Newly diagnosed and now ketoacidosis

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Ercokat

Ercokat

Member Since 2018
About 3 weeks ago my 7 year old Manx was diagnosed with diabetes. His blood sugar was high and he was not responding to Prozinc. The vet kept increasing the units until he was up t9 8. He started throwing up and had diarrhea. He was very sick. He stayed overnight at the office, and she gave him human insulin 35 to get him under control. She had me take him home the next day. He wasn’t eating or drinking. I took him back to the vet. She said he had ketoacidosis. Today was his 3rd office visit this week. I now have fluids to give him at h9me, and I am force feeding him. He is getting 1 unit of Prozinc now. I was under the impression that the high doses of Prozinc caused him to become so sick. Is this correct? Or did the high doses of insulin cause the vomiting and diarrhea, which caused the ketoacidosis? He seems better at times, then he doesn’t. Can I cure him at home? Thank you to Kristen for referring me here!
 
Ercokat said:
About 3 weeks ago my 7 year old Manx was diagnosed with diabetes. His blood sugar was high and he was not responding to Prozinc. The vet kept increasing the units until he was up t9 8. He started throwing up and had diarrhea. He was very sick. He stayed overnight at the office, and she gave him human insulin 35 to get him under control. She had me take him home the next day. He wasn’t eating or drinking. I took him back to the vet. She said he had ketoacidosis. Today was his 3rd office visit this week. I now have fluids to give him at h9me, and I am force feeding him. He is getting 1 unit of Prozinc now. I was under the impression that the high doses of Prozinc caused him to become so sick. Is this correct? Or did the high doses of insulin cause the vomiting and diarrhea, which caused the ketoacidosis? He seems better at times, then he doesn’t. Can I cure him at home? Thank you to Kristen for referring me here!
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Did the vet say he has ketones in his urine or full ketoacidisis? Ketoacidosis is very serious and I’ve never heard of a vet sending a kitty home with it. Most cats spend several days at the vet with iv fluids and iv insulin before they can come home. If he has ketoacidosis I would find another vet and take him in immediatly. If he has ketones in his urine but not ketoacidisis then fluids food and insulin can be done at home. Are you testing his glucose levels at home? It’s especially important that his glucose is kept at a safe range until the ketones are flushed. You should also test for ketones at home. You can get the urine strips at any pharmacy. If there are more than trace levels I would recommend back to the vet.
 
She said he had ketones in his urine, and used the word “ketoacidosis” as well. He spent the night at the vet last week for the same thing, but she sent him home the next day. He seems okay for a bit, and then appears very sick. I’ve brought him back twice this week. Yesterday he did still have ketones in his urine. Apparently I need to get some test items today.[/QUOTE]
 
Here's a recent thread about a cat with a serious DKA. There's lots of information in it about DKA recovery, post #13 has a shopping list for blood glucose monitoring and post #15 has some other tips about recovery and testing for ketones at home.

I'm hoping that your kitty is just in the "ketones, not DKA" stage, which can be treated with less than 24-hr intensive care. Food, insulin, + fluids are the key, but as Jessica says, testing for ketones is critical. A cat can go from "small" ketones to full-blown DKA in less than 24hrs.
 
Ercokat said:
I was under the impression that the high doses of Prozinc caused him to become so sick. Is this correct? Or did the high doses of insulin cause the vomiting and diarrhea, which caused the ketoacidosis?
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It seems unlikely, but it's hard to say without more info and I'm not a vet. In general, ketones are brought on when there is too little insulin, not too much. That said, 8U of ProZinc is a high dose! There are some high-dose conditions that require that much insulin, but it's hard to know for sure if those dose changes were warranted without close monitoring of blood glucose at the different doses. Did your vet do glucose curves, or just test fructosamine to make the dose decisions?

The best way to determine the needed dose is to home-test blood glucose (away from vet stress, which can raise BG and make it look like more insulin is needed), and the sooner you can get that going, the better, but the immediate health concern is the ketones. At what point in all the vet visits was the dose reduced from 8U to 1U of Prozinc? Before or after the ketones were detected?

How is your cat (name?) doing right now? Eating and drinking at all?
 
Nan & Amber said:
It seems unlikely, but it's hard to say without more info and I'm not a vet. In general, ketones are brought on when there is too little insulin, not too much. That said, 8U of ProZinc is a high dose! There are some high-dose conditions that require that much insulin, but it's hard to know for sure if those dose changes were warranted without close monitoring of blood glucose at the different doses. Did your vet do glucose curves, or just test fructosamine to make the dose decisions?

The best way to determine the needed dose is to home-test blood glucose (away from vet stress, which can raise BG and make it look like more insulin is needed), and the sooner you can get that going, the better, but the immediate health concern is the ketones. At what point in all the vet visits was the dose reduced from 8U to 1U of Prozinc? Before or after the ketones were detected?

How is your cat (name?) doing right now? Eating and drinking at all?
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His name is Rory. He is pretty weak right now, and he just threw up which isn’t a good sign. I’m going to give him more fluids now. He is just sitting in his bed. I have been making him eat. Small spoonfuls of wet food. I’ve seen him drink occasionally. He went from 8 units to 2,and then when she tested him last week he was at 267, and she had me do one because ... well, I’m not even really sure why. Sigh. I’m confused, tired, and scared.
 
:bighug: :bighug: :bighug:

It's a really good sign that he's eating some food, and getting some fluids into him. Throwing up isn't good, but weakness per se isn't unexpected even if he's currently free of ketones and recovering. These episodes make them feel really really lousy.

Have you been dealing with the same vet this whole time? I hate to say it, but not all vets have enough experience with feline diabetes to be effective in a case like this (even if they're great in general!). It's hard to know how wise the care decisions have been in this case without more info. If Rory was actually in ketoacidosis, I'd question the decisions to keep sending him home (it really isn't something to be dealt with using home care), but if it was just recurring small amounts of ketones that were apparently resolving during the vet visit it could be reasonable. Still, I'd be looking into local ER or other 24-hr vets to see what kinds of alternatives you have (you'll want to have their numbers/locations handy in any case, in case Rory goes into a sudden decline). Ketones are quite treatable if caught early, but the longer the situation goes on, and in particular the more severe a DKA episode is, the harder and more expensive treatment is, so you want to make sure Rory is getting the care he needs.

One other thing to consider is that for DKA (or even often just a ketones episode), there's often some kind of underlying trigger-- an infection or inflammation, for example. Urinary tract infections (UTIs), pancreatitis, sometimes even dental disease and pain are common triggers. Given Rory's multiple episodes this week, there may be some underlying health issue that needs to be addressed. Did your vet do any tests while Rory was there?
 
I stopped in at an animal hospital this morning that was recommended to me. They were so unhelpful and said they couldn’t see him for another day ... it convinced me to stop at his current vet to talk. She explained her reasoning for sending him home last week because he was so unhappy and stressed there, but stable enough to be at home. She gave me ketone test strips, and ordered me a glucose monitor that will arrive tomorrow. We talked about his blood tests from yesterday, which indicated no kidney issues, but she is afraid of possible pancreatitis. I got home and fed him a teaspoonful of food, and I will let him be for a bit before bothering him again. He’s sitting on his chair in the sunshine, and seems happy for the moment. The vet tech told me that most of their cats who are diagnosed with diabetes get insulin and are fine; I guess my baby is the exception.
 
OK, that sounds pretty good. There are tests for pancreatitis, but no "cure", treatment is symptomatic (pain meds, anti-nausea meds, fluids). That's another thing to talk to your vet about, whether she thinks some supportive meds would help. A good anti-nausea med can work wonders (ondansetron and Cerenia are two common ones), if that's the problem. One caution: sometimes they will try an appetite stimulant first, and that's not a great idea if the problem is really nausea. They get more hungry, but still don't "want" to eat :(.

Glad he seems to be resting and recuperating at present. Hope he continues to improve. Sometimes all they need is to just get started eating again and they start feeling better.
 
Nan & Amber said:
OK, that sounds pretty good. There are tests for pancreatitis, but no "cure", treatment is symptomatic (pain meds, anti-nausea meds, fluids). That's another thing to talk to your vet about, whether she thinks some supportive meds would help. A good anti-nausea med can work wonders (ondansetron and Cerenia are two common ones), if that's the problem. One caution: sometimes they will try an appetite stimulant first, and that's not a great idea if the problem is really nausea. They get more hungry, but still don't "want" to eat :(.

Glad he seems to be resting and recuperating at present. Hope he continues to improve. Sometimes all they need is to just get started eating again and they start feeling better.
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Thanks so much for talking with me! I brought him back again today, and asked for anti nausea meds. She gave him a shot, but I can’t remember what it was. He ate a tiny bit of wet food for her. He’s been sleeping ever since. I forced some wet food in him, and am just sitting here next to him. He is purring loudly. I am going to give him fluids shortly. The only other option is to give him a feeding tube.
 
Hi Karen - it's Kristen from the asthma group. I'm glad to see you here and I hope Rory will be OK. I've never had one of mine have ketones or in ketoacidosis. When I saw your posts last night, I knew you needed help from the more experienced people here.

For those of you helping, when Karen said 8 units it was 4 units twice a day. That's still a high dose for a cat new to insulin. Karen, when the meter arrives you might also get some help in the Prozinc forum. There's a sticky at the top of that forum that talks about how to start a cat on Prozinc. Getting him to eat on his own and resolving his ketone issue has to take precedence over everything else. If you need help learning how to test, ask away. Lots of people here can help you with the mechanics of testing.
 
No, Kristen ... it was 8 units TWICE A DAY! So 16 units a day! He is now on 1 unit twice a day. He has ketones in his urine. The vet has ordered the meter for me, and it will come tomorrow. He is fairly lethargic right now, but I was thrilled that I just got him to lick about a teaspoon of baby food off my finger, and he got up on his own for water. I gave him fluids earlier. This is hard.
 
:eek: I really thought you'd said 8 units in a day. Yikes that is a crazy dose. I'm glad you're here now. Hang int there and keep up the good work feeding him and getting fluids in.
 
He isn’t doing well. The doctor said she could put in a feeding tube. I really don’t want to do that to him.
 
Ercokat said:
He isn’t doing well. The doctor said she could put in a feeding tube. I really don’t want to do that to him.
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The thought of a feeding tube is horrifying but it can be a life saver. It's not as daunting as you might think. I had a kitty with a feeding tube for three weeks decades ago and we both tolerated far better than I could have imagined beforehand. If your finances permit I'd go for it because it could well get him back on track.

Is he in hospital getting proper DKA (diabetic ketoacidosis) treatment - fluids to balance electrolytes, doses of fast acting insulin to get his BG down, whatever he needs to get him eating? I think this is a situation that really is beyond your ability to handle at home. My diabetic cat had a bout of DKA two months after diagnosis. He spent 3 days in the ER ICU but did recover.
 
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I'm with Kris, I think DKA is more than anyone can manage at home. I had an NG tube in one of my foster cats this year, not for anything related to diabetes, and it was a lifesaver. The whole process was much simpler than anything I'd imagined. An NG tube is a small tube that's passed through the nose and into the stomach. It's not as invasive as a true feeding tube that's surgically implanted.

I'm sending you lots of good vibes. I know the decisions you are facing are not easy. I wish you peace in making the best decisions for you and Rory.:bighug:
 
Kris & Teasel said:
The thought of a feeding tube is horrifying but it can be a life saver. It's not as daunting as you might think. I had a kitty with a feeding tube for three weeks decades ago and we both tolerated far better than I could have imagined beforehand. If your finances permit I'd go for it because it could well get him back on track.

Is he in hospital getting proper DKA (diabetic ketoacidosis) - fluids to balance electrolytes, doses of fast acting insulin to get his BG down, whatever he needs to get him eating? I think this is a situation that really is beyond your ability to handle at home. My diabetic cat had a bout of DKA two months after diagnosis. He spent 3 days in the ER ICU but did recover.
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He is at home. He was in the hospital overnight last week and they sent him home. He was scratching them and was miserable. But I’m afraid he is dying at home. I can’t get him to eat anything. He just sits in one spot, and if I pat him he purrs this strange sounding purr that I’ve never heard from him. The vet ordered me a glucose meter, said they could get it quicker than I could online, and now it isn’t coming until Tuesday. I’m afraid Tuesday will be too late. I could’ve had one overnighted to me. I’m so frustrated and don’t know what to do. The girl who answers the phone at the vet isn’t being pissy when I call. I don’t need crap like this right now.
 
For glucose monitoring at home you DO NOT need the alphatrak. You can go to Walmart and buy a meter, test strips and lancets. No prescription needed.

But I think if your boy is going to make it, that you need to take him to an ER clinic. You don't need any permission or input from your vet to do this. Just take him. He probably needs to be hospitalized for a few days. It will not be cheap.
 
AbyResq said:
For glucose monitoring at home you DO NOT need the alphatrak. You can go to Walmart and buy a meter, test strips and lancets. No prescription needed.

But I think if your boy is going to make it, that you need to take him to an ER clinic. You don't need any permission or input from your vet to do this. Just take him. He probably needs to be hospitalized for a few days. It will not be cheap.
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I agree. You need to take him to the ER clinic ASAP. You won't be able to deal with this at home. It seems, too, that your regular vet isn't equipped to do it. This needs 24/7 care by experienced emergency/ICU staff. Please do what you need to do for your kitty.
 
I brought him back to our vet today. She forced him to eat, which I was unable to do. She is taking him home with her tonight. He is slightly jaundiced, and she believes he has fatty liver. It never ends. . I’ve lived here for 2 years, but I had no idea that there is no 24/7 animal hospital here! I would have to drive to Richmond (we aren’t even a suburb of Richmond)! It’s over an hour away. When animals stay overnight at any of the vets here there is no staff! I moved here from a much less populated area where there was an emergency vet as well as animal hospitals! WTH? I’ve been crying all day, and all my husband has to say is “you’ve spent too much on this cat already”. .
 
I'm so sorry. What a terrible way to find out about the lack of services in your area.

I'm glad your vet was able to get him to eat, and that she is dedicated enough to bring him home with her. What was the decision on the feeding tube? I've heard lots of people echo Kris's experience; it seems scary, but can be an absolute lifesaver when nothing else works.

Keeping you guys in my thoughts tonight, I hope Rory can pull through.
 
She thinks she can get him to eat without the tube. She got him to eat in the office. She is going to feed him every 30 minutes. I’m very thankful she is willing to try and save him. I wonder if there is some kind of veterinarian board that decides where animal hospitals are located? My county has over 300,000 people, but apparently someone determined our population isn’t high enough for an ER vet? Crazy.
 
He went home with the vet again. He has fatty liver and is jaundiced. I went to visit him before they went home at noon. He seems the same. He did purr when I started patting him. She’s hand feeding him much better than I could. I feel so sad for him.
 
Ercokat said:
He went home with the vet again. He has fatty liver and is jaundiced. I went to visit him before they went home at noon. He seems the same. He did purr when I started patting him. She’s hand feeding him much better than I could. I feel so sad for him.
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What a living vet you found to take him home with her. Might be beget care even then an emergency vet. I'm sorry you're husband isn't being more supportive however I do understand the stress high vet bills can cause.

Hopefully he had a good night and is on the way to recovery.
 
My baby passed away this morning at the vet’s home. I’m devastated. I wonder if I could’ve saved him if I had done things differently? So sad.
 
Ercokat said:
My baby passed away this morning at the vet’s home. I’m devastated. I wonder if I could’ve saved him if I had done things differently? So sad.
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Oh no! I'm so sorry! Really you guys did everything you could. Sorry it was his time to go. :(
 
Oh, how terrible... I am so sorry this happened, please don't blame yourself. DKA plus fatty liver is a huge hill to climb, even with the very best care many do not make it. You did all you could.
 
I am so sorry for your loss, you are a great kitty mom and you did the best you could do, don’t blame yourself:rb_icon:cat_wings>o Rest In Peace Rory
 
I'm so sorry about your poor beautiful baby. I lost my Dweezil (also a Manx kitty, diagnosed at age 6) almost a month ago, also from repeated bouts of DKA over a week-long period. He went to sleep at age 9 and a half, weak but held and surrounded by love.

It is SO hard...these precious fluffies. Sometimes they just can't fight anymore.

I also think some vets don't quite feel the same sense of urgency that we do when we see ketones and/or our babies wilt. When they won't eat, the ER is needed.

But sometimes due to the high cost, location and lack of service, lack of 100% attentive treatment there, a highly stressed cat who the staff want to send home quickly to avoid making things worse, or just...too many underlying problems that keep coming back, our fluffies just can't keep going.

I am in tears reading this. Two Manx babies are now frollicking over the Rainbow Bridge.
 
so sorry for the loss of your little loved one...you did the very best you could do...consider Ercocat may have had something else going on that you had no control over...you said you heard a "purr you had never heard before"...perhaps Ercocat had heart issues that can hide...he is at peace and not suffering...big big hugs from all of us..please visit the grief support group here ....there are kind hearted wonderful ppl here that can really help you get through your loss...they have sure helped me as I lost my Bubbles to a similar fate on March 15th and every day she is all i can think about....you arent alone in your grief ...there is I grief counselling between 8 to 10 pm eastern time nearly every night if you feel you need it...
 
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