New to Forum - Diabetic Kitty Comes Home Today

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Kelley and Merlin

Kelley and Merlin

Member Since 2020
Hi everyone,

My name is Kelley and I live in the suburbs of Houston, Texas. I have a 12.5 year old kitty, Merlin, who I adopted about 11 years ago. He was recently diagnosed with feline diabetes (I took him to the vet because I was concerned about his behavior and weight loss) but he has now ended up in the vet's office (before my Lantus order arrived from Chewy's) after starting to vomit clear liquid on Wednesday night. He spent Thursday and Friday at the vet's office and I pick him up this afternoon.

His bs when he arrived at the vet on Thursday morning was 459. He has been on IV fluid for SEVERE dehydration, IV antibiotics to prevent any diabetic-related infection, anti-nausea medication, and another type of insulin (can't remember the name) for the last two days. He has bounced back a little. He ate a little on Thursday night. He only had one insulin dose on Thursday but it brought his bs down to the low 300s. On Friday he received two doses of insulin and his bs is now in the 170s. I believe this morning's dose of insulin brought it down to the 160s. However, the vet said he didn't eat last night.

The vet wants him to come home this afternoon as there will not be anyone in their office on Sunday. I'm so nervous. I've ordered an Alpha Trak glucometer, but I have a human glucometer here at home. It reads low (it read 303 before I took him in on Thursday morning, when his bs was really 459). I need to try to get him to eat (vet said let him eat anything he wants), continue his antibiotics (orally), monitor his glucose with the human glucometer, and give him insulin (for the very first time tonight). I will take him back to the vet on Monday for them to check him again.

He is down to 7.5 pounds (he's normally about an 11 pound cat). He's lost 2 pounds just in the last two weeks.

I'm super stressed and scared. I love him so much and can't stand the thought of losing him.

I'd appreciate any advice anyone may have to offer.

Thank you.
Kelley
 
Hi Kelley,

Welcome to yourself and Merlin. I'm glad you've found us and we'll do all we can to help you two. :)

On a bit of a fly-past so excuse the brusqueness of this reply. I just wanted to get the info to you ASAP - particularly about meds to help with eating (see below).

First up, the human glucometer is fine for testing. Check that you have a good supply of strips in the house. (FYI, the normal cat BG reference range on human meters is 50-120mg/dL.)

My understanding is that you're due to pick up Merlin today. If they're not automatically offered, I suggest asking the vets for the following:

1. Anti-nausea tablets (Cerenia and/or ondansetron).

2. Appetite stimulant.

These meds should hopefully help you help Merlin eat enough while you're nursing him at home. The anti-nausea meds are doubly important here because oral antibiotics can sometimes upset the digestive system.

I suggest that you ask the vet for guidance on what to do about dosing if Merlin hasn't eaten too well (e.g. how much to give as a token dose in such circumstances).

Also I suggest asking the vet about whether any problem with pancreatitis or ketones/diabetic ketoacidosis may have caused Merlin's symptoms (the latter is a serious [ETA] but treatable complication of diabetes). If pancreatitis were to prove to be the issue then the vet should also send you home with pain meds for Merlin (e.g. buprenorphine) - see IDEXX Pancreatitis Guidelines for more info if you need it.

Secondary to the anti-nausea meds, here are some tips to encourage food intake:

Persuading Your Cat to Eat (see the list of baby foods on this page - sometimes kitties will eat some of this food when they won't accept anything else).

Also, in case you haven't seen the following post in the FAQ section, it includes suggestions for higher carb food options that can be used to raise BG numbers if needed:

Hypo toolkit

If you haven't already got any at home, I suggest grabbing some urine ketone test strips when you're out and about today (always wise to test for ketones as a precaution, especially in the early days of treatment!).


Again sorry for brisk tone. Please keep posting for help because different members are here at different times. :)

Hope to catch up with you later. Keep safe while you're out and about.


Mogs
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Mogs already gave you great advice and I just wanted to say welcome! :bighug::bighug::bighug:

anti nausea meds is a must. Merlin won’t eat if he’s nauseated. Minnie has IBD so I’m all too familiar with that struggle :( but on ondansetron twice a day she does very well. Make sure they send you home with the meds Mogs mentioned.

as for food, I’d also try baby food. I’ve had some luck with Minnie even when she won’t eat anything else. Gerber is a good brand. Turkey or chicken are my to gos. Just make sure it has no onions or any condiments

let us know how he does at home!
 
WELCOME Kelly and Merlin. We ALL know the feeling. We've all been there. Lucky for us we found FDMB.
Its natural to be nervous and scared when a loved one is sick. I think the questions Mogs has asked are very important. Please answer them the best you can. ok? I think for you to get better acquainted with how this board works you may want to check this link out:
New? How You Can Help Us Help You!

We are a dedicated group of cat lovers that want nothing but the best for any person that finds this forum. Theres also a ton of information here at your fingertips, with good people to help you navigate it all. Youve landed in a safe place for Merlin.
WELCOME TO OUR FAMILY:bighug:

This is the best darn site on this planet to learn everything you need to know about feline diabetes
jeanne
 
Kelley Lynette said:
Hi everyone,

My name is Kelley and I live in the suburbs of Houston, Texas. I have a 12.5 year old kitty, Merlin, who I adopted about 11 years ago. He was recently diagnosed with feline diabetes (I took him to the vet because I was concerned about his behavior and weight loss) but he has now ended up in the vet's office (before my Lantus order arrived from Chewy's) after starting to vomit clear liquid on Wednesday night. He spent Thursday and Friday at the vet's office and I pick him up this afternoon.

His bs when he arrived at the vet on Thursday morning was 459. He has been on IV fluid for SEVERE dehydration, IV antibiotics to prevent any diabetic-related infection, anti-nausea medication, and another type of insulin (can't remember the name) for the last two days. He has bounced back a little. He ate a little on Thursday night. He only had one insulin dose on Thursday but it brought his bs down to the low 300s. On Friday he received two doses of insulin and his bs is now in the 170s. I believe this morning's dose of insulin brought it down to the 160s. However, the vet said he didn't eat last night.

The vet wants him to come home this afternoon as there will not be anyone in their office on Sunday. I'm so nervous. I've ordered an Alpha Trak glucometer, but I have a human glucometer here at home. It reads low (it read 303 before I took him in on Thursday morning, when his bs was really 459). I need to try to get him to eat (vet said let him eat anything he wants), continue his antibiotics (orally), monitor his glucose with the human glucometer, and give him insulin (for the very first time tonight). I will take him back to the vet on Monday for them to check him again.

He is down to 7.5 pounds (he's normally about an 11 pound cat). He's lost 2 pounds just in the last two weeks.

I'm super stressed and scared. I love him so much and can't stand the thought of losing him.

I'd appreciate any advice anyone may have to offer.

Thank you.
Kelley
Click to expand...
Welcome Kelley
I know this is so overwhelming especially seeing as poor Merlin has been so poorly but take a few seconds just to take a breath and relax - you can do this!
You did well by Merlin by getting him to the vets and you have found the best site in the world for getting both advice and support.
You will be there for Merlin and everyone will be here for you.
Never be scared to ask any question you are concerned about even if you think it is daft (I've asked plenty!) No - one on here will ever make you feel silly.
Sending hugs to you both
Gill:bighug::bighug:
 
Kelley Lynette said:
Hi everyone,

My name is Kelley and I live in the suburbs of Houston, Texas. I have a 12.5 year old kitty, Merlin, who I adopted about 11 years ago. He was recently diagnosed with feline diabetes (I took him to the vet because I was concerned about his behavior and weight loss) but he has now ended up in the vet's office (before my Lantus order arrived from Chewy's) after starting to vomit clear liquid on Wednesday night. He spent Thursday and Friday at the vet's office and I pick him up this afternoon.

His bs when he arrived at the vet on Thursday morning was 459. He has been on IV fluid for SEVERE dehydration, IV antibiotics to prevent any diabetic-related infection, anti-nausea medication, and another type of insulin (can't remember the name) for the last two days. He has bounced back a little. He ate a little on Thursday night. He only had one insulin dose on Thursday but it brought his bs down to the low 300s. On Friday he received two doses of insulin and his bs is now in the 170s. I believe this morning's dose of insulin brought it down to the 160s. However, the vet said he didn't eat last night.

The vet wants him to come home this afternoon as there will not be anyone in their office on Sunday. I'm so nervous. I've ordered an Alpha Trak glucometer, but I have a human glucometer here at home. It reads low (it read 303 before I took him in on Thursday morning, when his bs was really 459). I need to try to get him to eat (vet said let him eat anything he wants), continue his antibiotics (orally), monitor his glucose with the human glucometer, and give him insulin (for the very first time tonight). I will take him back to the vet on Monday for them to check him again.

He is down to 7.5 pounds (he's normally about an 11 pound cat). He's lost 2 pounds just in the last two weeks.

I'm super stressed and scared. I love him so much and can't stand the thought of losing him.

I'd appreciate any advice anyone may have to offer.

Thank you.
Kelley
Click to expand...
HI KELLEY... So sorry about the diagnosis, but glad you found us! I know how scary and overwhelming it feels in the beginning... be we've got your back. And remember it's not a death sentence! They can live long healthy lives with diabetes. My cat was diagnosed 4.5 years ago. He should be feeling better soon.
 
Hi everyone, Thank you for the warm welcome. It's been crazy since I picked Merlin up yesterday. While he ate some on Friday which was encouraging to the vet, he hasn't eaten since.

So, when I picked Merlin up yesterday, the vet said his bs number in the afternoon was 60 and to NOT give insulin last night. However, because my Alpha Trak glucometer won't be here for a couple more days, she said to test him again when I get home so we can get a second idea for what he would show on a human glucometer knowing the animal glucometer read 60. I did get some anti-nausea meds in case he started throwing up again. So we came home with Prozinc, Clavamox, and some Metoclopramide. I was told to hold the Prozinc and Clavamox last night.

Well, when I got home and tested him, he was 141 on the human glucometer . I retested two hours later and his bs had gone up to 191. When I initially took him to the vet on Thursday morning my human glucometer was about 150 points lower than the animal glucometer (I got 303 at home and the vet got 458 when he arrived), so the vet started questioning if the tech wrote the number (60) down correctly in the office that afternoon. She suggested we go to the ER for a spot glucose check to determine if he needed insulin last night.

We loaded back up in the car and my dad drove us to the ER. We didn't make it to the end of the street and my lap felt warm. He had peed all over me. He has been so pumped full of IV fluid for two days and also had subcutaneous fluid administered before he came home.

The ER vet was amazing. Merlin's bs was 323. He was concerned about Merlin's breathing and a nasal discharge and wondered about pneumonia. He did a free x-ray and a free test for ketones and both were normal. They administered a half dose of insulin and a dose of the Clavamox. He also gave an appetite stimulant called Mirtazapine. I'm supposed to take Merlin back mid-day today for a check. I'm supposed to hold insulin this morning if he hasn't eaten - which he hasn't. He's still acting lethargic. He took a couple of licks of tuna juice about 30 minutes ago. I also got a syringe of baby food (turkey) in him about 20 minutes ago. He just turns his head away from anything I offer him. That is all he has eaten since Friday. He hasn't drank any water since we've been home either.

Something else I'm wondering about it a vet he saw a month ago said he had severe tooth decay (probably would lose a couple of teeth). However, it hadn't stopped him from eating and the ER notes say everything looked normal for teeth and gums.

I just took his bs again (5:45am) on the human glucometer and it is reading 229. So, I'm thinking his bs must be around 350-380.

I'm at a complete loss. I don't know why he won't eat or what to do about it. I'm scared that I'm just going to watch him starve to death.
 
Hi Kelley,

Glad to hear back from you. I've been worrying about how things were going.

My but ye have had quite the time! I've seen your post and I'll reply properly shortly - just need to give my kitty some medicine. I just wanted to let you know that, from what you describe, Merlin sounds like he may still be feeling nauseated. There are more suitable meds. More in a little while. In the meantime, could you let me know whether the first vets or the ER vets told you why they thought Merlin became lethargic and inappetent in the first place (e.g. pancreatitis, constipation, other)???

Hang in there!

:bighug:


Mogs
.
 
Hi Mogs, Neither really said. I know the vet (our normal vet) did blood work on Thursday and all organs were ok. I don't know if she said it or I suspected it, but I thought at one time he might be in ketoacidosis. It was weird, he was eating and acting normal on Wednesday and then that night started throwing up clear liquid literally all over the house. When I woke up that morning and saw what had happened during the night, I immediately took him to our regular vet and that is who he was with until yesterday afternoon.

I need to give you some back information that I forgot yesterday in the stress of it all. He was diagnosed several weeks ago by a vet closer to my home and prescribed Lantus. At that time, I had taken him in due to weight loss, sneezing, and looking a little wobbly but he was still acting and eating fine. I chose this closer vet due to the pandemic and ease of getting there. After the diagnosis, I immediately ordered very low/zero carb food and he's been eating that ever since. I also immediately ordered his Lantus on Chewy.com, but it took over a week for me to realize that Chewy was calling the vet's office and the vet would not confirm the prescription for shipping. I checked with Walgreen's and couldn't get it there. This new vet then finally told me they don't confirm their prescriptions via phone/fax for liability reasons and mailed me a copy of the prescription. When it arrived, I placed the order again with Chewy's, but this time had to mail them the original prescription before they would ship. So that was another week I was waiting. I actually just cancelled that order on Friday (it was going to ship out that day) because Merlin was already at our old vet's office and they had started ProZinc.

Merlin seemed to actually be doing well with the diet change until Wednesday night. I'm not sure what happened that night. He's been a different cat ever since. He was so incredibly dehydrated from the vomiting. I still don't know what caused the vomiting and if the blood sugar is completely out of control due to that episode or if it was happening prior to that while I was trying to get the Lantus and just finally showed itself on Wednesday night.

It seems that none of the vets can find any other problems with him other than severe tooth decay (by the new vet) which oddly the regular vet and ER are not finding.
 
Does this mean that your vet gave him Prozinc while he was at the office, prior to getting that 60 on the AlphaTrak yesterday?

Did they tell you what dose they gave?
 
Yes, they gave him 2 units of ProZinc yesterday morning around 7am. Then got the reading of 60 around mid-day I think. They started his ProZinc on Thursday (only got one dose of 2 units) and I believe it brought him down from 458 to lower 300s if I remember correctly. Then he got two doses on Thursday (and I think he came down to 170s on the first and 160s on the second). Then he got the morning dose on Friday and they got a reading of 60. He did eat Thursday night also because the vet was so happy to come in and see that he had eaten his food during the night. The only unassisted eating he has done since Wednesday was on Thursday night.
 
Kelley Lynette said:
I'm wondering if the reading of 60 yesterday was really 160 and they wrote it wrong.
Click to expand...

Hard to say... 60 is pretty low on an animal meter, but even 160 they might give the "no insulin" advice.

Kelley Lynette said:
After the diagnosis, I immediately ordered very low/zero carb food and he's been eating that ever since.

[...]

Merlin seemed to actually be doing well with the diet change until Wednesday night.
Click to expand...

Couple more questions: what food are you feeding, and did they assist-feed the same food at the vet's office or use their own?

And, related to some of the earlier discussion, do you know if they did a pancreatitis test?

Right now, he's on Prozinc (well, sort of), Clavamox (sort of), mirtazapine, and metoclopramide, but no pain meds, correct?
 
Kelley Lynette said:
the current situation of refusal to eat.
Click to expand...

Have you tried offering him some of his old favorite foods? When a diabetic cat won't eat, we temporarily throw the low-carbs rules out the window. It sounds like there's some serious nausea going on, so this probably won't work, but is worth a try anyway, just in case. Sometimes, even a temporary bout of nausea can cause cats to develop food aversions to the food they were eating at the time, so that they refuse it even after the nausea has resolved.
 
HISTORY

------------------------------------------------------------------------------------------------------
Vet A - Clinical Signs at Presentation (Late September/early October):
* Sneezing.
* Unexplained weight loss.
* Looking a bit wobbly (possible neuropathy?).
* Appetite normal.

Vet A Dx: Diabetes, severe tooth decay.
Vet A Rx: Lantus.

Actions Taken:
* Successful switch to low carb food - clinical signs (appetite, energy levels) good until Wednesday 14 October.
* Start of insulin treatment delayed (not received due to logistical/bureaucracy problems with vet/supplier). Order cancelled.

------------------------------------------------------------------------------------------------------
Vet B - Clinical Signs at Presentation (Thursday 15 October AM):
* Protracted vomiting - clear liquid (started night 14 October), severely dehydrated.
* Severely lethargic.
* BG spot check - 459 Alphatrak (on low carb diet, prior to start of insulin treatment).

Findings:
* Blood work - all organ function normal.
* No mention of any tooth decay.
* No mention of whether Merlin in DKA [Sounds like treatment for DKA - Mogs]
* No mention of root cause of nausea to Kelley.

Actions Taken:
* Hospitalised (Thursday 15 to afternoon of 17 Oct inclusive).
* IV fluids.
* Prozinc started.
* Additional type of insulin given (possibly rapid-acting?).
* Antibiotics (prophylactic).
* Anti-nausea medication - only time Merlin ate unassisted was Thursday night.
* Sub-q fluids before discharge.

Vet B Rx at time of discharge: Prozinc, Clavamox, Metoclopramide (prescribed for nausea or constipation? Useless for cat nausea.)

------------------------------------------------------------------------------------------------------
Home: Merlin not eating or drinking. Poor overall clinical signs.

------------------------------------------------------------------------------------------------------
ER Vet - Clinical Signs at Presentation (Saturday night):
* Nauseated.
* Inappetent.
* Lethargic.
* Nasal discharge - ER vet worried about pneumonia.
* BG 323 (Alphatrak)

Actions taken:
* X-ray - All normal.
* Ketone test - NEGATIVE.
* Examination of teeth/gums - all looks normal.
* Med adminisration: Mirtazapine administered for appetite, 1/2 dose Prozinc, Clavamox.

Current Clinical Signs (Home - Sunday AM, prior to ER follow-up):
* Lethargic.
* Inappetent.
* Not drinking.
* Small amount of food via syringe Sunday AM, first since Friday.
* Signs of nausea (turns head away from food, licked some tuna juice).
* Rapid weight loss - 2lb dropped in last two weeks.
* Wide swings in BG (e.g. 60 - 323)

------------------------------------------------------------------------------------------------------


Mogs
.
 
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Possible factors fuelling inappetence (not an exhaustive list - just common issues):
----------------------------------------------------------------------------------------------------------

* Possible upper respiratory tract infection (cats won't eat if they can't smell the food properly).

* Check for constipation (if a kitty's backed up then that needs to be sorted before good anti-nausea meds will work. Metoclopramide helps with gut motility but is USELESS for cat nausea).

* Possible DKA earlier in week (can take a kitty some time to get back to eating normally so effective anti-nausea and appetite stimulant meds may be needed for some time to ensure adequate calorie intake, aid consistent insulin dosing, and thus prevent possible relapse).

* Possible pancreatitis flare?

* Other infection?


Stuff to ask ER vet for:
-------------------------------

* Advice on what you might be able to do at home re the nasal discharge (to help Merlin smell things better).

* Check for pancreatitis.

If the ER vets didn't already rule out pancreatitis, I recommend asking them to do a Snap fPL test (it's not included in standard blood panels). It works like a pregnancy test and they can get an immediate yes/no/unclear result. If the result is unclear they can then order a Spec fPL test (needs to be sent to a lab).

* Another check for ketones, also for any possible urinary tract problems (glucose in urine can give rise to UTIs in not-yet-regulated feline diabetics).

* Cerenia injection for nausea (fastest way to get some anti-nausea benefit - tablets take longer to work - and may also have anti-inflammatory benefit).

* Vitamin B12 injection (can help with GI issues and appetite, and give a bit of a general boost).

* Ondansetron or Cerenia tablets to take home for nausea (IDEXX Labs concluded metoclopramide doesn't work well as an anti-nausea treatment in cats).

* Ask about famotidine for stomach acid (can build up when a kitty has been fasting too long - dealing with any excess acid can help the anti-nausea meds to work better).

* Appetite stimulant for home administration.

* If pancreatitis is in play, pain relief for home administration (usually sublingual buprenorphine). Anti-nausea and appy stimulant meds don't help as much if pain isn't managed.

* Advice on food and insulin dosing (no shot limit, what size dose to give if Merlin's not eating properly).

Note: The wide ranging BGs you're seeing may be in part due to Merlin being underweight (body's energy stores not what they should be). It might be an idea to discuss with the ER vet whether feeding a slightly higher carb food for the time being might help with insulin administration. (Technically, the right food for Merlin just now is the one he can manage to eat.) [ETA] Because feeding a slightly higher carb food temporarily may better support regular, safe administration of adequate insulin it could possibly help Merlin to regain weight more easily.

------------------------------------------------------------

I hope you're able to pick this up on your way to the ER. I'm sorry I couldn't get it to you quicker.


Mogs
.
 
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The ER kept him overnight. They said it is a guarded prognosis. They did some bloodwork and his electrolytes are off and that could be part of the reason he isn't eating. They will keep him on IV fluids and his meds until 7:30 in the morning, then I have to take him back to his normal vet. This ER vet today will syringe feed him, the one last night told me he didn't like to do that. I had to fill out a DNR. It breaks my heart, but if he slips away peacefully, I cant stand the thought of them hurting his little body trying to bring him back for a life that may not have a lot of quality to it.
 
Kelley Lynette said:
This ER vet today will syringe feed him, the one last night told me he didn't like to do that.
Click to expand...

Food is critical medicine in a possible DKA, so I'm very happy to hear that the ER vet is going to syringe feed (as for last night's vet.. :banghead:).

Don't lose hope. Even if he's in or on the edge of DKA, with proper treatment many cats can pull through. He's in the best possible place right now to give him a fighting chance.

:bighug: :bighug: :bighug:
 
Kelley Lynette said:
The ER kept him overnight. They said it is a guarded prognosis. They did some bloodwork and his electrolytes are off and that could be part of the reason he isn't eating. They will keep him on IV fluids and his meds until 7:30 in the morning, then I have to take him back to his normal vet. This ER vet today will syringe feed him, the one last night told me he didn't like to do that. I had to fill out a DNR. It breaks my heart, but if he slips away peacefully, I cant stand the thought of them hurting his little body trying to bring him back for a life that may not have a lot of quality to it.
Click to expand...
"Like" does not seem right when I press it for messages such as these - just know that it really means that I'm thinking of you both and keeping everything crossed.
(((Kelley)) (((Merlin)))
Gill
 
(((Kelley and Merlin)))

I'm hoping that the fluids and meds plus the syringe feeding will give Merlin the boost he needs. As Nan says above, if it is DKA then while it is true that cats can be really ill for a little while - especially during the hospitalisation stage - with correction of the electrolyte balance, insulin and assist feeding to restore regular metabolic processes, plus the right supportive treatments during convalescence many cats go on to make a full recovery.

I, too, am glad that the ER vet looking after Merlin has chosen to assist feed. If it is DKA then aggressive food and insulin treatment is key to restoring normal metabolism. As a general fact of their biology, cats shouldn't be fasted for very long.

By way of general information, sometimes in addition to nausea support a kitty with temporary eating difficulties might benefit from a feeding tube for a short while. They can and do save lives (easier, more reliable food, insulin, med and water administration - and they're not as scary in real life as they sound in theory!). Here's more information from a vet-authored site which might help you and give you some ideas about what to ask the vets:

catinfo.org - Feeding Tubes

When speaking to your own vet again (Vet B above) I suggest printing off the IDEXX guidelines for pancreatitis treatment before you go because the section on anti-nausea and appetite stimulant meds has all the information you need about the right general treatments for cat nausea - and from an authoritative source. I'm worried because that vet sent you home last time with metoclopramide for nausea and it's not really effective in cats. By way of a real-world example, our very caring and well-intentioned vet prescribed metoclopramide for my Saoirse to treat severe nausea and it wasn't worth a light (according to IDEXX cats don't have many of the receptors it works on). Two members here told me about ondansetron so I went back to the vet and pushed for the Rx (2mg every 12 hours for a 10lb cat). It was a little slow to work initially but within 48 hours she was able to eat much more readily - for the first time in weeks!! That plus an appetite stimulant saved her life. It's not fun, and we all wish it didn't happen at all, but sometimes it can be necessary to push a bit with the vets in order to get the right treatments in place for a kitty.

Did the ER vets tell you whether they did a ketone test or pancreatitis test?

Sending prayers for the ER to work some medical magic for Merlin. Anything we can do to help and support you, just let us know. We're here for the two of you.

:bighug:


Mogs
.
 
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Kelley, trying to compare human and pet glucometers is like trying to compare apples and sandals. Both glucometers work and are fine.
Before a company saw a market for poet-specific glucometers, all vets used a human glucometer.

This is what we know:
The lower the numbers are, the closer they are to each other. The higher the numbers are, the further apart they are. With high numbers, it really does not matter. High is high on any glucometer. It's the low numbers that you want to watch.

The "take action" number on an AlphaTrak is 68.
The "take action" number on a human glucometer is 50.

See? The numbers are not all that far apart.

I hope all goes well with your little one.
 
If Merlin's electrolytes are off, there's a good chance this is DKA and the ER is the best place your kitty can be. They will do repeat tests including for potassium, sodium, and bicarbonate. They want to avoid metabolic acidosis. Often the combination of an infection or inflammation plus not enough insulin plus not enough food tips the scales toward DKA. Generally, there ER will keep your kitty on a combination of a longer acting and short acting insulin, a dextrose drip (it provides nutrition and and offsets any potential problems with BG levels dropping), and fluids which help to dilute the ketones and counter the dehydration caused by DKA.

Hopefully, the ER has a Snap fPLI which is a rapid test for pancreatitis. If pancreatitis is present, you'll likely be sent home with a medication to manage pain (buprenorphine is what many cats are prescribed and I would vote strongly against any of the non steroidal antiinflammatories such as Metacam because they can cause kidney failure), an anti-nausea medication (Cerenia or ondansetron) and an appetite stimulant (e.g., mirtazepine). I may have missed whether someone linked our Primer on Pancreatitis.

I haven't a clue why you were given metoclopramide. It's typically used for GI motility problems and isn't really a preferred medication for nausea.

Once Merlin is home, the key is keeping him eating. Frankly, while low carb is ideal, the best food is a food he'll eat.

Please keep us updated on how Merlin is doing.
 
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Hi everyone,

I haven't had a chance to read everyone's posts yet. The ER has spent almost 24 hours now treating him for low potassium with potassium paste, syringe feeding, and IV fluids. My regular vet called them yesterday afternoon and I will be picking Merlin up in an hour and a half and taking him straight to her office. I am anticipating him staying, but I'm not sure. I called the ER around 5:00pm yesterday for an update and they said he was doing "very good." He was purring and loving on them. I doubt that he was eating on his own though. After reading about hypokalemia, it describes Merlin perfectly. Acting a little drunk and wobbly, not picking his head up, no appetite, following a severe vomiting episode. I think this may be the treatment he needed. I'm hopeful with a few more days of potassium supplementation (and from what I'm reading, possibly the permanent need for potassium supplementation) he will improve and start eating on his own. At that point, I can start learning how to care for him at home by monitoring his bs and giving him insulin. I feel emotionally exhausted. I feel asleep early last night or I would have logged on and provided an update. I just wanted to thank everyone for their support and all of the helpful information. I will be back on later this morning with an update and try to respond to everyone.

Kelley
 
I am reading through the above posts and see your comments about feeding tubes, Mogs. I was thinking about this yesterday. I plan to ask my vet this morning about this should he not start eating on his own. Thank you!

The ER did a ketone test the first time he was there and all looked good. I don't know if a pancreatitis test was done though. I will ask.
 
PS: I'm very glad you managed to get some rest last night. With Merlin being looked after in the hospital, getting some sleep was the best thing you could have done to help him. You need to look after you so that you can look after him. :)

:bighug:


Mogs
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Kelley Lynette said:
Hi everyone,

I haven't had a chance to read everyone's posts yet. The ER has spent almost 24 hours now treating him for low potassium with potassium paste, syringe feeding, and IV fluids. My regular vet called them yesterday afternoon and I will be picking Merlin up in an hour and a half and taking him straight to her office. I am anticipating him staying, but I'm not sure. I called the ER around 5:00pm yesterday for an update and they said he was doing "very good." He was purring and loving on them. I doubt that he was eating on his own though. After reading about hypokalemia, it describes Merlin perfectly. Acting a little drunk and wobbly, not picking his head up, no appetite, following a severe vomiting episode. I think this may be the treatment he needed. I'm hopeful with a few more days of potassium supplementation (and from what I'm reading, possibly the permanent need for potassium supplementation) he will improve and start eating on his own. At that point, I can start learning how to care for him at home by monitoring his bs and giving him insulin. I feel emotionally exhausted. I feel asleep early last night or I would have logged on and provided an update. I just wanted to thank everyone for their support and all of the helpful information. I will be back on later this morning with an update and try to respond to everyone.

Kelley
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Keeping everything crossed & thinking of you both Kelley
:bighug::bighug:
 
Hi everyone, Merlin continues to do well. I am picking him up in about an hour. I wanted to share these with you. They are the notes from his ER discharge this morning. I do bs testing and insulin for the first time on my own tonight at 9:00pm central time. I'm nervous! I'll be back on a bit later.

Kelley

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Hi everyone, just a quick update before Merlin and I go to bed. His bs was 61 when I picked him up from the vet at 4:30. We came home and I spent a long time just lovin' on him! He is eating well. I first tried some Fancy Feast low carb tuna and mackerel wet food. He took a few bites, but I think he doesn't like it that much. Then he found a couple of dog kibbles on the floor and ate that (first time ever!) so I gave him a little of his usual dry food and he gobbled it up! Then he ate about a quarter can of the urgent care wet food and right before his insulin I gave him about a half jar of turkey baby food. This was all over about 5 hours. I'm literally just feeding him small amounts of anything right now. I took his blood sugar at 8:30 and it was 174. Then he ate the turkey baby food and I gave him his potassium paste, antibiotic, and 1 unit of ProZinc. He's super alert and following me all over the house. Now he and I are getting ready for bed. It's been a long week. We will check in again tomorrow!

Kelley
 
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