New Here - Falafel, Second Round with Diabetes

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thornmallow__

thornmallow__

Member Since 2024
Hi everyone. I'm not sure how much detail is helpful, so I'm going to explain everything and hopefully it will help.

Earlier this week my cat, Falafel (~13 yrs old, 10 lbs), was suspected to have gone through DKA. On Tuesday, I took her to the emergency vet because she was acting odd - lethargic, disoriented, etc. The emergency vets gave her fluids and advised me to get a full workup at my regular vet, which I did on Wednesday. She got 2 blood tests (one quick one and one longer one), an X-ray, and I went back on Thursday for the results and an ultrasound. The regular vet told me her blood sugar on Wednesday read 400 (not sure of the unit, but assuming he used a pet meter). The ultrasound on Thursday confirmed she had no other underlying conditions, but was definitely diabetic (she has a heart murmur but he said it wasn't negatively affecting her). This vet is great in some ways, but he is very old school. His treatment plan was to get her on 2 units of Vetsulin, morning and night. I asked about glucose monitoring, and he said it wasn't necessary.

I adopted Falafel from a local rescue organization in 2021, and that organization told me she had previously developed diabetes when she was in the shelter due to stress. With diet change, they were able to get her into remission (and that's why I was ultimately able to foster/adopt her). I believe her diabetes came back because I changed her diet... at some point, due to her stomach issues, her vet advised me to have her start Hill's Science Diet I/D wet food. I supplemented that with the same type of dry food because it helped with the costs. Since earlier this week when my cat was in DKA, I switched exclusively to Fancy Feast pate (which is what she ate before) which I have been mixing with unflavored Pedialyte per the vet's suggestion. The vet also gave me NutriCal and told me to apply it to the roof of Falafel's mouth 3x a day (I have not been regular about this, it's so stressful to get the NutriCal in her mouth that I worry I'm doing more harm than good). Falafel's appetite seems strong, but I don't think she is eating anywhere near enough Fancy Feast - she should be having about 3 cans a day, but I think we're sitting at about 1.5-2 cans on average since yesterday and my prediction for today.

I was able to get an appointment at a second vet (recommended by the rescue organization) on Monday for a second opinion on Falafel's treatment plan. In the meantime, I took Falafel back to the vet today (Friday) for a shot of Vetsulin - I called the emergency hospital for advice and they said because her blood glucose was so high, I should stick with getting her some type of insulin while I await the second appointment at the other vet. I will be bringing her back tomorrow for another shot of Vetsulin, and that vet also told me to try to collect some urine to bring in to test for ketones, which I hope I can do. (I put shredded newspaper in her litter box so I can catch some, but Falafel does not seem enticed by it - I'm hoping she pees on the way to the vet because it seems like she always does that!)

Today, I bought the FreeStyle Lite monitor and test strips. Falafel had 2 units of Vetsulin at ~10:45am. I tested her at 5:09pm and the glucose reading was: 155 mg/dL.

My questions are:

1. Is this first reading a good sign? Considering she had Vetsulin about 5 hours ago, what conclusions can I draw from this?

2. I am confused about what to do next in terms of testing. I see that it is important to gather a glucose curve, is this something I should do on Sunday when she won't have access to any insulin? Is there a dummy guide for doing this? I want to test her tomorrow before/after she gets her Vetsulin shot to understand what it's doing - does this seem like a good second step?

3. The vet said that there's only a 50-50 chance this therapy will help, as about 50% of cats don't respond to treatment and to prepare for the worst. This seems wrong to me, or maybe that's wishful thinking - what have you all heard about this?

4. I was supposed to go on a trip next week. Is one week of treatment enough time to leave Falafel with my family? We all live together and my sister and brothers are committed to her care - but she is my cat. (Please don't crucify me for this... for now I've decided to play it by ear and will cancel the trip if I'm just too nervous to go nearer to the departure date.)

5. I typically work in office M-Th, but I'm WFH on Monday to take her to the vet. How can I manage when I'm not home to watch her?

6. Any other tips/things to note?
 
Hello and welcome. Is there a reason the vet didn't give you a vial of Vetsulin for you to do the shots yourself? You will also need U-40 syringes. The vet should be able to show you how to do the shots. You can practice on a thin skinned orange first.

Have you tried giving NutriCal from your fingertips? There are other options if she's feeling nauseous.

Answers where I can.
1. Going down to 155 is a good thing. The question is whether she went lower before hand or is still going down.
2. A curve without insulin being given is of no use. The purpose of a curve is to see how a cat is doing on a particular dose of insulin, and to help you find at what point after the shot is her low point, or nadir. Knowing that helps you know the best times to test. You should always test before the shot, to make sure it's safe to give insulin.
3. Not sure why your vet said insulin therapy dose not work. Especially if no other underlying conditions. Part of it may be the choice of insulin. Vetsulin (called Caninsulin, ie dog insulin in the rest of the world), is not a great insulin for cats. Longer lasting insulins like Lantus/glargine or Prozinc are what are currently recommended.
4. Do you think you can get your family members to test and give insulin? Perhaps leave them access to your login here so we can help if needed.
5. How many hours are you gone during the day? Many people get an automated pet feeder or leave out food for kitty to eat to stay safe if their numbers go low.
6. Since your kitty was in DKA, you should be testing for ketones at home. You can get ketones testing sticks at any pharmacy, ketostix are one brand. There are also blood meters that can help you do that. You don't need to take the urine into the vet. Some reading for you:
Tips to catch and test a urine sample

Is is very important that a cat recently DKA gets sufficient food to eat. She needs to eat more than normal. Here are some tips that might help: Suggestions on How to Stimulate Kitty's Appetite

Browse through the yellow starred Sticky Notes about Vetsulin at the top of this forum: Caninsulin / Vetsulin and N / NPH
 
Hi! The vet did not have enough Vetsulin to sell to me. He had me order on Chewy, but we didn't get the order in on time (it was close to 3:30pm when I was told to order). Because of Chewy's shipping rules for insulin, I wouldn't get the Vetsulin til Monday morning. He did provide me some U-40 syringes, and showed me how to do the shots for when I have the insulin. He is closed on Sunday so Falafel would miss the Sunday dose (which I guess is half a dose since she's only getting 2 units in the morning.)

She's not feeling nauseous, and is eating more - just not as much as it seems she should. I was trying to put the NutriCal on the roof of her mouth with my fingertip, but she fights me on it so I resorted to dabbing a bit on her snout so she can lick it off. I can keep doing this instead, especially since you mentioned she needs to eat more than normal after DKA.

1. I just tested her again (9:50pm, +11 hrs after her shot), and she is at 345 mg/dL. Is this dangerously high? I'm worried about going to sleep now. She also ate just before this test so maybe I should wait another hour or so and try again? Is it okay to give NutriCal if her BG is this high? Should I also stop giving her Pedialyte?
2. Understood. I will revisit the curve once I have an insulin regimen. When is a good time to do a curve? After she has been on insulin for 1-2 weeks?
3. I'm getting a second opinion in the hopes that the second vet will recommend a different insulin - this vet is very old school and not open to adjusting (see his reaction to asking about at-home glucose monitoring).
4. Yes I can! I've been keeping everyone updated about all this but will add my login info to the hypoglycemia sheet I printed and put on the fridge.
5. I would be gone probably from around 8:30am-6:30pm during the work week. I can/do leave food out for Falafel, but I notice she likes her wet food wet (so I often add a dash of water, or lately Pedialyte, to rehydrate) and mounded up, so I worry she won't eat as much when I'm not home.
6. I just ordered ketostix off Amazon.

Thanks for sharing the sticky, it spurred me to see if I can find Vetsulin locally this weekend. I'm hoping I can get it from Petco or Costco, but I'm not 100% sure they are stocked in my area. If I can't find the Vetsulin locally, will she be okay until Monday when I can get her back into the regular, second vet? I have an emergency vet nearby and am planning to run to them at the first sign of odd behavior on Sunday.
 
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1. 345 is not dangerously high. With Vetsulin (as per the Sticky Notes), you test, feed, wait to make she's eaten enough (30 minutes) then shoot. The food could influence the test number, but likely not a huge amount that you need to worry she'd normally be a lot lower. I'm not sure what the Pedialyte is supposed to do. I would keep up the NutriCal, or whatever she needs to keep up her calories. Calories are important in recent DKA.
2. You can do a curve any time. I wouldn't wait 2 weeks, in case the dose is taking her too low. Normally we start Vetsulin on smaller doses, but make exceptions for cats with recent DKA.
5. Some cats are grazers, so you can leave wetted down food, or an ice cube on top which will melt, keep it cool, and provide water - when the weather is warmer. Water added to food is good, you want her to get as much fluids as you can now. Cats that are hoovers need automated feeders so they don't eat all their food at once. You know which your cat needs.

Vetsulin is usually stocked by vets. Any chance your vet can refer you to another vet to get a spare bottle? Prozinc is also vet supplied, whereas glargine can be obtained at human pharmacies, which are open more hours. However this is likely a one time only problem. Recent DKA cats should not be missing insulin shots.
 
1. The Pedialyte was supposed to help restore fluids since she was so dehydrated. I'll keep that up and the NutriCal.
2. Will it be very disruptive if she has been on Vetsulin for 3-4 days, and I get a recommendation for a different insulin from the vet on Monday?
5. OMG, that is a genius idea. I'll try it in the warmer months. For now my brother promised to check on her food every hour to re-wet as needed.

Tomorrow I will ask the vet if he can refer me to another vet, or see if he has another insulin option available. I also found a couple vets that are open on Sunday. I thought maybe I could also just make an appointment at one of them, explain the scenario, and see what happens. I'll probably have to redo her tests at any of these clinics, but I'd rather do that than have her miss a shot.
 
Red & Rover (GA) said:
Is Falafel only getting one dose of insulin a day?
Click to expand...

Yes, the vet is only open long enough for her to get one shot in the morning. The vet's plan was we continue like this until I get my own Vetsulin on Monday and I can give her 2 units in the morning and 2 units at night.
 
thornmallow__ said:
Yes, the vet is only open long enough for her to get one shot in the morning.
Click to expand...
That's not good enough for a cat recovering from DKA.

Would it be possible for the vet to lend you the vial until Monday morning?

I'm copying something that a very respected member of this community wrote concerning treatment post-DKA.

You will be busy looking after him for the first week after he comes home, especially is he has not got his appetite back.
I am going to give you a list of things you can do now. Enforce he comes home so you are ready when he does​
      • buy Ketostix for testing ketones. Can be bought from Walmart in the US or a pharmacy. Or you can get a blood ketones meter. Both are OK.
      • Ask the vet for antinausea medication such as cerenia or ondansetron. Most post DKA kitties are nauseated for a time after discharge.
      • You may also need an appetite stimulant. Always give the antinausea medication first before the appetite stimulant.
      • Ask the vet about giving sub Q fluids at home. They can show you how to give them. If not we can show you.
      • Get a range of canned food for when Cookie gets home including some higher carb foods.
      • set up a spreadsheet and the signature before the cat comes home. If you have any trouble @@Bandit's Mom is a whizz at setting them up in a minute.
      • If you don’t already have a glucose meter I would buy a human glucose meter over an alphatrak meter. I know you have the libre attached but you will need a meter moving forward.
      • get a copy of all the path exults from the ER
Once your cat gets home this is what you will need to be doing.​
      • you need to give one and a half times as many calories as he/she normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,
      • Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
      • Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
      • Give antinausea medication if needed
      • Give appetite stimulant if needed after the antinausea medication
      • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
      • Give subQ fluids if the vet has agreed you can give them
      • Add all the BG data to the spreadsheet as you go so we can see it at a glance and test the BG frequently.
      • Post daily with updates and ask for help as often as needed. Ask any questions.
      • We can help you with the dosing of the insulin.
      • Report any lethargy, lack of appetite, diarrhoea or vomiting, or increased thirst to us immediately please.
 
I will see what the vet can give me tomorrow. Thanks for the additional info.

Is there anything I should keep a particular eye on tonight (it's 12:30am here)? She seems to be eating well and behaving normally. I have food out in different places for her to eat all night. She is very happy with the Fancy Feast classic pate. Could she pass away tonight with no insulin? Should I take her to the emergency vet right now??

Also, would you be able to provide additional insight - I am not actually sure Falafel went through DKA. The vet said he "suspected" it. Here is the timeline:

- Last weekend, she was eating very little. I thought she was sad because she was missing my parents so tried to give her treats and waited it out.
- Monday, I came home from work and realized she hadn't eaten all day. I found an old can of Fancy Feast and that got her to eat.
- Tuesday she was behaving oddly, lethargic and disoriented. I took her to the emergency vet. They gave her fluids, an anti nausea and an anti indigestion shots. The fluids helped a lot.
- Wednesday I took her for full bloodwork at her regular vet. He took an X-ray, longer blood test, and shorter blood test. Shorter blood test said the glucose levels were very high (I just had a look at her records - her BG was 407 mg/dL on the longer test). At this point he did not give her any insulin or confirm a diagnosis, but gave her fluids and told me to get her to eat as much as I could.
- Thursday, I brought her back in because he wanted to do ultrasounds to confirm she had no other underlying issues. I picked her up in the afternoon, and this is when the vet gave her a shot of insulin and told me she was diabetic. I ordered the Vetsulin on Chewy as soon as I found out, but I missed the ordering deadline for overnight shipping and found out I would only get the insulin on Monday.
- Friday I went back in and he gave her another insulin shot.

Based on this info, do you think she went through DKA? After posting here I no longer trust this vet. I have a second opinion appointment booked for Monday, but I will go to the urgent care/emergency vet tomorrow if he's not able to refer me to anybody else. I did call the emergency vet and they said unless she is in crisis, there is not much they can do to help.
 
For Monday and a new vet:
It's way past my bedtime. If you are unsure or have a crisis on your hands, post and ask for help. There are people here from around the world and someone should be online. Tonight, you have been talking with two Canadians.

If it is a crisis, scroll to the top of this thread. In the right hand corner there is a blue box that says Edit Thread Title. Clicking on that gives you the option to put up a red 911 or a question mark. You can also change the title to something like 'Help!' then the reason why you are putting up a 911.
 
Red & Rover (GA) said:
Symptoms of DKA and more information can be found here:
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

It is fairly simple to give fluids at home. We can walk you through that. And do ask for more of the drugs listed in post #9.

What can you do in the meantime? Entice Falafel (great name, btw) to eat. And add some water to her food.
Click to expand...

Thank you! I will ask about the additional medicines today and see if he can lend me the vial.

On a side note, I tested her BG this morning and she is at 388 mg/dL. So at least it seems relatively stable.
 
338 is not bad considering. But cats who have had DKA in the recent past can develop ketones even if the numbers aren't crazy high.

Ask if he can give you a prescription for vetsulin that you can take to another vet today. Then call around. Or have their front desk call.

Last resort: it's frowned upon because it is best that insulin not be contact with the lubricant in the syringe for a long time but ask for pre-loaded syringes for Sunday.
Or an even better idea - ask for just enough insulin pluse a bit extra insulin in a glass bottle.

Also ask for copies of the labs. You paid for them. They are yours. You have the right.
 
The fastest quickest solution here would be for your vet to give you a prescription for Lantus or its generic that you can fill at any human pharmacy, most of which are open 24 hours. It’s a much better insulin for cats anyway and if this was my cat, I’d call today and push for that. I’d argue the urgency especially since he doesn’t have any insulin to sell to you. DKA happens when a cat is not getting enough food and enough insulin. You’re handling the food but the insulin is still an issue and she needs it twice a day as already mentioned.

FYI, a cat in remission is still a diabetic controlled cat and should be on low carb foods for the rest of its life. No more dry food unless it’s a low carb one like Dr Elseys or Young Again Zero Carb
 
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Update: no ketones in her urine!!!

The vet gave me preloaded syringes for the weekend.

@Ale & Bobo & Minnie (GA) I wish I knew this before. Thanks for the advice. Definitely referencing the diet section if I ever change her food again.

Thanks everyone for all your help and advice. I will update on Monday after I get the second opinion.
 
Great news! Once the DKA is completely out of the picture, if you’re still feeding any dry food, you’ll want to transition her off of it or switch to one of the 2 I mentioned above.

Generally speaking, Vetsulin is not the best insulin for cats. As already mentioned by others, it was created for canines who have a much slower metabolism than cats so it doesn’t last the full 12 hours in between shots and your cat is not protected 24/7. A lot of vets, unfortunately, treat feline diabetes the same way they treat diabetes in dogs. You may want to share the guidelines from the American Animal Hospital Assn for the treatment of diabetes in both dogs and cats with both vets. the AAHA no longer recommends Caninsulin/Vetsulin for treating feline diabetes.

With a diabetic cat you need:
  • A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
  • A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
  • We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
  • HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly
Thank you for setting up the spreadsheet. Falafel is a cutie!!!
 
Just read Falafel's glucose level and it is 125 mg/dL and she is shaking/shivering. Signs of hypoglycemia? I put NutriCal on her gums and am making a slurry of food to feed right now according to the toolkit.
 
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he symptoms to be concerned about include but are not limited to:
  • staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
  • ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
  • disorientation (yowling, walking in circles, etc.)
  • twitching
  • stupor
  • convulsions or seizures
  • coma
I don't know if what you're seeing is "twitching." A test of 125 is not low. It may be lower than what Falafel is used to. It may also be that her numbers are on the way down given the way Vetsulin works.

I would re-test in about 20 min. This is information from the Lantus board on handling low numbers. It's not specific to all insulin but it will give you some guidelines for dealing with lower numbers.
 
Okay she's up to 152 mg/dL now - not sure if this is from the NutriCal but I was only able to force feed her a small bit. I will test again in another 20 minutes.

Also I think I may have overreacted... I noticed she was slightly trembling and seemed a bit unsteady when getting up to change sitting positions in her bed so I panicked. But I'm looking at her now and she looks completely back to normal.

Thank you for your help!!

ETA: Just retested (~25 mins later) and now she's at 170 mg/dL. I have to say I'm scared to give her insulin later and tomorrow morning, but will follow the test, feed, wait protocol.
 
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