New Member - 08/20/2021 - post DKA nervous

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Jordan Clark

Jordan Clark

Member Since 2021
Hi Everyone. Super new in my journey here with my sugarcat Toby. He was diagnosed last week, started insulin, one unit PZI twice daily, and Toby became quite ill, stopped eating and developed DKA. It was hard because prior to starting insulin he seemed to be quite well - I know he wasn’t really.
He was hospitalized for three days and responded well to fluids and is eating again and walking a bit more normally. He seems more like himself. He was discharged today for the weekend and I am very nervous as I don’t want him to slide backwards. I’m feeling super overwhelmed.
I have blood-injury-injection phobia. Diabetes is my worst nightmare - or an opportunity to desensitize depending on how you look at it.
I bought a Bayer Contour glucometer (Canadian) and I’ve watched some videos on how to get blood. I think I can do it. But I don’t know what the numbers are supposed to tell me, about dosing or about trends, or how often to check. I know I need to start a spreadsheet but looking at those does my head in a bit at this point.
I don’t know what I’m supposed to be watching for this weekend while he recovers. He has no ketones in urine as of test this morning. Do I need to be testing this weekend for ketones? Do I need to be really strict about low carb food/treats this weekend? He went days without eating before he was in hospital that I just really want to see him eat anything. He’s on appetite stimulant right now.
Thank you so much for any help and really just thank you for listening to my story. It’s heartening to post to a community that understands the panic I am feeling.
 
Welcome to FDMB.

When my kitty was diagnosed, she also was hospitalized with DKA (and hepatic lipidosis and pancreatitis). It's more than a little overwhelming. So, take a deep breath. You can do this! And yes, this is your motivation to desensitize.

DKA is typically the result of your cat having some inflammation or infection + not enough calories + not enough insulin. Essentially, your cat isn't getting enough calories so starts metabolizing stored fat which then caused ketone bodies to form. The ketones knock your cat's electrolytes out of balance. It's a serious situation and can go critical quickly. That's the scary part. This is a link to more info on DKA.

What's key to managing a post-DKA kitty is to make sure your cat is eating. Your cat should be eating roughly x1.5 the amount of calories you would ordinarily feed. Food is essential. Hopefully, your vet gave you an appetite stimulant (mirtazapine or cyproheptidine) in case you should need it. Fluids also help to dilute the ketones that are in the blood. Encouraging your cat to drink or adding water to your cat's food can help on the fluid front.

Insulin helps the end product of metabolism, glucose, get into the cells. It's important to be giving your cat insulin. Do not skip shots.

The numbers on the meter: First, you use a slightly different system for measuring glucose in Canada -- mmol/L -- versus the measuring system in the US (mg/dL). Since the majority of people here are from the US, we typically use US numbers. You multiply the number on your meter by 18. If you use our spreadsheet, the World template will automatically convert the World number to US format on a separate tab. I'm tagging @Bandit's Mom to give you a hand getting your cat's spreadsheet set up.
  • normal blood glucose (BG) is in the 50 - 120 range on a human meter, The ultimate goal is to get your kitty into that range.
  • There is an entire forum based on how to use Prozinc. I've linked the forum. There are posts on the basics about using Prozinc, dosing information, etc.
  • The dosing method sticky will walk you through the starting dose, holding the dose, reducing, and increasing the dose.
  • If you get a lower than expected pre-shot number (below 200), please ignore what is in the Prozinc sticky and post and ask for help. Some of our most fundamental rules are different for a cat that is prone to ketones or recently post-DKA.
It will also help if you could set up your signature. There's information on how to do that in the post on helping us to help you. It will also provide instructions on setting up a spreadsheet and how to understand what it means. We also have a post on home testing with videos if that would be helpful. (And yes, we probably do have a link for everything!!)

The beginning of the process of managing your cat's diabetes is overwhelming -- at first. It really does become a routine. Undoubtedly, there will be a lot of people stopping by to welcome you and your kitty. Chances are, we're all adding to your sense of being swamped with information. Please ask questions. The caregivers here are generous with their time and knowledge.
 
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Hi and welcome Jordon and Toby
Yes you need to test daily for ketones at the moment. Do you have some Ketostix or DiaKetostix to test the urine?

As Sienne has said, eating is very important. If he will eat the low carb food that is good. If you are having trouble getting him to eat, try something else. Eating trumps everything so even if it’s a high carb food , that is ok as we need him to eat. Offer snacks every couple of hours.
 
Jordan Clark said:
Hi Everyone. Super new in my journey here with my sugarcat Toby. He was diagnosed last week, started insulin, one unit PZI twice daily, and Toby became quite ill, stopped eating and developed DKA. It was hard because prior to starting insulin he seemed to be quite well - I know he wasn’t really.
He was hospitalized for three days and responded well to fluids and is eating again and walking a bit more normally. He seems more like himself. He was discharged today for the weekend and I am very nervous as I don’t want him to slide backwards. I’m feeling super overwhelmed.
I have blood-injury-injection phobia. Diabetes is my worst nightmare - or an opportunity to desensitize depending on how you look at it.
I bought a Bayer Contour glucometer (Canadian) and I’ve watched some videos on how to get blood. I think I can do it. But I don’t know what the numbers are supposed to tell me, about dosing or about trends, or how often to check. I know I need to start a spreadsheet but looking at those does my head in a bit at this point.
I don’t know what I’m supposed to be watching for this weekend while he recovers. He has no ketones in urine as of test this morning. Do I need to be testing this weekend for ketones? Do I need to be really strict about low carb food/treats this weekend? He went days without eating before he was in hospital that I just really want to see him eat anything. He’s on appetite stimulant right now.
Thank you so much for any help and really just thank you for listening to my story. It’s heartening to post to a community that understands the panic I am feeling.
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Just wanted to send along some love and positive thoughts. I am also in Canada, and my cat also just went through DKA (four days in hospital) and also on Prozinc!

Diabetes and testing can be overwhelming and hard at first but I promise testing will get easier and easier. I was so scared at first, and now it’s so easy- and weirdly, with time, we have found that the blood actually seems to come out of her ear easier, as if her ears have acclimated to being poked! It also does not really hurt them to have their ears poked- my cat sometimes gets annoyed that she has to sit still or that we are holding her ear, but doesn’t even seem to notice the actual poke.

Buddy also struggled to eat after returning home from the hospital, and needs an appetite stimulant and anti-nausea meds for pancreatitis. We normally feed only low carb food (fancy feast pates) but with her not wanting to eat, we just fed ANY and all wet food she would eat. With time, she is slowly coming around to eating her regular low carb food again.

Sending love and prayers for you and your kitty!
 
Thank you so much everyone!
Toby is doing ok, his appetite has declined a bit over the weekend even on the appetite stimulant so Im a little worried. His numbers have been ok. Yesterday I was hoping to get a home glucose curve but I had a very hard time getting blood, even though previously it wasn't a problem. Is that normal? Both in the morning preshot and the evening preshot he required multiple sticks, like 6! to get a sample.
He was in the vet today for a curve and his insulin was increased and Im pretty worried about it. I am going to post a new question to the main board cause it doesnt feel right to me!
 
OK thank you!!!

Today during the curve the vet increased Toby's insulin from 2units PZI AM and 1unit PM to 2units AM and PM. Based on a curve started at 8am this morning until 4pm this afternoon.
His numbers were:
AMPS: 24.7
+2: 22.3
+4: 16.3
+6: 10.5
+8: 6.0

Based on that the vet says 2 units is working great and we should do 2 units in the PM also.

I am nervous because in 4 hours will his BG go up enough not to cause a hypo when another 2units are administered? Also isnt it true that BG numbers are higher at the vet due to stress? I am so nervous to give 2 units this evening!! Obviously I don't understand enough about glucose curves.

Home test right now as we speak is:
+10: 10.8

Its never that low!

What should I do ?
 
If Toby’s appetite has dropped, he could be nauseated. If you don’t have an antinausea medication at home, as k the vet if he will give you some cerenia and ondansetron. Ondansetron often works better for nausea. Most DKA kitties recovering from DKA at home are still nauseated and need an antinausea medication for a week or two. The appetite stimulant will not be enough, if Toby is nauseated. And as we have said, eating plenty of food is so important at this stage.

Jordon, did you see the PM from @Bandit's Mom in the top right hand corner of the page about setting up a spreadsheet.
If we can get that spreadsheet set up for you and you add the data, we can help you so much more.
If the vet has increased the dose, it is all the more important that e can see the BG data and monitor the levels with you. You were giving 2 units of Prozinc. We recommend going up in 1/4 unit increments….a lot of vets go up in 1 unit increments which is a lot.

Ask the vet if he can check if Toby is dehydrated while he is in having the curve done. He may need some subQ fluids to correct it.
In relation to getting blood……are you warming the ear first and ‘milking’ the ear to encourage the blood into the ear?

Are you testing daily for ketones? This is really important at the moment as that can help tell us if Toby is getting enough food and insulin.
Please post daily so we can help you.
 
Jordan Clark said:
OK thank you!!!

Today during the curve the vet increased Toby's insulin from 2units PZI AM and 1unit PM to 2units AM and PM. Based on a curve started at 8am this morning until 4pm this afternoon.
His numbers were:
AMPS: 24.7
+2: 22.3
+4: 16.3
+6: 10.5
+8: 6.0

Based on that the vet says 2 units is working great and we should do 2 units in the PM also.

I am nervous because in 4 hours will his BG go up enough not to cause a hypo when another 2units are administered? Also isnt it true that BG numbers are higher at the vet due to stress? I am so nervous to give 2 units this evening!! Obviously I don't understand enough about glucose curves.

Home test right now as we speak is:
+10: 10.8

Its never that low!

What should I do ?
Click to expand...
Jordan, I am going to ask @JanetNJ if she can have a look at the BG levels and see what she thinks about the dose. I am not a Prozinc user.

Yes it is true that the cats BG levels are often higher at the vet due to vet stress.

10.8 (194) is a very safe number. Remember you can always give some food to increase the BG levels. If it is too low, you can give some higher carb food. Do you have a hypo kit set up?
 
Yes I do have a kit. I guess I’m just thinking according to the curve I am seeing the possible hypo episode wouldn’t likely be until six hours after dosing so at like two in the morning and I’m thinking I would be sleeping!
 
Jordan Clark said:
Yes I do have a kit. I guess I’m just thinking according to the curve I am seeing the possible hypo episode wouldn’t likely be until six hours after dosing so at like two in the morning and I’m thinking I would be sleeping!
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I haven’t seen any data except the BGs you posted today so I can’t really comment on when the nadir (lowest point ) is likely to be. You will just need to monitor closely and snacks every couple of hours, except the 2 hours preshot when you shouldn’t feed.
If the BG peshot is not above 230, I would stall, don’t feed and test again in 20 minutes to see if the BG is rising. And post and ask foe help. Change the subject line to stalling…please help to get attention

please try and get that SS set up so we can help you. @Bandit's Mom should be online in a couple of hours to help you.
 
Ask for cerenia and an RX for ondansetron. Both are for nausea and work in different ways. Max was never DKA but did have chronic pancreatitis. He rarely vomited so I was surprised to see how much better he did and how much better he ate with ondansetron on board.
 
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Thank you so much for the recommendation for anti-nausea medication, that makes so much sense!!
I guess my big question is in how insulin works.
If this morning Tobys BG was 24.7 and he was given insulin and 6 hours later his BG was 6 (maybe a little lower because of vet stress) then even if he starts with an amount ok to dose at (above 230 (18) ) doesn't that mean that it will drop even lower than 6... Like if he starts lower than 24.7 will he drop lower than 6.
Im thinking maybe insulin doesn't work like that, to drop the BG in absolute numbers. Am I making any sense?
 
Wow, I am so confused lol
his PMPS reading is 29.2! So I am feeling much better to give him his prescribed dose of 2units. I am so surprised in two hours he went from 10.8 to 29.2. I really have so much to learn, ugghhh.
 
Hi! You're doing a fantastic job testing! I like the 2 u dose, but moving forward if he requires another increase you should do it in 0.25-0.5 increments rather than while units. :) that high preshot is probably a bit of a bounce from going lower than he's used to.
 
Thats what I was wondering. It was shocking to see some of the lowest numbers Ive ever seen followed right by the highest number I have ever seen. Is the idea that as things settle we hope not to see such fluctuations? Ive read a little bit about bounces but I'm unsure if there are ways of avoiding or moderating those bounces?
 
Jordan Clark said:
Thats what I was wondering. It was shocking to see some of the lowest numbers Ive ever seen followed right by the highest number I have ever seen. Is the idea that as things settle we hope not to see such fluctuations? Ive read a little bit about bounces but I'm unsure if there are ways of avoiding or moderating those bounces?
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Not much you can do about it. He's gotta get used to those lower numbers.
 
So we are continuing to see some really high pre shot numbers! I think its a little elevated because I havent been able to always ensure that he has no food for 2 hours pretest/shot. He hasn't been eating very good and we have definitely been offering him some higher carb options to get some food in him. It seems to be getting a bit better. When should I be worried about those numbers being so high? I haven't been able to take many samples during the day because work has been a bit crazy but i will try to keep doing that. I guess Im wondering if its possible that the 2 units is bringing the numbers down to an acceptable low but also causing these crazy highs when it wears off, is that sometimes just the way it goes? Is that dangerous? Thank you everyone! Also I am getting so much better with the testing, I mean my partner is still doing it but I think I actually may be able to do it myself in the near future. Toby is sooo patient and good about it :)
 
It’s impossible to know without more tests. Cats often go lower at night. You need to get at least one more test after the preshots. Did you get the nausea medications?
 
No I didn't yet, I am seeing him eat a bit better. I mixed a packet of "lickable stew treat" in with his pate and he ate almost all of it this morning. Do you think I should still request the anti-nausea meds? He haaaates medicine by the mouth
 
If he’s eating well you won’t need it. If he starts to not eat enough it’s good to have on hand. I used empty gel capsules for meds for my previous cats and dipped them in something yummy. My two I have know humbled me. One needed cerenia and she spit out the gel capsule. I found it under the bed later. I used to chase the gel cap with baby food but she has allergies so I’m not sure how I will pill her if needed. :banghead:​
 
Hi Christa. Are you able to get any tests in dugout the pm cycle please? He is probably dropping low in the pm cycle and bouncing from the low numbers. But we can’t know unless we can see the numbers.
Is he eating 1 and a half times as many calories as he normally would?
If not you may need an antinausea medication. I would ask the vet so you have some on hand,
It is really important he eats that food.
I see you are giving an appetite stimulant……..if he has any nausea, he really needs that cerenia or ondansetron before the appetite stimulant.
 
I am so unsure what his normal calorie consumption was because he (I hate to admit) was free-fed from a very large bowl. It doesnt seem like he is eating 1.5x the amount. And he is approaching his food like he wants to eat it then taking a few bites and walking away, maybe indicating nausea? Sometimes I think he's holding out for the treats haha. I will try to get some PM cycle numbers tonight, thank you!
 
I agree. That sounds like nausea. Definitely get the antinausea meds as soon as you can.
Can you tell me his weight and we can tell you how much he should be eating
 
I havent been able to get to the vet this week :( Just able to cover the basic preshot tests and insulin. Next week I am on holidays so I will get to the vet and start taking some mid cycle tests.
Toby weighs 13 lbs. He continues to eat very little wet food but he is eating his dry food. (Hills prescription diet - gluco support - which I now know isn't the best)
 
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