Newly diagnosed cat

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adriane

Member Since 2014
Hi Everyone,

My name is Adriane and my cat Prince was just diagnosed with diabetes. I was able to bring him home from a 4 night stay at a 24hr hospital last night. He was admitted with DKA. I have some concerns about the care that he received because my sister’s cat is also diabetic and was recently admitted with DKA, and his experience was a bit different.

Namely, it was my understanding that my sister’s cat (JuJu: Ava and Matt’s cat. They are on here too!) was ketone negative when released, while my cat still had a number/level of 2. Does this seem strange to anyone? Are cats frequently released while they still have ketones present?

Also, Prince hasn’t been interested in eating too much. He’s on an appetite stimulant, but I still haven’t seen him eat more than a couple of bites. This morning I took his BG at 6:45am and it was 59, so I took it again an hour later and it was 72. He is supposed to get his Lantus shot now. Should I give him the shot (1.5 units), should I wait?

Any advice is appreciated.

Thank you!

Adriane & Prince
 
Hi Adriane! I can't advise about ketones though I am sure someone will be along who can.

With BG that low, I wouldn't shoot. That can cause a hypo. I don't have any experience with Lantus but a lot of people here do. I'll post on Lantus to see if anyone can come and give some more advice for you. Welcome!
 
Thank you Rachel.

I have just checked his BG again; it's now 113. So, it's steadily increasing, but I'm still not sure at what point I should shoot. I don't have work or class today, so I will keep testing him on the hour, but what number would anyone suggest I go ahead and give the insulin at? Also, he's still not eating. Maybe I should give him a half dose in an hour or so?

Any thoughts are appreciated!
 
Hello Adriane,

Those blood glucose numbers you're currently seeing are normal blood glucose numbers for a cat.

The general advice for those new to dealing with feline diabetes is that no shot is given if the blood glucose is below 200.
Your situation is slightly more complicated though in that your kitty is getting over DKA and has a diminished appetite. I would strongly suggest that you wait to hear from some experienced Lantus users, who should be around soon. (I don't use the same insulin as you.)

Best wishes, and welcome to FDMB,

Eliz
 
Hello.
He needs to eat.
Until someone more experienced than me comes on, let's say you are stalling the shot right now.


the recipe for ketones...is infection, no insulin and no food.
So let's get some food on board.... by that time, more folks will show up.

What appetite stimulant did they give you?
And when you present food does he kinda smack his lips and turn away.... that show nausea. ( especially if he wants to eat
and is asking for food)
Sometimes they need the nausea addressed before giving the appetite stimulant and a lot of vets don't think that way.


Did you recently switch his food?
The most important thing at this moment is to find what he will eat. If you are trying to transition, that may have to take
a backseat to getting food in him.

suggestions: baby food, stage 1 meat and broths only
cooked chicken
kfc chicken - peel off the fried skin
lunchmeat - deli style.... just look at the ingredients
cook an egg
can of human tuna - the good stuff ( watch for additives)
 
I just know that the recipe for DKA is not enough insulin plus not enough food plus an infection or other systematic? stress.
Can you get him to eat anything? Have you tried all kinds of toppings and any other foods? He needs to eat and he needs his insulin. I don't know why they released him with ketones, but maybe he was out of DKA but still had ketones? I don't know enough about it. Is he on antibiotics? That can cause an appetite loss.

I'm glad his BGs are rising. I'm glad you're home testing. Please let us know what his next test is.
Keep in the back of your mind that Lantus should be given every 12 hours too, so if you shoot in an hour, can you keep up with that schedule? This is difficult. I hope some more people come along with more help for you.

I am guessing you have urine test strips to use at home.
 
Hi Elizabeth, Thanks for the advice. I will keep checking his BG and will consider shooting when I see numbers nearing 200.

Hi Rhiannon, I had some tuna in the house, so I gave him a little. I gave him about a tablespoon, just to see what happens. He drank the tuna water, but didn’t really eat the tuna. I also bought him some turkey treats (they are just pure frozen turkey, nothing else) and he ate one of those. Before he went to the hospital, I only fed him once a day at 7pm. So, he’s not used to eating early. I’ll try to keep feeding him, and I’ll keep testing him, and I guess we’ll see.

Hi Dyana, He was never very severe DKA, meaning he was never sick. I took him to the doctor because he was drinking and peeing excessively and I noticed that he had lost a couple pounds. Other than that, he has always had full energy. Yes, he is on antibiotics. I will test him again soon and post the number.

Thanks for everyone’s help.
 
Update: at 10:30am his BG is 140 and that's using the Relion Prime which I've read measures 30ish points below the machines specific to cats. So, I'm guessing that's around 170ish. It's 2.5 hours past his scheduled 8am dose, so I'm not sure if I should entirely skip it, give a half dose, or still wait it out. I'm a little nervous to keep waiting because I know Lantus is 12 hour drug, so if I shoot at midday I'll be waking up in the middle of the night to give him another, which isn't sustainable...
 
Adriane

Welcome to FDMB. I'm sorry Prince is not feeling well. How are his ketones today? You should be urine testing them twice a day.

As long as you are there to test him and you get some food in him, you can shoot at 2.5 hours late but you've got to get food in him or his BG will come back down. Any food...see below. We can worry about getting him back on track on time in a little bit.

The appetite stimulants are fine as long as you've addressed nausea which was already mentioned. Can you discuss with your vet getting some ondansetron for Prince? Many vets are not familiar with this human drug that works well for nausea in cats. Dolasetron (Anzemet) is a veterinary drug, might also help if the vet does not want to write you a prescription for ondansetron. The cheapest place to get ondansetron, if your vet agrees to it, is Costco. You don't need a lot right now....maybe five pills (they are 4 mg usually and dosed 1/4 twice a day).

Right now, two things are really important: food and insulin. He must have both. Right now, it doesn't matter what he eats....even if is pizza with all the toppings or ice cream. He just needs calories. And he must have insulin.

From previous posts:

Here are some things you can do do entice your cat to eat:
-sometimes in order to get a cat to eat you even have to resort to dry it is more important that they eat. there are a couple low carb / grain free brands -- EVO and wellness core.
-making a buffet to give him choices
- heating food
sprinkle food with :
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo chicken treats -- crumble into dust over food -- my Wolfie loves this stuff.
- poor a little water from tuna in water over food ( I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats-- check labels)
-powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.
other ideas of foods to offer your kitty to stim appy:
- trader joe tuna for cats
-baby food -- beechnut turkey and broth or chicken and broth. they have no onions or other additives. some babyfoods have onions . please read labels if you can't find beechnut.
- kentucky fried chicken
- deli turkey /chicken
- plain cooked ( boiled or baked ) chicken breast
-canned chicken for people (watch the label that their are no onions)
- chicken broth -- low sodium
If enticements don't work, you should consider:
-assist feeding ( syringe or make little meatballs and place in mouth)
Click to expand...
 
Any update?

Also...i can set up a spreadsheet for you very quickly....it's really helpful for us in helping you and I know you have your hands full.

I'm going to send you a private message to get some info so I can do the SS. Look for it in the upper left corner of the forum. It should say "1 new message" next to the User Control Panel.
 
Hi Marje and Gracie:

I haven’t checked his ketones today yet. I will go to store this evening and purchase strips.

I was avoiding giving him his dry food because I thought that would be worse for him, but I’ve given it to him now and he’s eating well. He’s eaten about a quarter cup now. Should I go ahead and give him insulin, or wait to check his BG again?

He is currently prescribed Amoxicillin, Famotidine, and Cyprophetadine. I will discuss ondansetron with my vet when I take him for a follow-up later this week.

Thanks for the advice.
 
Let him have the dry for now....the best food for a sick cat is the one it will eat. We can adjust the insulin dose and you can slowly switch him to canned once he's better.

Yes...pls check his BG and if it's still going up, shoot and let him have whatever he will eat.

I would make the nausea med a priority if it were me. Will explain more later.
 
Update: his BG is now 194 and I went ahead and gave him the shot. He's eating the dry food really well. I should have measured, but I didn't. I would guess he's eaten over 1/4 cup now. Should I continue to let him graze all day? Also, what does the late shot mean for his next dose? Should I plan to give him another dose at 11:30 tonight? Sorry for all the questions. I appreciate everyone's help.
 
Good job, Adriane.

I would see if you can get him to eat some canned by crushing the dry and putting it over it. Start with bigger pieces of dry so he gets the dry but starts tasting the canned. If he refuses to eat it, let him have dry for now.

Please get a +2 test for him. Also...please let me know what your shooting schedule "needs" to be and when you have to get back on it for work. Thanks, Adriane.
 
Yes, the next shot 12 hours from when you actually gave the shot. How long did you stall? You can work the shot back to your normal time by 15 minutes at each shot or half an hour once a day.

Sometimes it can be difficult to transition a cat from dry to wet food. As others have said, right now the important thing w/ DKA is that he eats so he can get his insulin. When he does start eating wet food, you will probably see a dramatic drop in his BG which will call for a reduction in insulin. For now one step at a time and get Prince eating and negative ketones.

Some cats will cooperate w/ ketone testing, others will not. If you have trouble getting a sample, we have lots of tricks to share.
 
Hello and Welcome :cool:

You are in the very best of hands here. Many of us have kitties that have been through DKA, myself included.

regarding your question on timing - Lantus is given every 12 hours so if you shot at 11:30am then 11:30pm would be the next shot.
The reason Marje asked about what your shooting time needs to be is so that we can help you make any timing adjustments safely.

Along with getting enough calories, enough insulin and addressing any infection and/or inflammation, hydration is also very important.
If your kitty will tolerate it, add a little water to the food.

Please get the ketostix (urine test strips) as soon as possible. I recommend testing several times daily as ketones can quickly develop to life threatening levels.
My Black Kitty went from 'trace' (the urine reading which is just above 'none') to 'large' (the highest urine reading) in exactly 24 hours and ended up back in the hospital one month after his first DKA episode.

I know you are getting bombarded with information right now and it may be tough to absorb it all.
Hang in there - and hang in here. :cool:
 
Update: Prince has probably eaten ½ cup now. Nausea really doesn’t seem to be an issue. I think he just hates canned food. I’ll try mixing the two and see if he will eat that at all. He has also drank a little water.

At +2 his BG is 362

Marje: I added this number to the SS you created for me, but I’m not sure how to link it to my FDMB. Also, I’m not really sure what my shooting schedule needs to be at this time. I’m on Xmas break from Grad school and I don’t have my official schedule for the new quarter yet, so I’ll have to get back to you. I work also, but it’s relatively flexible. I can make 11:30am/11:30pm work for right now, since that’s when I shot him today.

Should I take the food away now? Before he was diagnosed I would only feed him at 7pm because if I leave food down all day, he will eat excessively. But he’s about a pound underweight now, so maybe I should just leave it down?

Ann & Tess, Sandy and Black Kitty: I’m going to buy the ketone strips tonight and try to test him. He hasn’t gone to the bathroom at all today though.
 
I had the SS linked and you changed it when you updated the signature block ;-) :-D

I'll put it back on.

Ok...let's see how he does on the current schedule. You have the latitude tht if he is still high at +11 today, to shoot an hour early to work toward getting him back on schedule.

I'd pick up the food now NS try to get him to eat mixed. If he still refuses, it's more important for him to be eating and small amounts more often is better.
 
Update: I tested Prince's BG at +6 and it had gone up from his +2 reading. Before it was 362, now it is 381. Should I do anything about this? Dose him sooner?
 
Each meter can have up to a 20% variance so this number is actually flat.

I'd recommend you test him at +11 (11 hours after his shot today) and if he's still this high, you can shoot his 1.5u at that time. That will put you one hour closer to getting back on schedule. If you can be on a 10:30/10:30 schedule, then you can shoot at +11 (10:30 pm).

I would imagine thst number is reflective of the dry food and also his liver reacting to the lower numbers. His liver has become accustomed to high numbers and when his BG comes down, the liver perceives it as "unsafe" and releases counterregulatory hormones and glucagon which drive the BG back up to what the liver sees as "normal".

How has he been eating today?
 
Okay, I'll test him at +11, and go from there. Once I allowed him to eat the dry food, he has had no problems eating. He ate an initial 1/4 this morning before I shot, and another 1/8 to 1/4 throughout the first half of the day. I took the food away once I thought he'd had around 1/2 cup. I'm going to try to mix a little wet food in when I feed him before his pm shot. Hopefully, he eats it.
 
adriane said:
...Relion Prime which I've read measures 30ish points below the machines specific to cats. ...
Click to expand...

We used to think the difference was 30 mg/dL at the low end. Further research finds that, on the average, taking hundreds of paired samples, human glucometers read from 30 - 40 % lower than pet specific meters.

Also, home glucometers, regardless of type, may read +/- 20% from what a lab would get.

With both of those bits of info, it really isn't useful to attempt to convert from meter type to another.

Example.
A test of 200 mg/dL could be as high as 240 mg/dL and as low as 160 mg/dL (the +/- 20%). That is a span of 80 mg/dL.
Now take those 2 numbers and divide the lower number by 0.7 and the higher number by 0.6 to estimate an AlphaTrak (which results in the widest possible range for the estimate)
160 / 0.7 = 228.6
240 / 0.6 = 342

Now you've got a possible range from 228.6 to 342 for estimating the reading of an AlphaTrak. The span of possible values is 113.4 mg/dL wide - and not very helpful.
 
Hi BJM:

Thanks for the info. That's helpful to know. I guess I won't consider that too much then.
 
Welcome, Adriane. You've come to the right place. My Mikey was diagnosed about the same time as JuJu. There's a ton to learn, but the experience folks here will take you through step by step. One thing I wanted to add, is that the medication ondesteron (or however you spell it) is also known as Zofran. You may have heard of it by that name. It's awesome stuff in humans and cats.
 
Update: Prince’s BG at +11 was 331, so I went ahead and fed him and gave him his insulin. He ate pretty well about 1/4 cup. He also drank a decent amount. I tried to mix the dry with the wet 50/50, and he wouldn’t have anything to do with it. I’m going to try maybe 75/25 tomorrow and see if that helps. If not, I guess I’ll just start trying different wet brands and see if he likes any. I purchased ketone test strips and I’m going to try to get a reading tomorrow. Mary: I’ll look into the medication you suggested. However, I don’t suspect that Prince is nauseous at all. He’s been eating fine since I let him have the dry again, and he hasn’t thrown up. Thanks again for everyone’s help and advice!
 
Adriane

glad he's not experiencing any nausea. It never hurts to have the ondansetron around, if possible.

instead of trying to transition him from dry to Purina DM, why not try some of the Fancy Feast Classics? They are low carb and many cats take right to them. The DM is poor quality ingredients and most of us in FDMB feed other low carb foods.

The other priority is the urine ketone test strips. it's important to keep an eye on it. And I would just suggest continuing to put additional water in his food.

I would also suggest a before bed test to see what he's doing before you go to bed. Hope you get some rest.
 
Update: So Prince’s BG has been running pretty low in the morning 70’s-80’s. Which I’m a little confused about because at this point his Lantus should be wearing off, so I would think it would be high. Has anyone experienced this? Is there some type of adjustment I should make?

Anyway, I fed him (still only eats dry) and after about 30min, his BG still hadn’t come up. I went ahead and shot him anyway because I thought it was important to try to stick to the 12hrs, and then I had to leave the house. Then, I talked to a couple of people and they said I should never dose when low and then leave the house. Thus, I was praying and panicking the whole time bc I was scared he’d be hypo by the time I got back. Thankfully, he’s fine. I just checked him at +4 and he’s 365. I did leave some food down just in case he had some instinctual desire to eat if he got too low. All the food was gone when I got home, but I can’t be sure how much he ate because my roommate has a cat and she certainly ate some also.

Since Prince has been low in the morning, does anyone have an opinion as to whether it would be okay for me to feed him maybe 1-2 hours before his scheduled dose? I know you typically do them back to back, but it seems to take his BG awhile to rise after he eats.
 
Many cats run lower overnight. You might want to set an alarm overnight and check on him around +5 to make sure he isn't going too low. He may need a 0.25 unit dose reductio..
 
Okay, I'll set an alarm tonight. It's just odd because his daytime 12 he's been running high, but then his nighttime 12, he's low. I'd think if he needed a reduction that it'd be low both times, but this is only his 4th day being on a long acting insulin. He was on a drip in the hospital. So, I'm sure he's still adjusting.
 
adriane said:
Okay, I'll set an alarm tonight. It's just odd because his daytime 12 he's been running high, but then his nighttime 12, he's low. I'd think if he needed a reduction that it'd be low both times, but this is only his 4th day being on a long acting insulin. He was on a drip in the hospital. So, I'm sure he's still adjusting.
Click to expand...

What you may be seeing is called bouncing. When the glucose level drops quickly or drops to an unfamiliar lower level than usual, the body responds as if it were heading into hypoglycemia, which triggers hormones that release stored glucose (glycogen). It can take up to 3 days or so for that to level out.

So, if he were dropping somewhat low, for him, overnight, he might be bouncing higher during the day. The overnight test will help you identify if that is what is happening.
 
Hmm... interesting. So, would you recommend that I give him some food if he's low when I test him at +5 in the middle of the night? Or should I just let it go as long as it's not too low?
 
Adriane

I agree that he's clearing a bounce at night, going lower, and then shooting up the next day. So if you can get some spot checks, it will help you pinpoint what he's doing.

I wouldn't take his dose down unless you can catch him going below 50.

You also don't want to feed him two hours before his shot because you don't want his PS number to be Iinfluenced by food.

If you'd like to start posting in the Lantus TR forum, there are more of us to follow along and help. You don't have to follow the TR protocol to post there.
 
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