Post DKA Advice Needed

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DArcey and Buddy

DArcey and Buddy

Member Since 2020
Hi there!

Our cat Buddy is currently in the hospital recovering from a big DKA scare. She is improving and we have gone from talks about having to put her down to talks about bringing her home which is exciting, but we know we are going to have to up our game when it comes to her care.

So our main concern now is the after care for DKA and we are just finding a lot of different information regarding what level of ketones is safe for her to be at when Buddy comes home. We see posts saying that if there are trace ketones (which I believe is anywhere around the 1.5 range) it is an emergency and we should go to a vet, but the vets seem to want to send her home even if her ketones are still 2.4-2.8 (When she was originally brought into the ER she was in the 4.1 range)

She is eating on her own with some assistance from an appetite stimulant, but she is also fighting severe pancreatitis which can make feeding a big struggle at times.

We are prepared to monitor her ketones at home with urine strips and with a blood meter once we find one (looking at getting a Precision brand). But we are just confused- if we were to take her home while her ketones are still around 2.4, how would we be able to tell if she is truly okay? Would we just assume she is if those numbers are staying the same or going down? We are just concerned about bringing her home at those numbers, because if 4 days at the vet only brought the ketones down to 2.4, we are scared that it could potentially quickly become an emergency again at home, and we could be looking at another crisis.

We have also heard that sub q fluids can be helpful in flushing our small ketones. The vet has not brought this up, but if it might help, we would ask for fluids to be sent home with us, or insist on it if it could be essential.

Any advice would be appreciated, as well as loving thoughts and prayers for our Buddy girl!

D’Arcey
 
I am very new here, so I have no advice, but am sending up prayers and loving thoughts right now for Buddy. What a terrifying ordeal! I would be just like you, everything you questioned made perfect sense to me. Get well soon, beautiful Buddy!
 
Hi D’Arcey and Buddy and welcome to the forum
Yes we can help you nurse Buddy back to good health. The first couple of weeks will be a lot of care, but the fact she is eating is good!

DKA happens when there is not enough insulin, not enough food and an infection or inflammation is in the body. In Buddy’s case I would think it was the pancreatitis.
Looking at the SS it looks like the drop to 1.5 units over the couple of weeks was not enough insulin and she may not have been eating as well with you away, and the pancreatitis on top of it all completed the recipe.
So the treatment for DKA, after they are discharged from hospital is making sure the recipe for DKA does not happen.

Before she leaves hospital I would ask the vet for
  • Some antinausea medications. Ask if you can have some cerenia and some Ondansetron. They work on different pathways and can be given together. Even if she is not nauseated now she may get nauseated as both post DKA kitties and cats with pancreatitis get nauseated, sometimes for a few weeks .
  • Ask about getting some sub Q fluids to give at home and ask them to show you how to give them. It’s not hard. And ask how much and how often.
  • Ask about pain medication for the pancreatitis as pancreatitis is painful
  • Ask for a copy of all the lab results to be emailed to you.
While you are waiting to bring her home, there are a few things you can do to prepare.
  • Stock up on low carb food and also some higher carb foods. Sometimes they can be picky after both DKA and pancreatitis so you need to have a variety of foods to offer. Have the higher carb foods there in case of low numbers but also in case we need to give her some higher carb food so we can give the insulin….I’ll explain later.
  • Have plenty of test strips
  • Have plenty of ketone test strips to test the urine.
After you get Buddy home these are the things you need to be doing.
  • She needs to be eating 1 1/2 times as many calories as she would normally eat. So feed her the main meals before the insulin doses and then offer snacks every couple of hours during the day and evening. Food is like a medicine when treating DKA.
  • Don’t skip insulin doses. If the BG is not high enough stall, dont feed and test again in 20 minutes to see if the BG is rising. Post and ask for help. Change the subject line to reflect the issue.eg preshot xx stalling PLEASE HELP. Sometimes we need to give some higher carb food so we can increase the dose of insulin if there are ketones present so just have some on hand in case it is needed. It may not be.
  • Test daily for ketones. If there are any ketones, you will need to test more often. If you are using urine strips we need to know if there is even a trace of ketones. Put the result into the remarks column of the SS so we can see it. If you are using a blood meter, the number to be concerned about is 2.4 to 2.55
  • Encourage extra fluids. If she will tolerate it, put a warm teaspoon of water in each snack
  • Test before every dose of insulin and again during the cycles to see how low the dose is taking her and keep the SS up to date so we can help you
  • Post daily for help. It is important that the ketones are monitored daily as they will give us an indication if the dose of insulin is enough and she is eating enough food.
If that doesn’t make sense please let me know and I will explain further.
Wishing Buddy a very speedy recovery. And we hope to see both you and Buddy here very soon :)
 
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Thank you so so so much for all this. This has been very overwhelming. We picked her up half an hour ago. She has already eaten half a can of food.

Prior to all this, she was eating 3-4 cats of fancy feast a day. So, she would need at least 5-6 cans a day now? Or should we do a calorie calculator of how much a cat her size should eat, and then multiply it by 1.5? Should we perhaps stop feeding the fancy feast, and purposely only feed something more high calorie, so that she automatically takes in more calories without having to eat more food, even though would mean a high carb food?

I am also not sure what to do in terms of insulin amount. As you see, she was getting 1.5 units prozinc for the last 2.5 weeks- and when the vet moved back to prozinc, they went back to 1.5 units. However, she was doing well for a long time at 2.5/3 units- and we only cut her down because we were out of town, and didn’t expect my parents to test her blood other that prior to giving insulin.

Any thoughts would be appreciated!
D’Arcey
 
Hi D’Arcey,
That is wonderful Buddy is home. I am so glad she is eating. That is often half the battle as many cats have not much appetite after DKA and / or pancreatitis. The fancy feast is fine. It’s calories not carbs that need to be counted. It is 1 and a half times as much so don’t increase the carbs.
You can use the remarks column in the SS to say when and how much you feed and also the ketone result.
As far as how much insulin to give it looks like the 1.5 is enough as you have 2 green BGs. The BGs and the results of the ketone tests will be your guide as to whether the insult is enough
I don’t use Prozinc insulin so I will tag a couple of people who do. How long before Preshot?
@Panic @JanetNJ
 
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