Newly Diabetic-DKAx1, 12/9

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pablo'smom

pablo'smom

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Diagnosis: 12/5 On last Thursday, 12/5, I took my cat, male 8 y/o, to the urgent care/walk-in vet because he was drinking/urinating more and always hungry. I wanted to take him to his regular vet, but they couldn't get him in for a week so I took him to their partner emergency/walk-in/urgent care vet. They ran labs and he came back with a glucose of upper 400s and dehydration. They diagnosed him with diabetes and gave him fluids and sent me home with ProZinc insulin, 1 unit every 12 hours. Note: weight was 14.6

DKA 12/8: Yesterday, 12/8, he started having diarrhea and anal gland issues around 4:30pm but was acting completely normal otherwise and so I took him into the same vet around 6:00pm and he had a fever of 104.8. They ran labs and glucose was 521 but everything else was normal so the vet gave him Convenia injection (have mixed feelings about that especially because he did it without asking) and some anti-diarrhea meds and sent us home around 8pm. note: the vet did not check ketone levels despite me asking about ketoacidosis concerns and weight was 13.52 (scary)

I gave him his usual feeding and he ate some then immediately vomited. He did drink some water and urinated fine. I called the vet and they had me give his insulin even though he didn't eat because his glucose was 521. I I gave his insulin around 8:15/8:30pm. Shortly after, he started acting super tired and wouldn't eat which is not like him at ALL. I called the vet and they said to monitor him. However, within a couple hours he was laying under my bed completely out of it. He would go try to eat but then wouldn't. I got him to eat a liquid treat and some water. He seemed to be getting more lethargic so I took him back to the vet because I knew something was very wrong.

Arrived at the vet at about 11:30pm. It was a different vet on shift at this time. His temp went down to 102.8 and the vet rechecked labs including ketones. She even questioned why the other vet didn't check his ketones. Glucose was 276 and ketones 15 and the vet considered him borderline DKA. The vet decided to hospitalize him to give fluids and flush the ketones out of his system along with monitor his glucose levels over the course of a day. I called around 9:30am and they said he ate some food (yay!) and seems more alert. He still has ketones but they are monitoring him and gave him his insulin so they can track how he reacts over the day and get a glucose curve.

With all of this being said, I am very overwhelmed and exhausted. Any advice on how to handle this? I am so worried for him. I'm trying everything I can to help him. Will he be okay?
 
Hi and welcome to you and Pablo.
It sounds as if the ketones/DKA was caught early which is good, so well done for taking him back to the vet quickly.
It is really good he is eating, many cats don’t in that situation.
I am going to give you a list of things you will need to be doing when he comes home. Some of the things you can do before he comes home so you are organised. He will need extra monitoring and care for a couple of weeks as he recovers from the DKA
  • you need to give one and a half times as many calories as he 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 him whatever he will eat as eating any food is better than not eating.
  • Think about hometesting the blood glucose. It’s is important we/you know what is happening with the blood glucose. You canbuy a ReliOn premier glucose meter from Walmart very cheaply. You will also need a box of 100 test strips, a box of lancets size 26 or 28 inches to pick the ear and come cotton balls to hold behind the ear. We can help you to learn how to test. We all do it and it won’t hurt Pablo.
  • 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. You will need a bottle of Ketostix from Walmart or a pharmacy to test Pablos urine. If you don’t think you can collect a urine sample there is a blood ketone meter you can use. It is more expensive but probably easier. Let me know if you want to know more about those.
  • Give antinausea medication if needed. Ask the vet to send Pablo home with preferably some ondansetron tablets. You will need a script for those from the vet and then get them at a human pharmacy. Otherwise cerenia is any other option.
  • Give appetite stimulant if needed after the antinausea medication
  • Give extra fluids. If Pablo will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about giving subQ fluids at home
  • Set up a spreadsheet and test the BG frequently. More info about that below.
  • Post daily with updates and ask for help as often as needed.
  • You will need to go out and buy some suitable low carb foods for Pablo to eat. There is no need for expensive prescription foods. Also get some higher carb foods for a hypo box and if needed for lower numbers. Get a good variety as he may be a bit fussy with food when he comes home.
HOMETESTING HINTS AND LINKS

HELP US HELP YOU this link has the spreadsheet, signature and hypo box information in it.

FOOD CHART look for foods 10% or under carbs for everyday feeding. And get some medium carb 11-15% carbs and 16 and above high carb foods for hypo box and in case of low numbers.

COLLECTING A URINE SAMPLE

 
Update: his ketones are down and glucose has been stable. As soon as I can, I will get all the labs/readings from the vet. He was doing better so they were ready to send him home, but then he ended up vomiting so they are keeping him longer to monitor. Hopefully they can get him to keep down food so I can bring him home.
 
pablo'smom said:
Update: his ketones are down and glucose has been stable. As soon as I can, I will get all the labs/readings from the vet. He was doing better so they were ready to send him home, but then he ended up vomiting so they are keeping him longer to monitor. Hopefully they can get him to keep down food so I can bring him home.
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I’m sorry he vomited. But better at the vet than once home.
In the meantime get yourself set up so you are ready for when he comes home.
 
I think getting urine to measure ketones at home would be too difficult. What ketone blood meter do you recommend? Also, are human meters for ketone and glucose accurate for cats? I just got off the phone with the vet and they are keeping him another night. His glucose is 235 and he still has trace amounts of ketones. He was given an anti-nausea med and was able to eat a liquid treat but won't eat anything else. So far he hasn't thrown up again. They are going to offer him different kinds of foods to just get something in him and to make sure he can keep it down so this way when I bring him home we know he can keep food down and is feeling better.
 
Also this is his current diet/medication run down:
Breakfast: 7am
-3/4 can of Purina Proplan prime plus chicken or turkey/giblet
-1/8 cup of Hill's Prescription biome diet dry food
-1/4 teaspoon of Miralax mixed with temptations chicken liquid treat
-1 unit of insulin (ProZinc)
Dinner: 7pm
-the exact same thing as above

I know that the temptations liquid treat is going to have to be cut out as I'm sure its high in carbs. I need help finding a substitute though because he gets Miralax twice a day and will only eat it when its mixed in something tasty. He quit eating it when I tried Churu's instead. As for his dry food, he absolutely LOVES dry food which is tragic because it's high in carbs. I am willing to cut out dry food completely if it is best for him. Ideally a tiny amount of a low carb dry food would be nice so he can be happy. His wet food is 3-4% carbs. I heard good things about Fancy Feast pate as well. I think I will keep him on his current wet food if it is good for him. Also his current calories are about 280 a day. I assume this has to go up since he has lost so much weight so fast and he used to be a sturdy boy. Any recommendations for diet?
 
Hi there! I can offer a couple pieces of information for you.

We use the KetoBM blood meter, seems to work fine but the strips are expensive. I think we got it at Walmart.

Pookey was a dry food lover as well. We started by slowly switching to a low carb dry, Dr. Elsey’s or Young Again are popular here. That went well but we are exclusively on FF pates now. There is more than one way to do the diet though, so I’ll let others comment.
 
Tim & Pookey said:
Hi there! I can offer a couple pieces of information for you.

We use the KetoBM blood meter, seems to work fine but the strips are expensive. I think we got it at Walmart.

Pookey was a dry food lover as well. We started by slowly switching to a low carb dry, Dr. Elsey’s or Young Again are popular here. That went well but we are exclusively on FF pates now. There is more than one way to do the diet though, so I’ll let others comment.
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I think I'll end up switching him to only wet food to help keep his glucose in check. He might be upset about it but I just want him healthy.
 
update: Just called the vet, his current glucose is 305. He won't eat anything they offer him. I'm not sure if it is due to stress and anxiety of not being home or what but hopefully he eats soon.
 
I am considering either keeping him on the Purina ProPlan wet food or switching over to fancy feast pate and I think I will try to mix his Miralax into the wet food and hopefully that'll work. Are there any good diabetic friendly treats that I could give him? Also, I am very concerned with his lack of eating and drastic weight loss. Fingers crossed that in the morning I will hear good news from the vet. Part of me is wondering if bringing him home will get him to eat, but I'm not sure. I'll make sure the vet gives him an appetite stimulate at the very least.
 
pablo'smom said:
I am considering either keeping him on the Purina ProPlan wet food or switching over to fancy feast pate and I think I will try to mix his Miralax into the wet food and hopefully that'll work. Are there any good diabetic friendly treats that I could give him? Also, I am very concerned with his lack of eating and drastic weight loss. Fingers crossed that in the morning I will hear good news from the vet. Part of me is wondering if bringing him home will get him to eat, but I'm not sure. I'll make sure the vet gives him an appetite stimulate at the very least.
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It is very common for cats with DKA to not want to eat. Having a good antinausea medication is crucial in their recovery so make sure you get some before discharge. An appetite stimulant is fine but he will need an antinausea medication first because it is not good to give an appetite stimulant to a nauseated cat.

One of the low carb dry foods Tim mentioned above is ok to give diabetic cats. Until Pablo is eating well again, I would be inclined to let him eat what he will eat, because eating something trumps everything else. And he is going to need to eat 1 and a half times as much food as he normally does for a while to make sure the ketones stay away. By all means try the fancy feast pates, and whatever else you think he will like.
For treats have a look at the freeze dried treats and foods that chewy has. They are low carb.
And you will need to be feeding him more often than just twice a day though.
The purina proplan is low carb and is fine if you are willing to pay for it. You can check out the carb content on the food link I gave you.
But at the end of the day, if he will only eat higher carb food or his old dry food for a few days or a week while he is recovering, that is fine.
And it is possible he will eat better at home for you. Just make sure you have those anti nausea medications as you don’t want to get caught at home with none and need some and the vet is closed.
I see Tim recommended a blood ketone meter. Abbott also have one.
And yes human meters for ketones and blood are accurate for cats. Most of us here use human meters and our dosing methods are based on the human meter.
Please keep us updated on his progress. Sending him best wishes for a full recovery:cat:
 
Update: they called this morning and said that his glucose levels have been good (I’ll ask for the exact numbers when I get there). He ate more but did have diarrhea. The vet said that was drooling a little bit last night but she thinks it’s from nausea so they are keeping him on an anti nausea med and sending me home with one. His temp was 103 last night but 99 this morning (I’m not sure why it’s all over the place). They did an x ray and it showed an abnormal gas pattern so they are going to redo it in a bit but she said it could be from all the GI issues (vomiting diarrhea) he’s been having. She told me to go up and visit because she honestly wants to send him home because she thinks he’ll be more himself and start eating more etc if he was home.
 
Deborah & Muffy(GA) & Wendall said:
Why is he getting Miralax when he already has diarrhea? It's for constipation.
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He has had constipation issues in the past but since the diarrhea started he hasn’t had his Miralax. The vet is going to send him home with me and we are hopefully going to get him eating. He did eat a little bit this morning but is having diarrhea issues. His glucose at 10:00am so about an hour and a half ago was 215. We are giving anti nausea meds and a probiotic and going to see what we can do. I bought the Relion and everything and have researched into what I need to do to get his glucose at home on his ear. Fingers crossed he starts doing better and he eats at home. He still does have some gas and diarrhea in his system and the vet said she didn’t see anything on ultrasound that looked weird and his x ray is a little weird but she said it might be from all the GI issues so we can send him home and see what happens. He started purring when he saw me and is much more alert and active.
 
update: he is not lethargic and is acting relatively normal and keeps going to his food bowl and sniffing as if he wants to eat but won't. Hopefully he will have an appetite soon.
 
He has eaten a few bites (maybe 6 pieces of dry food?), he keeps having diarrhea and grooming himself and so I'm trying to keep him clean so he doesn't get an even more upset stomach. I gave him his appetite stimulate so hopefully we see progress soon.
 
Update: sorry for so many updates but this has been SO stressful. I got his glucose on his ear (I'm going to create a spreadsheet as soon as I can). At 3:27pm so about 35-40 mins ago it was 149 and 147 using the ReliOn; I checked it twice since I was nervous it wasn't accurate. He actually held still and purred while I did it? I guess he likes the ear massage? He wants to eat and keeps going up to his food but has eaten very little. He keeps have smelly diarrhea leak out and I'm constantly wiping him. He doesn't really seem lethargic. He hasn't slept much and just moves around and lays down as I can tell he is uncomfortable with the diarrhea leaking since he keeps trying to groom down there. I gave him his anti-nausea med at 3:00pm and he is due for an antibiotic at 10:00pm. He also has a probiotic sprinkled on his food. I will be taking his glucose in another 2 hours then again in 2 hours before he is due for insulin to see how he is doing and if I can give insulin or not.
 
update: he has been eating little bits here and there. He has not vomited and the diarrhea has finally subsided. Glucose readings: 6pm-128, 7pm-124, 8pm-113. The vet said to hold off on insulin until the morning since he hasn't eaten a full meal and his BG is not high. He is currently sleeping. Hopefully we can get his diet and bathroom habits back to normal.
 
Poor boy must feel uncomfortable with the diarrhoea. I’m glad it is subsiding.
The sniffing food and walking away is nausea. I hope the medication starts to work soon. It is very important he eats well at this point.
What medication did they give you for the nausea ?
And what antibiotics is he prescribed?
I’m concerned about you skipping a dose of insulin with recent DKA and ketones. I can see the preshot BG was only 113 so if you are having to skip doses because the pre shots are too low to shoot, the dose may need to be reduced a bit so you can shoot both am and pm cycles as this is important you can do this.
What dose of ProZinc did they send him home on?
It is important you are able to test for ketones every day at the moment, as we need to know if any ketones are still present.
If you can get the spreadsheet set up it will help us to be able to help you. Let us know if you need help with this.
Keep posting for help and support. We want to help you.
 
Here are all the medications they gave:
Antibiotic- Ayradia: 0.5mL orally every 12 hours; he already started this at 10am and is due soon
Anti-nausea- Ondansetron 4mg: 1 tablet every 12 hours; he already started this at 3pm today
Appetite Stimulant- Mirataz: 1.5 inch strip of ointment to ear every 24 hours; he started this today as well (note: I have been measuring his glucose the other ear just to prevent any weird readings)
Probiotic: Proviable-forte
Insulin: ProZinc 1 unit every 12 hours; his last dose was 8am so almost 14 hours ago

I have the ketone test strips for his urine but he has not peed since being home.

He keeps eating here and there and now is sleeping. I'm going to check his BG again soon to make sure it is okay.
 
pablo'smom said:
Anti-nausea- Ondansetron 4mg: 1 tablet every 12 hours; he already started this at 3pm today
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He can have that dose every 8 hours quite safely. If he is not eating well, I would give it 8 hourly.

pablo'smom said:
Antibiotic- Ayradia: 0.5mL orally every 12 hours; he already started this at 10am and is due soon
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That is flagyl.
pablo'smom said:
have the ketone test strips for his urine but he has not peed since being home.
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Pleaselet us know when you get a result please:)

What are the times you are giving the insulin now that he is home?
If the schedule does not suit you, you can bring the next dose forward to suit you better . This is possible because you skipped the last dose.
 
He just ate some more dry food and is purring and up and about! I order the KetoBM so I can more easily get ketones but it unfortunately won't be here until Thursday. He is interested in wet food but then turns to his dry food instead. I usually give insulin 7am and 7pm but we got a little shifted from the hospitalization etc.
 
pablo'smom said:
usually give insulin 7am and 7pm but we got a little shifted from the hospitalization etc.
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So you can go back to the 7am and 7 pm at the next dose if you like because it is going to be more than the 12 hours necessary between cycles.
If you shoot 7 am tomorrow morning, how many hours will that be after the last dose given?
 
23 hours, he seems to be doing okay right now. He went pee before I could catch urine for the ketone strips but at least he is urinating. He is slowly eating more and more.
 
3 hours and also he seems to be twitching his legs and ears in his sleep more than normal. I also thought his breathing seemed different but his rates are normal and he isn't labored breathing. It could be because I'm not used to all the weight loss on him and am now overanalyzing everything but he is currently peacefully sleeping next to me. I have an exam tomorrow for a few hours but my mom is going to stay with him for me and monitor him.
 
If you are concerned about the Preshot number maybe not being high enough, at 7 am post and ask for help. I don’t think I will be awake as I live in Australia but hopefully someone else will be around.
 
pablo'smom said:
What preshot numbers are usually considered too low?
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Are you using the ReliOn meter you mentioned above?
If so, because you are new to diabetes and we don’t have any BG data for Pablo, I would not shoot below 200. You would stall, don’t feed the meal, and test again in 20 minutes to see if the BG is rising. And post and ask for help.
Because he has had DKA and ketones we dont want you skipping doses of insulin because he needs that insulin to keep the ketones away. So depending on what the Preshot is, we would suggest a smaller dose.
 
His BG was 250 this morning at 7am before eating so I did give him his 1 unit of insulin because now he is finally eating more and even ate some of his wet food! I am going to keep offering him food all throughout the day and monitor his BG so he can fully recover. He is much more himself this morning and we are slowly getting his appetite back and he has started drinking water.
 
pablo'smom said:
His BG was 250 this morning at 7am before eating so I did give him his 1 unit of insulin because now he is finally eating more and even ate some of his wet food! I am going to keep offering him food all throughout the day and monitor his BG so he can fully recover. He is much more himself this morning and we are slowly getting his appetite back and he has started drinking water.
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This is good news. Keep up your good work.
Do you need help with setting up the spreadsheet?. The signature is easy. Just follow the instructions in post 2 in the link Help Us Help You
 
I'm going to start the spreadsheet now. His glucose was 272 at 9:25am (about 2.5 hours after shot) and then it is 323 at 2:38pm (about 7.5 hours after shot). I assume its high because he ate so much food today and his appetite seems to be back so should I go back to feeding him before giving insulin? He has had access to some food throughout the day just because he is so skinny and wasn't really eating the last couple days and is recovering from DKA. Tomorrow I'll have the ketone blood meter so I'll be able to to check that unless I can catch him urinating which is quite difficult.
 
pablo'smom said:
His glucose was 272 at 9:25am (about 2.5 hours after shot) and then it is 323 at 2:38pm (about 7.5 hours after shot). I assume its high because he ate so much food today and his appetite seems to be back so should I go back to feeding him before giving insulin? He
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He needs to be eating really well. Don’t restrict his food. That increase in the BG from 2.5 hours to 7.5 hours is not very much and is normal.
What do you mean ‘should I go back to feeding him before insulin’? Aren’t you feeding him before the insulin doses?
 
The vet had me feeding him 2x a day and he is the kind of cat to eat all his food in one sitting so I would feed him about 6:50am and he would be done by 7:00am and I would then give him his insulin and same thing 12 hours later. Since coming home from the vet yesterday, I have had wet food and dry food out for him and he would eat little by little and now seems like he wants to inhale everything in one sitting which is how he's been for years (he isn't allowed to free gaze normally as he would be 20lbs). Should I keep wet and dry food out for him to eat whenever or feed him his scheduled meals before dosing?
 
pablo'smom said:
The vet had me feeding him 2x a day and he is the kind of cat to eat all his food in one sitting so I would feed him about 6:50am and he would be done by 7:00am and I would then give him his insulin and same thing 12 hours later. Since coming home from the vet yesterday, I have had wet food and dry food out for him and he would eat little by little and now seems like he wants to inhale everything in one sitting which is how he's been for years (he isn't allowed to free gaze normally as he would be 20lbs). Should I keep wet and dry food out for him to eat whenever or feed him his scheduled meals before dosing?
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Always give him a meal before the insulin. With ProZinc, you don’t have to wait 30 minutes after the food to give the dose. You can give it straight away.
Because he has had DKA we want him to be eating more than usual for a few weeks to make sure the ketones are kept away.
If he were my kitty, I would give him his main meals as usual and then measure out the balance of what you need him to eat for the rest of the day and evening into smaller amounts and then put those down for him over the course of the cycle. Is that doable?
My Sheba would have also put on weight if I had a let her free feed, so I put the food down for her in smaller amounts for the snacks.
Another alternative is to use an automatic timed feeder which will open when you program it.
 
That definitely is doable for the most part as he will only be left alone very little over the next few weeks. I am basically creating a plan that either me or my mom will be home to watch him and I'm training her on everything as I learn too.
Also a few questions:
1. How many calories should he be having a day?
2. What food should I be giving him? Dry? wet? both? and if so what brands/kinds? I currently have purina pro plan and FF wet food in which both are 4% carbs or less depending on type/flavor. He loves dry food and will probably eat more if he is given dry food with wet food and not just wet food these next few weeks. I can get a low carb dry food as well. Ideally I want him on wet food only diet or a mainly wet food diet with dry food as snacks not meals.
3. How much food should he get before a dose (so twice a day)? and then how do I measure out the balance for the rest of the day in-between morning and evening dosing?

Sorry that is a lot of questions but I want to make sure he is getting enough when he needs it and I just want to see him improve.
 
update: he had a little bit of loose stool (like a quarter size amount) but it was not as liquidly as yesterday and had some shape to it. He is acting normal. Drinking more water, I assume he might be dehydrated. However, when he is sleeping, I've noticed he will occasionally have twitches. They are mostly in his back legs/thighs and ears but sometimes tail. I've only noticed it once above his eyes as if he is raising his eyebrows. During these his breathing seems a little weird as if his body is moving in a wave on his abdomen? But his respirations are always 24-30 no matter what and he isn't mouth breathing so I'm assuming its just the muscle twitches making it look like that. I'm concerned about seizures but they are never while he's awake and its mostly all in his back legs. Could it be an issue with his electrolytes?
 
Thanks for setting up the spreadsheet and adding the data. That’s helpful.
When you have time, could you put any results of ketone tests into the remarks column of the SS please as it makes it easy for us to keep track that way? Thanks.
pablo'smom said:
1. How many calories should he be having a day?
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How many calories was he having before he got sick? He needs to be having 1 and a 1/2 times that many.
pablo'smom said:
What food should I be giving him? Dry? wet? both? and if so what brands/kinds? I currently have purina pro plan and FF wet food in which both are 4% carbs or less depending on type/flavor. He loves dry food and will probably eat more if he is given dry food with wet food and not just wet food these next few weeks. I can get a low carb dry food as well. Ideally I want him on wet food only diet or a mainly wet food diet with dry food as snacks not meals.
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Any low carb wet food is OK. Have a look at the food chart I linked in post 2 above to find more options.
There are a few low carb dry options for you to try. Sometimes they can give loose poops so be careful with them just at the moment with the current loose poop issue you have. Have a look at post 4 in this link for dry food low carb options https://felinediabetes.com/FDMB/threads/how-to-reduce-home-testing-stress.289344/
pablo'smom said:
How much food should he get before a dose (so twice a day)? and then how do I measure out the balance for the rest of the day in-between morning and evening dosing?
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In post 6 above you say what you are feeding him in the morning and at night. I’m not sure how big the can of proplan prime is but if it is normal size, that sounds like a good breakfast. Then you could give him some of the dry food and a teaspoon of some low carb wet food for snacks during the day and evening/ night. I would give him at least 3 snacks each cycle. Do you think this would be more than he has been getting? If not you might want to increase the amount a bit to where he is eating 1 and a half times as much as before he got sick.
pablo'smom said:
update: he had a little bit of loose stool (like a quarter size amount) but it was not as liquidly as yesterday and had some shape to it. He is acting normal. Drinking more water, I assume he might be dehydrated. However, when he is sleeping, I've noticed he will occasionally have twitches. They are mostly in his back legs/thighs and ears but sometimes tail. I've only noticed it once above his eyes as if he is raising his eyebrows. During these his breathing seems a little weird as if his body is moving in a wave on his abdomen? But his respirations are always 24-30 no matter what and he isn't mouth breathing so I'm assuming its just the muscle twitches making it look like that. I'm concerned about seizures but they are never while he's awake and its mostly all in his back legs. Could it be an issue with his electrolytes?
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Is he dreaming when he is twitching?
If I were you I would take a video of the twitching and shoe it to your vet.
 
Before he got sick he was getting around 280 calories. It was 1.5 cans (the 3 oz ones) of wet food and then 1/4 dry food a day along with 2 liquid treats for the Miralax he was taking. So far today he is mostly just eating dry food but I did get him to eat some wet food, I'm hoping to get his stool back to normal soon and am trying to get him to eat whatever he will.

As for the twitching, I don't know if he is dreaming or not. I'm not sure how to tell but it only happens when he is out cold. I talked to his primary vet today and briefly mentioned it and she said it could be him dreaming since its when he is sleeping. She said it could be something to do with electrolytes from dehydration since he was in the hospital and has had a rough few days. She also mentioned watching out for face twitching since this is most likely indicative of a seizure, but if it is his legs then its more likely dreaming. I'll try to get a video when I can.

Tomorrow I will be able to take his serum ketones at home so hopefully we see good results. I am very worried for him and am afraid he is going to decline to the point we can no longer help him :(
 
pablo'smom said:
Before he got sick he was getting around 280 calories. I
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If he was getting 280 calories before he got sick, then you need to be trying to get him to eat 420 calories if you can until he is fully recovered. Just try and bump the amount up a bit more each day.
For the loose poops you could try some plain mashed pumpkin. Just add about 1/2 teaspoon into the food 4 times a day and see if that helps.
 
Update on meds: His vet had me take out the anti-nausea and appetite stimulant since he is eating and not throwing up so he is currently on his insulin, antibiotic, and probiotic. Although he HATES the antibiotic and gags and spits every time I have to give it.

I'll try to give him more and more wet food if he will eat it, if not he might have to have more dry food enough though it's not ideal. Also, I have tiki cat pumpkin puree meal toppers that are for digestion. I'll see if he likes them but in the past he seemed to be picky about pumpkin.

Hopefully we can get his diabetes uncontrol soon and get him back to his usual self. His primary vet was very helpful on the phone as she has experience with diabetic cats and sees a lot of them as regulars.
 
I think it is too early to stop the antinausea medication just yet. I would continue it for a bit longer. We want to make sure he is eating well.
The antibiotic may taste bitter. Is it a tablet or liquid? If it is a tablet you could put it into a capsule. If it is a liquid try putting it into a small amount of something very tasty.
 
She told me the nausea med is a more as needed thing and wants to see how well he eats without it because if he doesn't eat well then they are considering an ultrasound since he is having all the GI issues. The antibiotic is a liquid and it looks and smells gross so I can't blame him. Also they have me put the probiotic on his food so hopefully as he eats that'll help with everything. Do diabetic cats usually have GI issues? especially while recovering from DKA?
 
Also I know Hill's, purina and royal canin all make diabetic dry food. Do we know if they are actually healthy/low carbs? It's so hard finding carb content on dry food.
 
update: lots of updates for you guys.

Yesterday: I have been updating his spreadsheet so you can see numbers there but he was sitting in the 300s most of yesterday which I expected as he was snacking all day. He had some diarrhea leaking from him a few times last night with lots of gas and I just kept him clean so he wouldn't groom it. It wasn't as bad at the day before. Last night I woke up to him sleeping with his tongue out and it gave me a heart attack but he immediately put it back in and gave me a dirty look for waking him up. I took his BG took make sure he wasn't hypo or anything and it was 334 at that time. Then super early in the morning he was purring and crawling all over me which is usual for him.

Today: His AMPS was 282 and he ate a big breakfast (finally getting those calories in). He had 1/8 cup of dry food and a WHOLE 3oz can of FF pate so about 145 calories. He ate 3/4 of the can with his dry food then finished it off a couple hours later. His BG is 318 4.25 hours post shot. I am hoping the ketone meter arrives soon (it should be here any hour now). Also he was twitching his front paws and tail for a few seconds so I called and left a message for his vet. I am wondering if it is neuropathy and if B12 supplements will help. He is drinking plenty of water. I'm going to take his BG about 6-7 post shot then give him a snack to get more calories in before dinner. Also he finally pooped in the litter box and although it was diarrhea it was more paste like and not a liquid and it was a TON. I also left that in my message to the vet.
 
BIG UPDATE: ketones are only 0.1 mmol/L for the blood which is equivalent to 1.8 mg/dL on the urine strips!! He went from 15 mg/dL on Sunday night to only 1.8 today!
 
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