New Member - Cat in ER vet for high ketones, vent/advice

[fortheloveofugin]

Hi everyone, I am Julia and my baby boy's name is Ugin. He is my perfect 5 year old man, and we are seriously struggling to manage his diabetes. This is my first post, I am not sure what should be given for intros, I hope this is okay. This post is partially asking for advice, but also to vent, since this has been so exhausting and I feel like I just cannot win. He is currently in the hospital for high ketones, but at least fortunately did not reach the acidosis stage of DKA.

Ugin was diagnosed last December after going on steroids for an ear infection, that sent him into DKA, and he wound up in the hospital. So this is his second time ending up in the ER.
He is on 2 units of Lantus 2x/day, at 7am/7 pm.
The food is Purina Pro Plan Vet Diets DM Wet Cat Food, 2x/day.
Glucose usually hovers around 250 mg/dL when we have gotten his glucose curves.
Ugin had been doing really well on this regimen, but still peeing and drinking a lot. He is near impossible with trying to manually measure his glucose, he does kind of okay with the Libre when he keeps his little cat shirt on. So we struggle with measuring his BG.

The most pressing thing to me is preventing his ketones from getting high, since we cannot afford to keep going to the ER. His first hospital visit cost $10k, and he was in there for a week. It took maxing out 3 credit cards to pay for it and asking family for money. Tonight, we had to open another credit card for $7k. The cost is mind boggling. I am amazed we were even approved. We were already in such an unimaginably deep hole from his first ER visit, and now we are buried alive.
But when Ugin is healthy, you wouldn't even know he had diabetes. He is the sweetest boy and is absolutely worth it to me, and I can't imagine putting him to sleep. But we are so financially destroyed over this. This is the second time he has been to the ER in a year. This can't be a regular thing or we will be living in a cardboard box.

This visit, I noticed all the signs of DKA that he had last time. Lethargy, lack of appetite, and he was sleeping away from everyone and hiding. He didn't eat one of his meals so we couldn't give him his insulin. I took him to the vet, they said his blood glucose was in his normal range, but his blood ketones were 5 (they said it should be less than 1, I don't know what units they were in). Vet recommended we go to the ER.

Even though we caught it before he went into full blown DKA, we still ended up in the hospital. And his BG wasn't outrageously high either. I feel like everything went downhill so fast, and I literally cannot afford to make anymore mistakes with his diabetes.

Anyone have tips for managing/preventing high ketones?
Sorry if this post is all over the place, it's been a long day.

 

[CORKY]

Good morning and Happy Holiday, I am so sorry you are going thru all this Ugin he is gorgeous, I am sure you have to be overwhelmed, emotional and financially, I don’t Know if you are aware that there are foundations that help cats in need. I had a similar situation when Corky was hospitalized and diagnosed, he spend 8 days there $8k, and believe me I feel you, the organization that assisted.me is called DCIN. But on our main forum there is a thread with Foundations that has links others. My Corky’s has never had DKA, I do read other posts and try to understand it, but I am not qualified enough to be able to give you advice on it. The food you are given though it is supposed to be great by the name it is not low carbs, perhaps you should look into the nutrients of the food, I just got up to give Corky his shot and meal I’m on my phone , staying up to start cooking stuff, but on a bit I will send you a cat carb calculator link as well as I will tag a couple a members that can assist you better on that, hang in there, I know that just like you, I would do anything for my 2 fur balls

 

[Robo & B]

Hi Julia, welcome I'm sorry you're having such a difficult time at the moment. Ugin in gorgeous

I can't give any advice on the DKA but I can sympathise on the cost front! There are members here who are much more able to advice on getting him better regulated and avoiding DKA, I know some members give subQ fluids at home, have blood ketone test meter (we can give tips on getting blood from his ears), syringe feed when necessary etc.

It's a little quiet here today because of the thanksgiving holiday weekend. I'm going to tag some members for you and also attach a new members guide. We like numbers here and all have spreadsheets set up to keep close track. But we can help you with that don't feel overwhelmed, you can work through it at your own pace.

Sticky - New? How You Can Help Us Help You!

@Suzanne & Darcy
@Sienne and Gabby (GA)
@Marje and Gracie
@Wendy&Neko

 

[CORKY]

Thank you Robo, I did say I was tagging, but did not included on the post, Happy Holiday, glad to know you are here today

 

[Marje and Gracie]

Hi Julia, welcome I'm sorry you're having such a difficult time at the moment. Ugin in gorgeous

I can't give any advice on the DKA but I can sympathise on the cost front! There are members here who are much more able to advice on getting him better regulated and avoiding DKA, I know some members give subQ fluids at home, have blood ketone test meter (we can give tips on getting blood from his ears), syringe feed when necessary etc.

It's a little quiet here today because of the thanksgiving holiday weekend. I'm going to tag some members for you and also attach a new members guide. We like numbers here and all have spreadsheets set up to keep close track. But we can help you with that don't feel overwhelmed, you can work through it at your own pace.

Sticky - New? How You Can Help Us Help You!

@Suzanne & Darcy
@Sienne and Gabby (GA)
@Marje and Gracie
@Wendy&Neko

I’m hoping one of the others will pop on. I’m in Kenya presently and getting ready to shortly get on a flight and WiFi is spotty. Hopefully, one of the others can pop on but I’m going to also tag @Bron and Sheba (GA) as she is excellent with DKA and also in Australia so not affected by the holiday in the US.

Best of luck @fortheloveofugin

 

[CORKY]

Good to know

 

[Wendy&Neko]

Hello and welcome. Sorry you've had to go through all this for your little boy. First, some tips that might help with finances in this post: Financial Help Links

In what way is Ugin difficult to blood test? We've had people deal with fractious cats before, so maybe we have some tips that can help with that.

He didn't eat one of his meals so we couldn't give him his insulin.

From this post if you want to learn more on DKA: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.
This means that you should not skip insulin if he doesn't eat a meal. Even cats going under anaesthesia who cannot eat, can get a half a dose of insulin. Lantus also doesn't onset (start to work) for typically a couple of hours, so you have time to get food in him before the insulin starts to work.

You may need some supplies around the house to help prevent DKA if you see some first signs, which are listed in the post I linked above. See if you can get some anti nausea medication like ondansetron, to have in the house should he start to seem off his food. Signs of nausea includes seeming hungry, going and sniffing food and walking away, possibly drinking more water instead of food. Try getting some other low carb food options for him. It's not uncommon for cats to get tired of the DM. Maybe he just wants some variety. Getting calories in him will help you fight DKA. Last thing about food, you can feed multiple small meals a day. That's easier on his pancreas and is what human diabetics do. You might be able to get more calories in him with several small meals in the day and night.

Start testing ketones at home, with either urinary test strips or blood ketones meters. These tests might give you a heads up.

We've seen some cats throw ketones with blood glucose levels in the mid 200's. Ideally he'd be spending more time in the 100's. Maybe if we can figure out ways to help you get some blood sugar data, you can get to an insulin dose that gets him in better numbers.

 

[fortheloveofugin]

I was not expecting so many replies, I so appreciate how much advice and support I have gotten already I will be looking into the Foundations/DCIN financial support. While I really hope this won't be an ongoing situation, with in and out of ERs, I would rather be prepared. I am sure many people have had to choose between saving a life and finances, and the pain of such a position is unimaginable I am so sorry to everyone that has been there.

I did not know that about giving insulin anyway, and will remember that. I will also ask about anti nausea meds. And should I also ask for appetite stimulants, would those help?
He has problems with always being hungry, and is relentless about finding food. I have brought this up to his vet more than once. But she has never said anything about it. I'll add she is a great vet and has been very helpful, but we have never addressed this directly.

And with manual blood testing, I can usually get him in a position where he is snug and get a hold of his ear/paw. But he is afraid of the sound of the lancet pen when I push the button, and it is hard for me to gauge just by hand doing it without the pen to get a blood drop. But I am more successful without the pen than with it. And when I can get a blood draw, I can't get the blood to bead up, that is hardest part. Sometimes I have gone through his ear. I feel so guilty messing with him, even though I know how important it is to get a reading.
I found the How to Create a Spreadsheet thread and will try filling it out, but I attached his Libre3 data, I know it's kind of long I apologize.

The update I have from the ER today is his glucose levels have been weirdly in the 200s all day, regardless of the food he eats, insulin, etc. But his ketones are still elevated. So they are not sure how everything can be perfect but his ketones aren't going down. They are calling a critical care doctor to see if there is something they are missing. They are close to sending him home since he is pretty stable. But we just don't know why everything else is fine but there's the ketones situation.

 

[Sienne and Gabby (GA)]

Free handing with a lancet takes a bit of getting used to. Honestly, I found the lancing device less helpful than free handing. One consideration is the gauge of the lancet you're using. When starting out, you want a wider gauge lancet-- 26 gauge or thereabouts is preferable. Once your cat's ear bleeds more easily you can switch to a thinner gauge.

I'm wondering whether your kitty needs a slightly higher carb diet. If you think about humans who switch to a "keto" diet which is essentially high protein, they can have slightly higher ketone levels. If you add some carbs to your cat's diet, it may help. It may be something to discuss with the vet.

 

[Allie & Gen]

Oof. Well, first at all I want to offer some significant sympathy, as I've been there - my cat was in DKA when he was initially diagnosed too (hospitalized for 3 days). I had few resources at the time and was terrified - and I was (and am) fairly poor, so the financial burden was (and is) significant. It's getting so much worse, too. (His 3-day DKA hospitalization back in 2021 cost roughly the same as one all-day stay for hypoglycemic crisis last week - around $3.5K.) It's awful with a beloved family member suffering and the terrifying expenses racking up, all at once.

Home blood testing can be tough; I was so dramatically unsuccessful with it four years ago that I'm pretty much relying on my Libre for now, as I think any chance of success for me will require a very slow and careful approach with my very resistant (to any form of physical interference! except his insulin shots, thankfully) cat. Hopefully you'll have better luck; people around here are very good and there are tons of good tips. That said, while the Libre may be less accurate and ideal in many ways, it's still incredibly helpful. Stress can really amp up BG levels in a diabetic cat, so there's a balance to be struck.

Entering your Libre data into a spreadsheet will be immensely helpful for everyone, one way or another. The spreadsheets are much less complicated to set up than they seem at first (having done mine three days ago) - and while it might be good to get all your past data entered eventually, if that's onerous, just starting now or going back a few days would be a great start. Lots of good experienced help for the spreadsheets here, too - I'm new, but I'm very experienced with Google sheets in general and happy to chime in in a pinch.

I hope they're able to get his ketones down for you; that uncertainty sounds super stressful (another thing I can relate to from recent experience)! All the best with everything.

 

[Wendy&Neko]

An appetite stimulant can be helpful, as long as they have had an anti nausea medication like ondansetron or Cerenia first. You want to make sure nausea is controlled before making them hungry, or you can get food aversion. Mirataz, the transdermal ear cream, is good for that.

When cats are unregulated, which always being in the 200's would mean, they aren't able to properly get all the food into the cells where it needs to go. If you can get him into better blood sugar numbers, his "starvation" should go down.

 

[squeem3]

Two meals a day just doesn't work for many diabetic cats. Small meals throughout the day and even night works best. Since your vet has no advice on the constant hunger, go ahead and increase the number of meals you feed. Many people here use a programmable timed feeder. Canned food is fine to leave in a feeder.

One small way to save money is to feed a commercially available brand of canned food instead of the Purina DM. There's nothing in the DM that makes it any good for diabetic cats. The DM stands for dietetic management not diabetes management. Brands such as Fancy Feast, Friskies, Weruva, Tiki Cat, and Wellness are affordable to many. You just want to feed the varieties that are under 10% carbs. Use the food charts to suitable low carb food: Links to FOOD CHARTS You don't need the vet's permission to feed whatever you feel is best for your cat.

Testing tips: Hometesting Links and Tips

Warm ears bleed best. If you're not warming the ear up first, do so. Most people use a "rice sock" but there are other methods.

Some lancet devices may have a louder click than others. You can try a different lancet device. Some lancet devices have adjustable depth settings. Try all of them to see what works. Don't be afraid to press the device firmly against the ear. Hold the rice sock of a wad of cosmetic squares under the ear so you have a firm surface to poke against and keep your fingers safe.