New Member - DKA Recovery and Newly Diabetic

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Allison_RemyRo

Allison_RemyRo

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Hello! New member here (Allison) with my 8 year old cat (Remy) from Ohio. Remy was lethargic and not eating last Wednesday (11/6/24), so we took him to his normal vet, where they told us he has diabetes and DKA and referred him to an emergency vet. They confirmed DKA and also said he had hepatic lipidosis. His numbers on check in were BG = 421 and Ketones = 6.7. He stayed at the emergency vet for 2 nights on fluids, insulin, and other medicine and was also given a feeding tube. On Friday, they told us he had tried eating on his own and his numbers were improving, so we took him home (we thought he would be way more comfortable / familiar at home and would recover better because he is a very anxious cat).

Since Friday, his BG numbers at home have been improving, but not good. Yesterday / today (4ish - 5ish days after diagnosis and initial treatment), he hovers around 230 - 250, with spikes after eating that go up to around 300 - 310. He eats (feeding tube only) 3 times a day (Hills recovery food, blended with water through the tube), and gets insulin after his morning and evening feeding. It's 1.5 unit of insulin (Glargine). He also gets 1/2 pill of Maropitant (anti nausea) and a topical treatment of Mirtazapine (appetite stimulant) once a day, each. They sent us home with sedation (Gabapentin), but we used it the first two days and then cut back and then stopped because he was so out of it (disoriented, sedated).

Our concern / questions are what is normal and how long things should last. His BG numbers seem to be going in the right direction, but his personality is very off - is that still physical or mental (I'm sure the vet was traumatizing)? He has not eaten on his own at home, despite being offered food. And, he is urinating around the house / on himself / while lying down (but, he has also successfully used the litterbox). His walk also appears to be a bit hesitant / stumbling and he is mostly just lying down, under the bed a lot. This is still just the morning of the 6th day since he started treatment, so we're unsure if this is okay, or if we should be doing something else. We really want him to eat on his own. We do have an appointment to take him back for a recheck tomorrow afternoon - are there other questions I should be asking or concerns I should bring up?

Thanks!


Remy - 8 year old, diagnosed DKA on 11/6/24, released from hospital on 11/8/24, BG = 250s, with 300 - 320 spikes after eating (monitored by FreeStyle Libre), insulin 2x a day, on feeding tube 3x a day (will not eat on own), lethargic and urinary troubles / concerns
 
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Allison_RemyRo said:
Hello! New member here (Allison) with my 8 year old cat (Remy) from Ohio. Remy was lethargic and not eating last Wednesday (11/6/24), so we took him to his normal vet, where they told us he has diabetes and DKA and referred him to an emergency vet. They confirmed DKA and also said he had hepatic lipidosis. His numbers on check in were BG = 421 and Ketones = 6.7. He stayed at the emergency vet for 2 nights on fluids, insulin, and other medicine and was also given a feeding tube. On Friday, they told us he had tried eating on his own and his numbers were improving, so we took him home (we thought he would be way more comfortable / familiar at home and would recover better because he is a very anxious cat).

Since Friday, his BG numbers at home have been improving, but not good. Yesterday / today (4ish - 5ish days after diagnosis and initial treatment), he hovers around 230 - 250, with spikes after eating that go up to around 300 - 310. He eats (feeding tube only) 3 times a day (Hills recovery food, blended with water through the tube), and gets insulin after his morning and evening feeding. It's 1.5 unit of insulin (Glargine). He also gets 1/2 pill of Maropitant (anti nausea) and a topical treatment of Mirtazapine (appetite stimulant) once a day, each. They sent us home with sedation (Gabapentin), but we used it the first two days and then cut back and then stopped because he was so out of it (disoriented, sedated).

Our concern / questions are what is normal and how long things should last. His BG numbers seem to be going in the right direction, but his personality is very off - is that still physical or mental (I'm sure the vet was traumatizing)? He has not eaten on his own at home, despite being offered food. And, he is urinating around the house / on himself / while lying down (but, he has also successfully used the litterbox). His walk also appears to be a bit hesitant / stumbling and he is mostly just lying down, under the bed a lot. This is still just the morning of the 6th day since he started treatment, so we're unsure if this is okay, or if we should be doing something else. We really want him to eat on his own. We do have an appointment to take him back for a recheck tomorrow afternoon - are there other questions I should be asking or concerns I should bring up?

Thanks!


Remy - 8 year old, diagnosed DKA on 11/6/24, released from hospital on 11/8/24, BG = 250s, with 300 - 320 spikes after eating (monitored by FreeStyle Libre), insulin 2x a day, on feeding tube 3x a day (will not eat on own), lethargic and urinary troubles / concerns
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@Bron and Sheba (GA)
 
I have to go out to an appointment but will get back to answer this asap :)
If the cerenia ( antinausea ) is not working, ring and ask the vet for some ondansetron. It’s better for nausea. It’s important Remy eats lots so please get into this. I’ll be back
 
Update on Remy - I took him back to the vet ER today because his feeding tube area became infected (which explains the continued lethargy a bit). I had just changed the cotton around it 2 days ago, and looked at the area yesterday and it was fine both times. They said it's an aggressive infection and put him on antibiotics and he'll be staying in the hospital again. Hopefully things improve quickly.

Remy - 8 years old, DKA 11/6/24 and released 11/8/24, E-Tube Infection 11/12/24 and readmitted, currently in hospital
 
@Allison_RemyRo
Hi Allison, I'm sorry to hear that Remy is not doing well :bighug:
Bron will get back to you , she's wonderful.
When ever you get a chance can you fill out what we call our signature

Can you set up your signature
Your signature should be in gray letters, do you see mine at the end of my post
This is where you can set up what we call your signature, it's at the end of everyone's post in gray letters. Just tap on your name up top then tap on signature and add this information. You will link it to your spreadsheet

  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Bexacat or Senvelgo (if applicable) and dates
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Sending prayers for Remy :bighug::bighug::bighug:
What a beautiful boy
 
Hi Allison,
I’m sorry to hear Remy has ended up back in hospital.
Hopefully with the new antibiotic he will soon improve. What antibiotic has he been put on?
Post DKA kitties do take a while to bounce back. Some kitties do it sooner than others. Have hepatic lipidosis as well complicates things a bit.
I’m glad to hear he has a feeding tube inserted. That will make things easier for not you and Remy in the beginning, especially if he is reluctant to eat.
It is very common for post DKA kitties to be nauseated and not New Member - DKA Recovery and Newly Diabetic | Feline Diabetes Message Board - FDMB want to eat, and having the hepatic lipidosis will only add to this. But don’t despair. We have had many cats with both these illnesses and they have recovered. It just takes time.
Here is a list of what we would suggest for Remy:
  • you need to give one and a half times as many calories as he normally eats. At the moment he is being tube fed, but when he starts to eat on his own, 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 Remy 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 spreadsheet so we can see. Please report any trace ketones at all. If you don’t already have these, get a bottle of Ketostix from a pharmacy, collect a urine sample from Remy and test as per the directions on the bottle. We don’t want to see any ketones in the urine.
  • Give antinausea medication if needed. As I mentioned above, ondansetron is a better anti nausea for cats than cerenia. Ask the vet for a script for some and then you get the ondansetron from a human pharmacy. Ondansetron can be given 3 times a day. Cerenia and ondansetron can be given together as they work on different pathways in the body.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Remy will tolerate warm water in the food, put a teaspoon into each snack. At the moment you can give these fluids via the tube.
  • Ask the vet about subQ fluids…
  • Set up a spreadsheet and test the BG frequently. We can help you with this if you like. I will ask @Bandit's Mom to contact you.
  • Post daily with updates and ask for help as often as needed.
I would like to see Remy getting more food than only 3 times a day. How much of the recovery food is he getting in total a day? Remember he needed 1 and a 1/2 times as many calories as he normally eats at the moment. If you can get the ondansetron it may help him to be able to eat some food on his own.
Here is the link to the spreadsheet help us help you
Try and get all the above sorted out before Remy comes home so you are all set up.
If you have any lab results you can share with us that would be helpful. The vets should be able to email them to you. To post the lab results here just copy and paste them into this page.
Please post any updates of Remy’s progress :)
 
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Hi, all. Unfortunately Remy passed away in the middle of the night last night. The feeding tube site infection was incredibly aggressive, and it was all just too much for the little one. We’re absolutely devastated, but thank you so much for everyone who read this and responded to this post. He was pretty out of it yesterday when we took him in, so I hope he wasn’t in too much pain or too scared. He’s resting now. Thank you, all.
 
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