NEED HELP - Cat Critical Condition - diabetic ketoacidosis

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sjfound

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Hi,

I have a 9 year old Siamese cat. I actually have 2 from the same litter. Emma looked like she was losing a bit of weight lately but I didn't notice quickly enough. It's also hard to monitor who's using the litter box when you have 2 and you see them both come down and eat.

The night before last Emma started throwing up a lot. We thought it was hairballs (she's prone to that). I went to work yesterday. When I came home she was worse. Nose dry, curled up and then got up and threw up bile a couple of times. I rushed her to emergency and after a full examination and tests last night (with a phenomenal vet), it was determined that she had Diabetes and was currently in diabetic ketoacidosis. Her glucose numbers were off the charts, and one liver number was up a bit. Extremely lethargic.

They kept her in over night to start an aggressive treatment plan and hook her up to an IV. I was there until about midnight. The vet went back and forth 3 times during the night. They told me it was 50/50 that she would make it. It's 11AM and she's still with us. Her glucose number went from off the charts to 26 and then at 3AM went back off the charts again. At 8, it was back to 22. They have gone into surgery with another animal and are supposed to call me in the next little while.

Could some one help me out? I totally don't know what to do. I don't have a lot of money. I'm already at $1,000 as of this morning. I will keep going but I can't afford to spend $5000 or so though I love her with all my heart. I have a small child and there are expenses we have. I asked if she was suffering last night and they said she wasn't, but was extremely sick and couldn't guarantee I'd have a cat at the end of the weekend. I'm taking it hour by hour right now. Don't read this wrong - I have not given up on her. I've been up all night crying with my other cat who's lost without her sister and litter mate.

What do I do? What should I be looking for in test results? How long until I should make the decision to not go forward? Time and money just don't seem to be on my side right now.

As for ongoing care, I know about the insulin injections and we could do that, though my husband and I both work all day.

Any help or advice? I'm waiting for a call back from the vet any time now.

Thank you.
 
Looks like your kitty is in the best hands right now, sending prayers for a full recovery.
Hang in there, update when you can.
 
Hang in there for Emma. She needs to be at a 24/7 ER where everything can be monitored and I'm not sure if where she is now will cover her thru Sunday. They can pull through this even though they look awful, feel awful and all you can do is leave her in the vets hands. Mishka was in DKA when I got her home and spent a week at ER. She is where she needs to be right now and once she is over this battle and starts getting insulin she should come all the way back and be just fine. Please keep us updated on how Emma is doing and then we can help you with what you need to buy for hometesting, urine testing, etc. Sending many prayers for your little girl.
 
So sorry you and Emma are going through this.

You are doing everything right. She's where she needs to be right now. Several people here have gone through this with their cats, they should hopefully be around soon and can give you some advice on specific things to look for.

Sending healing thoughts and strength your way.
Hang in there.
Odiesmom
 
You are doing the right thing for now. Many kitties here have recovered from DKA episodes and are living full & happy lives. Don't lose hope!

Sending lots of hugs and prayers for your Emma. Please keep us posted!
 
Update - they have her glucose down to 15, but I just got back and she is sitting like a cat does on the arm of a chair but eyes are almost shut and only a little responsive. They said it was an improvement to them because last night she laid on her side and they had to check a few times to see if she was still alive. I want to hope so much that we are in the right direction and she will start to show some other signs of life soon (eat/drink/pee), but I don't know....They will monitor levels throughout the rest of the day and tonight.
 
15x18 = 270 in U.S numbers

I'm assuming you're in Canada or Europe?
We use this format to translate non U.S BG numbers, your number x 18

Hang in there, lots of prayers for you both!
 
Are they syringe feeding her right now? She needs to have some food in her regardless because she could easily slip into fatty liver from not getting any food. Cats are odd birds - the less they eat, the less they want to eat.
 
Do you have a t-shirt or something that you've worn and not washed yet? (Or a couple?) If so, bring it into the vet's and ask them to put it in the cage with her. Your familiar scent will bring Emma comfort. (The spare shirt is in case the first one gets soiled.)

((hugs)) to you and ((Emma)).
 
sjfound said:
Update - they have her glucose down to 15, but I just got back and she is sitting like a cat does on the arm of a chair but eyes are almost shut and only a little responsive. They said it was an improvement to them because last night she laid on her side and they had to check a few times to see if she was still alive. I want to hope so much that we are in the right direction and she will start to show some other signs of life soon (eat/drink/pee), but I don't know....They will monitor levels throughout the rest of the day and tonight.
Click to expand...




Your cat just needs aggressive care and time to recover. Give her some time.

My cat has been this way before - so, they can get better.

Best,
Pam & Layla
 
Thanks for the replies. No news at this point. My other cat is so upset. She's just wandering and meowing. When I went in at lunch time today, I had found a small stuffed toy she used to play with, so I did give her that and put it in with her. Any other advice is very appreciated. The vet is amazing. She is so dedicated and isn't charging us every time she goes into check to try to keep the costs down.

I really think the diabetes has developed from cortisone injections she had to get a couple of years ago. She went through a time where patches of fur were coming out and the skin was getting infected. They used to give her cortisone injections to fix everything. They warned me that a side effect was diabetes and that it didn't matter how many or few she had. It could just happen. She hasn't had one since March 2008, and the skin condition seemed to be gone so I thought the risk was gone. We contacted the people that owned her parents today and none of them had ever had diabetes, so it appears might not be genetic, may be because of that. I wish so much I had caught this earlier.

Lost without her here today...and trying not to lose hope.
 
Not good. Blood glucose levels very high all day long and insulin is not bringing it down. Peeing alot but worried about kidneys now. Going to do full blood work again in the AM, but not looking good. Can anyone help???? Why is it not coming down this time. It's been almost 24 hours. She's still not eating. They were giving her sugar in her IV, but now are changing to just saline solution. I don't understand. They mentioned that her body may be becoming resistant to the insulin or something else is shutting down.

Broken hearted...
 
*huge hugs*
You and Emma have had a horrible weekend.
I wish I had words of wisdom or advice.... or a magic wand to make her feel better.

Odiesmom
 
What do you mean they were giving her sugar in her IV? That's only going to raise her numbers unless they are using R insulin and she's dropping so low they have to give her sugar to get her out of a possible hypo. Are they monitoring all her electrolytes? Is this a 24/7 ER place?
 
This is what confuses me to. They were giving her sugar in her IV because she won't eat at all is my understanding. Not sure on insulin type. I will ask that. Since 5pm, they changed to a saline drip instead to see if this brings it down. Other thing that confuses me is they are using a human machine, so machine just reads 'high', but they don't know how 'high' it is. They had it down to normal levels yesterday - never has been dangerously low.

Vet is young but she is very committed to my cat. Has been in there every 3 hours all weekend. She is going in all through the night tonight too.

So - bloodwork in the AM may show more damage somewhere else, but what should I be asking looking for? Her behaviour has improved a bit but won't eat. Doesn't move around, but meows now and then now.

If they can't get it down out of 'high', how long can she last like that or do I need to be making the decision to put her down?

I really don't want to. I don't care about money, but I don't want her to suffer a long death.

Please advise..
 
Do you have a 24/7 ER place you can get to? Vet may be very caring but apparently she may not be up to date on DKA and treating it. By now she should have a main line catheter in her for easy access to blood......all her electrolytes should be monitored.......you don't need a vet that is inexperienced with dealing with DKA.
 
I'm so sorry you and your cat are going through this. DKA can certainly be fatal, but very sick cats can also make it through and recover completely.

I'm simplifying here, but there are different kinds of insulin, ranging from very fast/short acting (think of a shove) to gentler/longer acting (think of pressing something down slowly but firmly for a longer time). The insulin "R" is more of a shove down on the blood glucose. My understanding and personal experience with DKA is that it's typical for a cat being given "R" insulin to concurrently be given an IV with glucose.

It's important to understand that insulin is the "key" which opens up cell walls and lets the food (blood glucose) into the cells. However, the glucose in the IV is not going to be enough to keep your cat going. They should be force feeding the cat, because the liver will be damaged (it can totally heal though) if the cat goes several days without eating. That happened to my cat and he did fully recover from serious liver damage. However, in DKA the cat feels sick so she doesn't feel like eating. In addition to the syringe feeding, the vet can give her an appetite stimulant pill like cyproheptidine (http://www.marvistavet.com/html/body_cyproheptadine.html), which works very well to make the cat feel hungry. There is also another appetite stimulant, mirtazipine, which also is anti-nausea. (http://www.marvistavet.com/html/mirtazapine.html) I really recommend strongly that your cat be given an appetite stimulant, unless the vet can explain exactly why she shouldn't have it.

The other thing to know is that there is something called rebound. It can occur from the blood glucose either dropping too quickly (remember "R" is a shove) or dropping too low. To save itself from a too-fast or too-low drop in blood gluose level, the body releases more glucose into the blood. This may be the source of the renewed high BG that your cat is experiencing. It really is a delicate balancing act so hopefully your vet is consulting with others if he/she doesn't have practical experience. The IV to keep the cat hydrated during all this is really essential, and again getting some food in the cat is critical.

You might want to review this article. It's about humans in DKA, but it's really helpful in understanding the nature of the problem. It emphasizes that the problem starts with insuffient insulin in the body so that blood glucose can't get into the hungry cells. http://www.diabetesselfmanagement.com/A ... oacidosis/ . Note that an underlying cause can be infection -- my cat went into DKA with a urinary infection, and such an infection is very common in an uncontrolled diabetic (think of all that sugar in the bladder for germs to eat).

To sum up, DKA is very survivable with aggressive 24/7 treatments, including IV, short acting insulin, forced feeding and appetite stimulation meds, plus treatment for any underlying problem such as bladder or dental infection.

best luck,
laur
 
Thank you so much for your response. mirtazipine is the drug she wants to start her on tomorrow. She hasn't eaten since Thursday night and we are now almost into Monday. I know the food they have in the cage would not interest her. She is a very finicky eater anyway. Is there a good food for me to give them? I really don't want to force feed her through a tube. She is an easily stressed cat and I believe this would do her in itself.

What was your experience with mirtazipine? How long does it take to work?

The original blood tests showed raised levels for kidney/liver damage. They are doing another round tomorrow morning. I was going to ask her about doing a urine test..

Her glucose levels did come down Saturday but have been elevated since Saturday night now (now Sunday night). With DKA, how long until they could go back to normal and the cat could survive?

Thank you again so much....
 
Bring in whatever food she is used to eating and maybe you can try and see if she'll eat for you. Mishka has been through at least 3 DKA episodes that I can remember since '03........also several battles just with high ketones but her blood pH was still within range. When she was in for DKA it was usually a week before all her electrolytes were back to normal.......at one point her blood pH was so low she was close to iminent death. Could you ask tomorrow what her blood pH is? Sending prayers and keep fighting........they can get pretty bad before turning around.
 
sjfound said:
mirtazipine is the drug she wants to start her on tomorrow. She hasn't eaten since Thursday night and we are now almost into Monday. I know the food they have in the cage would not interest her. She is a very finicky eater anyway. Is there a good food for me to give them? I really don't want to force feed her through a tube. She is an easily stressed cat and I believe this would do her in itself.
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ANything your cat will eat is good. She has to eat, or she will go into fatty liver disease (hepatic lipidosis). The fact the liver enzymes were elevated is already showing liver damage. The liver -can- regenerate but believe me, your cat does not need the complications of HL and you do not need the expense. Read about it here. http://www.marvistavet.com/html/hepatic_lipidosis.html .

There are several types of feeding tubes, as you will read about in the link I just gave. One is through the nose (naso-gastric). My Danny had this when he was too sick with diabetes, messed up electrolytes, fatty liver and jaundice to undergo even the very brief anesthesia for a regular feeding tube. I believe it is easy and fast for them to place the naso-gastric tube. This helped him stabilize enough for an esophageal (neck) feeding tube in a day or two. I was very nervous about the feeding tube at first, for the same reasons you are worried. But now I would not hesitate for a minute to get a cat a feeding tube after my experience with Danny. It takes only a few minutes under anesthesia and using a feeding tube greatly reduces stress on a cat. The pet can simply lie there, being petted and stroked, while the food goes slowly in. No stress of syringe feeding, etc. Many meds can also be given through a feeding tube -- again, so much less stress. For both you and the cat!

Danny had his esophogeal feeding tube for about 2 months and he was getting hills A/D canned food. See http://www.hillspet.com/products/prescription-diet/pd-feline-ad-caninefeline-canned.html . The a/d was mixed with Rebound liquid (http://www.allivet.com/Rebound-p/28927.htm) . If I faced a similar situation now, once my cat was at home I would try feeding well-blended raw food. But at the vet, a/d would be the likely choice.


sjfound said:
What was your experience with mirtazipine? How long does it take to work?
Click to expand...
Actually I've only used cyproheptadine for appetite stimulation, but I have heard others praise the mirtazipine. I believe you should expect to see results from either one within the first dose or two.


sjfound said:
The original blood tests showed raised levels for kidney/liver damage. They are doing another round tomorrow morning. I was going to ask her about doing a urine test..
Click to expand...

Not sure what the urine test would show as far as kidney or liver, except in showing the kidney's ability to concentrate urine, but with your cat no doubt on an IV, I am not sure you will get anything really useful. For liver damage, your cat should be put on denosyl or denamarin (denosyl + Marin) which provides tremendous support for healing the liver. It can cause some nausea in some case so I think the mirtazipine would be a good call. Remember the liver can absolutely heal, but getting food into the cat is essential to limiting damage.

Then again the urine test could be helpful in indicating whether your cat may have a urinary infection. The vet should also look at the teeth to see if there is a dental condition contributing to the elevated BG.

sjfound said:
Her glucose levels did come down Saturday but have been elevated since Saturday night now (now Sunday night). With DKA, how long until they could go back to normal and the cat could survive?..
Click to expand...

I don't think you are going to see the blood glucose go to "normal"; that's extremely unlikely. Due to vet stress, illness, infection, etc, the BG will continue to be elevated. It is difficult to regulate a cat in a few days under the best conditions, and trying to do that at a clinic where the cat is stressed, not eating normally, etc makes regulation an almost impossible goal. What you are instead trying to accomplish in a couple days is:
- deal with any infection or pain
- medicate for nausea and appetite stimulation
- keep the cat well hydrated
- get/keep the cat's electrolytes in balance
- get the cat to the point that easily digestible food is being regularly consumed
- administer enough insulin to unlock the cell walls so that some food (blood glucose) can get inside the cells. This will stop the cat's body from breaking down its own fat and muscle in a desperate bid for survival.
- help reverse liver damage with denosyl or denamarin

good luck,
laur
 
Get her started on the mirtazipine as soon as possible. It is an amazing drug.
My son's cat refused to eat for days and had lost lots of weight. Mirtazipine got him
eating again and he eats like a pig and has gained weight.

The first thing i got him to eat was tuna juice. Then he liked
the Pro Plan sardines and tuna. Now he is eating the Fancy Feast chicken and tuna real well.
I would sit a fresh can of food in front of him every two hours (always a fresh can)
and first he sniffs, then licks his lips awhile and then he eats.
I think offering the fresh food every two hours made a difference.
 
Update - her blood tests were worse this morning. Liver and kidney numbers have worsened as well as severely anemic. Electrolyte levels are good. Still no interest in eating or drinking. They are force feeding her through a syringe a bit today. She hasn't eaten since Thursday. Also scared because I found out today that the IAMS recall on pet food is the one she eats and can result in B1 Deficiency. Not sure if this has contributed to problems or not but I called the vet to let her know?

What do I do? Here are the facts I'm faced with:

- Blood test numbers are worse. Red cell count is bad, liver and kidney numbers are bad.
- White blood cells are fine.
- Electrolytes are good.
- No interest in eating or drinking. Still not moving around. but sits there in normal cat position with head held up.
- Finally got glucose levels down after being high for 24 hours but now way too low.
- On a saline drip instead of a glucose drip now.
- Veins are starting to break down for blood testing. Legs all bruised (this is the one that is killiing me and making me wonder if I should go on or let her go today)
- They want to give her marcazapine for stimulating appetite but might not have it for a day or two...not sure if we have time
- They suggested nasal feeding tube but I know this will stress her and where do you draw the line....

Vets says not good and if her own cat she would be on the fence of going any longer. The blood tests and her veins is what is hurting me most. She has such dignity. I don't want her to feel like a lab experiment.

Help??? Should I just let her go now?
 
Here is a link to some information about feeding tubes. This article is on Dr. Lisa Pierson's site. If it were me, I would keep trying and try the feeding tube.
http://www.catinfo.org/feedingtubes.htm

Feeding tubes are apparently not too awful for cats and are needed in many cases. Here's a quote from Dr. Lisa from that article:

"Feeding tubes save lives and are not used as often as they should be for anorexic patients.
Unfortunately, when most people hear the term "feeding tube", they tend to panic - feeling like this is the end of the road for their cat. However, feeding tubes should not necessarily be viewed as a doom and gloom 'last ditch effort' or as a 'heroic measure'. I often hear people say "oh, I would never put my cat through that!" Unfortunately, these folks are not recognizing the tremendous value of feeding tubes to support ill patients while they heal from a temporary illness or injury. Most cats are not bothered by the tubes at all! The human is the one who is bothered by it as the cat just goes about its daily routine."

Sending healing thoughts and purrs to your kitty.
 
I am really really sorry that you guys are going through all of this!

Unfortunately it is hard to know how much all of this is affected by her lack of eating; cats when they feel crappy really don't like to eat and it can send things out of wack in a hurry. Sometimes forcefeeding for a few days is sufficient to bring them right back and those liver and kidney values may be just fine. But we aren't her vet, we don't have her values or her infront of us and so it is pretty hard to make that judgement call.

What does your vet say about the anemia? Could it have something to do with the DKA or is it separate?

If you decide to keep trying, cyproheptadine/periactin is another appetite stimulant and they may have it on hand, and syringe feeding ever hour or two should be done for certain. Feeding tubes are not inhumane even if it sounds that way and can make a huge difference, but it is another expense and there is no certainty. I would imagine that she may have heptatic lipidosis from not eating, and if she does then she needs the tube.

I know expenses are a huge issue for you and we don't fault you for that. There is no guarantee either way; you could spend a lot more money and end up having to euthanize her, or she may come out of it. Going by her behaviour is of no help right now either which makes it more difficult.

I'd talk more with your vet about the anemia and how it would be treated, whether she has hepatic lipidosis and what her prognosis is with those two conditions...

Big hugs

Jen
 
Update - she was able to get the mirtazapine. It will start to be administered to her at 5pm (an hour from now). Vet is leaving the clinic herself to go pick up and bring back for her. I pray with all my heart that this drug can start the healing process she needs. And then the blood test numbers will start to change as she eats.
 
Fingers crossed that she turns the corner soon and starts to feel better.

You're in our thoughts. Sending strength and healing vibes.

*hugs*
Odiesmom
 
Am sending prayers your way. Harley has had an NG tube twice now with great success. He was "advanced" to a PEG tube (stomach) and has had it for several months. He does not even know it is there and plays like always. The NG tube is great and I was able to lay with him while I fed him.

Pattie
 
I really hope she turns the corner soon. I know bloodwork can be all out of whack if something is going on. Does your vet know if the liver/kidney values can be out of whack with DKA? I know when any little thing was wrong with Cuddles, her liver values were out of whack. Fix whatever it was, and the values went back to normal. I'm wondering how many things may be out of range, because she's not eating. That would be my main concern right now. I think they did some kind of glucose drip on my dad in the hospital once too. It was because it was ALL through IV's.. but there was a glucose drip, as well as insulin drip. Isn't part of DKA, them not eating? They need the sugar as well as the insulin to resolve the DKA?

As far as I know, I think appetite stimulants usually only take hours to start working at times. I've used cypro in the past, but have also used mirt with a foster I had. Both worked. Heck, I used valium for Kami one time, to calm her down.. and it just made her RAVENOUS! So not sure if it would matter if your kitty is DKA.. but at the shelter, for cats that won't eat, and it's looking dire.. they actually inject some valium into the vein. I saw it myself once, and THAT will stick with me forever! They actually had a buffet of food sitting around this cat on the exam table. Held him down, did the injection, and let him up, while watching him. Not even 10-20 seconds later, he's devouring everything on every dish in front of him! :shock: Something about how the valium affects the brain in a cat or something. Apparently it doesn't always work, but there's a very high percentage, of it actually working. (I think the injectible valium has a higher percentage of working than the oral valium.. it just happened that the oral stuff was more than enough for my kitty! I wasn't even using it as an appetite stimulant for her!)
 
Update - We got to see Emma yesterday (both my husband and me). She looked a little better to me, but not moving around. Concerned with how bruised legs are due to blood tests. Scratched her under the chin and she started to purr. Not really loud but she did purr for both of us.

They tried to give the mirtazipine last night unsuccessfully. It was in liquid format and extremely bad tasting and she threw it right back up. They have tracked down pill now and got down into small enough dosage. Will start to give to her in the next 30 minutes. Still not eating without it, but being force fed through syringe. I said I was willing to discuss nasal feeding tube but she wants to try the drug.

Glucose levels have stayed normal (low end of normal).

She also got up and peed in her litter box twice! Up to now, she had been peeing where she lay.

Need to get her eating - please continue with prayers. And thank you for your continued support.
 
If Emma has had an IV all this time, it can lower the Hematocrit and they can become anemic. Stopping IV fluids and going to sub-Q might help. Also, food will help the liver along with Marin and Denosyl. She may also need at least Pepcid A/C for nausea. As for the bruises and taking blood, if they had put in a main line catheter that would have enabled them to get blood whenever needed without doing a lot of vein draws. Sending many, many prayers for a complete and sudden turnaround for Emma. Yes, they can look like they are at death's door and then suddenly turn the corner and get well.
 
I'm so sorry to read about what Emma's been going through. I'm glad she's made it so far, and I'm praying that she continues to get better. Angel was DKA at diagnosis, too, but she recovered after almost a week on IV at the hospital, so please don't lose hope.

You haven't said where you're located. If you're in the U.S., you might want to check into whether your vet accepts Care Credit, which can offer interest-free payments for 6 months or more.
 
> They tried to give the mirtazipine last night unsuccessfully. It was in liquid format and extremely
> bad tasting and she threw it right back up.

They can also have it made into a transdermal gel -- you just rub it on the inside of the ears for it to take effect. Possibly not as effective as oral consumption, but if the getting it in orally is traumatic, this is another option. (We did transdermal appetite stimulants a lot, because Gwyn would sometimes stop eating if you tried to force something in her mouth while she wasn't hungry.)
 
UPDATE:


EMMA IS COMING HOME FOR ONE NIGHT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

She is still not eating well (licks syringe), but drank water for the first time today. She is standing and crying to be let out of the cage. Glucose levels are good. She is peeing and kicking the litter around. Still trying to get more vitamins and minerals in her as well.

Vet called this morning and they want to unhook her from IV at 7pm tonight and let her come home until 8AM tomorrow. They say she is showing an interest in food and wonder if she is home with us and Anna (her sister) if this might be enough to get her to eat. I then have to bring her back to be readmitted in the AM.

I'm so excited but want to do everything right for her. I will bring her litter box and everything up to our bedroom so she doesn't have to try to go anywhere and get her blanket set up at the end of our bed where she also sleeps.

Thank you for the continued prayers. Please continue to keep her in your thoughts and prayers.
 
yaaay! So glad you get to spend the night with Emma at home.
I hope she decides to eat and is soon well enough to come home permanently.

Odiesmom
 
Oh my gosh I'm just reading this and I feel so bad for you. I hope the vet didn't hit you with too much $$$. That is such a hard decision when everything is so expensive. I hope everything goes well and she gets back to normal.
 
OMG I went through that with Andy. Twice! But that was 7 years ago and he's still with me today. I hope you have the same good fortune!
 
My cat seemed to go through a similar (if not shorter) 4 night experience. When I got her home, she had lost a lot of muscles and couldn't jump up on the bed. You might want to get a couple small stable boxes and build some "stairs" for her to get up and down off the bed.
 
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