slots open right away and they will tell me to go to the ER, no other vet at the office seems to be able to take Mav in for a check if my vet is unavailable- then they rather seem to send me to the ER.

The technician are supposedly running back and forth to the vet as I'm speaking with her to ask the questions, but there is no space for discussion- the vet can simply reply and she's most likely busy with an appointment at the time. I always demand a call back, but she's always so packed with appointments that "she never gets to it," or I miss the call and can't reach her again. I have an appointment on Tuesday and will try to voice my concerns regarding this again to her as I do get to speak to her over the phone then. I really do think this vet is caring and she's the only one that actually read through Mavericks binder of Med history so she knows it almost as well as me, I just hope to be able to discuss with her in another way so we can change approach- this is har when I never met her in parson and probably never will.

There are several reasons to why I haven't shopped around for another vet, partly because I do think she cares, and because of our situation. I have a super busy 2 year old and are due with a baby in February. My husband works long days so he is to no help when it comes to vet visits unless the hours are good. We are military family that just moved here so no family or friends close by to help. The initial vet I went to was 20 min from here and going there with my toddler was challenging and stressful for the cat. This vet is literally 1.5 minutes away from my house with car. The hours makes my husband being able to help. I have taken Maverick to appointments no less than 1-2 times per week since he got sick, and stopped by to pickup meds at least 1/week, and I know that I'd have to keep on with the weekly/ or hopefully bi-weekly appointments at least until we get the IBD under control and he regulates on the insulin - and doing this with a toddler and a newborn simply wouldn't work. But if I end up having to change vet, I'd definitely take your advice! And I may even do it just to check if there is any other vet really close by (: If so would that post go in the main forum?
 
Mathilda: you've got a lot on your plate that's for sure.

"And I may even do it just to check if there is any other vet really close by :) If so would that post go in the main forum?"
Yes, you could post on the main or the Lantus forum.

I've phoned other clinics and checked vet's areas of interest online too. Unfortunately, I found that all vets in my area knew less about FD than the experienced people on this board. :rolleyes:
 
Hi Sienne,

Sienne and Gabby (GA) said:
Mogs - in all likelihood a cat isn't going to drink as much as you would be giving by sub-q. With humans and heart failure, oral liquids are restricted. If any IV medications are required, the amount administered by IV is factored in. (Humans don't usually get sub-q.)
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Thanks for this info. Being in the UK, support for sub-qs is not great (and I think that's going to be the case with our vets). Lúnasa has both CKD and HCM, hence my specific interest in this. As things stand at the moment, Lúnasa can quite happily polish off up to 50ml of oral fluids (water flavoured with cat soup) a few times a day (have had to resort to this when she won't eat enough, because if she doesn't eat much she stops drinking water from her bowl). The vets haven't given me much of a steer on the cardiac side of things, so thanks for your help with this.

(Mathilda: Apologies for the slight frankenthread. :oops: )


Mogs
.
 
Judy and Freckles said:
Mathilda: you've got a lot on your plate that's for sure.

"And I may even do it just to check if there is any other vet really close by :) If so would that post go in the main forum?"
Yes, you could post on the main or the Lantus forum.

I've phoned other clinics and checked vet's areas of interest online too. Unfortunately, I found that all vets in my area knew less about FD than the experienced people on this board. :rolleyes:
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Yes, I'm just learning what a huge range of expertise there is on this board, I think many vets get stuck in routine and older methods perhaps, and the "wait and see" approach of just dealing with one issue at the time may feel safer and be more comfortable many times.

If I make a new post for that, should I link this post? I just realized linking previous posts is the way to go, but I'm unsure when to do it and when not to.
 
Critter Mom said:
Hi Sienne,


Thanks for this info. Being in the UK, support for sub-qs is not great (and I think that's going to be the case with our vets). Lúnasa has both CKD and HCM, hence my specific interest in this. As things stand at the moment, Lúnasa can quite happily polish off up to 50ml of oral fluids (water flavoured with cat soup) a few times a day (have had to resort to this when she won't eat enough, because if she doesn't eat much she stops drinking water from her bowl). The vets haven't given me much of a steer on the cardiac side of things, so thanks for your help with this.

(Mathilda: Apologies for the slight frankenthread. :oops: )


Mogs
.
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The more questions, the more we all learn! This is great! Thank you Mogs (:
 
Mogs - so sorry you are in the heart vs CKD dance too. :bighug: So many treatments for one are contraindicated for the other. As Sienne, who is way more knowledgeable than me on things heart said, cats don't usually go overboard on oral liquids. Neko was fine on oral.

Mathilda, there are lots of other options to food for IBD than what your vet has you feeding. Including me, lots of people here with experience with novel protein foods and diabetes. My girl ate raw food, so plenty of options for her. But there are commercially available foods as well and all likely cheaper than what you are getting at the vet. Plenty of rabbit or venison options. I've got a non diabetic now who has rabbit as one of her go-to foods. Options include products from Nature's Variety Instinct, Rawz, Ziwipeak, commercial raw options from Stelly & Chewy's and Primal. I think there are even more venison options available. Lamb is usually a novel protein for most too, and that is even more easy to find. A good probiotic is also important - I give Visbiome, which is designed specifically for IBD.
 
Wendy&Neko said:
Mogs - so sorry you are in the heart vs CKD dance too. :bighug: So many treatments for one are contraindicated for the other. As Sienne, who is way more knowledgeable than me on things heart said, cats don't usually go overboard on oral liquids. Neko was fine on oral.
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Thanks, Wendy. :bighug:

Good to know that Neko did OK with the oral fluids. For us, it's likely to be the Noodle's only available option. I can't get over her with the diluted cat soup. She absolutely mullers it! It also helps with administration of her meds and supplements.


Mogs
.
 
Wendy&Neko said:
Mogs - so sorry you are in the heart vs CKD dance too. :bighug: So many treatments for one are contraindicated for the other. As Sienne, who is way more knowledgeable than me on things heart said, cats don't usually go overboard on oral liquids. Neko was fine on oral.

Mathilda, there are lots of other options to food for IBD than what your vet has you feeding. Including me, lots of people here with experience with novel protein foods and diabetes. My girl ate raw food, so plenty of options for her. But there are commercially available foods as well and all likely cheaper than what you are getting at the vet. Plenty of rabbit or venison options. I've got a non diabetic now who has rabbit as one of her go-to foods. Options include products from Nature's Variety Instinct, Rawz, Ziwipeak, commercial raw options from Stelly & Chewy's and Primal. I think there are even more venison options available. Lamb is usually a novel protein for most too, and that is even more easy to find. A good probiotic is also important - I give Visbiome, which is designed specifically for IBD.
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Yes, I told her (via the receptionist) I wanted to try the Nature's Variety Instinct, her answer was that she didn't like the protein (whatever that means), and said to try the vet diets. Honestly, the vet diets has crappy ingredients and I'd probably just say he won't eat it. I tried some of the instinct original rabbit- I really wanted to try the venison or the limited ingredient rabbit, but store didn't have it- but he likes the rabbit original, the only thing with that one I am little uncertain of is that it contain pork. Is pork considered novel protein? He mostly been on chicken/poultry or fish based protein before. Someone suggested Ziwipeak and I currently have it in my chewy shopping cart- I think all those ingredients looks good so I'm hoping he'll eat that. Should I stick to one taste/brand for a while after transferring from the current food? Or does that not matter as long as all is novel protein? And should I introduce the novel food slowly, or just switch? I know a slow transfer is normally preferred, but not sure what the best is with IBD involved.
He is on Proviable probiotic right now- do you have any experience of that one?
 
Mathilda and Maverick said:
Maverick has been on the 1Unit now for the last 3 days (6 cycles), and I did end up giving him 1.25 this morning- was that too quick? Now I'm very worried
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If you have decided to do the TR (you need to put that in your signature) you were fine to increase to 1.25 U today.
You need to stay with that dose for at least 6 cycles to let the depot settle, unless he drops under 50 in which case you decrease the dose.
Have you tested for ketones today?
 
Wendy&Neko said:
Pork is novel if he hasn't had it before. I pick out the peas and carrots in the Instinct.:rolleyes: Here's a website that is a good read and a section on food transitions: https://www.ibdkitties.net/switching-foods/

Proviable is a good probiotic from what I've heard - glad to hear he's on one.
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Great, thanks! I'm glad to hear Proviable has a good reputation! Is the probiotic a longterm supplement? Haha, yeah Maverick is not too crazy about the big chunks of vegetables either, but the rest goes down (: Thank you!
 
Bron and Sheba (GA) said:
If you have decided to do the TR (you need to put that in your signature) you were fine to increase to 1.25 U today.
You need to stay with that dose for at least 6 cycles to let the depot settle, unless he drops under 50 in which case you decrease the dose.
Have you tested for ketones today?
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Ok, thank you! He tested negative for ketones both this morning and this afternoon, but he's definitely been more tired today and his Bg's has been in the 300s all day.
 
Bron and Sheba (GA) said:
Great no ketones.
Are you going to give him the 50 mls of subQ fluids today?
Keep up the frequent snacks of food.
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I am still debating whether to give him the fluids tonight or not, I'm leaning towards not give it tonight, but I'll check his RR, try get another ketone test, and then make a decision from there. He keeps on asking for food so plenty of small snacks all day (and night) (:
 
Mathilda and Maverick said:
I am still debating whether to give him the fluids tonight or not, I'm leaning towards not give it tonight, but I'll check his RR, try get another ketone test, and then make a decision from there. He keeps on asking for food so plenty of small snacks all day (and night) :)
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Great he is eating so well...keep it up Maverick.
I would ask the vet to verify about the subQFluids if I were you.
They can be so good with ketones in the picture but caution is needed if there are other issues.
 
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