Possible DKA??

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tabasu

Member Since 2013
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=98890

6.5 year old male feline diagnosed diabetic on 5/21/13

His first visit his urine tested positive for ketones and blood sugar (BS) was 372

His vet started him at 1 unit glargine twice daily & ½ can wet m/d low carb food at 7:15 am & 7:15pm (Every 12 hours).. We went back to the vet a few days later because had he had been consistently negative for ketones but seemed very lethargic. At that time the vet changed his insulin to .5 unit twice a day. Two days later his urine tested positive for ketones again and when we called the vet the practice told us that his vet was no longer working there and advised that he return to 1 unit twice daily again. He was negative for ketones all week but by the next appointment (about a week later) his urine was positive again.The new vet moved him to 1.5 units twice daily and said that it is ok for him to also have ¼ cup of dry m/d low carb food between feedings. Since then he has been mostly ketone-free and no lethargy.

Then our other cat (F-6yr) started scratching badly enough that we were concerned because she had bumps on her neck & face that seemed to have started when we began the hard food in between feedings. We figured she may be allergic to the dry food so we started subbing the dry food with friskies pate (low carb) which they have eaten before without problems and her skin issues went away so we have been keeping that up. Until last night he has been clearing his plate at all feedings and would also eat what she left over.

Yesterday we noticed that he was not eating as much as usual and didnt appear to be feeling well so we tested blood sugar about 12 hours after insulin and it was at 297. He ate a little this morning but didnt finish & vomited sometime after (mostly liquid). Even though he is drinking water he appears to be dehydrated (camped at his water bowl). Turgor test is maybe a little slow to return but not severe and capillary refill is normal (1-2 seconds). His urine tested Positive for ketones again (high) and he was very lethargic. He is only taking a few steps at a time before laying back down and hasnt eaten much since vomiting so we tested his blood sugar again & it is at 303 (about 8 hours after insulin).

Im afraid he is experiencing diabetic ketoacidosis but have thought that before because of the ketones and he just needed a dosage change. Im not sure what other information might be helpful but Im at a lost for what to do. I already owe hundreds to the vet and am sure they will hospitalize him if I go in there saying I think hes in DKA. Is there anything else I can look for to confirm or does that require lab work? My boyfriend and I are militant about his feeding & insulin schedule and check his urine regularly for ketones and he has been negative. I dont understand how he can suddenly be so sick. Ive decided while typing this that I am taking him to the vet as soon as my boyfriend returns from work with our vehicle but any advice would be appreciated.

Thank you.
 
I just re-read your last paragraph, I'm glad you are taking him to the vet as well. I hope your kitty feels better.
 
Trace ketones should be a call to the vet.

High ketones in the urine sample should be visit to the vet ASAP, emergency vet if required.

In combination with the dehydration, DKA is more likely with the high ketone levels.

Signs of Diabetic Ketoacidosis (DKA)
Drinking excessive amounts of water OR no water
Excessive urination
Diminished activity
Not eating for over 12 hours
Vomiting
Lethargy and depression
Weakness
Breathing very fast
Dehydration
Ketone odor on breath (smells like nail-polish remover or fruit)

Causes of Diabetic Ketoacidosis (DKA)
Insulin dependent diabetes mellitus
Inadequate insulin dosing or production
Infection
Concurrent disease that stresses the animal
Estrus
Medication noncompliance
Lethargy and depression
Stress
Surgery
Idiopathic (unknown causes)
Risk Factors for DKA
Any condition that causes an insulin deficiency
History of corticosteroid or beta-blocker administration
Diagnosis
Laboratory tests performed by your vet are necessary for diagnosis. Depending on how sick your cat is, the testing can be extensive (and expensive). Your veterinarian will determine what tests are necessary. At a minimum, testing is likely to include a number of blood tests and a urine test.
Treatment
If the cat is bright, alert, and well-hydrated, the cat will not require intensive care. Your cat will require insulin, food, constant access to water, and close monitoring for signs of illness such as vomiting, anorexia, and lethargy.

Treatment of cats who show signs illness require inpatient intensive care. The goal of treatment is to correct dehydration, electrolyte depletion, to reverse the high ketones in the blood and the metabolic acidosis that is present, and to increase the rate of glucose use by insulin-dependent tissues.

Veterinary care for DKA involves intravenous (IV) fluids, usually supplemented with potassium, monitoring by observation and urine and blood tests, and sometimes feeding by a tube. Treatment may involve a hospital stay of five days or more and often costs about US$2000. Without treatment, "sick" animals with DKA will die.

Testing for Ketones
Simple urine tests can detect ketones. This is done by collecting a urine sample and inserting a special dip stick into the urine. Some urine ketone strips detect only ketones while other types test for both glucose and ketone levels. Urine ketone strips will detect only some of the ketone bodies produced by the body, not all of them. Strip storage, handling, and testing procedures are similar to those used for glucose test strips. Strip test results are indicated by presence of color changes, indicating presence of ketones, either quantitatively (giving you a number for the ketone concentration) or by descriptive terms (for example, negative, trace, small, or large). False positives may occur if you are also using certain medications or vitamins, or if the strips have been handled or stored improperly. If you wish to test blood instead of urine for ketones, there is a meter that allows for home testing, the Abbott Precision Xtra meter. Outside of the US, the meter is known by the brand name Precision/Optimum/Xceed. The premise behind blood testing for ketones is the same as that for favoring glucose testing of blood over urine. The Precision Xtra meter is offered by Hock's online pharmacy for US$29.95 in October 2006. The ketone test strips are about US$30 for a box of 50. The Precision Xtra also does blood glucose testing with standard blood glucose test strips made for use with the meter.

When to call the vet
In a diabetic, any urinary ketones above trace or trace urinary ketones plus some of the signs listed above, are cause to call a veterinarian immediately. If your vet doesn't offer after-hour emergency care, be sure to have the number and location of a 24 hour emergency veterinarian.
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I dont understand how he can suddenly be so sick. Ive decided while typing this that I am taking him to the vet as soon as my boyfriend returns from work with our vehicle but any advice would be appreciated.
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First, glad that you decided to bring him to the vet. All I can add is that DKA usually happens very quickly. My cat Bob was diagnosed with diabetes, and no ketones were present in his urine. Three days later, he was in the ER with DKA. From zero to sky high in no time flat. The symptoms you described above sounded very familiar to me. Especially the lethargy and not wanting to eat. Bob would take a couple of steps, howl, and lay down. He did it for over 24 hours before I could get him to the vet. She told me then that if I'd waited another 24 hours, he most likely wouldn't have survived them.

Sending healing thoughts and prayers to your little guy.
 
Back from the vet with Bubba. The vet was concerned at the fact that ketones were present but also stated that his clinical signs seemed to indicate that he was hypoglycemic. We asked multiple times about DKA and the vet explained that the way that they test for DKA is to obtain an arterial blood sample and that it isn't recommended. He also mentioned that his BG being at 300 wasn't really that high, and with ketones only showing up in the last few days, he wasn't too concerned about DKA. He said DKA takes a while to really set in, and usually with higher glucose levels. We don't think he believed it was hypoglycemia or DKA, but he basically said "We don't know".

They gave him some fluids and sent us home, and the vet mentioned "he's not critical", which made us feel better. We got home and checked him BG; it was at 299, so it appears his high is around 300. We opened a can of food and set it down for him. That was about 30 minutes ago and he refuses to eat any. The vet specifically told us, if he doesn't eat tonight, give him his insulin anyways, if he also doesn't eat again tomorrow morning, don't give it to him and bring him in.

We want to get a bit of food in him, but it looks like he isn't going to be eating much right now. Once we give him his insulin we will be checking his BG every 3 hours to make sure he isn't getting too low. Hopefully, he will eat a little in the next few hours so we can feel better about it.
 
He also mentioned that his BG being at 300 wasn't really that high, and with ketones only showing up in the last few days, he wasn't too concerned about DKA. He said DKA takes a while to really set in, and usually with higher glucose levels.
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I'm certainly not a vet, and not an expert when it comes to DKA, but from my experience with Bob, and with others I've witnessed here, I don't agree that DKA takes a while to set in. Nor do I believe that high BGs are required.

DKA usually has 3 "ingredients".

Insufficient insulin.
Insufficient food.
Some sort of infection present.

Dehydration also seems like a common thing.

I understand them wanting to make sure you give insulin. And if you can keep testing, you'll see any drop in BG if it happens. You can try a few things to get him to eat. Sometimes parmasean cheese on top of the food will work. Mixing a little warm water into the food can work too. Sometimes they'll lick food off of your finger if you pester them enough. Water from a can of tuna on top of the food. Heating it for a few seconds in the microwave. Anything that makes it stinkier seems to help. If you have to force the issue, if you have some sort of feeding syringe you can mix the food with water and force him to eat. Just do so in small amounts so he doesn't choke on it.

Let us know how it goes.
 
Mishka never ran high numbers....heck, she came to me in DKA and we have battled it too many times plus times it was only ketones, not DKA. DKA is based on the blood pH and Mishka usually was in the mid 100's and also no sign of infection, no UTI, ultrasounds done...apparently Mishka never needed a reason because every test run never gave us a reason. Vet is wrong......trace can go to max in a heartbeat, not several days. Ketones are nothing to mess around with or wait on.
 
Carl & Bob said:
I'm certainly not a vet, and not an expert when it comes to DKA, but from my experience with Bob, and with others I've witnessed here, I don't agree that DKA takes a while to set in. Nor do I believe that high BGs are required.

DKA usually has 3 "ingredients".

Insufficient insulin.
Insufficient food.
Some sort of infection present.

Dehydration also seems like a common thing.

I understand them wanting to make sure you give insulin. And if you can keep testing, you'll see any drop in BG if it happens. You can try a few things to get him to eat. Sometimes parmasean cheese on top of the food will work. Mixing a little warm water into the food can work too. Sometimes they'll lick food off of your finger if you pester them enough. Water from a can of tuna on top of the food. Heating it for a few seconds in the microwave. Anything that makes it stinkier seems to help. If you have to force the issue, if you have some sort of feeding syringe you can mix the food with water and force him to eat. Just do so in small amounts so he doesn't choke on it.

Let us know how it goes.
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Thank you for your reply. We have tried several of your suggestions and unfortunately, none of them have worked. He seems almost disgusted with food at the moment.

We have been giving him his insulin regularly, but last night, I think I missed with the injection (I don't think I pierced the skin). Other than that, he has been eating fine, and we have been giving him his insulin regularly. Is it really possible that 1 missed injection could cause DKA? I think that is why his Dr mentioned it probably isn't DKA, because he has had plenty of food, and had his insulin on schedule, and he hasn't had any ketones in his urine because we checked 2 days ago.

I think we are just confused mostly. From what we have read, the lack of food is what can cause DKA (as you have suggested), not the other way around. He got sick and stopped eating, it's not that he wasn't eating, and that made him sick (at least we think). We don't really have much experience with this though, so I guess we will just have to wait and see in the morning. I am going to stay up all night with him, watching for him to eat and checking his BG. If nothing has changed or he has gotten worse by 7:30 when the vet opens we are going to take him in.

I just want to say thanks to everyone on behalf of my girlfriend and I; we really appreciate the support. I read about your cat Bob, Carl&Bob and I am happy to hear you were able to get him help in time.
 
Is it really possible that 1 missed injection could cause DKA?
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It is highly unlikely that just one missed shot would cause DKA. Most people "miss" with shots on occassion. We call them "fur shots" because you can usually feel the wetness from the insulin on the fur. It's just something that happens once in a while.

The other thing that can happen if a cat won't eat for an extended period of time is heptic lipadosis (I probably botched the spelling on that!). Also called "fatty liver". But that usually won't happen in just one day. Other things that can cause lack of appetite are pancreatitis, an infection or inflamation of the pancreas. That's usually very painful and cats suffering from that usually won't eat, and just lay around in what we call the "meatloaf" position feeling and looking miserable.

I'm glad you're planning on taking him in first thing in the morning if you don't see any improvement. Ask the vet if there could be any infection present. It could be something as simple as a UTI.

Hoping he feels better soon.
 
Hope + (((Baby)))GA said:
Mishka never ran high numbers....heck, she came to me in DKA and we have battled it too many times plus times it was only ketones, not DKA. DKA is based on the blood pH and Mishka usually was in the mid 100's and also no sign of infection, no UTI, ultrasounds done...apparently Mishka never needed a reason because every test run never gave us a reason. Vet is wrong......trace can go to max in a heartbeat, not several days. Ketones are nothing to mess around with or wait on.
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His ketones are at the max, the stick turns dark purple almost instantly. This has happened once before though and then it went away almost instantly. One time before I missed his injection (missed the skin). I obviously didn't want to try and give him more in case I was wrong about missing, so I just waited. About 9 hours later I tested his urine and Ketones were in the "Large" category; it surprised me how fast it happened. I gave him his next injection on schedule and 6 hours later I tested his ketones again to find there were none.

But what does that mean? I was under the impression that, yes ketones are very bad, but that it wouldn't be serious unless we let the problem persist. If we went several days I could see it becoming a problem, but him not getting insulin with 1 meal is enough to cause all this?

I guess what we really want to know is, what do we do? Is there anything we should be telling the vet we want done? We just aren't sure how we should be handling this.


EDIT: Thank you Carl & Bob, that is what we were looking for. We plan on getting a full blood panel done tomorrow morning and the vet even said if we come in early we could have the results back by the end of the day.
 
Great on the blood panel. What the vet will most likely be looking at besides the ketones and glucose levels are his electrolytes. I think they get all out of whack when it's DKA, and those numbers will help your vet in determining exactly what's going on.
 
Carl & Bob said:
Great on the blood panel. What the vet will most likely be looking at besides the ketones and glucose levels are his electrolytes. I think they get all out of whack when it's DKA, and those numbers will help your vet in determining exactly what's going on.
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Ok sounds good. Just as an update, we just checked his BG, 2 hours after his 1.5U of Lantus he is at 245. For comparison he was at 299 right before the insulin which was 12 hours since his last injection.

I'm happy he isn't too low, but at the same time now we are starting to question whether or not he was regulated correctly, considering he is still at 245 without eating a single thing. We will be doing more BG tests throughout the night, checking every two hours. I'm interested in seeing how low he gets without any food.

Thanks again!
 
No matter what sort of numbers you see, don't let one cycle of insulin make you draw any conclusions as to how well or not the Lantus is working. Take a look, when you have time, at any cat's spreadsheet. You'll see two, four, six, you name it, cycles on the same exact dose, and not often will you see any duplication of numbers.

The most important thing to keep in mind is that a BG test is nothing more than a snapshot in time. What you will see, over time, is "patterns" in the numbers, where the exact values aren't important, but rather the trends you see are what matters. Besides food and insulin, there's a lot of "other things" going on daily inside a cat's body that can affect the BG numbers. Try not to let the numbers drive you bonkers.
 
Carl & Bob said:
No matter what sort of numbers you see, don't let one cycle of insulin make you draw any conclusions as to how well or not the Lantus is working. Take a look, when you have time, at any cat's spreadsheet. You'll see two, four, six, you name it, cycles on the same exact dose, and not often will you see any duplication of numbers.

The most important thing to keep in mind is that a BG test is nothing more than a snapshot in time. What you will see, over time, is "patterns" in the numbers, where the exact values aren't important, but rather the trends you see are what matters. Besides food and insulin, there's a lot of "other things" going on daily inside a cat's body that can affect the BG numbers. Try not to let the numbers drive you bonkers.
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That's a good point, thanks.

Update: Bubba just vomited. It was entirely water, not even discolored except for at the end it had bile in it. He has been literally laying down with his head in the water bowl lapping up water. I am stunned by how much water came out of him. He seems ok, and started cleaning himself immediately. Now he is just laying back down in his favorite spot and hasn't tried to drink any more water. We are going to check his glucose again in about 1 hour.
 
Update: Bubba was really trying to give eating a go, but he didn't really eat anything. He took maybe one little nibble. It's like he want's to eat, but just can't stomach it. At this point, I can't wait for morning to take him back in.

Just checked his BG and it was at 233; 2 hours ago he was at 245, and he started at 299. He is sniffing around the food again, and I think I am going to put down a fresh can of tuna hoping he might eat even a little. He just seems interested in licking the juices off though. I think he is just so nauseous he doesn't want to eat anything. :YMSIGH:

I will check his BG again in 2 hours.
 
Hope he does better. Just learning the stress have not even gotten ours on insulin yet and already a scare.
 
Vonix said:
Hope he does better. Just learning the stress have not even gotten ours on insulin yet and already a scare.
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Don't stress out too much, it get's easier. I still have no idea what is happening with him and I think that is what scares me most.

But once you get them regulated and monitor them well it will get easier.
 
I'm glad you're taking Bubba to the vet, and I hope you go first thing in the morning as soon as they open.

My cat had the same symtoms and he did have DKA, and he is a DKA survivor.
I have been on this board and the ones before this one, for a long time. I have heard of cats that can go into DKA without high BG numbers, and it can come on suddenly.

I hope you keep thinking possitive. I'm glad you're getting the blood work done, and I wish the best of luck to you and Bubba at the vet today.
 
Dyana said:
I'm glad you're taking Bubba to the vet, and I hope you go first thing in the morning as soon as they open.

My cat had the same symtoms and he did have DKA, and he is a DKA survivor.
I have been on this board and the ones before this one, for a long time. I have heard of cats that can go into DKA without high BG numbers, and it can come on suddenly.

I hope you keep thinking possitive. I'm glad you're getting the blood work done, and I wish the best of luck to you and Bubba at the vet today.
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Thank you. I am really hoping we can get him over this and regulated properly.

I just checked his BG, exactly 6 hours after his 1.5U of Lantus and he was at 280. That is without anything to eat. Here is what his BG looks like for the night:

8:35 right before insulin: 299
10:35 two hours after insulin: 245
12:35 four hours after insulin: 233
2:35 six hours after insulin: 280

Come to think of it, I have never seen his BG below 250 except for tonight with no food. I really just think we never had him regulated properly. I think we will mention that to the vet and take our spreadsheet.

Thanks again.
 
If he doesn't eat this morning, ask the vet for some feeding syringes (they usually give them to you for free). He needs to eat. You may need to blend some food until it is the consistancy of a milkshake (with no chunks that can get stuck in the syringe) and help him to get some calories into him. Here is a recommended video on assist feeding: http://www.youtube.com/watch?v=U6o17wH6ujk He may need this help with getting calories into him, until he feels better and eats on his own.

You may also want to try insulin syringes with the 1/2 inch needle on them, if you're not already using them. That may help you with the piercing of the skin issues.
 
Dyana said:
If he doesn't eat this morning, ask the vet for some feeding syringes (they usually give them to you for free). He needs to eat. You may need to blend some food until it is the consistancy of a milkshake (with no chunks that can get stuck in the syringe) and help him to get some calories into him. Here is a recommended video on assist feeding: http://www.youtube.com/watch?v=U6o17wH6ujk He may need this help with getting calories into him, until he feels better and eats on his own.

You may also want to try insulin syringes with the 1/2 inch needle on them, if you're not already using them. That may help you with the piercing of the skin issues.
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I'm almost certain the vet is going to hospitalize him. I'm sure they will either force feed him themselves or give him a feeding tube of some kind. We are worried about how much that will cost, but at this point we are willing to do anything to get him feeling better.

Thanks for the tips though. If the vet does let him come home, I will definitely do that.
 
I'm glad you know that. He really needs some hospitalization to get through this.
I had two choices of hospitals, and each were over an hour away. I chose the University of Pennsylvania School Of Veternary Medicine in Philadelphia. I went to visit him everyday, and that really helped him to know that he wasn't alone or abandoned, and he very slowly got better.

Take a Tshirt or your pajamas or your pillowcase, something with your scent on it, with you to put in his cage, and bring another one everyday when you go to visit.

I found the costs to be less than 1% of what a human would have to pay for the same treatment my cat got. J.D. was hospitalized for a lot longer than normal (8 and 1/2 days) and the cost was about $4300. Most cats are only hospitalized for about 3 to 5 days.

Keep possitive. Your Bubba can get through this. Once he's feeling better, if you keep posting, we can help you with getting his diabetes more in control. Best Of Luck to Bubba.
 
Dyana said:
I'm glad you know that. He really needs some hospitalization to get through this.
I had two choices of hospitals, and each were over an hour away. I chose the University of Pennsylvania School Of Veternary Medicine in Philadelphia. I went to visit him everyday, and that really helped him to know that he wasn't alone or abandoned, and he very slowly got better.

Take a Tshirt or your pajamas or your pillowcase, something with your scent on it, with you to put in his cage, and bring another one everyday when you go to visit.

I found the costs to be less than 1% of what a human would have to pay for the same treatment my cat got. J.D. was hospitalized for a lot longer than normal (8 and 1/2 days) and the cost was about $4300. Most cats are only hospitalized for about 3 to 5 days.

Keep possitive. Your Bubba can get through this. Once he's feeling better, if you keep posting, we can help you with getting his diabetes more in control. Best Of Luck to Bubba.
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Thank you. I'm happy to hear your cat got better. I'm concerned about leaving him there over night. I know no one will be there to take care of him for probably 10 hours a day, and I want to see about being able to drop him off in the morning so they can do their thing, but bring him back home at night. Do you know what they do when they hospitalize them? Are they just trying to get them stable with food and insulin?

Thanks for the reply.
 
Update: We took Bubba to the vet this morning and we have been there for a few hours. By time we left, he seemed to be doing worse. We got him there and they took him back almost immediately because he was breathing fast and heavily.

The doctor came in and we went over the usual with him. The doctor was very concerned with his breathing and said he wanted to do an X-ray to rule out and lung issues. We agreed, and also agreed to let them hospitalize him. We waited around for the X-ray results, and we got some news we weren't expecting. His liver is enlarged quite a bit; about 2x the doctor said. There didn't seem to be any masses or anything, and the doctor said he couldn't feel anything.

So right now, it's not looking good. The doctor basically said there is a very small possibility that there may be a mass we can't see, but it's most likely caused by something else. From what he told us, he seems to think it's either complications from the diabetes or maybe something like pancreatitis.

Right now, we are just telling ourselves that if it was from the last few days of food changes and a missed insulin shot that put him in such a horrible state, he probably wasn't going to make it very long anyways.

Like I said in a previous comment, it could be that he never actually has been regulated, and maybe he's been sick for a while, although he did have a full panel done about a month ago that we figure should have shown problems with the liver.

Currently, they are trying to regulate him, they are giving him I/V fluids, and also trying to syringe feed him. No one is on premises overnight, so we will most likely be taking him home tonight.

I think we have both come to the realization there is a good possibility he won't make it through this. It was just so sudden. He was fine a few days ago. I guess now we wait. I will be calling them in a few hours for an update. Thanks again everyone for your support.
 
Bubba and you are in our positive thoughts and prayers. Hoping for the best.

Bringing Bubba home sounds like what I would do if there wasn't 24 hour monitoring at the vet.

Please keep us updated when you can. We will be worrying and hopeing right along side you.
 
Deb & Wink said:
Bubba and you are in our positive thoughts and prayers. Hoping for the best.

Bringing Bubba home sounds like what I would do if there wasn't 24 hour monitoring at the vet.

Please keep us updated when you can. We will be worrying and hopeing right along side you.
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Thank you so much Deb. Right now, we are just hoping for the best but expecting the worst.
 
I am Hoping The Best for Bubba, too. Did they get the blood work done and the results back?
Were they able to feed him during the day?
J.D. was in critical condition when he went in to the hospital and was barely able to lift his head the first day or two, but he slowly got better in the care of the hospital. He came home with a feeding tube. They kept saying they would not release him until he ate on his own at the hospital but he just flat out refused, so they put a feeding tube in, and after 8 and 1/2 loooong days he finally came home, and he soon was eating on his own after a couple of days of being home. That was over 7 years ago.
I hope your boy pulls through too.
 
Dyana said:
I am Hoping The Best for Bubba, too. Did they get the blood work done and the results back?
Were they able to feed him during the day?
J.D. was in critical condition when he went in to the hospital and was barely able to lift his head the first day or two, but he slowly got better in the care of the hospital. He came home with a feeding tube. They kept saying they would not release him until he ate on his own at the hospital but he just flat out refused, so they put a feeding tube in, and after 8 and 1/2 loooong days he finally came home, and he soon was eating on his own after a couple of days of being home. That was over 7 years ago.
I hope your boy pulls through too.
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Thank you Dyana, I'm very happy for you and J.D. We did not get any blood work done because apparently his BG was much higher than we were reading, so the doctor diagnosed it as DKA.

We just got him home and he is doing a lot worse. He can barely hold his head up, and he almost looks drugged. We are pretty sure he won't make it through the night. At the same time, every once and awhile he gets a little burst of energy and he rolls onto his back or gets up to get some water, so that is good. They checked his BG right before we left and he was at 338, which is down a lot from 490, but like I said, it's pretty hard right now to think he is going to make it through the night. It feels like he is barely hanging on. When he does walk he stumbles and is very wobbly. I guess we will just have to wait and see, but right now I think we have both come to the realization that he most likely won't make it to morning.
 
If you pull up his scruff, does it return to place quickly? If not, dehydration is probably part of the problem.

Is he showing any interest at all in eating?
Take a look at his gums and see if they appear pink.
I wish I had some idea of how to help you besides prayers...
 
Carl & Bob said:
If you pull up his scruff, does it return to place quickly? If not, dehydration is probably part of the problem.

Is he showing any interest at all in eating?
Take a look at his gums and see if they appear pink.
I wish I had some idea of how to help you besides prayers...
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Yes, he is very hydrated. They gave him a ton of fluids today and the doctor even mentioned he is definitely better in the hydration department.

No interest in eating at all. I opened a can, and he would usually come running, but instead, he just laid on the ground and didn't even flinch.

His gums appear pink, although I don't know how pink we are looking for. It looks like pink taffy.

Thank you for your prayers Carl, you and everyone else here have been great in supporting us.

Unfortunately, I just think he is too far into DKA. We were under the impression it takes weeks for that to happen, and weeks of ketones but apparently that is not the case. If he does make it through the night, I am hoping we can get him in and on an I/V again with insulin to get him to normal levels. Right now it is not looking good though.

Thank you again everyone.
 
Pink taffy is good. You can also press on the gums, which should make the color go away and then return. White or gray is not good.

If the vet assumes DKA then they should be trying to balance or return his electrolytes to where they are supposed to do. I think they do that by adding supplements to his fluids. His BGs are not awful, it's the ketones that have to be gotten rid of. Don't give up hope. If he can make it back to the vet, they can make things better.
 
Carl & Bob said:
Pink taffy is good. You can also press on the gums, which should make the color go away and then return. White or gray is not good.

If the vet assumes DKA then they should be trying to balance or return his electrolytes to where they are supposed to do. I think they do that by adding supplements to his fluids. His BGs are not awful, it's the ketones that have to be gotten rid of. Don't give up hope. If he can make it back to the vet, they can make things better.
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Thanks Carl. Yea, they give him all types of supplements today I believe. The thing with his ketones is, when we tested him yesterday, it went instantly to the dark purple marker (the darkest one). We tested him when he got home today, and it went to the dark purple marker, but did it much more slowly. It took almost the full 15 seconds to get that dark. I don't know if that means anything, but it was nice to see.

While we haven't given up hope, we are just trying to be realistic I guess. We don't want to get our hopes up. :YMSIGH:

Thanks again Carl.
 
Sending prayers to your Bubba. I hope you can get him to the vet first thing in the morning.
 
Thank you so much everyone. Bubba made it through the night, and I think he wasn't as bad as we had thought initially. Throughout the night he seemed very sick, but it also seemed like maybe he was just exhausted.

We took him in today, and he didn't seem any different than when we took him home. They gave him a BG test right when they got there, and to our surprise she came back saying he was at 90. This has us worried because if he is 90 now, 12 hours after getting insulin, what was he at 6 hours ago? His behavior last night was closer to that of a cat experiencing hypoglycemia, so we are a bit worried. We gave him insulin this morning about an hour before his BG test, so that isn't good either. They said they would monitor him very closely and probably give him some sugars to raise him a bit.

The doctor seemed very concerned, because she was basically saying at 90 he shouldn't be acting this way, but also said he has been through a lot physically and mentally. This whole thing doesn't make any sense. At 7:30 P.M. last night he was at 338 still, so they gave him his 1.5U of insulin and sent him home with us, and now 12 hours later he is at 90. I just don't understand it.

Last night around 8:30 P.M. we called the doctor because we had a few questions, and we ended up talking to a different doctor because ours had gone home for the night. We mentioned he was lethargic and seemed drugged and she told us to put Karo syrup on his gums. We ignored this and assumed she just didn't know his situation, but now we are thinking he might have been very low.

Does this make any sense to any of you?


EDIT: We are sitting here talking and we think we know what happened.

Like I said, our doctor went home yesterday early around 5:30 so another doctor took over monitoring him. At 7:30 P.M. the replacement doctor checked his BG and he was at 338. She had instructions to give him 1.5U of his insulin and she gave it to him. About 1 hour later at 8:30 P.M. we talked to her (the replacement doctor) and told her he was acting drugged and really out of it. She said we should put Karo syrup on his gums to bring his BG up a bit, and we thought she just didn't understand his situation.

Now here is what we think happened. At 7:30 the replacement doctor checked his BG, he was at 338. She saw in the notes that she was to give him 1.5U of insulin, and she gave him fast acting insulin, not realizing he was suppose to be given lantus. That would explain his hypoglycemic behavior around an hour after getting the insulin, and his low numbers even now. Right now we are a little pissed off that this happened. It explains why she thought it was normal for him to maybe have gone from 338 to too low in a matter of an hour.

We are just so tired of all this crap.

Thanks as always everyone, you have been a huge help.


EDIT 2: Now we are sitting here thinking about what kind of damage this caused him. If he is at 90 right now, he was hypo all night and he clearly was showing signs of it. We were thinking he was just on his way out, but in reality he was just hypoglycemic. The doctor this morning even mentioned that he shouldn't be in such terrible shape at 90, but it makes sense now knowing he has probably been hypo all night. It's all starting to make sense now. He appeared very "high" last night. He is at 90 now, but what damage could this have caused if he was hypo for the last 12 hours?
 
Thank you for the update. Keep us posted please.

Sending calming vines and 'go away stress' vines and get some sleep vines to you. You are real troopers caring for Bubba the way you have been and you must be exhausted.

Hope you can get some rest soon.

Please, take care of yourself and come cry on our shoulders or rant against the vet mistakes or anything else you need to do. We have been there and understand what you are going through.


deep breath, hold, breathe out. deep breath in, hold, breathe out. deep breath in, hold , breathe out. Slow and steady.
 
I remember one time I went to go visit J.D. in the hospital when he had DKA and there was a paper list attached to his cage, and he was pretty sick, so I was non-chalantly looking at it and read a 28 and realised that was a BG number they had recorded for him. My eyes got kind of big and I had to ask a resisdent if I was correct and she said "yes". I never saw that list attached to his cage anymore for some reason (like they didn't want me snooping). Anyway, R insulin is often used to get the BGs down in a hurry when the cat is in the hospital with DKA and a dextrose drip is used simultaineousy to bring the BGs up if they go too low, while the cat is tested and monitored continuously.
 
Thanks guys. You all are very good at making us feel a lot better. We just feel so stupid not realizing he was hypo last night. I guess the good thing is he wasn't seizing or unconscious. I am hoping they can keep him steady and get some food in him. Maybe if we can keep that up for a few days, he will start to get better. To be realistic though, his liver is still enlarged, which we aren't sure if that is something that will get better. I guess we will just have to wait and see. Thanks again everyone.
 
Herdo said:
...Just checked his BG and it was at 233; 2 hours ago he was at 245, and he started at 299....
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233 and 245 are basically the same number due to 20% meter variance....299 could also be near the same, again, due to variance of the meters....So basically, he could be running "flat"...
 
No disrespect intended: I would fire that vet immediately, if it was me. I am infuriated reading everything that you and kitty have been through with his vet "care". Just my opinion, though. And no disrespect to you; you have been on quite a rollercoaster. Now, if you would like to find a GOOD vet who is familiar with diabetic cats, insulin and promotes home testing, let us know your approximate area and we can surely recommend someone for you. I sure hope kitty is better; hang in there :-D You're in my prayers
 
I am sorry you are having so much trouble and hope Bubba feels better soon. One of my cats has had a hypo and been in a coma. He has a residual tremor and his vision isnt great but otherwise he is fine.

Once he is a bit better let us know and we can work out a plan to stop this happening again. The main thing - home testing - will be key here to keep him safe and preventing another incident.

Wendy
 
Thanks for all your comments guys. We are pretty mad right now, we just aren't sure what to do. Right now we are just hoping it didn't cause any damage, and that he can pull out of this. I am waiting on a call back from the doctor right now.

As for finding a new vet, we are definitely going to. The only reason we are even with this place at the moment is because of our original doctor who was there. We found a doctor that we were absolutely in love with and she was just perfect. We saw her a few times over the next couple weeks. We brought him in on a Friday afternoon to check his numbers and things and everything was great. I called her the next day with just a general question and I was told "She isn't with us anymore". They won't tell us what happened, but we are assuming she was let go. Friday afternoon there was no indication from her that she wouldn't be with the practice anymore, and then the next morning she was gone. After that happened, we simply stayed with this practice because we had an outstanding balance with them.

Thanks again everyone!


UPDATE: The doctor just called. He said his BG numbers were still stable at 125, and he is still holding down 5ml of wet food every 2 hours. His words however were "He still looks terrible". They checked his electrolytes and found he was low, so they have been giving him potassium and other supplements in his fluids to try and get him feeling better. He said he looks a little better and more alert, but he is still really sick.

The doctor said "I know you want to bring him home tonight, and usually I would say that's a good idea, but because his electrolytes are so low, I think maybe we should leave him here hooked up to the I/V all night. If you take him home tonight, it will be like starting over tomorrow morning." I completely agree with him, but at the same time we are now a bit hesitant to leave him there all night after last night. I do trust this doctor the most, but we are still pretty scared.
 
I'm disappointed with your vet too, because I think they should have run the blood work to see if his electrolytes were messed up, as often happens with DKA. How do they know without testing, if he needs and what he needs added to his IVs?

Good luck finding your beloved vet again, but if you can't find her right away, I would try another vet.

I hope Bubba is eating at the vet either on his own or by assistance from the vet techs. He needs food, especially if his liver is sick.
 
Dyana said:
I'm disappointed with your vet too, because I think they should have run the blood work to see if his electrolytes were messed up, as often happens with DKA. How do they know without testing, if he needs and what he needs added to his IVs?

Good luck finding your beloved vet again, but if you can't find her right away, I would try another vet.

I hope Bubba is eating at the vet either on his own or by assistance from the vet techs. He needs food, especially if his liver is sick.
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Thanks Dyana. They have been giving him 5ml every 2 hours, so that is good. Hopefully he can just stay strong long enough to get through this.
 
I'm glad he's eating. If he comes home with a feeding tube or if you have to assist feed with a syringe for a while, once he's home be prepared. If you can get IAMS Maximum Calorie that would be great for assist feeding as it is low carbs (about 6%) and has 330 calories per can.
 
I think the vet tonight on an IV is a good idea.
Ask if you can have a copy of his chart, or ask for an itemized bill that shows everything they've done. If he was given 1.5u of anything other than lantus, it should be listed somewhere. Then you'll know for sure.
 
UPDATE: We just got back from seeing Bubba. His BG was at 130, which is really good considering he hasn't gotten insulin in 12 hours. The doctor said he won't be giving him insulin tonight because he wasn't low which made us feel better. Bubba isn't necessarily looking any better unfortunately. I mean he is a tiny bit perkier and the vet mentioned him acting a bit better, but it was negligible in my opinion.

The vet is worried because he is saying once they get their BG at a reasonable level, he should start improving. His potassium levels were low. 2.2 this morning and 2.9 now, and the doctor said he wants him in the 3s. They are continuing to give him 4x the normal amount of potassium in his I/V tonight, so he thinks he should be at normal levels tomorrow. He said if he doesn't show signs of improvement within 24 hours we should really start to worry and "consider other options".

So I have to ask. For those of you that have battled DKA before, what was the turning point? Once their BG levels got under control did they start improving quickly? I figure that because he has been through so much in the last few days, it may take a few days of him at normal levels to start improving, right? The doctor seems surprised to not see him getting better, although at the same time he is saying his low potassium levels could definitely be causing him to still be as sick as he is. I just feel like it would make sense that he may need a few days at good BG and potassium levels to start improving; he has been through a lot.

As always, thank you everyone for being here for us. It really means a lot.
 
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