Possible DKA again a month later?...

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Hine87

Hine87

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Jasper only recently went through DKA the first week of September and at his last appointment at the end of the month we discussed taking care of his teeth since we were thinking that that is the culprit to not being able to control his BG. I wanted to talk to my husband first before I scheduled the appointment but I figured as well to hold off a few weeks until it got closer to one month where I had to schedule another check up anyways(stupid reason I realize, but while I am in school I always seem to put things off that I shouldn't). But yesterday evening we were all at a farm so I had a friend check his BG and give his insulin that was already pre-measured for him. When he was taking care of Jasper and right before he gave him his shot he vomited. When we did get home near midnight I checked his BG again and 2-3 more times that night he vomited. It wasn't until the morning that he actually threw up a little food-the other times it was more of a clear liquid, saliva I would assume? He does not seem lethargic but wants to rest and is hiding out a bit in rooms he would normally not be in. He also is not eating (that I've seen) (which I first thought he had an upset stomach) but he has been drinking water, well I did see him drink water when we got home this evening and the water bowl had half the water in it (but we do have another cat). He is still very alert, purring, perked up his ears when he heard my husband opening canned kitty food, walking, etc. It is only the no eating and hiding out bit that has me worried. We bought a box of ketone strips and my husband tried to get a sample from the little box but I don't know the last time he had peed before we got home and he diluted the pee in water a little bit so I am not sure how accurate that test would be. It seemed to change color only very slightly. His numbers have me worried too...I already plan on calling Monday as long as things do not turn for the worst. We are still strapped for money since our Japan move and Jaspers first DKA episode I honestly do not want to go through this again-although more than just the financial it is heart wrenching to see him sick and a husband that only seems to be looking at our budget.
 
Sometimes, Merlin gets an upset stomach and he spits up clear sometimes whitish vomit. It isn't much but a little here and a little there. Sometimes he is still hungry but sometimes he is not interested. I give him 1/4 tablet of Pepcid AC. If he doesn't eat it, then I crush and dissolve it in water and syringe feed it. I usually up the dose to 1/2 tablet as some of it usually doesn't all get into his mouth via a syringe. Just a thought that he may only have an upset stomach...hopefully.
 
Thank you! I will look into grabbing that in the AM if he doesn't appear to be getting any sicker but dang he has me worried. I checked on him a few minutes ago where he is hiding in the bathroom (he hasn't been in there since DKA) but once I saw him his head was popped up and started purring as soon as I petted him. Another thing I thought was weird is that he keeps flicking his tail like he would usually do if he is annoyed or playing around the house. He was doing it last night and today as well-seems a bit odd.
 
Also, I would still try to catch a ketone test. I usually watch him go into the litter box and stick that test strip behind him as he pees. If you don't think you can catch him, you can put some plastic saran wrap in there and hopefully you can catch a little. I tried that a couple of times and it worked one time. Others have replaced the litter with small rocks (like the size of aquarium rocks) and usually you can find a pool of urine. Since Jaspers numbers have been pretty high for sometime, it would be good to get a test.
 
I had to go run and feed. One more thing I wanted to see if we can't get Jasper to eat. It is very important that cats eat otherwise, it could lead to other complications. When was the last time Jasper ate?

Things that you can do to try to entice him to eat.
* Sprinkle parmesan cheese on top of his food.
* Boil some chicken and shred it up for him
* Add chicken broth (no dextrose) to his food
* Try tuna or tuna juice
* Do you have any bonita flakes or Forti Flora?
 
Awesome thank you! Jasper surprised me by jumping up on my desk while I was working and started up purring again. Few minutes with me and than went for some water and to the litter box, I rushed to get the strip ready but than he decided to poop...and it turns out he has diarrhea =/ I haven't changed his food at all so I'm not sure what the cause of that is. My husband did tell me a few minutes ago that it appeared he ate a little bit of food today. Jasper is a really messy eater and always has been where he smooshes the food down into the corners of the bowl and up and out and makes a huge mess. My husband said the bowl looked like Jasper had eaten from it lol. I will keep an eye on to see if he eats anything tonight! I have seen him drink water twice so far.
 
It does sound like something is off. I hope the diarrhea resolves. And yes, a ketone test would reassure you that he is not having another DKA episode. Wonder if he could have gotten into something at your friend's farm? Try some of Cindi's excellent suggestions for enticing him to eat.

I am not sure what to say about the numbers. He does still seem very high. Pretty consistently. I think I would give the 2.5 three cycles, getting nadir numbers and maybe some in the +3/8 range. My thought is that he might have an earlier or later nadir. After three cycles, maybe increase by 0.25 and test again for several cycles. He has been in high ranges for awhile and might have developed some insulin resistance and thus need a little more aggressive approach. The yellow preshot surprised me but I don't see it repeated.
 
I would definitely keep an eye out and grab a ketone test when you can. Something I tried when my Gypsy wouldn't eat was giving her some of the treats she loved (we have freeze dried chicken treats). If she wouldn't even eat those, I knew something was up. I do that now when I worry that my non sugar cats are not eating...they always come running and eat them! I also crushed them on top of their canned food when I was changing foods to get them to eat. Do you add water to canned food? That might help too since it will make it sort of a gravy...I do warm water so they can smell it.
 
Also, for the money thing, check in to Care Credit maybe. I recently got it when we became regulars at the vet (sigh). You can get zero interest for a certain length of time which might help.
 
Thanks everyone! He did get better so I am thinking it was because of his BG sitting so high for so long this weekend. Last night he was running around like crazy playing with his mouse and our other kitty but I scheduled an appointment anyways for today to get his teeth taken care of. So hopefully his numbers will start to get better after this. They are looking at extracting 2 teeth at $49 each, not too bad from what I have read from others. I dropped him off about an hour ago and will pick him up in about an hour or two and a little nervous about all of it. The past day or so since I upped his insulin to 2.5 he has been in the 300's but this morning he was about 537! =(

Rachel-I had thought about care credit-I didn't realize the interest free for that long, I like that deal but when he had his DKA last month I decided not too since my credit card had better interest. Although now with you saying zero interest that would have been nice. Ah well though, his teeth appointment turned out to be less than I was expecting so I am pretty happy-as long as they do not have to take any extra teeth out. I hope not.
 
Well, he was quoted to have two teeth extracted today but by the time I went to pick him up the vet extracted 13 of his teeth! Much more than we both thought...once she got looking more closely and taking care of the plaque he was in rough shape. BUT she did give me a break on the teeth that came out really easy by not charging me for those and a small discount on the overall bill since she knew we spent a lot on his DKA treatment. I am so thankful for her doing that to help me out when she is running a small clinic that is dedicated to cats only. He didn't have any insulin at all today and as of a few minutes ago he was 317! That is a nice number to see and I hope to see better numbers since his teeth are finally taken care of. The vet wants to start off with two units tonight, do a curve here probably within the next few days and monitor him pretty closely.
 
Well that was so much more than you bargained for 13 teeth!! Holy Cow!!! And 317 after no insulin all day is quite a surprise too. It will be interesting to see what his AMPS will be .
 
Wow, that was a lot more bad teeth than expected! Nice his BG was pretty decent after all that and with all those bad teeth gone, you will hopefully see some big improvement in his BG's. Best of luck to Jasper!
 
It sounds like you have a great vet, Sarah! I hope he will feel much better without those infected teeth and that it will make a big difference in his bg levels.
 
I checked him again right before I went to bed at +3/11pm and he was 284 but this morning he was 130 8AM and now that it is pushing 11AM I checked him again and he is at 245, so I should probably go ahead and give him some insulin now but I am unsure how to dose him, the vet wanted me to do the 2 units but if he is already a few hours in I'm sure he would need a lower dose-maybe 1.5 units?
 
I would definitely reduce. You don't want the same cycle that gave you an unshootable number. If you shoot now, can you wait 12 hours for the next shot?
 
Do you think the 1.5 should be ok? I am always up late with homework so I can easily stay up until 11 for his nighttime shot.
 
I think I'd be more cautious. He is really dropping after his dental. I think I do one. If it's too little, then you can do more next time?
 
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