New Member...Spreadsheet

Hello all! I am very excited for my sugar girl Henri and I to be members of this forum! I will warn you that I am technologically illiterate so it may take me some time to figure this whole thing out. So let me introduce myself!

My name is Katie and my 12 year old 14.6lb Henri (I couldn't tell if she was a boy or girl when I found her...now its Henrietta if she does something she shouldn't lol) was diagnosed with diabetes, hepatic lipidosis and ketoacidosis on Monday Aug 24th. She was at the ER vet for 5 days. She is home now but is still having trouble with her appetite. As of a couple days ago she is officially completely on low carb wet food. Tika cat, fancy feast and purina proplan. They are high calorie foods which is great because of her lack of appetite. I do put some tuna water on her food If it is the end of the night and she has just not gotten enough calories in. I test her ketones daily and she tests positive for trace amounts. She is on lantus, and we recently dropped her dose from 1 unit 2x a day to .75 unit 2x a day due to a scare I had when her numbers dropped to 56 at midnight. I'll post the link to my chart so you all can see. I was also warned about the bounce and explained why this happens. I am curious if any of you could take a look at her spreadsheet and let me know what you think of her values overall and more recently in the past couple days. I was worried bc her AMPS was 456 this morning...but it seems to have come down...nicely I think?

I know I have some more questions but I literally can't process anything right now lol...You can probably see from the spreadsheet that I haven't gotten much sleep so I may attempt a nap soon.



https://docs.google.com/spreadsheets/d/1OG2DE6K4Qn7i8E1vlvwgISq4hp_Pv9_8b-80OdX7zts/edit?usp=sharing

 

Hello and welcome. You wouldn't be the first person with a cat name after the wrong sex accidentally. I can think of two others right now.

You've had a lot to deal with and I imagine a rough start. Did the vet give you any antinausea medications or anything to help with his appetite? You are right that it's very important that she eat.

Today's AMPS higher number was the result of a bounce, which can mean wobbly numbers for up to six cycles.

Good for you on monitoring the ketones, you'll need to do that at least once, maybe twice a day if you can. Lots of liquid on the food will help flush ketones. Some caregivers are able to give fluids (if OK with the vet) and that also helps flush out ketones. If the ketones keep showing up, it may be you'll have to raise the dose back - but perhaps give something a little bit higher carbs to bring up those lower numbers. Getting a good amount of insulin will help fight those ketones.

 

WELCOME TO FDMB Wendy is one of our VERY best!
I just wanted to say WELCOME (btw I'm tech challenged too)

This is a loving caring community of cat lovers. We all have the same thing in common feline diabetes. You have landed in a safe place.
WELCOME TO OUR FAMILY
jeanne

 

Thank you for the response and the warm welcome!

I didn't get anything for nausea from the vet but she hadn't thrown up until today. I do have an appetite stimulant to give her...shes due for it tomorrow. She threw up in the morning before food and this evening after a small "snack". It was mostly bile and hair though. I have noticed that shes been grooming herself a lot more so it could possibly have something to do with that? Actually I'm pretty sure of it now bc she literally just threw up a giant hairball..it looks like there's a 6 inch snake on my couch lol

Will trying to get more calories into her than she needs help with the Ketones? I have a vet appointment next week and I was thinking of asking them to do fluids for her. I did speak tot the vet last week and told her that there were trace amounts of Ketones present. She said as long as they're trace and not more that she's not worried. I was thinking of getting a meter to test ketones in the blood bc I know they show up there first. I didn't realize that about the ketones and the insulin helping her fight them off. She does drink quite a bit of water on her own and she loves the water fountain too. The running water is definitely helping to keep her hydrated.

This may be a silly question but is a cycle a 12 or a 24 hour period? Is there a high number that I should be concerned with and any symptoms I should be looking out for with a high number like you do for a low number? I'm worried about her AMPS getting into the black range

 

A cycle is a 12 hour period, as in, each time you give a shot a new cycle starts.

I wanted to say welcome! FDMB is literally a lifesaver.

I went through DKA with my girl. It is super important to keep getting food and fluids into your cat. As Wendy suggested above, you may feed something higher carb to avoid those super low numbers, for now. When dealing with DKA recovery, personally I’d rather give higher carbs and more insulin than risk low appetite or not enough calories.

Is the appetite stimulant you were given mirtazapine?
It is commonly recommended to give nausea medicine with that too, because often a low appetite is due to nausea. I’ve had mirtazapine as a human, and it made me eat like a zombie. I would hate to feel super hungry but also sick to my stomach at the same time, so you may want to ask for some Cerenia or even ondansetron. Signs of nausea may include licking lips frequently, smelling food but walking away without eating, and loss of appetite.

After DKA with my girl, she was down to barely 4lbs, and I hardly slept for about 5-6 weeks. Every 3 or 4 days I would get one whole sleep cycle, the rest would be teensy naps. So I know you must be exhausted right now!! Just know you aren’t alone.

And while trace ketones are not an immediate emergency, any ketones are still... not great. (But don’t panic, just keep treating.) Anyone here will tell you any ketones over trace, go to the vet right away. But if you can get some extra fluids subcutaneously, that may help Henri feel a lot better, sooner. I was told the key to DKA is insulin and food and fluids, and it’s a marathon, not a sprint, so recovery may take some time and a little sacrifice of sleep.

Welcome, I’m so glad you and Henri found this place!!

 

Nausea doesn't always mean throwing up. It could result in just inappetance, or sniffing the food and walking away. Sometimes hanging out by the water bowl is a symptom too. You do not want to give an appetite stimulant to a nauseous cat, or they will develop food aversions. With recent hepatic lipidosis - you definitely don't want that! I fostered a HL kitty for the local shelter and it was a bear finding something he would eat.

This post may be of interest - it also contains names of blood ketone meters. Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

 

HI Katie!!! Welcome to the FDMB!!

Happy to see you are over here from the FB group and that you've been getting some great advice and help!

Good job on your Signature too!

 

Thank you for the warm welcome! It's so nice to have support and people to help you through the tough and confusing times! Eventually I'll get the hang of it

 

Hi Katie,

Welcome to you and Henri. Sorry to hear your little one has had such a tough time of things.

Sometimes cats recovering from DKA can have residual nausea and that can make it harder for them to eat. If Henri isn't currently receiving anti-nausea and appetite stimulant support, you can find recommendations for these treatments in the following document:

IDEXX Pancreatitis Treatment Guidelines

Although the document specifically refers to pancreatitis, the meds to help with nausea and appetite issues are applicable to DKA recovery also.

Here are some other resources you may find helpful:

Nausea symptoms and treatments

Persuading your cat to eat (check out the baby food recommendations - many cats will eat those when they won't touch anything else)


Mogs
.

 

Interesting! I hadn't thought of it that way. My vet wont be open until Tuesday, I'll give a call in and ask her about it. It has definitely gotten easier to feed her. When she first came home I would spend 2.5 hours following her around the house trying to get her to et and I was lucky to get 30 or so calories in. I was doing this 3-4 times a day. And unfortunately I gave her high calorie kitten kibble to try to get her to break 100 calories. The past 4 or 5 days she has been eating so much better so I thought I would wean her off of that kibble. She has been kibble free for 3 days now I think? My vet told me for a sedentary cat at 14.6 lbs, 180 calories daily is good and so far today she is at 170 calories of low calorie wet food and 2 L-lysine treats. It not takes me only an hour to get a full meal (50-70 calories) into her. I don't know the carb content of the L-lysine treats but it gets her to eat her clavamox without my having to try to shove it down her throat.
If im a little shy of her 180 calorie mark for the day I'll put some tuna water on the food to get her to eat the last little bit :/ Hopefully she'll be eating better and without so much prompting soon.

Thanks for the link on the Ketone stuff! I'll check it out now

 

Thank you!

 

Thank you! I'll check this out. Neither the regular nor the emergency vet mentioned any nausea. I can't get in touch with my vet until Monday bc of the holiday but I'll call ASAP to discuss it with her. She is on an appetite stimulant and due for her next dose tomorrow.
I did try the baby food and she is so picky she turned up her nose! I do have some high calorie, low carb pate that shes been into. If I need to get a little more into her than she's willing to eat, I put a little tuna water on it...or sometimes if i put a tiny piece of tuna on the end of a spoon...if she smells the tuna she will sometimes just eat the food in front of her lol She hasn't caught on yet (knock on wood) lol

 

WOW...lots of good info! maybe i'll call the ER vet and see if they can do something for nausea. My vet unfortunately isnt open until Tuesday

is it the carbs or the calories that helps with the ketones? I guess i'm not really understanding what about the food, and insulin that helps. I get the fluids though and I think if she's still testing for trace Ketones when we have our appointment next week, that I'll ask about getting sub Q fluids

 

Clavamox is infamous for making cat's nauseous. If you're not already doing it, you should probably add a probiotic too. Antibiotics are great for killing bacteria, but they don't know to leave the "good" bacteria needed in the intestines....they just kill them all! Then you end up with a cat with diarrhea

 

It's calories that helps ketones. Ideally a higher calorie, lower carb food is good. It's carb that can boost the blood sugar, which can be a good thing if their blood sugar is low. So it's a good idea to have a various selection of different carb foods. This spreadsheet from Dr. Lisa at catinfo.org lists many of the commercially available foods. For a diabetics as a regular diet, a low carb of under 10% is best. Getting some 10-15% and above 15% are good for lower blood sugar numbers.

 

yikes! Can a cat have a people antibiotic or is there a special one I should look for. I can go to the pet store tomorrow morning.
I keep hearing about her condition and the nausea, I didn't realize the clavamox could make it worse. It's really frustrating that the vets don't explain these things to you. She could be feeling terrible and I wouldn't even know! I wonder if there's anything else I can do to help with potential nausea without straining the liver

 

Ah OK. I do have some high carb foods in case her sugar drops again but she is mostly eating high calorie, low carb. Right now her sugar is in the red. It seems like its all over the place and I'm assuming it's still that bounce thing bc of her drop a couple nights ago? I posted the link to her spreadsheet but I'm sure if I did it corrently

 

Antibiotic? Or Probiotic?

Probiotic's put the good bacteria back into the intestines that the antibiotics kill. Human ones are fine. A lot of people use Renew Life (available at WalMart). There's a lot of choices though but basically, the more live cultures the better.

 

Ooops, sorry. I meant to say probiotic. My brain is fried lol
I take a probiotic daily and was wondering if she could use that one since I have it at home already. It's PB8 brand.

 

My diabetic also has some IBD and probiotics can be really important for her. As a bonus, the powders can smell yummy, and yummy-smelly foods are what make them want to eat!

Fortiflora is not a great probiotic compared to others out there but a lot of people use it to encourage feedings. Here are the ones I have right now, Alice wanted to show them off apparently.

Note that giving the antibiotic and probiotic in the same dose or meal is not recommended. Good to wait two hours after antibiotic. I don’t think the probiotic will mess up the antibiotic, but the antibiotic will mess up the efficacy of the probiotic for sure.

 

Good job!

Just hold that .75 dose for now. Have you read about the 2 dosing methods we use? There's Tight Regulation and Start Low, Go Slow. At some point, you'll want to choose one (but you can always change your mind). The one you pick will help us give you advice on when to increase (if necessary)

TR takes a little more testing (which you're already doing) and a little more "nerve", but gives the best chance at remission. It's an aggressive protocol that's been published in a veterinary journal though so there's real research behind it's use. You hold the dose for at least 6 cycles and if it's not getting you where you want, you can increase. If they drop below 50, they "earn" a reduction.

Start Low, Go Slow is better for people who can't (or won't) test at least 4 times a day or for people who just aren't sure they can do TR. A lot of people think it's somehow "safer" (I guess because it sounds logical to start low and go slow) but the bad part about that you hold the dose for 7 days and then run a curve (test every 2 hours for 12 hours or every 3 hours for 18) and base the dosing decision on that. Holding the dose for 7 days if it's not getting the results you want can be hard for some people. Also, holding a dose too long can lead to glucose toxicity (where basically their body gets used to being too high even with the insulin and you end up having to give even more to "break through" that)

We've had cats go OTJ using both methods though! Again, you don't have to make a decision right now if you don't want to and you can switch at any time if you want also.

As long as there's no sugar or xylitol in it.

I'd also like to invite you over to the Lantus forum. You'll get the most experienced people who all use depot insulin's like Lantus, Basaglar and Levemir.

We have a specific way we post there that makes it easy for the people who are scanning the forum see how each cat is doing so if they see something that concerns them, (or people using the ? or 911 prefix), they can get to those people first.

Here's some information on how to post in the Lantus, Basaglar, Levemir forum

 

Re: your question, is it the carbs or calories...

It’s the calories, if we simplify it.

If you were unable to get your cat to eat any low carb right now at all, high carb and more insulin would still be better than low carb.

The reasons insulin and calories are critical to DKA recovery:

ketones happen as a byproduct when the body burns muscle for energy.
When a diabetic cat does not have enough insulin in her body to use the sugar she consumes from food as energy for her cells on a daily basis, her body will start to eat fat, then it will eat the muscle. It’s like having a body starve from the inside out. If a body doesn’t have the insulin it needs to make sugar a useable fuel for cells, then it’s like putting gasoline into a bicycle... it’s fuel for something, but unusable unless you added an engine (the engine is the insulin here). So then the sugar gets cleared by the kidneys and peed out, and the body keeps feeling hungry and desperate for energy on a cellular level. This is why diabetics can feel like they are absolutely starving and eat and eat and eat.... the energy doesn’t get used from the food. And even if they can use the protein and fat, they can’t keep processing those nutrients if they don’t have a small amount of glucose to help power the cells. The body’s metabolism is a whole delicate system dependent on every other part functioning too, to some reasonable degree.

So. If we want to stop producing ketones we need to stop burning muscle for energy so we need to make sure the cells can use the energy from the food.


There’s a great sticky somewhere on here that explains diabetes in some great basic terms, insulin acts like a “key” and unlocks the cell to let the sugar in... I’ll look for it.

I know there is a lot to learn at first but I swear later on it won’t feel like your head is being crammed to the brim with confusing information. It will be easier and it will make sense.

 

https://www.felinediabetes.com/FDMB/threads/what-is-feline-diabetes.194441/

This is the sticky. It gives such a great explanation of diabetes, I thought I understood already but found out I had room to understand better.

 

One last thing, maybe someone else can comment more on. Slippery elm bark for nausea... you could get that without waiting for your vet to open, maybe it’s on amazon prime one day shipping or something? I have never used it but seen it recommended a lot.

 

SEB can be great, but you have to give it two hours apart from any other medication. It might also be available at your local vitamin or nutrition store. Look for an organic one, preferably from North America.

 

awe...she protecting her probiotic lol Thank you! I'll give her some of mine at lunch tomorrow

 

Thanks! I'll start with

Thanks! I'll have to read up alittle more on the 2 different methods but based on your description I think I would actually prefer TR. The only days that are difficult to test are tuedays and thursday bc I work 10 hour days...but my husband can test twice while I'm at work and I so a test in the morning and 2 more at night...so if 5 tests are OK that would work for us.

I just checked the bottle...no xylitol. I had actually asked the vet about xylitol a few weeks ago bc I had to make my other kitty mouthwash and I needed to use benadryl. She said xylitol is a problem for dogs and not cats? is the xylitol thing just not for diabetic kitties then?

 

thanks!

Maybe I'll ive her some tomorrow...I'll do lunch time that way I am no where near meds and it'll be easier bc it's one less thing for me to keep track of as far as timing goes lol

 

That is an amazing explanation! Thank you so much! I just jotted that down in my "random crap I need to know about feline diabetes" Journal lol I know i'll have to read through it a few times to remember and understand it...especially with the lack of sleep

 

interesting! I'll check that out now! Thank you!

 

xylitol is poisonous to both dogs and cats

 

Yikes! I can't believe I asked outright about that bc I knew it was poisonous for dogs and she said not for cats. I have to check the bottle of benadryl I used to make her mouthwash. Thank you!

 

NO DOUBT you must be exhausted!!!! And I have been there! You’re doing really well. You’re taking notes! So organized!

It is completely normal for it to take time to digest all of this information. But that “how does diabetes work” sticky really helped me put into frame what I was doing and allowed me in the long run to make more independent decisions later on in our FD journey. at one point before FDMB I was calling the vet in a panic every other day it seemed like.

 

lol I had started out calling the vet in panic and then from all I saw through the FB group I realized the advice they were giving me was for lack of a better word...crappy. I think I might have started reading that sticky but didn't finish. I have to do it when my mind is fresh. Tonight is the first time ive seen my girl into her food, asking for it, sitting at the widow...she is even grooming herself and played with her catnip toy today! It really feels like my Henri girl is coming back to me and boy is it such a relief! The day/night isn't over yet...I think I have to keep a close eye on her tonight since her +2 was lower than her PMPS. But I'll just continue to take it one day at a time

 

I know what you mean, I always feel relieved when my girl bounces back from something and starts to act like her happy self.
I have adhd and can’t always digest the reading I want to get into or need to get into. Take your time. It’s a process.

It’s great you found the FD group though. My vet wasn’t bad, but she just couldn’t be next to me every single day. This is a chronic illness that sometimes requires a type of daily support a regular vet’s office just can’t reasonably give. And if you don’t live with it and experience it, even a vet is not necessarily going to fully understand some aspects of what is needed. But I think human health care can be like that too, we may have to advocate for ourselves at times to get the care we need.

This is a one day at a time illness. Things will settle down, you'll get into routine, you’ll find nights you get real sleep again.

 

definitely! I'm counting the minutes until her +4 lol

 

Ok I just spit my coffee all over the screen. hahaha I couldnt have put it better!

KEEP UP THE GOOD FIGHT!
jeanne