Newly diagnosed kitty still in DKA

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jen1rocks

jen1rocks

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My kitty Poop Cat was diagnosed on 6/8 with diabetes, at this time he was in DKA, not eating, had lost weight and dehydrated. He was put on 1 unit of insulin 2 times per day and 150 mL of NaCl Normal Saline per day to treat his dehydration. I took him back in yesterday 6/10 because he had not eaten anything and I am worried about him, I just want to know if this is normal with DKA, how long it takes for him to start feeling better and for the ketones and glucose to get straightened out, any advice, etc. I have been keeping notes on him for a couple of days now and listed below so that you can get an idea of what is going on:

6/9
1430 - 1 unit insulin, no food eaten, urinated in litter box, seems to be a more normal amount
1530 - 175 mL NaCl Normal Saline subcutaneous, lethargic

6/10
0230 - 1 unit insulin, no food eaten, did drink water, laying under bed
1430 - 1 unit insulin, no food eaten, urinated a large amount in the carrier while on the way to the vet, he lost 12 oz since last visit on 6/8, subcutaneous fluids increased, Rx for appetite stimulant, told that if there is vomiting or diarrhea to take directly to the kitty ER
1600 - 1 mL Mirtazapine (appetite stimulant as prescribed by doctor)
1700 - 200 mL NaCl Normal Saline subcutaneous (doctor upped the amount) no food eaten, the Mirtazpine was supposed to work in 30 min - 1 hr
1830 - fed approximately 2 - 3 Tbs diluted wet D/M food through a syringe over 2 hours

6/11
0230 - 1 unit insulin, no food eaten, more urine in litter box, no vomiting or diarrhea, fed approximately 1 Tbs of diluted wet food, still lethargic but seems a little more feisty
0530 - no food eaten, fed approx 1 Tbs of diluted wet food, acting the same as at 0230

Any input on this is greatly appreciated!!
 
It is good to see that you are syringe feeding him! When I first saw at the beginning of your post that he wasn't eating, I was getting worried about him developing fatty liver - which can turn badly very very quickly. It is normal for them not to want to eat while dealing with ultra high ketones, but it is vitally important that they get food in their system.

Was kitty diagnosed with a high ketone level, or full blown DKA? Usually if kitty is dealing with full DKA, they need to be on a fast acting insulin drip along with a constant drip of fluids. This also usually means a 24/7 vet hospital stay.

What kind of insulin are you giving? Is it different from the insulin that has been given previously? What are his glucose numbers right now? Are you able to test his glucose at home with a human glucose meter?

I know others will chime in here with more resources for you, but everyone is going to want some more information before we can give you suggestions or help interpret what is going on in your situation.

I hope your kitty feels better soon, and we will all do our best to help you guys in any way we can!!!
 
hi there

just offering support and prayers that your kitty pulls through.

Others will be along soon - so do check back in with us - in the meantime please help us by answering some of the questions posted above.

((((hugs)))
 
He is on PZI insulin, bovine I believe, this is the only insulin that he has ever had and it was started on 6/9 at 230pm. At his first visit, his blood glucose was 343 and he had a high level of ketones and glucose in his urine but those numbers I don't have on hand. The doctor did say that hospitalization is the usual course for this but since he is the feisty kitty that he is, she didn't think that he would do well there (or that the techs would come out unscathed) with IVs and being poked and prodded by people that he doesn't know because he couldn't be sedated the entire time and that it would STRESS him out big time. The doctor is aware that I have experience in treating sick animals (giving SQ fluids, medicating, etc while volunteering at the local pound and with a local rescue group) and I am a nursing student with human clinical experience and a pretty good understanding of the disease, so she decided that I could take him home and treat him there BUT if there is any vomiting, diarrhea, change in behavior, etc to take him back in. I am assuming that the ketones and glucose were not high enough to warrant the IV insulin drip at that time.

I took him back in yesterday because he was not eating and had not shown any signs of improvement, this time I saw another doctor and she prescribed the Mirtazapine for his appetite and upped the fluids, which the Mirtazapine had no effect on him. She did say that he did still have ketones and glucose in his urine and I don't have those numbers either unfortunately. The doctor did agree that I should force feed him and again that if there is any vomiting or diarrhea to take him in immediately, and she did mention ketoacidosis.

I do not have a home glucose meter, I was not sure if I should get one or what kind to get, any suggestions here too would be awesome.

Thanks for the help! Poop Cat says thanks too!
 
Most any of the major human glucometers are used by any number of people on this board. I am partial to the relion meters from Walmart since they are cheaper, very accurate, and the test strips are one of the cheapest on the market. We use the relion confirm meter (0.3uml blood sample - smallest needed on the market) and this meter also does not require calibration for each set of strips. The meter runs around $10 and 50 strips are $18 at Sam's club and $20 at walmart. I know others use the One Touch Ultra and AccuCheck Aviva with good results as well. You can usually find strips for these meters on ebay much cheaper too.
 
Reli-On meter at Walmart....get test strips, lancets and pick up some Keto-Diastix. Test his urine and keep an eye on the ketone levels with the Keto-Diastix. Get food into him as often as possible and instead of doing 200mls at a time, maybe split and do 100 b.i.d. Also, try and space out giving fluids and giving shots together. Very few of us will fight heavy amounts of ketones at home because electrolytes need to be monitored and usually R insulin is used by the ER vets along with a drip. ER vets and techs are usually pretty good at handling fractious kitties of which Mishka was one of them. She battled DKA several times in the beginning but it can become life threatening very quickly. If he becomes jaundice, it is usually the start of fatty liver and at that point appetite stimulants will not work and should not be given. Then a feeding tube is needed to turn that liver around. Prayers coming for your kitty that you can turn it around for him without a 24/7 facility but ketones can quickly go into DKA.
 
Hi Jen,

I'm surprised your vet wants you to treat at home for DKA. This condition should be treated in a 24-hour facility. I know that sub-q fluids help, but they don't have the same impact as the iv fluids and, treating this way - in my opinion, will prolong the recovery period.

You should go buy a meter this afternoon. You can buy any brand but you want to look at the cost of the strips in making your decision, but this is very important in monitoring his blood glucose levels.

How much are you feeding? You need to make sure he is eating, on his own or through assisted feedings, what he would normally eat during the course of the day (about 6 ounces of food or about 180ml in a syringe).

Best,
Pam & Layla
 
I definitely would ask the vet how much food Poop Cat should be getting. It doesn't seem like the amounts you have listed are very much, or very frequent. I don't have experience with force feeding, but I would think you would want to try to mimic what he should be eating on his own. A definite question for the vet.

When my kitty was DKA (and it's all kind of a blur now) it seems like every day my vet was talking about kidney or liver values, like she was doing at least daily blood work to check on the functioning of other organs. And administering stuff through his IV to adjust whatever needed adjusted.

Buddha was in intensive care for most of a week, Sunday night through Friday. When he came home that Friday, he was eating on his own.
 
Thanks for the suggestions on the meters, I will be heading to Sam's right after work!

The doctor just called to check on him, she has something at the office for cats that is similar to Ensure for humans and said to continue the syringe feedings of the wet food. She says to continue with the fluids also and to weigh him before I administer them and if he loses anything to take him in. She asked if maybe he didn't like the new food, I told her that we offered him a little tiny bit of the wet kitten food and even opened the can next to him - this usually gets him all worked up, and all he did was sniff it for a minute. She did test his blood when we came in the first time, this is where we saw that he was dehydrated and that some of his electrolytes were depleted, mainly Na and Cl, hence the NaCl Saline that we are using.

I have been giving him the fluids b.i.d. or t.i.d. mainly because he won't sit for long enough to get all of the 200 mL's in at once, but I am making sure that he is getting all of it.

His usual diet is 1/4 cup dry food in the morning and 1/4 cup in the afternoon, I feed him Science Diet Mature. If he had his way, when he is feeling good, he would eat the entire bag of food in one sitting!I didn't try to give him too much food all at once since he has not eaten in over 24 hours, I don't want to upset his stomach and cause him to vomit. He didn't fight it too much, not like how he fights the fluids, I think that he likes the taste but he just isn't hungry maybe.

My husband just sent me a text saying that he seems to have perked up a little, he put him on the bed by the window - which he loves and he is peeking out and isn't slumped over like he was before. Unfortunately he still has no interest in food.

I really do appreciate your guy's input, I have dealt with other kitty problems, but nothing like this before. I will keep updating on him.
 
Will he eat the dry food he likes? If so, feed him that. At this point, feed him anything he wants to eat. Once he is over the hump then you can try switching him to a canned food he likes. Push comes to shove, we feed what ever the kitty wants just to get him/her to eat.
 
You might also try some D/M dry. The wet food will be the best in the long term. You could mix some of the SD mature with the D/M to coax him along too.

But if the D/M wet goes in and stays in, just more of it more frequently would help him out. My understanding of the way things works is that if his body isn't getting enough calories to keep him going, then his body starts converting his stored fat into energy, one of the byproducts of that fat to energy conversion is ketones. So as long as he's not getting enough insulin and food, then he's at risk.
 
You are exactly right Donna, the body burns Carbs (glucose) first, then fat (the byproduct is ketones) and then protein. They lose weight when the body doesn't have the "key" (insulin) to open the cells to use the glucose for energy, this causes the glucose to stay in the blood and be excreted in the urine. So then, since the body doesn't have it's #1 fuel glucose, it turns to fat for energy, causing the weight loss and the ketones in the urine.

We have tried to feed him wet kitten food, D/M wet and dry, his regular dry food, and beef jerky kitty treats, he isn't interested, I even thought of cracking open a can of tuna and seeing if he will drink the water from the can. Maybe I will try this and see if he is interested and pour some on the food if he is interested. If not he will be getting the syringe again, I'm not going to give up on him, he is my bff, we have been through a lot together!
 
On the meter question, I think the one people are mentioning is the Relion Micro (I have a different Relion, but if I buy another one it will be the Micro for the smaller blood sample it takes!!!) - I think those are a Walmart brand (?). The biggest cost you will have is test strips - I don't know what Sam's carries, but before you buy, check the test strip prices and buy one where you are comfortable with the price of the test strips. Really any meter should be fine.

Have you tried things like tuna juice or baby food (chicken or turkey, be sure no onions/flavoring in it - Gerber is clean I think)? Some cats will chow on stuff like that even if they won't touch their regular food.

When giving the fluids are you warming them a little bit before hand? I don't think the vets do that, but I've read about people here who do that at home and the cats seem to tolerate the fluids much better that way. I don't recall how they warm them or to what temp, but I'm sure we can get that info if you need it.

I would think more insulin may be needed, but if you can get a meter today and succeed in testing (it's easy once you get the hang of it, but can be challenging at first - sounds like you have some experience though that might help you get the hang of it quickly) hopefully that will help you determine that. The key tests with PZI if you have limited testing opportunities are preshots (before giving insulin), and the cycle lows/nadirs, which can vary, but are generally between 5 and 8 hours after the shot. I usually go for a +6 or +7 if I know that's the only mid-cycle test I will get. If that # is in diabetic #s, the dose is probably too low. If you have reading time, we have a sticky over on the PZI forum that has some useful links and a few basics in it.
 
On the meter question, I think the one people are mentioning is the Relion Micro (I have a different Relion, but if I buy another one it will be the Micro for the smaller blood sample it takes!!!) - I think those are a Walmart brand (?).
Click to expand...

yes, its Walmarts brand.

Relion Micro and the regular one,,,if u go with Relion meters, make sure the strips match for the right meter....meter runs about $9 -12 dollars, strips of 50 about $20, so that makes the Relion an affordable choice.
 
Ketones can develop because of insufficient food, insufficient insulin and or infection. Has he been checked for infection? Have his electrolyte levels been tested? NOrmal treatment for ketones is fluids, fast acting insulin (if electrolytes aren't too wacky) and treatment of any infection. I'm confused by your vet's treatment plan.

In the meantime, I'd be force feeding him using a syringe....
 
Ok I got the meter, any advice on where to get the blood? Poor kitty, I tried the skin on his back and nothing.
 
From the health links forum viewtopic.php?f=14&t=287

Sit on the floor with cat between your legs, and be calm
We warm the ear gently with a thin old sock filled with 1/2c uncooked rice.
Put on a thin sheen of vaseline to help the blood bead up
Have your strip ready and partially inserted into the meter
have your lancet device and lancet primed and ready to go

Gently warm ear a bit
Keep sock inside the ear for stability
Put the pen against the edge of the ear and click the device to go off and there 'should' be a drop of blood
keep cat still while you push stip in, bring strip to the drop of blood and let it 'sip' up the blood
wait for meter to count down

This may take a few tries

Jen
 
Thank you so much! After quite a few pricks and a couple of strips, I got it.

Now it is 260 when it was at 343 on Tuesday!
 
Congrats!

Now, a caution on interpreting the numbers...remember that blood glucose levels will vary throughout the day in relation to when the shot was given, so if this new number was at a different time than the previous, it may account for the difference...but on the other hand it is great you were successful and it may well represent an improvement! Wooo!
 
Another food to try is prescription A/D. Sick cats usually eat it well, but if they don't, it is easily blenderized to smooth for syringe feeding.
 
Thanks everyone!

I took his blood sugar right before his insulin, so 12 hours after his last dose. The last time it was taken was before he had recieved any treatment, when he was diagnosed.

He is still not eating on his own but I was able to get about 42 mL of the prescription liquid food and about 10 mL of diluted D/M and he did drink some water on his own. On top of this I was able to get the 200 mL of fluids in him in two settings a couple of hours apart.

So now do I take his blood sugar every time before I give him insulin or once daily until it levels out? confused_cat
 
Take his blood sugar every time before he gets a shot, for as long as he gets shots. Kitties can give stable numbers for a long time and then one day throw you a low number out of the blue. If you aren't testing before every single shot, you might miss that oddball low number and overdose the kitty, with unpleasant results.

Keep testing. It really does get easy, though that's hard to believe at the start.
 
I tested him again today at the same time as yesterday and I think that I found the sweet spot on his ear after poking him a few times. He is at 218 today before his insulin! He seems to have perked up a bit but still isn't eating on his own, so I have assisted him with this a few times today already. I gave him half of his fluids this morning and weighed him before this, he lost 0.3 lbs since Thursday. I called the vet's office to tell them about his progress and they think that he is coming along fine, not to worry much about 0.3 lbs and to keep up on the liquid CliniCare diet until he starts eating on his own.

Thank you again for everyone who has posted advice for us, it is greatly appreciated! I will keep posting his progress until he is out of the woods.
 
It sounds like you both are doing much better. Congrats on the successful blood test. If you can, get a few more tests in before it's time for another shot. I can't find on your posts what kind of insulin you are using, but you are looking for the low point in the cycle (It's called the nadir). With most insulins, that is somewhere between 4 and 6 hours after the shot. That is the number you want to base your dosage on.
 
I think he is on PZI, so nadir is likely in the +5 to +7.5 or so range. I usually try for a +6 test if I know that's the only test I'll get in. This last PS of 218 is really really good! I agree it's smart to get a mid-cycle check in if you can and see what the low end of the cycle might be. Glad things are going so well, hopefully he will start eating on his own soon! :)
 
Hi Jen,

I'm sorry I didn't see this sooner. Sounds like you're doing a great job!

When my kitty, Alex was dx'd back in Sept. He had DKA also (probably for about 2 or more weeks) and after 24 hours my vet asked me to bring him home and take care of him at home as well...for the same reasons you cited. He was weak, and had no interest in eating at all either. However, he was alert, and had spirit, and clearly wanted to be with me. I was so scared. I hadn't found this board yet. I didn't know how to test or even know that you could home test and I didn't know how to give fluids myself. All I did was syringe feed him mostly baby food, give him nutrical, and give him his insulin shots. I took him back and forth to the vet 2 or 3 times a day for fluids for a week (he's 3 minutes away).

After about 3 days he started to walk over to the food bowl like he wanted to eat and I'd put food down for him but he didn't even taste it. They are nauseated from DKA and while they may want to eat they really aren't hungry for a while. He started accepting baby food from a spoon after 3 or 4 days and he started picking at things he really really liked (like tuna and canned chicken) after about 5 days. That was all he would eat for about 2 weeks. Maybe more. Or canned fish cat foods like Tiki Cat. When your kitty starts to want to eat, and he will, you have to give him what he likes(except dry food, of course). It's important to get food into him whether it's people tuna or chicken or baby food and if it's cat food...even better. :-D And keep giving fluids as long as your vet suggests it.

He will come around and in a couple of weeks he'll be eating cat food again and acting more like his old self. I didn't think it would happen with Alex but it did. It just takes time.

Like I said, you're doing a great job, :thumbup you know so much more than I did at that point in time. Unfortunately, I think Alex is the most ketone prone cat in the world so now i know more than I care to. :roll:

Hugs to you and you've got tons of help here as you can see... :YMHUG:

Caryl, Alex (and Jackson)
 
On Saturday night I gave him his clinicare and a little bit later offered him some tuna, he vomited. So we took him in to the kitty ER immediately, not sure if the vomiting was from the stinky tuna after the clinicare or if it was something worse. It turns out that he was NO LONGER in DKA BUT his potassium was extremely low and he was running a fever, this is why he was so weak and still not interested in food. So we decided to hospitalize him so that he could get IV potassium and have his glucose monitored 24/7.

The ER doctor decided that he was well enough for us to take him home late last night, he was eating and his labs were all within normal range! Except for his glucose of course, which was high, but from what I understand it is going to be a while before we have that regulated in him. He would have been able to come home sooner but at one point his blood sugar bottomed out at 60 at the peak time of his insulin when he was not eating, the doctor wanted to make sure that this wasn't going to happen the next time he got his insulin while he was eating and thankfully it didn't.

We took him home, he was still weak but he immediately jumped up on the back of the couch in his favorite sleeping spot and started grooming himself then settled down for a nap. This morning when I took his glucose it was 265 so I gave him his insulin, he ate about 1/4 cup of dry D/M and had used the litter box, both urine and feces, this is his first good BM since this whole thing started. Now we have an appointment at 11 with his regular doctor today.

The doctor at the ER said that he wasn't sure about the Relion meter being accurate for animals and said that I should get an Alpha Track, does anyone have any information on this?
 
one of the common issues with with Alpha Track is you can only get strips at vets or online (I heard) plus they are very pricey...so say for example its late or a holiday and you're down to two strips - and your vet is closed....human meters are reliable and just as good and less expensive for strips (ei: Relion is the best deal for strips)
Plus of course the vets want you to but it from them - big $$$ for them, lol.

there is info around on the Alpha Track, I will try to collect it for u and post it.

a good idea is to have a back up meter, many of us do, however, you also dont want to be going back and forth with different meters or you'll make yourself crazy second guessing each reading from different meters.

I'll be back with some links for you on the Alpha Track if someone doesnt beat me to it first. :razz:
 
Don't fall for that BS when it comes to the meters. AlphaTrak was just a marketing ploy when they discovered how many people were testing their cats with human meters. The only good thing is that they did send reps around to vets to market the meter which enlightened many vets to hometesting. It is expensive, strips are expensive, and if you run out of strips, your local pharmacy won't carry them ........you would have to pray your vet is open and has a vial to sell.

So glad he is home with you and doing better and I was thrilled when I saw you were using Clinicare liquid diet. That stuff is high potency, everything the body/liver needs, in liquid form and is also one of the best for tube feeding.
 
Re: Newly diagnosed kitty / Pet Glucometers

I have both the AlphaTrak and the Ulticare iPet glucometers. Both are very good. Both have expensive test strips that I have to order online for the best price.

If you have a newly diagnosed cat, especially one that is having a rough time like yours, it might be worth the investment. They are more accurate than human glucometers for animals, something I hate to admit (!), but research has shown they are. On the other hand, if your cat is not seriously ill and you are just tracking the TREND of the blood glucose, many internal medicine vets feel that a human glucometer is just fine. And every vet I've talked to says if you can't afford one of the animal glucometers, by all means, use a human glucometer. After all, that is still what many vets use and is used for the vast majority feline diabetes research.

Hugs to you and your kitty,
Rebecca
 
Our internal medicine vet recommended that I buy a human one. She showed me how to test on a human one.

When I asked about switching from the OneTouch Ultra Mini to the True Track due to costs, she said it was fine. We compared readings for several tests and they were all within about 15%. Her point was that we're not making dosing decisions based on 0.3, we're looking at the bigger picture.

Odiesmom
 
really, there are variations between all meters. we're looking for the trend in numbers, high, low, up, down, etc. for that we don't need to overpay for an expensive meter for which we might be in trouble if we run out of strips and the vet's not around!

concerned that you're not testing for ketones at home. please go to the pharmacy and invest in ketone test strips. (they're usually behind the pharmacy counter.) honestly as much as i am able to do with my own kitty in a DKA situation especially when they're not eating i think i'd feel safer with them at a 24-hr facility. they can go down fast, and it looks like electrolytes are still being depleted. but if cost is the issue, please test for ketones every time your cat pees. the easiest way to use them is to see first if the litter you use gives a false positive ketone reading. to do that, mix some of the litter from the box with some water and dip a ketone test strip in it. if within 15 seconds you don't see a positive reading you're all set to test ketones the easy way. next time your cat pees and before it gets covered up with more litter, dip the test strip in the newly peed-on litter and check to see whether it shows ketones. even if the color variations on the key code look similar you will see a positive reading very clearly because it almost glows in the dark. i'd keep monitoring for ketones during this time.

wonder whether the supplement they suggested was KMR like they use for kittens? that would be available at the pet store. right now the most important thing is to get food in them so whatever your cat will eat is fine. i've heard a/d (which you get from the vet) goes down smoother in a syringe and may be easier to feed. is your cat on any antibiotics for infection? we suspect DKA comes from a combination of too high blood glucose, insufficient insulin, not eating (or not eating enuf), and infection, so we want to make sure all of these things are taken care of.
 
Ok, went to the doctor today and she says that he is looking pretty good and gave me a potassium supplement and amoxi, he was on cefa drops in the hospital. She also suggested that I continue with the SQ fluids every other day until the next appointment (in one week).

We tested his blood sugar using the Aplha Track and my ReliOn meters, the Alpha Track was 310 and the ReliOn was 288, so about a difference of 22. The doctor told me to continue monitoring him at home keeping in mind that the number is probably around 20 higher than what it is reading, this will help us over the next week see if his insulin needs to be adjusted or not.

Actually, I am testing for ketones at home with the strips, I bought those on Sunday. At that time I did use them and they were negative, and when I took him into the hospital they confirmed the results, not to mention the horrible breath was gone too.
 
All meters are allowed a standard error of +/- 10%, so your human meter is well within that range.
Honestly, I think that with one or two exceptions, nobody has shown there to be any benefit to the pet meters.
 
I hope your kitty is doing better today. I just wanted to say something about the SQF - 200 mL is a fairly large amount of fluids per day, based on Angel's experiences and what I've read of other kitties here. Angel had a congenital heart murmur, so it was imperative that her SQF were spread out over the day. At one point, after she was in acute renal failure, she was on 100 mL TID, for a total of 300 mL per day. But this overloaded her heart, and she went into congestive heart failure. Her kidneys were able to recover sufficiently to cut the SQF in half for about a year after that, but when they got worse and we had to increase the fluids again to 200 mL, her heart ended up failing again, and that's why I lost her.

My point is that even if Poop Cat doesn't have any known heart problems, I wouldn't risk overloading his heart. I'd definitely recommend splitting the daily fluids into 2 doses 12 hours apart, at least. But you said he's on SQF every other day now - how much? If it's 200 mL every other day, then I think 100 mL every day would be preferable, despite the desire to avoid stressing him with more needle sticks. :(
 
agree with heather. dr lisa (DVM) spoke about this before. if there's a dehydration issue it would be better to give half the amount but every day instead of the full amount every other day.

(cleo had ketones and a heart murmur when first diagnosed. we gave 75ml BID for months afterward.)
 
I gave him 75mL bid yesterday so a total of 150mL. He is a fairly large cat - almost 14lbs, before this ordeal he was around 17lbs, from what the doctor said the dosage is based on weight. Good idea about doing it q day instead of bid, he is REALLY getting irritated with me poking him especially now that he is feeling better!

Last night when I took his blood sugar before his insulin it was at 108 so I held the dose and called the doctor, she agreed that I should hold and check it again at the next dosage time which was this morning, she said to hold if under 200 as a general rule.When I checked it this morning it was 341 so I gave him the insulin, is this common or just until he gets regulated? I am really glad that I have been checking him before administering the insulin, (as suggested by the people on this board :-D ) if I didn't do it this time I am sure that he would have went hypoglycemic on me.
 
Preference I believe ........I use the 1/2" because with the short I have a hard time telling if the needle is even in. Then again, if you have a cat that is hard to shoot and sometimes you just jab, a short would be better.
 
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