New Member 7/30/24 - Newly diagnosed cat in DKA. Refusing food.

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Mercedes & Elsie

Mercedes & Elsie

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I’m going to do my best to include all details.

Elsie (13 years old) was diagnosed with diabetes on July 20. The vet gave the option to try Bexacat or go directly to insulin. Bexacat sounded like a great new medication that would be easier to manage and I was told that once on insulin Bexacat wouldn’t be an option, so we tried it.

At the appointment her ketones were elevated, just above 3. I was told that they were higher than recommended to start the drug but right on the line and that she was otherwise an alright candidate for it. I realize now that she absolutely should have never been on it and I’m so upset at myself for even trying it.

So, after a few days on Bexacat she had a recheck and her glucose was okay but ketones had doubled and were at 7.2. At the time I did not realize what a severe risk DKA is and was following the advice of the vet. Since she was still getting around and seemingly okay, they let me choose to keep her on it a little longer to see if they would flush out. I decided to stick it out, thinking that she just needed a bit of time to level out.

A couple days later she would only eat half of the food I had put the pill into (a very small amount) and I was worried about ketones so I called in to have a recheck asap. Her ketones were down to 6.8 (still high) but the vet still gave me to option to keep on it. I really had no idea the risk still and I’m so upset at myself for not starting insulin that day. Anyway, she continued to refuse food that day and that night she became seriously lethargic and was wetting herself without even realizing it and just in a scary state. At this point she had not taken any more Bexacat because she had refused the food.

The very next morning she was hospitalized for the day, switched to insulin, and received IV fluids along with anti-nausea medications. She ate some food on her own for them too. I took her home for the night (no 24-hour care at that vet) and took her in again in the morning. She did not eat for me.

They did the same fluid and meds that day but had to feed with a syringe. Ketones were back at 7.2.

I took her home with some urgent care food and a syringe to encourage feeding, as well as her new insulin (Lantus). Since the vet is closed on Sundays I had her for Saturday night and Sunday with instructions to give 1 unit of Lantus each morning after food. Since she hasn’t been eating much, I was told that even a mL would be enough but that she had to eat for insulin. I was able to get a couple mL of food down but that’s it. On Monday (yesterday) we were back for a recheck. At the vet I realized how yellow her skin had become and mentioned it during the exam. Because of this we ran a blood panel (had done this on day one but the glucose was the only thing of concern at about 460). Her glucose was okay but ketones a little above 5.

Yesterday’s blood panel was only able to half run since the jaundice messed up the results. A couple new numbers had skyrocketed. I need to ask for the results again because I can’t remember what they were but there were a few possibilities of what they indicated, one being fatty liver.

At this point the vet started talking seriously about end of life care and how far I wanted to push this. I do not have the funds for emergency icu care (especially after this week of vet bills) and said I wanted to give her the best shot she has without the ICU.

So, we have fluids to give subcutaneously, we have some appetite stimulant gel, the insulin, and some urgent care food.

The biggest issue is that I really am having a hard time getting her to eat. I can get in a couple mL at a time but that barely anything. She is so weak. My poor baby. I have just been holding her and singing to her and bawling. Today was my third day administering insulin and my first day giving fluids. We tried the appetite stimulant yesterday but I think it made her super drowsy. She finally got some actual sleep though. I think I’m going to try it again today but with less gel. I’m also waiting to hear back from the vet about take-home options for the anti-nausea medication she received while hospitalized.

I feel like I’m rambling at this point but it’s been a really tough week and I just don’t know what to do. I think she would be fine right now if we never tried the Bexacat. I’m heartbroken.
 
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I’m so sorry you are in this situation and pray for the best. I would ask for medication for nausea, preferably ondansetron. It needs to be given about every 8 hours . If that’s too difficult ask for cerenia which works well for many cats. Appetite stimulants don’t often work well if a cat is nauseous and most DKA cats are. I hope your cat feels better quickly. :bighug:
 
tiffmaxee said:
I’m so sorry you are in this situation and pray for the best. I would ask for medication for nausea, preferably ondansetron. It needs to be given about every 8 hours . If that’s too difficult ask for cerenia which works well for many cats. Appetite stimulants don’t often work well if a cat is nauseous and most DKA cats are. I hope your cat feels better quickly. :bighug:
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Thank you! Is there a reason why you suggest the one anti-nausea med over the other? I know the latter one is what they had given her while she was hospitalized but if the first one you mentioned is better somehow than that is great to know.
 
Hey Mercedes,
I'm not extremely active here, but got an email notification about your reply on the other thread, so thought I'd check out your "main" post [this one].

A couple of things I wanted to ask/point out, for what it's worth:
• Always always ALWAYS trust your gut. No one knows your cat better than you. This is by no means a "vet bashing" statement. I've just learnt the above the hard way - for the first year of my Mister's diabetes I was blindly following the vets' advice. And I do mean vets because we have gone through approx 20+ veterinary professionals until finally have found the right one for us; the person who considers his behaviour, my observations, my speculations etc etc as opposed to solely going by their textbook knowledge.
• Lantus, albeit a long lasting human insulin, still to be given twice a day in 12 hours intervals. It is because cats' metabolism is much faster than humans' so even though Lantus lasts 24 hours in humans, it does not in cats. There's a lot of info on it in the allocated sub-forum [Lantus/Levemir/Biosimilars]. You also likely will be asked to set up a spreadsheet so the experienced members can guide you on dosing etc.
[Side note: we are on Tresiba, which is the longest lasting insulin, approx 42 hours in humans... Yet I still have to dose Mister BID.]
• Did they do your girl's blood panel with her age related reference values? I'm just asking this because above a certain age the reference values shift slightly. We having to have bloods done every 3-6 months, and I have noticed that when my Boy's age isn't stated, he is in wnl for most of his haematology and biochemistry. However, when I re-examined his labs with his age appropriate reference ranges certain levels were off, prompting us another check-up. [He is 11 years old by the way, this is just to state that your girl would likely fall into the "older/senior feline" values too. But again, I'm not sure at what age the reference values change.]
This mishap may not have happened on your end, but I'd look into it, especially if according to her labs everything is fine, yet she's showing signs of jaundice.

Definitely don't give up on her, I'm sure she's a trooper, and there's lots of help on this forum x

Edit: Apologies, I've literally just skimmed your post, but now I see her labs were indeed off in certain places. There is an option to input her labs to the spreadsheet.
Double apologies actually, because I made the assumption that you're home testing her [hence all this spreadsheet talk]. It would be advised you get a human glucometer and start testing her BG at home. There are dual meters that check blood ketones too, but the test strips for those are quite dear... for home ketone testing you could buy urine Ketostix from the chemist.
 
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Don Degludec said:
Hey Mercedes,
I'm not extremely active here, but got an email notification about your reply on the other thread, so thought I'd check out your "main" post [this one].

A couple of things I wanted to ask/point out, for what it's worth:
• Always always ALWAYS trust your gut. No one knows your cat better than you. This is by no means a "vet bashing" statement. I've just learnt the above the hard way - for the first year of my Mister's diabetes I was blindly following the vets' advice. And I do mean vets because we have gone through approx 20+ veterinary professionals until finally have found the right one for us; the person who considers his behaviour, my observations, my speculations etc etc as opposed to solely going by their textbook knowledge.
• Lantus, albeit a long lasting human insulin, still to be given twice a day in 12 hours intervals. It is because cats' metabolism is much faster than humans' so even though Lantus lasts 24 hours in humans, it does not in cats. There's a lot of info on it in the allocated sub-forum [Lantus/Levemir/Biosimilars]. You also likely will be asked to set up a spreadsheet so the experienced members can guide you on dosing etc.
[Side note: we are on Tresiba, which is the longest lasting insulin, approx 42 hours in humans... Yet I still have to dose Mister BID.]
• Did they do your girl's blood panel with her age related reference values? I'm just asking this because above a certain age the reference values shift slightly. We having to have bloods done every 3-6 months, and I have noticed that when my Boy's age isn't stated, he is in wnl for most of his haematology and biochemistry. However, when I re-examined his labs with his age appropriate reference ranges certain levels were off, prompting us another check-up. [He is 11 years old by the way, this is just to state that your girl would likely fall into the "older/senior feline" values too. But again, I'm not sure at what age the reference values change.]
This mishap may not have happened on your end, but I'd look into it, especially if according to her labs everything is fine, yet she's showing signs of jaundice.

Definitely don't give up on her, I'm sure she's a trooper, and there's lots of help on this forum x

Edit: Apologies, I've literally just skimmed your post, but now I see her labs were indeed off in certain places. There is an option to input her labs to the spreadsheet.
Double apologies actually, because I made the assumption that you're home testing her [hence all this spreadsheet talk]. It would be advised you get a human glucometer and start testing her BG at home. There are dual meters that check blood ketones too, but the test strips for those are quite dear... for home ketone testing you could buy urine Ketostix from the chemist.
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Welcome Mercedes and Elsie, you are in the right place, the experts here will try to help you in your concerns, I am far from an expert but a long time member, is important for Elsie to feed only on Wet foods between 0-10% carbs, I prefer Fancy Feast. When my Corky came home from the hospital 8 day later diagnosed with diabetes, We came home with MIRATZ, to open appetite, it really works wonders immediately, is prescribed once daily changing ears , applies just a bit in the inner inside of the ear, I always have some on hand, in case I need it, the rest, of your concerns about insulin, dosing, other concerns with Elsie, I will tag another expert member for that, in the meantime post everything about Elsie, lab test, insulin, dose, how often, what food she eats, do you home test, anything that can help to help you, You are in the right place, and yes, trust your gut!!:bighug::cat::cat:
@Sienne and Gabby (GA)
 
Mercedes & Elsie said:
Thank you! Is there a reason why you suggest the one anti-nausea med over the other? I know the latter one is what they had given her while she was hospitalized but if the first one you mentioned is better somehow than that is great to know.
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Ondansetron works better for nausea and cerenia works well for vomiting. Every cat is different. My cats all responded better to ondansetron, when given the correct dose one of my current cats needed 2mg every 6-8 hours and then the appetite returned. Some cats actually need both. It sounds like they didn’t t send you home with either one. With your cat night eating well I wonder why not.
 
Hi and welcome to the forum . I’m sorry you are going through this.
Here is what you need to be doing after Elsie has come home from the ER
  • you need to give one and a half times as many calories as 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 she 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. As mentioned above, ondansetron is he best one.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Elsie will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids…I see you have those.
  • Set up a spreadsheet and test the BG frequently…I will ask @Bandit's Mom to contact you as she can help you as I’m sure you are busy with Elsie.
  • Post daily with updates and ask for help as often as needed.
Sorry I have to rush out but wanted to post this first. :bighug:
 
Thank you everyone for replying! I am going to respond to all in one here.

First, I was told that the 1 unit of insulin per day is because of the adjustment period after switching from the Bexacat and because she isn’t eating well yet.

I have a ketone/glucose meter coming in the mail and am waiting for my partner to pick up a regular glucose meter today in the meantime. I would have already but when I was at the store they didn’t have one with ketones and at that time the ketones were the main focus since she was on the Bexacat and her glucose was okay on that.

I do have Mirataz and tried that last night but it made her more disoriented and super sleepy. I did try it again just a little bit ago but with much less gel than was suggested. I’m thinking that it will work much better with anti-nausea medications, as mentioned, and am waiting for the vet to approve it. She hasn’t vomited at all through this so I am going to ask for the Ondansetron when they call back.

As for food, she had been on both the wet and dry urinary care foods from Science Diet but currently I have some urgent care wet food from the Hills brand that the vet sent home with us. I have been mixing it with water into a slurry and trying to administer it with a feeding syringe, as advised by the vet. I can get a couple mL in at a time when I’m lucky, but she has been heavily refusing food.

Her refusal to eat is my biggest hurdle right now. I have the fluids, I have the insulin, I have the Mirataz, I just really need her to eat. I hope we can get the anti nausea medication today and that it helps. The Dr we saw yesterday was not the one we’ve been seeing since she was not in the office and he’s the one that started talking about the worst outcome. He mentioned the anti-nausea but then I guess it got overlooked while we talked about the other things. I said I was going to try and give her the best shot possible and that is when he set me up with the fluids and the Mirataz.

She also got a b12 shot yesterday. I asked about other stuff like potassium but that was one of the parameters of her blood panel that wouldn’t run because of her jaundice. He said they would need to know what her levels were to administer it since it can be dangerous.
 
Bron and Sheba (GA) said:
Getting the ondansetron is a priority for you today. Hopefully that will make things easier all round. Don’t give up. We frequently see this situation with post DKA cats. Keep posting
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Thank you for the support. It is truly giving me so much more hope than yesterday’s heartbreaking appointment. I am still waiting for the approval but I did just call the vet for the third time today so that I could add a note that the anti-nausea medication I would prefer is Ondansetron. Will hopefully be getting a call back soon.
 
Make sure you are giving the insulin twice a day. Once a day is not enough. With DKA it is really important that the insulin doses are given. The insulin and the food are the two things that will help get rid of the ketones. Hopefully @Bandit's Mom will be along soon to set up your spreadsheet then we can help with dosing.
How much sub Q fluids are you giving. They help flush out the ketones.
 
The vet only had cerenia so I just got back with that and gave her a half pill, as prescribed. Waiting for that to kick in.

She got 150 mL of fluids yesterday at the vet as they demonstrated to me how to do it. This morning was my first administration and it went okay. But I think I may have actually only gotten about 125 mL in.

As for insulin, I just got the glucose monitor and have not done a test yet. I am a bit wary to give extra insulin without talking to the Dr that prescribed it but once I check her sugar I will decide if I still feel that way. I did ask when her Dr would be back in the office and they said tomorrow so I will definitely be calling and going over some things with her now that I have all this extra information. Thank you all so much.
 
I just now checked her blood sugar and it is at 229. I know that is high so I am open to administering a second shot of insulin today. If I want to make it be 12 hours apart from this morning’s shot, that will be in one hour.

I am going to look at some info in the forum for advice on how much to give in the second shot. Will also be trying to set up a spreadsheet tonight.

Any advice on how much insulin she should be getting in one hour would be great! Her weight yesterday was 8lbs and her blood sugar right now is 229. I am going to try to get her to eat for the first time since administering the anti-nausea medication an hour ago.
 
Mercedes & Elsie said:
The vet only had cerenia so I just got back with that and gave her a half pill, as prescribed. Waiting for that to kick in.
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FYI - you can get Ondansetron anywhere, its a human drug. Your vet can write you a prescription for it - I got mine filled at the grocery store pharmacy last time I needed some.

Also I am by no means an authority on anything, especially since I am on the struggle bus myself getting Buster regulated, however for an 8lb cat 150ml daily (?) seems high for sub-Q fluids, but that is from my experience giving it for kidney disease. It could be appropriate for DKA.

I'm sorry your kitty is struggling right now.
 
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Costco has ondansetron and their prices are usually good but any pharmacy such as CVS or Walgreens will have it. I used Good RX to check pricing. Like mentioned above get an RX from your vet. :bighug:
 
They would not let me take one anti-nausea med and get a script for another at the same time because they don’t want to double the med. The girl at the counter was trying to tell me the work basically the same and I just bit my tongue and asked when Elsie’s original Dr will be in. I’ll speak with her about it tomorrow.
 
It amazes me how ignorant so many are. I’m glad you got something though. The two medications work in different ways to reach the same goal. Some vets carry cerenia but not ondansetron and it’s difficult to convince them to write an RX. With pancreatitis many cats need both. I hope your regular vet will write it for you. It really has helped my cats more than cerenia.
 
Yes, ondansetron and cerenia can be given together as, as @tiffmaxee dats, they work in different pathways.
If the ketones were still at 5 yesterday I would give 1 unit of Lantus twice a day. Test before all the doses and try and set some tests in during the cycles so we can see how far down the dose is taking Elsie. Keep posting please.
Any luck with feeding?
 
Bron and Sheba (GA) said:
Yes, ondansetron and cerenia can be given together as, as @tiffmaxee dats, they work in different pathways.
If the ketones were still at 5 yesterday I would give 1 unit of Lantus twice a day. Test before all the doses and try and set some tests in during the cycles so we can see how far down the dose is taking Elsie. Keep posting please.
Any luck with feeding?
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I am trying to get her to eat now but not really having much luck. I still have to do the syringe feeding and it’s a bit difficult. She hates it and I just feel horrible doing it. Was only able to get half a mL down just now but I am going to try for more. She has been very groggy these last few day with momentary bursts where she seems more lucid and tries to walk but is too wobbly and weak to really get far. So I try to feed when she’s lucid.

If I can’t get her to eat, do I still give the insulin? Maybe less than 1mL? And shall I recheck again just before administering?
 
Yes check BG again before giving insulin and post result. Then we can decide dose. Are you able to get another ketone test ?
Continue to persevere with the syringe feeding. I will give you a link about it below.

Do you have honey or karo at home in case of low numbers ?
 
Bron and Sheba (GA) said:
Yes check again before giving and post result. Then we can decide dose. Are you able to get another ketone test ?
Continue to persevere with the syringe feeding. mill give you a link about it below.

Do you have honey or karo at home in case of low numbers ?
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I can get another recheck from the vet tomorrow for ketones and glucose I’m sure… it costs $55 just for that recheck though. I won’t have a meter here at home till probably Thursday.
 
Mercedes & Elsie said:
Yes, I just got one today. I checked earlier for the first time about an hour ago and it was 229. I commented above more about that but it’s quite a few comments up now. Elsie weighed 8lbs yesterday.
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Yes I read that but when you said you could get a ketone and glucose test done tomorrow at the vet I was uncertain. that’s good you have a glucose meter.
Try and get some food into her now. Is it nice and thin?
 
Elise, I am so sorry about this outcome. You did everything possible you could have for Mercedes.:bighug::bighug::bighug:.

Take care of yourself now, this is so devastating.
 
Hi everyone. Thank you so much for your thoughts and condolences. It has been very helpful to have found you all and even though it was too late for my baby girl, I am comforted by all of you. It hurts to see that other kitties have passed as well, but there is also comfort in knowing I am not alone in my pain now.

Elsie was laid to rest under a beautiful large tree on our property that blossoms into a big pink bouquet in the spring.

Between my partner and I, we also have 4 other cats and a corgi so I have been getting love and snuggles from them. I do worry about my one kitty though that grew up with Elsie as her big sister and only cat friend. She still hasn’t made friends with my partner’s 3 cats and she seems sad today. I am going to be working extra hard to get her to make friends with the other kitties so she isn’t lonely.
 
Elsie was the first pet I cared for as an adult. I’ve had her since just before she turned 1 and I was 18 or 19. I had also babysat her for a couple months when she was younger than that so I had known her most of her life. I am 32 and hadn’t lost a pet since I was a little kid. It hurts so bad. I was her world and she was mine. I know it’s not my fault but it’s really hard not to feel like I failed her.
 
Mercedes & Elsie said:
I was her world and she was mine.
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I wish all cats could know that kind of love.

I’m so sorry for your loss. Her spot under the big tree sounds beautiful and I’m sure you’ll think of Elsie every time it blooms. Special hugs and scritches to Elsie’s friend kitty as well. I do believe animals are capable of loving and grieving.
 
I don’t think for a moment you failed her. You did everything you could to help Elsie get better. It is so hard losing a beloved kitty. It sounds like a beautiful place you laid her to rest. I do hope her kitty friend makes friends with the others. Look after yourself. We all understand what you are going through.
 
Thank you guys. This really is an incredible community. I will make sure that if I ever meet anyone with a diabetic cat to send them here.

And I agree about animals loving and grieving. I believe they feel so very deeply. Maynard (My other cat, she’s female, funny name I know) has definitely seemed down today. She was sticking close to Elsie in her last days. She slept in Elsie’s bed last night and I’ve never really seen her in there by herself… sometimes she would nap with Elsie in there but not often. I have been giving her lots of love and attention. This is her first experience with death and the loss of her one and only feline friend/sister must be tough.

We are all so blessed to have known our sweet little sugarcats. Too sweet for their own good. I’m glad your babies had the love and care you guys obviously gave them. I’m sorry we all know this pain.
 
Mercedes & Elsie said:
Elsie was the first pet I cared for as an adult. I’ve had her since just before she turned 1 and I was 18 or 19. I had also babysat her for a couple months when she was younger than that so I had known her most of her life. I am 32 and hadn’t lost a pet since I was a little kid. It hurts so bad. I was her world and she was mine. I know it’s not my fault but it’s really hard not to feel like I failed her.
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that is really tough, to lose a kitty you've had since you were a teen. That's a really nice long life for her though, and I'm sure you gave her the best life she could have. I am sorry for your loss.
 
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