Newly Diabetic....DKA x2

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AshC

Member Since 2024
My kitty was diagnosed on November 11th after noticeable weight loss. Ketones at that time were 7. She spent the night at the ER vet as my vet doesn't provide after hours care. Over the next 3 days she spent the day at my vets office for fluids and monitoring. We started Novolin N on November 14th. After some research and finding this group I asked to switch to Lantus and I transitioned to a low carb diet. She had picked up weight and we were seemingly doing ok. She was found to have bladder & kidney stones and we switched to purina DM a few days ago. So far she has hated the DM food regardless of what I mix in it. On 12/4 she vomited bile after refusing most of her breakfast her glucose was 493 which is higher than it had been for a few weeks, urine ketones were negative. I tried everything I could think of to get her to eat and finally boiled chicken was a winner and no vomiting. This morning her glucose was over 500 and 3 hours after her 1U of lantus she was closer to 600. So I contacted my vet and took her in. I just picked her up and her ketones were 3 at drop off and when I picked her up they were over 5 despite IVF and her glucose is over 600. I dropped food off and the cans are unopened. I have a feeling they did not feed her at all today. They want me to bring her back in in the morning for more fluids ketone recheck, and a glucose curve. I feel like doing a curve while in ketosis isn't accurate.

As soon as I got home she's eaten half a can of medium carb food and is drinking like there is no tomorrow. Her eyes are bright shes walking around. Is there anything else I should be doing for ketones overnight!? I also feel as if I need to look for a new vet because my current one is "unfamiliar" with feline diabetes and I'm getting frustrated. I've attached her spreadsheet for reference.

https://docs.google.com/spreadsheet...3VdncB1lKu59r4ILNpTGpR3CQjg/edit?usp=drivesdk
 
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Hi there! I am not experienced enough to answer your questions, but you’ve come to the right forum. Hopefully a senior member here will respond soon!
 
Goodness, what an ordeal. It sounds like she’s feeling better, which is good. The basic recipe for DKA is is an insufficient supply of insulin + inappetance + infection or other systemic stresses.

Keep adding as much water into the food as you can, and at this point, get as many calories in as she’s willing to eat. Keep testing for ketones at home, you really want to watch for any signs that ketones are building up, so test as often as possible. Keep an eye on her behaviour, if she becomes lethargic and stops eating again, along with ketones more than a trace with the Ketostix, it’s time to take her to a vet.

You don’t need to run a curve there, you can and do test BG at home. If she is continuing to eat, and you are testing for ketones, the best they can offer is fluids.

Take the DM food back, they’ll give you a refund, just tell them your cat won’t eat it.

How is she doing tonight?
 
Christie & Maverick said:
Goodness, what an ordeal. It sounds like she’s feeling better, which is good. The basic recipe for DKA is is an insufficient supply of insulin + inappetance + infection or other systemic stresses.

Keep adding as much water into the food as you can, and at this point, get as many calories in as she’s willing to eat. Keep testing for ketones at home, you really want to watch for any signs that ketones are building up, so test as often as possible. Keep an eye on her behaviour, if she becomes lethargic and stops eating again, along with ketones more than a trace with the Ketostix, it’s time to take her to a vet.

You don’t need to run a curve there, you can and do test BG at home. If she is continuing to eat, and you are testing for ketones, the best they can offer is fluids.

Take the DM food back, they’ll give you a refund, just tell them your cat won’t eat it.

How is she doing tonight?
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They prescribed the DM food for the bladder & kidney stones, but if she won't eat it then I feel like we are not helping anything. She's eaten 2.5 3oz cans of FF since 630 pm EST they are all 14 carbs a can, but she's eating so I'll take it. Shes drinking tons of water. I have a blood ketone meter arriving Saturday. Glucose was 503 and 522 an hour after 1U of Lantus on the Alphatrak 3. The relion meter just says Hi. So far urine ketones are still trace. I am looking for a vet that is more familiar with feline diabetes.
 
I’ve not had experience with kidney or bladder stones in cats but I find that odd that the vet would prescribe diabetic cat food to treat those conditions.
 
Christie & Maverick said:
I’ve not had experience with kidney or bladder stones in cats but I find that odd that the vet would prescribe diabetic cat food to treat those conditions.
Click to expand...

I had to do a little research...he originally prescribed Hill's but it was almost 30% carbs. The purina DM is a safe carb % and has the st/ox environment to prevent crystals that form stones.
 
Hi Ash and Esme and welcome to the forum.
I am sorry you have both been through this.
Here is a list of what you need to be doing if your kitty has had DKA
  • 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 her whatever she will eat as eating any food is better than not eating. If she will only eat higher carb food or even dry food at the moment, let her. It may not be ideal, but eating anything trumps everything.
  • 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. Are you using urine strips or a blood ketone meter at home? Either is ok.
  • Give antinausea medication if needed. I would ask the vet for some ondansetron. You will need him to write a script and then you take it to the human pharmacy to be filled. DKA kitties are often nauseated.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids. I see at the moment you are going back for fluids at the vet. Are the fluids the vet is giving IV or sub Q fluids?
  • test the BG frequently. Why are you using 2 types of glucose meters? It is better to stick to one if you can. The human meters are fine.
  • Post daily with updates and ask for help as often as needed.
 
Bron and Sheba (GA) said:
Hi Ash and Esme and welcome to the forum.
I am sorry you have both been through this.
Here is a list of what you need to be doing if your kitty has had DKA
  • 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 her whatever she will eat as eating any food is better than not eating. If she will only eat higher carb food or even dry food at the moment, let her. It may not be ideal, but eating anything trumps everything.
  • 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. Are you using urine strips or a blood ketone meter at home? Either is ok.
  • Give antinausea medication if needed. I would ask the vet for some ondansetron. You will need him to write a script and then you take it to the human pharmacy to be filled. DKA kitties are often nauseated.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids. I see at the moment you are going back for fluids at the vet. Are the fluids the vet is giving IV or sub Q fluids?
  • test the BG frequently. Why are you using 2 types of glucose meters? It is better to stick to one if you can. The human meters are fine.
  • Post daily with updates and ask for help as often as needed.
Click to expand...

We do 2 meals and I have an automatic feeder with ice packs for wet food snacks throughout the day and overnight.
I have ketone strips at the moment, I have a blood meter coming tomorrow.
I mix water with her food and snacks to make sure she stays hydrated.
The vet did IV fluids, but is sending me home with supplies for subq if I need them over the weekend.
I used Alphatrak in the beginning before I found the forum and the strips are EXPENSIVE. I switched to the relion mostly except for yesterday when the relion just read Hi and I could get a reading on the Alphatrak.
I came back to the vet this morning for ketone recheck and she has gone from 5.2 yesterday to 5.5 today, but our glucose is under 500 unlike yesterday. She is eating without issue. My vet wants to switch to hills prescription food to keep her bladder stone from worsening, but we are going to hold off on the switch until her ketones are down and her glucose stabilizes. Where is the best place to post if i need semi-emergent advice?
 
AshC said:
We do 2 meals and I have an automatic feeder with ice packs for wet food snacks throughout the day and overnight.
I have ketone strips at the moment, I have a blood meter coming tomorrow.
I mix water with her food and snacks to make sure she stays hydrated.
The vet did IV fluids, but is sending me home with supplies for subq if I need them over the weekend.
I used Alphatrak in the beginning before I found the forum and the strips are EXPENSIVE. I switched to the relion mostly except for yesterday when the relion just read Hi and I could get a reading on the Alphatrak.
I came back to the vet this morning for ketone recheck and she has gone from 5.2 yesterday to 5.5 today, but our glucose is under 500 unlike yesterday. She is eating without issue. My vet wants to switch to hills prescription food to keep her bladder stone from worsening, but we are going to hold off on the switch until her ketones are down and her glucose stabilizes. Where is the best place to post if i need semi-emergent advice?
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@Bron and Sheba (GA)


@AshC
I tagged Bron for you , it's 1 AM where she lives Australia , but I'm sure she will respond later on tonight
 
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@AshC
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.


When you get your ketone meter you can add what the ketones are in the remarks section of your spreadsheet
 
That’s good news that she is continuing to eat and that the vet has given you subq fluids to administer at home. How much did the vet suggest to give? You want to be careful not to over hydrate and/or be cautious if the kitty has an underlying heart condition. Hopefully your vet has checked that out.

Haven’t given subq fluids before, here is a helpful video https://www.felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/

You can keep posting here on Main with updates and questions :)
 
Christie & Maverick said:
That’s good news that she is continuing to eat and that the vet has given you subq fluids to administer at home. How much did the vet suggest to give? You want to be careful not to over hydrate and/or be cautious if the kitty has an underlying heart condition. Hopefully your vet has checked that out.

Haven’t given subq fluids before, here is a helpful video https://www.felinediabetes.com/FDMB/threads/how-to-give-subcutaneous-fluids-video.144366/

You can keep posting here on Main with updates and questions :)
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Thank you! He didn't mention a specific amount actually. I've never given subq fluids either, but I put IVs in people so hopefully that helps me somehow. She had an ultrasound a couple of weeks ago and they did a brief look at her heart and it was normal so was everything else except the bladder & kidney stones and mild CKD was mentioned.
 
You’re welcome :). I’d maybe give them a call and ask, since you want to start off gradually with the lowest amount that will maintain hydration. By small amount it’s usually around 60-100 ml a day for cats around 8-10 lbs, but best to ask your vet for guidance. Since your kitty seems to be fairly stable at the moment, with no vomiting or diarrhea it would seem to me a good place to start.
 
Yes post here for help. If it is urgent I would change your subject line to reflect that and put help in the line. If it is an emergency you can use the 911 sign which is there at the beginning of the subject line.

With subQ fluids I would not give more then 100mls and you need to make sure the fluids you have given before have been absorbed. They create a bulge of fluid so it’s not hard to see. And don’t give the fluids in the same place in her body you give the insulin. Check with the vet but I would suggest giving her the fluids each day because they will help flush out ketones.

I am concerned the ketones are above 5 at the vet. Keep testing at home and put any results into the remarks column of the SS please so we can see easily.
With the food, is she getting 1and 1/2 times as many calories as she normally gets? If not I would increase the amount of food she is getting. And I would let her eat whatever she will eat at the moment. I wouldn’t try any switching of food.
Keep posting any time you have a question and feel free to tag me anytime.
 
Ketones were 0.9 yesterday! So we are doing pretty good. I've checked her right before I leave for work which is a couple of hours before her PM shot. Of course shes not as hungry and thirsty as she was with the glucose of 500 and ketones, but still eating and drinking. With the decreased water intake she does have a small amount of blood in her urine again. Im currently looking at a couple of feline vets in my area that are more familiar with diabetes
 
Bron and Sheba (GA) said:
Great! Keep posting. We are watching the SS.
Click to expand...
I can't thank you enough!! I'm trying all of the tricks to keep her eating (parmesean cheese, oregano, toppers etc....). She has an appetite she just isn't thrilled with most of the wet foods I've offered including the ones she has loved previously. She was strictly kibble fed before. She won't touch Dr. Elseys. I have samples of other flavors and Epigen, but with the stones I'm not sure those are beneficial long term
 
AshC said:
I can't thank you enough!! I'm trying all of the tricks to keep her eating (parmesean cheese, oregano, toppers etc....). She has an appetite she just isn't thrilled with most of the wet foods I've offered including the ones she has loved previously. She was strictly kibble fed before. She won't touch Dr. Elseys. I have samples of other flavors and Epigen, but with the stones I'm not sure those are beneficial long term
Click to expand...
You are doing a great job helping Esme. It can be hard at times but you will get there:)
Esme is lucky to have you!
 
We saw a new vet yesterday who is more familiar with diabetic cats. She was wonderful! She looked over Esme's spreadsheet and is happy with the progress we've made. Her labs are perfect, even her fructosamine is within range. We started Cerenia yesterday to help with the cystitis we've been battling through all of this and we're going to give the purina DM food another go why we are on the Cerenia in case it upsets her stomach. We'll continue the Gabapentin for discomfort and recheck urine in a week or two. Her ketones are all over the place over the past couple of days, but after the Cerenia yesterday she was running around like her old self so fingers crossed we continue having pretty good days and she starts gaining a little weight back.
 
Those ketones are dropping down into more normal levels. Keep up the food and fluids and insulin.
Are you getting a Preshot test in the pm cycles? I can’t see any for the last several days. Also a test during the pm cycle if possible.?
Lantus dosing is based on how low the dose is taking the BG and at the moment we are missing half the data. It looks like you may need a dose increase but I would need to see data from the pm cycle before suggesting that.
 
Bron and Sheba (GA) said:
Those ketones are dropping down into more normal levels. Keep up the food and fluids and insulin.
Are you getting a Preshot test in the pm cycles? I can’t see any for the last several days. Also a test during the pm cycle if possible.?
Lantus dosing is based on how low the dose is taking the BG and at the moment we are missing half the data. It looks like you may need a dose increase but I would need to see data from the pm cycle before suggesting that.
Click to expand...


On the nights I work I check her glucose right before I leave which is about 2.5 hrs before her insulin as my husband can't check it. I'm off for the next few days so I'll be able to get PM cycles and I'm going to do a curve tomorrow. We are going to give the DM food another try and see if I can convince her to eat it. My vet mentioned potentially adding the hydracare packets as well to make sure she is drinking enough water with the stones.
 
It isn’t necessary to feed the DM food. There is nothing special about it. Ordinary low carb canned food is just as good and most cats like it better. At the moment we want Esme to be eating lots of food. If she doesn’t like the DM food don’t worry.

Can you teach your husband to test the BGs?
I thought my husband would never agree to learn but when I had to go into hospital unexpectedly he learnt to do it and was great at it. And it was so good to have a second person who could test
 
Bron and Sheba (GA) said:
It isn’t necessary to feed the DM food. There is nothing special about it. Ordinary low carb canned food is just as good and most cats like it better. At the moment we want Esme to be eating lots of food. If she doesn’t like the DM food don’t worry.

Can you teach your husband to test the BGs?
I thought my husband would never agree to learn but when I had to go into hospital unexpectedly he learnt to do it and was great at it. And it was so good to have a second person who could test
Click to expand...
We've talked about it and may attempt it soon. Esme let's him give her insulin because she's distracted by dinner, but she doesn't tolerate much else from anyone but me and I dont want her to hide from him and not get her insulin. Luckily I leave for work pretty late in her cycle. We had hoped the SX/OX properties in the purina DM food would help with the bladder/kidney stones and prevent surgery if at all possible, but with everything I have read if I can find wet food within the safe carb range and low in phosphorus it has the same effect
 
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@AshC
I don't know if this will help you with the food
Tyler was blocked once, had to take him to the ER ,

He had struvite crystals ,I needed to change his food.

The food that was suggested by the ER was too high in carbs so I found this and have been feeding this , never raised his BG and knock on wood hadn't been blocked since

Purina Pro Plan Urinary Tract Health Beef & Chicken Entree flavor Pate

Purina Pro Plan Urinary Tract Health Chicken Entree

They are both low carb and low in phosphorus


The Purina Pro Plan Urinary Tract Health islow carb and low phosphorus
Beef and Chicken Entree pate
Carbs are around 4.80
Phosphorus is 1.44 dry matter

They also have Chicken Entree in Gravy which isn't pate it like tiny pieces of chicken like the size of a chicklet piece of gum lol remember them, they are like tiny tiny chunks
Carbs are 4.5
Phosphorus 0.78 dry matter


Can you add TR to your spreadsheet somewhere up top, I see you do have it in your signature
 
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I will take a look at the purina! She actually likes chunkier foods so hopefully these will work. I've looked at a raw diet, but I'm still researching. I'll add TR to my sheet. I was hoping to have a little better/tighter control at this point, but the cystitis caused a few bumps in the road and these lower AMPS and her bouncing after have caused some difficulty.

Any idea on the carbs & phos for the purina pro turkey & giblets??
 
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AshC said:
Any idea on the carbs & phos for the purina pro turkey & giblets??
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This is from the Chewy site where they ask questions
Turkey and Giblets should be fine

What is the as fed basis for phosphorus and sodium?
Answer by • Sep 14, 2023
This recipe has a Sodium content of 0.23% as fed (1.02% on a dry matter basis) and a Phosphorus content of 0.31% as fed (1.36% on a dry matter basis).
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Answer This Question
What is the percentage of carbohydrates on a dry matter basis and an as fed basis? Thank you.
Answer by • Jul 19, 2023
This variety contains approximately 1.2% Carbohydrate content on an as fed basis (5.3% on a dry matter basis).
 
Diane Tyler's Mom GA said:
This is from the Chewy site where they ask questions
Turkey and Giblets should be fine

What is the as fed basis for phosphorus and sodium?
Answer by • Sep 14, 2023
This recipe has a Sodium content of 0.23% as fed (1.02% on a dry matter basis) and a Phosphorus content of 0.31% as fed (1.36% on a dry matter basis).
0LikesReport
Answer This Question
What is the percentage of carbohydrates on a dry matter basis and an as fed basis? Thank you.
Answer by • Jul 19, 2023
This variety contains approximately 1.2% Carbohydrate content on an as fed basis (5.3% on a dry matter basis).
Click to expand...
Well all those look like great options!! She ate purina urinary dry before so I think it'll be a hit.
 
Hi Ashley,
You are holding the dose too long. Can you post more often for advice?
If the F in the number of units stands for fat, we don’t use those until the cat is on a tiny dose and only needs a tiny adjustment. At the moment Esme is not in that position.
I would increase the dose to 1.25 units.
Do you have the 100 unit syringes with the 1/2 unit markings?
 
@AshC
Please see Bron's post above about increasing the dose of you got the syringes with the half unit markings since we adjust the doses by 0.25 units at a time, I only tagged you to be sure you saw it
Maybe re- read about the TR dosing method again :cat:

  • Full and half-unit syringe scales:





49823063143_3437e9e997_o.jpg



If you are using the Lantus pen you would
You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-...inges/dp/B009LTE0DO?tag=felinediabetesfdmb-20

What state do you live in ?


Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006


We use the syringes because with using the pens you can only adjust the dose by whole units with a pen so we use the syringes since we either increase or decrease by 0.25 units at a time
 
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Bron and Sheba (GA) said:
Hi Ashley,
You are holding the dose too long. Can you post more often for advice?
If the F in the number of units stands for fat, we don’t use those until the cat is on a tiny dose and only needs a tiny adjustment. At the moment Esme is not in that position.
I would increase the dose to 1.25 units.
Do you have the 100 unit syringes with the 1/2 unit markings?
Click to expand...
I do have the U100 with 1/2 unit markings. I can increase to 1.25 tonight. I had a caliper sheet created already.
 
Diane Tyler's Mom GA said:
@AshC
Please see Bron's post above about increasing the dose of you got the syringes with the half unit markings since we adjust the doses by 0.25 units at a time, I only tagged you to be sure you saw it
Maybe re- read about the TR dosing method again :cat:

  • Full and half-unit syringe scales:





49823063143_3437e9e997_o.jpg



If you are using the Lantus pen you would
You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-...inges/dp/B009LTE0DO?tag=felinediabetesfdmb-20

What state do you live in ?


Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006


We use the syringes because with using the pens you can only adjust the dose by whole units with a pen so we use the syringes since we either increase or decrease by 0.25 units at a time
Click to expand...
I am in Kentucky. I've always used syringes with my lantus pen and the Relion U100 syringes at Walmart are pretty cheap
 
Bron and Sheba (GA) said:
Hi Ashley,
You are holding the dose too long. Can you post more often for advice?
If the F in the number of units stands for fat, we don’t use those until the cat is on a tiny dose and only needs a tiny adjustment. At the moment Esme is not in that position.
I would increase the dose to 1.25 units.
Do you have the 100 unit syringes with the 1/2 unit markings?
Click to expand...
Would we increase to 1.25 still where she has had low AMPS recently and a bounce last night?? I go back on PM shift on the 28th for 5 days so I will not be able to do PM cycle testing until I am off again on the 2nd
 
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