possible early stages ketoacidosis

Status
Not open for further replies.
Sabrina

Sabrina

Member Since 2010
Sabrina is now 16 yes old, 5 years a diabetic, 17lbs. Given Lantus 3.5 units twice daily.
She had episodes of vomiting on Tuesday night, probably over a dozen times. Was very lethargic to the point she was leaning her head against the wall and just laying there. Once she vomited while laying down! Gave her 200 ml of Lactate Ringers subq to get her through the night.
Took her to vet Weds morning. She gave her an anti nausia shot, xray and bloodwork. Blood work showed elevated kidney enzymes but just barely on high side. (BUN 34, CREA 2.2) Liver was fine. But AMYL 1286. Her Sodium and Potassium within normal range. X-ray nothing stood out.
Went home with another bag of Lactated Ringers and a urine collection kit. She does not pee in a litter box anymore, she pees on pee pads. Was only able to get a sample this morning on a pee pad I turned upside down. Was going to take it in tomorrow.
Was given instructions to give her 200 mls of lactated ringers subq every other day. But she is not drinking, so gave her the 200 on Friday and 100 Sat. She does not seem to be eating either. We have 3 other cats so difficult to tell, but we offer her a "treat of friskies is canned" when we give her an insulin shot and she has refused to even taste it. We even offered her tuna with juice and no go.
My concern is her glucose is all over the place!
Friday: AM 361 - gave 3.5 units; PM 173 - gave no insulin
Saturday: AM 351 - gave 3.5 units; PM 244 - gave 2 units
Sunday: AM 173 - gave no insulin ; PM 396 - gave 3.5 units
Can glucose go up and down so drastically if she isn't eating?
She doesn't get around very well, stays in her bed or closet all day.
Do I keep her going or not?
 
Last edited by a moderator:
I dont see a current spreadsheet, and without more data its hard to say whats going on. One thing I see is that you have been erratic in her dosing. Lantus is supposed to be given every 12 hours and given the same dose each time. It is a depot insulin, and you should read the stickies on the protocol for managing BG and dosing. She could very well be on too much insulin, or not enough..either way. Without data, theres no way to know. Also you dont base the dose amount on the preshot numbers. You base the dose amount on how low the dose takes her, which is the"nadir", roughly 5/6 hours after shot. I am nowhere near an expert or qualified to advise on what to do. I hope someone more experienced can comment soon. I am just basing my comments on my own experience on this board and the knowledge Ive gained here. If you are not testing mid cycle I would advise to do get more test in to see how low she may be going. Some cats can start out at 300 and 6 hours later be in the 40s..my cat has done this, I know it happens. Please start reading about Lantus and the protocol on the main Lantus/Levemir forum page. What do you feed? Is it wet..dry? Hopefully she starts eating soon. Not good giving a kitty insulin with no food on board. Please ask questions. There are many here to help you.
 
Did the vet test her for ketones?
Do you have ketostix to test her at home?
Do you think you could syringe feed her?
 
I don't have enough experience to suggest anything other than to test Sabrina's urine for ketones. Do you have ketodiastix at home?

Hopefully other members with more experience will be along soon to help you further.
 
Have you tested for ketones? You can even drag the strip across the wet part of the pee pad if you can't get a good sample. I doubt the pee sample will be good for any tests tomorrow - it needs to be fresh. If she were mine, I'd either go to ER tonight or be sitting at the vet's door when they open tomorrow. Possible DKA isn't something to put off.
 
Can glucose go up and down so drastically if she isn't eating?

short answer... yes. it can drop low without eating. and it can go high as well.

it sounds to me like you need to isolate her so you will know if she is eating. And you need to experiment with finding something she Will Eat.

everyone here will be glad to help you with the dosing management....
 
Has she had ketones or been DKA in the five years since diagnosis?
 
Have not tested for ketones. Vet wanted to get urine but she had already peed in the kennel on the way to the vet.
Don't have testing sticks either.
She has has never been tested for ketones since diagnosis. this is the first time she has had any symptoms that anything was wrong.
she did have her first urinary tract infection last Oct. But recovered fine with that.
I don'the have a spread sheet. I have done glucose curves on her but none recently.
I could try to force feed her but she has a very stubborn personality and is very difficult to do things to.
 
Testing for ketones is literally just dipping a strip of plastic with a little litmus paper on the end of it in fresh urine and comparing it against the colors after 15 seconds. Ketone strips are available at most pharmacies that carry diabetic supplies - humans use them too. They're not expensive and are worth their weight in gold if there's a suspected situation like you're in right now.
I also encourage doing whatever possible to be sure she gets food into her body.

HUGS and good thoughts....
 
IF, repeat, IF there are ketones behind Sabrina's current condition, then IMHO that is your #1 priority.
Ketones scare the crap out of me. My guy, Bob was DKA right after he was diagnosed and nearly died. He survived, went OTJ 3 months later, and stayed that way for 2 1/2 years. When his diabetes came back suddenly, ketones were there again, and this time I wasn't as blessed.
Neither time however, was "vomiting" a symptom I saw. Total lack of appetite, yes. Extremely lethargic? Definitely. Very dehydrated as well.
So, in your shoes, I'd be seeing the vet asap. If they can't get a urine sample, they can check her blood for ketones. That test would be more accurate, because it tells you if they are there "now". Before they show up in her urine.

If she shows ketones, you might have to insist that she eat. Because withholding insulin when ketones are present is not a good thing. Some people don't or won't give insulin if a cat isn't eating. There are currently three Think Tank discussions at the top of the Think Tank forum that point out why "no food = no insulin" is not a great idea. Even a reduced dose is better than nothing.
Fluids will help, and ask your vet about continuing them. Hopefully the anti nausea shot will help her be able to keep any food you can get in her to stay there.

Prayers for you and your girl, and please keep us posted.
 
Here's a page of info about using Ketodiastix (including tips on how to catch pee!)
http://www.sugarpet.net/urine.html

But as well as testing the pee do also have an awareness of how your kitty's breath smells. It should smell like typical kitty breath. Breath that smells fruity/peardrops/acetone can also be indicative of ketones.

Keeping fingers and paws crossed that all goes well for your girl.
Please keep us updated.

Eliz
 
Only 2 of 3 types of ketones have an odor we can detect (fruity or like vinegar), so a urine or blood tests is better.
Also check dehydration which can happen when the glucose is elevated. Gently pull up the scruff at the neck and release. If the skin stays pulled up or 'tented', moderate to severe dehydration may be present.
 
Ok...no ketones!! Got urine this morning and taking it in to have urinalysis done. Vet mentioned she wanted to check for protein also.
Just force fed her a canned food the vet gave me. Now waiting to see if any vomiting occurs.
Thank you everyone for your advice and support!
 
You might want them to test for pancreatitis -called a spec fPL test. My cat started vomiting suddenly and this was the cause. If Sabrina is still reluctant to meet I would ask for some anti nausea or anti vomiting tablets to give at home for the time being.
 
Following on from Sarah's recommendation, having an appetite stimulant such as cyproheptadine can be a valuable adjunct to the anti-vomiting and anti-nausea meds for Sabrina's medicine chest. If it is pancreatitis, buprenorphine can help with pain.
 
But remember - be sure to give an anti-nausea meds with or before the appetite stimulant. Nothing worse than wanting to eat but feeling sick if you try.
 
Sabrina is hanging in there. Her urinalysis did show some protein, no ketones and ph of 6.
My doctor is suspicious that her issues are kidney related. Her best guess is her kidneys are working around 25% to 33%.
I'm continuing subq fluids and started force feeding her k/d blended with water and added fortiflora digestive enzymes. She hates
it and complains the whole time, but she has always been cantankerous On the positive side I saw evidence she went to the water
bowl tonight! She's a splasher
 
Thanks for updating us. I'm relieved to hear Sabrina's holding her own.

If you haven't already discovered it, Tanya's site is an absolute goldmine of information for cats with kidney problems.
 
Status
Not open for further replies.
Back
Top