Post-DKA

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Starfiregirl

Starfiregirl

Member Since 2019
Hello friends, I’ve learned so much from you already! You’ve helped my sweet girl, Principessa, tremendously as she recovers from DKA and pulled this kitty mama back from panic and heart stopping conditions so many times already! I’m increasing in confidence day-by-day. Forgive me, but I can’t seem to find this: Do you take AMPS before breakfast, before shoot or after breakfast before shoot? I would also appreciate any encouragement you may have on post-DKA. Principessa has good days and then she just stops eating about every 3rd day. Her BGs have highs (350-515!) and “lows” (150-200) I have kept her eating w daily fluids and appetite stims. She is eating only FF (good carb or zero carb) only and she likes them. Not sure we’re at root cause of what has her not eating or drinking consistently. We’ve had ultrasound: pancreas good. She’s done antibiotics following a high white count that likely started this episode where she stopped eating and ended w DKA and hospitalization (sadly, before I knew about testing ketones). She’s on Lantus. Any encouragement would be deeply appreciated! Or, help getting started: feel free to point me to your favorite tools or articles. Kind regards, Princi & Lee
 
Welcome Lee and gorgeous Principessa. This is a fabulous community and I'm sure a more experienced member will come along to help you with your question regarding the Post DKA issue. As far as AMPS and PMPS are concerned the rule is test, feed and shoot in that order. For the PMPS no food for two hours before testing. Hope this helps. You may want to set up your signature (the grey text that appears under my post). To do this you go to your name on the top right hand side of the page, click on this and you will get a drop down box. On the left you will see signature, usually we set it up with cat name, your name, date of diagnosis, weight of cat, type of insulin , type of meter you are using and if you have already decided whether you will follow SLGS or TR method. Type of food you are feeding and any other issues illnesses, don't forget to save. This helps members help you without having to ask the basic questions every time. When you have time you may also want to set up your spreadsheet, this is important to track your BG numbers and gives members crucial information when advising you on increases/reductions on dosing. You will find a sticky in "the basics: New to the group? start here". I'm certainly not in any way an expert but if you have any problems just post for help and I'm sure someone will help you out. Fantastic that you are testing. it is so important, so well done. You've taken a big step already.

Deirdre
 
Thank you, Deirdre!! You’re my first reply ever and I’m SO grateful! Honestly, I’m in tears, just to know supportive community is out there — it’s been a few weeks of very difficult journey. Only those who love one of these precious fur babies can truly get it. :bighug:

I just set up my sig and just downloaded my spreadsheet template. We’re on our way!
 
Hello! I am so sorry for the journey that brought you here but glad you found us because this place is absolutely a lifesaver. Two months ago my cat was hospitalized for 3 days for DKA. Thought she was going to die in my arms on the way to the ER. And NOW she is getting so healthy again I am in complete shock and awe sometimes.

But it’s not going to happen magically overnight and you may need to spend some serious nursing time with Principessa. Someone told me it is a marathon, not a sprint. I did not sleep very much for several weeks and sometimes I was feeding Alice out of my hand.

I just want to stop in right now and say it can get better and there is a lot of support here. I’m taking my mini nap before my next blood sugar test and I will look back in later. Hugs to you both! :bighug:
 
Wow! So great to hear from you!! :bighug: I had just found your thread and wrote to you at the same time you wrote to me! :) I can’t thank you enough for understanding what I’m going through and reaching out with encouragement. I’m about to do SQFs and go to sleep. THANK YOU! Warmest regards from Princi and me
 
Hi Principessa amd Mom,
I'm so glad your little girl is much better. Such a fright for you.
Have you managed to setup your SS yet? If you are having any trouble just post and ask for help.
Am I right in assuming she has been a diabetic since 10/2017 but has recently had DKA?

The recipe for DKA is not enough insulin, not enough food, and an infection/inflammation. And of course plenty of fluids to flush out any ketones. I see you are giving subQ fluids. How much and how often?
So what is really important is to make sure she is getting plenty of food to eat, and enough insulin (it is really good you are home testing the blood sugars as you will be able to see what the BSLs are doing and it takes out the guess work.) and the infection has been treated which is very important. Do you know what the infection was or was it just the high white cell count that alerted the vet? Does Principessa have any symptoms of the infection at all now?
Are you testing every day for ketones?
Keep asking lots of questions and we will help in any way we can.
Bron
 
Starfiregirl said:
Thank you, Deirdre!! You’re my first reply ever and I’m SO grateful! Honestly, I’m in tears, just to know supportive community is out there — it’s been a few weeks of very difficult journey. Only those who love one of these precious fur babies can truly get it. :bighug:

I just set up my sig and just downloaded my spreadsheet template. We’re on our way!
Click to expand...
Good morning, so happy I could help. Everyone here "gets" it. We've all been there, feeling lost and scared. I thank my lucky stars I stumbled upon this forum, the folks here have helped me tremendously and it is so reassuring to know that there are people here who understand how frantic you can feel at times. Big hug:bighug: and again welcome to the group.
 
>>Have you managed to setup your SS yet?
I just downloaded the SS last night. Will be setting it up today. I’ve been keeping a log, but not as conducive to share.

>>Am I right in assuming she has been a diabetic since 10/2017 but has recently had DKA?
Yes

>>The recipe for DKA is not enough insulin, not enough food, and an infection/inflammation.
Yep, sadly, that’s what happened. Sadly, my vet of 20 yrs whom I’ve loved and found trustworthy thru many beloved pets, didn’t test for ketones—for a week of taking Principessa to her daily. Ugh.

I see you are giving subQ fluids. How much and how often?
I’m giving her 100 ml 2x day. Regardless what the vet says (taper her off), I see they make her feel better and feeling better = she eats. I did have a sense they were “flushing ketones” though I didn’t have that specific info at the time.

>>So what is really important is to make sure she is getting plenty of food to eat, and enough insulin
This is where I’m struggling a bit. When she wants to eat, as she is now, she seems ravenous the entire day.. So, it’s difficult to feed only every 12h. It seems eating is so important; her poor little body has been quite ravaged by the DKA, and seems she needs to rebuild. But when I feed her all she wants, it often drives her BG up very high. For instance, last night I had waited 12h to feed her: she ate 4 cans of food! 3 cans FF Tuna Fish in Gravy Grilled (13 carbs/can) and one can FF ATURAL White Meat Chicken & Tuna in broth (0 carbs). This am AMPS is 412. She’s eating well right now and I’ll give her 4U Lantus.

>>Do you know what the infection was or was it just the high white cell count that alerted the vet? Does Principessa have any symptoms of the infection at all now?

I don’t know what the infection was, but at the time she did AB orally to start, them she was hospitalized and they continued AB intravenously. We’re seeing an Internal Medicine specialist today for the first time and I’m going to ask her to recheck white count. What would be the symptoms of infection? Every 3 days so far — corresponding to appetite stim — she gets puny and stops eating. I don’t know the root cause of this and this is what really worries me! Any ideas? This is Day 3, tho, and so far she’s eating (looking at me asking for a 2nd can of food for breakfast now. Yay!!

>>Are you testing every day for ketones?
Most days, yes. She has had no ketones for about 2 weeks now! Wow! I’m so happy to stop and realize that.

So, she had high white count 5/19 and started AB + daily fluids, liver “count” extremely high, diagnosed and hospitalized w DKA 5/24-5/26. Crashed terribly at home 5/27 w extremely high BG + Ketones again 5/28. Saw new vet who started talking how hard this was going to be (translate: putting her down; yes, will not be seeing that vet again. Got ultrasound: pancreas + organs looked normal. Liver a little bit “lit up” but not to worry, fairly unremarkable. (I’m going to ask new vet to do liver count today.) Merciful vet at EC where ultrasound was performed gave me appetite stims so I was able to get her eating. Merciful vet at EC where she was hospitalized gave me SQF + lesson later that night. What a day that was!!!

2 wks of daily fluids, learning to test glucose, giving anti-nausea + appetite stims when she stops eating. Very high BGs and a couple of lows that were very scary. She seems to not feel well when she’s in the 100’s—tho I know that’s eventually where we need to be: Any insight on that? Because I’ve seen her come dangerously close to death from too much insulin, I’m terribly afraid of giving her too much. So glad I’ve got testing down now and getting blood from her ear!!! Huge milestone!!

I can’t thank you enough for responding and caring!! <3

I’ll update after vet appt. today. How I hope she is actually helpful!!!

Warmest regards,
Lee & Princi

UPDATE From Visit w New Internal Medicine Vet Today:

All of Princi’s bloodwork was normal!!! Liver and white count being particular exciting! She gained weight to over 8 lbs up from scant 7.3 lbs!!! The vet was so informative, helpful and validating—I feel quite blessed to have found her. She’s supportive of me doing glucose testing and continuing SQF’s. She thinks Princi has turned the corner and encouraged me to let her eat—feeding her 4x day w 2 12h shoots. She advised me on her insulin for her highs. She agreed I should always have anti-nausea and appetite stims in our medicine cabinet and wrote generous scripts.

Everything I’ve learned — mostly from you all—has worked!! It’s an incredibly happy day for Principessa and I and please give yourself a huge pat on the back as well. Big hugs and purrs from us!

Princi & Lee
 
So glad to hear this good news! But do give yourself a huge pat on the back first. You are the one who has been nursing her and learning frantically and you put yourself into her and her care and success. :)

Before your update after the vet visit you said it was difficult to feed her 2x/day only, and I am glad to see that you are going to feed her more often now. Many diabetic cats do best with several small meals a day of low carb wet food. For my cat’s recovery from DKA because she was so severely emaciated, I fed her as much as she wanted. She has gone from 4lbs to 7lbs. :) ECID but I would be more concerned about your cat getting enough calories generally, so the body doesn’t start breaking down fat and muscle tissue again. I would need to go back over her history and other info though to really say what I think beyond-definitely feed more than twice a day!!!

Glad she has shown improvement! You must be relieved. :)
 
I'm glad the visit to the new vet went well today Lee and thanks for answering all my questions. That is really good that all the blood work was normal and the WCC was normal.
Is the new vet happy for you to be giving as much as 100mls twice a day SubQ?
As Cassandra said feed Princi as often as you need to....except for the 2 hours before preshot as we need the BSL to not be food influenced. While recovering from DKA he needs as much food as he will eat to combat ketones developing again.
What did you mean by "she advised me on her insulin for her highs."?
 
Hi Lee, one thing I noticed in the post answering Bron's question was that you are feeding Principessa 13% food right now. This carb content is a bit high. You should look for a food that is lower than 10%. You will find an extensive list compiled by Dr. Pierson in the Feline main health board. FF classic pates are a good choice. You can keep the gravy food in her hypo kit for the eventuality she drops too low.
 
Jerry dutchboy said:
Hi Lee, one thing I noticed in the post answering Bron's question was that you are feeding Principessa 13% food right now. This carb content is a bit high. You should look for a food that is lower than 10%. You will find an extensive list compiled by Dr. Pierson in the Feline main health board. FF classic pates are a good choice. You can keep the gravy food in her hypo kit for the eventuality she drops too low.
Click to expand...
Yes, that's a good point.
Unless Lee is giving higher carbs to get the BSL up higher..sometimes when recovering from DKA, higher carbs are given so that a good dose of insulin can be given to counteract the ketones. We really need the SS to be up and running and to see some data so we can see what the BSLs are doing and what food is being fed. Probably better not to change any of the food just yet until the BSLs are being tested and recorded on the SS, as lowering the carb content will most likely lower the BSL..does that make sense?
How is the spreadsheet coming along Lee?
 
Bron and Sheba said:
Yes, that's a good point.
Unless Lee is giving higher carbs to get the BSL up higher..sometimes when recovering from DKA, higher carbs are given so that a good dose of insulin can be given to counteract the ketones. We really need the SS to be up and running and to see some data so we can see what the BSLs are doing and what food is being fed. Probably better not to change any of the food just yet until the BSLs are being tested and recorded on the SS, as lowering the carb content will most likely lower the BSL..does that make sense?
How is the spreadsheet coming along Lee?
Click to expand...
Thank you Bron..I have no experience with DKA and didn't know this. Learning again, yes it makes sense.:)
 
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