Max - Newly diagnosed with a bout of DKA

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Chris Ca

Member Since 2019
Hi! I posted in the intro group and was encouraged re-post here! So, here goes :)



During the last week of August and into early Sept, Max started getting rather picky about his food, and eventually was refusing all of it. Tried all kinds of different foods, etc. He was primarily eating GO! canned chicken stew - approx 17% carbs as fed. Not much luck with other foods. We started to notice some significant weight loss, and frequent large urination in his box. With the knowledge we have now, he was clearly headed down the DKA path.

He went to his (old) vet on Sept 9, they took blood for labs and also xrays, trying to get an idea of what might be wrong. Fructosamine was part of these labs. We were called back to the vet on Sept 13, where the initial tentative dx for diabetes was made. Lantus was provided, along with training and a variety of prescription diabetes diet wet cans. At this appointment they also took urine and additional blood for testing. The vet was somewhat unconvinced that it was diabetes for sure.

That evening, Max was very much not himself. Staring off into space, still refusing to eat, etc. I had only just started reading into this forum and other resources online, so everything was still very new and information overload! We were not particularily happy with the dx we had received and my partner and I had been discussing getting a second opinion and just eating the cost of additional lab work.

Sept 14 morning, Max had still not eaten anything. We called our other vet at 8am (they regularly see our pooch) and they got us in for an appointment an hour later. We headed over, the new vet was very thorough with his initial diagnosis. Looking for other things that may be wrong, etc. He took max into the back to collect urine and do a BG test. He came back to us within 3 minutes VERY concerned. Max's ketones were very high on a test strip (sorry, dont have the exact number). Max was immediately hospitalized with them for DKA treatment.

He responded well throughout his time at the hospital. We received frequent updates on how he was doing. Ultimately he stayed with them for 3 days. We picked him up Monday afternoon (Sep 16).

Since he's been home, he's been getting 1U AM and 0.5U PM of Lantus. Food wise, he's been pretty uninterested in the MD pate and prefers the dry. He will eat his full portions of the dry across an 8 hour window or so, and we provide food every 12 hours, a little before his insulin shot.

I started measuring regularly in the last 2 days, based on my reading here ;) SS is in signature below.

If anyone has tips on ideas to get him to eat his darn pate, I'd love to hear them! I will be picking up some FF today on my way home from work. Ironically, when we first adopted Max we fed him FF pate exclusively!
 
Hey, I fairly new here so will let the other more experienced members offer advice. We have however lived through 3 episodes of DKA recently and each time I have learnt more and more, the main way out is food, liquids and insulin. Feeding little and often low carb food is ideal, but in all honesty any food will help rid the body of ketones. I got a big ish syringe and managed to feed via syringe (watered down pate) and that kick started Toby's appetite and he began to eat on his own, a good tip is to pour tuna water on the food, the smell really gets their interest. If Max isn't drinking you can also syringe water, Toby was too weak at times to drink and when I syringed him with water he was so grateful.
I'm not sure if any of that helps, but rest assure you're not alone and you've definitely come to the right place. Some of the amazing more experienced members will be along soon I'm sure. All the very best to you and Max x
 
Link for transitioning to wet food here



From: "Suggestion on How to Stimulate Kitty's Appetite"
sprinkle food with :
-making a buffet to give him choices
- heating food
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo chicken treats -- crumble into dust over food -- my Wolfie loves this stuff.
- poor a little water from tuna in water over food ( I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats-- check labels)
-powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.
 
Hi Chris, glad to see you post here in this forum. The Fancy Feast classics are low carb, also Friskies pates and some of the 9 Lives varieties. Other members like Weruva, Tiki Cat and Tiki Cat After Dark. Don't know what is available of those in Canada.

Here is some info about transitioning from dry to all wet low carb: Transitioning your cat from dry to wet food
Here's a list of canned foods in Canada.
Canada
Idjit wouldn't eat the DM canned food from the vet either, and Idj is a terrific eater! It has pork in it and he is not a fan. If you can manage it, several small more frequent meals works best for our sugar cats. Many members that work use timed feeders so kitty has food available during the day, or at night. Or, mix some wet food with a little water or broth, freeze in ice cube trays and leave out to thaw and be eaten.

Here is something just for FYI:
New? How You Can Help Us Help You!

I have read that recovery from DKA takes time, it's a very serious condition. Please test his urine with the ketostix or if that really is impossible, there are meters that measure ketones as well as BG.
Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):
put the end of the test strip right in his urine stream as he's peeing
slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee. Clean lentils or aquarium gravel in the box works too.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

Well, shuffle my cards! Just read your response in the Intro forum..
"I'll pickup some keto stix for sure. I also think I want to get different syringes, as ours dont have half U measures and it's pretty tricky to eyeball! I'm actually the cat dad, my partner Kate is the cat mom :) We're doing this as a team... i've got the research down, figured out BG readings etc, Kate is mostly doing the injections and metering as well. I have a needle fear to get over!"

Chris, I apologize, it's hard to tell with your name. Please add Kate to the signature so we know who's who. Teamwork is cool..I couldn't do Idjit w/o Dear Hubby (DH).

Please read the stickies at the top of the Lantus forum, there is a great deal to read, but it's all good info that you will need to digest to help Max back to superhero form. Post there with dosing or any insulin issues.

Please post as often as you like, ask lots of questions, keep in touch and let us help you along.

Edited to add:
Chris did Kate shoot insulin this morning? It's not on the spreadsheet and I will just caution you to keep the SS updated. There may come a time when it's really important to have all the data there and current. Also, as I believe someone already said, it's usually best to inject the same dose of insulin morning and night.
 
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@Idjit's mom Thanks for the edit! Max did get 1U this morning, I updated that now. Still getting the hang of the SS! We're doing the 1U / 0.5U based on the vet's instructions, but we have a recheck Monday and will definitely ask about the dosing.

They asked us to do a BG curve at home around Sept 28, probably to give some time for the Lantus to have been in his system for a while, and the DKA recovery to run its course.
 
Hi Chris, Kate and Max and welcome

Looks like you have been given great advice.
I'm really glad to see you are testing the BG levels. That is so important.

Just peeked at your SS and I see a 4.3 (77) at +6 on the am cycle. Did you get another test after that?
If you see a low number like that again it is really important to test again about 30 minutes later to see that the number is going up not down..
Do you have some higher carb wet food and honey at home in case of low numbers? If you don't, I would strongly advice that you go and get some today as you done want to be caught without any.

DKA kitties need enough food, enough insulin and be having any infections or inflammation treated so that ketones don't redevelop. Plenty of fluids is important too. Food is like a medication for DKA kitties so try and ensure that Max is getting plenty of food in every day.

I think someone mentioned that Lantus works best with the same dose being given in both cycles.
You would be better giving 0.75 units night and morning than giving different doses. The 0.75 equals the same amount given per day, but it is giving in equal doses which is better for the Lantus and will not mess up the depot that Lantus has. Does that make sense?
 
Thanks @Bron and Sheba (GA) , we appreciate the info! Still wrapping my head around the SS colours, what the various BG readings "mean", what is normal, etc etc. We didn't get another test after that 4.3, but now I know better! As for HC foods, we've definitely got honey on hand, and I'll be going thru the various wet foods we have and tagging the carb % on them. Max is still picky on wet food, although he gobbled up almost half a can of FF pate this morning. We're definitely focusing ensuring he is eating given the DKA situation!

We have a recheck at the vet on Monday, and I'll definitely ask about 0.75 / 0.75 equal dosing. We will need to get new syringes, as we have 0.5ml/cc U100 ones that dont have half-unit marks. Getting the 0.5 right is challenging enough already!
 
There are two types of insulin. One is an in and out insulin, meaning that there is no insulin left in the system. The other, of which Lantus (glargine) is one, is a depot insulin. A depot insulin craves and works best with consistency in dosing. I agree with Bron that you would be better off giving the same dose in both cycles.

From: http://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/ – which is well worth reading before you see the vet.
After you inject it into your subcutaneous tissue, the acidic solution is neutralized by your body to a neutral pH. Because glargine is not soluble at a neutral pH, it precipitates out into a form that's not soluble in subcutaneous fat, and there forms a relatively insoluble depot. From that pool, or depot, of precipitated glargine in the tissues, small amounts slowly move back into solution over time and then to the bloodstream.

If you are looking for half unit syringes in Canada, try a couple of pharmacies. Some pharmacists claim they do not have half unit marked syringes but make them look anyway. BD UltraFine 31g 3/10 is one. @Wendy&Neko says it is a purple and yellow box.

Alternatively, there are a few places in the US that ship to Canada.

Calipers also help to maintain a consistent dose: http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/
 
Chris, Kate and Max..just saw the avatar. Max is so very cute, just want to hug that little guy! Sweet, sweet face. :cat:
 
He is very photogenic!!! :)

The transition to wet food continues, we're making progress! He didnt eat his dinner food last night until 5am today - he grazed at it between 5-10am. I think that explains the high reading AMPS reading. I'm home all day so will see how is 1U shot behaves. Gonna have to get more test strips soon... I've been looking into human meters too, as the AlphaTrak strips are stupidly expensive here - approx $2/strip CAD.
 
Chris, the AT strips are stupidly expensive here too, and they are half the price you are paying in Canada. Kitties are so funny with appetite and eating habits.

If you like, you can start a new thread on the Main Health forum here to ask fellow Canadian members for human meter recommendations and where to get them and strips at a good price.

Youch on the high BG last night and this morning. Hopefully you can try to get some mid-cycle tests in today and tomorrow and see where the BG goes and when.
 
Testing strips are not cheap in Canada. On the other hand, we pay far less for insulin that the US does.
It is recommended that you have at least 200 strips on hand, keeping one container of strips in your Hypo Tool Box at all times.

A lot of Canadians use the FreeStyle Lite. It takes a small drop of blood (0.3). A box of 100 strips (2x50) costs between $80 and $90. The benefits are the small amount of blood and the availability of strips at a pharmacy.

There is also the Bravo meter. The strips, last time I checked, ran just over $40/100. The downsides are (1) it takes a larger drop of blood (0.6), (2) it reads a bit higher than the FreeStyle Lite – I did side-by-side comparisons, (3) if you run out of strips, you cannot buy them locally. In a low number situation, you will go through strips faster than you imagine. Information about the Bravo is here

There are a lot of companies that offer a free meter with purchase of 100 strips. Like a printer, it's not the cost of the machine that is the problem, it is the cost of the ink. Do check the cost of the strips and the size of the drop needed before committing.

How to get strips cheaper:
(1) Save up and use PC Optimum points at Shoppers Drug Mart. Watch for monthly seniors days (there's one coming this Thursday). If you are not a senior, get a family member or a friend to buy them for you.
(2) If you live close to the border, you can buy the strips in the US. A quick check of the Walmart (US) website shows the strips at half the price. Other sites are a bit more expensive.
(3) Some people watch for and buy FreeStyle Lite strips on ebay. I've never done this. Do check the shipping costs, expiry date. Do not buy open containers. The container contains a preservative to help keep the strips fresh. The strips should always be stored in the container and not exposed to fresh air.


Hopefully, other Canadians will chime in on their meter/strips cost and recommendations. @MrWorfMen's Mom
 
Welcome to FDMB from a fellow Ontarian.

I used the AT2 and Freestyle Lite meters. The one advantage is that the strips for the Freestyle Lite can be used in the AT2 and provide a ball park BG. Without the proper code for the batch of Freestyle strips the results won't be as accurate as is possible but it means you always have the AT2 as a backup meter even if you don't have the specific AT2 strips on hand.

I too would recommend giving Lantus consistently, same dose twice daily. Those higher BGs today are likely from bouncing from the lows of the last couple of days along with the effect of the different doses morning and night.

Below is a picture of the box of syringes you're looking for. Walmart may only carry the 6mm needle size with half unit markings and they are fine too but some folks find they are more prone to fur shots with the shorter needles. If you ask Walmart pharmacy will order the 8mm for you. They should also be available at Shoppers although prices there are higher unless you have Optimum points to use.
IMG_20150705_160318994.jpg
 
@Red & Rover (GA) thanks for the intel! I think we'll look into getting the Freestyle Lite. I found a coupon to get the meter for free with 100 strips, so thats certainly manageable. It and the strips look so similar to the AT2! We'll have Kate's dad get it using that discount option :)

@MrWorfMen's Mom We've got the vet recheck tomorrow so will be asking about equal dosing morning and night. We'll definitely get those BD needles as we're finding even the 0.5 dose on the Elimedical syringes the vet gave us very difficult. I see on your profile you're in Etobicoke, we're in the Beaches :)
 
Thankfully, I have not dealt with DKA and hope I never do, but I have dealt with a cat that will not eat. I have done a lot of syringe feeding and a food that is smooth and good for syringe feeding is Hill's a/d, I cannot use a/d because of the fat content but it would probably be good at this time for your kitty. This can only be bought at the vet, so you might ask your vet.
Hope, your sweet looking little kitty continues to improve.
 
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