My 16 year old cat was recently diagnosed with diabetes, need advice please.

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Dan&Heather

Dan&Heather

Member Since 2016
I first noticed something wasnt right with my cat Mittens about a week ago when she wasn't finishing her food, which she rarely leaves any behind. All she was doing was mostly licking the gravy and now she has lost a lot of weight. I brought her into the vet on monday but had limited money and it cost $50 to get her in to see a vet on and we only had a $100 left and the vet decided what tests were most important, she did a blood test and it came back with high glucose of 508mg/dl(I hope that number makes since, its whats on the paper work).

She then suggested we bring her Fox Valley Animal Referral Center in Appleton, Wi which is a few hours away but not the problem, they said it could cost in the thousands to stabilize her for a few days to a week and thats a problem because i dont have that kind of money, if i did i would spend it in a heartbeat. The other option they gave me was euthanasia, im almost going nuts since hearing it. Im 32 and had her for more than half my life so i wanna do anything i can.

Im hoping someone can give me some advice, ive been all tears since getting the news and cant imagine not having her in the house. I had an appointment set for the euthanasia this morning(12/21/16) but i dont think i can give up on her that easy so im hoping someone can help me and tell me what i should do.

I got test results that show she has high glucose levels, what do i need to do to get a prescription for insulin? Me and the wife are more than willing to do our research on here and learn whatever we need to. I know theres alot to the hometesting but i hope someone can help me learn.

Sorry if i posted in the wrong section, and thanks in advance for any help.
 
I dont want to bring her in this morning but i also dont want her to suffer if she cant eat. Im lost as to what i should do, i get so sad everytime i look at her and know i dont got what i need to help her. I read a little bit on "glucose curves" iirc, is that a same day in and out? Would that be less expensive than the thousands they said it might be? I get paid on thursday and am willing to spend every dime if its enough and if she makes it that long. All she is eating is a few licks of gravy and some chunks of food since i chop it up real fine and add a little water, but she licks it for a while and walks away. I try that every couple of hours but she never eats alot.
 
I suppose i should add a few more details about Mittens. Shes 16-17 years old female and fixed, not exactly sure of the breed, American shorthair maybe? Monday was her first trip to the vet since she was real young when we had her fixed. I will be taking my cats on regular vet visits after this, its just she hates the car so i always felt bad when i thought about taking her in to see a vet for a check up. Sorry for spamming with posts, i dont wanna leave any info out, any questions just ask.
 
Hi Dan. I totally feel for you. Is there a way for your boss to advance you some money so you can get some insulin and some syringes? There are lots of ways to save money, and we can help you with that. For instance, if you look in The Supply Closet there are often people selling extra supplies inexpensively or giving them away. And you don't need to feed expensive veterinary prescription food, a lot of us feed Fancy Feast, the Classic or pate varieties. Also, you don't need to buy an expensive glucometer from your vet, most of us use a human glucometer from Walmart. I just want you to know there is hope. You can contact DCIN (Diabetic Cats In Need) as they might be able to help you too. Try buying a couple jars of baby food, the kind that are only meat and broth (no onions or garlic) and see if she will eat that.
I wish you the Best Of Luck with Mittens. I hope you find a way to help her live out her golden years.
 
Thank you so much for the reply Dyana it means alot. I will look into "The Supply Closet" right after posting. Im pretty sure i could get the money for the insulin, glucose meter and syringes today, but not the total amount to bring her in to the vet for stabilization. I have been getting her the fancy feast classics the last two days since its what i read was recommended on a budget, but she still just take a few licks and moves on. I hope to god im not too late. Thank you for the tip on baby food, i will head to the store soon and look. I will also look into the DCIN. Thanks so much for the reply, so glad i found this place! Is it possible for the glucose levels to lower overtime or are they always this high until she gets some insulin? I cant stand to see her like this.

Thanks so much again for the help :)
 
Did the vet say anything else was wrong with her? Did he test her for ketones? I would pick up some ketone test strips (you'll find them in the pharmacy section) and test her at least daily. If she tests over a trace in ketones, a vet stay will be needed. I hope and pray she is ketone free.
Please keep posting here with questions, or need for support. Hopefully your vet will help you out and knows a decent amount about diabetes in cats.
 
Hi Dan,

:bighug::bighug::bighug:

Just sending a very quick reply for now because I can see how desperately worried you are. There may be several things you can do to help Mittens.

Dan&Heather said:
All she is eating is a few licks of gravy and some chunks of food since i chop it up real fine and add a little water, but she licks it for a while and walks away.
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Mittens sounds like she's nauseated. If she's looking for food she has an appetite and that's a real positive.

See the symptom checker at this link:

Nausea and appetite problems - symptoms and treatments

There are meds which can treat nausea and help her start eating again.

Questions:

When did Mittens last do a poop? Is there any chance she might be constipated? (Asking this so I can work out which meds to suggest.)

Is there any yellowing of skin/eyes?

Is Mittens dehydrated? (Pull up scruff of neck to see whether it quickly 'snaps back' into place; check gums to see whether they feel sticky.)

Would you be able to afford an Rx today from the vet who examined her (might be able to request it over the telephone as Mittens has been recently examined).

More to follow once you send answers to the above.


Mogs
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Hi--

Oh, I'm so sorry! It's obvious how much you care for Mittens, and how much this is tearing you up!

A couple things right off the bat: unless there is some other serious health complication such as diabetic ketoacidosis (Dyana mentioned checking for ketones-- this is cheap to do at home, and absolutely critical with a diabetic cat who isn't eating well), Mittens probably doesn't need a $1000+ hospitalization to get started on insulin treatment. If you can get up and running on home testing ASAP, it's actually easier to get to the right insulin dose for Mittens if you are assessing her at home (cats get stressed at the vet, which raises their glucose levels, sometimes by 100+ points-- the dose needed at a vet's office may be too high once the cat gets home and calms down).

Second: along with getting up and running on home testing and testing for ketones, the #1 thing Mittens needs right now is to start eating again. It sounds like she might have some nausea, and that is why she isn't eating. The baby food, or something very plain like boiled chicken breast (chopped up) may be something she can eat, but there are also some anti-nausea medications that can help a lot. Other members have a lot of experience with this and will have more specific recommendations about which anti-nausea medications seem to work best with cats, in the meantime, just try the bland food. [edit: and Mogs already posted after I wrote this- hooray! She's one of the ones who is an expert in this, and will have excellent suggestions]

So then, the priorities: test for ketones if your vet didn't, get her back eating (or figure out why she's not), start getting comfortable with home testing her blood glucose to guide her insulin treatment, then figure out the insulin treatment itself.

More later, in the meantime, please try to take a deep breath, there's still lots of hope for Mittens and we are here to help in any way we can!
 
@Dyana Im not sure if she was tested for anything else because we only had a limited amount of money at that time so the vet said she would test for what she thought was most important and only gave us a few pieces of paper, this is a picture of the main one http://imgur.com/a/aMkDq . I will look for the strips and baby food in a few hours when the bank opens, i plan on getting a few temporary checks i can write since i get paid the next day it should be fine. I will reply as soon as i know more, i plan on calling the vet again when they open to talk to them again and ask some more questions. Thanks so much again for the assistance, i will look into the ketone test strips and the proper baby food in just a few hours! Thanks for the hope when i was really feeling hopeless, im sure everyone here loves their cats as much as i do and it feels good to be here.

@Critter Mom She does try to eat and drink but only a few licks at a time. The last time i seen her poop was 2 days ago and looked yellow and runny(probably from all the gravy she was sipping and lack of solids?) Her skin and eyes look normal, no yellowing. She does seem dehydrated, and monday when we brought her to the vet the doctor gave her some fluids because of dehydration, im unsure if it helped tho. I would try my best to come up with the money and im sure i could come up with it as long as its not too expensive, otherwise thursday for sure i can, i hope thats not too late. But if i came up with the money can she write me a prescription for the insulin? because all she gave me was a test sheet and a price for euthanasia :( Hope i dont gotta bring her to Appleton just to get a Rx, its a little over 2hr car ride there and shes never been in the car that long and i dont think i could get to appleton today either, but if i need to i will try everything i can.

@Nan & Amber Thanks for the positive words, I hope youre right about not needing a $1000 stabalization, i feel like that would almost be too much stress for the way she looks to be feeling. I will also look into the ketone strips, baby food and getting her some chicken breast.

Thanks to everyone here! I already know this is a great site with alot of helpful people :) thanks for all the feedback, i will keep updating this.
 
Sometimes when a kitty is constipated, the runny stuff can be pushed around the hard stuff that's stuck in there. Sorry for the graphics. You'll have to ask your vet about giving any medications for constipation as some may do more harm than good.
Your vet should write the prescription for insulin for you. I would just tell him that you want to buy it less expensively other than directly from the vet's office.
Sending eating vines to little Mittens. She needs to eat.
 
Thanks for all the kind words, it really does mean a lot to me. I will be calling the vet in a hour and will update you all. Thanks again for all the help.
 
Hi Dan,

Thanks for the info. Please don't head for the shops/call the vets for a short while until I can post more suggestions for you. It shouldn't take too long.

In the meantime can you let me know the following - straight away, please!

Does Mittens ever crouch in an uncomfortable/tense-looking meatloaf position after eating?

Does she ever retreat/withdraw somewhere after trying to eat a little?

Does she ever seek out a cool surface to lie on after eating (e.g. stone/tiled floor)?


Mogs
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@Critter Mom Ok, i will take your advice and wait a little while, im reading alot on here anyway.

Yes she does crouch like that, maybe now more than previously(unless im just noticing it more).

Just the past few days shes been going behind the couch(where she is now) and sometimes underneath but this has only been since i noticed she wasnt right in the past couple days, i dont recall her going back there before. Usually she would just lay infront of the fridge on her rug or in the living room on the carpet.

Most of our apartment is hardwood floors or linoleum, i got a big rug in the living room and other rugs throughout the house so its kinda hard to tell if she was seeking out the cold floor or just too lazy to move somewhere else.
 
** LONG POST ALERT **

Possible problems:

As advised above you need to establish Mittens' ketone status straight away (vet should have tested for this when high BG was detected. :banghead: )

Ketones - without enough food and insulin ketones can develop and may be one potential cause of nausea.

collect a urine sample as soon as possible so that you'll have something to test when you get back from shops (see shopping list below for info on strips).

Tips for catching and testing urine

If ketones are present there's a risk of DKA (but wait to see what the urine test shows).
Dan&Heather said:
Yes she does crouch like that, maybe now more than previously(unless im just noticing it more).
Click to expand...
Dan&Heather said:
Just the past few days shes been going behind the couch(where she is now) and sometimes underneath but this has only been since i noticed she wasnt right in the past couple days, i dont recall her going back there before.
Click to expand...
The crouching and hiding behaviour may be due to pain as well as nausea. Both are common symptoms of cats experiencing a pancreatitis flare. Yellowy poop/diarrhoea could possibly be due to a pancreatitis or liver issue (small bowel diarrhoea). If the loose stool looked a bit fluffy/marshmallowy (steatorrhea - fatty stool) that is another pointer to a possible pancreas issue (problem with fat digestion). If the bowel motion was very whiffy that's another clue.

IDEXX pancreatitis treatment guidelines - may help to use this for discussions with vet.

List of clinical signs to describe for vet:

* Nausea - some appetite present but reluctance to eat (tell vet about Mittens wanting to eat, licking food, then walking away)
* Yellow, loose stool (tell vet if it looked marshmallowy and whether it was very smelly)
* Crouching in uncomfortable meatloaf position (possible indicators of pain - if more marked/frequent occurrence after eating may also hint at pancreatitis)
* Hiding behaviour (may be sign of severe nausea and also significant pain)
* Tell vet if Mittens has been lethargic (several things may cause lethargy but it is part of the symptom cluster for pancreatitis so important to mention)

If it proves necessary (and if it is feasible) to take Mittens for another vet exam today ask the vet to check for abdominal discomfort and also back pain (pain from pancreatitis may in some cases radiate around to the back). If an exam takes place ask the vet to make sure that Mittens isn't constipated.

A blood test could help with diagnostics (SNAP fPL in-house test or Spec fPL lab test for pancreatitis) but as costs are an issue you could ask the vet to treat on an 'as if' basis.

POSSIBLE TREATMENTS TO DISCUSS WITH THE VET

Treatments for Nausea/Inappetence (in absence of constipation):

* Cerenia (maropitant) is probably the most affordable nausea treatment. It's available as an injection but I believe that in In the US you can also get tablets to treat feline nausea.

* Ondansetron - another effective anti-nausea treatment BUT the branded version of this drug is Zofran and it is not cheap. If a generic is available then that should be cheaper. If you need this drug ask the vet to dispense a small amount first. You can always request more as funds allow. (Ondansetron is a human drug so a written veterinary Rx can be filled at a human pharmacy. It might be worth calling around local pharmacies to check cost/availability if needed.)

Note: Cerenia may work faster than ondansetron to alleviate nausea symptoms.

Managing nausea with constipation present:

Treatment with metoclopramide (Reglan) for 1 or two days can help restore better gut motility. Some vets prescribe metoclopramide for any nausea symptoms but cats have very few of the receptors it targets (see IDEXX document) so it doesn't help manage nausea, only gut motility problems. Cerenia or ondansetron needs to be given BUT if any constipation issue is not resolved first they won't be effective. Once any constipation is resolved they should work well.

Appetite stimulant (may be needed for a little while in conjunction with anti-nausea med BUT nausea needs to be treated first, else appy stimulant won't work).

* I usually suggest cyproheptadine. It's an antihistamine, effect lasts about 8-12 hours so is very controllable. (Human medicine - can get written Rx if vet doesn't carry it.)

* Mirtazapine is another commonly used appy stimulant. A tiny dose is given every 2-3 days. It has far more side effects than cyproheptadine (and may cause dangerous adverse reaction (serotonin syndrome) if used in combination with ondansetron.

Pain Relief

If vet considers pancreatitis to be possible cause of Mittens' symptoms then pain relief can help a great deal (and may help flare to subside faster). Ask the vet for an Rx for buprenorphine if pain meds are indicated.

Vitamin B12 Injection

If you do go to the vet and if funds allow a dose of B12 may give Mittens a bit of a boost, help with appetite a little and possibly help calm inflammation a little.

More on food and test supplies in a few minutes. Watch this space ...

Fluids

If Mittens is dehydrated some sub-q fluids might help her feel better and give an initial boost. If not an option for cost reasons see food notes for suggestions on how to increase oral fluid intake. If pancreatitis is the issue better hydration should help to alleviate some discomfort.


Mogs
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PS - if you're in a real bind and don't have any other options ask the vet about whether it would be OK to give Mittens some famotidine. (Pepcid AC - must be the one with ONLY famotidine as the active ingredient. Other Pepcid products are harmful to cats.)

Famotidine is an acid blocker. It's not likely to help much (certainly not with any pain issues) but it is better than not trying anything. Definitely doesn't compare with Cerenia or ondansetron for nausea management.

ETA - Speak to your vet first before giving any medications!!!


Mogs
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Feeding

Feeding very small, very frequent amounts of food can help. Even if it's just a teaspoonful per hour it can help break the nausea-inappetence-worse nausea cycle because the little bit of food may counter stomach acid buildup and settle the tummy. Most important of all it will keep some calories and nutrients going into Mittens' body and that is critical. (I've done my share of all-nighters!)

Bland foods may be less likely to trigger nausea. As suggested above the plain meat/broth baby foods for very young infants (no onion or garlic!) may tempt Mittens to eat a little. Try warming it a little first. Also try putting some of the food onto your fingers to see if you can get Mittens to lick it off. Sometimes the bit of company and encouragement can encourage a nauseated kitty to try eating a little more than they would if it were presented on a dish. (And the warmth from the hand might make it more appealing.)

Another thing to try is poaching chicken breasts in water. Keep the watery broth from the cooking and offer it both on its own and mixed in with some of the chicken. Because it's flavoured it may encourage Mittens to drink more. Try mincing the chicken finely in a food processor can make it easier to get down). Another idea to try is to blend some of the meat and broth into a thick-ish gloopy soup and again offering that from the hand.

Another member here had good success getting their kitty to eat by mixing together some home poached chicken with some chicken/broth baby food.

Raising the food and water dishes may make it more comfortable for Mittens to eat (less chance of reflux)

More tips later today. Shopping list is next ... (sorry I can't type faster).


Mogs
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All I can add, Dan, is that we can help you address Mittens' issues step by step. You've been given great advice . Try to stay as calm as you can. Do some reading here about how to test blood glucose at home and how to use urine dipsticks to test for ketones.
 
Your help has been amazing, i just got back from the store with some chicken flavored baby food with broth. Tried warming it and she was not interested, even added a little water and still no interest. I gotta wait a few more hours for the ketone strips(embarrassing but its the day before payday) but i do plan on trying anything. Waiting on my wife to call the vet, i dont think they open til 9.

Im trying not to panic but she looks so weak, her front of her body looks normal just maybe a tad skinny, its her back end which really shows the weight loss. Googling earlier in the week lead me to kidney failure? I hope i was just reading the worst but she does not look great. She tried drinking from her water dish a little bit ago and she was just pawwing at it like she couldnt drink. It breaks my heart to see her like this, if shes suffering i dont want to keep it going but i dont wanna go for euthanasia either.
Her pic on my profile was from 2 years ago in her prime so its not a recent pic.

Im gonna go over the posts in this topic again and have my wife read thru them when she gets up.
 
INSULIN OPTIONS (in order of best clinical properties for cats):

Lantus or Levemir (U100 insulins)

- gentle action, long duration in cats.
- very expensive in US, much cheaper from Canada for the long term but if immediate treatment is necessary you need to get SOME INSULIN for Mittens as early as possible.
- Available with written Rx from human pharmacies. You may be able to find a pharmacy locally willing to sell you one Lantus pen. You can use a normal insulin syringe to draw the dose directly from the pen cartridge, so you don't need the special needles for use with the Lantus pen.

Prozinc or PZI insulins (OTHER MEMBERS - is this a U100 OR A U40 INSULIN? I'm not sure so please post a note for Dan.)

- fairly gentle action, not quite as long-acting as Lantus or Levemir (not sure of cost in US)

Vetsulin (U40 insulin)

- may drop BG level quite hard and fast in first few hours after dose and so has a somewhat 'harsher' action. Some cats get on well with this insulin.
- frequently used to treat feline diabetics. Dose typically doesn't last as long as the insulins described above. (Again, not sure of costs in US.)

Novolin N

- sometimes used for feline diabetics.
- similar properties to Vetsulin (harsh drops, intermediate-acting).

If insulin is needed, then any of the above is better than no insulin at all.

SHOPPING LIST - Test Supplies & Stuff for Hypo Kit

Testing for ketones is a priority.

For today, are any of your friends or neighbours diabetic? If yes, then you might be able to borrow their glucometer and perhaps get a couple of urine test strips to check Mittens' pee for ketones? Or might a local vet be kind enough to give you a couple of ketone strips to use today (plus the colour chart for checking the results)?

Walmart

- KETONE TEST STRIPS! - IIRC Walmart do ketone strips in their Relion range. Otherwise Keto-diastix or similar strips are ideal.

- Relion Confirm or Micro glucometer - strips are affordable and only need a tiny blood sample. (Very popular with US members here.)

- Supply of test strips (Confirm and Micro use the same strips IIRC, but check with advisor at the store to be safe)

- Lancets (28 or 29 gauge are ideal - larger diameter so easier to get a sample)

- U100 syringes with 0.5 unit markings (o.3ml syringes are better - easier to measure dose) - can be used with U100 insulins. (Note: it is possible to use them with U40 insulin but you would need advice from your vet or from FDMB on how to correctly use them with a conversion chart.)

Hypo Kit

- Honey or karo
- A couple of tins of food with a gravy base (e.g. Fancy Feast Gravy Lovers)


Mogs
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ProZinc is a U40 insulin. It's expensive in Canada and the US - $100 to $120 per 10 mL vial. Vetsulin is quite economical I think but has to be relpaced monthly.
 
Dan&Heather said:
Im trying not to panic but she looks so weak, her front of her body looks normal just maybe a tad skinny, its her back end which really shows the weight loss. Googling earlier in the week lead me to kidney failure?
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Weight loss tends to be more noticeable on the hindquarters.

Chronic kidney disease (CKD) can cause nausea and inappetence problems. Depending on the stage of the disease a great deal can be done to help CKD kitties. Here is a hugely respected website devoted to their care:

Tanya's Site


Mogs
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Dan&Heather said:
She tried drinking from her water dish a little bit ago and she was just pawwing at it like she couldnt drink.
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Upon reading this, Dan, my best suggestion to you would be to get Mittens to the vet today for fluids. Dehydration will make her feel really lousy. While there are no guarantees, giving fluids can make a cat feel a lot better quite quickly - and it could give you more time to get other supportive treatments in place.

I know it's the last thing you want to hear but right now I think Mittens needs a vet's help. Since it is payday tomorrow I am hoping and praying that any vet you approach will have the compassion and understanding to help Mittens today.

Please, please contact DCIN as soon as possible. It is an amazing organisation and if they are in a position to help it could make such a difference to you all.

Again no guarantees, but I have seen and read about some cats who make amazing recoveries once they start getting the right treatments to overcome nausea and inappetence problems (my own little one included). My heart goes out to you all over Mittens' current predicament. Sending prayers and positive, healing thoughts for your dear, beautiful girl.

(((Mittens)))

:bighug:


Mogs
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Thank all you so much, i cant say it enough. My wife just went to see about some money and if we can well bring her to the vet today for fluids. I will also look into DCIN as well, when she gets back im gonna boil some chicken and try hand feeding it to Mittens, hope to god she eats it. Sorry if some of my posts havent made a whole lot of sense, i havent had much sleep the last few days. Ill reply back a little later with more info.
 
Hi everyone, this is Dan's wife Heather. I first of all want to thank everyone here for trying to help us. We are boiling chicken right now so we can see if she will try and eat some of it, I also got keytone test strips. I just called the vet and cancelled the appointment to have her put to sleep because I just cant do it without knowing I've tried everything I can. While I was on the phone with the vet I asked about insulin and why we cant start her on it right now as when I was there it didnt sound like an option. While I was there I felt like it was either 24 hr animal hospital or be put to sleep, she didnt really mention insulin and I was too distraught to think of it. She said we could bring her in and start her on insulin if thats what we wanted to try. She said she would write a prescription and I can get it at a pharmacy, its expensive but I would spend everything I have and go without food if it meant Mittens feels better. She said that she doesnt think the insulin will work fast enough to make a difference with her. I wish I knew more about this, I dont know why if she needs insulin would it not start to help her once we gave it to her. I feel like I think of 10 more questions everytime I talk to her. I guess I'm asking for your opinions on what we should do next. I'm hoping she eats some of the chicken.
 
Oh, my... My heart goes out to you :bighug::bighug::bighug:, I know how panicking this kind of thing can be.

Some (more) advice: Always assuming no ketones, I wouldn't start the insulin until Mittens starts eating, and preferably not before you are also comfortable with the home testing. I don't want to scare you when you are already stressed out, but insulin on an empty stomach can have terrible (fatal) consequences-- you need to get her eating first. The fluids might help with that, and then the next line of anti-nausea/pain relief meds that Mogs suggested. A prescription for insulin would not be out of line, but I wouldn't actually give her the shot until she's back on her feet a bit more-- the high blood sugars are contributing to making Mittens feel lousy, but addressing that in isolation won't make her feel that much better, and could be dangerous.

Keep asking questions-- we are here for you!
 
One more question, I bought the ReliOn Ketone test strips, I'm just not clear on what thats for. What exactly does it mean if she is positive for ketones?
Ok, thank you for the reply, we will wait on insulin for right now. I dont want to give it to her if it may be dangerous. What is the next step if we cant get her to eat the chicken?
 
A positive test for ketones means she is at risk for diabetic ketoacidosis (DKA)-- a very very serious health emergency that requires immediate vet attention. Anything that reads above "trace" on the ketone stick is cause for concern-- DKA can develop very quickly. It is also very expensive to treat-- all but the most mild of cases really can't be treated at home-- so all fingers and paws crossed that that's not in the mix, or if it is that you are able to catch it very early in the process. Here's a link to some more info: http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

Because DKA is so serious and expensive to treat, that's just about the only time we would ever recommend giving insulin to a cat that wasn't eating well, and only really if the caretaker is very experienced and well-prepared to detect and deal with the consequences of a too-big drop in blood sugar (hypoglycemia: see http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/).

I know all this sounds really scary, and I don't mean to give the impression that it somehow seems like ketones/DKA is the most likely thing causing problems for Mittens, because I don't necessarily think that's true. We emphasize testing for ketones and avoiding/treating hypos because DKA and hypos are so serious if they do happen (even if they are rare), and they are very easy to check for.
 
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Ok. Thank you for clearing it up for me, I'm trying to follow along with all of the advice but it feels very confusing. We will test for ketones as soon as we possibly can. This kills me, but I have to go to work now, I'm already two hours late and cannot take the day off. My husband will be here with her and said he will keep trying to get her to eat. I feel like getting her to eat and testing for ketones is priority right now. I am tired and scared though, so I hope I'm sorting through all of this information correctly. I have logged onto this message board on my phone and will probably keep having more questions while I'm at work. I just want to understand everything so we can try anything and everything but in a healthy way for Mittens.
 
Hi Dan and Heather,

Oh how my heart goes out to you. :bighug: and I'd be reluctant to make any irreversible decisions until I was sure ...

(((Dan and Heather)))

I offer suggestions to all who come here as though their cat were my own - and I would move mountains for my little ones.

I stand by my earlier recommendation: please get Mittens to a vet for fluids as soon as possible. No guarantees but sometimes the difference fluids make can be quite extraordinary in some cases. And it could buy you time to get other supportive measures in place.

Do your best to catch a urine sample in the meantime and test it for ketones at home if you can (and post the results here). Otherwise get the vets to do a check immediately.

If trace or higher ketones detected insulin treatment needs to start straight away - even at a reduced dose to take into account Mittens' problems with eating. (The vet should be able to help with this.) It is possible that fluid treatment may flush trace ketones out of the system. Higher than trace is a more serious issue but lets take things a step at a time for now.

I would also ask the vet to check for constipation and if present prescribe appropriate treatment (e.g. metoclopramide for 1-2 days). If constipation isn't an issue I would ask for Cerenia and B12 (Cerenia is NEED to HAVE, B12 is nice to have). If Mittens doesn't respond by eating a little something within a short time I would look to ask the vet to give an appetite stimulant. A LOT of coaxing may be needed to encourage Mittens to eat something but if a recovery is possible persistence can pay huge dividends. Assist feeding either by hand or with a syringe may be needed.

The other priority is to contact DCIN as a matter of urgency. They have helped many cats here. Again no guarantees but in the past they have been known to help with emergency veterinary treatment costs and they have helpled save cats' lives.

Diabetic Cats in Need are on Facebook.

Will post again shortly.

Praying hard for all of you.


Mogs


EDITED TO ADD:

Re fluids, if IV fluids aren't a cost option then subcutaneous fluids are at least worth a try. (And sub-q treatment can be continued at home following instruction from the vet.)
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NB - DCIN have helped cats with DKA in the past.

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ETA - if DCIN do accept a kitty my understanding is that they can help co-ordinate things with the treating vets so that treatment goes ahead without unnecessary delay.

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@Dan&Heather -

There's a lot to take in - especially when there's a lot of time pressure - but for now please ask your hubby to focus on my post immediately above this one (post #30). These are the priorites for now.

Based on extensive experience of dealing with eating issues in my own cats and also on what I've learned here I think Mittens really needs some medical intervention here to help her to eat. I could be wrong but from what you're describing I don't think coaxing at home is going to be enough just now.


Mogs
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Dan&Heather said:
Hi everyone, this is Dan's wife Heather. I first of all want to thank everyone here for trying to help us. We are boiling chicken right now so we can see if she will try and eat some of it, I also got keytone test strips. I just called the vet and cancelled the appointment to have her put to sleep because I just cant do it without knowing I've tried everything I can. While I was on the phone with the vet I asked about insulin and why we cant start her on it right now as when I was there it didnt sound like an option. While I was there I felt like it was either 24 hr animal hospital or be put to sleep, she didnt really mention insulin and I was too distraught to think of it. She said we could bring her in and start her on insulin if thats what we wanted to try. She said she would write a prescription and I can get it at a pharmacy, its expensive but I would spend everything I have and go without food if it meant Mittens feels better. She said that she doesnt think the insulin will work fast enough to make a difference with her. I wish I knew more about this, I dont know why if she needs insulin would it not start to help her once we gave it to her. I feel like I think of 10 more questions everytime I talk to her. I guess I'm asking for your opinions on what we should do next. I'm hoping she eats some of the chicken.
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thank you for hanging in there. i know how overwhelming this is. i'm sorry your vet doesnt seem to be very encouraging. the diabetes can certainly be treated, usually with insulin but in some cases a dietary change can have an immense impact in itself. that is just a secondary concern at this point due to the extreme nausea/diarrhea/and dehydration kitty has going on. i too agree with Mogs above that needs to be managed and most likely by a vet. Just a bunch of fluids alone could make all the difference and works wonders. it sounds like her diabetes just got ahead of her and until she gets hydrated and less nauseous, she's not going to get better.

because your vet isnt encouraging, let me encourage you there is no need to throw in the towel on this kitty. hydration and food first, then worry about diabetic management.
 
Ok, here's where we're at right now. I'm hating life because it just won't allow for me to do this like I know I should. I am at work and have to remain so until 6pm EST. I cannot take the day off or I will get a 3 day suspension which would make paying the rent impossible and we only have one car and he's been up far tooling to have driven me safely. I just called the vet and made an appointment for in the morning to get her fluids. I feel awful though that she has to wait. Is there anything I can do in the meantime at home? I have an oral syringe that we've been trying off and on to get water into her system. We just squirt a little into her mouth and she swallows. She doesn't like it and neither do we but I know she needs water. Is this a good idea? Should we keep trying that at least for tonight until she can get the fluids in the morning?

Also my husband has been up for roughly 30 hours so he was falling asleep on the couch waiting for her to go to the liter box so he could try the strips. Unfortunately he didn't realize she went to the liter box until he heard her in there and she was already getting out. The best he could do was dip the strip into it as she hasn't been in the habit of burying her waste for quite a while now. We know it's not the best way to test and we will continue to wait to collect a proper sample and test it. He said it was hard to tell what it said, he said it was hard to tell he thought it said small-moderate. I wish I was there so I could help him. I'm not sure exactly how much it being somewhat mixed with liter will affect the results, some I'm sure.

I just don't know what to do. He did say she drank some water. I feel like we're torturing her by making her wait till tomorrow.
 
If she can handle water from a syringe, you could try making a thin soup of wet food and warm water or plain meat (no seasoning, garlic, onions) baby food and water to syringe into the side of her mouth. This would have to be done in small amounts and frequently (every 30 minutes?). You can do this at home and it will give her some nutrition and hydration.
 
Did she drink the water on her own? That would be a good sign. No matter what is going on with her, the more water the better. It's hard to get a lot in via syringe, but every bit helps. Kris's suggestion of trying to get a bit of food in that way is a great one-- syringe-feeding is difficult, but again, every bit helps in this situation.
 
Also: breathe, and try not to let the stress of this situation take over. You are doing the very best you can for Mittens-- it won't help her if you get a 3 day suspension and have trouble with rent, Dan's doing heroic work already by staying up 30hrs and continuing to try to care for her (I am not sure how to interpret the litter+urine result btw; waiting for some more experienced folks to weigh in). All you can do is your best.

Have you or Dan been able to contact DCIN yet?
 
Hard to know about the ketone test strip result. There are ways to get a better sample. One is to put a layer of kitchen plastic wrap over the area of litter Mittens prefers in order to catch a little urine. If she's not too shy you can try putting a shallow long-handled kitchen spoon under her backside as she pees. Generally the strip is dipped, excess shaken off and allowed to develop for 15 seconds before reading it. Looking at it under a bright light is best.
 
Yes she drank the water on her own, he had to kinda hold it for her but with some encouragement she did drink it. We have been trying to mix a little bit of the food in with water and give it to her with the syringe, we weren't sure if we were supposed to but it felt right because at least she got a tiny bit of something. We will continue waiting to get a better sample of urine for the strips. She's going in tomorrow morning for fluids, we'll just keep trying to help her drink with the syringe for tonight.

Thank you so much, you have no idea how helpful you have been. We felt less than hopeless last night and now even if everything we do ends up not working we will feel much better knowing we tried our best. That's why we couldn't go thru with the appointment to put her to sleep today, we just felt like we hadn't tried hard enough. Even if we can't fix this, if it's gone too far, I want everyone on here to know that we appreciate the hell out of all of you, your support and encouragement mean everything to us. Without you we may have gone thru with it and forever felt like we gave her up too soo. At least now no matter the outcome we know we tried for our little girl, we're gonna fight this until we know for sure there's no more we can do
 
Dan&Heather said:
I have an oral syringe that we've been trying off and on to get water into her system. We just squirt a little into her mouth and she swallows. She doesn't like it and neither do we but I know she needs water. Is this a good idea? Should we keep trying that at least for tonight until she can get the fluids in the morning?
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Kris & Teasel said:
If she can handle water from a syringe, you could try making a thin soup of wet food and warm water or plain meat (no seasoning, garlic, onions) baby food and water to syringe into the side of her mouth.
Click to expand...

I would try this suggestion from Kris but I would not make the baby food/water slurry too watery because if Mittens is throwing ketones then any hope she has means getting FOOD into her as well as fluids. Food and fluids are all that I know of that you can try to do at home with your current supplies.

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SUPPLIES TO PICK UP FOR TONIGHT (if at all possible) - suggest Walmart so you can grab glucose testing supplies

* The baby food you're using - don't run out of this (including some to bring to the vets tomorrow in case Mittens needs feeding there).

* Famotidine (Pepcid AC - check with the pharmacist that it ONLY contains famotidine) - also call the vet to check it's OK before giving any to Mittens. Typical dose is 1/4 of 10mg tablet for a 10lb cat but check dosage with your vet if you get the OK to give the medication.

* Relion glucometer (Confirm or Micro), some test strips for the meter and some 28-29 gauge lancets (may be labelled as 'alternate site' lancets)

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*** Please don't freak out when you read the following. Trying to help. ***

There's no easy way to say this but a cat with ketone levels at small to moderate should be taken straight to hospital for specialist care to flush out ketones (and in Mittens' case to start insulin treatment) to stop the cat from going into DKA.

Right now we are where we are so all we can do is try to find a way through this.

Please, please contact Diabetic Cats in Need immediately. If they were to accept Mittens you might be able to get vet care straight away (no guarantees here but there's no down side to asking them if they can help).

At the moment all you can do at home is try to keep getting the food / fluid slurry into Mittens (per above).

* Go slowly and steadily with the syringe feeding; you don't want her to vomit.

* Syringe water or food FROM SIDE TO SIDE across the mouth and allow time for Mittens to swallow. (It may help to wrap her up in a towel, kitty burrito style).

(Do not syringe food or fluids from the front to the back of the mouth because the cat could end up with fluid or food in the lungs.)

* The famotidine (provided vet says its OK to give) may do something to reduce stomach acid and possibly help Mittens to manage getting food down. (Again, no guarantees.)

* If you do administer famotidine you need to follow it with about 3-5ml of water or food slurry to wash the tablet down into the stomach properly.

I am tagging @Meya14, one of our members who is extremely knowledgeable about ketosis and DKA. If she comes online tonight this tag will let her know that help is needed. (Can't guarantee she'll log in but if anyone here can really help you tonight, it's Meya.)

Sending prayers and healing thoughts,


Mogs
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NB - put the plastic food wrap over the litter in Mittens' box to collect another sample of urine to test. Put the litter box somewhere you can closely monitor it for activity.

It helps to do a double thickness of the food wrap. Make a little 'well' by pushing down gently on the film so urine will collect in the hollow.

If you don't have food wrap use a plastic bin bag.

Do another ketone test and post the result here. (If Meya does respond to the tag she'll need to know the result.)

(I suggest that after collecting the sample put some fresh plastic down over the litter ready to collect another sample in case it is needed.)

(I sincerely apologise if my tone sounds very directive or a bit bossy at the moment It's not intended that way; I'm just trying to get information posted a bit quicker.) :bighug:


Mogs
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Suggestion:

Poach some chicken breast in water. Once it has cooked keep the broth. Put some in a dish, let it cool and offer it to Mittens with a bit of encouragement like you did earlier to see if she will drink for you. (Less stressful than the syringe and it may help her to take a greater volume of fluids onboard.)

Still praying for you all.

:bighug:


Mogs
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Ok. I'm going to get all the things on that list as soon as I get back to town. She wouldn't eat the chicken we boiled for her easier but we will try again and make sure to keep the water so she can try to drink it. I just finished my application to diabetic cats in need. Hopefully they will help, if not I will continue to do anything I can if it means spending every last dollar I have. Thank you
 
Dan&Heather said:
I just finished my application to diabetic cats in need. Hopefully they will help,
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I am praying that they will.

Dan&Heather said:
She wouldn't eat the chicken we boiled for her ... we will try again and make sure to keep the water so she can try to drink it.
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I use about 4 US cups of water for 2 large chicken breasts diced into chunks for cooking. The broth is watery but it is flavoured and may encourage Mittens to drink a little more - probably with encouragement, like you did earlier. Talk soothingly to her and give her plenty of gentle praise and fusses every time she eats or drinks anything - it can really help. The watery broth helped me get Saoirse through pancreatitis and recently helped me to get my civvie, Lúnasa, through a major GI upset. I really hope it will help Mittens, too.

(((Mittens)))


Mogs
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Hi there: Just so I'm clear, as this was a really long post, the following is what I've gathered:

1. Cat not eating. How long ago did this start?
2. Cat not started on insulin yet. BS ~500ish.
3. Not home glucose testing yet?
4. May have small-moderate ketone test.
5. Was a lab for potassium run (look for it in your paperwork, may say potassium or "K")
6. No other medications currently being given for nausea or other issues.

What I would start with:
1. Contact DCIN and get to a diabetic friendly vet ASAP, don't go back to your old vet. I'm not sure in appleton, but in Milwaukee I go to a very good vet that is cat only, and a diabetic specialist. This is your best option for recovery.

2. Please get a glucometer and start testing at home, there are plenty of videos on youtube, and members here can guide you. Glucometer from walmart is about $20 with strips.

3. Continue to syringe feed, aim for every 2 hour feedings. Try to get a 5.5oz can of food in her each day.

4. Obtain insulin ASAP, and once you are BS testing, you will be safer starting insulin. Without insulin it's unlikely her appetite will return and unlikely she will recover. If you cannot afford lantus or levemir (~$80-90 a pen), then you might want to consider getting a cheap insulin like Novalin N (not R!!!) which is harder to dose, but better than nothing at all with ketones. ***Novolin-N is available over the counter in wisconsin*** although not all pharmacies will sell without a script. Novolin-N will require 3 times a day, every 8 hour dosing to really prevent ketones. This insulin is about $20 a vial, from walmart.

5. Ask your vet to show you how to do subQ fluids at home.
 
This is wonderful information for Dan+Heather (and Mittens), @Meya14, thank you for stepping in! I had no idea that Novalin-N was available OTC in Wisconsin-- that could potentially make a huge difference in this situation.

One point of clarification on "don't go back to your old vet": I agree that their current vet doesn't seem to be on top of the challenges facing Mittens at all, and hopefully DCIN will step in to help Dan and Heather transfer to a better vet in a timely fashion. But if they don't hear back from DCIN in time, they should go ahead with their appointment with the old vet tomorrow morning for fluids and any other supportive care that seems do-able, correct? Not ideal, but better than nothing in the short term?

Sorry, I know I'm being overly pedantic, it's just that there have been lots of suggestions made by multiple people in this thread [raises hand], mostly consistent with each other but sometimes confusing [raises hand again], so when something really specific is said that may contradict earlier advice I want to make sure we're all on the same page in what we're recommending to try to get Mittens the best care possible in the current circumstances.

Dan+Heather: I hope things are going well so far, keeping you and Mittens in my thoughts tonight :bighug:.
 
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