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IttyBit

Member Since 2013
My Bitty has been dx'd for exactly 2yrs. Once we found out I joined here & did my research. We changed him to all pates (friskies/FF/wellness) 10% or less, no more dry, PZI insulin. I thought he was pretty well controlled until about 3-4mths ago. If I increased dose he had high numbers, if I decreased he had highs so I started giving him less initially at shot time & then a small token dose of 0.2u at 6hrs post shot (evening only). It was the only thing that helped but even that wore off. So I posted here & you guys suggested I stay consistent with dosing so I did at 0.6u. He did good at that for awhile & then life struck for me 2mths ago. I had our 1st baby & suffered a major back injury during labor. Came home with a back injury & a new baby needless to say I didn't have much time to focus doing a curve to figure out what was going on. So I just stuck with the 0.6u until about 2wks ago when I noticed him creeping into the 400's pre-shot. I backed off to 0.4u to see what happened. They improved but not huge, mainly down to below 350 though. The last week I spent another week in the hospital having my gallbladder removed. Gahhhh!

Anyways he's seemed pretty normal as much as I really noticed with all my issues going on & a newborn. He did seem a lil dehydrated as his skin didn't bounce right back when pulled. Otherwise normal behavior, no dandruff or any other signs of being uncontrolled. Well yesterday at 4am we woke up to him howling & laying in front of the water bowl. My hubby checked him & it read 576, 2hrs pre-shot. He gave him 0.2u then to get something in him. I waited an hour & when I went to check him he was just limp. Meter read hi, his eyes were dialated & he was a lil wobbly. I loaded him up & immediately took him to the Vet school here who has emergency services. They said he was 8-10% dehydrated, hi BS, high ketones but his urine was concentrated properly, low RBC so anemic & heard a heart arrhythmia. Said he needed fluids right away & get his BS down. They wanted way too much so I took him to my vet since they were finally opened. She gave him sub q fluids instead of IV & insulin. Said we would go back tomorrow for a chem test & CBC once he's hydrated & when she checked his heart sounded normal. I brought him home yesterday afternoon. He started to look a lot better but slowly deteriorated over night. Wouldn't eat, use the bathroom & just layed around somewhat non responsive to us. I called her again in which she said syringe feed him an egg to get some food in him. We did & his BS was then under 200 but later began to spike. I only gave him 0.2u 6hrs post shot since he wasn't eating at all. He made it through the night but didn't move more than 10'. This mornings BS was again hi. We gave him 1U IM & 0.8u sub q based on vet recommendation. It's been below 300 all day & we're running a curve so every 2hrs. We've also given him cat food through syringe every 4hrs. He did pee once this morning on his own & he can drink on his own. But he's very wobbly so we put everything close to him. He's only walking a couple feet before he lays back down & stays there for hours. He looks miserable like he could go any minute. He is much more responsive to us today & we just got him to eat a treat on his own. The 1st thing he's eaten on his own since we brought him home. But he's still very lethargic & not really moving. The vet mentioned heart attack but he didn't really seem symptomatic of that. He seemed more symptomatic of a stroke than heart attack. But it's clear it was an "episode" of something that started all this. Even though he's showing improvement I'm terrified we may need to put him down :(

Can anyone tell me if they've experienced this with theirs? Does it sound like a stroke or something else? And if his ursine was concentrated correctly could he still have kidney damage or does that just mean he's not in failure right now? Any help appreciated! I can't bare the thought of him suffering & he looks like he is. The vet also mentioned his intestines felt "ropey" which could just be inflammation, what would cause that in a diabetic?

Sorry so long!
 
It sounds like diabetic ketoacidosis to me http://www.felinediabetes.com/ketones.htm

Its very serious!!!!!

- Are you home testing his pee for ketones? If not go and get some urine strips from your local pharmacy so you can check asap.

- Its very important he eats. So keep syringe feeding him. And try and get him to drink as much as possible - Check this page (Scroll down) https://docs.google.com/document/d/1NSWUx2ak7wcs2_G5TXr7BhPMrU7CVmW_3ouKPTUQhhA/pub for tips on getting a cat to eat

- Its also important he gets insulin. Keep giving him insulin twice a day - I will ask another PZI user to comment on dose.

- Keep testing every four hours or more if you start to see him drop - we want to make sure he doesn't drop too low either

How is he doing now?


Wendy
 
It is hard to know what might be going on. It does sound like more than the diabetes, and certainly could be a bad DKA episode plus some other medical probelm. We usually advise taking the cat to an ER for 24 hour care if they are in DKA. I understand that is cost prohibitive for you, but they can give him an IV and administer insulin in amounts and varieties that can help. (they often give a fast acting insulin in addition to his usual kind.)

The only suggestion I'd have about the insulin dose is you can give PZI every 8 hours, as long as the number is rising, not falling. If he is in very high numbers, then increase the dose by .5 at a time. But monitor carefully. He seems to have a lot going on and you want the insulin to help, not make things worse.
 
I'm not testing ketones at home, I have 4 cats that all use the same box. I've tried locking him up separately before to test but he had a fit. So I've never figured out how I could, any suggestions there? She tested yesterday morning & said they were high but urine was concentrated correctly. He did also have high proteins in the blood. I have an appt to take him back tomorrow at 11:15am for the CBC & chem, should I be testing ketones tonight if I'm taking him in? What do I need to feed him to avoid adding more protein if it's DKA? Higher carb food? I gave him beef with gravy purred earlier & the following bs was 286. So this time I gave him FF chicken following bs 236.

I had gestational diabetes while pregnant & when I did high protein low carb I also had ketones. I had to add more carbs, less protein & add insulin to get them under control. Would that be the same plan in felines? More carbs which in turn equals more insulin? I'm still testing every 2hrs & he's still getting insulin. Vet said if I notice it going up give it no less than 6hrs so she's suggested more often than 12hrs right now. This last 1 it hit 286 at 9hrs so I gave him insulin. Should I do that or no? He's drinking decently, taking the syringe food well & we finally got him to eat 1 treat but that's it on his own. He seems to be getting a lil more coherent with time & now folding his front paws looking more comfortable. But I can't be sure if he's improving or not. He seems he is but it could be me making more of it than it is wanting him to be ok ya know?
What cut off an I looking for that's too low? So far he's been 183-286 range all day. Thanks!
 
The only reason to test for ketones is to know if they are high enough that he needs to go to the ER. If that isn't an option....

I don't know about the food differences. At this point, I would feed him whatever he will eat. You want him to eat. Meat Baby food, without any spices, is sometimes a good option.

IMHO, I wouldn't give insulin under 180 and then be very careful. Our general line in the sand is not to shoot under 200. It sounds like his numbers are generally pretty good. Anything under 250 or so is in a decent range. We really worry about ketones if they have an infection, aren't eating and are in high bg ranges (300-400). But they can have DKA even with lower ranges, especially if an infection is present.
 
We'll they were high yesterday but vet didn't suggest overnight care? She provides it though so I'm not sure why not. I just couldn't afford the Vet school, they wanted $1400/day & my vet would do it far cheaper. Can I give him potassium at home since that's usually how they treat?

Update: he just got up & walked across the room when we called him!!!! HUGE improvement!! I just need to figure out what to feed him. He's eating whatever we syringe feed him but since we're pumping so much more insulin right now I'd assume I should stick with the gravy food? So he doesn't get too low, the low carb food is like he's overdosed on insulin & he bounces. I'm guessing it's just like my situation, more carbs, less protein which means higher BS numbers & insulin but who cares if it works!
 
I would feed him whatever he will eat right now but the goal is to move him to a low carb wet as soon as possible.
He might be overdosed and bouncing or he might not be getting enough insulin. Need a few mid cycle tests for a few days in a row to know for sure.. day and night.

Whats his BG like now?

I would recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. Sue recommends this too low number is 180 .
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Do that for a few days and we will get a great picture of whats going on and we can go from there. Better regulation hopefully.. and get him out of DKA safety. Its dangerous right now cos they can go back in so fast.

You aren't out of the woods yet
 
I would go get some ketone test strips tonight or first thing tomorrow morning and if he tests over a trace, I would take him to the vet. Keep encouraging him to eat, anything, even if it's not low carb. The recipe for DKA is not enough insulin plus not enough food plus an infection or other stress.

I wish you the Best Of Luck. My cat is a DKA survivor. It costs a lot to get him through it, but at least a hundred times less than what a human would pay for the same treatment at a hospital. I'm glad you have the Vet School available to you, should you need it. I took J.D. to the University of Pennsylvania School Of Veterinary Medicine, when he had DKA. He was in critical condition when he was admitted. He wouldn't eat for them at the hospital, so they put a feeding tube in, which he quickly dispensed with once he got out and home. That was 8 years ago, Christmas time.
 
He has made huge improvement in the last couple hours! Walking around, coherent, purring ect. He even ate a lil bit of food on his own. We still syringe fed him to make sure he got enough bulk in him. He's still pretty fatigued but I'm sure that'll take awhile. He's getting wet now, I'm testing every 2hrs & since we first fed him the beef with gravy (friskies puréed w/water) they've run:

289 6hrs post shot
286 8hrs post
9hrs gave 0.9u/fed FF chicken puréed w/water
236 1.5hrs post shot
191 3.5hrs post shot/fed Friskies beef n gravy puréed w/water
187 5.5hrs post shot

Obviously getting this down we're way off schedule for normal shot time. So at what point should I give him insulin again? Trying to get back on schedule for 2x/day but if his BS starts rising again from food what number should I shoot him at? Over 300 maybe? Right now we're about 4hrs off, if he goes thru the night ok till next time great but I realize he may not. We're about 14hrs out from our vet appt so I want to keep him tightly regulated until then.
 
I am glad he has perked up. That's a good sign.

At this point he is still dropping. I wouldn't shoot until he starts up. Over 300 sounds good. Maybe not worry too much about the schedule - it will probably get messed up tomorrow with the vet visit?
 
He just ate some more on his own!! His wobbles seem to be clearing up a lot as well & he walked back to the main litter box (25ft) & urinated. Ok I'll watch for if he gets close to 300. Right now he's about 7hrs post shot & I just tested again, it's 198 so about mid cycle. Thank you all so much! And pp I'm so glad to hear your kitty pulled through ok!
 
His behavior is 100% normal, however I'm still chasing these numbers all over the place :/ I'm testing ever 2-3hrs & we got another HI reading. Vet still has me doing fraction units IM when over 400 to get it down quick & sticking with 1u sub q at our normal shot time, maybe this is the problem? I think I'm just going to try 1u at shot time like normal & see.

The vet called & said ketones/BG was high on blood work but his liver/kidneys actually look pretty good thank god!! But I'm curious what's keeping him high right now, does he really have an infection of some kind (I'd think that would show in CBC?) or is it the extra insulin she has me giving I'm not sure.
 
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